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Neuro Tx 2
Neurology
| Question | Answer |
|---|---|
| Peripheral vertigo tx | bedrest, antihistamines, anticholinergics and/or benzo; mild exercise |
| vertigo tx: 4 Classes of Drugs to Suppress Vestibular System | Anticholinergics, Antihistamines, Phenothiazines, Benzodiazepines |
| Aspirin recommended for 10-yr stroke risk of: | 6-10% |
| Ischemic stroke: Tx | tPA (within 4.5 hrs of sx onset); head CT w/o evidence of hemorrhage/complicating lesion |
| If pt not tPA candidate: Tx: | poss endovascular tx; MERCI clot retriever? |
| Acute stroke mgmt | Temperature; Fluids/Glucose; BP; Antithrombotic agents |
| Acute ischemic stroke: tx BP? | No (drop in MAP can drop CBF, make things worse) |
| Secondary stroke prevention | Plt antiaggregants (ASA); Anticoagulants; BP; Lipid lowering; Endarterectomy |
| Antihypertensives & stroke risk | each 10 mmHg drop in BP = 28% decrease stroke risk |
| tx: ischemic/TIA vs cardioembolic stroke | ischemic/TIA: antiplatelet tx; cardioembolic: anticoagulant tx |
| hemorrhagic stroke tx | supportive; mgmt of HTN & edema (mannitol, steroids); poss surg/clipping |
| TIA tx | Ppx antiplatelet tx (ASA, plavix, aggrenox, etc); if cardiogenic: anticoag (IV hep, LT warf) |
| TIA tx if anterior circulation | poss carotid endarterectomy |
| Non-absence seizure meds | Carbamazepine, phenytoin, or valproic acid. Newer meds (topamax, gapapentin, keppra, lamictal); felbamate for refractory |
| Absence seizure meds | Valproate or ethosuximide |
| status epilepticus tx | airway mgmt; prevent aspiration; mgmt hyperthermia (cooling, poss neuromx blocker); IV ativan/valium; phenytoin |
| Tx after single seizure if: | structural lesion or recognized abnormal EEG |
| Pneumococcal meningitis Tx | ceftriaxone (if GP diplococci seen, add Vanc, pending cx) |
| Meningococcal meningitis: nasal carriage eliminated with: | Rifampin (alt: cipro or ceftriaxone) |
| Meningococcal meningitis: DOC | Acqueous Pen G |
| H flu meningitis DOC | ceftriaxone |
| Brain abscess tx | prolonged IV Abx, surg drainage; monitor tx w/ serial scans; if <2 cm poss medical tx only |
| tx most pts w/ clin syndrome of viral encephalitis: | empirically for HSV encephalitis |
| MS: Goals of tx | Tx whole dz; slow accumulation of disability; Reduce relapse rate & CNS inflam (lesions) & progression of brain atrophy (shrinkage); improve pt QOL (including cognitive) |
| MS tx: to slow relapse rate: | glatiramer subQ qd & interferon-beta |
| MS tx: for secondary progressive MS: | poss immunosupp (cyclophosphamide, azathioprine) for secondary |
| MS tx: for acute relapse: | corticosteroids (methylprednisolone) |
| MS tx: to improve fatigue: | amantadine & pemoline |
| MS tx: to improve spasticity: | baclofen & diazepam |
| Seizures: preferred mode of tx | monotherapy |
| Rationale for polytherapy for seizure | Consider 2d agent if inadequate control after trials of 2 diff single agents; Diff MOAs, AE, DI’s |
| Phenytoin & Albumin | Low alb (poor renal fn); order Free PHT levels; can adjust PHT conc for low alb if cannot get free PHT level |
| DOC for new onset partial: most common: | CBZ, Lamictal, oxcarb, PHT |
| DOC for partial, refractory | lamictal, oxcarb, Topamax |
| DOC: adjunct: partial, refractory | Gabapentin; Lamotrigine; Keppra; Oxcarb; Topamax; Zonisamide |
| DOC: Genl Seizures, Absence, Newly Dx | Lamotrigine; Ethosuximide; Valproate |
| DOC: Primary Genl (Tonic-Clonic) | Topiramate; Valpro (Alt: Lamotrigine) |
| Status Epilepticus: Tx: | IV Diazepam (slow push x 2 min); IV Lorazepam; Phenobarb injxn if failure of benzo & PHT |
| Tx for high grade gliomas | Primary tx = surg resection, RTx, CTx; most sig prognostic factors: extent of surg resection, age, & performance status |
| First treatment modality for high grade glioma | Surgery |
| Std tx for WHO III &IV gliomas: | Radiation tx (role of RT in WHO II gliomas is controversial) |
| Brain tumor: Rad Tx Modalities: | Whole brain (ltd use now in gliomas); Focal RTx: Conventional high-dose (59.4 Gy x 42 days; 2 cm border around tumor area) or IMRT; Stereotactic (gamma-knife) |
| Std of care: high grade gliomas | Resection; RTx & 42 days temozolomide; then (if stable dz), adjuvant CTx |
| Brain tumor: CTx: passage across BB depends on: | Molecule Size; Lipid solubility; Ionization state |
| medically intractable epilepsy | failure of 2 or more medications to prevent further seizures |
| success rate of temporal lobectomy for tx of epilepsy | 85-90% remain seizure free for life |
| Phenytoin (a hydantoin) MOA | Stabilize neurons from hyperexcitability by controlling cellular Na, without depressing CNS |
| Ethosuximide MOA | Motor cortex depression and elevated stimulatory threshold by reducing low threshold thalamic calcium currents |
| Benzodiazepine MOA | potentiate effects of GABA =. decrease seizure activity |
| Carbamazepine MOA | Reduce response and potentiation of impulses |
| General tonic-clonic seizure tx | valproate, carbamazepine |
| simple partial seizure tx | carbamazepine |
| complex partial seizure tx | carbamazepine |
Created by:
Abarnard
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