neuro

Question 1

abortive treatments for migraine (mild to moderate)

Answer 1

simple analgeisc, NSAIDS, como analgeiscs (like APAP/ASA/caffeine),

Question 2

abortive txs fo rmigraine (mod to severe)

Answer 2

5HT receptor agonists (triptans), ergotamine preps (a little more dangerous than triptans because of ergotism)

Question 3

rescue therapies for migraine

Answer 3

corticosteroids, opoid combos

Question 4

for which drug class should you evaluate possible cardiovascular disease first?

Answer 4

triptans

Question 5

how is headache severity classified?

Answer 5

Mild: Patient is aware of headache but able to continue daily routine with minimal alteration  Moderate: The headache inhibits daily activities but is not incapacitating
 Severe: The headache is incapacitating
 Status: A severe headache that has lasted more than 72 hours

Question 6

best combo analgesic for migraines

Answer 6

APAP/ASA/caffeien

Question 7

medication overuse HA criteria

Answer 7

AHeadache present on ≥ 15 days/month fulfilling criteria C and D
B. Regular overuse for > 3 months of one or more drugs that can be taken for acute and/or
symptomatic treatment of headache
C. Headache has developed or markedly worsened during medication overuse
D. Headache resolves or reverts to its previous pattern within 2 months after discontinuation of
overused medication

Question 8

consider prophylactic migraine tx when

Answer 8

Frequent headaches (>2/week)
 Migraine significantly interferes with patient’s daily routines, despite acute treatment
 Contraindication to, failure, adverse effects, or overuse of acute therapies
 Patient preference
 Presence of uncommon migraine conditions, including hemiplegic migraine, basilar
migraine, migraine with prolonged aura, or migrainous infarction

Question 9

3 beta blockers that are studied and effective for migraine prophylaxis

Answer 9

propranolol, timolol, metoprololf

Question 10

are ARBs and ACE effective for migraine prophylaxis?

Answer 10

possibly

Question 11

AE of beta blockers for migraine prophylaxis

Answer 11

fatigue, depression, nausea, dizziness, insomnia, exercise intolerance

Question 12

DOC for migraine prophylaxis. other options?

Answer 12

beta blockers; other options are TCAs (amitryptiline), SNRIs (venlafaxine), AEDs (valproic acid, topiramate)

Question 13

what are some natural products that are effective for migraines?

Answer 13

caffeine (enhancs NSAIDS), chasteberry (PMS), magnesium (if low magnesium), butterbur extra, feverfew, riboflavin, coenzyme Q, melatonin

Question 14

what is the most important thing to monitor patents migraines?

Answer 14

headache diary

Question 15

how long should you wait for HA to be controlled before considering tapering prophylactic tx?

Answer 15

3-6 mo

Question 16

AE of sumatriptan
indication
CI
trade name 
dosage forms

Answer 16

ae: Dizziness, sensation of warmth chest fullness & nausea most common
Angina, arrhythmia, cerebral & myocardial ischemia rare (

Question 17

1 abortive therapy for cluster HA; second line tx

Answer 17

oxygen; second line are triptans and ergots

Question 18

prophylactic therapy for cluster HA

Answer 18

verapamil (best), lithium, prednisone, ergotamine (rescue)

Question 19

first line tx’s for conjunctivitis (bacterial)

Answer 19

trimethoprim + polymyxin B; ciprofloxacin ointment , bacitracin ointment + polymyxin B

Question 20

aminoglycoside drops
indication
moa, ae,

Answer 20

MOA: Inhibit bacterial protein synthesis Products
• Tobramycin (Tobrex®): available as generic (less expensive) and less ocular toxicity
• Gentamicin: higher ocular toxicity
• Neomycin: only available as a combo, high ocular toxicity Uses
• Most effective against G- (esp. Pseudomonas)
• Also synergy against some G+
Adverse Effects: Localized ocular toxicity and hypersensitivity, lid itching, lid swelling and conjunctival erythema (

Question 21

FQ drops

moa, ae, indication

Answer 21

MOA: Inhibits bacterial DNA gyrase Products
• Ciprofloxacin (Ciloxan®) 2nd generation
 solutionandointment
 canpptoutandleaveawhitishsolid
• Ofloxacin (Ocuflox®) 2nd generation
 solutiononly;moresoluble->higheraqueousconcentrations
• Levofloxacin (Quixin®) 3rd generation
• Moxifloxacin (Vigamox®) 4th generation (no-preservative)
• Gatifloxacin (Zymar®) 4th generation (BAK preservative)
• Besifloxacin (Besivance) similar to 4th generation Uses
• Corneal infections/ulcers
• Severe conjunctivitis
Adverse Effects: White crystalline precipitates; lid margin crusting; crystals/scales; foreign body sensation; conjunctival hyperemia; bad/bitter taste in mouth; corneal staining; keratopathy/keratitis; allergic reactions; lid edema; tearing; photophobia; corneal infiltrates; nausea; decreased vision; chemosis.
Comments
• Not used first-line for conjunctivitis due to poor Strep coverage, expense, and resistance concern

Question 22

TMP + polymyxin

indication, moa, ae

Answer 22

MOA: Inhibits folic acid synthesis
Product: Trimethoprim + Polymyxin B (Polytrim®) Uses:
• G+, G- (except Pseudomonas, so add polymyxin for the Pseudomonas activity)
• Especially effective against Haemophilus influenzae and Strep. Pneumoniae Adverse Effects: Low toxicity
Comments
 Good for kids
 Cost-effective, first line treatment for conjunctivitis

Question 23

indications for corticosteroids in eyes

Answer 23

allergic rhinitis, inflammation, or + antibiotic to make it clear faster but increases risk of masking infection

Question 24

what eye med is good for itching?

Answer 24

NSAIDS

Question 25

mild approaches ot allergic conjunctiivsi

Answer 25

1 avoid allergen, 2 artificial tears to dilute, 3 topical antihistamine +/- oral

Question 26

moderate approaches to allergic conjunctivitis

Answer 26

mast cell stabilizers, topical NSAIDS, ST topical corticosteroids

Question 27

cycloplegics indication, moa, ae

Answer 27

Use: For reduction of inflammation and pain Adverse Effects: Increased intraocular pressure; transient stinging/burning; irritation with prolonged use (eg, allergic lid reactions, hyperemia, follicular conjunctivitis, blepharoconjunctivitis, vascular congestion, edema, exudate, eczematoid dermatitis). Comments: • All cycloplegics have red caps • Like putting the eye in a cast

Question 28

when should ointment eye drops be applied?

Answer 28

at hs, b/c blur vision

Question 29

cosmetic agent for increasing eyelash growth, ae

Answer 29

bimatoprost (latisse) could darken iris and skin around eyes

Question 30

drugs that can increase

Answer 30

``` Corticosteroids  Ophthalmic (high)  Systemic  Inhaled/Nasal  Ophthalmic anticholinergics  Vasodilators (low)  Cimetidine (low) ```

Question 31

med for glaucoma that is dosed once/day

Answer 31

prostaglandin analogs (travaprost)

Question 32

first line therapy for glaucoma

Answer 32

travoprost, beta blockers

Question 33

travoprost indications moa ae

Answer 33

Q24h dosing  IOP Lowering up to 28-30%  MOA:  outflow of aqueous humor  Adverse Effects:  Common:  iris pigmentation (latanoprost > travoprost > bimatoprost), growth of eyelashes and itching (15-45%)  Less common: dryness, visual disturbance, burning, eye pain,  pigmentation of skin @ eye  Comments:  First-line therapy (American Academy of Ophthalmology POAG Preferred Practice Pattern, 2015)  Contact lenses: replace 15 min after dose

Question 34

beta blockers eye drops | indications, moa, ae

Answer 34

Example: Timolol (Timoptic)  Q12-24h dosing  IOP Lowering 20-35%  Nonselective (timolol, levobunolol, metipranolol; carteolol with ISA) > selective (betaxolol)  MOA:  production of aqueous humor  Adverse Effects/Contraindications:  Minimal local adverse effects: stinging on application, dry eyes, corneal anesthesia, blepharitis, blurred vision  Systemic AE:  HR & BP, bronchospasm, masked sx of hypoglycemia, CNS sedation (one drop of timolol 0.5% in each eye equals about 10 mg orally)  Contraindications: asthma, COPD, sinus bradycardia, 2-3 heart block, HF, hypersens  Comments: First line therapy

Question 35

adjunct for beta blockers or prostaglandins in eyes

Answer 35

alpha adrenergic agonsits (brimonidine)

Question 36

are oral carbonic anhydrase inhibitors good for glaucoma?

Answer 36

not well tolerated

Question 37

beta blocker/CAI combo example

Answer 37

dorzolamide/timolol (cosopt)

Question 38

after starting a glaucoma med, how soon should you follow up?

Answer 38

2-4 weeks, assess response and adherence