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