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wiscflor
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What's the difference between a Tension Headache and Migraine?
Tension Headache - bilateral, mild-moderate
Migraine - usually unilateral throbbing, moderate-severe, can last hours to days
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What are the two main treatments for migraines?
- Abortive Therapy
- Prophylaxis
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Abortive Therapy:
What does it mean?
What are the drugs?
What are their methods of actions?
Terminate the headache one it's started
- Triptans: Sumitriptan (Imitrex)
- Ergotamine: DHE
- Vasoconstrictors
- (Not for people with HTN)
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What kind of drugs are used in prophylaxis treatment?
- Beta Blockers
- Calcium Channel Blockers
- Tricyclic Antidepressants
- Anticonvulsants
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Cluster Headache
What is it?
How does it occur?
S/S?
How long does it last?
Headaches that occur in clusters for weeks to months
Vasodilation of trigeminal area
Stabbing pain of orbital, supraorbital or temporal area
60-90 minutes
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Cluster headache treatments:
- High flow O2
- Ergotamine
- Calcium Channel Blocker - Verapamil
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Headaches can often be confused with what other diagnoses?
- Temporal Arteritis
- Trigeminal Neuralgia
- Tumor
- Aneurysm
- Infection
- Trauma
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What are the diagnostic tests for headache?
- None if the diagnosis is not clear
- CT or MRI for trauma
- LP for infection
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What is an autoimmune degeneration of the CNS that happens via demyelination?
Multiple Sclerosis
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What are some s/s for Multiple Sclerosis?
- Urinary Retention
- Weakness
- Muscle spasms
- Dysphagia
- Dysphasia
- Neuropathic pain
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Purpose for Multiple Sclerosis treatment:
Corticosteroids
For acute exacerbations
- (Taper dosage)
- (Multiple side effects)
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Purpose for Multiple Sclerosis treatment:
Beta-Interferon
- Decreases exacerbation
- Helps flu-like symptoms
(Self-injection)
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Purpose for Multiple Sclerosis treatment:
Bethanechol
Stimulate flaccid bladder
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Purpose for Multiple Sclerosis treatment:
Baclofen
- Muscle spasms
- Decrease seizure threshold
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What drugs treat bladder spasms for Multiple Sclerosis?
- Oxybutynin (Ditropan)
- Tolterodine (Detrol)
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The disease of the basal ganglia causes
Parkinson's Disease
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What are some s/s of Parkinson's Disease?
- Resting tremor
- Bradykinesia
- Rigidity
- Loss of postural reflexes
- Shuffling gait
- Blank or "masked" expression
- Dysphagia
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What is the #1 choice medication for Parkinson's Disease?
Levodopa/Carbidopa (Sinemet)
(If overmedicated, can lead to psychosis)
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How does Entacapone (Comtan) interact with Sinemet?
Improves efficacy
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For a Parkinsonian, when is the best time to give protein?
At night
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What is an autoimmune disease of the neuromuscular junction?
Myasthenia Gravis
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What are the s/s of Myasthenia Gravis?
- Fatigue
- Weakness in eye movements, chewing, swallowing, speaking
- Difficulty breathing
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What medications must be avoided with Myasthenia Gravis?
- Quinide
- Beta Blockers
- Aminoglycosides
- Procainamine
- Phenytoin
- Neuromuscular Blockers
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What diagnostic test improve Myasthenia Gravis?
What drug must be on hand as the antidote?
Tensilon Test
Atropine
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Treatments for Myasthenia Gravis
- Neostigmine (Prostigmine)
- Corticosteroids
- Immunosuppressants Azathioprine (Imuran)
- Thymectomy
- Plasmaphoresis
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What is the difference between Myasthenic Crisis and Cholinergic Crisis?
How do you differentiate the two?
- MC - Severe muscle weakness, impacts swallowing and breathing
- CC - Similar presentation but caused by excessive cholinergic drugs
Tensilon Test
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A 45y/o woman with Myasthenia Gravis presents to the ER with trouble swallowing and difficulty breathing. Which of the following are true:
A) Her symtpoms will improve wtih Neostigmine (Prostigmine)
B) Acetylcholine Receptor antibodies will be decreased
C) A Tensilon test will be need to establish the etiology of the crisis
D) None of the above
C) A Tensilon test will be need to establish the etiology of the crisis (this multiple choice question has been scrambled)
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A 78y/o male is experiencing worsening of his Parkinson's Disease. He notes that he is "freezing" and has difficulty walking in the late afternoon. Which actions should the home health nurse take?
A) Review his medication dosage and scedhuling, an discuss with the physician
B) Encourage him to nap when this happens
C) Tel him to increase the duration of this morning walk to strengthen his muscles
D) All of the above
- A) Review his medication dosage and scedhuling, an discuss with the
- physician
(His meds are wearing off)
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