Neuro

Question 1

All of the following are contraindications to the use of triptans? Select all that apply

Ischemic heart disease or cerebrovascular disease
Sustained hypertension
Pregnancy
All SSRI’s
Diabetes
Peptic ulcer
Basilar or hemiplegic migraines

Answer 1

Ischemic heart disease or cerebrovascular disease
Sustained hypertension
Pregnancy
Basilar or hemiplegic migraines

Question 2

All of the following are non-pharmacological treatments of epilepsy EXCEPT ONE, which ONE?

Avoid sleep deprivation.
Minimize the use of alcohol and drugs.
Discuss with the patient and family members precautionary measures to be taken during crises.
Emphasize the importance of observing restrictions on driving vehicles.
Herbal remedies and dietary supplements.

Answer 2

Herbal remedies and dietary supplements.

Question 3

Anti-epileptic drugs have important drug interactions. Which of the following can cause symptoms including cognitive impairment if taken with anti-epileptic drugs?

valproic acid (Depakene)
topiramate (Topamax)
phenytoin (dilantin)
carbamazepine (Tegretol)

Answer 3

topiramate (Topamax)

Question 4

In order to prevent headache by over-consumption of pain medication, it is better to limit the monthly use of non-opioid analgesics to:

Less than 15 days
Less than 10 days
Less than 7 days
Less than 20 days

Answer 4

Less than 15d

Question 5

True or false

Antiviral therapy (acyclovir, famciclovir or valacyclovir) alone provides a significant advantage over placebo in the treatment of Bell palsy?

True
False

Answer 5

False

Question 6

True or False

Donepezil, rivastigmine and galantamine have different structures and modes of action but appear to have similar efficacy in the treatment of Alzheimer’s.

True
False

Answer 6

True

Question 7

True or false

In Bell palsy, there is good empirical evidence of pain relief if corticosteroid therapy initiated early.

True
False

Question 8

True or false

In Bell palsy, there is good empirical evidence of pain relief if corticosteroid therapy initiated early.

True
False

Answer 8

True

Question 9

True or False

In the treatment of epilepsy, divalproex sodium (Epival) is the most desirable option for women of child-bearing age.

True
False

Answer 9

False

Question 10

Which of the following are conditions that are contraindications to the use of beta-blockers in migraine prophylaxis? Select all that apply.

Asthma
Type II diabetes
Heart failure
Hypertension

Answer 10

Asthma
Type II diabetes
Heart failure

Question 11

Which of the following options represent correct prescribing regulations for methyphenidate (Ritalin®)? Select all that apply.

written with repeats
faxed with repeats
verbal with repeats
verbal with no repeats

Answer 11

written with repeats
faxed with repeats
verbal with no repeats

Question 12

Red Flags of Headaches?

Answer 12

S - Systemic symptoms (fever, stiff neck, weight loss) or secondary risk factors (HIV, CANCER)
N - Neurologic symptoms or signs (speech imp, sensation loss, dec LOC)
O - Onset: abrupt, peak< 1 min (thunderclap)
O - Older: first at age > 50 (giant cell arteries, glaucoma)
P - Previous headache history (new or change - more frequent, more severe, different location)
P - Postural, positional
P - Precipitated by Valsalva, exertion, etc. (sex, workout)
P - Papilledema

Question 13

What is the Pharm approach for acute migraine?

Answer 13

Triptan &/or NSAID +/- Antiemetic

Triptan/NSAID Combo product - sumatriptan/naproxen sodium (Suvexx) (max 9d/month)

Triptan max use 9days/month
NSAID max use 14d/m

Question 14

When should migraine prophylaxis be considered?

Answer 14

If >3-6 headache days/month

Question 15

Meds approach to migraines?

Answer 15

identify triggers on calendar, use Tylenol/advil
Almotriptan indicated for kids >12yrs

Question 16

Pregnancy safe meds for acute migraines?

Answer 16

Tylenol, Advil (2nd tri only), metoclopramide, caffeine (<200mg/d), last line - sumatriptan (only safe triptan, but generally avoided)

Prophylaxis - propanolol

Absolutely No ergot, topiramate, valproic acid, ACEs/ARBS

Question 17

Approach to menstrual migraines?

Answer 17

Pre-emptive NSAID (Naproxon 500mg bid), long-acting triptan, estradiol gel starting 2d before menstruation & cont for 6d

Question 18

Migraine Prophylaxis 1st line

Answer 18

Beta-blockers - propranolol or metoprolol
Amitriptyline - 50-75mg hs
Topiramate - 100mg/day
Candesartan 16mg/day (least response from above)

Question 19

What herbal options are available for migraines?

Answer 19

Magnesium citrate best evidence and considered 2nd line, otherwise Riboflavin or Co-Q 10

Research not the greatest for Butterbur

Question 20

Best treatment for tension headaches?

Answer 20

identify stressors, simple analgesics, prophylaxis best: amitriptyline

Question 21

When do you consider a medication overuse headache?

Answer 21

When there is inc HA freq, inc acute med use, dec efficacy of acute meds

Defined as:
- ≥10 days/month for ergots, triptans, opioids and combination analgesics
- ≥15 days for non-opioid analgesics: acetaminophen and NSAIDs

Question 22

What is the best preventative agent in pregnancy?

Answer 22

Propanolol

otherwise: magnesium, amitriptyline

Question 23

Folic acid recommendations for pregnancy when on anti epileptics:

Answer 23

SOGC: 1mg folic acid daily from 3m preconception to 12w gestation then switch to 0.4-1mg

Canadian Headache Society: 4-5mg folic acid for people of childbearing potential age when on valproic acid

Question 24

When should cholinesterase inhibitors be avoided or discontinued?

Answer 24

Bradycardia (caution when on beta-blockers), syncope, active peptic ulcer disease,

Question 25

What is the 1st line med given for dementia?

Answer 25

Cholinesterase inhibitors commonly Donepezil start low and slow. Taper off when needed

Question 26

When should memantine (NMDA receptor antagonist) be considered in dementia?

Answer 26

Only if intolerant of Cholinesterase inhibitors

Question 27

When should seizure meds be initiated?

Answer 27

after a second unprovoked seizure or if there is high likelihood of re-seizing (through MRI or EEG findings)