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Neuropharmacology

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Acute Neuro Care

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Abstract

Neuro-critical care involves the use of various drugs. Knowledge of these drugs in terms of dose, adverse effects, and use in special populations is essential for good patient care. It is imperative that medications are used appropriately during neuro-emergencies and neurological life support. The right choice of medication depends upon the knowledge of the pharmacodynamics and pharmacokinetics of the drug. Medications discussed here include antiepileptic drugs, sedatives, analgesics, neuromuscular blocking drugs, antihypertensive agents, thrombolytic agents, antiplatelets, oral anticoagulants, and hemostatic agents. Drugs used in subarachnoid hemorrhage, for reducing intracranial pressure, managing hyponatremia and myasthenia gravis are also briefly mentioned. Patients presenting with neuro-emergencies are either already consuming these drugs and having certain adverse drug reactions or the physician will have to use these for curtailing the acute episode. The chapter covers salient pearls for using these medications by first responders in the emergency department and neuro-critical care unit.

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Author information

Authors and Affiliations

  1. All India Institute of Medical Sciences, Bhubaneshwar, India

    Swagata Tripathy & Suma Rabab Ahmad

Authors
  1. Swagata Tripathy
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  2. Suma Rabab Ahmad
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Editor information

Editors and Affiliations

  1. Division of Neuroanaesthesiology, Department of Anaesthesiology and critical care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

    Prasanna Udupi Bidkar

  2. Senior consultant and Head, Neuroanaesthesiology & Neurocritical care, MGM Healthcare Pvt Ltd, Chennai, Tamil Nadu, India

    Ponniah Vanamoorthy

Multiple Choice Questions

Multiple Choice Questions

  1. 1.

    The drug of choice for partial seizures is:

    1. (a)

      Carbamazepine

    2. (b)

      Diazepam

    3. (c)

      Ethosuximide

    4. (d)

      Phenytoin

  2. 2.

    The mechanism of action of antiepileptic drugs is:

    1. (a)

      Enhancement of GABA-ergic (inhibitory) transmission

    2. (b)

      Inhibition of excitatory (usually glutamate-ergic) transmission

    3. (c)

      Modification of ionic conductance

    4. (d)

      All of the above

  3. 3.

    Osmolality of Hypertonic saline is about

    1. (a)

      900 mosm/dL

    2. (b)

      1100 mosm/dL

    3. (c)

      557 mosm/dL

    4. (d)

      630 mosm/dL

  4. 4.

    All are true about Nimodipine except—Nimodipine

    1. (a)

      Has low oral bioavailability (2.7–27.9%),

    2. (b)

      Has a short half-life (2 h),

    3. (c)

      Is highly protein bound (98–99%),

    4. (d)

      Is renally metabolized.

  5. 5.

    Regarding dose of thrombolytic in acute ischemic stroke which is correct

    1. (a)

      Alteplase—0.9 mg/kg IV (Maximum 90 mg) infused over 1 h with an initial IV bolus of 10% of the total dose over 1 min

    2. (b)

      Tenecteplase—0.4 mg/kg IV single bolus dose

    3. (c)

      Both a and b

    4. (d)

      Neither a and b

  6. 6.

    Clopidogrel is a prodrug: the major enzyme involved in the conversion of clopidogrel into an active metabolite is

    1. (a)

      CYP2C19

    2. (b)

      ABCB1

    3. (c)

      P2Y12

    4. (d)

      GPIIIA

  7. 7.

    Only test necessary prior to initiating alteplase thrombolysis

    1. (a)

      Blood glucose

    2. (b)

      International normalized ratio,

    3. (c)

      Activated partial thromboplastin time

    4. (d)

      Platelet count

  8. 8.

    Alteplase should not be administered if

    1. (a)

      Patient has got treatment dose of LMWH within last 24 h

    2. (b)

      Patient has got abciximab

    3. (c)

      Both a and b

    4. (d)

      Neither a or b

  9. 9.

    All are true about Mannitol except:

    1. (a)

      Mannitol is secreted and reabsorbed by the tubules.

    2. (b)

      It retains water and causes an “osmotic diuresis.”

    3. (c)

      It is useful clinically in management of rhabdomyolysis.

    4. (d)

      It is used in medical management of raised ICP.

  10. 10.

    Management of DIND

    1. (a)

      Pharmacologically induced hypertension

    2. (b)

      Intravascular volume optimization

    3. (c)

      Intraarterial Papaverine

    4. (d)

      All the above

Answers: 1. (a), 2. (d), 3. (a), 4. (d), 5. (c), 6. (a), 7. (a), 8. (c), 9. (a), 10. (d)

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Tripathy, S., Ahmad, S.R. (2020). Neuropharmacology. In: Bidkar, P., Vanamoorthy, P. (eds) Acute Neuro Care. Springer, Singapore. https://doi.org/10.1007/978-981-15-4071-4_4

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  • DOI: https://doi.org/10.1007/978-981-15-4071-4_4

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-4070-7

  • Online ISBN: 978-981-15-4071-4

  • eBook Packages: MedicineMedicine (R0)

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