Misc pt 2 in 862

how do drugs affect the CNS

• altering neurotransmission

• ex: dopamine, acetylcholine, norepinephrine, serotonin

  • can cause stimulant properties: excitement, euphoria, decreased fatigue, increased motor activity

inhibitory, sedative properties

• depression

• sedation

• fatigue

• decreased motor activity

  • impaired thought/decision-making

  • impaired driving

  • impaired operation of heavy machinery

  • impaired gait

endogenous

having internal cause or origin; growing or originating from within an animal

exogenous

relating to or developing from external factors; growing or originating from outside an organism

-mimetic

marked by simulation of another bodily process or disease; also used as a word termination indicating simulation of a function, process, etc, designated by the root to which is affixed; mimics

-lytic

word termination denoting lysis of the substance indicated by the stem to which it is affixed

• stimulate a nervous system = agonists

• inhibit a nervous system = antagonist

sympathomimetics

agonist on sympathetic nervous system

sympatholytics

antagonist on the sympathetic nervous system

stimulant drugs augment

• norepinephrine

• dopamine

• acetylcholine

ADD or ADHD drugs

• methylphenidate (Ritalin, Concerta)

• dexmethylphenidate (Focalin)

• amphetamines (adderall, Vyvanse)

• can cause PSNS to go into hyper mode

• use: childhood and adult ADD or ADHD; autism syndromes

• are psychomotor stimulants; increase motor activity in patients w/ ADD or ADHD; if abused can cause excitement or euphoria

• blockade of the reuptake of monamines

endogenous chemical

• control involuntary functions: HR, BP, respiration, persipiration, digestion

• can be influenced by thought and emotion

  • psycholocial component: chronic stress

• adjusts in response to stressful situations

adverse effects of ADHD meds

• insomnia

• weight loss

• anxiety

• agitation

• cardiac arrhythmias

• tachycardia

• increased respiration

• dyspnea

• seizures

• tremors

• vertigo

• hypertension

• confusion

• nausea

• diarrhea

• addiction potential

dopamine

• mesocortical: cogntion, memeory, attention, emotional behavior and learning

• nigrostriatal: movement and sensory stimuli

• mesolimbic: pleasure and reward seeking behaviors, addiction, emotion, perception

adverse effects for dopamine drugs

• postural hypotension

• dysinesias: ataxia, facial tics, extremity tics

• hallucination

• insomnia

dopamine agonists

• bromocriptine

• Primipexole (mirapex), ropinirole (ReQuip)

• uses: Parkinson’s disese; restless leg syndrome

• increase dopamine in the CNS

adverse affects of dopamine agonists

• hallucination

• insomnia

• malaise

• nightmares

• dizziness

• dyskinesia

• confusion

anticholinergics

• benztropine (congetin), diphenhydramine (Benadryl)

• uses: Parkinson’s disease, and allergic reactions

• inhibit central cholinergic activity

adverse effects of anticholinergics

• confusion

• agitation

• tachycardia

• palpations

• dry mouth

• urinary retention

• constipation

• blurred vision

Alzheimer’s Disease meds

• acetylcholinesterase inhibitors: cholinergics - doepezil (Aricept)

• uses in early mild/nod Alzheimer’s disease to improve cognition function, and to slow the progression of AD

• enhance cholinergic function by increasing the concentration of acetylcholine by inhibiting the breakdown of acetylcholine

adverse effects of AD meds

• aggitation

• diarrhea

• increased urination

• increased salivation and sweating

• confusion

antidepressants

• TCA (tri-cyclic antidepressant): amitriptyline (Elavil), nortriptyline (Pamelor, Aventyl)

• uses: depression, sleep, nerve pain

• block the reuptake of NE and/or 5-HT into noradrenergic or serontergic nerve terminals thus not terminate and prolonging the stimulation

• blocj “dirty receptors”: muscarinic choleinergic receptors, adrenergic receptors, and histamine receptors - what causes many of the side effects

SSRI

• fluoxetine (Prozac), sertraline (Zoloft)

• selective for serotonin → increase the amount in a patients brain

• uses: depression, PTSD, PMDD, eating disorders, anxiety syndromes

• thought to increase suicidal ideations → disproven

atypical

• SNRI (serotnoin-norepinephrine reuptake inhibitors) duloxetine (Cymbalta), venalfaxin (Effexor)

• NDRI (norepinephrine-dopamine reuptake inhibitors) Bupropion (wellbutrin, SR, and XL)

• SARI (serotonin-antagonist and reuptake inhibitors

• NaSSA (noradrenergic and specific serotiniergic antidepressant

• SRI/%HT1A( partial agonist-serotinin reuptake inhibitor/serotinin 1A partial agonist

• used for depression, anxiety syndromes, smoking cessation, sleep, peripheral neuropathy, pain syndromes, hot flashes

• result in a relative increase in both norepinephrine and serotonin

adverse effects of atypical antidepressants

• sedation

• weight gain

• postural hypotension

• sexual dysfunction

• dizziness

• anxiety

• confusion

anxiolytics

benzodiazepines

• alprazolam (xanax), clozanepam (Klonopin), diazepam (Valium) lorazepam (Ativan)

• uses": sleep, muscle relaxers, amnesia, anxiety syndromes, seizures syndromes, alcohol withdrawal

• bezos bind to receptors to inhibit nerutransmitter release

• they exert their effects through interacting w/ the GABA receptor

  • inhibitory effects of GABA throughout the CNS

• duration action of Benzos varies considerably, and the formation of active metabolites plays a major role in their effect

  • short half life and minimal drug accumulation: alprazolam, lorazepam, oxazepam

adverse effects of anxiolytics

• drowsiness

• psychomotor impairment

• ataxia

• disorientation/confusion

• depression

• aggression

• irritability

• behavioral disinhibition

• anterograde amnesia

sedatives

• zolpidem (ambien), zaleplon (Sonata), eszopiclone (LUnesta)

• use: to induce sleep

• acts on a subset of benzos receptor family, BZ1

• no anticonvulsant or muscle relaxant properties, no withdrawal effect, little/no tolerance

adverse effects of sedatives

• nightmares

• sleep eating

• sleep walking

• agitation

• dizziness

• daytime drowsiness

antihistimines

• Meclizine (antivert), dimenhydrinate (Dramamine)

• used in type 1 hypersensitivity reactions; prophylaxis for motion sickness and vestibular diseases

• can make condition worse if on a long time

• act as vestibular sedatives if the cross the BBB and act on parasympathetic receptors

adverse effects of antihistamines

• sedation

• confusion

• dry eyes

• dry mouth

• ataxia

opioid agonists

• morphine, oxycodone, hydromorphone, fentanyl, codeine, methadone, acetaminophen, codein

• tramadol

• uses: mainstay of therapy for the treatment of pain

• relieve pain and induce euphoria by binding to the opioid receptors in the brain

adverse effects of opiods

• sedation

• constipation

• confusion

• dizziness

• nasuea/vomitting

• respiratory depression

• dysphoria

• euphoria

• hallucinations

• itching

muscle relacers

• carisoprodol (Soma), cyclobenzaprine (Flexeril), metaxalone (Skelaxin), tizanidine (Zanaflex)

• for muscle spasms and hyper-reflexia

adverse effects of muscle relaxers

• mental depression

• drowsiness

• dizziness/lightheadedness

• may impair mental and physical abilities

• trembling

• muscle weakness

• hypotension

• blurred vision

• drug interactions _ alcohol

retropulsion

ipsilateral pushing

lateropulsive pushing

laterpulsion

postural behavior with a continuum between light and severe forms

contraversive pushing syndrome

unique behavior post-stroke in which the individual uses their univolved limb to actively “push” themselves toward their involved side/contralateral lesion

etiology

• occurs with bothe left and rigth sided lesions

• occurs boht supratentorial and infratentorial

supratentorial

lesions happen in cerebrum

infratentorial

below tentorium

cerebellum and brainstem

theory

individuals align their body onto an erroneous reference vertically in relation to a damaged graviceptive network

• they think they are fully upright at 18 degrees of tilt, thus pushing themselves to align themselves as what they believed is upright

• purely trunkal proprioception, not visual or vestibular

prevelance

• over half of people with stroke have lateropulsion

• right side more prevelant

prognosis

• lower impairment and function scores on admission compared with those with only stroke

• often accompanied by neglect, anosgnosia, aphasia, apraxia

• up to 3.6 weeks longer to discharge from inpatient

• does extinguish overtime, especially by 6 months

diagnostic critera

1. spontaneous body posture (lateral tilt)

2. resistance to passive correction of posture

3. increase of pushing force by spreading of the uninvolved extremities from the body

   1. head

   2. UE abduction with elbow extension

   3. pelvic asymmetry

   4. leg abduction with hip and knee extension

   5. ankle platarflexion

outcome measures

• SCP

• BLS

scale for contraversive pushing

performed in sitting and standing, including

• spontaneous body posture

• resistance to passive correction of tilted posture

• use of the uninvolved extremities

pros and cons of SCP

• quick

• doesn’t capture change well

Burke Lateropulsion Scale

• performed in rolling/sitting/standing/transfers/walking

  • resistance present with posture correction

  • degree and timing of resistance

• score > 3 of 17

treatment

• combine goals

• determine intensity metric

• task-oriented adn capacity-building intervention

• active movement with clear, simple, concisten instructions to encourage an Earth-vertical position with visual feedback for body orientation; progression not defined by performance in a more simple context

contraversive assistance hierarchy

1. visual cue

2. verbal/tactile cue

3. adjust the environment to where we mechanically disadvanteg unaffected extremities

4. manual assistance

mechanical disadvantage

• wedging, reduce friction, destabilize

• equipment: sliders, scooters, physicoballs, elevating bedside tables

mechanical disadvantage for transfers

• transfer type: squat vs. stand

• transfer direction: towards uninvolved vs. involved

• therapist hand position

• equipment use

gait

can walk with patients, pushing behaviors is very variable

• didn’t increase pushing, so help them walk