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Neuro Tx 2

Neurology

QuestionAnswer
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