year 3. > neuro tx > Flashcards

neuro tx Flashcards

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1
Q

Tx for MND

A

No cure, tx symptoms

  • MND specialist nurses
  • tx comm. needs (speech therapy, voice banking)
  • nutritional tx (dietitian, PEG -percutaneous gastrostomy tube-)
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2
Q

Bulbar dysfunction MND tx

A

Comm aids (AAC)

Nutritional saliva

Gastrostomy

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3
Q

Botulism tx

A
  • antitoxin but only useful if given early before toxin has attacked nerves
  • therefore mainly supportive: Ventilation (otherwise will die)
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4
Q

Myasthenia gravis tx
(Not emergency)

A

1st line: pyridistigmine (long acting anticholinesterase inhibitor)

Long term: high dose prednisolone then Steroid sparing agents- aza/mycophenolate

thymectomy

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5
Q

which antibiotic should be avoided in mysathenia gravis

A

Gentamicin

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6
Q

Guillian barre syndrome tx

A

1st line:Immunoglobulin infusion
2nd: plasma exchange

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7
Q

Ms relapse tx
(mild, moderate and severe)

A

Mild: symptomatic tx

Moderate relapse: high dose oral steroids- oral methylprednisolone 0.5g daily for 5 days.

Severe relapse: admit for IV steroids (short period)

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8
Q

Ms spasticity tx
(first line and others)

A

baclofen and gabapentin first line
physio (important)

Botox for rare and severe cases

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9
Q

Ms sensory tx

(4)

A

Anti convulsant eg. Gabapentin

Anti depressant eg. Amitriptyline

Tens machine

Acupuncture

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10
Q

Acute pharmacological tx for migraines

A

NSAIDS (asp. Naproxen. Ibuprofen) and oral triptan +/- anti-emetic
or
oral triptan + paracetomol +/- anti- emetic

Take as early as poss.
If gastroparesis consider anti-emetic

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11
Q

When is prophylaxis for migraines given.

How long must they be tried fof

A

If >3 attacks a month/very severe

Must trial each for min. 3 months

Consider non pharmacological eg. Acupuncture, relaxation excersizes

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12
Q

prophylaxis for migraines

A

1st line:
- propanolol
Avoid in asthma, PVD, heart failure
or
topiramate (carbonic anhydrase inhibitor) (Na+ channel blocker)
AVOID in women of childbearing age as it may be teratogenic/reduce effectiveness of hormonal contraceptive

2nd:- Amitriptyline (blocks serotonin re-uptake) (causes vasoconstriction)
Se. Dry mouth, postural hypertension

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13
Q

if pharamocoligical prophylaxis migraine mx fails then consider…

A

10 weeks of acupunture

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14
Q

Tension headache tx

A

Relaxation physio

Antidepressant- dothiepin/Amitriptyline
- 3 months Rx

  • reassure
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15
Q

Cluster headache tx

A

High flow o2 for 20 mins

Sub cut sumatriptan 6mg injectable

Acute tx^^^^

long term: verapamil / Steroids- reduce course over 2 weeks

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16
Q

Cluster headache prophylaxis

A

Verapamil

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17
Q

Hemicrania tx

A

Indomethacin (absolutely cured by this, if not then it is a diff diagnosis)

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18
Q

Idiopathic raised intracranial pressure tx

A

Weight loss

Acetozalmide

lumbar puncture used for short term management

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19
Q

Trigeminal neuralgia tx

A

1st line: Carbamazepine,
(other drugs: gabapentin, phenytoin, baclofen)

Surgical (rare): ablation compression , decomrpession

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20
Q

when to refer for tigeminal neuralgia

A

failure to respond to tx/ atypical features:
-sensory changes
- deafness/ear problems
-hx of skin/oral lesions
-pain only in opthalmic division or bilaterally
-fam hx ms
- <40 yrs old

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21
Q

Giant cell arteritis tx

A

High dose steroids

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22
Q

When is acute blood pressure mx indicated for stroke

A
  • bp only lowered in the acute phase of stroke in
  • ICH (intracerebral haemorrhage) as to reduce haematoma expansion
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23
Q

Mx of intarcerebral harmorraghe

A

Correct clotting- vit k antagnoist, doac patients consider reversal

Control bp- sbp goal: 130-139 in <1hr & sustain for 7 days

surgical decompression for the well but deteriorating patient

Unless
Gcs<5…
(150-229 tx in <6hrs of symptom onset to achieve)

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24
Q

Primary generalised epilepsy
(same tx as tonic/atonic)
males
females

A

males
1st line: sodium valproate

Females: Lamotrigine

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25
Focal onset epilepsy tx
1st line: Levetiracetm or Lamotrigine 2nd: carbamezapine (same for men and women)
26
When to give epileptic drugs
Epilepsy Seizure with high risk of recurrence If they want it...
27
absence seizures tx
first: ethosuximide 2nd male: sodium valproate 2nd female: Lamotrigine or levetiracetm
28
LEMS (Lambert Eaton Myasthenic Syndrome) tx
3-4 diaminopyridine (increases ach, this helps as lems is due to voltage gated calicum channels not working properly= reduced ach= reduced muscle contractions)
29
Emergency tx for myasthenia gravis
plasmapharesis and IV immunoglobulins
30
mx of raised ICP
sedation: propofol, benzos, barbiturates maximise venous drainage; head of bed tilt (30 degrees), cervical collars et tube ties CO2 control- HYPERVENTILATION ( dec CO2= cerebral artery vasoconstriction) osmotic diuretics; mannitol, hypertonic saline CSF release If all the above fails then decompressive craniectomy
31
Myasthenia Gravis tx
first: pyridostigimine (long acting acetylcholinesterase inhibitors) 2nd: + prednisolone 3rd: aza etc 4th: thymectomy
32
chronic stroke managemen
HALTS -Hypertension: anti-hypertensive therapy started 2 weeks post stroke -Antiplatelets: 75mg clopidegrol once daily -Lipids-lowering: atorvastatin 20mg-80mg once nightly -Tobacco: stop Sugar- screen for diabetes
33
what type of stroke patients are offered cardioendarterectomy
patients who have had a TIA w/ ipsilateral carotid artery stenosis greater than 50%
34
suspected TIA management and when/what kind of referral
aspirin immediately (unless contraindicated*) If TIA 7 days ago: refer for specialist review w/in 7 days. **Contraindicated if patient is on DOAC/warfarin/has a bleeding disorder
35
when is aspirin contraindicated as TIA management
if patient has a bleeding disorder patient is already taking low dose aspirin
36
following a first seizure when should anti-epileptic drug treatment be commenced
following first suspected seizure, must be refferred for specialist review. anti-epileptic drug tx should not be started before review unless; -seizure activity on eeg - presence of a neurological defect - presence of structural brain abnormality - pt, parent or carer considers risk of further seizure to be unacceptable
37
what epilepsy patients can be prescribed midazolam
pts. with previous episode of prolonged/sewuential generalised seizures (so they can use midazolam in event of status epilepticus)
38
viral encephalitis tx
IV aciclovir
39
essential tremor tx 1st line tx
propanolol 1st line
40
ischaemic stroke secondary prevention management
clopidogrel 1st line 2nd: aspirin + mr dipyridamole 3rd: dipyridamole
41
management after TIA diagnosed
1st line: clopidogrel -aspirin + dipyridamole should be given to patients who cannot tolerate clopidogrel - high intensity statin
42
brain abscess tx
craniotomy abscess cavity debrided IV 3rd-generation cephalosporin + metronidazole intracranial pressure management: e.g. dexamethasone
43
symptomatic and defintive tx for normal pressure hydrocephalus
symptomatic- lumbar puncture defintive: ventirculo-peritoneal shunt
44
intracranial venous thrombosis tx
acutely- low molecular weight heparin long term- warfarin
45
subdural haemorraghe tx
small and asymtomatic- conservative otherwise- surgery: - acute- decompressive craniectomy -chronic- burr holes to relieve pressure
46
neurpathic pain tx
first-line treatment*: amitriptyline, duloxetine, gabapentin or pregabalin if the first-line drug treatment does not work try one of the other 3 drugs in contrast to standard analgesics, drugs for neuropathic pain are typically used as monotherapy, i.e. if not working then drugs should be switched, not added
47
myoclonic epilepsy tx
first-line: levetiracetam second line: lamotrigine (Sodium val very effective but not used due to risk of teratogenicity and is contrindicated in women under 55. Has to be prescribed by 2 specialists).
48
bladder dysfunction Multiple Sclerosis management
ultrasound first to assess bladder emptying if significant residual volume → intermittent self-catheterisation if no significant residual volume → anticholinergics eg. oxybutnin
49
acute stroke management: who is offered thrombectomy anterior circulation
offer thrombectomy within <6 hours of symptom onset if confirmed occlusion of proximal anterior circulation (CTA/MRA) if > 6 hours but <24 hours offer trhombectomy if above ^ AND potential to salvage brain tissue (ct showing limited infarct core volume) for all scenarios do with thrombolysis if within 4./5hours symptom onset
50
posterior circulation and thromebctomy: who should get it? (4)
acute ischaemic stroke <12 hours of onset. confirmed intracranial vertebral/basilar artery occlusion. NIHSS score is 10 or more, favourable PC-ASPECTS score and Pons-Midbrain Index
51
acute stoke management: thrombolysis
it is administered within 4.5 hours of onset of stroke symptoms and haemorrhage has been definitively excluded (i.e. Imaging has been performed)
52
how is vasospasm avoided in SAH
nimidopine (dihydropyridine CCB)- 21 day course (vasospasm occurs in SAH patients and causes subsequent ischaemic damage)
53
supportive management of SAG
rest etc. venous thromboembolism prophylaxis discontinuation of antithrombotics.
54
surgical management of subarachnoid haemorrhage
most intracranial anyuersms are treated with a coil, preferably within 24 hours
55
1st line tx for spinal cord compression from malignancy
dexamethasone + PPI
56
how does metocolpramide work
dopamine antagonist- anti emetic
57
give examples of anti-emetics which are dopamine antagonists
metoclopramide, domideperone (does not cross brain barrier), prochlorperazine
58
initial empirical antbiotic tx for bacterial meningitis ages 3 months - 60 years
IV cefotaxime Add vanc if recent prolonged/multiple abx use or travel to areas with highly resistant pneumococci. IV dexamethasone- before or w/ first dose of abx. No later than 12 hrs after starting abx. - avoid in septic shock, meningococcal septicaemia or if immunocomprimised or in meningitis following surgery
59
initial empirical therapy for bacterial meningitis >60 yrs
IV cefotaxime + amoxicillin add IV vancomycin if recent prolonged/multiple antibiotic use or travel to areas with highly resistant pneumococci IV dexamethasone the BNF recommend to 'consider adjunctive treatment with dexamethasone (particularly if pneumococcal meningitis suspected in adults), preferably starting before or with first dose of antibacterial, but no later than 12 hours after starting antibacterial; avoid dexamethasone in septic shock, meningococcal septicaemia, or if immunocompromised, or in meningitis following surgery'
60
initial empirical antbiotic tx for bacterial meningitits <3 months old
IV cefotaxime + amoxicillin (or ampicillin)
61
meningococcal meninigits antibiotic tx
IV benzylpenicillin or cefotaxime (or ceftriaxone)
62
Meningitis caused by Listeria abx tx
IV amoxicillin (or ampicillin) + gentamicin
63
mangement of patients for bacterial meningits without indication for delayed lp
IV access → take bloods and blood cultures Lumbar puncture IV antibiotics- empirical until known cause. IV dexamethasone (unless septic shock, meningococcal septicaemia, immunocompromised, or in meningitis following surgery)
64
immedieate management for GCS less than 8
intubate
65
wernickes encephalopathy tx
IV pabrinex (thiamine)
66
parkinsons: 1st line tx for improving daily activities
levodopa eg. co-careldopa
67
degenerative cervical myelopathy tx
decompressive surgery
68
Ms fatigue tx
Amantadine or modanifil
69
Ramsay hunt syndrome tx
Prednisolone + aciclovir
70
chronic primary pain tx
avoid all analgesia apart from anti-depressants.
71
peritumoural vasogenic oedema tx
glucocorticoids eg. dexamthasone this is given as the oedema can affect neuron transmission. glucorticoids reduce the oedema
72
narcolepsy tx
daytime stimulants eg. modanifil and nightime sodium oxybate
73
Hospital management of under 16s with a head injury and 1 risk factors (as opposed to 2)
Observe for a minimum of 4 hours from time of injury. If during observation there is a GCS<15, further vomiting, further episode of abnormal drowsiness then CT head injury
year 3.
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