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Therapeutics 2 > Module 5: Neurology > Flashcards

Module 5: Neurology Flashcards

1
Q

What are the Cholinesterase inhibitors?

A
  1. Donepezil
  2. Rivastigmine
  3. Galantamine

They increase levels of Acetylcholine in the synaptic cleft

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2
Q

What type of dementia would you not reccomend Cholinesterase inhibitors?

A

They are not recommended in Frontal temporal dementia, as they are not effective and may cause agitation

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3
Q

Please list the indications to use Donepezil cholinesterase inhibitor

A

Donepezil is the only cholinesterase inhibitor that is indicated for all disease severities of alzheimers dementia

it can be used in mixed alzheimers/ vascular dementia
Lewy body dementia
PArkinson Dementia

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4
Q

Please list the indications to use Rivastigmine

A

indicated for

Mild-moderate Alzheimers dementia
Mild to moderate Parkinson dementia

and its available in a patch form

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5
Q

please indicate the indications to use Galantamine

A

mild-moderate alzheimer dementia IF donepezil or rivastigmine are not tolerated

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6
Q

What are common adverse effects of Cholinesterase Inhibitors?

A
  • Diarrhea, nausea, vomiting, anorexia, weight loss
  • vivid dreams, tremor, vertigo
  • rhinorrhea
  • Can also cause prolonged QT interval
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7
Q

Jane just started taking Donepizil for Alzheimer Dementia and is experiencing lots of diarrhea, should the NP prescribe a medication to treat the diarrhea?

A

Avoid treating the side effects of a cholinesterase inhibitor with a new medication (e.g., oxybutynin to treat urinary frequency from a cholinesterase inhibitor); instead, consider reducing the dose or switching the cholinesterase inhibitor once the side effects have fully resolved after discontinuation of the initial agen

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8
Q

Jane just started taking Donepizil for Alzheimer Dementia and is experiencing lots of diarrhea, should the NP prescribe a medication to treat the diarrhea?

A

no

Avoid treating the side effects of a cholinesterase inhibitor with a new medication (e.g., oxybutynin to treat urinary frequency from a cholinesterase inhibitor); instead, consider reducing the dose or switching the cholinesterase inhibitor once the side effects have fully resolved after discontinuation of the initial agen

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9
Q

In which patient would you NOT consider stopping a cholinesterase inhibitor for dementia?

  1. Patient has not show clinically meaningful benefit
  2. Patient has intolerable adverse effects
  3. Patient has psychotic symptoms like aggitation
  4. Patient is now progressing to severe stage of terminal illness
  5. Caregiver decided to stop or poor adherance
A

you would NOT deprescribe cholinesterase inhibitor if a patient has signs of active psychotic symptoms (unless worsened after starting the medication)

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10
Q

Can we use Aducanumab to treat mild alzheimers?

A

no, Aducanumab, an amyloid beta-directed antibody, not approved at this time

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11
Q

If you patient has Dementia and new onset of depression would you treat it? If so with what?

A

Guidelines do not recommend the routine use of antidepressants to manage mild to moderate depression in people living with mild to moderate dementia, unless they have a pre-existing mental health problem.

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12
Q

If you had to use an antipsychotic for a patient with Dementia what would you use?

A

Try your best to avoid, but short term management of agression/psychotic symptoms in patients with severe dementia you may use risperidone

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13
Q

What medications are controversial in the prevention of Dementia?

A
  • Statins
  • Vitamins like E and B
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14
Q

When would you use the medication memantine to treat dementia?

A

you may use it in ADDITION to cholinesterase inhibitors for moderate-severe alzheimers disease, mixed AD/VD, Lewybody dementia

OR

mono-therapy in Alzheimer dementia if Cholinesterase inhibitors are not tolerated

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15
Q

What are some nonpharm treatments for headache?

A
  1. headache diary to identify triggers
  2. Apply ice/heat
  3. sleep in a dark noise free room
  4. Aerobic exercise 3 times weekly
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16
Q

What pharm treatment would you advise for tension type headache?

A

simple analgesics, tylenol asprin nsaids

effective for mild to moderate headache pain

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17
Q

What is the goal of migraine pharmacological treatment?

A

to alleviate headache pain and associated symptoms within 2 hours of treatment and/or 24 hours of sustained headache relief;

Treatment is more effective if taken early in the attack

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18
Q

What medication is the most specific and effacious for acute migraine treatment?

A

Triptans:
- almotriptan
- eletriptan
- frovatriptan etc

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19
Q

What are some contraindications to Triptan medication?

A

contraindicated in patients with cardiac disorders, sustain

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20
Q

when would you consider using Dihydroergotamine mesylate?

A

this medication is used to treat headaches and is used in patients who dont respond to triptans

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21
Q

what are some side effects that can occur with Dihydroergotamine mesylate?

A

if it is used more than 10 days per month is can cause a medication induced headache

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22
Q

What are the benefits of combination therapy?

A

combination therapy is more effective than monotherapy for headaches, you will offer naproxen/triptan combination to people who:

  • do not respond well to just triptans
  • patients who experience frequent headache recurrences after successful treatment with just triptans
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23
Q

What is first line for preventitive therapy of Tension type headaches?

A
  1. non pharm
  2. tricylic antidepressants (amitriptyline), SNRI, mirtazapine
24
Q

what are the indications to start preventitive treatment for migraines?

A
  • attackes interfere with ADL despite acute treatment
  • more than 4 attacks per month
  • failure/over use of acute treatment
  • adverse reaction to acute treament
25
Q

how do you treat medication over use headache?

A
  • tapering and stopping the offending agent
  • provide bridging therapy and starting prophylactic medication
26
Q

what can cause a medication over use headache?

A
  • using non-opiod analgesics (tylenol, nsaid) for more than 15 days/month
  • using triptans/opiods or combination analgesics for more than 10 days per month
27
Q

What medications can you use to phrophylactically treat headaches?

A
  1. antidepressants
  2. Beta blockers (propanolol)
  3. Antiepileptics (Divalproex sodium, Topiramate, gabapentin, valporic acid)
  4. Calcium Channel blockers (Verapamil, flunarizine)
    5.Lisinopril (angiotensin agent)
  5. Candestartan (angiotensin related)
  6. Pizotifen (seroton agent)
  7. Triptans ONLY FOR menstrual headaches
  8. Antibodies (Erenumab)
28
Q

which medication is not used for migraine prophylaxis?

  1. Candestartan
  2. ondansetron
  3. Erenumab
  4. Pizotifen
A

ondansetron

29
Q

which medication is not used for migraine prophylaxis ?

  1. Dexamethasone
  2. Topieromate
  3. Galcanezumab
  4. Divalproex sodium
A

dex

30
Q

What natural health products can be used for migraine prophylaxis?

A

Riboflavin
Magnesium Citrate
Co Enzyme Q10
Melatonin

31
Q

what are pre-pregnancy considerations to take when treating migraines?

A

When possible, preventive and acute headache medications should be discontinued before attempting to conceive

Especially valporic acid as it impairs folate production

32
Q

What meds are likely safe to use during pregnancy to treat headaches?

A
  1. tylenol
  2. Opiods
  3. Metoclopramide
  4. Propanolol

try to avoid triptans

33
Q

would you consider prophylactic treatment for tension headaches?

A

no,

prophylaxis is only for MIGRAINES that are moderate-severe.

Reserve the triptans and special meds for migraines

34
Q

Which is not considered successful migraine prophylaxis

  1. more than 50% reduction in migraine frequency
  2. Decrease in migraine frequency or duration
  3. improved response to acute treatment
  4. Less than 5 Migraine attacks per year
A
  1. is a lie.
35
Q

What drug interactions should you consider when prescribing an NSAID to a patient?

A
  1. Lithium can interfere with sodium/water balance, so you need to monitor lithium levels when nsaid is added
  2. SSRI + NSAID increased risk for GI bleed
  3. Possible reduction in antihypertensive effect of ACE, Beta blockers, and diuretics
36
Q

what are your first line meds for migraine prophylaxis?

A
  1. betablockers (propanolol)
  2. Amitriptyline
  3. Topiramate
  4. Candestartan
37
Q

What prophylactic treatment would you offer pregnant women>

A

Magnesium
Propanolol
Amitriptyline
Verapamil

38
Q

How would you treat bell palsy if its been less than 7 days with mild weakness

A

you wouldnt
just tape eye shut at night and use eye drops

39
Q

If its been less than 7 days of bell palsy but symptom are worsening and patient has complete paralysis, how would you treat?

A

prednison 60mg X 5 days then taper down over 5 days

40
Q

would you treat a patient with antivirals if they have bell palsy?

A

antiviral therapy shows no significant improvement compared to placebo.

This discrepancy may be due to the misdiagnosis of Ramsay Hunt syndrome as Bell palsy.

Ramsay Hunt syndrome is a herpes zoster infection of the VII cranial nerve, typically with a visible skin eruption (vesicular rash); it can, however, present without skin involvement, in which case it becomes difficult to distinguish from Bell palsy.

41
Q

What meds are used to treat Parkinson’s Disease?

A
  1. Levodopa most beneficial
  2. Dopamine Agonists
  3. MAO inhibitors
42
Q

What considerations do you need to take with levodopa for parkinson’s disease?

A
  • Levodopa has superior motor benefit but increased risk for dyskinesia
  • Patient can experience intermittent episodes of unresponsiveness
  • freezing and fluctuations
43
Q

What meds are used to treat Generalized Tonic-clonic seizure

A

Levetricaetam
Lamotrigine
Valporic Acid/Divalproex

44
Q

What meds do you use to treat Absence seizures

A

Ethosuximide

45
Q

What meds do you use to treat Myoclonic seizures

A

Levetiracetam
Valporic Acid/Dvalproex

46
Q

What meds do you use to treat tonic or atonic seizures?

A

Valporic acid/Divalproex

47
Q

What meds do you use to treat focal seizures or unclassified tonic clonic seizures?

A

basically everything:
Levetricaetam
Lamotrigine
Valporic Acid/Divalproex
brivaracetam
oxcarbazepine
carbamazepine

48
Q

What is the issue with Antiseizure medications and oral contraceptives?

A

basically antiseizure meds can interfere with the effectiveness of oral contraceptives

A patient needs to take OCO with estrogen higher than 50mcg to provide protection, but this doesnt exist

the only contraceptive method that MIGHT provide protection is:
- IUD
- Depot injection

**not nuva ring thats impacted

49
Q

True or false?

Approximately 90% of patients with epilepsy who are seizure-free for at least 9 months prior to pregnancy will remain seizure-free during pregnancy.

A

True

50
Q

True or false

Patients of childbearing potential who take ASMs should receive a daily oral supplementation with a multivitamin containing 1 mg folic acid,

beginning at least 3 months before conception and continuing until 12 weeks’ gestational age,

to potentially reduce the risk of teratogenic effects associated with ASMs

A

True

51
Q

What investigations would you order for persistent hiccups?

A

Investigations
Complete history (including medication and alcohol use) and physical examination looking for causes of vagus or phrenic nerve irritation, malignancy or CNS disease; if no abnormalities are identified, it is reasonable to perform laboratory tests (CBC, electrolytes, creatinine) and a chest x-ray​[2]

drug-induced persistent hiccups are uncommon; alcohol, corticosteroids and benzodiazepines are the drugs most frequently implicated​[2]​[3]

Further investigations (e.g., upper GI tract endoscopy, CT brain, abdominal ultrasound) depend on findings from the approach listed above

If all investigations are negative or etiologic treatment is impossible, a therapeutic trial to stop the hiccups is warranted.

52
Q

What medications can you use to treat hiccups?

A
53
Q

What medications would you prescribe to treat nausea for patient with headache?

A

dimenhydrinate
metoclopramide
domperidone)

54
Q

Jane was prescribed ritalin for her new diagnosis of ADHD she is 18 years old, after 10 days she says she has upset stomach nausea and vomiting

what would you do?

A

Suggest taking Ritalin with food. Nausea typically goes away after a few weeks. Try a short-acting drug vs. long-acting to mitigate appetite loss

Stimulants should be trialed for 3- to 4-weeks, although improvement of core ADHD symptoms is often observed within the first week of therapy. Patients who do not tolerate or respond to one stimulant after 3-4 weeks of therapy should be switched to an alternative stimulant.

55
Q

What medications/conditions are contraindicated to be used with triptans?

A
  1. CVD disease
  2. Pregnancy
  3. Basilar or hemiplegic migraines
  4. HTN
56
Q

What antiseizure meds would you prescribe for someone who is pregnant

A

Preferred ASM may be lamotrigine, levetiracetam & oxcarbamazepine.

57
Q

What are conditions that are contraindications to the use of beta-blockers in migraine prophylaxis

A

asthma
type 2 diabetes
Heart failure

Therapeutics 2 (12 decks)

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