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PPT Phase II > Migraines, Insomnia, CNS Infection > Flashcards

Migraines, Insomnia, CNS Infection Flashcards

1
Q

what class of drug are triptans sumatriptan and zolmitriptan?

A

5-HT1 agonists

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2
Q

what is thought to be the mechanism of action of triptans in migraine?

A

constriction of cranial blood vessels and inhibition of neurotransmission in ther peripheral trigeminal nerve and in the trigeminocervical complex.

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3
Q

what is the MOA of antiepileptic drugs thought to be in terms of migraines?

A

GABA-mediated suppression of neurotransmission through trigeminocervical complex in the brainstem. modulate neuronal excitability through effects on voltage-gated Na+ channels

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4
Q

what lifestyle changes should you recommend to people with migraines?

A

avoidance of known triggers, stress management, good sleep hygiene, adequate hydration, regular meals, exercise, maintenance of healthy weight.

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5
Q

what acute pharmacological treatmetn can you prescribe for migraine?

A

simple analgesia such as ibuprogen, aspirin, paracetamol. then could offer triptan alone or in combo with paracetamol and NSAID (e.g. sumatriptan).
consider offering antiemetic (metoclopramide or prochlorperazine)

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6
Q

how long after starting treatmetn for migraine should you follow up an adult pt?

A

2-8wks

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7
Q

when should you consider preventative treatmetn for migraines?

A

if migraines are having sig. impact on quality of life and daily function (roughly more than once a week on average) or are prolonged and severe despite optimal acute treatment.
if acute treatments are contraindicated or ineffective.
if person is at risk of medication overuse headache due to frequent use of acute drugs.

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8
Q

name 3 pharmacological therapies that can be used as migraine prophylaxis

A

propanolol, topiramate (anti-epileptic) or amitriptyline

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9
Q

what is the MOA of Z-drugs used for insomnia?

A

bind to GABAa receptor increasing GABA-mediated CL- influx into cell which inhibits neurotransmission.

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10
Q

what are zolpidem and zopiclone examples of and what are they used for?

A

Z-drugs used in insomnia.

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11
Q

what is the most common organism causing bacterial meningitis in a child <1 month old?

A

group B streptococci, followed by E.coli, S.pneumoniae, Listeria monocytogenes

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12
Q

what is the most common organism causing nbacterial meningitis in 1 month-4yr olds?

A

Haemophilus influenzae type B

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13
Q

what is the most common organism causing bacterial meningitis in >4yrs to young adult age?

A

Neisseria meningitidis (meningococcus)

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14
Q

what is the organism that is the most common cause of bacterial meningitis in older adults?

A

streptococcus pneumoniae (pneumococcus)

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15
Q

meningococcal disease refers specifically to infections caused by whcih bacteria?

A

Neisseria meningitidis

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16
Q

what is Kernig’s sign?

A

pain and resistance on passive knee extension with hips fully flexed

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17
Q

what is Brudzinski’s sign?

A

hips flexed and pain when you bend head forward

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18
Q

which antibiotic should you give for suspected meningococcal disease in the community providing they have no allergy to penicillin?

A

benzylpenicillin

19
Q

what is the class and MOA of benzylpenicillin?

A

beta-lactam antibiotic.

Binds to penicillin binding protens and inhibits synthesis of peptidoglycan layer of cell wall.

20
Q

how is benzylpenicillin administered and why?

A

IM or IV because only 1/3rd of orally administered dose is absorbed as the rest gets destroyed by stomach acid.

21
Q

which antibiotic or group of antibiotics should be prescribed first line as empirical therapy for meningitis in the ED providing pt has NKDA.

A

ceftriaxone or cefotaxime (cephalosporins) - they have bactericidal activity for both pneumococci and meningococci and are able to cross the BBB and penetrate the CSF in useful quantities

22
Q

if you are suspecting meningitis and there is going to be a delay in doing the LP, should you hold off on giving abx until after LP?

A

No - don’t delay giving abx. they should be givin within at least 1hr of coming to hospital.

23
Q

what is the MOA of cefotaxime?

A

inhibit cell wall synthesis.

24
Q

can you give cephalosporins to people with hypersensitivity to penicilins?

A

no

25
Q

what can be given to help prevent/treat cerebral oedema and act as an adjunct treatment of bacterial meningitis?

A

dexamethasone 10mg IV

26
Q

name some adverse effects of using steriods

A

DM, osteoporosis, proximal muscle weakness, skin thinning, easy bruising, gastritis.
mood and behavioural changes include insomnia, confusion, psychosis, suicidal ideas. mineralocorticoid actions can result in HTN, hypokalaemia and oedema.
long term it can prevent endogenous cortisol secretion and if stopped suddenly it can cause Addisonian crisis.

27
Q

when a person is diagnosed with meningitis, what responsibilities do you have in terms of public health?

A

bacterial meningitis is a notifiable disease meaning all cases need to be notified to the relevant public health authority and the Consultant in Communicable Disease Control (CCDC) should be contacted early

28
Q

who is meningitis prophylaxis indicated for?

A

those who have had prolonged close contact with the case in a household-type setting during the 7 days before onset of illness, or those that have been directly exposed to large particle droplets/secretions from teh respiratory tract around the time of admission to hospital

29
Q

when should meningitis prophylaxis be given to case contacts?

A

ideally within 24hrs after diagnosis of the case.

30
Q

what acn be used as prophylaxis for meningitis?

A

ciprofloxacin or rifampicin. it is a one-off dose

31
Q

who usually instigates meningitis prophylaxis?

A

public health team

32
Q

other than prophylaxis for meningitis close contacts, what else needs to be offered?

A

relevant vaccines if the person is unvaccinated. these include Hib, men B and C, pneumococcal and quadrivalent men ACWY

33
Q

what are the pathophysiological differences between meningitis and encephalitis?

A

viral meningitis - inflammation of the meninges surrounding the brain and spinal cord.
encephalitis - inflammation of the brain parenchyma

34
Q

How do sx of meningitis and encephalitis differ?

A

Viral meningitis - sx of headache, neck stiffness, photophobia.
encephalitis - flu-like sx (inc fever), headache, altered GCS/confusion

35
Q

what causes viral meningitis

A

most commonly herpes viruses but can be caused by a variety of viruses, bacteria, fungi and parasitic organisms

36
Q

what organism causes encephalitis?

A

herpes simplex virus

37
Q

how would you treat suspected herpes simplex encephalitis?

A

aciclovir

38
Q

what is the MOA of aciclovir?

A

guanosine analogue which inhibits synthesis of viral DNA. it requires phosphorylation by viral enzymes that are not present in uninfected host cells, thus preventing cytotoxic effects on human cells. aciclovir targets viral DNA polymerase, terminating DNA synthesis and thus replication

39
Q

would you use aciclovir for viral meningitis?

A

no because it is not caused by herpes simplex. viral meningitis tends to resolve on its own

40
Q

other than herpes simplex virus, what else is aciclovir indicated for?

A

varicella zoster infections

41
Q

name some side effects of aciclovir

A

headache, dizziness, GI disturbance, skin rash. high dose IV can cause renal impairment

42
Q

how is aciclovir administered for encephalitis?

A

IV

43
Q

how long is the course of aciclovir in encephalitis

A

minimum 14 days (min 21 days if immunocompromised)

44
Q

when a pt is on aciclovir it is importnat that they drink lots, why?

A

to decrease risk of intra-tubular precipitation of the drug

PPT Phase II (37 decks)

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