Neurology

Question 1

What drugs are good for generalized motor seizures?

Answer 1

Valproate, Levetiracetam, Lamotrigine, Perampanel

Question 2

What are levetiracetams AEs?

Answer 2

Sedation, Irritability, depression, agitation (keppra crazies)

Question 3

What AC’s have interactions with hormonal contraceptives?

Answer 3

Phenobarbital, phenytoin, carbamazepine, oxcarbazepine, eslicarbazepine, topiramate doses >200 mg/day decrease effectiveness of hormonal contraceptives

Valproate and lamotrigine will have decreased effectiveness due to hormonal contraceptive

Question 4

Which ACs have high teratogenicity?

Answer 4

Valproate, phenobarbital, topiramate (take folic acid supplementation to help with this)

Question 5

What are the easy phenytoin dosage adjustment rules?

Answer 5

<7mg/L increase by 100 mg/day, 7-12 mg/L increase by 50 mg/day, >12 mg/L increase by 30 mg/day or less

Question 6

What treats non motor seizures?

Answer 6

Ethosuximide, Valproate

Question 7

Does zonisamide cause renal stones?

Answer 7

YES

Question 8

Can oxcarbazepine cause hyponatremia?

Answer 8

YES

Question 9

How quickly should alteplase be given?

Answer 9

Within 60 minutes, can be given up to 4.5 hrs. Can use if patient awakens with symptoms.

Question 10

What is alteplase dosing?

Answer 10

0.9mg/kg IV max of 90mg, 10% of dose given as bolus. Remainder infuse over 1 hour.

Question 11

What are alteplase exclusions?

Answer 11

Intracranial or subarachnoid bleeding, other active internal bleeding, surgery, trauma, stroke within 3 months, BP >185/110, if lowered must be stabilized before treatment and maintained 180/105 for 24 hours., AV malformation, aneurysm that’s bad

Question 12

What is the best secondary stroke prevention?

Answer 12

1st 90 days - aspirin and clopidogrel. After 90 aspirin, dipyridamole/aspirin, clopidogrel, cilostazol, warfarin

Question 13

What is CHADSVASc?

Answer 13

CHF, Hypertension, Age > 75 (2), DM, Stroke or TIA, vascular disease, age 65-74, sex category (female). If 1 give oral anticoagulant, aspirin, or no therapy.

Question 14

Can amantadine cause a reddish blue discoloration?

Answer 14

YES, can also help with dyskinesia effects

Question 15

What are the COMT inhibitor side effects?

Answer 15

Diarrhea, Urinary discoloration (entacapone)

Question 16

How to initiate parkinsons therapy?

Answer 16

Doapmine agonist for <65, carbidopa/levodopa for >65, COMT may be helpful for >65 and selective MAOI may help slow disease progression

Question 17

What does apomorphine help with in parkinsons?

Answer 17

On/off phenomenon

Question 18

How to help with wearing off effects in carbidopa/levodopa?

Answer 18

Give doses more frequently, add COMT inhibitor, add dopamine agonist, use controlled release dosage form

Question 19

How to help with on-off phenomenon?

Answer 19

Add COMT inhibitor, selegiline, rasagaline, dopamine agonist, apomorphine, redistribute dietary protein

Question 20

How to reduce dyskinesia?

Answer 20

Reduce dopaminergics, add amantadine

Question 21

How to treat or prophylax tension headaches?

Answer 21

NSADIS, Tylenol. Prophylaxis is tricyclic antidepressants, Botulinum toxin can be helpful

Question 22

How to treat or prophylax cluster headaches?

Answer 22

Oxygen, intranasal lidocaine, triptans. Prophylaxis is emgality, lithium, verapamil, melatonin, subocciptal betamethasone

Question 23

How to treat acute relapse of MS?

Answer 23

IV Methylprednisolone, Oral prednisone, IV adrenocorticotropic hormone.

Question 24

Which MS drug is safe to use during pregnancy and oral?

Answer 24

Dimethyl Fumarate