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Extra > Neurology 1 > Flashcards

Neurology 1 Flashcards

1
Q

simple and complex partial seizures; and secondary generalized

A 
carbamazepine (tegretol)- drug of choice
also: 
topirmate (topramax)- one associated w/ weight loss
phenobarbitol
lamictal
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2
Q

drugs for tonic clonic

A

carbazepine (tegretol) used first line or with dilantin(phenetoin)
Lamotrigine (Lamictal) (add on)
Gabapentin (Neurontin) (adjunct)
Phenobarbital

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3
Q

absence seizures

A

Ethosiximide (Zarontin) – first line
Valproic acid (Valproate, Depakote)
Preferred if patient has concurrent tonic/clonic
Lamotrigine (Lamictal)

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4
Q

myoclonic seizure

A

Gabapentin (Neurontin)

Lamotrigine (Lamictal)

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5
Q

myoclonic and tonic

A 
Valproic Acid  (Valproate, Depakote)
Clonazepam (Klonopin)
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6
Q

Levetiracetam (Keppra)

A 
generalized or focal seizures
dose 1000-3000 mg qd or bid
steady state achieved in 2 days
side effects: 
Somnolence
Ataxia
Headache
Behavioral Changes
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7
Q

Carbamazepine (Tegretol):

A

inhibits Na channels which inhibits release of NorEpi
800-1200 mg (start at 200 mg bid)
monitor cbc, lft
Warnings: Serious and sometimes fatal dermatologic reactions to include toxic epidermal necrolysis (TEN) and Stevens-Johnson Syndrome (SJS)

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8
Q

phenytoin(dilantin)

A

Alters Na+, K+ and Ca2+ conductance, membrane potentials
300-400 mg
IV dilantin pt must be on cardiac monitor
Warning: Cardiovascular risk associated with rapid infusion
side effects: Gingival hypertrophy, hirsutism, coarsened facial features, megaloblastic anemia

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9
Q

Valproic Acid (Depakote

A

increases gaba

WARNING: Life threatening adverse reactions. Hepatotoxicity

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10
Q

Lamotrigine (Lamictal)

A

250 mg bid

Effective in the treatment of children with newly diagnosed absence seizures.

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11
Q

Gabapentin (Neurontin):

A

300 -1200 mg po tid

side effects somnolence

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12
Q

Topiramate (Topramax):

A

Start at 25 mg/day and then taper up for 6 weeks for up to 400 mg
this is the one that ppl come in for weight loss

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13
Q

what drugs need to check lft

A

valproic acid, carbamazepine or felobamate

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14
Q

status epileticus

A

give thiamine in case of alcoholics
D50W- 25-50 mL in case hypoglycemia
midazolam 2.5 mg IM or 5 mg IV or diazepam 10 mg IV
need to get phenetoin in quick cause those are only short term meds 18-20 mg (need cardiac monitoring for phenytoin)
if seizure continue
Phenobarbital: loading dose of 10-20mg/kg IV by slow or intermittent injection (50mg/min)
Respiratory depression and hypotension common

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15
Q

Atarax (Hydroxyzine

A 
sleep med
10-25 mg qHs
Contraindications:  
Pregnancy
Seizure disorder
Liver disease
Kidney disease
Side Effects:  tremors, confusion, seizures,
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16
Q

Lunesta (Eszopiclone)

A 
Dose:
2-3 mg po immediately before bed
1mg po qhs for elderly
Contraindicated:
Alcohol or CNS depressant use
History of substance abuse
Pregnancy Category C
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17
Q

Rozerem (Ramelteon)

A

melatonin agonist

8mg po 30 mins prior to bedtime on empty stomach

18
Q

yore’s first line sleep med

A

melatonin

atarax (hydroxyzine)

19
Q

what does narcolepsy have low levels of

A

hypocretin

this promotes wakefulness

20
Q

multiple sleep latency

A

sleep disorder diagnostic tool. It is used to measure the time elapsed from the start of a daytime nap period to the first signs of sleep called sleep latency. The test is based on the idea that the sleepier people are, the faster they will fall asleep.

21
Q

meds for narcolepsy

A

modafinil (provigil)-1st line tx
armodafinil (nuvigil)
ritalin

22
Q

polysomnography

A

comprehensive recording of the biophysiological changes that occur during sleep. Includes EEG, eye movements (EOG) muscle activity (EMG) and heart rhythm (ECG), leg movement, tracheal noise, pulse oximetry, end tidal co2

23
Q

hallmark of Alzheimer’s

A

Amyloid-rich senile plaques
Neurofibrillary tangles
Neuronal degeneration

24
Q

most common cause of death in alzhemirs

A

aspiration pneumonia

infected decubital ulceratons

25
Q

meds for alzhemiers

A 
cholinesterase inhibitors
increase levels of Ach
Donepezil (Aricept) 5 mg po at bedtime
Rivastigmine (Exelon)‏ - 4.6mg/24hrs (max 9.5)
Galantamine (Reminyl)
NMDA receptor antagonist (mod to severe)
decreases glutamate
Memantine (Namenda)‏ (5mg po qday)
26
Q

criteria for vascular dementia

A

Cerebrovascular disease evident on history, examination and/or imaging.
Along with:
Onset of dementia within 3 months or (rapid onset)
Abrupt, fluctuating or stepwise progression in dementia

27
Q

picks disease

A

subtype of frontal temporal dementia
Characterized pathologically by the presence of Pick bodies (silver staining intracytoplasmic inclusions) in the neocortex and hippocampus.

28
Q

frontaltemporal dementia

A

personality changes
preservation (say same phrases over and over)
mutuism (inability to speak)
• Insidious onset and gradual progression• Early decline in social/interpersonal conduct• Early impairment in personal conduct• Early loss of insight• Early emotional blunting

29
Q

normal pressure hydrocephalus

A

wet
wacky
wobbly
can use miller fisher test (gait assessment before and after removal of 30 cc of CSF)

30
Q

lewy bodies dementia

A

Characterized by dementia accompanied by delirium, visual hallucinations, and parkinsonism. Other common symptoms include syncope, falls, sleep disorders, and depression.

31
Q

how to diagnosis lewy body

A

The central feature required for a diagnosis of DLB is progressive cognitive decline of sufficient magnitude to interfere with normal social or occupational function.

Two of the following core features are essential for a diagnosis of probable DLB, and one is essential for possible DLB.
Fluctuating cognition with pronounced variations in attention and alertness.
Recurrent visual hallucinations that are typically well formed and detailed.
Spontaneous motor features of parkinsonism.

32
Q

cjd

A

Dementia with rapid onset and deterioration
Motor deficits
Seizures

33
Q

causes of delirium

A 
I WATCH DEATH
infections
withdrawl
acute metabolic
trauma
cps pathology
hypoxia
defeciencies
endcrinopathies
acute vascular
toxins or drugs
heavy metals
34
Q

tx of delirium

A

haloperidol (haldol)

associated w/ torsades de points and qt prolongation so monitor on cardiac monitor

35
Q

tx of choice for delirium from drug or alcohol withdrawl

A

benzodiazepine

36
Q

ct indications

A 
Skull and skull base, vertebrae
     (trauma, bone lesions)
 Ventricles
     (hydrocephalus, shunt placement)
 Intracranial masses, mass effects
     (headache, N/V, visual symptoms, etc.)
 Hemorrhage, ischemia
     (stroke, mental status change)
 Calcification
     (lesion characterization)
37
Q

ct angio indications

A 
Atherosclerosis
Thromboembolism
Vascular dissection
Aneurysms
Vascular Malformations
Penetrating trauma
Evaluation of carotids
38
Q

indications for mri

A 
Subacute and Chronic hemorrages
Cerebral Infarct
Primary and Metastatic Brain Tumors
Intracranial Abcess
Multiple Sclerosis and other Demyelinating Diseases
New onset or refractory seizures
Vasculitis
39
Q

cerebral angiography

A

Cerebral angiography is the gold standard for imaging the carotid arteries and evaluating cerebral aneurysms after subarachnoid hemorrage

40
Q

etiologies of coma

A 
TBI
Hypoxic-ischemic encephalopathy (HIE)
Is generally seen during code when it took to long and eventually heart started but the brain was w/out o2 for too long
Drug overdose
Intracranial hemorrhage
CNS infections
Brain tumors
41
Q

coma breathing patterns

A

Cheyne-stokes: cyclic pattern, hypernea & apnea—seen patients w/ bilateral hemispheric or diencephalic insults
Hyperventilation: injury to pontine or midbrain tegmentum (also seen in ????)
Apneustic breathing: prolonged pause end of inspiration—indicates lesions to mid- and caudal pons
Ataxic breathing: irregular in rate an tidal volume—damage to medulla

42
Q

Weakness, numbness, tingling or unsteadiness in a limb

A

lhermittes sign

MS

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