Neurology Flashcards
Name the restrictions in using felbamate
Hepatotoxicity and aplastic anemia, need patient consent
Describe the DDI between lamotrogine and valproic acid
VPA decreases lamotrigine metabolism
Name adverse effects found more often in oxcarbazepine than carbamazepine
Hyponatremia, however blood discrasias are less common (but more common in CBZ)
Name seizure medications that can increase phenobarb concentrations
Oxcarbazepine
Phenytoin
VPA
Name seizure medications that can increase PHY concentrations
Oxcarbazepine, Phenobarbital, Topiramate
Name which drugs can increase CBZ concentrations
Cimetidine, diltiazem, verapamil, erythromycin, isoniazid, theophylline
Name medications that can decrease valproic acid serum concentrations
OCs, meropenem, rifampin
What seizure medications should be avoided in pregnancy?
VPA, PHY, CBZ, lamotrigine, phenobarbital
What is the blood pressure requirement for tpa?
< 185/110
How must you separate direct thrombin inhibitors or direct factor Xa inhibitors from tpa?
48 hours
For those uneligible for tpa, what is the next line in therapy for ischemic stroke patients?
Aspirin 325 mg within 48 hours of stroke onset and 81 mg maintenance dose
Besides antiplatelet therapy, what are medications should be used for secondary prevention of ischemic stroke?
Hypertensive meds, goal < 140/90 mmHg
High intensity statin in patients < 75 yo with stroke or TIA
What medication combination is contraindicated with apomorphine?
Ondansetron, granisetron, palonosetron due to profound hypotension; sulfite sensitivity
How can you treat dyskinesias caused by parkinson meds?
Decrease the carbidopa/levodopa dose, removing selegiline and dopamien agonists or add amantidine
What are methods to combat on-off syndrome of parkinson meds?
Decrease frequency of levo/carbidopa, use apomorphine
Which tripans offer non-oral routes to combat vomiting?
sumatriptan and zolmitriptan
What are significant contraindications of triptan AND ergot use?
CAD, stroke, uncontrolled hypertension, PAD, ischemic bowel dx, pregnancy
How would your ppx for a tension HA?
TCA, botulinum toxin
Acute tx: APAP/NSAIDs
What ppx would you use for cluster HAs?
Verapamil, melatonin, lithium
What triptan agents can you use for cluster HA acute treatment?
Sumatriptan (SQ, intranasal) and zolmitripan (intranasal)
What infections should be screened and vaccinated for before using alemtuzumab?
Herpes zoster and TB
*Avoid all live virus vaccines
Name contraindication for fingolimod
MI, unstable angina, stroke, TIAs, decompensated HF, Mobitz type 2 second or third degree block, baseline atc > 500 msec, Class Ia or III antiarrhythmic drugs
What are some necessary monitoring parameters for fingolimod?
Bradycardia for 6 months, decrease in lymphocytes, macular edema
What are the risk factors that increase your risk of developing progressive multifocal leukoencephalopathy while in natalizumab?
AntiJCV ab, longer treatment duration (> 2 years), previous treatment with an immunosuppressant
What are ways to eliminate teriflunomide faster?
Cholestyramine, activated charcoal powder
What are medications that can treat spascity?
Baclofen, tizanidine
What agents can treat fatigue from MS?
Amantidine, methyphenidate
