Pharmacology and Therapy of CNS and ANS

Comprehensive practice flashcards covering pharmacology and therapeutic protocols for CNS infections, cerebrovascular diseases, syncope, and autonomic nervous system disorders based on the lecture transcript.

When is antiviral therapy usually indicated for Cytomegalovirus (CMV) infection in immunocompetent hosts?

It is not usually indicated except in primary CMV infection during early pregnancy, where valacyclovir may reduce the likelihood of fetal infection.

What is the recommended empiric intravenous regimen for bacterial meningitis in adults with normal renal function?

Ceftriaxone ($2\,g$ every $12\,hours$) or Cefotaxime ($2\,g$ every $4$ to $6\,hours$).

Under what condition should Vancomycin be added to the empiric treatment of bacterial meningitis?

In countries with ceftriaxone resistance rates $>1\,percent$, at a dose of $15$ to $20\,mg/kg$ IV every $8$ to $12\,hours$.

What additional antibiotic is recommended for adults $>50\,years$ of age with bacterial meningitis?

Ampicillin at $2\,g$ IV every $4\,hours$.

What is the standard empiric treatment for suspected Herpes Simplex Virus (HSV)-1 encephalitis?

Acyclovir at $10\,mg/kg$ intravenously every $8\,hours$, initiated as soon as possible.

According to the Glasgow and Blantyre scales, what scores define impaired consciousness in cerebral malaria?

Glasgow coma score $<11$ in adults or Blantyre coma score $<3$ in children.

What is the clinical indicator for acidosis in severe malaria?

A base deficit of $>8\,mEq/L$, plasma bicarbonate $<15\,mmol/L$, or venous plasma lactate $>5\,mmol/L$. Clinical indicators include rapid, deep, labored breathing.

What is the recommended dosage for intravenous Artesunate in the treatment of severe malaria?

$2.4\,mg/kg/dose$ at $0\,hours$, $12\,hours$, and $24\,hours$, followed by once daily doses.

Which antimalarial agent should be added for patients with severe malaria due to P. vivax or P. ovale to target liver stage forms?

Primaquine.

What are the six classic clinical findings of tetanus caused by Clostridium tetani toxin?

1. Stiff neck, 2. Opisthotonus, 3. Risus sardonicus, 4. Board-like rigid abdomen, 5. Periods of apnea/upper airway obstruction, 6. Dysphagia.

Why does neonatal tetanus typically progress more rapidly (over hours rather than days) compared to adults?

Because axonal length is proportionately shorter in infants.

What is the preferred antimicrobial treatment for tetanus?

Metronidazole ($500\,mg$ IV every $6$ to $8\,hours$), with Penicillin G as a safe alternative.

What is the standard oral treatment regimen for Cerebral Toxoplasmosis in immunocompetent individuals?

Pyrimethamine ($100\,mg$ loading, then $25$ to $50\,mg$ daily) plus sulfadiazine ($2$ to $4\,grams$ daily) plus leucovorin calcium ($10$ to $25\,mg$ daily).

What alternative drug is used for toxoplasmosis if pyrimethamine is unavailable or if the patient has a sulfonamide allergy?

TMP-SMX ($5\,mg/kg$ trimethoprim component) or Atovaquone ($750\,mg$ four times daily).

What is the role of Rifampin in the treatment of a bacterial brain abscess?

It should not be used as monotherapy, but may be used in combination with other agents to enhance antimicrobial activity.

What are the recommended antiretroviral regimens for non-complication HIV/AIDS according to the USDHHS?

1. Dolutegravir plus tenofovir and either emtricitabine or lamivudine; 2. Bictegravir-tenofovir alafenamide-emtricitabine; 3. Ritonavir-boosted darunavir plus tenofovir and either emtricitabine or lamivudine.

Which diuretics can be used to decrease CSF production in cases of slowly progressive hydrocephalus?

Furosemide and acetazolamide.

What defines High-risk TIA according to the ABCD2 score for the purpose of starting Dual Antiplatelet Therapy (DAPT)?

An ABCD2 score of $\geq 4$.

What is the dosage for short-term Dual Antiplatelet Therapy (DAPT) in minor ischemic stroke ($NIHSS \leq 5$)?

Aspirin ($160$ to $325\,mg$ loading, then $50$ to $100\,mg$ daily) plus clopidogrel ($300$ to $600\,mg$ loading, then $75\,mg$ daily) for the first $21\,days$.

Why should glucose-containing fluids and hypotonic fluids like 1/2 isotonic saline be avoided in acute stroke management?

Glucose can exacerbate hyperglycemia and hypotonic fluids can exacerbate cerebral edema.

What blood pressure threshold must be maintained before administering alteplase for acute reperfusion therapy?

Blood pressure must be at or below $185/110\,mmHg$.

Which agent is used to reverse the effects of Dabigatran in cases of intracerebral hemorrhage?

Idarucizumab.

What is the primary management goal to prevent rebleeding in Aneurysmal subarachnoid hemorrhage (SAH)?

Early repair of the unsecured aneurysm with surgical clipping or endovascular coiling.

What are the potential toxicities associated with the use of Nitroprusside in hypertensive emergencies?

Cyanide and thiocyanate toxicity.

What is the mechanism of action of Betahistine in the treatment of vertigo?

It produces a long-lasting increase in cochlear blood flow.

How should a patient be positioned immediately following a witnessed syncope to restore cerebral perfusion?

Lay the patient supine with legs elevated to enhance venous return to the heart.

Which anticholinergic drug is used to prevent motion sickness and postoperative nausea/vomiting?

Scopolamine.

What is the clinical use for the cholinomimetic drug Bethanechol?

Postoperative and neurogenic ileus and urinary retention.

Which adrenoreceptor antagonist is used specifically for urinary retention in benign prostatic hyperplasia?

Prazosin, doxazosin, terazosin, or tamsulosin.