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NURS 531 Advanced Pharmacotherapeutics Exam 2 Study Guide

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Exam 2 Study Guide 1. Mechanisms of cerebral injury (hypoxia, ischemia, increased ICP) ● Hypoxia / ischemia ○ Primary problem: reduced oxygen (hypoxia) and/or blood flow (ischemia) → ATP depletion. ○ Cellular cascad ...

Exam 2 Study Guide 1. Mechanisms of cerebral injury (hypoxia, ischemia, increased ICP) ● Hypoxia / ischemia ○ Primary problem: reduced oxygen (hypoxia) and/or blood flow (ischemia) → ATP depletion. ○ Cellular cascade: failure of Na⁺/K⁺ ATPase → Na⁺/water influx → cytotoxic edema; Ca²⁺ influx → activation of proteases, lipases, endonucleases → membrane and mitochondrial damage; increased glutamate release → NMDA-mediated excitotoxicity → further Ca²⁺ overload. ○ Reperfusion injury: ROS formation, inflammation, blood–brain barrier (BBB) disruption. ○ Selective vulnerability: vulnerable regions: hippocampal CA1, neocortex layers 3/5, Purkinje cells in cerebellum. ● Increased intracranial pressure (ICP) ○ Causes: edema (cytotoxic or vasogenic), hemorrhage, mass lesion, hydrocephalus. ○ Consequences: decreased cerebral perfusion pressure (CPP = MAP − ICP) → worsened ischemia; herniation syndromes (uncal, central, tonsillar) → brainstem compression, cranial nerve deficits, altered consciousness. ○ Clinical signs: headache, vomiting, altered mental status, papilledema, Cushing triad (hypertension, bradycardia, irregular respiration) in advanced cases. 2. Stroke: risk factors, subtypes, deficits by region ● Risk factors ○ Non-modifiable: age, male sex, prior stroke/TIA, family history. ○ Modifiable: hypertension (biggest), atrial fibrillation (embolism), diabetes, hyperlipidemia, smoking, carotid atherosclerosis, oral contraceptives (in some), illicit drug use (cocaine), sedentary lifestyle. ● Subtypes ○ Ischemic (≈80–85%) ■ Thrombotic: in situ atherosclerotic plaque → occlusion (often at branch points/cervical carotid, MCA). ■ Embolic: cardiac (AF, mural thrombus) or arterial-to-artery; sudden onset, may be multiple territories. ■ Lacunar: small vessel lipohyalinosis → small subcortical infarcts (e.g., internal capsule) producing pure motor/sensory syndromes. ○ Hemorrhagic ■ Intracerebral hemorrhage (ICH): hypertension-related (basal ganglia, thalamus), amyloid angiopathy (lobar in elderly). ■ Subarachnoid hemorrhage (SAH): ruptured aneurysm → thunderclap headache, meningismus.

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