Neurology Medications – Flashcards

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