Neurology Medications – Flashcards
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What is the inflammation of the membranes of the brain?
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Meningitis
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What is the inflammation of gray and white matter of the brain?
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Encephalitis
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What is the inflammation of the spinal cord? It can be infectious or non-infectious.
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Myelitis
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What is it called If CNS infection spreads from adjacent structures, such the sinuses and middle ear?
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Contiguous spread
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What is called if systemic bacterial infection spreads to the CNS?
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Hematogenous seeding
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What is called if a dormant infection is reactivated?
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Reactivation
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Which route of CNS infections is caused by trauma, neurosurgery, and/or shunts?
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Direct inoculation
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In a treatment plan for bacterial meningitis, what is the most important portion that should begin immediately?
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Empiric Abx therapy (bactericidal)
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In a treatment plan for bacterial meningitis, what type of empiric abx dose is given at initiation?
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High-dose
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Prior to giving an abx for Bacterial meningitis, what is usually needed (if possible) ?
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LP and culture specimen
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What factors are taken into account for an abx to naturally penetrate the CSF?
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molecular weight (low), lipid solubility (high), and protein binding (low)
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What increases CSF penetration? What is done if there inadequate CSF penetration?
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- increased meningeal inflammation - intrathecal
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What is the fastest and most direct route for bacterial meningitis treatment?
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- IV therapy
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What is commonly seen in children and young adults in close living quarters?
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N. meningitidis
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What is the most common route of entry for N. meningitidis? What are the 2 most common symptoms?
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nasopharyngeal petechial rash and behavior changes
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What is 1st line of treatment for N. meningitidis?
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3rd generation cephalosporin
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What is used as an alternative for serious allergies to cephalosporin? Why is this drug avoided?
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Cholarphenical Toxic to liver and bone
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Those in close contact to one infected with N. meningitis, would use which medications?
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1) ** Rifampin 2) alternative: Ciprofloxacin
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What is recommended to help prevent N. meningitis? Who is highly recommended this vaccine? What age has FDA indicated this be a routine vaccination?
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- Meningococcal vaccine - close living quarters (college, military) - 11-12
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What population of people are more susceptible to S. pneumonia bacterial meningitis?
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- >60 yo - alcoholics - immunocompromised - splenectomy - sickle cell - cochlear implants
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What is absolutely necessary vaccination for someone who has a splenectomy or high risk situations?
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pneumococcal vaccine
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Where is primary place of infection for S. pneumonia bacterial meningitis?
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ENT/Lungs
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What is the first line medication for a S. pneumonia bacterial meningitis?
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Vancomycin + 3rd generation cephalosporin
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What is used to treat H. influenza bacterial meningitis?
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3rd generation cephalosporin
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Who do you commonly see with L. monocytogenes bacterial meningitis? What is the fist line treatment?
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- neonates, immunocompromised, alcoholics, elderly -Ampicillin
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What is used to treat gram - P. aeruginosa bacterial meningitis?
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_Cefepime or meropenem
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What is used to treat all other gram - bacterial meningitis?
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3rd or 4th generation cephalosporin or carbapenems
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What is the steroid treatment used for bacterial meningitis?
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Dexamethasone
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Dexamethasone is used to diminish the rate of what?
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hearing loss, neurological complications, mortality
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What is the recommended age in infants that a treatment of Dexamethasone can begin?
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> 2 month
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What is best treatment for acute bacterial meningitis of <1 month? What are the most likely organisms?
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- Group B Strep, L. monocytogenes, Klebsiella. - Ampicillin + 3rd gen Ceph (cefotaxime or Ceftriaxone)
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What is best treatment for acute bacterial meningitis of 1-23 months? What are the most likely organisms?
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Strep. pneumo, N. meningitidis, Group B strep, H. influenza, E.coli Vancomycin + 3rd gen Ceph (cefotaxime or Ceftriaxone)?
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What is best treatment for acute bacterial meningitis of 2-50 years? What are the most likely organisms?
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- N. meningitidis, Strep. pneumo - Vancomycin + 3rd gen Ceph (cefotaxime or Ceftriaxone)
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What is best treatment for acute bacterial meningitis of > 50 years? What are the most likely organisms?
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- Strep pneumo, N. meningitidis, L. monocytogenes, aerobic gram (-) bacilli - Vancomycin + 3rd gen Ceph (cefotaxime or Ceftriaxone) + ampicillin
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What is the best treatment for a CSF leak or basilar skull fracture? What organisms are most likely involved?
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- Vanco + 3rd generation ceph - Strep pneumonia, H. influenza
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What is the best treatment open trauma/ neurosurgical procedure?
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Vanco + Cefipime
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Which type of meningitis has s/s and an abnormal LP, but a negative bacterial culture?
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Aseptic Meningitis
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After primary infection, viruses may be dormant in nerve root and reactivate later. What is this?
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Aseptic Meningitis
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What is the most common virus involved in aseptic meningitis?
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Enterovirus
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What is the symptomatic treatment for viral meningitis?
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Rest, fluids, antipyretics, analgesics, antimetics
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Why are steroids avoided in viral meningitis treatment?
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Inhibitory affect on patient's immune function
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What is used for an HSV infection?
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Acyclovir
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What is used for CMV infections?
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Ganciclover
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Which virus in aseptic meningitis uses the trigiminal and olfactory nerve to reach the CNS?
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HSV1
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Which virus in aseptic meningitis uses the sacral nerve to reach the CNS?
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HSV2
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What is used as treatment for resistant HSV and CMV infections?
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Foscarnet
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What can are drug-induced causes of aseptic meningitis?
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- ** NSAIDS - Antimicrobial - Azathioprine - IV IgG - Vaccines - Allopurinol
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What are the 3 groups of CNS stimulants?
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- Methylxanthines - Nicotine - Amphetamine
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Name the Methylxanthines.
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Theophylline, theobromine, caffeine
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What CNS effects does Methylxanthines have? What are the effects if it's a high dose?
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Decreased fatigue Increased mental alertness High amounts - anxiety, tremors
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What develops rapid tolerance and the withdrawal causes fatigue and HA?
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Caffeine Fatigue and HA
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What CV effects does Methylxanthines have?
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positive ionotropic (force contraction) chronotropic (increase contraction rate)
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What GI effects does Methylxanthines have?
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stimulates gastric acid secretion
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What is highly lipid soluble and readily crosses the BBB? Due to it's ability to do this, what effects does it have on the body?
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Nicotine - Euphoria, arousal and appetite suppression, and relaxation
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What are the peripheral effects that nicotine has?
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Vasoconstrictive effects - increase BP and HR, also cause PVD
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What is nicotines therapeutic use?
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Smoking cessation
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What is increases catecholamines in the CNS?
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Amphetamines
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Which portions of the brain do amphetamines stimulate? What effects does this have on a person
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- cortex, brainstem, medulla - increased alertness, insomnia, decreased appetite and fatigue
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What are amphetamines therapeutically used for?
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- ADD/ ADHD - narcolepsy - appetite suppression (limited use)
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What are the amphetamine derivatives?
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- Ritalin, concerta - Daytrana - Focalin - Adderall
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What causes a degeneration of the dopaminergic neurons in the substantial nigra?
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Parkinson's Disease
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What has resting tremors, cogwheel rigidity, and arm swings when walking or shuffling?
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Parkinson's Disease
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What are the 3 general phases of treatment for Parkinson's Disease?
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Lifestyle modification Pharmacologic treatment Surgical treatment
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What is usually the treatment of choice to begin with in Parkinson's Disease? What does each medication assist with?
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Levodopa/carbidopa - dyskinesias Dopamine agonist - improve motor symptoms
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What are the pharmaceutical options for Parkinson's disease?
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Anticholinergic Amantadine MAOI Dopamine agonist Levodopa/ Carbidopa COMT inhibitor
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What blocks the actylecholine in the substantial nigra?
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anticholinergic
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freebie!
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Anticholinergics SE: Xerostomia, blurred vision, constipation, Urinary retention, Sedation, Orthostatic hypotension, confusion.
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What symptoms do anticholinergics improve on Parkinson's Patient's?
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resting tremors and droolings
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List the anticholingeric medications.
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Benztropine Diphenhydramine Trihexphenidyl Orpenadrine
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What should be avoided for patients greater than 70 and should be gradually discontinued to avoid worsening of PD?
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Anticholinergics
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Which antiviral medication id used for mild PD (especially tremors) and decreases motor fluctuations in patients?
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Amantidine
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Name the MOA-B inhibitors for Parkinson's. Whhich is metabolized by amphetamines?
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- Seligene** This one - Rasagaline
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If a patient with PD wants to delay tx with a dopamine agonist, which medication is used?
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MOA-B inhibitors
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Which medication is a precursor of dopamine, allowing it to cross the BBB? When do you use this medication?
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Levodopa For PD patients when symptoms interfere with patient's daily life
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What is decarboxylase inhibitor, blocking the conversion of levodopa to dopamine in the periphery?
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Carbidopa
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What increases the CNS penetration of Levodopa and decreases SE?
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Carbidopa
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What can you add to levodopa/carbidopa as the disease progresses and medication needs to be taken more frequently?
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Dopaminergic agonists
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What may delay the onset of levodopa/carbidopa?
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Stomach before meals
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What prevents peripheral degradation of Levodopa?
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COMT inhibitors
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What are COMT inhibitors used to treat?
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PD
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What are the COMT inhibitor drugs? Which one causes serious liver toxicity? Which has a shorter half life?
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Tolcapone - serious liver toxicity Entacapone - shorter half life
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Name the two categories of dopamine agonist.
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Ergot derivatives Non-ergot derivatives
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Name the ergot derivative drugs.
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Pergolide Bromocriptine
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Name the non-ergot derivative drugs.
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Pramipexole Ropinirole Apomorphine Rotigotine
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What are dopamine agonist used for during the first 5 years PD?
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decrease risk of motor fluctuation
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Progressive dementia affecting both cognition and behavior.
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Alzheimer's disease
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Which class of medication prevents the break down of Ach? When are these used?
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Cholinesterase inhibitors Mild to moderate Alzheimers
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With Cholinesterase inhibitors, what must be done over several weeks for all medications?
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Titration
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Name the cholinesterase inhibitor drugs.
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1) Tacrine 2) Donepezil 3) Galantamine 4) Rivastigmine
