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Dundee Medicine Treatment Summaries > Neuro Treatments Part 2 > Flashcards

Neuro Treatments Part 2 Flashcards

1
Q

1st Line Tx for acute generalised seizures

A

Benzo’s & ABCDE

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2
Q

Prophylactic Tx of generalised seizures

A

(if >2 attacks)

1st line –> Na Valproate

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3
Q

What drug is given instead of Na Valproate if patient is a female of childbearing age?

A

Lamotrigine

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4
Q

Specific Tx for absent seizures

A

Na Valp,

Ethosuximab

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5
Q

Specific Tx for Myoclonic seizures

A

Na Valp,
Levetircepam,
Clonazepam

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6
Q

What drug do you NEVER give to patients with myoclonic seizures?

A

Carbamazepine

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7
Q

Specific Tx for Atonic, Tonic & tonic-clonic seizures

A

Na Valp

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8
Q

How long must a patient NOT drive for following 1st seizure?

A

6 months for Car

5yrs for HGV/PCV

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9
Q

How long must a patient be seizure-free for before they can drive again if they have a Dx of epilepsy?

A

12 months for car (or 3 months if seizures occur during sleep)

10yrs off medication for HGV

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10
Q

1st Line Tx for focal seizures

A

Carbamazepine or Lamotrigine

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11
Q

2nd Line Tx for focal seizures

A

Na Valp

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12
Q

Mx for Status Epilepticus

A

EMERGENCY!!!! –> ABCDE

Tx algorithm:

1) Lorazepam (IV) 0.1mg/kg
- if no response, give 2nd dose after 10 mins
2) Phenytoin (IV)
3) Diazepam infusion
4) Dexamethasone
5) General anaesthesia

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13
Q

S/Es of Na Valproate

A

Nausea –> so take with food

Wt gain, increased appetite, liver failure, pancreatitis, hair loss, oedema, ataxia

TERTATOGENIC
thrombocytopenia,
encephalopathy

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14
Q

Dose of Na Valproate

A

300mg/12h increase by 100mg every 3 days to max of 30mg/kg

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15
Q

S/Es of Lamotrigine

A

Rash –> SJS, TEN

Diplopia, blurred vision, tremor, agitation, N+V

APLASTIC ANAEMIA - bone marrow failure

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16
Q

Dose of Lamotrigine

A

Monotherapy = 25mg/day increase by 50mg every 2 weeks to max 100mg/12hr

1/2 dose if on Na Valp also

x2 dose if on carbamazepine

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17
Q

S/Es of Phenytoin

A

High toxicity –> Nystagmus, diplopia, tremor, ataxia

Depression, acne, gum hypertrophy

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18
Q

CIs of Phenytoin

A

Progesterone contraception

because it is a liver enzyme inducing drug

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19
Q

S/Es of Carbamazepine

A

Leucopenia

Blurred vision, diplopia, balance problems, rash,

20
Q

CIs of Carbamazepine

A

Progesterone contraception

since liver enzyme inducting drug

21
Q

Dose of Carbamazepine

A

100mg/12hr increase by 200mg every 2 weeks to max 1000mg/12hr

22
Q

When/how should you stop AEDs?

A

Consider stopping if seizure free for >2yrs.

Taper off over 2-3 months

23
Q

What kind of diet helps in epilepsy?

A

Ketogenic: high fat low carb & controlled protein

24
Q

Tx for Peripheral neuropathies:

1) Motor
2) Vasculitic
3) Inflammatory

A

1) Tx cause & symptomatic relief
2) pulsed IV prednisolone & cyclophosphamide
3) IV IG, steroids, may need AZA or cyclo

25
Q

Tx for Guillian-Barre Syndrome

A
  • Plasma exchange, plasmapheresis = filters blood to strip out demyelinating substances
  • IV Ig infusion
  • Supportive care = 1/4 its need ventilation & ECG monitoring for arrhythmias
26
Q

Tx for HSMN (Charcot-Marie-Tooth)

A

Goal = maintain movement, muscle strength, flexibility

Supportive - physio, OT, orthosurgery etc.

27
Q

1st Line Tx for LEMS (Lambert-Eaton)

A

3,4-Diaminopyridine (DAP), IV IgG,

28
Q

What is the mechanism of action for 3,4-DAP (used to Tx LEMS)?

A

LEMS is an autoimmune disease attacking Ca channels in pre-synaptic terminal & thus preventing release of ACh….

3,4-Diaminopyridine blocks K-channels -> AP lasts longer and more Ca has chance to enter pre-synaptic terminal => hopefully more ACh can be released into NMJ

29
Q

What regular Ix do patients w/ LEMS need?

A

Regular CXR/CT due to risk of malignancy! (Small cell lung cancer paraneoplastic syndrome)

30
Q

1st Line Tx for Myasthenia Gravis (MG)

A

Pyridostigmine

+ prednisolone for relapses

31
Q

What is the mechanism of action for pyridostigmine?

A

Long-acting cholinesterase inhibitor

32
Q

Other Tx for Myasthenia Gravis (other than pyridostigmine)

A

IV Ig or plasmapheresis

Thymectomy - consider if <50yo and NOT responding to pyridostigmine

33
Q

What needs to be regularly monitored in patients w/ Myasthenia Gravis?

A

Vital capacity –> since usually die from aspiration pneumonia

34
Q

What Antibiotic must be AVOIDED in patients w/ Myasthenia Gravis?

A

Gentamicin

–> can cause “Myasthenia Crisis” leading to resp fail.

35
Q

Mx for Myasthenia Crisis

A

Intubate, high-dose steroids, plasmapheresis & IV Ig

36
Q

1st Line Tx for MND e.g. ALS

A

Riluzone.

NB: can prolong life by ~3 months by delaying onset of ventilation. BUT not all pt’s want this

37
Q

Symptomatic relief for NMD:

  • Resp
  • Muscle spasms/cramps
  • Cant expel mucous
  • Drooling
A
  • Resp –> non-invasive ventilation (BiPAP at night)
  • Muscle spasms/cramps –> Baclofen
  • Can’t expel mucous –> Carbocistein (mucolytic)
  • Drooling –> Anticholinergic
38
Q

What is the mechanism of action of Riluzone?

A

Anti-glutamine action via blocking Na Channels to prevent release of glutamine.

39
Q

Tx for hydrocephalus

A

Ventriculoperitoneal (VP) shunt.

OR

Endoscopic third ventriculostomy (ETV) - used more for non-communicating hydrocephalus

40
Q

CI to VP shunts

A

AVOID if Dx tumour - since the tumour can disseminate into peritoneal cavity via VP shunt

41
Q

Extra-dural haematoma Tx

A

Definitive Tx = Craniotomy + surgical clot evacuation

42
Q

Tx of acute sub-dural haemorrhage

A

small or incidental finding –> conservation observation

OR

Decompressive craniectomy

43
Q

Tx of Chronic sub-dural haemorrhage

A

small or incidental + no neuro deficit = conservative observation (hope it will dissolve itself)

Severe or neuro deficit = Burrhole decompression

44
Q

Tx of SAH

A

Tx according to cause:

  • intracranial aneurysms are at risk of re-bleed so need intervention within 24hrs
    - -> majority = coil insertion
    • -> minority = craniotomy + surgical clipping

GIVE nimodipine (CCB) to decrease risk of vasospasm in cerebral arteries

45
Q

Tx of Cx of SAH

A
  • Re-bleeding = coils or clips
  • Delayed ischaemic neuro defects = Fluids for triple “H” therapy (induced HTN, hypervolemia, haemodilution)
  • Hydrocephalus = usually transient
  • Seizures = give anti-convulsant
  • HypoNa = can affect hypothalamus causing transient “cerebral salt wasting” so give fludrocortisone + Na supplements

NEVER fluid restrict!!

Dundee Medicine Treatment Summaries (3 decks)

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