Bcacp - Neurology Exam Questions And Answers

Causes of cognitive impairment? Depression, thyroid disease, B12 or folate deficiency, Drug induced (anticholinergic, BZD etc), substance abuse, CNS or UTI infection, vascular dx, stroke Common test used in clinical practice for AD? Mini mental state examination Screening tool - not diagnostic Normal MMSE score? 24-30 Mild and moderate impairment according to MMSE? 17-23 10-16 Cholinesterase inhibitors - approved for severe AD? Inc acetylcholine availability donepezil and rivastigmine patch (galantamine and oral rivastigmine = mild-mod only) What are the factors for selecting first line AD drug? All work the same, donepezil best tolerated (donepezil 23 mg is poorly tolerated) Warnings/cautions with cholinesterase inhibitor use? COPD or asthma; slow HR, peptic ulcer disease (increase gastric acid production) Dose of galantamine, donepezil, memantine, rivastigmine galant = 4- 12 BID (minimum effective dose = 16mg/day) donep = 5 - 10 daily to 23 memantine = 5/day until max 10 bid riva = 1.5 BID to max 6 bid (target dose) MOA of memantine, what severity of AD is it approved? NMDA rec antagonist Namenda, XR mod to severe (no efficacy data for mild) Mono +/- AChEI What is the only AD drug that we worry about renal fx? Memantine CrCL 5 = 30mg BID or 14mg XR Primary drug induced causes of cog impairment? anticholinergic, BZD, CNS active Cholinesterase inhibitor AE? GI, wt loss, bradycardia, exacerbation of pulmonary disease memantine AE? constipation, dizzy, headache Inhibitory neurotransmitter GABA Excitatory neurotransmitter Glutamate gabapentin mg daily Sedation, wt gain Dec dose in renal dysfx venlafaxine 75-225mg HTN Dec dose if CrCl 50 carbamazepine Tegretol. Monitor CBC. Enzyme inducer. 4-12 mcg/mL. HLA-B phenytoin Dilantin. Highly protein bound. 10-20 mcg/mL. fosphenytoin Loading dose IV/IM NTE 150 mg/min - dilute with NS only zonisamide Zonegran Trmt refractory seizure Potent inducers CBZ, phenobarb, phenytoin, primodone Potent inhibitor VPA valproic acid Depakote. 50-100 mcg/mL. Preg D phenobarbital Luminal. Major sedation. ethosuximide Zarontin. Absence seizure. lamotrigine Lamictal Good for renal dysfx Takes several wks to get to effective dose Pregnancy D valproate, phenytoin, carbamazepine, clonazepam, topiramate oxcarbazepine Trileptal. Hyponatremia. topiramate Topamax. Hyperthemia. Kidney stones. levetiracetam Keppra. No significant DDI. Renally eliminated Absence seizure ethosuximide, lamotrigine, VPA Bone d/o in epilepsy DXA every 5-years Ca 1200mg + vit D 800 IU Generalized seizure lamotrigine, topiramate Cluster HA trmt O2 x 15-20 mins, IN or INJ triptan - sumatriptan = SC, nasal - zolmitriptan = nasal Prevention: verapamil, Li, topiramate naratriptan Amerge. Onset 1-3 hrs. Long duration. frovatriptan Frova. Onset 2-3 hrs. Longest duration. Can be used for prevention rizatriptan Maxalt PO, ODT (mint) sumatriptan Imitex.