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Flashcards in Treatments 1 Deck (168)
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1

Bacterial meningitis <1 month

Ampicillin (Listeria) + cefotaxime/gentamicin (E. coli, GBS)

2

Bacterial meningitis (1 month-60 yrs)

Cefotaxime/Ceftriaxone (S. pneumo, N. meningitidis), Vancomycin (MRSA), Dexamethasone

3

Bacterial meningitis > 60 yrs

Ampicillin (Listeria), Cefotaxime/Ceftriaxone (S. pneumo, N. meningitidis), Vancomycin (MRSA), Dexamethasone

4

Prophylaxis, meningococcal/HiB meningitis

Rifampin or Ciprofloxican

5

Fungal meningitis

Amphotericin B intrathecally

6

TB active infection (meningitis, pulmonary)

Rifampin, Isoniazid, Pyrazinamide, Ethambutol

7

Viral meningitis

Supportive, empiric abx until bacterial meningitis excluded, Acyclovir if suspected HSV

8

Reye syndrome

Supportive

9

Viral encephalitis

Supportive, maintain normal ICP, Acyclovir until HSV r/o

10

Brain abscess empiric abx for comorbid oral, sinus, ear infx

Metronidazole + 3rd gen ceph (ceftriaxone)

11

Brain abscess empiric abx for hematologous spread, neurosurgery

Ceftriaxone + vancomycin (MRSA)

12

Brain abscess

Empiric abx, corticosteroids for mass effect (to decrease swelling), usu need neurosurgical drainage

13

Rabies

Clean wound thoroughly, Rabies IG + vaccine

14

Tension HA

NSAIDs, can use triptans, dihydroergotamine

15

Cluster HA

100% O2 (>6 L/min on non-rebreather for >15-20 min)
Can use triptans, dihydroergotamine

16

Migraine HA

Triptans (sumatriptan) or Dihydroergotamine (vasoconstrictors), NSAIDs, anti-emetics (chlorpromazine, prochlorperazine, metoclopramide) in varying combos

17

Pseudotumor cerebri

Acetazolamide (first line, start low and increase)
Discontinue inciting agents (vit A, Accutane, long term tetracyclines for acne, corticosteroid withdrawal), weight loss if obese
Invasive - serial LPs, optic nerve sheath decompression, lumboperitoneal shunting

18

Trigeminal neuralgia

Carbamazepine (first line), Baclofen (alone or combo), Anticonvulsants, Surgical decompression

19

First TIA

ASA + statin if LDL >100

20

TIA/stroke due to AF

Warfarin + statin if LDL >100

21

TIA/stroke + CAD

Clopidogrel + statin if LDL >100

22

Repeat TIA/stroke while on ASA

Clopidogrel or Aggrenox + statin if LDL >100

23

CAD surgical indications

Carotid endarterectomy:
Symptomatic patients w/ narrowing 70-99%
Symptomatic men w/ narrowing 50-69%
Asymptomatic patients w/ narrowing 80-99% if life expectancy >5 yrs

24

CAD nonsurgical treatments

HTN 35, TG <7%
Smoking cessation, exercise, red wine (avoid heavy drinking), ASA/Aggrenox/Clopidogrel

25

Ischemic stroke

Thrombolysis w/i 3-4.5 hrs, 6 hrs if direct catheter to brain and no C/I (hemorrhagic - look at CT/MRI, recent surgery/bleed, current AC, BP >185/100)
Antiplatelet started w/i 48 hrs (ASA/Clopidogrel/Aggrenox, Warfarin)
Statin started w/i 3 days
BP control if >220/120 or if CAD (wait for BP control in ischemic, may decrease perfusion)
PT, treat underlying disorders

26

Hemorrhagic stroke

Reverse AC (restart 2 wks after stable)
Control BP
Control ICP
Surgical decompression w/ shunt if blood collection
Usu need neurosurgery consult
PT, treat underlying disorders

27

Control increased ICP

Mannitol (lasts 4-5 hrs)
Hyperventilation
Anesthesia
Head of bed to 30 degrees

28

Parenchymal hemorrhage

Supportive, control ICP
Seizure prophylaxis w/ anticonvulsants
Surgical decompression if large
AVM or aneurysm repair if needed

29

SAH

Reverse and d/c AC
Systolic BP <150 if cognitive fxn intact (Labetalol, avoid nitroprusside and nitroglycerine - can +ICP)
Nimodipine (CCB) to prevent vasospasm
Good brain environment (avoid hypoxia, hypoglycemia; maintain normal pH, euvolemia, normothermia)
Ventriculostomy to monitor ICP in some patients
Surgical clipping/coiling if aneurysm

30

Epidural hematoma

Control ICP, good brain environment
Drain blood (surgical burr hole, drain w/ radiographic guidance)