NEURO 1 Flashcards

1
Q

TRIGEMINAL NEURALGIA

  • Treat with anticonvulsant/anti-seizure meds:
    o _____ with serial CBC and LFTs  FIRST LINE
    o Oxcarbazepine/Trileptal (does not have FDA indication yet)
  • Baclofen, Topiramate, or Lamotrigine (Lamictal) may be tried alone or in combo with above
  • _____ may relieve pain especially in those nonresponsive to conventional drugs or with MS

FOR THOSE WITH VASCULAR COMPROMISE LEADING TO SYMPTOMS

  • Microvascular surgical decompression and separation of the anomalous vessel from the nerve root produce lasting relief of symptoms
  • Elderly patients – _____ (cutting out that nerve) is sometimes preferred because it is easy, has few complications, and provides symptomatic relief for a period of time
  • _____ to the trigeminal nerve root is another noninvasive approach that appears successful in patients
A

Carbamazepine
Gabapentin
rhizotomy
Gamma radiosurgery

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2
Q

POST HERPETIC NEURALGIA

PREVENTION OF POST-HERPETIC NEURALGIA

  • TREAT THE HERPES ZOSTER OUTBREAK TO REDUCE THE RISK OF POST-HERPETIC NEURALGIA  _____ or Valacyclovir when given within 72 hours of rash onset reduces the incidence of post-herpetic neuralgia by half
  • Systemic corticosteroids do not help

TREATMENT
- Management of the complication is essentially medical:
o Simple _____ (Tylenol, NSAIDs)
o _____ (amitriptyline or nortriptyline is often effective)
o Other patients respond to carbamazepine, phenytoin, gabapentin or pregabalin
o A combo of gabapentin and morphine orally may be better than each agent taken alone
o Topical capsaicin cream (zostrix) may be helpful
o Topical lidocaine is worth a trial

PREVENTION OF HERPES ZOSTER ITSELF
- Administration of attenuated _____ to patients over the age of 60 is important in reducing the likelihood of herpes zoster and reducing the severity of post herpetic neuralgia should reactivation occur

A

Acyclovir
analgesics
TCAs
zoster vaccine

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3
Q

ATYPICAL FACIAL PAIN

  • Simple _____, TCAs, carbamazepine, oxcarbazepine, phenytoin – response is disappointing
  • Opioids pose danger of addiction
  • No surgical attempts should be made
A

analgesics

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4
Q

GLOSSOPHARYNGEAL NEURALGIA

  • _____ and _____ are treatments of choice prior to surgical procedures
  • Microvascular _____ often effective and is generally preferred over rhizotomy
A

Oxcarbazepine
carbamazepine
decompression

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5
Q

BELLS PALSY

  • Approximately 60% of cases recover completely without treatment
  • _____ (60mg qd x 5d then a taper) increase the chances of complete recovery at 9-12 months by 12-15%
  • Valacyclovir or acyclovir (antivirals) indicated when there are _____ (post-herpetic symptoms)
  • Protect eye with lubricating drops and _____ and patching if eye closure is not possible
  • PT if facial function needs to improve
  • No role for surgical decompression
A

Steroids
vesicles
ointment

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6
Q

MIGRAINE HEADACHES

  • DRUG THERAPY (2 pathways: Prophylaxis or Acute Episodes) **chart on slide 42 **acute vs. chronic tx of migraines

o PROPHYLAXIS = take every day to prevent future headaches or if you get very often (ex: 2 migraines a week)
1) BETA-BLOCKERS: _____ for vasculature  vasodilate
2) CCB: _____ for vasculature  vasodilate
3) ___: Amitriptyline or venlafaxine regulate serotonin & help neuropathic pain
4) _____: Topiramate (TOPAMAX) or Valproic acid clean drugs, don’t cause weight gain
OTHER CARDIOVASC DRUGS: Candesartan (ARB) or Guanfacine (↓ HR)
 MONOCLONAL ANTIBODIES against ____: ErenUMAB, fremanezUMAB, GalcanezUMAB  newer, injectable or infused (for most severe pts, tried all other prophylaxis)
 Adjunctive: Botox, Riboflavin, Butterbur

o ACUTE EPISODES = nonspecific or specific
 NONSPECIFIC
1) _____ (single or in combo with each other)
o ASA
o NSAIDS – good for pain relief but hard on GIT
o Acetaminophen
o Narcotics ***avoid because habit forming
o _____ (good for potentiating pain esp in combo with NSAIDS or ASA)
2) ANTI-EMETICS as needed for n/v: Prochloperazine, Metoclopramide, _____

 SPECIFIC **side effects or contraindications of Triptans and Erogtamines
1) _____ = vasoconstrictor  older drug, effective, may cause rebound _____
**
avoid in pregnant pts & pts with significant __ disease
2) _____ = vasoconstrictor  enhances serotonin and/or dopamine blockade (available in many forms/preps, may cause n/v)
o Names end in “triptan” – don’t need to memorize them all: sumatriptan, almotriptan, eletriptan, etc.
**avoid in pregnant pts; hemiplegic or _____ migraines; pts with _____ risk factors (uncontrolled HTN, prior stroke or TIA, DM, dyslipidemia, obesity)
**
contraindicated in coronary or peripheral _____ disease
o Can be used with caution in controlled HTN
o Best benefit = combined with naproxen (combo pill)

A
Propranolol
Verapamil
TCA
ANTICONVULSANTS
CGRP
ANAGLESICS
caffeine 
Zofran
ERGOTAMINE
headaches
CV
TRIPTANS 
basilar
stroke
vascular
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7
Q

MENSTRUAL MIGRAINE

_____, Ergotamine derivatives, hormone manipulation (Birth control)
o Don’t use BC in older pts or stroke risk pts

A

NSAIDS

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8
Q

MENOPAUSAL MIGRAINE

  • TX = _____ replacement (pure estradiol may be useful w/ continuous dosing)
A

estrogen

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9
Q

CLUSTER HEADACHES

  • Avoid triggers
  • Abortive therapy
    o FIRST LINE if they agree/comply = 100% __ therapy (usually works immediately)
     Can be used adjunctively
    o Oral medications are generally not effective
     Can use _____ (injectable pens or sublingual) or ergotamines
     High dose prednisone (60-80 mg daily until headache frequency diminishes) LIMIT to 5-7 days, only used if nothing else works
    o Intranasal lidocaine
-	Prophylaxis  choose based on comorbid conditions
o	Antidepressants: SSRIs
o	Anticonvulsants: Lithium, Topamax
o	\_\_\_\_\_
o	CCB: Verapamil
A

O2
SumaTRIPTAN
Ergotamine

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10
Q

CHRONIC PAROXYSMAL HEMICRANIA

  • TX = Oral _____, indomethacin are effective (CPH is treated as cluster headache)
A

NSAIDs

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11
Q

TENSION TYPE HEADACHE

  • Nonpharmacologic therapies as in migraines:
    o Elimination of triggers
    o Biofeedback (done more in neuro offices)
    o Relaxation
    o Moderate exercise
    o Cognitive-behavioral therapy
    o Quit smoking
    o Acupuncture
    o Maintain regular sleep and eating patterns
  • PREVENTITIVE: TCA or _____
  • ABORTIVE: _____
A

SSRIs

NSAIDS

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12
Q

POST TRAUMATIC HEADACHES

  • TX = may respond to simple analgesics
    o Severe headaches may need preventive treatment as outlined for migraine (avoid triggers, try drugs, log headaches, etc.)
    o _____ and if that doesn’t work  NSAIDS
A

Tylenol

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13
Q

PRIMARY COUGH HEADACHES

  • TX = _____ 75-150 mg orally may provide relief
A

Indomethacin

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14
Q

NEUROPATHIES ASSOCIATED WITH CRITICAL ILLNESS

  • Treatment is _____
  • Prognosis is good provided patients recover from the underlying critical illness

TOXIC NEUROPATHIES

  • Treatment is by preventing further _____ to the causal agent
  • Isoniazid neuropathy is prevented by pyridoxine supplementation
A

supportive

exposure

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15
Q

OVERALL NEUROPATHY TREATMENT

  • Treatment is of the underlying cause
  • When feasible, __ is done to prevent contractures
  • _____ can maintain a weak extremity in a position of useful function

PROTECT AREAS OF POOR SENSATION

  • Anesthetic extremities must be PROTECTED from injury
  • To guard against _____, patients should check water temperatures and hot surfaces with a portion of the skin having normal sensation
  • Cold water for washing or reduce setting on the hot water heater
  • Shoes should be examined during the day for grit or foreign objects to prevent pressure lesions
  • Patients with polyneuropathies or mononeuritis multiplex are subject to additional nerve injury at pressure points and should avoid such behaviors as leaning on elbows or sitting with crossed legs for lengthy periods
  • The use of frame or cradle to reduce contact with bedclothes may be helpful

MEDS *FR: MEDS USED TO TREAT PERIPHERAL NEUROPATHY

  • Neuropathic, burning pain – may respond to simple analgesics such as _____ or NSAIDs and to gabapentin
  • Painful diabetic neuropathy – duloxetine/_____ or venlafaxine/effexor may be helpful (antidepressants)
  • Episodic stabbing pains – may respond to _____, pregabalin, carbamazepine, or TCAs
  • Opioids may be necessary for severe hyperpathia or pain induced by minimal stimuli but use should be avoided as much as possible

AUTONOMIC DYSFUNCTION
- Postural hypotension helped by wearing waist-high elastic stockings and sleeping in a semi-erect position at night
o _____ reduces postural hypotension but doses as high as 1 mg/day are sometimes necessary for patients with diabetes and may lead to recumbent hypertension
- Midodrine (alpha-agonist) is sometimes helpful
- ED and diarrhea are difficult to treat

A
PT
splints
burns
aspirin
cymbalta
gabapentin
Fludrocortisone
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16
Q

ACUTE BACTERIAL (PURULENT) MENINGITIS

TREATMENT = based on causative agent
- Patient will die if they don’t get abx, start BEFORE work-up is complete
o 18-50 years old: S. pneumo, N. meningitides  _____ + _____ (IV)
o > 50 years old: S. pnuemo, N. meningitides, L. mono, gram – bacilli, group B strep  VANCOMYCIN + CEFTRIAXONE + _____
o IMPAIRED cellular immunity: S. pneumo, L. mono, gram – bacilli  VANCOMYCIN + AMPICILLIN + _____
o Post-surgery or post-trauma: Staph aureus, S. pneumo, aerobic gram - , coagulase neg staph, diptheriodes  VANCOMYCIN + CEFEPIME (referred to as VancoPIME)
- Must make prompt diagnosis and offer immediate treatment
- KEY to abx tx: prompt administration of appropriate abx
o Abx needed early in clinical course
o Bacteria must be sensitive to antibiotic
o Antibiotic must cross BBB and achieve sufficient CSF concentrations to kill bacteria
- If bacterial meningitis is suspected  lumbar puncture becomes emergency procedure
o ↑ ICP is common in bacterial meningitis and there is a rare risk of brain _____ (which might prevent an LP from being done)
o If pt is _____, elderly, presenting with signs of _____, focal neuro signs, or papilledema  get CT first
 All other pts can get LP without CT
- In patients with ↑ ICP  can give IV steroids
o IV steroids: _____ in adults as early as possible
o Only give to pt who has probably has bacterial meningitis (based on clinical and CSF findings), who is immunocompetent, and has no contraindications for steroids

PROPHYLAXIS FOR FAMILY

  • Family has ↑ risk of developing bacterial meningitis
  • If N. meningitidis meningitis  treat all close contacts with _____ or _____
  • If H. influenzae type B meningitis  chemoprophylaxis for kids in close contact that are under 4 with NO Hib vaccine
A
VANCOMYCIN
CEFTRIAXONE
AMPICILLIN
CEFEPIME
herniation
immunocompromised
coma
DEXAMETHASONE
RIFAMPIN
CIPROFLOXACIN
17
Q

VIRAL (ASEPTIC) MENINGITIS

TREATMENT  mostly symptomatic

  • _____ for headaches and antiemetics for vomiting
  • If herpes simplex, CMV, or varicella is identified (these viruses response to antivirals)  use high dose _____ to shorten duration of the meningitis
  • If sure that it is viral (and not bacterial or other)  hospitalization is not necessary, but observation at home is requited
A

Analgesics

antivirals

18
Q

ENCEPHALITIS

  • Generally _____  get fever down, control cerebral edema
  • Give _____ (-cyclovirs) for HSV, varicella, CMV (these viruses respond to antivirals)
A

supportive

antivirals

19
Q

BRAIN ABSCESS

  • Treatment = ___ therapy (IV abx x 6-8 wks) and _____ drainage (aspiration of pus)  surgical drainage is #1!!!
    o As soon as clinical dx is made  give broad spectrum abx
     Abx have to penetrate brain abscesses and brain parenchyma, and control aerobic and anerobic bacteria
    o Surgical aspiration is using CT guided stereotactic technique  culture whatever is aspirated
     Continuous serial CT scans to check for expansion
  • MANNITOL (osmotic diuretic that helps ↓ ICP) or _____ to control ↑ ICP (use carefully)
A

abx
SURGICAL
STEROIDS

20
Q

NEOPLASMS

MENINGIOMA
-_____ resection, good prognosis but they can reoccur

GLIOBLASTOMA MULTIFORME
o Surgical _____  hard to get the whole entire tumor; have to balance between getting tumor and destroying brain tissue (will damage some normal healthy brain tissue)
o Radiation therapy (XRT)
o _____ (oral chemo agent) *know this

A

surgical
debulking
Temozolomide