Card Set Information
Review for NP Boards
Abortive treatment for Migraine Headache
NSAIDs (ASA, ibuprofen, naproxen, ketoprofen)
What are some preventive medications for migraine headaches
Calcium channel blockers
TCA - used as off label
What two classes of drugs are used to "abort" headaches:
Triptans (Serotonin 5HT1 receptor agonists
- Almotriptan (Axert)
- Naratriptan (Amerge)
- Sumatriptan (Imitrex)
- Zolmitriptan (Zomig)
- dihydroergotamine (Migranal)
What are the prophylactic agents used to treate headaches:
Propanolol (inderal LA)
In what type of patients should you not describe "Triptans" to?
patients with coronary artery disease
patients with poorly controlled hypertension
Triptans are vasoconstrictors therefore can cause rise in BP and increase risk for Stroke
Can you use triptans and ergotamine together within a 24 hour period?
No, avoid concomitant use of triptans and ergotamine within a 24 hour period
Pregnancy/Lactation Considerations -
What Pregnant Category are Triptans?
What Pregnant Category are Ergotamine?
Triptans are Pregnancy Cat. C (benefits vs. risk must be weighed)
Ergotamine are Pregnancy Cat. X (Avoid use in pregnancy)
What is Trigeminal Neuralgia?
A disorder of the 5th cranial nerve (trigeminal nerve) which produces severe pain in the lip, gum, cheek, and/or face
What is the etiology (cause) of Trigeminal Neuralgia?
Compression of the 5th cranial nerve from unknown causes, tumors or vascular malformations
What is the assessment findings of Trigeminal Neuralgia?
severe pain in the lip, face, mouth, gum, cheek
pain may be in "bursts", with pain free period after bursts
pain may be elicited by touch, changes in temperature or a light breeze on the cheek
May initially thought to be of dental origin. very unbearable
What drug is used as first line treatment for Trigeminal Neuralgia?
100mg PO BID
What Pregnant Category is Carbamazepine?
What do you have to monitor?
Pregnant Category D (not safe to use)
Check carbamazepine levels
Check LFT and CBC
monitor for hyponatremia and decrease WBC or platelet counts, discontinue if evidence of bone marrow depression occurs
Definition of Syncope
A sudden, brief loss of consciousness with a spontaneous recovery
List and explain the seven etiology of Syncope:
- decrease cardiac output from peripheral vasodilation and bradycardia
- due to medications, hypovolemia, autonomic dysfunction
- due to coughing, micturition or defecation
- due to sudden decrease in cardiac output (aortic stenosis, arhythmias)
Carotid sinus syncope
- manual pressure/stimulation of the carotid arteries
6. other causes - depression, ETOH, Drug abuse, psychogenic, subclavian steal syndrome, cardiomyopathy
What diagnostic studies needs to be done on a patient with syncopal episode?
BP in both arms (difference of 20 mm Hg or more considered abnormal)
Orthostatic Vital Signs
Flexion/Extension of neck 10 times to stimulate vertebrobasilar insufficiency
Flexion/extension of arms to stimulate sx of subclavian steal syndrome
Neuro exam (CT, MRI, EEG if abnormal)
What is considered normal on orthostatic vital signs?
normal findings are systolic pressure decrease of less than 10 mmHg
increase in diastolic 2-5 mmHg
increase in heart rate 5-20 beats
(if HR does not increase, consider cardiac origin)
What are some prevention and nonpharmacological managment for a patient with syncope?
Prevention - rise slowly from lying or sitting or standing
Nonpharmacologic Mgmt -
elevate patients leg if due to vasovagal or hypotension
elastic support stockings to prevent orthostatic hypotension
change position slowly
increased sodium intake to help expand volume
Why do pregnant woman experience synocpal episode?
What position should they be in?
Vasovagal syncope may present in pregnant women from compression of the vena cava and aorta
positioning the pregnant woman on her left side should relieve the compression and the symptoms
What is the definition of a Transient Ischemic Attack (TIA)
TIA - a sudden onset of neurological deficits which is caused by cerebral ischemia and lasts less than 24 hours
What are some causes of TIA
atherosclerotic disease within the brain and/or carotid arteries
microemboli from atrial fibrillation, cardiac valve disorders
could be spontaneous
cerebral artery vasospasm
use of oral contraceptive
What medicatons do you need to place patient who just experience a TIA on?
Antiplatelet therapy (clopidogrel 75mg QD)
ASA or Ticlopidine (Ticlid 250mg BID)
What kind of prevention and/or nonpharmalogical management can we do for patients with TIA?
control their blood pressure, lipids and diabetes
Define seizures disorders (convulsion, epilepsy):
seizures which are recurrent are termed:
a transient alteration in behavior with or without loss of consciousness, sensory perception, motor function and/or autonomic function.
seizures are due to excessive rate of neuronal discharges
seizures which are recurrent are termed epilepsy
Which seizure disorder is considered a medical emergency?
Name two types of seizures and their descriptions:
- begins with motor symptoms characterized by recurrent contractions of muscles in one part of the body
- Simple - consciousness not impaired, Jacksonian-type seizures begin in one part of the body and progress to contiguous body parts over seconds or minutes
- Complex - consciousness impaired
- Mixed - begin as simple or partial and evolve into generalized tonic/clonic; consciousness impaired
- bilaterally symmetrical but without local onset
- Absence (Petit Mal) - brief arrest of activity and loss of consciousness
- Atypical absence
- Myoclonic - muscle movements are repetitive
- Tonic Clonic
- Tonic, clonic or atonic seizures
Meningitis: inflammation of the brain and spinal cord caused by infection with bacteria, viruses and fungi. Occasionally parasites are responsible for meningitis
List three etiologies of Meningitis:
Bacterial (strep pneumoniae - most common)
Viral (enterovirus- most common)
What is the most common meningitis seen in immunocompromised adults, especially those with AIDS
Cryptococcal meningitis - most common meningitis seen in immunocomprised adults, especially those with AIDS
Assessment findings of a patient with Bacterial meningitis:
neck pain/stiff neck
nausea and vomiting, especially in children
decreased level of consciousness
postitive Kernig and Brudzinksi signs
Assessment findings of an infant with Bacterial meningitis:
sleeping more than usual
cries when moved
What is a Positive Kernig Sign?
Kernig Sign - complete extension of leg causes neck pain and flexion
What is a Positive Brudzinski sign?
Brudzinski sign - flexion of legs when neck is passively flexed.
(passively flex patient neck, if infection is present, patient will bend their legs)
Assessment findings of a patient with viral meningitis:
illness last 2-6 days
Assessment findings of a patient with Fungal Meningitis:
worsening headaches over a period of days
vomiting for days or weeks
Diagnostic findings of meningitits:
CSF Gram stain and cultures
: CSF may be turbid, presence of WBC's and elevated protein levels
CSF decrease glucose if bacterial
CSF Gram stain and cultures
: presence of infectious agent
: elevated WBC
: positive 80% of time
What is the pharmacological management of a patient with Meningitis:
Abx specific for culture
: Ampicillin PLUS 3rd generation cephalosporin; may need to add aminglycoside
: may decrease morbidity and mortality
Analgesics for headache
Antivirals not recommended.
Define Multiple Sclerosis:
a disease of the central nervous system which is slow and progressive. It is characterized by demyelination of nerve cells in the brain and spinal cord which produces a variety of neurologi deficits
Assessment findings of a patient with Multiple Sclerosis:
paraesthesias in extremities, weakness or clumsiness of a hand or leg
stiffness or unusual fatigability of a limb
transient blindness or pain in the eye
speech may be slow with hesitancy at beginning of word
mild emotional disturbances (apathy, lack of judgment, emotional lability) due to scattered CNS involvment
difficulty with bladder control
deep tendon reflexes increased; superficial reflexes dimished
Charcot's triad (scanning speech, nystagmus, tremor) common in later stages of disease
Management of a patient with Multiple Sclerosis:
What are the goals of pharmacologic manangement?
avoid factors which precipitate attacks (hot weather, fatigue)
Goals of pharmacologic treatment are to slow disease progression, improve symptoms and decrease relapses.
No current therapy is completely effective