Case 13 Pharma and Management

Question 1

Mannitol use and MOA

Answer 1

Given IV to reduce acute raised ICP and is an osmotic therapeutic agent

Question 2

Mannitol ADR and contra

Answer 2

ADR: electrolyte imbalance, diuresis, thrombophlebitis, hypotension
Contra: if anuric or if active intracranial bleed

Question 3

Dexamethasone use and MOA

Answer 3

Given IV to act as a POTENT anti-inflammatory to reduce intracranial swelling
Steroid forms complex with glucocorticoid receptor- acts as a transcriptional regulator to reduce inflammation

Question 4

Dexamethasone ADR and Contra

Answer 4

ADR: chronic use: immune suppression, Cushing’s syndrome, osteoporosis
Contra: if immuno-compromised, if diabetic

Question 5

Midazolam use and MOA

Answer 5

Iv or buccal anticonvulsant given to manage acute epileptic seizures
It is a benzodiazepine that increases GABA-ergic suppresion of nerve activity.
Increases Cl- into neurones - hyperpolarises nerves to reduce impulse propagation

Question 6

Midazolam ADR and contra

Answer 6

Drowsiness, cardiac arrest, paradoxical excitement or aggressive behaviours
Contra: if pre-existing CNS depression or severe respiratory depression

Question 7

Carbamazepine use and MOA

Answer 7

Oral long-term seizure management.

Inhibits aberrantly active CNS voltage gated- Na+ channels and also a GABA receptor agonist

Question 8

Carbamazepine ADR or Contra

Answer 8

ADR: allergic skin reactions, aplastic anaemia, blurred vision, dizziness
Contra: prophyriac, if cardiac AV node conduction block

Question 9

Signs and symptoms of raised ICP

Answer 9

Headache, nausea, vomiting

Cranial nerve palsies- 3rd and 6th

Question 10

Cushing’s response

Answer 10

Bradycardia, decreased respiratory rate, hyPERtension

Question 11

Papillodema

Answer 11

DOES NOT COME ACUTEKY

Question 12

EDH shape

Answer 12

Biconvex-lentiform shaped

Question 13

Subdural

Answer 13

Concave towards brain, under less pressure
Ruptured bridging veins
Older patients
Sudden onset occipital headache

Question 14

Clipping of an aneurysm

Answer 14

Stop aspirin/warfarin

Control hypertension

Question 15

Flow of CSF

Answer 15

Lateral ventricles - foramen of monro- thrid ventricle- down aqueduct of sylvius -down brainstem into the fourth ventricle (hindbrain)- goes out through foramen of lushka- subarachnoid space- absorbed into arachnoid spaces and venous sinuses