Drugs & Doses: Neurology

Question 1

Trigeminal Neuralgia

Answer 1

Carbamazepine 100mg BD – can titrate up every 7 days as needed to max 400mg BD
Also – gabapentin / pregabalin / phenytoin used

Question 2

Cluster Headache Prevention

Answer 2

Verapamil 80mg TDS titrating up to 160mg TDS (always do ECG prior and before dose increase)

Question 3

Bell’s Palsy Treatment

Answer 3

Prednisone 1mg/kg (max 75mg) daily for 5/7

Question 4

Dementia Treatment Options - Be Specific if you can…

Answer 4

Donepezil 5mg nocte x 4 weeks, if tolerated increase to 10mg nocte
Rivastigmine 4.6mg transderm/24hrs, increasing to 9.5mg after 4/52
Galantamine 8mg mane for 4/52, increasing to 16mg if tolerated
Behavioural disturbances - 0.25mg risperidone BD or olanzapine 2.5mg daily. In Lewy body dementia and Parkinsons, use Quetiapine 50mg BD

Question 5

Narcolepsy Treatment

Answer 5

Modafanil 200mg PO Daily

Question 6

Restless Legs Treatment

Answer 6

Levodopa + benserazide OR levodopa + carbidopa OR OR gabapentin / pregabalin / pramipexole

Question 7

Essential Tremor Treatment

Answer 7

Propranolol 10-20mg BD or primidone 62.5mg nocte

Question 8

Motor Neurone Disease Treatment

Answer 8

Riluzole (Na channel blocker) slows progression

Baclofen 10-25mg TDS

Question 9

Shingles Treatment + Pain Management. Post-Herpetic Neuralgia Treatment.

Answer 9

Valacyclovir 1g Q8H for 7/7
Acute pain - regular analgesia, lidocaine 5% patch, pred 50mg for 7/7
Post herpetic neuralgia - amitriptyline 10mg nocte

Question 10

Migraine Treatment (+Nausea Management)

Answer 10

Aspirin 900mg oral, repeat after 4 hrs as needed (OR Paracetamol 1gm OR Ibuprofen 400mg)
Metoclopramide 10mg TDS for nausea
Triptans – eg Naratriptan 2.5mg PO OR Sumitriptan 50-100mg PO (max 300mg/day, paeds 10-20mg >6yo) – wait 2 hrs between doses

Question 11

Migraine Prophylaxis Options

Answer 11

Amitriptyline 10mg PO nocte → increase daily dose by 10mg up to maximum 75mg daily
Nortriptyline 10mg PO nocte → increase daily dose by 10mg up to maximum 75mg daily
Candesartan 4mg PO daily → increase daily dose by 4mg up to maximum 32mg
Pizotifen 0.5mg PO nocte → increase daily dose by 0.5mg up to maximum 1.5-3mg
Propanolol 20mg PO nocte → increase daily dose by 20mg up to maximum 160mg daily divided into 2-3 doses
Sodium Valproate 200mg PO nocte → increase daily dose by 200mg up to maximum 500mg BD
Topiramate 25mg PO nocte → increase daily dose by 25mg up to maximum 100mg BD
Verapamil Sustained Release 90mg PO daily → increased daily dose slowly over 3 weeks up to maximum 240mg daily

Question 12

Peripheral Neuropathy Options (Be Specific)

Answer 12

Anticonvulsants → pregabalin (75mg po daily, review in 7 days), gabapentin, valproate
Antidepressants → amitryptiline (10mg nocte review in 7/7), duloxetine, venlafaxine
Topical Nitrate Spray
Opioid Analgesics

Question 13

Parkinsons Disease Treatment Options

Answer 13

Levodopa / Carbidopa OR Pramipexole

For nausea Domperidone 10mg TDS