TBI Pharmacological Management Flashcards

Which medication is prescribed for post-TBI headache that is refractory to standard analgesics?

Answer: Amitriptyline

Amitriptyline (a tricyclic antidepressant) is commonly used for prophylaxis of chronic post-traumatic headache.

What is the main pharmacological goal when managing elevated ICP in a TBI patient?

Answer: Reduce ICP while maintaining adequate cerebral perfusion pressure

Management aims to lower ICP while ensuring CPP remains adequate (typically >60 mmHg) to prevent secondary ischemic injury.

Donepezil (an acetylcholinesterase inhibitor) is sometimes used post-TBI to address which deficit?

Answer: Memory and cognitive impairment

Donepezil enhances cholinergic transmission and has shown benefit for memory and attention in moderate-to-severe TBI patients.

Why must antidepressants be used cautiously during the early post-TBI period?

Answer: Many lower seizure threshold and can worsen cognitive function acutely

Some antidepressants (especially TCAs and bupropion) lower seizure threshold, which is hazardous in the already seizure-prone acute TBI brain.

Zolpidem has been reported to paradoxically improve arousal in some minimally conscious TBI patients due to what mechanism?

Answer: It paradoxically inhibits overactive inhibitory pathways, releasing functional circuits

The paradoxical awakening effect of zolpidem in some MCS patients is thought to result from inhibition of dysfunctional over-inhibited thalamic circuits.

Prophylactic antiepileptic therapy after TBI is typically continued for how long according to current guidelines?

Answer: 7 days for early seizure prevention only

Current TBI guidelines recommend 7 days of prophylactic antiepileptic therapy for early post-traumatic seizure prevention, not long-term.