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Neuro > Pharmacology + Toxicology - Neuro > Flashcards

Pharmacology + Toxicology - Neuro Flashcards

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
Q

Tx T. gondii infection

A

Sulfadiazine + pyrimethamine

NOT neurosurgical removal of lesions

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26
Q

Tx PML

A

Caused by JC virus (ds DNA virus)

HAART can be effective in improving survival

Cytarabine is NOT effective in clinical trials

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27
Q

Tx status migrainosus

A

Prochlorperazine

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28
Q

Help w/ restless legs syndrome

A 
Clonazepam
Gabapentin
L dopa
Dopamine agonists (pramipexole, ropinirole)
Opiates

Neuroleptics, CCB and caffeine can worsen sx

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29
Q

How does INH affect B6?

A

Doesn’t decrease absorption

But interferes w/ participation in metabolic pathways

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30
Q

Carbon tetrachloride

A

Potent hepatic toxin

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31
Q

Rett syndrome Tx

A

No tx - etiology unknown

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32
Q

Trihexyphenidyl

A

Anticholinergic drug

Can decrease signs of parkinsonism caused by drugs interfering w/ D neurotransmission by creating relative deficiency of AcH neurotransmission

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33
Q

Do you use L dopa for drug induced parkinsonism?

A

NO! Can worsen psych condition and not improve parkinsonism

Use anticholinergic drug (trihexyphenidyl)

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34
Q

Tx Tourette’s

A

Haloperidol
Pimozide
Trifluoperazine
Fluphenazine

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35
Q

Tx Meige syndrome

A

Botulinum toxin injection

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36
Q

Tx spasmodic torticollis

A

Botulinum toxin injections

Most meds (trihexyphenidyl) are not very helpful

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37
Q

Can get gastric disturbances w/ corticosteroid use - how do you tx this?

A

Ranitidine

Heart healthy diet for high cholesterol

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38
Q

Baclofen

A

Antispasmodic agent for MS

CAn also use tizanidine
Benzos

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39
Q

Drugs causing neural tube malformations

A

All antiepileptics, esp valproic acid

Colchicine

Papaverine

Caffeine

Irradiation

Hyperthermia

Antimetabolites

Salicylates

Vitamin A

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40
Q

ACTH to tx

A

West syndrome

Tuberous scleroisis infantile spasms

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41
Q

Triorthocresyl phsophate

A

Damages Upper and lower motor neurons

Damage severe + permanent

AKA Jerk in bootleg alcohol

Acute sx look like AchE activity of poison - organophosphate poisoning

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42
Q

Rescue for organophosphate poisoning

A

Atropine + pralidoxime

At most immediate risk of severe bronchospasm + diaphragmatic paralysis

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43
Q

Personality changes + tremor + ataxia

Works in paper, pulp, and/or electrochemical plants

What is likely poison?

A

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
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44
Q

Lead poisoning manifestations

A

Bilateral neuropathies (radial N –> wrist drop)

Ab pain
Constipation

Anemia
Basophilic stippling

Linear discoloration along gingival margin

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45
Q

Tx lead poisoning

A

Penicillamine (chelating agent)

EDTA

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46
Q

Arsenic poisoning sx

A

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
Q

Ergot poisoning sx

A

Potent vasoconstricting agent derived from rye fungus

Histo changes in CNS
- degeneration of posterior columns and dorsal roots

Peripheral neuropathy too

48
Q

Manganese poisoning

  • sx
  • how do you get it?
A

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
Q

CO poisoning

  • what gets it
  • what does it look like
A

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
Q

Ciguatera poisoning

  • where do you see it
  • what does it look like
A

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
Q

Tx hepatic encephalopathy

A

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
Q

Common drugs causing nystagmus

A

EtOH

Barbituates

53
Q

What drugs can cause reversible posterior leukoencephalopathy?

A

Cyclospoirne

Tacrolimus

54
Q

Causes toxic labyrinthitis

A

Salicylates
Alcohol
Quinine
Aminoglycosides

Can have accompanying vertigo

55
Q

Reduce sx of vertigo

A

Promethazine
Dimenhydrinate
Meclizine

56
Q

Tx Meniere’s disease

A

Salt restriction

Diuretics

Surgery not great

57
Q

Aminoglycoside ototoxicity

  • vestibular affected?
  • cochlear affected?
A

Vestibular

  • streptomycin
  • gentamicin

Cochlea

  • Kanamycin
  • tobramycin
  • neomycin

Can get disequilibrium after exposure
- drugs are concentrated in endolymphatic fluid causing ototoxicity

58
Q

Tx schistosomiasis

A

Praziquantel

Can result in negligible reversal of disability due to SC injury

59
Q

Thallium poisoning

A 
Hair loss
Stupor
GI distress
Seizures
HA

Painful symmetric primarily SENSORY neuropathy

60
Q

Tx lambert-eaton

A

3,4 Diaminopyridine

61
Q

Tx Guillain Barre

A

IV Ig

Plasma exchange

62
Q

Drugs provoking AIP

A

Barbiturates
Phenytoin
Sulfas
Estrogens

63
Q

Tx AIP

A

IV hematin

Supportive

64
Q

NO poisoning

A

Can cause peripheral neuropathy

Megaloblastic anemia

Numbness
Paresthesias
Limb spasticity
Ataxia

Hard to tell from B12 deficiency

65
Q

Give how much thiamine for acute Wernicke encephalopathy?

A

50-100 mg IV

66
Q

Ppx cluster headaches

A

Methysergide

- but can cause fibrosis (retroperitoneal, pulm, endocardial)

67
Q

Tx malignant hyperthermia

A

Dantrolene
- prevents release of Ca from SR

Supportive

68
Q

Used to improve outcome of pt w/ severe traumatic head injury

A

Hypothermia

Decreases cerebral metabolism, decreases acidosis, inhibits excitatory NT that are harmful

69
Q

How long tx herpes encephalitis?

A

14-21 day acyclovir

70
Q

tx optic neuritis

A

IV methylprednisolone

71
Q

Tx trigeminal neuralgia

A

carbamazepine
Phenytoin
Baclofen

72
Q

Tx spastic bladder

A

TCAs

Oxybutynin

73
Q

Tx spasticity

A

Baclofen

Tizanidine (a2 agonist) – stops spasticity w/o affecting strength

74
Q

Status epilepticus

  • tx
  • ppx
A

Tx

  • IV benzos (lorazepam, diazepam) –> 1st line
  • Phenytoin

Ppx

  • Phenytoin
  • Benzo
75
Q

Tx glioblastoma multiforme

A

Resection
Radiation

CAn maybe use 1,2 bi (2-chloroethyl-1-nitrosurea) (BCNU) but not great

76
Q

How fast give tPA for stroke that is not hemorrhagic?

A

Within 3 hrs

77
Q

Tx ALS

A

Riluzole (glutamate inhibitor)

78
Q

Tx restless leg syndrome

A

Dopamine agonists

79
Q

Smoking cessation

A

Varencicline

Better than bupropion

80
Q

1 cause drug induced myopathy

A

Steroids!

  • happens w/in 1 week of drug initiation
  • diffuse muscle weakness, rhabdo
  • painless proximal muscle weakness
81
Q

Tx Tourette

A

Clonidine
Pimozide
Haloperidol

82
Q

Meds exacerbating sx of myasthenia gravis

A

Abx
Amino glycosides, tetracyclines

Beta blockers

Antiarrhythmics
Quinidine, procainamide, lidocaine

83
Q

Tx BPV

A

Meclizine

84
Q

Do you use steroids in Bell’s palsy if Lyme is suspected?

A

No!!!

85
Q

What helps w/ dyskinesias from anti-PD meds?

A

Amantadine

86
Q

Drug induced parkinson’s culprits

A

DR inhibits

  • prochlorperazine
  • metoclopramide

Decrease dopamine drugs

  • reserpine
  • tetrabenizine

Typical antipsychotics

87
Q

Tx tardive dyskinesia

A

Benzo

Baclofen

Tetrabenazine

88
Q

What is good alternative for metoclopramide to avoid TD?

A

Domperidone

No cross BBB

89
Q

Tx meningeal involvement of Lyme disease

A

IV ceftriaxone 10-14 days

IF allergic,
Tetracycline qid for 30 days

90
Q

Tabes dorsalis develops what type of infection?

A

Leptomeningitis = infection of pia or arachnoid = meningitis

91
Q

Meds for seizure AND migraines

A

Topiramate

Divalproex

92
Q

Tx narcolepsy

A 
sodium oxybate (GHB)
- gives you more slow wave sleep and gets you out of REM

methylphenidate,
amphetamine,
methamphetamine,
modafinil

93
Q

Phenytoin S/E

A

Gingival hyperplasia

Cerebellar purkinje cell degeneration causing NYSTAGMUS?

94
Q

Carbamazepine S/E

A

Na issues

Agranulocytosis

95
Q

Pt w/ antiphospholipid Ab + active sx of disease (clots, etc), what tx do you use?

A

Anticoagulation

96
Q

Pt w/ antiphospholipid Ab + NO active sx of disease (clots, etc), what tx do you use?

A

Anticoagulation = antiplatelet —> can use either!

97
Q

Tx multiple system atrophy (Shy Drager)

A

Intravascular volumen expansion

  • fludrocortisone
  • salt supplements
  • a-adernergic agonists
98
Q

Ototoxicity/nephrotoxicity

A

Cisplatin

Aminoglycosides (esp Gentamicin - damage inner ear hair cells)

Vancomycin

99
Q

Which antiepileptic has never been approved as a monotherapy drug?

A

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
Q

Which antiepileptic has highest stevens johnson syndrome risk

A

Lamotrigine

101
Q

Why don’t you want to give valproate to young girls for primary generalized seizures?

A

Increased risk for developing PCOS

102
Q

DO NOT use carbamazepine in….

A

Primary generalized seizures!

103
Q

Tx brain edema

A

3% saline

Mannitol

104
Q

How many strokes does coumadin prevent?

A

70%

105
Q

Antiepileptics ok for liver failure

A

Renally cleared!

Levetiracetam
Gaba[entin
Pregabalin

106
Q

Which antiepileptics most likely to cause NTD in baby?

A

VAlproate

Phenobarbital

107
Q

Which drugs cause optic neuropathy

A

Amiodarone

Ethambutol

108
Q

Drugs reported to cause convulsions

  • common at at therapeutic doses
  • occassionally
A

Common:

  • Meperidine
  • D-R antagonist drugs
  • Clozapine

Occasional

  • lidocaine
  • imipenem
  • isoniazid
  • theophylline
  • haloperidol
109
Q

1st line drug for partial seizure

A 
Levetiracetam
Zonisamide
Lamotrigine
Oxcarbazepine
Topiramate
Carbamazepine
Valproic acid
110
Q

1st line drug for tonic-clonic seizure

A

Valproic acid
Lamotrigine
Levetiracetam
Zonisamide

111
Q

1st line for absence seizure

A

Ethosuximide
Valproic acid
Lamotrigine

112
Q

1st line for myoclonic seizure

A

Valproic acid
Topiramate
Levetiracetam

113
Q

1st line for lennox-gastaut syndrome

A 
Valproic acid
Lamotrigine
Topiramate
Rufinamide
Zonisamide

Neuro (3 decks)

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