Use of NOAC in atrial fibrillation FXa Inbibitor Eliquis (Apixaban) minimal interaction with cytochrome, 25% excreted renal Usual dose: 5 mg bid Use the lower dose of 2.5 mg bid, if 2 of following: over age 80 Creat over 1.5 weight <60 kg End stage renal disease: 5 mg...

Aspirin: • only agent established as effective for early treatment of acute ischemic stroke.• Should be given asap if no bleed• No Aspirin for 24 hours after tpa. Optimal dose not clear, 50 to 325 mg as effective as higher dose For Asian patients with high-risk TIA or minor...

Meniere disease: triad of episodic vertigo, tinnitus, hearing loss Meniere syndrome: above from other inner ear disorders Treatment Avoid high salt, caffeine, alcohol, nicotine, stress MSG Vestibular rehabilitation Vasodilator: Betahistine 8-16 mg tid, available only as compounded preparation in US Diuretic: hctz 25 mg/Triamterene 37.5 mg = Dyazide As...

For neck and back pain – based on review by Dr S Orrange – Read original article First line: Acetaminophen, nsaid 9 popular muscle relaxant Methocarbamol (Robaxin) 750 1-2 tab q8h, less sedating, about $15 for 90 pill Cyclobenzaprine (Flexeril) 5 to 10 mg tid, may cause drowsiness, 5...

Autoimmune hemolytic anemia (AIHA) Immune thrombocytopenia and or autoimmune neurtopenia substantial portion has Autoimmune lymphoproliferative syndrome (ALPS) Treatment IVIG is used commonly to treat AIHA Steroid: initially effective, most relapse after stopping therapy, alternative therapy is required...

Alirocumab and evolocumab are fully humanized monoclonal antibodies that bind free plasma PCSK9 Mechanism = Decrease level of PCSK9= less free PCSK9 is available in plasma to bind to LDL-R= Increased LDL-R allow the liver to remove more LDL-C Alirocumab Dose Hyperlipidemia, primary:Initial: 75 mg sq every 2 weeks...

For hyperlipidemia, statin decreases the risk of stroke Lipid lowering by other means (eg, fibrates, resins, diet) has no significant impact on stroke incidence May have anti-atherothrombotic properties May have a role in plaque stabilization, reduce inflammation, slow carotid arterial disease progression, improve endothelial function, and reduce embolic stroke...

If Last known normal between 3-4.5 hours Evaluate risks and benefit of TPA If any of the following, no tpa over 80 years old taking oral anticoagulant NIHSS > 25 Previous Stroke plus Diabetes Imaging study showing evidence of injury over 1/3 of MCA territory...

AAN 2015 guideline Link to original article = please read the original article Unruptured intracranial aneurysm = UIA Subarachnoid hemorrhage = SAH Risk factors and recommendations Smoking increase risks of UIA: smoking cessation Hypertension may play a role in growth and rupture: treat Hypertension Intermittent imaging studies needed to...

Abbreviated summary of NIHSS No Neuro deficit score is 0 Larger number INDICATES more deficit Level of consciousness: 0-3 Speech 2 questions: 0-2 2 commands: 0-2 Dysarthria: 0-2 Aphasia: 0-3 Gaze: 0-2 Motor each limb: 0-4 Ataxia: 0-2 Sensory: 0-2 Extinction/Neglect: 0-2 Additional resources NIH Stroke Scale online form...