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year 3. > neuro tx > Flashcards

neuro tx Flashcards

1
Q

Tx for MND

A

No cure, tx symptoms

  • MND specialist nurses
  • tx comm. needs (speech therapy, voice banking)
  • nutritional tx (dietitian, gastrostomy)
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2
Q

Bulbar dysfunction MND tx

A

Comm aids (AAC)

Nutritional saliva

Gastrostomy

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3
Q

Botulism tx

A
  • antitoxin but only useful if given early before toxin has attacked nerves
  • therefore mainly supportive: Ventilation (otherwise will die)
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4
Q

Myasthenia gravis tx
(Not emergency)

A

1st line: pyridistigmine (long acting anticholinesterase inhibitor)

Long term: high dose prednisolone then Steroid sparing agents- aza/mycophenolate

thymectomy

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5
Q

which antibiotic should be avoided in mysathenia gravis

A

Gentamicin

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6
Q

Guillian barre syndrome tx

A

1st line:Immunoglobulin infusion
2nd: plasma exchange

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7
Q

Ms relapse tx
(mild, moderate and severe)

A

Mild: symptomatic tx

Moderate relapse: high dose oral steroids

Severe relapse: admit for IV steroids (short period)

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8
Q

Ms spasticity tx
(first line and others)

A

baclofen and gabapentin first line
physio (important)

Botox for rare and severe cases

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9
Q

Ms sensory tx

(4)

A

Anti convulsant eg. Gabapentin

Anti depressant eg. Amitriptyline

Tens machine

Acupuncture

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10
Q

Relapsing-Remitting ms tx

A

1st line: tecfidera (oral)/interferon (injectable)

last line: stem cell transplant

1st line- natalizumab on passmed- monocolonal antibody

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11
Q

Acute pharmacological tx for migraines

A

NSAIDS (asp. Naproxen. Ibuprofen) and oral triptan +/- anti-emetic
or
oral triptan + paracetomol +/- anti- emetic

Take as early as poss.
If gastroparesis consider anti-emetic

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12
Q

When is prophylaxis for migraines given.

How long must they be tried fof

A

If >3 attacks a month/very severe

Must trial each for min. 3 months

Consider non pharmacological eg. Acupuncture, relaxation excersizes

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13
Q

prophylaxis for migraines

A

1st line:
- propanolol
Avoid in asthma, PVD, heart failure
or
topiramate (carbonic anhydrase inhibitor) (Na+ channel blocker)
AVOID in women of childbearing age as it may be teratogenic/reduce effectiveness of hormonal contraceptive

2nd:- Amitriptyline (blocks serotonin re-uptake) (causes vasoconstriction)
Se. Dry mouth, postural hypertension

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14
Q

if pharamocoligical prophylaxis migraine mx fails then consider…

A

10 weeks of acupunture

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15
Q

Tension headache tx

A

Relaxation physio

Antidepressant- dothiepin/Amitriptyline
- 3 months Rx

  • reassure
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16
Q

Cluster headache tx

A

High flow o2 for 20 mins

Sub cut sumatriptan 6mg injectable

Acute tx^^^^

long term: verapamil / Steroids- reduce course over 2 weeks

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17
Q

Cluster headache prophylaxis

A

Verapamil

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18
Q

Hemicrania tx

A

Indomethacin (absolutely cured by this, if not then it is a diff diagnosis)

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19
Q

Idiopathic raised intracranial pressure tx

A

Weight loss

Acetozalmide

lumbar puncture used for short term management

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20
Q

Trigeminal neuralgia tx

A

1st line: Carbamazepine,
(other drugs: gabapentin, phenytoin, baclofen)

Surgical (rare): ablation compression , decomrpession

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21
Q

when to refer for tigeminal neuralgia

A

failure to respond to tx/ atypical features:
-sensory changes
- deafness/ear problems
-hx of skin/oral lesions
-pain only in opthalmic division or bilaterally
-fam hx ms
- <40 yrs old

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22
Q

Giant cell arteritis tx

A

High dose steroids

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23
Q

When is acute blood pressure mx indicated for stroke

A
  • Lowering bp (if >185/110) for safe thrombolysis
  • ICH (intracerebral haemorrhage) as to reduce haematoma expansion
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24
Q

Mx of intarcerebral harmorraghe

A

Correct clotting- vit k antagnoist, doac patients consider reversal

Control bp- sbp goal: 130-139 in <1hr & sustain for 7 days

surgical decompression for the well but deteriorating patient

Unless
Gcs<5…
(150-229 tx in <6hrs of symptom onset to achieve)

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25
Q

Primary generalised epilepsy
(same tx as tonic/atonic)
males
females

A

males
1st line: sodium valproate

Females: Lamotrigine

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26
Q

Focal onset epilepsy tx

A

1st line: Levetiracetm or Lamotrigine

2nd: carbamezapine

(same for men and women)

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27
Q

Partial seizures tx (uni)

A

1st: carbamazepine and lamotrigine (Lam takes a while to work)

Then can add on other drugs eg. Gabapentin

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28
Q

When to give epileptic drugs

A

Epilepsy

Seizure with high risk of recurrence

If they want it…

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29
Q

absence seizures tx

A

first: ethosuximide
2nd male: sodium valproate
2nd female: Lamotrigine or levetiracetm

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30
Q

LEMS (Lambert Eaton Myasthenic Syndrome) tx

A

3-4 diaminopyridine

(increases ach, this helps as lems is due to voltage gated calicum channels not working properly= reduced ach= reduced muscle contractions)

31
Q

Emergency tx for myasthenia gravis

A

plasmapharesis and IV immunoglobulins

32
Q

mx of raised ICP

A

sedation: propofol, benzos, barbiturates

maximise venous drainage; head of bed tilt (30 degrees), cervical collars et tube ties

CO2 control- HYPERVENTILATION ( dec CO2= cerebral artery vasoconstriction)

osmotic diuretics; mannitol, hypertonic saline

CSF release

If all the above fails then decompressive craniectomy

33
Q

Myasthenia Gravis tx

A

first: pyridostigimine (long acting acetylcholinesterase inhibitors)
2nd: + prednisolone
3rd: aza etc
4th: thymectomy

34
Q

chronic stroke managemen

A

HALTS

-Hypertension: anti-hypertensive therapy started 2 weeks post stroke
-Antiplatelets: 75mg clopidegrol once daily
-Lipids-lowering: atorvastatin 20mg-80mg once nightly
-Tobacco: stop
Sugar- screen for diabetes

35
Q

what type of stroke patients are offered cardioendarterectomy

A

patients with ipsilateral carotid artery stenosis greater than 50%

36
Q

suspected TIA management and when/what kind of referral

A

aspirin immediately (unless contraindicated) and referred for a specialist within 24 hours unless tia attack was over a week ago in which case refer for within 7 days.

37
Q

when is aspirin contraindicated as TIA management

A

if patient has a bleeding disorder

patient is already taking low dose aspirin

38
Q

following a first seizure when should anti-epileptic drug treatment be commenced

A

following first suspected seizure, must be refferred for specialist review.

anti-epileptic drug tx should not be started before review unless;
-seizure activity on eeg
- presence of a neurological defect
- presence of structural brain abnormality
- pt, parent or carer considers risk of further seizure to be unacceptable

39
Q

what epilepsy patients can be prescribed midazolam

A

pts. with previous episode of prolonged/sewuential generalised seizures

(so they can use midazolam in event of status epilepticus)

40
Q

viral encephalitis tx

A

IV aciclovir

41
Q

essential tremor tx 1st line tx

A

propanolol 1st line

42
Q

ischaemic stroke secondary prevention management

A

clopidogrel 1st line

2nd: aspirin + mr dipyridamole

3rd: dipyridamole

43
Q

management after TIA diagnosed

A

1st line: clopidogrel
-aspirin + dipyridamole should be given to patients who cannot tolerate clopidogrel

  • high intensity statin
44
Q

brain abscess tx

A

craniotomy abscess cavity debrided

IV 3rd-generation cephalosporin + metronidazole

intracranial pressure management: e.g. dexamethasone

45
Q

symptomatic and defintive tx for normal pressure hydrocephalus

A

symptomatic- lumbar puncture

defintive: ventirculo-peritoneal shunt

46
Q

intracranial venous thrombosis tx

A

acutely- low molecular weight heparin

long term- warfarin

47
Q

subdural haemorraghe tx

A

small and asymtomatic- conservative

otherwise-
surgery:
- acute- decompressive craniectomy
-chronic- burr holes to relieve pressure

48
Q

neurpathic pain tx

A

first-line treatment*: amitriptyline, duloxetine, gabapentin or pregabalin
if the first-line drug treatment does not work try one of the other 3 drugs
in contrast to standard analgesics, drugs for neuropathic pain are typically used as monotherapy, i.e. if not working then drugs should be switched, not added

49
Q

juvenile myoclonic epilepsy tx

A

sodium valproate

50
Q

bladder dysfunction Multiple Sclerosis management

A

ultrasound first to assess bladder emptying
if significant residual volume → intermittent self-catheterisation
if no significant residual volume → anticholinergics eg. oxybutnin

51
Q

acute stroke management: who is offered thrombectomy
anterior circulation

A

offer thrombectomy within <24 hours of symptom onset if confirmed occlusion of proximal anterior circulation (CTa/MRA)
AND
if potential to salvage brain tissue (ct showing limited infarct core volume)

offer thrombectomy WITHIN 6 HOURS of symptom onset if confirmed occlusion of proximal anterior circulation on CTA/MRA

for all scenarios do with thrombolysis if within 4./5hours symptom onset

52
Q

posterior circulation and thromebctomy: who should get it?
(4)

A

acute ischaemic stroke <12 hours of onset. confirmed intracranial vertebral/basilar artery occlusion.
NIHSS score is 10 or more,
favourable PC-ASPECTS score and Pons-Midbrain Index

53
Q

acute stoke management: thrombolysis

A

it is administered within 4.5 hours of onset of stroke symptoms and
haemorrhage has been definitively excluded (i.e. Imaging has been performed)

54
Q

how is vasospasm avoided in SAH

A

nimidopine

(vasospasm occurs in SAH patients and causes subsequent ischaemic damage)

55
Q

supportive management of SAG

A

rest etc.
venous thromboembolism prophylaxis
discontinuation of antithrombotics.

56
Q

surgical management of subarachnoid haemorrhage

A

most intracranial anyuersms are treated with a coil, preferably within 24 hours

57
Q

1st line tx for spinal cord compression from malignancy

A

dexamethasone + PPI

58
Q

how does metocolpramide work

A

dopamine antagonist- anti emetic

59
Q

give examples of anti-emetics which are dopamine antagonists

A

metoclopramide, domideperone (does not cross brain barrier), prochlorperazine

60
Q

initial empirical antbiotic tx for bacterial meningitis ages 3 months - 50 years

A

IV cefotaxime

61
Q

initial empirical therapy for bacterial meningitis >50 yrs

A

IV cefotaxime + amoxicillin

62
Q

initial empirical antbiotic tx for bacterial meningitits <3 months old

A

IV cefotaxime + amoxicillin (or ampicillin)

63
Q

meningococcal meninigits antibiotic tx

A

IV benzylpenicillin or cefotaxime (or ceftriaxone)

64
Q

Meningitis caused by Listeria abx tx

A

IV amoxicillin (or ampicillin) + gentamicin

65
Q

mangement of patients for bacterial meningits without indication for delayed lp

A

IV access → take bloods and blood cultures
Lumbar puncture
IV antibiotics- empirical until known cause.
IV dexamethasone

66
Q

immedieate management for GCS less than 8

A

intubate

67
Q

wernickes encephalopathy tx

A

IV pabrinex (thiamine)

68
Q

parkinsons: 1st line tx for improving daily activities

A

levodopa
eg. co-careldopa

69
Q

degenerative cervical myelopathy tx

A

decompressive surgery

70
Q

Ms fatigue tx

A

Amantadine or modanifil

71
Q

Ramsay hunt syndrome tx

A

Prednisolone + aciclovir

72
Q

chronic primary pain tx

A

avoid all analgesia apart from anti-depressants.

73
Q

peritumoural vasogenic oedema tx

A

glucocorticoids eg. dexamthasone

this is given as the oedema can affect neuron transmission. glucorticoids reduce the oedema

74
Q

narcolepsy tx

A

daytime stimulants eg. modanifil and nightime sodium oxybate

year 3. (32 decks)

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