Neurological Disorders: Assessment

Pharmacist’s role in Assessment of neurological disorders:

• medication safety

• effectiveness of medications

• patient counseling

• interprofessional collaboration

• early detection

Pharmacist’s relevance to mental status:

• monitor for drug-induced confusion, sedation, or delirium

• assess cognitive side effects of medications

• Questions to ask: 

  • who am i

  • where am i

  • what day is it?

Pharmacist’s relevance to motor and coordination assessments:

• ID drug-induced movement disorders

• monitor for fall risk from sedatives or other CNS depressants

• evaluate therapeutic response in parkinson’s disease treatment

• assessments:

  • Romber’s Test

Pharmacist’s Relevance to Sensory and Reflex:

• ID drug-induced peripheral neuropathy

• recognizing changes in reflexes as a sign of drug toxicity

Pharmacist’s relevance to cranial nerve assessments:

• monitoring for patient complaints of vision changes, dizziness, or facial weakness

• identifying if this is a potential side effect of a medication

• referring the patient for medical care

Glasgow Coma Scale (GCS): 

• assess level of consciousness in trauma or critically ill patients

• score = < or equal to 8 indicates neurological injury/coma

• max = 15, min = 3

Mini-Mental State Examination (MMSE):

• screens for cognitive impairment

• used for patients suspected of dementia or alzheimer’s disease

• max = 30

• anything below 23 is indicative of cognitive impairment

Pain scales:

• visual analogue scale

• Wong-baker Faces pain rating scales

• numeric rating scale - rates best and worst pain numbers over past 24 hours

Pharmacist’s relevance to standardized scales: 

• can interpret a patient’s baseline neurological status and communicate effectively with other members of the healthcare team

• helps in monitoring effects of medications used to treat conditions like dementia

Imaging Tests:

• MRI/CT Scans

  • PET Scans

MRI/CT Scans:

• detailed picture to detect tumors, injuries or abnormalities

PET scan: 

• shows metabolic or biochemical function of tissues and organs

• can identify: 

  • tumors and seizures

  • neurodegenerative diseases

  • functional abnormalities

  • neuroinflammation

Electrical Tests and Lumbar Puncture:

• EEG (Electroencephalogram)

• Nerve Conduction Studies (NCS)

• EMG (Electromyography)

• Lumbar puncture (Spinal Tap)

EEG (Electroencephalogram)

• measures brain’s electrical activity to diagnose seizures, sleep disorders, and brain damage

Nerve Conduction Studies (NCS) and EMG (electromyography): 

• evaluate nerve and muscle health

• looks for causes of weakness or sensation loss-

Lumbar Puncture (Spinal Tap):

• analyzes fluid around your brain and spine to check for infections

Which assessment tool is used to determine eyes, motor and verbal function after TBI? 

Glasgow Coma Scale

What assessment tool is used to measures the brain's electrical activity to diagnose seizures, sleep disorders and brain damage? 

Elctroencephalogram (EEG)-

Peripheral neuropathy may be determined by which assessment measure? 

Ability to feel, touch, pain, vibration

Assessment of stroke symptoms:  

• vision changes

• sleep disturbances

• seizures

• incontinence

• paralysis

• fain

• fatigue

• depression 

• MAIN ONE: FAST

FAST assessment of Stroke: 

• uneven smile

• weak arm

• slurred speech

• call 911 in time

Types of Headache:

• migraine

• cluster

• tension

• sinus

Migraine - onset and duration:

• 4-72 hours

Migraine - severity: 

• mild to severe

Migraine - type of pain:

• dull to throbbing, unilateral

• temporal

• peak pain intensity within an hour of onset

Migraine - associated symptoms:

• nausea

• vomiting

• photophobia

• phonophobia

Migraine - relieved by:

• rest: quiet dark place

• medications

Cluster - onset and duration:

• early morning hours, lasts 15-180 mins

Cluster - severity: 

• excruciating

Cluster - type of pain:

• stabbing

• unilateral

• feel like happening under eye

• more common in men

Cluster - associated symptoms:

• tearing of eye

• rhinorrhea

• drooping of eye

• sudden onset

• peak pain 2-15 mins

• nausea

• vomiting

• phonophobia

• photophobia

Cluster - relieved by: 

• rapid onset-acting medications 

• (injectable, nasal spray)

Tension - onset and duration: 

• later in day

• variable duration

• hours to weeks

Tension - severity:

• mild to moderate

Tension - type of pain: 

• pressure, bilateral

Tension - associated symptoms:

• tiredness

• irritability

• females greater than male

Tension - relieved by:

• rest

• exercise

• anagesics

Sinus - onset and duration: 

• throughout the day

• lasts hours until event is resolved

Sinus - severity of pain:

• mild to moderate

Sinus - type of pain: 

• pressure

• primarily behind eyes and forehead

Sinus - associated symptoms: 

• nasal stuffiness

• rhinorrhea

Sinus - relieved by:

• hot showers

• decongestants

Types of Seizures:

• focal - one part of brain

• generalized - whole brain

Parkinson’s disease - signs: 

• cogwheel rigidity

• shuffling gait

• postural instability

• micrographia

• hypophonia

• bradykinesia

Parkinson’s disease - symptoms

• pill-rolling tremor

• weakness

• drooling

• paresthesias/numbness

• difficulty swallowing

• depression

• sleep disturbances

Medications that cause TREMORS:

• beta-agonists

• caffeine

• glucocorticoids

• sympathomimetics

• tricyclic antidepressants

Medications that cause PARKINSONISM:

• antipsychotics

• metoclopramide

• prochlorperazine

• reserpine

TBI or Concussion symptoms:

• headache

• loss of conciousness

• confusion/ in a fog

• amnesia surrounding traumatic event

• dizziness

• ringing in ears

• nausea

• vomiting

• slurred speech

• delayed response to questions

• dazed

• fatigue

Which disease state is most likely to have the following abnormalities: dysphagia, hemiparesis, spasticity, foot drop? 

stroke

Cogwheel rigidity is associated with which disease state or drug adverse effect? 

parkinson’s disease