Term
| what characterizes the appearance of remyelinated (astrocyte shielding seen in early MS) MS lesions on MRI? |
|
Definition
| T1 (fat) MS remyelinated lesion MRI: abnormal. T2 (water) MS remyelinated lesion MRI: some value in differentiating from demyelinated areas. |
|
|
Term
| what is the effect of testosterone on men w/relapsing-remitting MS? |
|
Definition
| exploratory findings suggest that testosterone treatment is safe and well tolerated and has potential neuroprotective effects in men with relapsing-remitting MS. |
|
|
Term
| can the anterior visual system be used in modeling neuroprotective in MS in response to novel therapies? |
|
Definition
| yes, the retina constitutes a biomarker for predicting similar changes due to MS within the CNS in general |
|
|
Term
| what genetically-related differences have been found between MS pts who respond to beta IFN therapy and those tho don't? |
|
Definition
many of the detected differences between
responders and nonresponders were genes associated with ion channels and signal transduction pathways (glypican 5, collagen type XXV α1, hyaluronan
proteoglycan link protein, calpastatin, and neuronal PAS domain protein 3). the study also suggests that genetic variants in heparan sulfate proteoglycan genes may be of clinical interest in MS as predictors of the response to therapy. in addition to new insights into the mechanistic biology of interferon beta, these results help define the molecular basis of interferon beta therapy response heterogeneity. |
|
|
Term
are MS pts who are disease refractive to multiple therapies before starting natalizumab more at risk for immune reconstitution inflammatory syndrome (progressive multifocal
leukoencephalopathy (PML)) w/temporary or permanent natalizumab dosage suspension? |
|
Definition
yes. overall, relapses occurred more often in younger patients with fewer natalizumab infusions prior to therapy
interruption. prior disease control resumed after reinstitution of natalizumab therapy in all patients. |
|
|
Term
| what is the ratio of response to IFN beta in MS pts? |
|
Definition
| multiple MRI evaluations disclose that approximately only half of the patients treated with interferon beta achieve and maintain a full response to the drug over time, although an additional small number of individuals may still restore an optimal response to the drug after an initial failure. |
|
|
Term
| how do CBT and zolpidem work together to tx persistent insomnia? |
|
Definition
in patients with persistent insomnia, the addition of medication to CBT
produced added benefits during acute therapy, but long-term outcome was optimized when medication is discontinued during maintenance CBT. |
|
|
Term
| what are diagnostic/management schemes for status epilepticus? |
|
Definition
rapid treatment requires prompt recognition of SE’s signs and symptoms and a high index of suspicion for this condition. ideally, medical care should be guided closely by a neurologic
specialist in the ICU. no matter what medications are selected, a goal-directed protocol is essential in facilitating delivery of appropriate treatment as efficiently as possible. a combination of tx including seizure suppressants and neuroprotectants such as N-methyl-D-aspartate antagonists, free radical scavengers, second messenger modulators (ie, nitric oxide or adenosine), and earlier therapies may become available for the many as yet unrecognized incidents of SE in the neuro-ICU. |
|
|
Term
| what is the correlation between sedative/hypnotic use and fall risk in elderly pts? |
|
Definition
| the use of sedatives/hypnotics, antidepressants,and benzodiazepines demonstrated a significant association with falls in elderly individuals. |
|
|
Term
| what common drugs can lead to insomnia? |
|
Definition
medications affecting neurotransmitters, such as norepinephrine, serotonin, acetyl-choline, or dopamine. antibiotics, antihypertensives, and oral contraceptives, and thyroid replacements
can induce insomnia in susceptible individuals. chronic and long-term sedative/hypnotic use to induce
sleep may cause tolerance to the sedative effect, and can contribute to
chronic insomnia. |
|
|
Term
| even though flumazenil is considered to be a BDZ antagonist, how can it perform in chronic BDZ users? can it be used for zolpidem abuse detox? |
|
Definition
| as a partial bland agonist. for zolpidem abuse, abrupt discontinuation of the medication and rapid detoxification using flumazenil, has been suggested. |
|
|
Term
| what are the issues w/prescribing BZDs for grief? |
|
Definition
first, there is no evidence base supporting this practice or any
medication for either normal grief or complicated grief, which has duration of at least 6 months by current consensus. second, given how common loss is in the general population, this practice might unnecessarily expose
large numbers of people who are having normal reactions to loss, including high-risk populations such as the elderly, to inappropriate treatment. third, based on the posttraumatic stress disorder literature and because
posttraumatic stress disorder may be highly comorbid with complicated grief, it is theoretically possible that benzodiazepines might actually lead to worse outcomes by impeding the normative grieving process, especially at higher doses. in one small randomized controlled trial, low doses of diazepam neither helped nor
hindered the course of bereavement. however, those who received diazepam had significantly less resolution of sleep problems compared with the placebo group. |
|
|
Term
| what is the challenge in enforcing DUI laws in pts using antianxiety/sedative hypnotics? |
|
Definition
the notion of establishing threshold concentration limits in blood for certain drugs, akin to punishable blood alcohol limits eg, 0.20 g/L or 0.50 g/L), or enacting graded penalties
depending on drug concentration is hard to motivate owing to *weak concentration-effect relationships and to the development of tolerance after long-term therapy. zero-concentration
limits or LOQ laws represent a much simpler and more pragmatic way to enforce DUID legislation compared with the traditional impairment laws making it a lot easier to convict an offender. |
|
|
Term
| what is the rationale for taking the centrally acting muscle relaxant carisoprodol off the market? |
|
Definition
| high abuse potential, narrow therapeutic range, and increased risk of traffic incident potential. |
|
|
Term
| why should BZDs not be used for neuropathic back pain? |
|
Definition
| increased risk of chronic drug dependence |
|
|
Term
| why is promethazine (antihistamine) contraindicated for pts under 2 y/o? |
|
Definition
it can cause serious side effects,
including respiratory depression that could be fatal |
|
|
Term
| what is an example of sex-based differences in PSTD tx response? |
|
Definition
individuals with PTSD who have been
raped tend to respond better to cognitive behavioral therapy than do combatveterans with PTSD. pts w/mothers w/PSTD are more likely to be themselves at risk. |
|
|
Term
| what characterizes brain activity of PSTD pts? |
|
Definition
altered brain activity in the PTSD patients was associated with
poorer performance in both learning
and recall |
|
|
Term
| what is a possible biomarker for PSTD pts? |
|
Definition
|
|
Term
| can beta-blockers such as prazosin help w/PSTD? |
|
Definition
this might be
able to prevent neuronal injury
caused by elevated levels of corticosteroids in the brain |
|
|
Term
| what method of administration for promethazine in migraine tx can lead to infection and gangrene? |
|
Definition
| IV-push. the preferred way is IM injection. |
|
|
Term
| what ADRs exist for paliperidone (antipsychotic)? warnings? |
|
Definition
| injection site rxn, somnolence/sedation, dizziness, akathisia, EPRs. warnings: transient ischemic CV attack, neuroleptic malignant syndrome, QT prolongation, tardive dyskinesia, hyperglycemia/DM, wt gain, hyperprolacinemia, orthostatic hypotension/syncope, leukopenia/neutropenia/leukocytosis, cognitive/motor impairment, seizures, and suicide. *IM use only* |
|
|
Term
| what is the only way that promethazine should be administered? |
|
Definition
deep IM. IV/subcu = gangrene potential (severe tissue injury, including
gangrene, requiring fasciotomy, skin graft, and/or amputation) |
|
|
Term
| what characterizes the correct approach for off label antipsychotic drug therapy in elderly pts? |
|
Definition
evidence is needed from RCTs and
from observational studies on the risks and benefits of drug therapy in the same populations that will be exposed
to these drugs. there is a need to develop a system to track off-label use so that efforts can be focused on developing evidence on risks and benefits in indications that have not been assessed through the standard regulatory approval process. most importantly, ensuring drug safety in elderly people will require the collaborative effort of researchers, regulators, manufacturers, professional organizations, and health care provider organizations to send the right message to prescribers. |
|
|
Term
| are nursing home residents prescribed antipsychotics at a rate higher than other otherwise? |
|
Definition
|
|
Term
| are frontal cortical 5-HT2A receptors involved in the pathophysiology of schizophrenia? |
|
Definition
| yes - they are bound less in schizophrenic pts |
|
|
Term
| did the FDA black box advisory on antipsychotic medication use in elderly pts w/dementia have an effect? |
|
Definition
|
|
Term
| what gene is associated w/antipsychotic-induced wt gain? |
|
Definition
| the endocannabinoid pro129Thr FAAH polymorphism |
|
|
Term
| is there an association between obsessive compulsive symptoms and schizophrenia? |
|
Definition
| yes pts will commonly present w/both |
|
|
Term
| has palperidone (atypical antipsychotic) been shown to be an effective tx for schizophrenia? |
|
Definition
|
|
Term
| does sex have an effect on central D2 receptor density? |
|
Definition
|
|
Term
| if n/v associated w/CA chemo tx is refractory, what should then be done? |
|
Definition
empirical trials combining several therapies to block multiple emetic pathways should be attempted. often, oral administration of medication
is not feasible and alternate routes such as rectal suppositories, subcutaneous infusions, and orally dissolvable tablets should be considered |
|
|
Term
| what warnings are associated w/metoclopramide (antiemetic)? |
|
Definition
| depression, EPRs, parkinsonian-like syndromes, tardive dyskinesia, neuroleptic malignant syndrome (hyperthermia, muscle rigidity, altered consciousness, evidence of ANS instability), exacerbation of HTN, fluid retention, and volume overload |
|
|
Term
| what antiemetics are recommended for peds? |
|
Definition
| ondansetron (serotonin agonist) along w/oral hydration and not promethazine, metoclopramide and trimethobenzamide (older drugs) |
|
|
Term
| since post discharge n/v (PDNV) after office-based anesthesia is an under-recognized problem, what is the recommendation? |
|
Definition
clinicians providing anesthesia in an office-based setting should therefore consider opioid-free propofol sedation
with regional/topical anesthesia or have a plan for PDNV prophylaxis and rescue treatment when general anesthesia
is required. a transdermal scopolamine
patch or a 40mg aprepitant capsule before surgery, 4mg i.v. dexamethasone during the case, and 0.075mg i.v. palonosetron may be the most advantageous treatment options for patients at risk for PDNV. |
|
|
Term
| how do promethazine and metoclopramide compare as hyperemesis gravidarum tx? |
|
Definition
promethazine and metoclopramide
have similar therapeutic effects in patients who are hospitalized for hyperemesis gravidarum. the adverse
effects profile was better with metoclopramide. |
|
|
Term
| what is the association between antidepressant rx and depression severity? |
|
Definition
the magnitude of benefit of antidepressant medication compared with
placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. for patients with very severe depression, the benefit of medications over placebo is substantial. |
|
|
Term
| what is the implication of the current psychotropic medication polypharmacy trend? |
|
Definition
while some of these combinations
are supported by clinical trials, many are of unproven efficacy. these trends put patients at increased risk of
drug-drug interactions with uncertain gains for quality of care and clinical outcomes. |
|
|
Term
| can bupropion increase seizure risk? |
|
Definition
yes. bupropion, like other antidepressant agents, lowers seizure
threshold. |
|
|
Term
| what antidepressants are more likely to cause bone loss in older women? |
|
Definition
the use of SSRIs but not TCAs is associated with an increased rate of bone loss at the hip in this cohort of
older women. |
|
|
Term
| why do medical students likely receive poor mental health care? |
|
Definition
depressed medical students more frequently endorsed several depression
stigma attitudes than nondepressed students |
|
|
Term
| how long should antidepressant (venlafaxine) GAD tx continue to prevent relapse? |
|
Definition
| 12 mos. if pts relapse after 6 mos, they will most likely respond to a 2nd course of tx w/the same medication. |
|
|
Term
| what is the effect of bupropion tx on pts trying to quit smoking? |
|
Definition
tx with bupropion is associated
with improved ability to resist cue-induced craving and a reduction in cue-induced activation of limbic and prefrontal brain regions, while a reduction in craving, regardless
of treatment type, is associated with reduced activation in prefrontal brain regions. |
|
|
Term
| what does the 5-HTTLPR moderate? |
|
Definition
| the relationship between stress and depression |
|
|
