Neurology 1 Flashcards
simple and complex partial seizures; and secondary generalized
carbamazepine (tegretol)- drug of choice also: topirmate (topramax)- one associated w/ weight loss phenobarbitol lamictal
drugs for tonic clonic
carbazepine (tegretol) used first line or with dilantin(phenetoin)
Lamotrigine (Lamictal) (add on)
Gabapentin (Neurontin) (adjunct)
Phenobarbital
absence seizures
Ethosiximide (Zarontin) – first line
Valproic acid (Valproate, Depakote)
Preferred if patient has concurrent tonic/clonic
Lamotrigine (Lamictal)
myoclonic seizure
Gabapentin (Neurontin)
Lamotrigine (Lamictal)
myoclonic and tonic
Valproic Acid (Valproate, Depakote) Clonazepam (Klonopin)
Levetiracetam (Keppra)
generalized or focal seizures dose 1000-3000 mg qd or bid steady state achieved in 2 days side effects: Somnolence Ataxia Headache Behavioral Changes
Carbamazepine (Tegretol):
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)
phenytoin(dilantin)
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
Valproic Acid (Depakote
increases gaba
WARNING: Life threatening adverse reactions. Hepatotoxicity
Lamotrigine (Lamictal)
250 mg bid
Effective in the treatment of children with newly diagnosed absence seizures.
Gabapentin (Neurontin):
300 -1200 mg po tid
side effects somnolence
Topiramate (Topramax):
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
what drugs need to check lft
valproic acid, carbamazepine or felobamate
status epileticus
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
Atarax (Hydroxyzine
sleep med 10-25 mg qHs Contraindications: Pregnancy Seizure disorder Liver disease Kidney disease Side Effects: tremors, confusion, seizures,
Lunesta (Eszopiclone)
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
Rozerem (Ramelteon)
melatonin agonist
8mg po 30 mins prior to bedtime on empty stomach
yore’s first line sleep med
melatonin
atarax (hydroxyzine)
what does narcolepsy have low levels of
hypocretin
this promotes wakefulness
multiple sleep latency
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.
meds for narcolepsy
modafinil (provigil)-1st line tx
armodafinil (nuvigil)
ritalin
polysomnography
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
hallmark of Alzheimer’s
Amyloid-rich senile plaques
Neurofibrillary tangles
Neuronal degeneration
most common cause of death in alzhemirs
aspiration pneumonia
infected decubital ulceratons
meds for alzhemiers
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)
criteria for vascular dementia
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
picks disease
subtype of frontal temporal dementia
Characterized pathologically by the presence of Pick bodies (silver staining intracytoplasmic inclusions) in the neocortex and hippocampus.
frontaltemporal dementia
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
normal pressure hydrocephalus
wet
wacky
wobbly
can use miller fisher test (gait assessment before and after removal of 30 cc of CSF)
lewy bodies dementia
Characterized by dementia accompanied by delirium, visual hallucinations, and parkinsonism. Other common symptoms include syncope, falls, sleep disorders, and depression.
how to diagnosis lewy body
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.
cjd
Dementia with rapid onset and deterioration
Motor deficits
Seizures
causes of delirium
I WATCH DEATH infections withdrawl acute metabolic trauma cps pathology hypoxia defeciencies endcrinopathies acute vascular toxins or drugs heavy metals
tx of delirium
haloperidol (haldol)
associated w/ torsades de points and qt prolongation so monitor on cardiac monitor
tx of choice for delirium from drug or alcohol withdrawl
benzodiazepine
ct indications
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)ct angio indications
Atherosclerosis Thromboembolism Vascular dissection Aneurysms Vascular Malformations Penetrating trauma Evaluation of carotids
indications for mri
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
cerebral angiography
Cerebral angiography is the gold standard for imaging the carotid arteries and evaluating cerebral aneurysms after subarachnoid hemorrage
etiologies of coma
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
coma breathing patterns
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
Weakness, numbness, tingling or unsteadiness in a limb
lhermittes sign
MS
