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50 Cards in this Set
- Front
- Back
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What labwork should be done to rule out MS?
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Sed rate, Lyme titer, Antinuclear antibody (ANA), B12 level, Vitamin D level
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What will an MRI with Gadolinium reveal in a patient with MS?
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plaques but cannot determine if lesions are specific to MS
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What will the CSF from a lumbar puncture reveal in a patient with MS?
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Oligocional bands (CSF protein) Increased immunoglobin G (IgG) Increased WBC |
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Why does a visual evoked potential (VEP) get done in a patient with MS?
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Evoked potential Evoked response to assess nerve conduction |
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If 2 or more attacks or 2+ objective clinical lesions are seen in an MS clinical presentation, what additional data is needed?
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NONE
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If 2 more attacks or 1 objective clinical lesions are seen in an MS clinical presentation, what additional data is needed?
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dissemination in space on MRI Positive CSF increased to 2 or more MRI lesions attack involving different sites |
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If 1 attack or 2+ objective clinical lesions are seen in an MS clinical presentation, what additional data is needed?
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dissemination in space on MRI 2nd clinical attack |
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If 1 attack or 1 objective clinical lesions (clinically isolated syndrome = CIS) are seen in an MS clinical presentation, what additional data is needed?
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dissemination in space on MRI Positive CSF increased to 2 or more MRI lesions dissemination in time on MRI or 2nd attack |
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If insidious neurological progression in an MS clinical presentation, what additional data is needed?
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1 year of disease progression
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Using a multidisciplinary approach, who should a patient with MS be referred to?
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Neurologist for MS center Urology for bladder dysfunction Ophthalmology for baseline and ongoing monitoring Psychiatry for depression, coping Dermatology for skin, pressure, incontinence |
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What patient education should be offered to a patient who suffers from MS?
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Heat sensitivity - can aggravate symptoms Elevated temperature can further impair the demylinated nerve to conduct electrical impulses Advice: avoid heat, stay hydrated, ingest ice-cold water to bring down core temp, use cooling vest or cap |
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What is used for MS pharmacotherapy?
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Diease Modifying Agents to suppress immune system & slow progression |
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What is the immunomodulatory therapy for MS?
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For replapsing-remitting tx: Interferon (beta 1a and 1b) --> betsaeron, avonex, rebif, extavia glatiramer (copaxone) = synthetic protein natalizumab (tysabri) = monoclonal antibody |
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What bloodwork should be monitored with the immunomodulatory therapy for MS?
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-->depression LFT CBC |
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What is the immunosuppressive therapy for MS?
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For secondary-progressive OR progressive-relapsing mitoxantrone (novatrone) = antineoplastic --> can cause cardiomyopathy azathioprine (imuran) methotrexate (rheumatrex) cyclophosphamide (cytoxan) |
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What is prescribed for MS spasticity?
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Baclofen
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What is prescribed for MS urinary retention?
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Flomax Hytrin |
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What is prescribed for MS bladder spasms?
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Ditropan Detrol |
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What is prescribed for MS depression?
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SSRI
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What is prescribed for MS fatigue?
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Provigil Nuvigil Ritalin Symmetrel |
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What is the goal of Parkinson's treatment?
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Blocking the effect of acetylcholine with anticholinergic drugs Administration of levodopa, the precursor of dopamine |
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When is a CT or MRI of brain indicated for Parkinson's disease?
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Poor response to medication
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Why is Selegiline (Eldepryl) used for Parkinson's disease?
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INITIAL TREATMENT MAO (monoamine oxidase) inhibiter delays breakdown of dopamine may delay need for levodopa neuroprotective |
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Why are anticholinergics: Benztropine (Cogentin) & Trihexyphenidyl (Artane) used for Parkinson's disease?
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used to control tremor & rigidity watch for mental status changes dry mouth blurred vision |
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Why are antiviral: Amantadine (Symmetrel, Symadine) used for Parkinson's disease?
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anti-parkinsonian activity with central anticholinergic effect
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Why is Levodopa used for Parkinson's disease and is important to know about its use? |
--restores amount of dopamine reaching the basal ganglia --precursor to dopamine (which does not cross the blood brain barrier) --tends to be less effective as disease progresses --peripheral metabolism cause side effects such as jerky dance like movement of head |
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Why is Sinemet used for Parkinson's disease and is important to know about its use? |
--it is combination of Levodopa & Carbidopa --blocks peripheral metabolism and allows more of levodopa to enter brain than if levodopa is given alone |
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Why are Dopamine medications: Bromocriptine (Parlodel), Ropinirole (Requip), Pramipexole (Mirapex) used for Parkinson's disease?
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Reduce motor complications of dyskinesia & fluctuations in motor response to levodopa |
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Why are catechol o-methyltransferase inhibitors (COMT): entacapone (comtan) and tolcapone (tasmar) used for Parkinson's disease and is important to know about its use? |
potentiate levodpa effect for "wearing off" effect |
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What is the on-off effect of parkinson's medications? |
--after 2-5 years of treatment more than 50% experience fluctuations & complications in response to levodopa --shortened duration of improvement after each drug dose |
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What are seizure diagnostics? |
MRI = 1st choice*** EEG = may reveal epileptic brain waves abnormalities CT = rules out mass, bleeding, subdural collections, cerebral infarcts |
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What are seizure labworks? |
Blood glucose Drug, alcohol screen CSF, if suspect infection |
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Is the first seizure treated with anti-epileptic drugs? |
NO. seizure lasting longer than 10 minutes = EMERGENCY - Airway, Breathing, Circulation |
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What is NJ law regarding seizures? |
Physician must report: --recurrent convulsive seizures --recurrent episodes of unconsciousness or impairment --epilepsy CAN DRIVE IF SEIZURE FREE FOR 6 MONTHS |
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Which seizure antiepileptic drug (AED) makes oral contraceptives less effective? |
Carbamazepine (Tegretol) induces estrogen metabolism |
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Which seizure antiepileptic drug (AED) can cause Steven Johns Syndrome after 4 months of initiation? |
Carbamazepine (Tegretol) Oxcarbazepine (Trileptal) Phenytoin (Dilantin) Lamotrigine (Lamictal) |
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What is the goal of antiepileptic drug (AED) prescribing? |
Monotherapy least possible side effects (i.e. CNS lethargy, drowsiness) Controlling narrow therapeutic index via blood draw |
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What antiepileptic drugs (AED) have very narrow therapeutic indexes? |
Phenytoin (Dilantin) Carbamazepine (Tegretol) |
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What are first line antiepileptic drugs (AED)? |
Depakote = Divalproex Dilantin = Dilantin Klonopin = Clonazepam Tegretol = Carbamazepine Lamictal = Lamotrigine |
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What are adjunctive treatment antiepileptic drugs (AED)? |
Banzel = Rufinamide Gabitril = Tiagabine Keppra = Levetiracetam Lyrica = Pregabalin Neurontin = Gabapentin Trileptal = Oxcarbazepine Topamax = Topiramate |
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What is the indication for epilepsy sugery? |
Focal seizures Temporal lobectomy 65-95% complete seizure control |
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What blood work is done for Dementia diagnostics? |
CBC, metabolic panel Liver function TSH B12 & folate RPR, VDRL Drug & alcohol levels |
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What diagnostics should be done for Dementia? |
CT scan MRI of brain |
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What should be included in Dementia non-pharamcologic management? |
Safety Driving Healthcare Proxy Durable Power of Attorney |
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What cholinesterase inhibitors are used for Dementia management? |
Donepezil (Aricept) Rivastigmine (Exelon) Galantamine (Razadyne) for mild to moderate disease 1 to 2 year therapeutic span of meds |
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What NMDA (N-methyl-D-aspartate) receptor anatagonists are used for Dementia management? |
Memantine (Nameda) for moderate to severe disease |
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What referrals should be made once dementia is diagnosed? |
PT for exercise & adaptive equipment OT for safety Driving evaluations Speech therapy for swallowing evaluation Neurology Neuropsychology Geri psychiatrist (Hospice) |
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What diagnostics can be done for delirium? |
CT or MRI of head Lumbar puncture EEG = slowed brain waves |
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What blood work may be done for delirum? |
CBC, metabolic panel, urinanalysis, urine culture, thyroid , drug levels |
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What is the pharmocological management of delirum? |
haloperidol (haldol) droperidol (inapsine) |
