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BCACP > Neurology > Flashcards

Neurology Flashcards

1
Q

How many unprovoked seizures are required to make the diagnosis of epilepsy?

A

2 more than 24 hours apart

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2
Q

When would it be appropriate to consider discontinuing an AED?

A

Seizure free for 2-5 years with a normal EEG while receiving treatment

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3
Q

What black box warnings does carbamazepine carry?

A

-Increased risk of SJS/TEN with HLA-B*1502 allele (screen in patients of Asian and South Asian ancestry)
-Aplastic anemia
-Agranulocytosis

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4
Q

What are concerns with lacosamide therapy?

A

-DRESS
-Prolonged PR interval (ECG recommended for those with underlying proarrhythmic conditions)
-LFT elevations

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5
Q

What black box warnings does lamotrigine carry?

A

-Rash including SJS and TEN (increased risk if given w/ VPA or slow dose titration not followed)

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6
Q

What commonly used medication should not be administered with topramate?

A

Metformin (increased risk of lactic acidosis)

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7
Q

What black box warnings does valproic acid carry?

A

-Fetal risk including neural tube defects, other major malformations, and decreased IQ
-Pancreatitis

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8
Q

Which AEDs are preferred in those with hepatic impairment?

A

-Levetiracetam
-Gabapentin
-Pregabalin
-Topiramate

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9
Q

Which AEDs are preferred in those with renal impairment?

A

-Lamotrigine
-Valproic Acid

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10
Q

Which AEDs can be used for new-onset focal epilepsy?

A

-Lamotrigine (second-line)
-Levetiracetam
-Zonisamide

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11
Q

Which AEDs can be used for new-onset generalized epilepsy?

A

-Lamotrigine (second-line)
-Levetiracetam
-Valproic acid

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12
Q

Which class of medications should be used at home for treatment of seizure clusters?

A

Benzodiazepines
-Oral: clonazepam, diazepam, lorazepam
-Rectal: diazepam
-Nasal: midazolam, diazepam

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13
Q

How should allergic skin reactions due to AEDs be managed?

A

-Discontinue the medication
-Can use antihistamine or high-potency topical steroids for symptomatic relief of pruritus

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14
Q

What is the triad consistent with DRESS?

A

-Rash
-Fever
-Internal organ involvement

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15
Q

How should DRESS due to AEDs be managed?

A

-Discontinue the medication
-Oral corticosteroids for 2-3 months

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16
Q

Which AEDs can cause DRESS?

A

-Phenytoin
-Phenobarbital
-Carbamazepine
-Lamotrigine

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17
Q

What are the AEDs of choice during pregnancy?

A

-Levetiracetam
-Lamotrigine

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18
Q

What AEDs are enzyme inducers?

A

-Phenobarbital
-Phenytoin
-Carbamazepine
-Oxcarbazepine (at higher doses)

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19
Q

What is the definition of chronic migraine?

A

Headache either migraine-like or tension-like on 15+ days per month for more than 3 months, with the features of migraine headache on at least 8 days per month

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20
Q

What is first-line acute treatment for cluster headaches?

A

Triptans
-Sumatriptan nasal spray or injection
-Zolmitriptan nasal spray

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21
Q

What is first-line preventative treatment for cluster headaches?

A

Verapamil (high-doses - 360-960 mg/day)

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22
Q

What is second-line preventative treatment for cluster headaches?

A

Lithium (target level 0.4-0.8)

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23
Q

What is first-line acute treatment for tension-like headaches?

A

-APAP
-NSAIDs (naproxen, ibuprofen)
-Combination analgesics with/without caffeine

24
Q

What are preventative treatment options for tension-like headaches?

A

-Amitriptyline
-Mirtazapine
-Tizanidine
-Botox (refractory cases)

25
Q

What is recommended abortive/acute treatment of mild-to-moderate episodic migraines?

A

OTC analgesics

26
Q

What is recommended abortive/acute treatment of moderate-to-severe episodic migraines?

A

-Triptans
-Ergotamines
-Antiemetics
-Ditans
-Gepants

27
Q

What are contraindications to triptans?

A

-Uncontrolled HTN
-CAD
-PVD
-Stroke

28
Q

Which antiemetics are preferred for treatment of episodic migraines?

A

-Metoclopramide
-Prochlorperazine
-Promethazine

29
Q

What two gepants are approved for acute episodic migraine treatment?

A

-Ubrogepant
-Rimegepant

30
Q

Which patients may benefit from gepant therapy?

A

Those at high cardiovascular risk or with a history of CV/cerebrovascular event

31
Q

Which triptans have the fastest onset of action?

A

-Sumatriptan (nasal & SQ available)
-Almotriptan
-Rizatriptan (ODT available)
-Eletriptan
-Zolmitriptan (nasal available)

32
Q

What gepants are approved for migraine prevention?

A

-Rimegepant
-Atogepant

33
Q

What CGRP mAbs are approved for migraine prevention?

A

-Erenumab
-Fremanezsumab
-Galcanezumab
-Eptinezumab

34
Q

When should a CGRP mAb be consider for migraine prevention?

A

Inadequate response or inability to tolerate (due to side effects) at least two oral migraine preventative drugs

35
Q

What are some Level A medications used for migraine prevention?

A

-Metoprolol
-Propranolol
-Topiramate
-Valproic acid
-Botox
-Gepants

36
Q

What enzyme modification can effect the metabolism of certain opioids?

A

CYP2D6 polymorphism

37
Q

What are first-line treatment options for painful peripheral neuropathies?

A

-Duloxetine
-Venlafaxine
-Gabapentin
-Pregabalin
-Amitriptyline/Nortriptyline

38
Q

What are second-line treatment options for painful peripheral neuropathies?

A

-Carbamazepine

39
Q

What are third- and fourth-line treatment options for painful peripheral neuropathies?

A

-SSRIs (citalopram, paroxetine, escitalopram)
-Lamotrigine
-Opioids
-Lacosmide
-Milnacipran
-Oxcarbazepine
-Topiramate
-Valproic acid
-Tramadol

40
Q

What is a counseling point for levodopa-carbidopa?

A

Avoid taking with high-protein meals (can delay absorption)

41
Q

Which Parkinson’s medication should not be used as monotherapy?

A

Entacapone (COMT inhibitor) - must be used with levodopa

42
Q

Which medications can be added to levodopa if symptoms are not well-controlled on monotherapy?

A

-MAO-B inhibitor (selegiline, rasagiline)

-COMT inhibitor (entacapone, opicapone)

-Dopamine agonist (pramipexole, ropinirole)

*consider decreasing levodopa dose when another agent is added

43
Q

What is a long-term concern with levodopa?

A

Movement disorder/dyskinesias

44
Q

Which medications can be used for treatment of hallucinations in patients with Parkinson’s?

A

-Clozapine
-Quetiapine
-Pimavanserin

45
Q

Which class of medications is recommended to be initiated early of Alzheimer’s diagnosis?

A

Cholinesterase inhibitors
-Donepezil
-Rivastigmine
-Galantamine

46
Q

What is memantine’s place in therapy for Alzheimer’s?

A

-Add-on to cholinesterase inhibitor when patient’s condition progresses to moderate disease or continues to decline
-Monotherapy for those who cannot tolerate cholinesterase inhibitors

47
Q

What medications are recommended for treatment of essential tremor?

A

-Propranolol
-Primidone

48
Q

Why is carbamazepine typically initiated at a low dose?

A

Reduce incidence of dizziness

49
Q

Which triptans have the longest half-life?

A

-Frovatriptan (26 hours)
-Naratriptan (6 hours)

50
Q

Which triptan is not metabolized by MAO?

A

Eletriptan

51
Q

What co-morbid condition may warrant avoiding interferon B therapy?

A

Untreated depression

52
Q

Which AED is not eliminated through the kidneys?

A

Lamotrigine (metabolized through glucuronidation)

53
Q

Which AED is not metabolized through the liver?

A

Levetiracetam

54
Q

Which triptan has the fastest onset of action?

A

SubQ Sumatriptan

55
Q

What is a class side effect of cholinesterase inhibitors (i.e. donepezil, rivastigmine, galantamine)?

A

Bradycardia and syncope

56
Q

What medications are recommended as second-line treatment for essential tremors?

A

-Gabapentin (“probably effective”)
-Nimodipine (“possibly effective”)

BCACP (20 decks)

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