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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
Idiopathic Intracranial HTN
1st line --> Wt loss Other: - Acetazolamide - prednisolone - ventricular shunts
26
Acetazolamide Contraindications
Hepatic or Renal failure (since its a diuretic)
27
Trigeminal Neuralgia Tx: - 1st line - 2nd line - other
- 1st line --> Carbamazepine OR Baclofen - 2nd line --> Gabapentin or phenytoin - other --> surgical decompression or ablation
28
Nacrolepsy Mx
- sleep hygiene - lifestyle changes - may require Modafinil
29
DMD Mx
- Physio - Steroids --> prednisolone - Surgery --> to ease contractures - Air stacking --> prevent contracture of lungs - Cardioprotective drugs --> e.g. BBlockers + ACEis
30
Huntington's Disease Mx
1st line --> COUNSELLING (since high suicide risk!!) Tx mental health problems --> e.g. ADs for depression, anxiety Chorea Tx --> Tetrabenzine, anti-psychotics
31
What is the anti-chorea mechanism of Tetrabenzine?
UNKNOWN
32
Parkinson's disease general Mx aims
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
Examples of Dopamine Agonists used in PD Tx
Ropinirole Pramipexole Cabergoline & Bromocriptine
34
Baseline tests before starting Dopamine agonists
CXR, ESR, creatine, echo Because prolonged use causes pulmonary fibrosis
35
Contraindications of carbergoline & bromocriptine
avoid if Hx of OCD/addiction since they increase dopamine --> can cause increased reward response e.g. gambling, hyper sexuality, risk-taking behaviour
36
S/Es of dopamine agonists
Nausea | More likely to cause hallucinations in older pts (than L-dopa)
37
Tx for Nausea caused by dopamine agonists
Domperidone NEVER USE METOCLOPRAMIDE (since it is a dopamine antagonist!!!)
38
Mechanism of action of MAO-B inhibitors
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
Examples of MAO-B inhibitors
Rasagiline | Selegiline
40
Why is L-Dopa given w/ carbidopa?
Carbidopa is a peripheral decarboxylase inhibitor that prevents Levodopa being broken down in the body BEFORE it gets to the brain.
41
S/Es of Levodopa
N+V, somnolence, headache, cardiac arrhythmias, psychosis, postural hypoTN, Dyskinaesia --> due to TOO MUCH dopaminergic effect
42
What is the "ON-OFF effect" of levodopa?
Levodopa becomes less effective over time so try to use symptomatic control first.
43
Mechanism of COMT inhibitors (Entacapone)
Given w/ L-dopa and Carbidopa to slow the breakdown of L-dopa IN the brain by inhibiting COMT enzymes.
44
Symptomatic Tx of tremor in PD (drug-induced PD)
Trihexyphenidyl or procyclidine
45
What must you carry out first to assess type of stroke?
Head CT to differentiate between ischaemic and haemorrhage strokes. - ischaemic shows dark areas of brain
46
1st Line anti-platelet therapy for ischaemic stroke?
Aspirin 300mg given as soon as haemorrhage stroke is ruled out with CT.
47
1st line ischaemic stroke drug Tx (after anti-platelet)
Thrombolysis --> Alteplase
48
When is thrombolysis used to Tx ischaemic stroke?
Within 4.5 hours after ONSET of neurological symptoms
49
CI of thrombolysis
- Patient w/ previous intracranial haemorrhage - uncontrolled HTN - preg
50
When would you use mechanical thrombectomy for ischaemic stroke Mx?
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
2' Prevention of ischaemic stroke
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
What life-long therapy is given as 2' prevention of ischaemic stroke in pt's who CANNOT tolerate clopidogrel?
Life-long aspirin AND dipyridamole
53
Mx for Haemorrhagic Stroke
- Supportive --> stabilise ABCDE - STOP anticoag/antiplatelet therapy - Acutely lower BP
54
Mx of TIA
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
How long is specialist review for TIA in: - High risk pt - lower risk pt
- 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
How long must pt with TIA avoid driving?
ONE MONTH
57
First line Ix for Alzheimer's disease (AD)
MMSE, bedside cognitive testing (ACE III) | - MMSE score < 24 needs further investigation

Dundee Medicine Treatment Summaries (3 decks)

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