Unit 9-Neuro Flashcards
What are types of primary headaches
migraine, tension-type headache, cluster headache
What are main causes of secondary headaches
head or neck trauma; cranial or cervical vascular disorder; substance or its withdrawal; infection, sinuses
What headache characteristics would warrant worry?
onset after 50 y/o, sudden onset, accelerated pattern, fever and stiff neck, neuro changes
What are symptoms of tension headache?
dull pain radiating bilaterally from forehead to occiput in band like fashion-radiates into neck and trapezius-NOT present on awakening, rarely debilitating
What are symptoms of migraine headache?
nausea, photophobia, more women than men
What are symptoms of cluster headaches?
more in men, hypothalmic disorder is possible, occurs at specific times in sleep-wake cycle. Unilateral, stabbing in one eye, 15-180 min, 1-8 times daily
What can cause chronic daily headaches?
treating more than 2 headaches per week
How long do you need to withhold pain meds to treat MOH?
1-2 weeks
Who needs prophylaxis for tension headaches?
those who have more than 2 TTHs per week
What is first line treatment for TTH?
ASA and APAP
What is second line treatment for TTH?
NSAIDS, caffeine containing meds
What is third line treatment for TTH?
butalbital compounds
Where are migraines thought to originate?
trigeminovascular system of cerebrum
What is first line treatment for Migraine?
NSAIDS
What is 2nd line treatment for Migraine?
Caffiiene
What is third line treatment for migraine?
triptans
What 5HT/triptan has longest half-life?
frovatriptam (Frova)
What 5HT/triptan is oldest and fastest acting?
sumatriptam (Imitrex)
What are common prophylactic meds for migraine?
beta blockers-propranolol and timolol; TCAs nortriptyline; ca channel blockers; NSAIDS
When should peds patients receive prophylactic treatment for migraine?
last 1-3 hours or >1 day
Differentiate generalized seizures from partial seizures
Partial seizures begin in localized area of brain and may cause no change in consciousness Generalized seizures involve both hemispheres of the brain and result in early loss of consciousness
What is the standard definition of status epilepticus?
Seizure activity persisting for more than 30 min or 2 or more sequential seizures without recovery between them
When is drug therapy initiated in seizures?
After diagnosis is confirmed and pt has 2 or more seizures OR if pt has one or more risk factors for recurrent seizures
What are risk factors for recurrent seizures?
EEG, structural lesion, partial seizures, family history
What is first line treatment for seizures?
monotherapy based on type of seizure
What is oldest AED?
phenytoin/Dilantin
What is normal dosing of Dilantin?
5-6mg/kg/d in adults, 5-12 mg/kg/d peds
What are adverse effects of dilantin?
gingival hyperplasia, hirsuitism, SLE, Hypotension
What are special considerations with fosfophenytoin
use <5 days, after or during neuro surgery. 75mg=50mg phenytoin
What meds are used in partial seizures
carbemazepine and oxcarbamazepine
In what patients is valproic acid contraindicated
severe liver disease
What is the first choice for absence seizures?
zarontin
What are causes of major depressive disorder?
postpartum, SAD, dysthymia
Why are SSRIs favorable in treating depression?
increased tolerability, decreased lethality
what are potential side effects of SSRIs?
anxiety, insomnia, sexual dysfunction
What are SNRIs?
effexor, cymbalta, Pristiq
What is first line treatment for depression?
SSRIs
What is second line treatment for depression?
other SSRI, SNRI
What age group is prozac approved for?
ages 8 and up
In treating anxiety, who is best treated by benzos?
Those with acute exogenous anxiety to time-limited stressor
What med is used to treat benzo overdose?
mazicon
What is the drug of choice for anxiety?
SSRIs
What is first, second, and third line therapy for Generalized Anxiety Disorder?
SSRIs, Buspar, Benzos
What is first, second, and third line therapy for panic disorder?
SSRI, TCA, MAOI
what is first second line fro OCD?
SSRI, alternative SSRI
What benzos are approved in peds?
diazepam, alprazolam
What defines chronic insomnia?
> 3wks
How do oral contraceptives affect benzos?
they decrease clearance of benzos
What is half life of benzo receptor agonists?
5 hours
What is first line for insomnia?
non-benzos
What is second line for insomnia?
benzos
What is third line for insomnia?
barbs, antidepressents
what is first second and third line treatment for ADHD?
stimulants, non-stimulants/ antidepressant, bupropion
What is first line treatment for alzheimers?
cholinestrase (aricept, cognex)
