Medications

Question 1

Melatonin

Answer 1

Effective for circadian rhythm disorder

Helps initiate sleep

Question 2

Antihistamine

Answer 2

Help sleep w/o causing daytime drowsiness

Question 3

Clonidine

Answer 3

Alpha 2 agonist
Reduce sleep latency & night awakenings
2nd line med for impulsive and inappropriate social behavior

Question 4

Trazodone

Answer 4

Keep asleep longer

SE: priapism

Question 5

Mirtazapine

Answer 5

Helps with sleep
Effective if anxiety and decreased appetite also a problem
Keep dose low

Question 6

Zolpidem

Answer 6

Effective for initiation of sleep for a short time

Question 7

Quetiapine (Seroquel)

Answer 7

Agitation & aggression, Not 1st line med
Helpful with sleep
SE: wt gain

Question 8

Sertraline (Zoloft)

Answer 8

SSRI
1st line Anxiety/aggression, depression tx
Comes in a liquid

Question 9

Citalopram (Celexa)

Answer 9

SSRI
1st line Anxiety/aggression, depression tx
Comes in a liquid

Question 10

Fluoxetine (Prozac), Escitalopram (Lexapro) & Paroxetine (Paxil)

Answer 10

SSRI
1st line Anxiety/aggression, depression tx
More anticholinergic SE

Question 11

Guanfacine

Answer 11

Alpha 2 agonist
2nd line anxiety/aggression
Less sedating
Longer half life

Question 12

Propanolol

Answer 12

Beta blocker
Tx Sympathetic storming after TBI or anoxic event
Use HTN dosing guidelines

Question 13

Benzos

Answer 13

2nd or 3rd line in tx anxiety/aggression
Quick onset of action
Affective in children who don’t tolerate SSRI or alpha 2 agonist
Avoid PRN’s
Avoid in TBI due to slow processing speed

Question 14

Atypical antipsychotics

Answer 14

3rd or 4th line tx anxiety/aggression
Monitor wt, lipids, glucose and waist circumference
Extrapyramidal SE & tardive dyskinesia
Akathisia common SE when inc & dec med doses

Question 15

Risperidone

Answer 15

Tx anxiety/aggression
Start on BID dosing & inc after 3-4 weeks at each dose
Consider other dx if 1mg BID not addressing anxiety
SE: wt gain

Question 16

Aripirazole (Abilify)

Answer 16

Tx anxiety/aggression

SE: less wt gain and sedation as other atypical antipsychotics, akathesia

Question 17

ADHD Treatment

Answer 17

Stimulants: methylphenidate (Ritalin), amphetamine (Dexedrine)
-Monitor BP, HR, EKG, wt and ht
-Do not use if sleep disturbance is an issue
Atomoxetine (Strattera) or alpha 2 agonist if SE of stim not tolerated

Question 18

Stimulants in TBI

Answer 18

Demonstrate inc activity in cerebral cortex, caudate nucleus, and mediofrontal cortex
Activate dopamine/NE system

Question 19

Amantadine

Answer 19

Causes release of dopamine & may have a NMDA rec antagonist effect

Question 20

Modafinil

Answer 20

Uptake in anterior hypothalamus, hippocampus and amygdala

Question 21

Baclofen

Answer 21

Tx of spasticity
Well tolerated
Can be given to very young
Start slow to min sedation

Question 22

Diazepam

Answer 22

Tx of spasticity

Monitor sedation and processing speed

Question 23

Tizanidine

Answer 23

Tx of spasticity

Monitor sedation

Question 24

Dantrolene

Answer 24

Tx of spasticity

Monitor LFT’s

Question 25

Clonidine

Answer 25

2nd line Tx of spasticity

Question 26

Botulinum toxins

Answer 26

Tx of spasticity
Neuromuscular injection
Monitor amount/kg, respiratory function
Black box warning: systemic botulism

Question 27

Phenol

Answer 27

Tx of spasticity

May need sedation to ID motor point with E-stim

Question 28

Intrathecal Baclofen

Answer 28

Pump insertion for inc gen spasticity or opsithoclonus after TBI