NEURO 3 Flashcards
MULTIPLE SCLEROSIS
- Recovery from ACUTE RELAPSES
o Mainstay of acute tx = steroids don’t help outcome, they just get better faster
o May be hastened with corticosteroids, but extent of recovery is unchanged
IV is given first, typically _____
Followed by ORAL _____ daily for 1 week with a taper over the next 2-3 weeks
o Long term tx with steroids provides no benefit and does not prevent further relapses
o Transient exacerbations of symptoms relating to intercurrent infection requires no tx
Ex: Sometimes if UTI worsens symptoms, treatment for UTI may help symptoms instead of steroids
o Plasmapheresis is sometimes helpful in patients with severe relapses unresponsive to corticosteroids - Relapse prevention (1st line treatment is one of these)
o _____ (REBIF)
o _____ (ACONEX)
o Interferon Beta 1b (BETASERON, EXTAVIA)
interferon beta = immunomodulating drugs (less side effects, but ↑ risk of infections)
o Glatiramer acetate (COPAXONE) can potentiate depression
- Symptomatic therapy o Well-balanced diet o No smoking o Avoid excess ETOH o Patient education o Fitness program for fatigue o Counseling for depression
SPECIFIC SYMPTOM TREATMENT
Depression
- Take it seriously in this population
- Suicide is a leading cause of death in those with mild to moderate disability
- Many meds for MS exacerbate depression
- Use ____ or low dose _____ (ELAVIL) (TCAs)
o TCA’s cause sedation, dose at night and can be lethal (don’t use in suicidal pts)
Fatigue
- Most common symptom in MS very disabling
- Supervised fitness program, regular rest and sleep
- Can use:
o _____ (SYMMETEREL) – used for Parkinson’s or as an antiviral
o Pemoline (CYCLERT) used for ADHD
o Fluoxetine (PROZAC) antidepressant (SSRI)
Spasticity
- Common symptom that can be worsened by bladder or bowel distention or any infection
- Regular stretching and exercise
- Many meds: start LOW and go SLOW
o _____ (LIORESAL) – used a lot, it’s a muscle relaxant so it makes people tired
o VALIUM – benzo, promotes muscle relaxation, causes fatigue, highly addictive
o KLONOPIN – benzo, promotes muscle relaxation, causes fatigue, highly addictive
o PERIACTIN ¬(antihistamine)
Bladder Dysfunction
- Urgency, frequency, incontinence
- Can be caused by spastic bladder (if urinary residual volume is < 100 mL)
o Spastic bladder (↑ frequency), but don’t have good contraction (urinary retention) can get an UTI PRECIPITATE YOUR MS FR
o Avoid alcohol and caffein (bladder irritants)
- Drink plenty of fluids signals brain so you’re more efficient at getting the pee out
- Pelvic floor strengthening exercise (Kegels exercise)
- Frequent scheduled voiding times during the day
- _____ help with bladder spasticity (DITROPAN)
- Patients with large postvoid residual volumes may need intermittent catheterization
- Evaluate for UTI
METHYLPREDNISOLONE PREDNISONE Interferon Beta 1a Interferon Beta 1b SSRI’s amitriptyline Amantadine Baclofen Anticholinergics
PARKINSONS DISEASE
- Goal: control symptoms and slow progression of disease
- _____
INDICATIONS:
- Often starting point! – low SE profile
- Anti-viral medication
- Helpful for pts with _____ symptoms it helps all clinical features of Parkinsons in a pt with mild symptoms
- **Often used as a first line med in younger pts with mild symptoms who want to “put off” starting Levodopa
- **Can be continued after Levodopa is started and may help with the _____
SE:
- _____, confusion, depression, skin rashes, edema, __ disturbances, and cardiac arrhythmias - _____
INDICATIONS:
- Improves all of the major symptoms of parkinsonism; does not stop progression of disease
- Most effective drug for symptomatic treatment of PD
- 1st choice IF symptoms (esp. bradykinesia) become intrusive or troublesome pts with _____ and NOT MILD symptoms
SE:
- Concern that Levodopa only works for a “number of years” in pts SO if you start it too _____ it may run its course why we start amantadine first in pts with mild symptoms
- Early side effects: __, hypotension, cardiac arrhythmias ¬– tell pts probably going to go away
- Later side effects: – take off drug or lower the dose
restlessness, confusion, _____ (chorea, athetosis, dystonia, tremor, tics, myoclonus)
- _____ phenomenon (see below)
- Contraindications (see below)
3. carbidopa - CARBIDOPA/ LEVODOPA = SINEMET INDICATIONS: - Diminishes extracerebral breakdown of \_\_\_\_\_ SO more reaches the brain, lowers GI side effects
- dopamine agonists - Bromocriptine/Parlodel, Pramipexole/Mirapex, Ropinirole/Requip, Rotigotine, Injectable Amomorphine
INDICATIONS:
- Used as either monotherapy in early PD or in combo with other drugs for treatment of more advanced disease
*usually only monotherapy for a few years
- Might delay need to start _____
*ineffective in patients who show no response to Levodopa
SE:
- Increased risk of _____ control disorders (gambling, shopping, inappropriate sexual activity, etc.) – mania
- _____ (even falling asleep at inappropriate times), somnolence, nausea, edema, dyskinesias, confusion, postural hypotension
- Can develop _____ syndrome - MAO B inhibitors - (-giline):
Selegiline, Rasagiline
INDICATIONS:
- Useful in early PD, but only modest benefit as monotherapy
- Often used in conjunction with _____ (Carbidopa/Levodopa) to potentiate its effects and to modulate fluctuations - COMT Inhibitors
EXAMPLES: Entacapone, with each dose of carbidopa-levodopa
INDICATIONS:
- Often used when _____ prevent the increase of Sinemet, to help potentiate its effects without having to increase the dose - Anticholinergics
EXAMPLES:
Trihexyphenidyl/Artane, Benztropine/Cogentin
INDICATIONS:
- Useful as monotherapy in pts < 70 y/o WITH _____ but no significant bradykinesia or gait disturbance
- Also in pts with advanced disease who have persistent tremor despite treatment with other agents
*Don’t use if no tremor present
SE:
-poorly tolerated in the _____
8. Quetiapine/ Seroquel INDICATIONS: - Atypical antipsychotic - Sometimes added to control \_\_\_\_\_ symptoms or sleep disturbances
amantadine MILD dyskinesias restlessness GI MODERATE early N/V dyskinesias on-off phenomenon Levadopa Levodopa impulse Fatigue dopamine agonist withdrawal Sinemet side effects TREMOR elderly psychotic
BENIGN ESSENTIAL TREMOR
- Often unnecessary
- If required due to disability _____ daily may be helpful (once you withdraw BB, gets worse)
o _____ may be helpful if propranolol is ineffective (patients may be sensitive to it)
o If neither is effective, can try alprazolam, topiramate or gabapentin - Long-term therapy is typical; however, intermittent therapy is sometimes useful in patients whose tremor becomes exacerbated in specific predictable situations
- _____ may reduce tremor but adverse effects of weakness of injected muscle
- High frequency thalamic stimulation on one or both sides according to laterality of symptoms
- Subdural motor cortex stimulation has also been effective in a small trial
propranolol
Primidone
Botox
HUNTINGTONS DISEASE
• Need multidisciplinary team!
• Ambulatory client: goal is maintenance of _____
• Later: patients more susceptible to medical illness
• Need nutritionists, psychotherapists, genetic counselors
• PHARMACOTHERAPY:
o HD with moderately severe chorea, initial treatment with _____ (dopamine blocker)
o If not responsive to tetrabenxine, use atypical neuroleptics (dopamine antagonists)
_____
Risperidone
Aripiprazole
Not clozapine (agranulocytosis)
• PSYCHIATRIC THERAPY:
o Important for patients and their families
o Depression, irritability and mood swings common
o Antidepressants frequently prescribed
o Trazodone: more sedating, helpful for sleep disturbance
o Carbamezepine: for mood swings
o For exam need to know that we would treat their mood disorders. If they’re psychotic, treat with antipsychotic. If they’re depressed, give an antidepressant.
mobility
tetrabenzine
Olanzapine
AMYOTROPHIC LATERAL SCLEROSIS (ALS)
TREATMENT:
• _____ (Rilutek) 50 mg bid: slows progression of dz
o Antiglutamate agent: main side effects: asthenia (weakness), spasticity, increased liver enzymes – need to monitor liver enzymes
• Edavarone infusion
o Free radical scavenger, slows progression in patients with MILD disease
• ADJUNCTIVE THERAPIES:
o _____ for spasticity
o _____ (stretching, bracing, adaptive equipment)
o _____ dysfunction must be evaluated by speech therapist
Sialorrhea (excessive saliva and drooling): caregivers need to be taught suctioning techniques: use scopolamine patch
• COMMUNICATION:
o Intellectual functioning remains intact
o Alternate means of communication (like computers) should be explored
o Specially adapted systems available
o Information about artificial feeding tubes and ventilators need to be discussed before a crisis occurs
• PALLIATIVE CARE:
o To manage symptoms in terminal stage
o _____, diazepam, midazolam, chlorpromazine= relieve dyspnea, anxiety, restlessness
Riluzole Baclofen Physical therapy swallowing Morphine
