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Dundee Medicine Treatment Summaries > Neuro Treatments Part 1 > Flashcards

Neuro Treatments Part 1 Flashcards

1
Q

1st line Empirical Tx for bacterial meningitis

A

Ceftriaxone (IV) 2g bd

if PA: Chloramphenicol + vancomycin (IV)

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2
Q

Why is ceftriaxone used instead of penicillin for bacterial meningitis?

A

Ceftriaxone has longer half-life (T1/2)

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3
Q

Which drug is given before the 1st ABx dose as part of empirical Tx of bacterial meningitis?

A

Dexamethasone 10mg QDS

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4
Q

When do you stop giving dexamethasone in bacterial meningitis?

A

Once causative organism is proven to NOT be strep!

since dexamethasone only helps in Tx of strep

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5
Q

Treatment for TB meningitis

A

isoniazid + rifampicin

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6
Q

Treatment for neonatal meningitis (first 4 weeks of life)

A

Benzylpenicillin + Gentamicin

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7
Q

Treatment for viral meningitis

A

Mild –> supportive care.

Severe –> Aciclovir

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8
Q

Tx for encephalitis

A

IV aciclovir

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9
Q

Brain abscess

A

Neurosurgical drainage

ABx

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10
Q

What is used for prophylactic contact tracing in meningitis?

A

Ciprofloxacin (500mg - one time dose)

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11
Q

Contraindication for ciprofloxacin

A

children <12 yo

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12
Q

Acute migraine Tx

A

Triptans
+
NSAIDs, paracetamol, anti-emetics

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13
Q

Contraindications to Triptans

A

IHD, SSRIs, unstable HTN, COCP

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14
Q

Class & S/Es of Triptans

A

Class: 5-HT agonists

S/Es: “Triptan sensations”:

  • tingling
  • heat
  • tightness in throat or chest, heaviness, pressure
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15
Q

Migraine Prophylaxis:

  • 1st line
  • 2nd line
  • others
A

1st line –> propranolol, topiramate

2nd line –> amitriptyline

others –> gabapentin, pizotifen, valproate

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16
Q

Contraindications for BBlockers

A

CI: asthma, heart failure, peripheral vascular disease

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17
Q

Class and S/Es of Topiramate

A

Class = carbonic anhydrase inhibitor (anticonvulsant)

S/Es: wt loss, paraesthesia, impaired consciousness, TERATOGENIC!

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18
Q

Class & S/Es of Amitriptyline

A

Class = TCA

S/Es: dry mouth, postural hypoTN, sedation

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19
Q

How many migraine attacks are required before trialling prophylactic Tx?

A

over 3 attacks per month of extreme severity –> trial prophylaxis for 4 months

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20
Q

Tension Headache Tx

A

Acute –> reassurance + analgesia (paracetamol, NSAIDs (e.g. naproxen))

Chronic –> amitriptyline or dothiepin

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21
Q

Cluster Headaches Tx:

- Acute

A

Acute:

  • high flow 02 via non-rebreathable mask (20mins)
  • add SC Sumatripan
  • steroids –> reducing course over 2 weeks
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22
Q

Cluster Headaches Prophylaxis

A

Verapamil

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23
Q

SUNCT Tx

A

Lamotrigine or Gabapentin

24
Q

Paroxysmal Hemicrania Tx

A

Indomethacin

25
Q

Idiopathic Intracranial HTN

A

1st line –> Wt loss

Other:

  • Acetazolamide
  • prednisolone
  • ventricular shunts
26
Q

Acetazolamide Contraindications

A

Hepatic or Renal failure (since its a diuretic)

27
Q

Trigeminal Neuralgia Tx:

  • 1st line
  • 2nd line
  • other
A
  • 1st line –> Carbamazepine OR Baclofen
  • 2nd line –> Gabapentin or phenytoin
  • other –> surgical decompression or ablation
28
Q

Nacrolepsy Mx

A
  • sleep hygiene
  • lifestyle changes
  • may require Modafinil
29
Q

DMD Mx

A
  • Physio
  • Steroids –> prednisolone
  • Surgery –> to ease contractures
  • Air stacking –> prevent contracture of lungs
  • Cardioprotective drugs –> e.g. BBlockers + ACEis
30
Q

Huntington’s Disease Mx

A

1st line –> COUNSELLING (since high suicide risk!!)

Tx mental health problems –> e.g. ADs for depression, anxiety

Chorea Tx –> Tetrabenzine, anti-psychotics

31
Q

What is the anti-chorea mechanism of Tetrabenzine?

A

UNKNOWN

32
Q

Parkinson’s disease general Mx aims

A

Aim = increase dopamine!
Rules:
- if motor s/s affecting QOL = give Levodopa
- if not affecting QOL yet = give dopamine agonists, MAO-B inhibitors or levodopa

33
Q

Examples of Dopamine Agonists used in PD Tx

A

Ropinirole
Pramipexole
Cabergoline & Bromocriptine

34
Q

Baseline tests before starting Dopamine agonists

A

CXR, ESR, creatine, echo

Because prolonged use causes pulmonary fibrosis

35
Q

Contraindications of carbergoline & bromocriptine

A

avoid if Hx of OCD/addiction since they increase dopamine –> can cause increased reward response e.g. gambling, hyper sexuality, risk-taking behaviour

36
Q

S/Es of dopamine agonists

A

Nausea

More likely to cause hallucinations in older pts (than L-dopa)

37
Q

Tx for Nausea caused by dopamine agonists

A

Domperidone

NEVER USE METOCLOPRAMIDE (since it is a dopamine antagonist!!!)

38
Q

Mechanism of action of MAO-B inhibitors

A

Prevent breakdown of circulating dopamine.

However, only moderately effective, so used as add-on to dopamine agonist or L-dopa in sever PD s/s

39
Q

Examples of MAO-B inhibitors

A

Rasagiline

Selegiline

40
Q

Why is L-Dopa given w/ carbidopa?

A

Carbidopa is a peripheral decarboxylase inhibitor that prevents Levodopa being broken down in the body BEFORE it gets to the brain.

41
Q

S/Es of Levodopa

A

N+V, somnolence, headache, cardiac arrhythmias, psychosis, postural hypoTN,

Dyskinaesia –> due to TOO MUCH dopaminergic effect

42
Q

What is the “ON-OFF effect” of levodopa?

A

Levodopa becomes less effective over time so try to use symptomatic control first.

43
Q

Mechanism of COMT inhibitors (Entacapone)

A

Given w/ L-dopa and Carbidopa to slow the breakdown of L-dopa IN the brain by inhibiting COMT enzymes.

44
Q

Symptomatic Tx of tremor in PD (drug-induced PD)

A

Trihexyphenidyl or procyclidine

45
Q

What must you carry out first to assess type of stroke?

A

Head CT to differentiate between ischaemic and haemorrhage strokes.

  • ischaemic shows dark areas of brain
46
Q

1st Line anti-platelet therapy for ischaemic stroke?

A

Aspirin 300mg given as soon as haemorrhage stroke is ruled out with CT.

47
Q

1st line ischaemic stroke drug Tx (after anti-platelet)

A

Thrombolysis –> Alteplase

48
Q

When is thrombolysis used to Tx ischaemic stroke?

A

Within 4.5 hours after ONSET of neurological symptoms

49
Q

CI of thrombolysis

A
  • Patient w/ previous intracranial haemorrhage
  • uncontrolled HTN
  • preg
50
Q

When would you use mechanical thrombectomy for ischaemic stroke Mx?

A

Pt’s w/ acute ischaemic stroke confirmed as occlusion in proximal anterior circulation (by CT-A or MR-A)

& if potentially salvageable brain tissue

Must be carried out within 6 hours.

51
Q

2’ Prevention of ischaemic stroke

A

if high cholesterol (>3.5) then start statin
–> most Dr’s delay starting until 48hrs after due to risk of haemorrhagic transformation of stroke.

Anti-platelet therapy:

  • -> First 2 weeks = Aspirin (acute)
  • -> After 2 weeks = Life-long clopidogrel
52
Q

What life-long therapy is given as 2’ prevention of ischaemic stroke in pt’s who CANNOT tolerate clopidogrel?

A

Life-long aspirin AND dipyridamole

53
Q

Mx for Haemorrhagic Stroke

A
  • Supportive –> stabilise ABCDE
  • STOP anticoag/antiplatelet therapy
  • Acutely lower BP
54
Q

Mx of TIA

A

GIVE ASPIRIN 300mg IMMEDIATELY!!
- if pt has bleeding disorder or is taking anticoagulants, they need CT to rule out haemorrhagic stroke

+ atherosclerotic factors Mx e.g. lifestyle, statin, HTN control

55
Q

How long is specialist review for TIA in:

  • High risk pt
  • lower risk pt
A
  • High risk (i.e. older pt, HTN, duration of symptoms, crescendo TIAs or had previous TIA within last 7 days) get review within 24 hours
  • Lower risk (i.e. if suspected previous TIA over 7 days ago) then review within 7 days
56
Q

How long must pt with TIA avoid driving?

A

ONE MONTH

57
Q

First line Ix for Alzheimer’s disease (AD)

A

MMSE, bedside cognitive testing (ACE III)

- MMSE score < 24 needs further investigation

Dundee Medicine Treatment Summaries (3 decks)

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