near high yeild Flashcards
(29 cards)
how is CGRP calcitonin gene related peptide involved in migraines
during cortico-spreding depression it causes the realise of CGRP this causes vasodilation and neurogenic inflammation
how do triptans work
triptans bind to serotonin and decrease CGRP release
what is the first line treatment for acute migraines
ibruprofan 400mg increase to 600mg if needed
or
aspirin 900mg
or
paracetamol 1000mg
these should be taken as the symptoms arise
consider triptan with NSAID
oral sumatriptan 50-100mg alone (or with naproxen is the most effective)
offer an anti - emetic such as metroclopromide or prochloperezine 10mg for nausea and vomiting
what is a contraindication to triptan use
cardiovascular disease as they cause vasoconstriction
stroke
hypertension
use rimegpant instead
what kind of drug is rimegepant
CGRP antagonist
what advice should be given with migraine medication
limit to 2 days a week or 10 days a month to avoid MOH
what is the preventive treatment (reduce the occurrence of migraines)
beta blocker - propranolol
topiramate *pregnancy contradiction
tricyclic antidepressants - amitriptyline 25- 75mg at night
candasartan 16mg *pregnancy contradiction
sodium valproate over 55
flunarizine CCB
DOSES SHOULD BE GRADUALLY INSCREASED
what are other preventative treatments
botox around the head
CGRP monoclonal antibodies monthly
what is the acute treatment for tension headaches
paracetamol
NSAIDS
what is the preventative treatment for tension headaches
tricyclic antidepressants amitriptyline
what is a key feature of tension headaches
bilateral described as a tight band
what is a differential for cluster headaches
paroxysmal hemicarina
they are shorter but more frequent can last up to 30mins.
what is the treatment for paroxysmal hemicarina
indomethacin
what is the normal duration of cluster headaches
5mins 3hrs and 1-8 episodes a day
what is the treatment for acute cluster headaches
triptans
6mg sumatriptan s/c
zolmathiptal nasal
ORAL TRIPTANS NOT EFFECTIVE
oxygen therapy 10-15l for ANS symptoms
what is the transitional therapy for cluster headaches
(shortens cluster from 1 month to a week for example)
oral prednisone taper by 10mg every 2 days
greater occipital block - steroid (depomedrone) and local anaesthetic (lidocaine) to reduce inflammation and headache
what is the preventive treatment for cluster headache
veramipril 960mg
check each for heart block
toprimate
what is the treatment for myasthenia gravis
antichoinesterase pyridostigmine
neostigmine
steriods - prednisolone
immunosupression - azathiprine
what is the classic triad seen in meningitis
neck stiffness fever and altered mental status
neck won’t move to chin
fever >38
GCS<14
what are the most common organisms of bacterial meningitis
neisseria meningitis
streptococcus pneumonia
what is the most common cause of viral meningitis
enterovirosus
what should you look for in meningococcal meningitis
a rash that does not blanch
what is the corpus callosum
large bundle of nerve fibres connecting the cerebral hemispheres
what is the treatment for Gillian bers syndrome
immmunitherapty
