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PEBC > Neurology > Flashcards

Neurology Flashcards

1
Q

what dose suboxone must one be on for sublocade?- the SQ injection- for how long?

A

8-24mg for at least 7d

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2
Q

what dose of buprenorphine must one be on to use probuphine (the subdermal implant)?

A

=<8mg/d

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3
Q

how should methadoen be administered

A

10mg methadone/mL diluted to make a 100mL solution in orange drink

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4
Q

which has a max dose? methadone or buprenorphine

A

buprenorphine

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5
Q

which has higher tx retention? methadone or buprenorphine

A

methadone

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6
Q

if a methadone pt misses 3d of tx, what should be done?

A

contact MD (always even if <3d)
MD will decrease dose by 50%

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7
Q

what should be done if a methadone pt misses 4 or more days of their methadone?

A

contact MD (always)
restart at low initial dose ~30mg

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8
Q

what happens if methadone pt vomits dose

A

offer no more than 50% replacement only if vomited within 15 min and witnessed

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9
Q

when should a naloxone dose be repeated

A

3min

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10
Q

acamprosate is preferred for patients with ____ insufficiency

A

hepatic

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11
Q

how long do you hve to be abstinent from alcohol before starting acamprosate

A

14d

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12
Q

How long do you have to be abstinent from alcohol and opioids before starting naltrexone

A

alcohol = can start while still drinking
opioids = 7d

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13
Q

how long do you have to be abstinent from alcohol before starting disulfiram

A

48hrs

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14
Q

what are some complications of AUD

A

thiamine (B1) deficiency
low electrolytes
liver disease
wernicke’s encephalopathy

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15
Q

what should be nutritionally supplemented in all alcoholics

A

B1, glucose w/ B1, multivitamins

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16
Q

what is 1st line tx for alcohol w/d

A

BZDs

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17
Q

which BZDs are more preferred for elderly w/ AWS

A

lorazepam or oxazepam -intermediate acting BZDs

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18
Q

if the response to BZDs for AWD is not adequate, what can be added

A

phenobarbital

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19
Q

in short acting opioids, w/d starts in

A

8-24h

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20
Q

what are the long acting BZDs

A

diazepam
chlordiazepoxide
flurazepam

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21
Q

what are the short acting BZDs

A

ATM-alprazolam, triazolam, midazolam

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22
Q

in those on prolonged BZDs tx, taper should be over

A

6-12wks

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23
Q

T or F: there is currently no approved meds for CNS stimulant withdrawal

A

T- may use methylphenidate as maintenance

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24
Q

what is the pharm tx rec for chronic fatigue sx

A

supplementation
short trial of sedating AH or low dose hypnotics

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25
Q

what is a common condition w/ restless leg syndrome

A

iron deficiency

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26
Q

what is used to tx intermittent RLS

A

levodopa preps - carbidopa/ levodopa
BZDs
low potency opioids

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27
Q

what is used to tx chronic persistent RLS

A

GABA derivatives (gabapentin, pregabalin)
nonergot dopamine agonists (pramiprzole, ropinirole, rotigotine)

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28
Q

what may be used for severe refractory RLS in pregnant pts

A

opioids, BZDs, levodopa/ carbidopa (same as intermittent in normal pt)

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29
Q

THC is a _______ at CB1 and CB2

A

partial agonist = releases dopamine

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30
Q

CB2 is found ______ aand ____ and is involved in______

A

throughout immune system and blood cells
involved in immune and inflammatory functions

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31
Q

when does smoking/ vaporising cannabis onset

A

30s-5min

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32
Q

adults can possess or share ___g legal cannabis aand own up to ___ plants

A

30g
4 plants

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33
Q

1g dried cannabis = ___g fresh

A

5

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34
Q

avoid driving for __hrs after eating cannabis, ___ hsr after smoking

A

8hrs PO, 6hrs INH

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35
Q

what are the 4 conditions cannabis may be used for

A

neuropathic pain
MS spasticity
CINV
palliative cancer pain

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36
Q

how many neuropathic pain drugs or palliative cancer pain drugs must the pt have tried before cannabis

A

3 neuropathic
2 cancer

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37
Q

what is the suggested starting dose for cannabis

A

0.5g/d

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38
Q

1mg nabilone = ___mg THC

A

10mg

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39
Q

which approved cannabis product in Canada is metabolized by CYP enzymes

A

nabiximols spray

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40
Q

nabilone is approved for

A

severe N/V from cancer chemo

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41
Q

migraines have at least 2 of:

A

nausea, light sensitivity, itnerference w/ activities

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42
Q

MOA can occur with ____ d of simple analgesics or _____ days of opioids/ triptans

A

15d of simple analgesics
10d of opioids/ triptans

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43
Q

COC with ___ E content may precipitate migraines, ____ E may decrease the frequency

A

higher E = precipitate
lower E = decrease

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44
Q

what is the algorithm for acute migraines

A

if causing bed rest = triptans first, then may add NSAIDs
then may trial DHE +/- antiemetic and CGRP inhibitors

if not causing bed rest = simple analgesics with triptans as rescue prn

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45
Q

what is the onset of triptans

A

30-60min

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46
Q

should you ever repeat a triptan dose

A

you can after 2hrs, but 2nd dose is unlikely to be helpful if first didn’t provide relief within 2hrs

never mix 2 triptan types within 24hrs

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47
Q

which triptans come as an oral wafer

A

riza and zolmi

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48
Q

triptans are CI in pts with:

A

heart disease, cardiac sx, within 24hrs of another triptan, pregnancy

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49
Q

how many types of triptans should you trial

A

3

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50
Q

which triptan has a clear dose-response relationship

A

sumatriptan

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51
Q

which triptan has the slowest onset but the least AEs

A

naratriptan

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52
Q

which triptan should be used with caution in those taking proptanolol and avoided with MAOis

A

frovatriptan and rizatriptan

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53
Q

which triptan is CI within 72hrs of a potent CYP3A4 inhibitor

A

eletriptan

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54
Q

CGRP injections are used for _________, while PO are used for __________

A

inj = prevention
oral = treatment

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55
Q

when should migraine prophylaxis be considered

A

if migraines are having a significant impact on QoL despite appropriate abortive tx

risk fo MOH

=>4x/mth

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56
Q

how long should migraine prophylaxis be for? how long for benefit?

A

2mths for benetif
prophylax for 6-12mths

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57
Q

what is considered successful migraine prophylaxis

A

decrease in at least 50% frequency of days

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58
Q

what is preferred migraine prophylaxis in pts w/ comorbid mood disorder

A

TCAs (amitriptyline, nortriptyline), venlafaxine

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59
Q

what is preferred migraine prophylaxis in pts w/ comorbid HPTN

A

BB (propranolol)
candesartan
verapamil (best for cluster)

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60
Q

waht is 1st line for TTH prophylaxis

A

amitrpytline, nortrityline

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61
Q

what is prophylaxis for pregnancy/ BF Hs

A

propranolol

62
Q

which triptan is ok in breastfeeding

A

sumatriptan

63
Q

which seizure types have impaired consciousness (5)

A

complex partial seizures
secondary generalized tonic/ clonic
absence
generalized tonic/clonic
atonic

64
Q

what are 7 1st line tx for focal seizures

A

LTG, LEV, LAC, LTG, BRI, OXC, CBZ

(LLLV Boc (LV box))

65
Q

what is 1st line tx for absence seizures

A

ETHO

66
Q

what is 1st line tx for generalized tonic clonic

A

VPA, LEV, LTG

67
Q

what is 1st line for atonic seizures

A

VPA

68
Q

what is 1st line for myoclonic seizures

A

VPA, LEV

69
Q

which AEDs are enzyme inducers

A

CBZ, eslicarbazepine, oxazepine, PHT, PB, PHT, PRM, rufinamide, topiramate, clobazem

70
Q

which contraceptive methods are not affected by enzyme inducing AEDs

A

barrier, IUD, depot progesterone

71
Q

which AED most likely to cause CNS and GI dose dependent effects

A

CBZ, LTM, PRN, TOP, VPA

72
Q

which AED most likely to cause skin rash

A

LTG, CBZ, PHT

73
Q

what to do if AED causes skin rash in 1st 6wks

A

stop and use one that is not LTG, CBZ, PHT

74
Q

which AED causes neutropenia, which causes thrombocytopenia?

A

CBZ = neutropenia
VPA = thrombocytopenia

75
Q

which ED levels decrease in preg

A

TOLLL
topiramate, oxazepam, LAV, LEV, LTG

76
Q

____ levels can drop =>50% in pregnancy during 2nd and 3rd trim = 100% dose increase and back to normal dose immed after delivery

A

LTG

77
Q

pts on AEDs trying to conceive should take

A

1mg folic acid from preconception until end of 1st trimester
then 0.4mg/d to prevent neural tube defects

78
Q

___________ is metabolized into ________
primidone or phenobarb

A

primidone is metabolized to phenobarb

79
Q

what is clobazem typiclaly used for in seizures

A

add on for pts who are nearly seizure free due to broad spectrum + fast onset

80
Q

what is a AE limiting vigabatrin’s use

A

permanent vision loss

81
Q

wha tis a chronic AE of ETHO

A

behavioural problems

82
Q

LEV should be avoided in pts w/ a history of ______

A

psychosis

83
Q

which ED is associated with SJS and requires very slow titration

A

LTG

84
Q

what should be done with LTG after a COC is started

A

2x LTG dose

85
Q

which AED is associated with word finding difficulties

A

topiramate

86
Q

aim to reduce/ eliminate seizures within ___

A

1-4wks

87
Q

when may AED be stopped (typically life long)

A

seizure free for 2-4yrs or complete control within 1yr
onset between 2-35yrs
normal neuro exam and ECG

88
Q

which ED requires HLA testing to decrease risk of rash

A

CBZ

89
Q

which AED causes hyponatremia and induces its own metabolism

A

CBZ

90
Q

Topiramate effect on weight

A

weight loss

91
Q

VPA/DVP is ___toxic

A

hepatotoxic

92
Q

which NSAIDs should be used if GI risk is high

A

celecoxib + PPI

93
Q

which NSAIDs should be used if CV risk is high

A

naproxen + PPI

94
Q

what meds are 1st like for neuropathic pain

A

TCAs, gabepentin/ pregabalin, duloxetine

95
Q

duloxetine is 1st line for which kinds of pain

A

peripheral diabetic neuropathy, fibromyalgia

96
Q

morphine should be avoided in CrCL <

A

60

97
Q

which opioids should be avoided in CKD

A

morphine, codeine, meperidine

98
Q

which opioids are good for CKD

A

hydromorphone, methadone

99
Q

a fentanyl patch should be placed every ____ days

A

3

100
Q

how often should methadone be titrated

A

q3-7d

101
Q

in opioid management, how much of a decrease in pain intensity indicates efficacious tx

A

decrease by 30%

102
Q

how to dose breakthrough pain doses?
when would you increase the TDD instead of adding more breakthrough doses?

A

10-20% of TDD q1-2hrs if injection, q3-4h if PO

increase schedule doses if pt is using >4-6x/d

103
Q

how to switch opioids

A

incomplete cross tolerance = decrease dose by 25-50%

decrease dose by 50% if MEQ >90mg

104
Q

what is the conversion from codeine to morphine

A

x0.15

105
Q

what is the conversion from oxycodone, or hydromorphone to morphine

A

oxycodone = x1.5
hydromorphone = x5

106
Q

what MS drug is used for PPMS

A

ocrclizumab

107
Q

what deficiency may mimic sx of MS

A

vit B12 deficiency

108
Q

MS sx may be worsened by

A

extremes of temperature

109
Q

when should a MS pt switch to antoher DMT agent

A

if =>2 relapses after 6-12mths of tx with a DMT

110
Q

how long do DMTs take to show benefit

A

2-6mths

111
Q

siponimod is used for __________ to delay progression of physical disability

A

SPMS

112
Q

what are the 1st line DMTs

A

T-DIG
teriflunomide, dimethyl fumerate, interferon beta, glatiramer acetate

113
Q

what is standard 1st line tx for MS

A

interferon beta

114
Q

how long for interferon beta to take effect

A

3mths

115
Q

glatiramer acetate takes ____ months for effect

A

6

116
Q

what to monitor when using dimethyl fumerate

A

CBC, liver fxn, urinalysis

117
Q

which of the following should concomitant live vaccines be avoided:
1. interferon beta
2 .glatiramer acetate
3. dimethyl fumerate
4. all of the above

A

3

118
Q

teriflunomide has teratogenic effects that may alst up to

A

2yrs after d/c

119
Q

how long for teriflunomide to take effect

A

3mths

120
Q

in those who become pregnant while on teriflunomide, what should be done

A

washout with cholestyramine

121
Q

fampridine is used in MS to

A

improve walking ability

122
Q

how long does fampridine take to improve walking ability

A

4wks

123
Q

what may be given in acute relapse of MS

A

methylprednisolone for 3-5d then PO prednisone to decrease length and severity of relapse

124
Q

what supplementation should be given to all MS pts

A

vit D (min 1000 IU/d)

125
Q

fingolimod is for

A

very active MS disease

126
Q

natalizumab is for

A

very active RRMS

127
Q

how long to try a DMT before switching

A

6-12 mths

128
Q

which DMT is most likely to increase QTc

A

fingolimod

129
Q

____ (gender) are more likely to get MS and ____ (gender) are more likely to get PD

A

F = MS
M = PD

130
Q

waht are the 4 sx of PD

A

TRAP
tremor, rigidity, akinesia/ bradykinesia, postural instability

131
Q

T or F: there is no drug that helps with freezing in PD

A

T

132
Q

what is a differentiating factor for drug induced PD vs actual PD

A

drug induced = bilateral and symmetrical

does not or poorely response to L-dopa

133
Q

when to start tx for PD

A

when disease starts interfering with QoL

134
Q

which tx to choose in mild/ early PD

A

dopamine percursor + dopa decarboxylase inhibitor
MAOBi (in mild)
dopamine agonist

135
Q

which MAOBi has an amphetamine metabolite

A

selegiline

136
Q

which MAOBi has lowered bioavailability w/ high fat meals

A

rasagiline

137
Q

anticholinergics are used in PD to

A

decrease tremor

138
Q

amantadine is a

A

NMDA antagonist

139
Q

what is amantadine used for

A

used in later stages of PD to reduce L-dopa induced dyskinesias

140
Q

livedo reticularis is an AE of which PD drug

A

amantadine

141
Q

pramipexole, ropinirole, rotigotine are all

A

nonergot dopamine agonists

142
Q

dopamine agonists are not recommended in

A

> 70yrs, hx compulsive behaviours

143
Q

which dopamine agonist causes pulmonary fibrosis

A

bromocriptine

144
Q

levodopa in DP must be (select all that apply)
1. in combo with MAO-Bi to cross BBB
2. in combo with peripheral decarboxylase inhibitor to cross BBB
3. initial tx for >70yrs
4. taken separately from protein meals
5. given as CR dose for freezing

A

2, 3, 4

145
Q

what is the purpose of entacapone

A

a COMTi to extend L-dopa duration to manage wearing off

146
Q

which PD drug has AE of orange urine discoloration

A

entacapone

147
Q

what is used for severe “off” periods in PD

A

apomorphine

148
Q

how to manage end of dose wearing off for PD levodopa

A

increase levodopa dose or frequency
+ DA or COMTi
bedtime admin of levodopa CR or dopamine agonists
change to levodopa CR

MAOBi to reduce fof time

149
Q

how to reduce peak dose dyskinesias in PD

A

decrease dose of levo and increase frequency or + dopamine agonist
stop MAO-Bi
decrease dose and + COMTi
add amantadine

150
Q

which N/V drug may be used in PDs

A

domperidone

151
Q

what is the order to stop PD drugs in drug induced psychosis

A

anticholinergics, TCAs, AH, Anxiolytics, sedatives

Amantadine

DA

COMTi, MAOBi

L-dopa

152
Q

which antipsychotics may be used in DP

A

quetiapine, clozapine

PEBC (9 decks)

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