WorksheetsE2 Neurology
Total questions: 91
Worksheet time: 2hrs 31mins
(Select multiple) NON-modifiable stroke risk factors
Smoking
Age
Low birth weight
Ethnicity
What effect of low birth weight is a notable contributor to stroke risk?
Delayed Nephrogenesis
Necrotizing Enterocolitis (NEC)
Sleep apnea of the premature
Large birth weight
(True/False) Transient Ischemic Attacks can often predict future strokes.
True
False
Best definition for a penumbra regarding stroke?
The area surrounding the darkest point of a shadow
An area of potentially savable tissue if revascularized
The unsavable tissue in an ischemic infarction
The area directly targeted by alteplase (tPA)
You're asked to treat a SAH. What do you use?
Nicardipine
Nifedipine
Nimodipine
Ticlodipine
Select the 3 major manifestations of hemorrhagic stroke.
Major darkened areas on MRI/CT
Headache w/o loss of consciousness
Headache w loss of consciousness
Sudden lapse of consciousness
(Select both) What are the primary glial cells of the CNS?
astrocytes
Schwann cells
oligodendrocytes
Bands
What is the primary glial cell of the PNS?
Schwann cells
oligodendrocytes
astrocytes
CD52 expressing cells
(Select both) Choose the best mechanisms of interneurons
CNS - excitatory - glutamate and acetylcholine
CNS - excitatory - carbidopa and levidopa
PNS - inhibitory - GABA and glycine
PNS - excitatory - GABA and glycine
Choose the correct definition of seizure propagation
The breakdown of normal function in multiple areas and hyper-synchronization causing excessive excitation
A single seizure lasting >5 min
Two seizures within 5 min w/o a return to normal
1-2 min of tonic-clonic movements
(Select both) What is the definition of Status Epilepticus (StEp)
The breakdown of normal function in multiple areas and hyper-synchronization causing excessive excitation
A single seizure lasting >5 min
Two seizures w/in 5 min w/o a return to normal
1-2 min of tonic-clonic movements
(Select 3) Choose the best order of treating Status Epilepticus (StEp)
Immediate termination with an AED
Immediate termination with parenteral benzo
Prevention/Loading with Keppra, Fosphenytoin, or VPA
Control if necessary with an AED
What drugs are useable for Absence Seizures?
VPA, Phenytoin, Keppra
Ethosuximide, Phenytoin, Keppra
VPA, Ethosuximide, Lamotrigine
Lamotrigine, Carbamazepine, Oxcarbazepine
What is the only type of seizures Carbamazepine can't be used for?
Absence
Tonic-clonic
Generalized
Focal
(Select 2) What drugs inhibit T-type Ca channels?
Ethosuximide
Depakene
Tegretol
Oxcarbazepine
What drugs slow the rate of voltage gated Na channels?
Depacon, Topamax, Zonisamide
Ativan, Versed, Gabapentin
Abbath, Demonaz, Iscariah
Felbamate, Shingrix, Lyrica
What is the dosing for IV Ativan for seizure cessation?
0.1 mg/kg to a max of 4 mg
0.2 mg/kg to a max of 10 mg
20 mg PE/kg to a max of 150 mg PE/min
20-40 mg/kg @ 3-6 mg/kg/min
What is the dosing of IM Versed for seizure cessation?
0.1 mg/kg to a max of 4 mg
0.2 mg/kg to a max of 10 mg
20 mg PE/kg to a max of 150 mg PE/min
20-40 mg/kg @ 3-6 mg/kg/min
What is the dosing of fosphenytoin for seizure cessation?
0.2 mg/kg to a max of 10 mg
20 mg PE/kg to a max of 150 mg PE/min
20-40 mg/kg @ 3-6 mg/kg/min
20-40 mg/kg @ 1.5-3 mg/kg/min
What is the dosing of Depacon for Pediatric seizure cessation
0.1 mg/kg to a max of 4 mg
0.2 mg/kg to a max of 10 mg
20-40 mg/kg @ 1.5-3 mg/kg/min
20-40 mg/kg @ 3-6 mg/kg/min
What is the dosing of Depacon for Adult seizure cessation
0.1 mg/kg to a max of 4 mg
0.2 mg/kg to a max of 10 mg
20-40 mg/kg @ 1.5-3 mg/kg/min
20-40 mg/kg @ 3-6 mg/kg/min
After loading someone with Keppra, how will they appear?
Sleepy and confused
Angry and combative
Unbalanced
Ready for Med History to come ask questions
(Select multiple) Select the correct options for Pediatric Focal seizures
A - Oxcarbazepine
B - Ethosuximide
C - Carbamazepine, Phenytoin, VPA, phenobarbital
D - Zonisamide and Lamotrigine
What are the preferred loading AEDs for pregnant people?
Valproate
Lamotrigine or Keppra
Phenytoin and Phenobarbital
Spironolactone
What is a major ADE for phenytoin/fosphenytoin?
Intracranial hemorrhage
MAO overactivity concurrent with cocaine use
Cytokine storm
Cerebrum and Vestibular toxicity
What are the preferred (A) AEDs for Adult Focal?
Gabapentin and Lamotrigine
Carbamazepine, Keppra, Phenytoin, Zonisamide
Clonazepam and Primidone
Ethosuximide and VPA
(Select multiple) What are some alternatives for Adult Focal seizures?
B - Valproate
C - Carbamazepine
C - GABA, phenobarbital, lamotrigine, oxcarbazepine
D - Topamax, Valproate
(Select multiple) What are the top two categories for Elderly Focal seizures?
A - Gabapentin and lamotrigine
C - Carbamazepine
C - Gabapentin and Carbamazepine
D - Zonisamide
(Select multiple) What are some good options for generalized seizures?
carbamazepine
VPA and phenobarbital
ethosuximide and vigatraban
Topamax
What are the three primary ADEs for Carbamazepine?
SJS, severe hyponatremia, CBZE toxicity
Cerebrum or vestibular toxicity
Renal calculus
Urge to attend pharmacy school
If using VPA, (select two)
Half phenobarbital doses
Half phenytoin doses
Do not use VPA
Prefer Oxcarbazepine over carbamazepine
Aside from SJS and insomnia, what is ethosuximide's main ADE?
Blood dyscrasia (e.g. anemia)
Hyponatremia
SIADH
metabolic acidosis
Select Valproate's major considerations
Hepatotoxicity
Severe birth defects
Thrombocytopenia
Malignancy
Best drug for neonatal seizures?
Phenobarbital
Valproic acid
Keppra
Brivaracetam
Select the preferred indications for anticoagulants
Warfarin - valve replacement
Warfarin - primary stroke prevention without AFib
Xarelto - can't keep up with more than one pill per day
(Select Multiple) When is a higher INR goal used for replaced valves and TE risk reduction?
Higher risk valve type (Mechanical)
Higher risk valve placement (Mitral)
Thrombocytopenic patients
Younger patients
What anticoag regimen is used for valve replacements?
Aspirin with or without warfarin only
Aspirin and Plavix
Any DOAC
Idarucizumab
When can a thrombolytic be used?
Intracranial hemorrhage is confirmed
Patient is presenting 6 hrs after symptom onset
bp >185/110
Intracranial hemorrhage is ruled out
For which of the following can tPA be used?
Transient Ischemic Attack
Stroke with hypertensive crisis
Blocked un-bursted vessels in the brain
Stroke following a previous stroke a month ago
(Select multiple) What are some more contraindications for alteplase?
Thrombocytopenia or active major bleeding
Significant injury to head or malformation
NIH stroke scale @ 26
Severe hypoglycemia or hyperglycemia
What is the initial dosing for alteplase?
0.9 mg/kg up to 90 mg (100 kg)
2 mg/kg to a max of 4 mg
500 mg PR
6
(Select multiple) Choose some of the following recommendations after tPA is used
Delay Aspirin for 24 hrs
Neuro exams every 15 minutes until 2 hrs post-infusion
CT/MRI after 24 hrs and before giving anticoag
Immediate heparin
(Select multiple) Choose the correct times to use a bp med before tPA can be used.
Heart failure - Clevidipine
COPD - Cardene or Clevidipine
High Triglycerides - Clevidipine
CCB hypersensitivity - Normodyne
(Select multiple) What are some acceptable secondary prevention drugs when indicated?
Ticlodipine or Ticagrelor
Statins
Aspirin, Aggrenox, or Plavix
ACE, ARB, Thiazide diuretics
Post-stroke, is primary or secondary prevention used?
Primary
Secondary
Both?
None
Which cardioembolism anticoag isn't adjusted for renal function directly but is complicated by an SCr >= 1.5?
Edoxaban (Savaysa)
Brilinta
Plavix
Eliquis
Which major cardioembolism anticoag is dosed once a day?
Xarelto
Plavix
Pradaxa
How does pharmacy treat hemorrhagic stroke?
Lots of Aspirin and Plavix
Alteplase!
Both of the above
None, can't really do anything
What is the general first line for Parkinson's?
Rasagiline
Pramipexole
Carbidopa/Levodopa
Botox
What is the 1st action towards low response to Carbidopa/Levidopa?
Decrease dosing frequency
Add a MAO-B drug
Increase dosing frequency
Increase dosing strength
What best describes MAO-B inhibitors used for Parkinson's?
Pramipexole, Ropinirole, Rotigotine
Not Rasagiline, Selegiline, or Safinamide
Less efficacy and less dyskinesia compared to Carbidopa-Levidopa
No risk of serotonin syndrome
What are the primary ADE of dopamine agonists (e.g. pramipexole, ropinirole)?
Orthostatic hypotension and intense nausea
C. diff diarrhea
Murderous rage
Exacerbated motor symptoms
What SQ pen is used for Parkinson's severe freezing episodes?
Dulaglutide
Novolog FlexPen
Apomorphine
Somapacitan-beco
What is the primary purpose of Amantadine for Parkinson's?
Reducing Carbidopa-Levidopa's dyskinesia
Reducing need for istradefylline
Making tolcapone a viable option
Increasing orthostatic hypotension risks
Select the incorrect match
Rasagiline - MAO-B inhibitor
Rotigotine - Dopamine Agonist
Carbidopa-Levidopa - COMT inhibitor
Istradefylline - Adenosine A2A blocker
Which definition is incorrect?
On Period - patient experiences good response to meds
Off Period - symptoms emerge while on meds
Motor fluctuations - a patient is wavering between on and off periods
Dyskinesia - a seizure that begins in one part of the brain and spreads to another
(Select multiple) Check the counseling points for carbidopa-levidopa
You may be taking this more than three times a day
Take on an empty stomach
Don't stop without talking to your doctor
Controlled release or ER forms are first line
What are some problems of dopamine agonists like ropinirole?
Melanoma risk and prolonged use necessary for benefits
Highest risk of motor complications
Brand choices can be cheap
Not available at specialty pharmacies
Why is tolcapone such a bad drug and not to be used?
Frequent recalls
Intense renal toxicity
Fulminant hepatic failure
Blepharitis
What are the more severe side effects of amantadine?
Fulminant hepatic failure
Acute Kidney Injury
Hallucinations and edema
Superinfection
When could amantadine, MAO-B inhibitors, and dopamine agonists be first line
>65 years
Severe motor symptoms
<65 years, mild motor symptoms or only tremor
Prone to C. diff diarrhea
Select the correct meaning of SCME
Sensory Creative Manipulative Executive
Sensory Cognitive Motor Executive
Schwann Cells Mediate Everything
Which of the following is not helpful for MS patients?
Basal corticosteroid prophylaxis
Vitamin D supplements
Nicotine cessation
Early diagnosis
General, basic treatment for MS flares
Hydrocortisone cream
Prophylactic antibiotics
High dose short term corticosteroids
Glatiramer po
What best describes primary progressive MS (PPMS)?
An episode lasting >24 hours detectable by MRI
Distinguishable attacks and remissions; the most common diagnosis
Continuously worsening neuro function
What best describes relapsing-remitting MS (RRMS)?
An episode lasting >24 hours detectable by MRI
Distinguishable attacks and remissions; the most common diagnosis
Continuously worsening neuro function
What best describes Clinically Isolated Syndrome (CIS)?
An episode lasting >24 hours detectable by MRI
Distinguishable attacks and remissions; the most common diagnosis
Continuously worsening neuro function
Select all cells that play a role in MS
Th1 and Th17
CD52+ CD4+ T cells
Schwann cells
Oligodendrocytes
A patient with a current MS attack isn't responding to high dose steroids. What do you recommend?
Hydrocortisone cream
Glatiramer STAT
Corticotropin (ACTH)
Mitxantrone
Which of the following poses a threat to most MS therapies?
John Cunningham Virus
Hepatitis A
Ebola
Which of the following is incorrect regarding DMTs for MS?
Effect could take 1-2 years of use
Interferons (IFNs), glatiramer, and terifulnomide are reasonable for CIS
Natalizumab holds the highest risk of JCV
Spasticity is rare and unlikely for MS
What is considered first line for MS-related gait disruption and weakness?
Amantadine
Dalfampridine
SSRIs or TCAs
Propranolol
What is considered first line for MS-related Fatigue?
Amantadine
Dalfampridine
SSRIs or TCAs
Propranolol
Which of the following isn't a consideration for interferon (IFN) use for MS?
First dose needs to be at an HCP's office
Complications with depression
Transient hypersensitivity
Flulike symptoms requiring NSAIDs and potentially steroids
What 1st gen MS drug has the least side effects with the exception of a transient hypersensitivity?
Mitoxantrone
Interferon 1b
Peginterferon beta-1a
Glatiramer
Select all of the considerations for Mitoxantrone
Significant immunosuppression and leukemia
Hepato- and cardiotoxicity
Infertility
Alopecia
Which of the following is a first dose only concern for 2nd gen MS drugs and is the reason most are given in an office despite being a tablet?
Intense bradycardia
Macular edema
Skin cancer
Infection
What is the contraindication for most of the -mod drugs for MS?
Macular edema
Concurrent steroid use
Drug abuse
Major cardiovascular problems
Which MS drug has a contraindicated for certain CYP 2C9 polymorphs?
Siponimod
Natalizumab
Teriflunomide
Dimethyl fumarate
What MS drug can't be given to those wishing to be pregnant within 2 years?
Teriflunomide
Siponimod
Corticotropin (ACTH)
Nicorette
Check all of the side effects for dimethyl fumarate and diroximel fumarate
Flushing
Hepatotoxicity
Cardiotoxicity
1st dose bradycardia
Which of the following may not be a consideration for MS -mab drugs?
Listeria infection with Alemtuzumab (Lemtrada)
Latent infection risk like TB, JCV, or Hep B
Highest risk of PML (JCV) with Natalizumab (Tysabri)
Multiple doses per day
What is the correct consideration for Cladribine for MS use?
Lymphocyte count increase
Not separated from other drugs by 3 hours
Frequent dosing
Warnings for malignancy, teratogenicity, and herpes prophylaxis when leukopenic
Select the incorrect drug-mechanism
Ocrelizumab (Ocrevus) - anti-CD20 and anti-B cells
Alemtuzumab (Lemtrada) - anti-CD52
Natalizumab (Tysabri) - anti-CD8
Natalizumab (Tysabri) - reduces leukocyte transmission to brain
Select the incorrect drug-mechanism
Mitoxantrone - topoisomerase II inhibitor
Dimethyl and Diroximel fumarate - antioxidative
Cladribine - CD8 and CD4 promoter
Fingolimod (Gilenya) - activated lymphocyte release blocker
Select the 3 side effects for baclofen
Lower seizure threshold
hyponatremia
Sedation
Cognitive dysfunction
Which two spasticity drugs have considerable hepatic warnings?
baclofen
tizanidine
dantrolene
botox
What is the standard progression of therapy regarding spasticity?
Baclofen, Tizanidine, Gabapentin, Diazepam
Baclofen, Diazepam, Tizanidine, Gabapentin
Diazepam, Ativan, Lorazepam, Valium
Diazepam, Gabapentin, Glatiramer, Baclofen
Which spasticity drugs can't be used after a recent stroke?
Gabapentin and Diazepam
Botox and Diazepam
Baclofen and Tizanidine
Dantrolene and Diazepam
What is inhibited by drugs like tolcapone and entacapone?
The entry of carbidopa into the brain
conversion of levodopa to an inactive metabolite
Subtantia nigra darkening
Extrapyramidal movement
What group of drugs is most helpful for Parkinson's extrapyramidal movements (e.g. jerks and tremors)
Anticholinergics
MAO-B inhibitors
COMT inhibitors
ACE inhibitors
