Cognitive Screening Mini – Mental Status Exam – MMSE Montreal Cognitive Assessment – MOCA St Louis University Mental Scale – SLUMS Mood screening: Geriatric Depression.ScaleIADL: Instrumental Activities Of Daily Living Diagnosing Dementia: Rule out delirium and drug-related causes. Other causes: vitamin B12 deficiency, hypothyroidism, depression, NPH, opioids, sedative-hypnotics, antidepressants, anticholinergics, antiparkinson’s drugs Treatment: Initiate a cholinesterase inhibitor in […]
Neurology
Anxiety, OCD and PTSD
Generalized Anxiety Disorder (GAD): 6 months or more of excessive worry or anxiety. OCD – intrusive thoughts that can not be controlled PTSD: trauma related to avoidance of stimuli. Benzos are the first line therapy in anxiety. Can cause tolerance or dependence. Abrupt discontinuation can lead to withdrawal. Treat for 3-4 weeks until trial for […]
Seizures: Emergent and Codes
*See the seizure medication table for quick reference. Seizure overview. Head trauma: Early seizure – within first 7 days, prevent with 5/mg/kg day phenytoin (valproate has higher mortality) No prophylaxis for late seizures. Emergent: For emergent seizures, benzos are the drug of choice to stop seizing. Lorazepam – onset 2-3 minutes, 0.1 mg/kg up to 4 […]
Seizure Medication Table
Table: 1 – first line drug, 2 – second line drug, 3 – some effect, 4 – adjunctive therapy, 5 – used only when benefits outweigh risks Drug Focal Tonic-Clonic Absence Atypical Absence Atonic Myoclonic Infantile Spasms Status Epilepticus Lennox Gastaut Acetazolamide 4 4 3 3 Brivaracetam 3 […]
Ischemic Stroke
Risk factors: Age: risks double every decade over 55 Race: more risk in native Americans, second highest risk in African Americans then whites. Sex: risk higher in men Low birth weight Family History Diabetes Hypertension Oral contraceptive use Post-menopausal hormone use Atrial fibrillation Coronary artery disease Asymptomatic carotid stenosis Dyslipidemia Obesity Physical inactivity Sickle Cell Disease […]
Parkinson’s Disease
In patients who need to be initiation on dopaminergic agents, either levodopa or dopamine agonists can be used. Levodopa is better at improving motor functions, dopamine agonists are better at lessening motor complications. May also use a MAOI (rasagiline or selegiline only, they increase extracellular dopamine). Carbidopa/Levodopa is the mainstay of therapy, but often clinicians will use […]
Headache
Acute: Treat with NSAIDS, APAP, 5-HT receptor antagonists (triptans). Prophylaxis: Avoid precipitants, TCAs, propranolol, topiramate, verapamil, valproic acid, NSAIDs, Botox, Magnesium, Vitamin B12, CoQ10, feverfew Migraine: If they are recurrent, interfere with daily activities or patient prefers prophylactic therapy, prophylaxis should be considered. Use lowest effective dose, give 2 – 3-month trial, consider a choice that also […]