Tratament

Question 1

Arlevert: subst active+ mecanism de actiune + dozaj + indicatii

Answer 1

ARLEVERT (cinarizinum 20 mg + dimenhidrinatum 40 mg) : 1-1-1 dupa masa; Cinarizina- deprimant labirintic + amelioreaza circulatia cerebrala (antag de Ca); Dimenhidrinatul- act parasimpaticolitica + deprimant SNC la niv nn vestibulari din bulb ( antihistaminic cu proprietati anticolinergice)
Indicatii: vertij de diferite etiologii

Question 2

Sermion: subst active + mecanism de actiune + dozaj + indicatii

Answer 2

SERMION: nicergolina= derivat semisintetic de ergot; mecanism de act: blocant alpha 1-adrenergic=> vasodilatatie centrala si periferica ( nu si asupra coronarelor)
Indicatii:-tratam simptomatic in dementele: multiinfarct, Alzheimer, Parkinson; tulb cohleo-vestibulare
Sermion 30 mg 1-0-0 sau 1+ 1 inaintea unei mese principale

Question 3

Betaserc: subst active + mecanism de actiune + dozaj + indicatii

Answer 3

BETASERC: betahistinum : agonist partial al rec H1, antagonist al rec H3, cresterea fluxului de sange in zona cohleara + restul regiunii creierului
Indicatii: sdr Meniere, tratament simptomatic al vertijului vestibular
Betaserc 24 mg x2/zi
Betaserc 8 mg x3/zi

Question 4

Cavinton: subst active + mecanism de actiune + dozaj + indicatii

Answer 4

CAVINTON: vinpocetinum: creste selectiv fluxul sanguin cerebral
Indicatii: tratam tulb circulatorii cerebrale (dupa AVC, dementa vasculara, arterioscleroza cerebrala, encefalopatie hipertensiva si post-traumatica, ICVB)
Cavinton 10 mg cp 1-1-1 dupa masa
Cavinton 10 mg/2 ml : 1mg/kg/zi in PEV lent

Question 5

Tratamente abortive si de tranzitie in cefaleile primare

Answer 5

Tratamente abortive la domiciliu:
1. Analgezice non-specifice : Ibuprofen
2. Triptani +/- AINS
-agonisti ai rec selectivi de serotonina (rec 5-hidroxitriptamin 1B( blood vessels)D
produc vasoconstrictie=>posibila accentuare a hipoperfuziei=> posibil periculosi in migrena care se insoteste de deficite neurologice si la pacientii cardiaci
3. Ditani
- agonisti selectivi ai rec 5- HT1F
eficacitate ~ triptanii
risc cardiac mai mic
risc de sedare
4. Gepani
- antagonisti ai CGRP ( calcitonin gene-related peptide)
risc CV si SN mai mic
Tratamente abortive in spital:
1. O2 100% ( cefalee tip cluster)
2. Blocuri gg sfenopalatin/ n occipital ( cefalei primare intractabile)
3. Tratament parenteral:
a) AINS iv : Ketorolac
b) Metoclopramid iv
c) Antiepileptice iv: Acid valproic
d) Glucocorticoizi
Tratament de tranzitie: cura scurta de glucocorticoizi

Question 6

Tratamente preventive in cefaleile primare: indicatii + exemple

Answer 6

Indicatii: min 4 atacuri cefalee/luna
1. Tratament non-farmacologic: modificarea stilului de viata: imbunatatirea calitatii somnului, mese regulate, evitarea triggerilor ( alcoolul); jurnal de cefalee: frecv, severitatea episoadelor, factori trigger
2. Antiepileptice: Topiramat
ef adv: scadere ponderala, incetinire cognitiva, calculi renali
* inhibitor slab al anhidrazei carbonice
3. Antihipertensive:
a) beta-blocante: Propanolol
b) Blocante ale canalelor de Calciu: Verapamil
c) Blocante ale receptorilor de angiotensina: Candesartan
4. Antidepresive:
a) Triciclice : Nortriptilina -ef adv: toxic cardiac, ef antihistaminice, sedare, ef anticolinergice ( gura uscata, constipatie, retentie urinara)
b) Inhibitori ai recaptarii serotoninei si norepinefrinei (SNRI): Venlafaxina
5. Antagonisti CGRP injectabili; toxina botulinica
6. Canabinoizi