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