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Neuro > Therapeutics > Flashcards

Therapeutics Flashcards

1
Q

Causes of secondary headache

A
  • Trauma or injury to head/neck
  • Cranial / cervical vascular disorder
  • Non-vascular intracranial disorder
  • Infection
  • Homeostasis disorders
  • Disorders of the cranium, neck, any parts of the face / head
  • Psychiatric disorders
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2
Q

Red flags for headaches

A
  • Systemic symptoms including fever
  • Neoplasm in history
  • Neurologic deficit or dysfunction
  • Onset is sudden
  • Older age > 50 y.o.
  • Pattern change or recent onset of headache
  • Positional headache
  • Precipitated by sneeze, cough, exercise
  • Papilledema
  • Progressive headache with atypical presentation
  • Pregnancy or puerperium
  • Painful eyes with autonomic features
  • Post-traumatic onset
  • Pathology of immunocompromised
  • Painkiller overuse
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3
Q

Infrequent episodic TTH

A

at least 10 episodes so far and average <1 episode/month

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4
Q

Frequent episodic TTH

A

1-14 days/month for more than 3 months

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5
Q

Chronic TTH

A

15 or more days/month for more than 3 months

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6
Q

Episodic migraine

A

At least 5 migraine attacks in a lifetime, lasting 4-72 hours

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7
Q

Chronic migraine

A

At least 15 MHDs and at least 8 MMDs, for more than 3 months

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8
Q

Etiology of acute symptomatic seizures

A

Metabolic:
- Hyponatremia, hypocalcemia, hypomagnesemia, hypoglycemia

Toxic substances/drugs:
- Illicit drugs
- Medications (TCA, carbapenems, baclofen)
- Alcohol
- Benzo withdrawal

Structural damage:
- Stroke
- Traumatic brain injury

Infection/inflammation:
- CNS infections
- Febrile illnesses

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9
Q

Etiology of epilepsy

A

Structural:
- Hippocampal sclerosis
- Brain tumours
- Vascular malformation
- Glial scarring

Genetic:
- Dravet syndrome with SCN1A mutation

Neurodegenerative:
- Alzheimer’s

Metabolic:
- Inborn errors of metabolism
- Mitochondrial disorders

Infectious:
- Bacterial meningitis, encephalitis, neurocysticerosis

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10
Q

Symptoms of focal onset seizure

A

Motor:
- Clonic movements of the arm, shoulder, face, leg
- Speech arrest

Sensory:
- Numbness and tingling
- Visual disturbance, flashes of light
- Epigastric sensation

Autonomic:
- Sweating, salivation, pallor
- BP, HR deranged

Psychic:
- Flashbacks
- Hallucinations
- Affective symptoms (fear, depression, anger)

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11
Q

Symptoms of generalised tonic-clonic seizures

A

Tonic phase (beginning of GTC):
- Stiffening of limb, rigid posture
- Loss of consciousness
- Breathing may decrease/cease
- Cyanosis of nails, lips & face
- Usually lasts 10-20 seconds

Clonic phase:
- Jerking of limb & face that is asymmetrical and irregular
- Return from cyanosis
- Usually lasts 1 min
Across both phases:
- Incontinence, biting of tongue and mouth
- Noisy, laboured breathing

Subsequently:
- Brain is hyper polarised and insensitive to stimuli
- Lethargy, confusion, headache
- Full recovery may take a few hours

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12
Q

Symptoms of absence seizures

A
  • Lapse in awareness
  • Usually lasts a few seconds
  • More in children
  • Not associated with aura
  • Produces characteristic 3Hz spike waves
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13
Q

Symptoms of atonic seizures

A
  • All postural tone is suddenly lost
  • Short duration
  • Occurs in any age
  • Associated with diffuse cerebral damage & learning disability
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14
Q

Triggers for epilepsy

A
  • Hyperventilation
  • Photostimulation
  • Physical & emotional stress
  • Sleep deprivation
  • Sensory stimuli
  • Infections
  • Hormonal change
  • Drugs (theophylline, alcohol, high-dose phenothiazines, antidepressants e.g. bupropion, tramadol, carbapenems)
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15
Q

Drugs that can precipitate epilepsy

A
  • Theophylline
  • Alcohol
  • Benzodiazepine withdrawal
  • High dose phenothiazines
  • Antidepressants (bupropion, TCA)
  • Carbapenems
  • Tramadol
  • Baclofen
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16
Q

First-line agents for focal onset epilepsy

A
  • Carbamazepine
  • Phenytoin
  • Valproate
  • Levetiracetam
  • Lamotrigine
  • Topiramate
  • Gabapentin
17
Q

Agents for refractory focal onset epilepsy

A
  • Clobazam
  • Pregabalin
  • Perampanel
18
Q

First-line agents for GTC

A
  • Carbamazepine
  • Valproate
  • Lamotrigine
  • Topiramate
19
Q

Agents for refractory GTC

A
  • Clobazam
  • Levetiracetam
20
Q

Agents to be avoided in GTC

A

(If there is myoclonic or absence seizures or in juvenile myoclonic seizure)
- Carbamazepine
- Phenytoin
- Pregabalin
- Gabapentin
- Vigabarin

21
Q

First-line agents for tonic or atonic seizures

A
  • Valproate
  • Lamotrigine (2nd line)
22
Q

Agents to be avoided for tonic or atonic seizures

A
  • Carbamazepine
  • Pregabalin
  • Gabapentin
  • Vigabatrin
23
Q

First-line agents for absence seizures

A
  • Valproate
  • Lamotrigine
24
Q

Agents to be avoided for absence seizures

A
  • Carbamazepine
  • Phenytoin
  • Pregabalin
  • Gabapentin
  • Vigabatrin
25
Q

First-line agents for myoclonic seizures

A
  • Valproate
  • Levetiracetam
  • Topiramate
26
Q

Agents to be avoided for myoclonic seizures

A
  • Carbamazepine
  • Phenytoin
  • Pregabalin
  • Gabapentin
  • Vigabatrin
27
Q

Treatment of initial therapy phase of status epilepticus

A
  • IM midazolam 10 mg (>40 kg) or 5 mg
  • IV lorazepam 0.1 mg/kg/dose (max 4 mg)
  • IV diazepam 0.15-0.2 mg/kg/dose (max 10 mg)

Alternatives:
- IV phenobarbital 15 mg/kg
- PR diazepam 0.2-0.5 mg/kg (max 20 mg)
- IN midazolam

28
Q

What is qualified to be migraine without aura?

A

At least 5 attacks
At least 2 of the following:
- Unilateral
- Pulsating
- Moderate-severe
- Aggravated by or causing avoidance of daily activities

At least 1 of the following:
- Photo/phonophobia
- Nausea/vomiting

29
Q

What is qualified to be migraine with aura?

A

At least 2 attacks
At least 1 of the aura symptoms:
- Visual
- Sensory
- Motor
- Speech
- Brain stem
- Retinal

At least 3 of the following:
- At least 1 aura symptom lasting at least 5 mins
- 2 or more aura symptoms occurring in succession
- Each aura symptom occurring between 5-60 mins
- At least 1 positive symptom
- At least 1 unilateral symptom
- Accompanied with or followed by headache within 60 mins

30
Q

Criteria for migraine prophylaxis

A

AHS
- 2 MHD + moderate disability
- 3 MHD + some disability
- 4-5 MHD + no disability

EHF
- At least 2 attacks causing disability even with optimised treatment
- Risk of medication overuse and patient is fine with daily medicine

Neuro (5 decks)

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