Triptans: selective serotonin receptor agonists and work at the 5-HT1D serotonin receptor site, allowing an increase uptake of serotonin.
Ergotamines: act as 5-HT1A and 5 HT1D receptor agonists and do not alter cerebral blood flow.
NSAIDS: inhibit prostaglandin and leukotriene synthesis and are most helpful when used at the first sign of headache.
Fioricet: caffeine enhances the analgesic properties of acetaminophen, butalbitals barbiturate action enhances select neurotransmitter action.
Midrin: multidrug product that includes a vasoconstrictor, analgesic, and relaxant.
Excedrin Migraine: aspirin, acetaminophen, and caffeine combination. Can cause rebound headaches.
Neuroleptics: may be used as adjuncts in migraine headache therapy, because they help control nausea and vomiting.
Opioids: migraine rescue.
An infection of the meninges, CSF, and ventricles. It can be bacterial (pyogenic) or viral (aseptic).
Occurs via hematogenous spread. Organisms can enter the meninges through the bloodstream from other parts of the body. It also can be from an infection such as otitis media or bacterial rhinosinusitis. It is contagious through droplets.
Signs & Symptoms of Meningitis:
Presence of Kernig signs(lying supine and the hip flexed at 90 degrees; positive sign when extension of knee from this position elicits resistance or pain in the lower back or posterior thigh) and Brudzinki signs (passive neck flexion in a supine; results in flexion of the knees and hips)
Less common: seizures, vomiting, and altered consciousness
Diagnosis of Meningitis:
Lumbar puncture with CSF
CT or MRI of the head before LP
Treatment for people in contact of infected patient more than 4 hours:
Rifampin, ciprofloxacin, and ceftriaxone.
Treatment of Meningitis:
Ceftriaxone with Vancomycin
Focal neurologic dysfunction, with symptoms occurring acutely, worsening over a few days, and lasting weeks, followed by a period of partial to full resolution. MS is characterized by exacerbation and remission.
Common symptoms of MS:
weakness or numbness of limb
monocular visual loss
facial weakness or numbness
Two forms of MS:
Relapsing-remitting MS-episodes resolve with good neurologic function between exacerbations and minimal to no accumulative defects
Chronic progressive MS-episodes do not fully resolve and there are accumulative defects
Treatment of MS:
Maintenance-Betaseron or Avonex
Immunosuppressive therapy-methotrexate or mitoxantrone
Slowly progressive movement disorder that is largely caused by an alteration in dopamine-containing neurons of the pars compacta of the substantia nigra.
Diagnosis of Parkinson:
Six cardinal signs: tremor at rest, rigidity, bradykinesia, flexed posture, loss of postural reflexes, and masklike facies
Early treatment of Parkinson:
Absence: blank staring lasting 3-50 seconds accompanied by impaired level of consciouness
Myoclonic: awake state or momentary loss of consciousness with abnormal motor behavior lasting seconds to minutes; one or more muscle groups causing brief jerking contractions of the limbs and trunk, occasionally flinging patient
Tonic-clonic: rigid extension of arms and legs followed by sudden jerking movements with loss of consciousness; bowel and bladder incontinence common with postictal confusion
Simple partial or focal: awake state with abnormal motor, sensory, autonomic, or psychic behavior; movement can affect any part of body, localized or generalized
Complex partial: aura characterized by unusual sense of smell or taste, visual or auditory hallucinations, image or sound, stomach upset; followed by vague stare and facial movements, muscle contraction and relaxation, and autonomic signs; can progress to loss of consciousness
Treatment of Seizures:
an acute neurologic even in which all signs and symptoms, including numbness, weakness, and flaccidity, as well as visual changes, ataxia, or dysarthria, resolve usually within minutes but certainly by 24 hours after onset
Condition in which the patient exhibits an acute onset, over hours to a few days, of reduced ability to maintain attention to external stimuli and appropriately shift attention to new stimuli. Resulting in disorganized thinking.