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Neuro Tx 1

Neurology

QuestionAnswer
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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