Neurology

Question 1

Name the restrictions in using felbamate

Answer 1

Hepatotoxicity and aplastic anemia, need patient consent

Question 2

Describe the DDI between lamotrogine and valproic acid

Answer 2

VPA decreases lamotrigine metabolism

Question 3

Name adverse effects found more often in oxcarbazepine than carbamazepine

Answer 3

Hyponatremia, however blood discrasias are less common (but more common in CBZ)

Question 4

Name seizure medications that can increase phenobarb concentrations

Answer 4

Oxcarbazepine
Phenytoin
VPA

Question 5

Name seizure medications that can increase PHY concentrations

Answer 5

Oxcarbazepine, Phenobarbital, Topiramate

Question 6

Name which drugs can increase CBZ concentrations

Answer 6

Cimetidine, diltiazem, verapamil, erythromycin, isoniazid, theophylline

Question 7

Name medications that can decrease valproic acid serum concentrations

Answer 7

OCs, meropenem, rifampin

Question 8

What seizure medications should be avoided in pregnancy?

Answer 8

VPA, PHY, CBZ, lamotrigine, phenobarbital

Question 9

What is the blood pressure requirement for tpa?

Answer 9

< 185/110

Question 10

How must you separate direct thrombin inhibitors or direct factor Xa inhibitors from tpa?

Answer 10

48 hours

Question 11

For those uneligible for tpa, what is the next line in therapy for ischemic stroke patients?

Answer 11

Aspirin 325 mg within 48 hours of stroke onset and 81 mg maintenance dose

Question 12

Besides antiplatelet therapy, what are medications should be used for secondary prevention of ischemic stroke?

Answer 12

Hypertensive meds, goal < 140/90 mmHg

High intensity statin in patients < 75 yo with stroke or TIA

Question 13

What medication combination is contraindicated with apomorphine?

Answer 13

Ondansetron, granisetron, palonosetron due to profound hypotension; sulfite sensitivity

Question 14

How can you treat dyskinesias caused by parkinson meds?

Answer 14

Decrease the carbidopa/levodopa dose, removing selegiline and dopamien agonists or add amantidine

Question 15

What are methods to combat on-off syndrome of parkinson meds?

Answer 15

Decrease frequency of levo/carbidopa, use apomorphine

Question 16

Which tripans offer non-oral routes to combat vomiting?

Answer 16

sumatriptan and zolmitriptan

Question 17

What are significant contraindications of triptan AND ergot use?

Answer 17

CAD, stroke, uncontrolled hypertension, PAD, ischemic bowel dx, pregnancy

Question 18

How would your ppx for a tension HA?

Answer 18

TCA, botulinum toxin

Acute tx: APAP/NSAIDs

Question 19

What ppx would you use for cluster HAs?

Answer 19

Verapamil, melatonin, lithium

Question 20

What triptan agents can you use for cluster HA acute treatment?

Answer 20

Sumatriptan (SQ, intranasal) and zolmitripan (intranasal)

Question 21

What infections should be screened and vaccinated for before using alemtuzumab?

Answer 21

Herpes zoster and TB

*Avoid all live virus vaccines

Question 22

Name contraindication for fingolimod

Answer 22

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

Question 23

What are some necessary monitoring parameters for fingolimod?

Answer 23

Bradycardia for 6 months, decrease in lymphocytes, macular edema

Question 24

What are the risk factors that increase your risk of developing progressive multifocal leukoencephalopathy while in natalizumab?

Answer 24

AntiJCV ab, longer treatment duration (> 2 years), previous treatment with an immunosuppressant

Question 25

What are ways to eliminate teriflunomide faster?

Answer 25

Cholestyramine, activated charcoal powder

Question 26

What are medications that can treat spascity?

Answer 26

Baclofen, tizanidine

Question 27

What agents can treat fatigue from MS?

Answer 27

Amantidine, methyphenidate