TBI TBI Pharmacological Management 2 — Questions and Answers
Question 1: Propranolol is sometimes used post-TBI primarily to treat which condition?
- Depression
- Autonomic dysreflexia and sympathetic storming (Correct answer)
- Cognitive fatigue
- Hydrocephalus
Correct answer: Autonomic dysreflexia and sympathetic storming
Sympathetic storming (paroxysmal sympathetic hyperactivity) after TBI is often managed with propranolol to blunt adrenergic surges.
Question 2: Which medication is avoided in TBI due to its potential to lower the seizure threshold?
- Memantine
- Tramadol (Correct answer)
- Baclofen
- Modafinil
Correct answer: Tramadol
Tramadol lowers the seizure threshold and is generally avoided in TBI patients who are already at elevated seizure risk.
Question 3: What is the role of methylphenidate in post-acute TBI rehabilitation?
- Reduce intracranial pressure
- Improve attention, processing speed, and cognitive fatigue (Correct answer)
- Treat spasticity
- Prevent late post-traumatic epilepsy
Correct answer: Improve attention, processing speed, and cognitive fatigue
Methylphenidate (Ritalin) is used off-label in TBI rehab to improve attention, alertness, and cognitive processing speed.
Question 4: Hypertonic saline is used in TBI management primarily as an alternative to which drug?
- Dexamethasone
- Mannitol (Correct answer)
- Phenytoin
- Dopamine
Correct answer: Mannitol
Hypertonic saline serves as an osmotic therapy alternative to mannitol for reducing elevated intracranial pressure.
Question 5: Why is corticosteroid use (e.g., dexamethasone) contraindicated in acute TBI?
- They cause hypoglycemia
- The CRASH trial showed increased mortality with corticosteroids in TBI (Correct answer)
- They worsen spasticity
- They reduce CSF absorption
Correct answer: The CRASH trial showed increased mortality with corticosteroids in TBI
The landmark CRASH trial demonstrated that methylprednisolone infusion in acute TBI significantly increased 2-week mortality.
Question 6: Which medication is used to manage spasticity following TBI by acting as a GABA-B receptor agonist?
- Tizanidine
- Baclofen (Correct answer)
- Diazepam
- Dantrolene
Correct answer: Baclofen
Baclofen acts on GABA-B receptors in the spinal cord to reduce muscle spasticity common after TBI.
TBI TBI Pharmacological Management 2
Propranolol is sometimes used post-TBI primarily to treat which condition?