Neurology Flashcards
Droxidopa MOA/use
droxidopa: for neurogenic orthostatic hypotension in parkinsons
Apomorphine MOA/use
apomorphine: can be used for patients that have rapid/sudden wearing off of PD meds
Difference between dementia and mild cognitive impairment
-dementia: impairment in 2 out of 5 major domain functions and affects daily function!
-functional domains:
Memory
Executive: paying bills, planning
Perception: visuospatial, dressing, appearance
Language
behavior
-mild cognitive impairment: only 1 of the domains is affected and does not significantly impact daily functioning
Diagnostic difference between dementia with lewy bodies and parkinson disease dementia
Dementia with lewy bodies: onset of cognitive impairment within 1 year of motor dysfunction
Cognitive impairment after 1 year of motor dysfunction: parkinson disease dementia
What is the clinical presentation of Charot-Marie-Tooth disease?
numbness, distal extremity weakness, unsteady gait, areflexia, high arches, hammer toes, and atrophy of distal extremity muscles and foreleg muscles (“stork leg” deformity)
What paraneoplastic syndrome is associated with ovarian teratoma?
Anti-NMDA-R encephalitis
Treatment includes removal of the teratoma to eradicate the immune stimulus and immunosuppression with glucocorticoids or intravenous immune globulin.
What is uhthoff phenomenon?
Multiple Sclerosis: a transient worsening of baseline neurologic symptoms in the setting of hot weather, physical exertion, or fever. Any patient with a suspected relapse should be screened for causes of Uhthoff phenomenon masquerading as a relapse (or “pseudorelapse”) to avoid unnecessary treatment.
What is Lhermitte sign?
Shock-like sensation radiating down the spine or limbs with flexion of the neck.
Can happen with MS or with other causes of upper cervical cord lesions
What is Mitoxantrone?
Mitoxantrone: Only FDA approved tx for secondary progressive MS; Don’t use anymore due to cardiac toxicity and leukemia!
What is Ocrelizumab?
Ocrelizumab: only FDA tx for primary progressive MS
*Other MS medications are NOT helpful in progressive forms of MS
What is Dalfampridine? SE/adverse effects?
Improves walking speed, gait in patients with MS
Should not be used in patients with seizure disorder or kidney dysfunction!
What is Pimavanserin?
Pimavanserin is the only FDA med for Parkinson psychosis (BUT only start this once you have tried to stop dopamine receptor agonists like pramipexole, while maintaining patient on levodopa)
What should you monitor for when using carbamazepine?
hyponatremia and agranulocytosis
What are the contraindications to using Donepezil?
Relative contraindications for the use of cholinesterase inhibitors in the treatment of dementia include sick sinus syndrome, left bundle branch block, uncontrolled asthma, angle-closure glaucoma, and ulcer disease.
What is tetrabenazine used for?
Tetrabenazine: can be used for chorea in Huntingtons
What is apomorphine used for?
Used for rapid on/off symptoms in Parkinsons patients
How does Carbidopa work in PD?
Blocks the effects of dopamine outside of the brain, used alongside Levodopa
SE to be concerned with when using interferon beta for MS
Can worsen depression
What should you consider in choosing between glatiramer acetate and interferon beta for first line tx of MS?
Interferon beta can worsen depression
Glatiramer is better for patients with liver dysfunction
SE to be concerned with when using Fingolimod
Fingolimod-used for MS
Major SE: infection, heart block; Need first dose monitoring 2/2 occasional first dose bradycardia; needs regular eye exams due to risk of macular edema
SE to be concerned with when using Dimethyl Fumarate
Dimethyl fumarate-used for MS
SE: Infection risk correlates with prolonged lymphopenia so need to monitor blood counts
What is Teriflunomide used for? SE?
Teriflunomide-used for MS. Need dual birth control! Very teratogenic!
What is Natalizumab used for? SE?
Natalizumab: Used in MS, BUT only used as second line because of risk of PML (reactivation of JC virus)
How is dextromethorphan-quinidine used?
dextromethorphan-quinidine: for pseudobulbar affect in MS
SE of phenytoin
Gingival hypertrophy, peripheral neuropathy, cerebellum atrophy, pancytopenia, osteoporosis, hepatotox
SE of topamax
Nephro Lithuania and acute angle glaucoma, rarely psychosis
SE of keppra
Suicidal ideation and thrombocytopenia (rare)
SE of lacosamide
AV block and atrial fibrillation
SE of perampanel
AED med that can cause homicidal ideation
