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Tx > Neurologi > Flashcards

Neurologi Flashcards

1
Q

3B

Meningitis & Ensefalitis

A
  • <3 bulan → Ampi
    Ampisilin 150-200 mg/kgBB
  • > 3 bulan → Ceftri + Dexa
    Ceftriaxon 50-100 mg/kgBB + Dexa 0,15 mg/kgBB
  • Dewasa
    Ceftriaxon 2x2 g + Dexa 0,6 mg/kgBB
  • TB
    OAT Kategori 1 atau 2RHZE+4RH (terbaru 9-12 bulan) + Steroid o/k ekstra paru
  • Fungal
    Ampotericin B 1 mg/kgBB/hari
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2
Q

3B

Malaria Serebral

A
  • Lini 1
    Artesunat 2,4 mg/kgBB IV/IM (jam 0, 12, 24) → setiap 24 jam s/d mampu POArtesunat vial 60 mg + pelarut (Na bikarbonat 5%) = Sodium Artesunat 1 mlSodium Artesunat 1 ml + D5%/NaCl 0,9% 5 ml = 60 mg/6 ml (10 mg/ml)
  • Lini 2
    Artemeter 3,2 mg/kgBB IM
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3
Q

3B

Tx Tetanus

A

Isolasi ruangan gelap

  • Anti Toksin (Awal, kejang (-))
    DT (jumlah hari paling sedikit)
    1. HTIG 3.000-6.000 IU
    2. ATS 50.000-100.000 IU
  • AB (Tepat/eradikasi)
    Metronidazole drip 500 mg 7-10 hari
    Inj. Penicilin G 2,4jt IU/6 jam 7-10 hari
  • Kejang
    Diazepam
  • Cegah kambuh
    TT 0,5 ml IM
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4
Q

3B

Profilaksis Tetanus

A

Luka
TT → 0,5 ml IM
HTIG → 250-500 IU IM
ATS → 1.500-3.000 IU IM

  • Bersih
    • Riw vaksin (+)
      • Lengkap (+) ≥3x
        • > 10 tahun
          TT
        • <10 tahun
          -
      • Lengkap (-) <3x
        TT
    • Riw vaksin (-)
      TT
  • Kotor
    • Riw vaksin (+)
      • Lengkap (+) ≥3x
        • > 5 tahun
          TT
        • <5 tahun
          -
      • Lengkap (-) <3x
        TT
        +
        HTIG/ATS
    • Riw vaksin (-)
      TT
      +
      HTIG/ATS
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5
Q

2

Toxoplasmosis Serebri

A

Rujuk → Pirimetamin + Sulfadiazine

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6
Q

2

Abses Serebri

A

Rujuk → Cephalosproin, metronidazol

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7
Q

4

Tx HIV AIDS Tanpa Komplikasi

A

2 NRTI (Tenofovir, Lamivudin, Zidovudin)
+
1 NNRTI (Evafirenz, Nevirapin)

💡 1. Te La Va
2. La Zi Va
3. Te La N → bumil
Evafirenz → tidak disarankan bumil, WHO bilang aman

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8
Q

4

Profilaksis HIV AIDS

A

Kotrimoksazole 960 mg/hari

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9
Q

3B

Poliomielitis

A

Suportif: Fisioterapi

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10
Q

3A

Rabies

A
  • Awal
    Cuci luka, sabun, povidone iodine, alkohol
  • Tepat
    Vaksin Anti Rabies (VAR) 0,5 cc IM
    → Hari ke-0 2x
    → Hari ke-7 1x
    → Hari ke-21 1x
    Serum Anti Rabies (SAR) 20 IU/kgBB (50% infiltrasi + 50% IM)
    • Risiko rendah
      Luka lecet/epidermis
      Jilatan kulit
      → VAR 0,5 cc IM (4x)
    • Risiko tinggi
      Luka robek → otot
      Luka multipel
      Luka di bagian leher ke atas, genitalia → ujung tubuh
      → VAR + SAR
      VAR 0,5 cc IM (4x) + SAR 20 IU/kgBB (50% infiltrasi + 50% IM)
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11
Q

4

Tension Type Headache (TTH)

A

💡 PAcarnya IBU AMI
PAracetamol
IBUprofen
AMItriptilin

  • Tepat
    NSAID: pct 1000 mg, ibuprofen 400 mg
  • Profilaksis
    Amitriptilin 10-25 mg sebelum tidur
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12
Q

4

Migrain

A
  • Awal/non spesifik
    = Tx Tepat TTH

💡 Denny SUMARGOT
lagi Po A Sa

  • Tepat/Spesifik
    💡 SUMARGOT
    SUMAtriptan
    eRGOTaminSumatriptan mulai 50 mg/hari, maks. 200 mg/hari
    Ergotamin maks. 6 mg/hari
  • Profilaksis
    💡 Po A Sa
    PrOpanolol
    Amitriptiln
    aSam valproatBeta blocker: Propanolol 40-240 mg
    Amitriptilin 10-25 mg
    Asam valproat 250 mg
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13
Q

3A

Neuralgia Trigeminal/Tic Doloreux

A

💡 CAR Mu K
CARbamazepin
aMitriptilin
bloK nervus trigeminus

  • 1st
    Carbamazepine 200 mg/hari (600-1600 mg/hari)
  • 2nd
    Amitriptilin 25 mg/hari
  • Rujuk
    Blok n. trigeminus
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14
Q

3A

Cluster Headache

A
  • Awal/abortif
    Oksigen 100% 8-10L/i 10-15 menit

💡 Denny SUMARGOT
main sama VER A

  • Tepat/Spesifik
    =Migrain
  • Profilkasis
    💡 VER A
    VERapamil
    AmitriptilinVERapamil 160-320 mg
    Amitriptilin 10-25 mg
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15
Q

3B

Transient Ischemic Attack (TIA)

A

Aspilet 80-160 mg → rujuk

Aspilet = asam asetilsalisilat

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16
Q

3B

Stroke Iskemik
= Infark Serebral

A
  • Tepat
    💡 2A
    Ateplase
    Aspirin
    • <3 jam
      RT-PA (ateplase) 0,9 mg/kgBB 10% bolus, 90% infus (60 menit)
      KI: hipoglikemia <50 mg/dL
    • > 3 jam
      Aspirin 325 mg/24-48 jam
  • Anti hipertensi IV
    Jika TD >220/120 mmHg
    Target TD <185/110 mmHg💡 NINI LABIL
    NIcardipin drip 0,5-6 mcg/kgBB/menit → otak, ginjal
    NItroprusid drip 0,5-10 mcg/kgBB/menit
    nitrogliserin 5-200 mcg/menit → jantung, paru
    LABetalol drip 0,5-3 mg/menit
    dIltiazem drip 5-15 mcg/kgBB/menit
17
Q

3B

Stroke Hemoragik
= Hematom Intraserebral, Perdarahan Subarahnoid

A
  • Tepat
    Antihipertensi IV jika TD >180 mmHgTarget ICH <160/90 mmHg
    Target SAH 140-160/90 mmHgMannitol 20% 0,5-1 g/kgBB selama 20 menit, dilanjutkan 4-6 jam berikutnya
  • Definitif
    Kraniotomi
18
Q

3B

Krisis Hipertensi Emergensi: Ensefalopati Hipertensi

A

TD ↓ 2 jam → MAP 25%

  • Tx
    Anti HT IV💡 NI NI LA BIL
    Kecuali target organ jantung → nitroprusidNicardipin/nifedipin
    Nitroprusid/nitrogliserin/ISDN
    Labetalol
    Diltiazem
19
Q

4

Bell’s Palsy

A

Prednison 1 mg/kgBB/hari (max. 60 mg/hari) → dosis penuh selama 5 hari → tap off 10 mg/hari

Virus +
- HSV asiklovir 5x400 mg
- HZ asiklovir 5x800 mg

20
Q

3A

Meniere’s Disease

A
  1. Diuretik
  2. Diazepam
21
Q

4

Benign Paroxysmal Positional Vertigo (BPPV)

A
  • Non farmakologi
    Manuver Epley, Brandt Daroff, Semont
  • Farmakologi
    Betahistin 3x12 mg
22
Q

3A

Demensia

A

💡 2D: Dementia, Donepezil

  • Donepezil (Asetilkolinesterase inhibitor) 1x15 mg
  • Atasi penyakit dasar
23
Q

3A

Parkinson

A
  • Tremor&raquo_space;
    💡 Tremor
    Triheksifenidil
    • Antikolinergik
      THP
    • Agonis Dopamin
      Pramipexole
  • Kekakuan&raquo_space;
    Amantadine
  • Dominasi (-)
    • <60 tahun
      Pramipexole
    • > 60 tahun
      Levodopa
24
Q

3B

Kejang

A
  • Awal
    Kejang: Diazepam 0,3-0,5 mg/kgBB
25
Q

3A

Epilepsi

A

💡 PA CAR ELA Ga nAS
PArsial CARbamazepin
Etosuximide Lamotrigin Asam valproat (Lena)
General ASam valproat

  • Rumatan
    • Parsial
      Carbamazepin 400 mg - 2 g
      Asam valproat 750 mg - 4 g
    • General
      Asam valproat 750 mg - 4 g
      Carbamazepin 400 mg - 2 g
    • Lena
      Etosuximide 500 mg
      Lamotrigin 100-200 mg
      Asam valproat
26
Q

2

Status Epileptikus

A

Diazepam 0,3-0,5 mg/kgBB IV → Fenitoin 15-20 mg/kgBB IV ATAU Fenobarbital 15 mg/kgBB IV→ ICU

27
Q

3B

Trauma Medula Spinalis = Complete Spinal Transection, Acute Medulla Compression

A

Kortikosteroid: Metil Prednisolon

  • <3 jam
    • Awal
      MP 30 mg/kgBB IV bolus selama 15 menit
    • Maintenance
      Infus MP 5,4 mg/kgBB/jam selama 23 jam
  • 3-8 jam
    • Awal
      MP 30 mg/kgBB IV bolus selama 15 menit
    • Maintenance
      Infus MP 5,4 mg/kgBB/jam selama 47 jam
  • > 8 jam
    Tidak dianjurkan
28
Q

3A

HNP

A
  • Non Farmako
    Hindari FR: angkat berat
    Turunkan BB, korset
  • Farmako
    • Awal
      NSAID
    • Tepat
      Analgetik adjuvan: gabapentin, carbamazepin, pregabalin
  • Definitif
    Rujuk → Laminektomi
29
Q

3B

Perdarahan Intrakranial = EDH, SDH

A

Resusitasi ABCDE

Simtomatis (kejang → diazepam 10 mg IV)

Rujuk
→ operatif (kraniotomi)/
→ manitol 20% 0,25-1 g/kgBB selama 20 menit diulang 4-6 jam kemudian (Sediaan 500 mL, 200 g/1000 mL)

30
Q

3B

Fraktur Basis Cranii

A

Rujuk

31
Q

3A

Guillain Barre Syndrome (GBS)

A

Imunoglobulin IV 0,4 g/kgBB/hari 5 hari
Plasma paresis
Steroid

32
Q

3B

Guillain Barre Syndrome (GBS) dengan gagal napas

A

+ Alat bantu napas

33
Q

3A

Miastenia Gravis

A

Asetilkolinesterase inhibitor: rivastigmin, neostigmin, piridostigmin 60-120 mg PO 6x1

34
Q

3B

Krisis Miastenik

A

Gangguan napas → IVIG, plasma paresis, rujuk u/ tymectomy (jika penyebab timoma)

35
Q

3B

Insomnia

A

Early Onset Insomnia: BZP short acting (alprazolam, lorazepam, triazolam, diazepam)

Middle Onset Insomnia: BZP long acting (estazolam, flunazepam)

Late Onset Insomnia: Antidepresan: amitriptilin
BZP long acting

Tx (13 decks)

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