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Pharmacology + Toxicology - Neuro Flashcards

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1
Q

Unexplained coma - what do you give?

A

IV glucose
Thiamine (possible Wernicke’s)

Naloxone (opiates OD)

Flumazenil (benzo OD)

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2
Q

When use antipsychotics for deliurium?

A

only when behavioral measures have been ineffective for symptom control and are necessary to prevent patient harm or to allow evaluation and treatment.

Low-dose haloperidol, risperidone, and olanzapine are equally effective in treating agitation associated with delirium.

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3
Q

Tx Mild migraines

A

NSAIDs

Acetaminophen

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4
Q

Tx Severe midraines

A

Triptan

  • CONTRAINDICATED for cardiovascular disease
  • use Dihydroergotamine

DO NOT use dihydroergotamine for CAD and pregnancy

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5
Q

Ppx migraine

A

topiramate

valproic acid (divalproex sodium, sodium valproate)

amitriptyline

metoprolol, propranolol, timolol

butterbur (root extract from the plant Petasites hybridus)

relaxation therapy, and biofeedback

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6
Q

Tx tension headaches

A

NSAIDs

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7
Q

Ppx tension headaches

A

TCAs

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8
Q

Tx medication overuse headache

A

Withdraw offending medication

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9
Q

Tx cluster headache

A

Oxygen inhalation (7 L/min)

SubQ sumatriptan

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10
Q

For what kinds of dementia can you use cholinesterase inhibitors?

A

Alzheimers

Dementia w/ Lewy Bodies

Mixed alzheimer and vascular dementia

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11
Q

Cholinesterase inhibitors for dementia

A

Donepezil
Galantamine
Rivastigmine

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12
Q

Tx to + to cholinesterase inhibitor tx for dementia

A

Memantine

- noncompetitive NMDA R antagonist

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13
Q

Tx dementia w/ hallucinations/delusions/behavioral disturbances

A

Antipsychotics

  • risperidone
  • olanzapine
  • quetiapine

ATYPICALS!

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14
Q

Tx severe dystonia

A

Botulinum toxin (esp w/ cervical dystonia)

Anticholinergic meds (less effective)

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15
Q

What should you give before abx in bacterial meningitis

A

Dexamethasone

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16
Q

Drugs causing a/w neuropathy

A

Amiodarone
Cisplatin
Colchicine
Dapsone

HIV drugs

  • Didanosine
  • Zalcitabine
  • Stavudine
Hydralazine
Isoniazid
Metronidazole
Nitrofurantoin
Paclitaxel
Phenytoin
Vincristine
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17
Q

Tx pain and dysesthesias of axonal polyneuropathies w/

A

TCAs (amitriptyline)
Gabapentin
Pregabalin
Duloxetine

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18
Q

Do you use steroids for
Guillain Barre?
Chronic inflammatory demyelinating polyneuropathy?

A

GB - no evidence that can improve the course of illness

CIDP - YES!

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19
Q

What can cause Horner syndrome that is vascular?

A

EXTERNAL carotid artery dissection
- fibers of SNS travel w/ external carotid artery

Think of external carotid artery dissection w/ painful Horner syndrome

Internal carotid artery pathology doesn’t cause anhidrosis

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20
Q

Can lamotrigene be used immediately?

A

No

Needs to be slowly to treated over many weeks because did risk of severe rash

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21
Q

PPX for common migraine

A

Verapamil
Amitriptyline
Propanolol
Valproate

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22
Q

worsen migraines in susceptible people

A

Nitroglycerin

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23
Q

When start ppx for headaches?

A

When occur at least 1-2x / month

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24
Q

Would you use metoclopramide, sumatriptan and ergotamine for headache tx longterm?

A

NO!

Can cause rebound syndrome causing daily HA

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25
Tx T. gondii infection
Sulfadiazine + pyrimethamine NOT neurosurgical removal of lesions
26
Tx PML
Caused by JC virus (ds DNA virus) HAART can be effective in improving survival Cytarabine is NOT effective in clinical trials
27
Tx status migrainosus
Prochlorperazine
28
Help w/ restless legs syndrome
``` Clonazepam Gabapentin L dopa Dopamine agonists (pramipexole, ropinirole) Opiates ``` Neuroleptics, CCB and caffeine can worsen sx
29
How does INH affect B6?
Doesn't decrease absorption But interferes w/ participation in metabolic pathways
30
Carbon tetrachloride
Potent hepatic toxin
31
Rett syndrome Tx
No tx - etiology unknown
32
Trihexyphenidyl
Anticholinergic drug Can decrease signs of parkinsonism caused by drugs interfering w/ D neurotransmission by creating relative deficiency of AcH neurotransmission
33
Do you use L dopa for drug induced parkinsonism?
NO! Can worsen psych condition and not improve parkinsonism Use anticholinergic drug (trihexyphenidyl)
34
Tx Tourette's
Haloperidol Pimozide Trifluoperazine Fluphenazine
35
Tx Meige syndrome
Botulinum toxin injection
36
Tx spasmodic torticollis
Botulinum toxin injections Most meds (trihexyphenidyl) are not very helpful
37
Can get gastric disturbances w/ corticosteroid use - how do you tx this?
Ranitidine Heart healthy diet for high cholesterol
38
Baclofen
Antispasmodic agent for MS CAn also use tizanidine Benzos
39
Drugs causing neural tube malformations
All antiepileptics, esp valproic acid Colchicine Papaverine Caffeine Irradiation Hyperthermia Antimetabolites Salicylates Vitamin A
40
ACTH to tx
West syndrome Tuberous scleroisis infantile spasms
41
Triorthocresyl phsophate
Damages Upper and lower motor neurons Damage severe + permanent AKA Jerk in bootleg alcohol Acute sx look like AchE activity of poison - organophosphate poisoning
42
Rescue for organophosphate poisoning
Atropine + pralidoxime At most immediate risk of severe bronchospasm + diaphragmatic paralysis
43
Personality changes + tremor + ataxia Works in paper, pulp, and/or electrochemical plants What is likely poison?
Mercury Pathologic change in CNS: - cerebellum - extensive damage to granular cell layer More parasthesias rather than dysthesias - also damages calcarine cortex of occipital --> constriction of visual fields
44
Lead poisoning manifestations
Bilateral neuropathies (radial N --> wrist drop) Ab pain Constipation Anemia Basophilic stippling Linear discoloration along gingival margin
45
Tx lead poisoning
Penicillamine (chelating agent) | EDTA
46
Arsenic poisoning sx
Tonic clonic seizures Less dramatic encephalopathy Hemolysis Mucosal irritation Polyneuropathy that develops w/ chronic poisoning is resistant to tx w/ chelating agents (like BAL)
47
Ergot poisoning sx
Potent vasoconstricting agent derived from rye fungus Histo changes in CNS - degeneration of posterior columns and dorsal roots Peripheral neuropathy too
48
Manganese poisoning - sx - how do you get it?
Miners can inhale it Looks like Wilsons disease Parkinsonism is prominent feature - axial rigidity - dystonia can also happen ``` Neuronal loss in globus pallidus putamen caudate hypothalamus cerebellum ``` Tx w/ L dopa not as effective
49
CO poisoning - what gets it - what does it look like
Victims of fires Suicide ppl w/ CO Gas exposure in unventilated setting Characteristic besides decreased O2 is delayed neuo deterioration occuring 1-3 weeks after initial event - EPS disorder - Parkinsonia gait - bradykinesia Hypodensities in globus pallidum bilaterally are classic
50
Ciguatera poisoning - where do you see it - what does it look like
Foo =d poisoning common in FL, HI Dinoflagellates make toxin --> consumed by reef fish Ciguatoxin acts on voltage-gated Na channels --> increased Na permeability --> increased excitability ``` Sx: ab discomfort nausea vomiting diarrhea ``` ``` Neuro sx Paresthesias HA fatigue ataxia myalgias TEMP REVERSAL - cold stuff feels uncomfortably hot ``` IV mannitol can help tx
51
Tx hepatic encephalopathy
Lactulose - allows bacteria in GI to assimilate ammonia Dietary restriction on protein not as good anymore b/c need protein to allow recovery of liver function
52
Common drugs causing nystagmus
EtOH | Barbituates
53
What drugs can cause reversible posterior leukoencephalopathy?
Cyclospoirne | Tacrolimus
54
Causes toxic labyrinthitis
Salicylates Alcohol Quinine Aminoglycosides Can have accompanying vertigo
55
Reduce sx of vertigo
Promethazine Dimenhydrinate Meclizine
56
Tx Meniere's disease
Salt restriction Diuretics Surgery not great
57
Aminoglycoside ototoxicity - vestibular affected? - cochlear affected?
Vestibular - streptomycin - gentamicin Cochlea - Kanamycin - tobramycin - neomycin Can get disequilibrium after exposure - drugs are concentrated in endolymphatic fluid causing ototoxicity
58
Tx schistosomiasis
Praziquantel Can result in negligible reversal of disability due to SC injury
59
Thallium poisoning
``` Hair loss Stupor GI distress Seizures HA ``` Painful symmetric primarily SENSORY neuropathy
60
Tx lambert-eaton
3,4 Diaminopyridine
61
Tx Guillain Barre
IV Ig | Plasma exchange
62
Drugs provoking AIP
Barbiturates Phenytoin Sulfas Estrogens
63
Tx AIP
IV hematin Supportive
64
NO poisoning
Can cause peripheral neuropathy Megaloblastic anemia Numbness Paresthesias Limb spasticity Ataxia Hard to tell from B12 deficiency
65
Give how much thiamine for acute Wernicke encephalopathy?
50-100 mg IV
66
Ppx cluster headaches
Methysergide | - but can cause fibrosis (retroperitoneal, pulm, endocardial)
67
Tx malignant hyperthermia
Dantrolene - prevents release of Ca from SR Supportive
68
Used to improve outcome of pt w/ severe traumatic head injury
Hypothermia Decreases cerebral metabolism, decreases acidosis, inhibits excitatory NT that are harmful
69
How long tx herpes encephalitis?
14-21 day acyclovir
70
tx optic neuritis
IV methylprednisolone
71
Tx trigeminal neuralgia
carbamazepine Phenytoin Baclofen
72
Tx spastic bladder
TCAs | Oxybutynin
73
Tx spasticity
Baclofen Tizanidine (a2 agonist) -- stops spasticity w/o affecting strength
74
Status epilepticus - tx - ppx
Tx - IV benzos (lorazepam, diazepam) --> 1st line - Phenytoin Ppx - Phenytoin - Benzo
75
Tx glioblastoma multiforme
Resection Radiation CAn maybe use 1,2 bi (2-chloroethyl-1-nitrosurea) (BCNU) but not great
76
How fast give tPA for stroke that is not hemorrhagic?
Within 3 hrs
77
Tx ALS
Riluzole (glutamate inhibitor)
78
Tx restless leg syndrome
Dopamine agonists
79
Smoking cessation
Varencicline Better than bupropion
80
#1 cause drug induced myopathy
Steroids! - happens w/in 1 week of drug initiation - diffuse muscle weakness, rhabdo - painless proximal muscle weakness
81
Tx Tourette
Clonidine Pimozide Haloperidol
82
Meds exacerbating sx of myasthenia gravis
Abx Amino glycosides, tetracyclines Beta blockers Antiarrhythmics Quinidine, procainamide, lidocaine
83
Tx BPV
Meclizine
84
Do you use steroids in Bell's palsy if Lyme is suspected?
No!!!
85
What helps w/ dyskinesias from anti-PD meds?
Amantadine
86
Drug induced parkinson's culprits
DR inhibits - prochlorperazine - metoclopramide Decrease dopamine drugs - reserpine - tetrabenizine Typical antipsychotics
87
Tx tardive dyskinesia
Benzo Baclofen Tetrabenazine
88
What is good alternative for metoclopramide to avoid TD?
Domperidone No cross BBB
89
Tx meningeal involvement of Lyme disease
IV ceftriaxone 10-14 days IF allergic, Tetracycline qid for 30 days
90
Tabes dorsalis develops what type of infection?
Leptomeningitis = infection of pia or arachnoid = meningitis
91
Meds for seizure AND migraines
Topiramate | Divalproex
92
Tx narcolepsy
``` sodium oxybate (GHB) - gives you more slow wave sleep and gets you out of REM ``` methylphenidate, amphetamine, methamphetamine, modafinil
93
Phenytoin S/E
Gingival hyperplasia Cerebellar purkinje cell degeneration causing NYSTAGMUS?
94
Carbamazepine S/E
Na issues | Agranulocytosis
95
Pt w/ antiphospholipid Ab + active sx of disease (clots, etc), what tx do you use?
Anticoagulation
96
Pt w/ antiphospholipid Ab + NO active sx of disease (clots, etc), what tx do you use?
Anticoagulation = antiplatelet ---> can use either!
97
Tx multiple system atrophy (Shy Drager)
Intravascular volumen expansion - fludrocortisone - salt supplements - a-adernergic agonists
98
Ototoxicity/nephrotoxicity
Cisplatin Aminoglycosides (esp Gentamicin - damage inner ear hair cells) Vancomycin
99
Which antiepileptic has never been approved as a monotherapy drug?
Levetiracetam (keppra) - it only works for a short period of time! - has mood change/behavior change side effects Good for bridging, use with other meds, But not as a monotherapy
100
Which antiepileptic has highest stevens johnson syndrome risk
Lamotrigine
101
Why don't you want to give valproate to young girls for primary generalized seizures?
Increased risk for developing PCOS
102
DO NOT use carbamazepine in....
Primary generalized seizures!
103
Tx brain edema
3% saline Mannitol
104
How many strokes does coumadin prevent?
70%
105
Antiepileptics ok for liver failure
Renally cleared! Levetiracetam Gaba[entin Pregabalin
106
Which antiepileptics most likely to cause NTD in baby?
VAlproate | Phenobarbital
107
Which drugs cause optic neuropathy
Amiodarone | Ethambutol
108
Drugs reported to cause convulsions - common at at therapeutic doses - occassionally
Common: - Meperidine - D-R antagonist drugs - Clozapine Occasional - lidocaine - imipenem - isoniazid - theophylline - haloperidol
109
1st line drug for partial seizure
``` Levetiracetam Zonisamide Lamotrigine Oxcarbazepine Topiramate Carbamazepine Valproic acid ```
110
1st line drug for tonic-clonic seizure
Valproic acid Lamotrigine Levetiracetam Zonisamide
111
1st line for absence seizure
Ethosuximide Valproic acid Lamotrigine
112
1st line for myoclonic seizure
Valproic acid Topiramate Levetiracetam
113
1st line for lennox-gastaut syndrome
``` Valproic acid Lamotrigine Topiramate Rufinamide Zonisamide ```

Neuro (3 decks)

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