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Neuro Tx 1
Neurology
| Question | Answer |
|---|---|
| Brain tumor: Std of care: Grade I | Surgery +/- RT |
| Brain tumor: Std of care: Grade II | Surgery; Observe; If progression: CTx |
| Brain tumor: Std of care: Grade III | Surgery; RT with temozolomide; 12 cycles of temozolomide |
| Brain tumor: Std of care: Grade IV | Surgery; RT with temozolomide; 52 weeks rotational CTx |
| epidural spinal mets: tx | irradiation |
| Ulnar neuropathy: Tx | modify activity; extensor splint at night; NSAIDs; surgery (nerve transposition or ligament release); No C’steroids |
| Meralgia paresthetica: Tx | often self-ltg; hydrocortisone injxn; nerve transposition |
| Fem neuropathy: Tx | Tx etiology; splints/braces; PT |
| Sciatic n. palsy: Tx | Tx etiology; behave change; anti-inflam; PT; surg |
| CN VII palsy: Tx | prednisone; artificial tears/eye patch; No Surg |
| Dejerine-Sottas Dz: Tx | Supportive; plasmapheresis; dietary restriction |
| AIDP (GBS): Tx | Anti-inflam; plasmapheresis; IVIg; mech ventilation; OT/PT |
| MG tx | cholinesterase inhib: pyridostigmine; thymectomy; c'steroids, immunosuppressants, IVIg |
| LEMS tx | plasmapheresis & immunosuppressive tx |
| Essential tremor Tx | Firstline: Beta-blocker; Primidone; benzos for anxiety related |
| Ataxic (intention) tremor: Tx: | Meds usu ineffective; Weights; surgical lesions of ventrolateral thalamus in severe cases |
| Parkinson Dz: Levodopa (L-dopa) efficacy | 80% of pts improve; Sinemet treats akinesia & is less effective in treating tremor. |
| L-DOPA MOA | precursor of DA (which cannot cross BBB; L-DOPA can) |
| Dopamine agonists MOA | Act like DA at DA receptor; may allow for reduction in dose of Sinemet required & may decrease on-off probs |
| Huntington Tx | Ctrl dyskinesia: chlorpromazine; behav disturbances: DA receptor blockers: neuroleptics (haloperidol, clozapine); DA reserve depleters (reserpine no longer used) |
| Wilson: Tx | Should begin before neuro Sx onset; early tx prevents neuro sequela devt; eat low Cu foods; sulfurated potash with meals (prevent Cu absorption); chelator (d-penicillamine) to remove absorbed Cu |
| Wilson dz: Tx: foods to avoid | liver; chocolate; mushrooms; shellfish; nuts |
| Menstrual migraine tx | triptans given acutely; NSAIDs; OCP |
| Migraine: use preventive med (as well as abortive) if: | >8 HA / month |
| Tension type HA: antidepressants | TCA (amitriptyline, nortriptyline); Duloxetine |
| Cluster HA: Abortive Tx | O2 100% at 6-8 L/min x 15 min; DHE-45 IV; Sumatriptan or Zomig; Intranasal lidocaine; Poss Lupron IM |
| Cluster HA: Prophylactic Tx: | Verapamil; Lithium; valp, cryptohepatadine; prednisone taper; relief in 1-2 days |
| Triptans: MOA: | constrict intracranial blood vessels, inhibit vasoactive neuropeptide release, & interrupt pain signal transmission centrally |
| Mgmt of 85% of symptomatic carotid stenoses | carotid endoarterectomy |
| components on Triple H therapy for SAH | hypervolemia, heme dilution, hypertension |
| when can a burr-hole be done to treat subdural hemorrhage | 2 weeks after injury |
| Treatment for myelomeningocele | planned c section, emergent closure of defect within 24 hours |
| Begin levodopa tx when: | pt experiences functional impairment |
| DA agonists: MOA | Act directly on dopamine receptors in the corpus striatum |
| COMT inhib MOA | Increase amount of levodopa available to cross BBB (allows prolonged On periods; often add on when levodopa efficacy begins to diminish) |
| Selegiline MOA | Acts centrally to prevent DA destruction (MAO-B: metab of DA); fx diminish over time |
| Anticholinergics: indication in Parkinsons | Reserved for resting tremor early in the dz in younger pts. Benztropine (Cogentin): MOA suppress central cholinergic, prolong dopamine activity |
| Antiviral may be used for Parkinson dz (+/- levodopa): | Amantadine (Symmetrel). MOA: increase dopamine / block reuptake |
| Amantadine MOA | augment DA presynaptic release; block reuptake; block glutamate transmission; renal metab (dose adj) |
| ALS Tx | Riluzole; cough assist device, chest PT, BiPAP; PEG feeding tube; |
| Duchenne/Becker Tx | Prednisone (age 5) for Duchenne; Supportive (orthotics, resp, cardiac, PT/OT); cardiac TP in Becker |
| Wilson: tx | reduce copper intake; chelate; transplant |
| Duchenne/Becker Tx | supportive, corticosteroids, PT, ortho, cardiopulmonology |
| Alzheimer disease tx | Mild-moderate dz: cholinesterase inhibitors (donepezile, galantamine, rivastigmine). Advanced dz: Memantine (NMDA receptor agonist). |
| increased ICP 2/2 head injury: | induced hyperventilation, IV mannitol, IV furosemide |
| Levodopa MOA | Levodopa is a precursor that crosses blood-brain barrier and is converted to dopamine |
| Entacapone (Comtan) MOA | Inhibits catechol-O-methyltransferase => increases levodopa concentrations |
| Selegiline (Carbex, Eldepryl) MOA | increases dopamine activity |
| Carbidopa MOA | inhibits decarboxylation of peripheral levodopa; does not cross BBB |
| Dopaminergic meds for PD | Ropinirole (Requip), pramipexole (Mirapex) |
| Alpha-adrenergic agonists include (20: | midodrine, phenylephrine (mimic effects of epinephrine and norepinephrine) |
| Alpha-1 blockers include (4): | doxazosin, prazosin, tamsulosin, terazosin |
| Alpha-2 blockers include: | mirtazapine |
| Beta-1 agonists include (2) | dobutamine, epinephrine |
| Beta-2 agonists include (3): | epinephrine, formoterol, salmeterol |
| Non-selective beta blockers include (4): | carvedilol, labetalol, propranolol, sotalol |
| Beta-1 blockers include (2): | atenolol, metoprolol |
Created by:
Abarnard
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