Neuro Flashcards
All of the following are contraindications to the use of triptans? Select all that apply
Ischemic heart disease or cerebrovascular disease
Sustained hypertension
Pregnancy
All SSRI’s
Diabetes
Peptic ulcer
Basilar or hemiplegic migraines
Ischemic heart disease or cerebrovascular disease
Sustained hypertension
Pregnancy
Basilar or hemiplegic migraines
All of the following are non-pharmacological treatments of epilepsy EXCEPT ONE, which ONE?
Avoid sleep deprivation.
Minimize the use of alcohol and drugs.
Discuss with the patient and family members precautionary measures to be taken during crises.
Emphasize the importance of observing restrictions on driving vehicles.
Herbal remedies and dietary supplements.
Herbal remedies and dietary supplements.
Anti-epileptic drugs have important drug interactions. Which of the following can cause symptoms including cognitive impairment if taken with anti-epileptic drugs?
valproic acid (Depakene)
topiramate (Topamax)
phenytoin (dilantin)
carbamazepine (Tegretol)
topiramate (Topamax)
In order to prevent headache by over-consumption of pain medication, it is better to limit the monthly use of non-opioid analgesics to:
Less than 15 days
Less than 10 days
Less than 7 days
Less than 20 days
Less than 15d
True or false
Antiviral therapy (acyclovir, famciclovir or valacyclovir) alone provides a significant advantage over placebo in the treatment of Bell palsy?
True
False
False
True or False
Donepezil, rivastigmine and galantamine have different structures and modes of action but appear to have similar efficacy in the treatment of Alzheimer’s.
True
False
True
True or false
In Bell palsy, there is good empirical evidence of pain relief if corticosteroid therapy initiated early.
True
False
True or false
In Bell palsy, there is good empirical evidence of pain relief if corticosteroid therapy initiated early.
True
False
True
True or False
In the treatment of epilepsy, divalproex sodium (Epival) is the most desirable option for women of child-bearing age.
True
False
False
Which of the following are conditions that are contraindications to the use of beta-blockers in migraine prophylaxis? Select all that apply.
Asthma
Type II diabetes
Heart failure
Hypertension
Asthma
Type II diabetes
Heart failure
Which of the following options represent correct prescribing regulations for methyphenidate (Ritalin®)? Select all that apply.
written with repeats
faxed with repeats
verbal with repeats
verbal with no repeats
written with repeats
faxed with repeats
verbal with no repeats
Red Flags of Headaches?
S - Systemic symptoms (fever, stiff neck, weight loss) or secondary risk factors (HIV, CANCER)
N - Neurologic symptoms or signs (speech imp, sensation loss, dec LOC)
O - Onset: abrupt, peak< 1 min (thunderclap)
O - Older: first at age > 50 (giant cell arteries, glaucoma)
P - Previous headache history (new or change - more frequent, more severe, different location)
P - Postural, positional
P - Precipitated by Valsalva, exertion, etc. (sex, workout)
P - Papilledema
What is the Pharm approach for acute migraine?
Triptan &/or NSAID +/- Antiemetic
Triptan/NSAID Combo product - sumatriptan/naproxen sodium (Suvexx) (max 9d/month)
Triptan max use 9days/month
NSAID max use 14d/m
When should migraine prophylaxis be considered?
If >3-6 headache days/month
Meds approach to migraines?
identify triggers on calendar, use Tylenol/advil
Almotriptan indicated for kids >12yrs
Pregnancy safe meds for acute migraines?
Tylenol, Advil (2nd tri only), metoclopramide, caffeine (<200mg/d), last line - sumatriptan (only safe triptan, but generally avoided)
Prophylaxis - propanolol
Absolutely No ergot, topiramate, valproic acid, ACEs/ARBS
Approach to menstrual migraines?
Pre-emptive NSAID (Naproxon 500mg bid), long-acting triptan, estradiol gel starting 2d before menstruation & cont for 6d
Migraine Prophylaxis 1st line
Beta-blockers - propranolol or metoprolol
Amitriptyline - 50-75mg hs
Topiramate - 100mg/day
Candesartan 16mg/day (least response from above)
What herbal options are available for migraines?
Magnesium citrate best evidence and considered 2nd line, otherwise Riboflavin or Co-Q 10
Research not the greatest for Butterbur
Best treatment for tension headaches?
identify stressors, simple analgesics, prophylaxis best: amitriptyline
When do you consider a medication overuse headache?
When there is inc HA freq, inc acute med use, dec efficacy of acute meds
Defined as:
- ≥10 days/month for ergots, triptans, opioids and combination analgesics
- ≥15 days for non-opioid analgesics: acetaminophen and NSAIDs
What is the best preventative agent in pregnancy?
Propanolol
otherwise: magnesium, amitriptyline
Folic acid recommendations for pregnancy when on anti epileptics:
SOGC: 1mg folic acid daily from 3m preconception to 12w gestation then switch to 0.4-1mg
Canadian Headache Society: 4-5mg folic acid for people of childbearing potential age when on valproic acid
When should cholinesterase inhibitors be avoided or discontinued?
Bradycardia (caution when on beta-blockers), syncope, active peptic ulcer disease,
