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P2F Neuro > 10] Pharmacology > Flashcards

10] Pharmacology Flashcards

1
Q

Most common form of ischemic stroke

A

Embolic

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2
Q

Slow, cautious behavior

A

L CVA

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3
Q

Left sided neglect

A

R CVA

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4
Q

Most fatal stroke

A

Hemorrhagic

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5
Q

No clinically proven pharmacological intervention exists

A

Hemorrhagic stroke

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6
Q

What’s an important predictor of outcome?

A

Clot volume

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7
Q

Less common stroke symptoms

A

Nausea and vomiting
LOC
Convulsions

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8
Q

What does FAST stand for?

A

Face
Arm
Speech
Time

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9
Q

Irregularly irregular rhythm

A

A fib

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10
Q

Increased risk in pts with HTN, HF, or lung disease

A

A fib

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11
Q

How does a fib cause a stroke?

A

Unorganized flow so theres blood pool in atria and creates a clot in the atria then travels thru bloodstream to the head and blocks an artery causing a STROKE

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12
Q

Pharm for hemorrhagic stroke?

A

Surgery/interventions

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13
Q

Pharm care for ischemic stroke?

A

Drug therapy

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14
Q

TX goals

A

Reduce current injury
Prevent complications
Prevent stroke recurrence

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15
Q

Drugs for early stroke care

A

1] TPA (tissue plasminogen activator)
2] antiplatelets
3] anticoagulants

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16
Q

Dissolves arterial clots

A

TPA (alteplase)

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17
Q

Decreases risk of long term neuro deficit

A

TPA

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18
Q

When does TPA have to be used?

A

Within 3 hours of stroke Sx, recent studies said within 4.5 hour

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19
Q

Side effects of altepase

A 
Bleeding
Cerebral edema
Seizure
Hypotension
Fever
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20
Q

Exclusion criteria for tPA

A

Hemorrhagic stroke; b/c it has to be ischemic

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21
Q

PT after tPA treatment

A

Rest for 24 hours

Early mobilization is safe and feasible less than 24 hours

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22
Q

Tool used to predict stroke risk in pts with a fib

A

CHADsVasc score

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23
Q

CHADsVasc score is used to guide selection of?

A

Antiplatelet/anticoagulant therapy

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24
Q

Scoring of CHAD

A

0, 1, 2 or greater

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25
Q

1 point on CHAD

A

Moderate; no Tx or aspirin or oral anticoagulant, up to you.

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26
Q

Score of 2 or greater on CHAD

A

High; oral anticoagulant

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27
Q

Common 3 antiplatelets

A

Aspirin
Clopidogrel (placid)
Dipyridamole/aspirin (aggrenox)

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28
Q

Started within 48 hours of stroke; A fib with moderate risk

A

Aspirin

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29
Q

Inhibits the enzyme cyclooxygenase to reduce production of thromboxane A2

A

Aspirin

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30
Q

Side effects of aspirin

A

Bleeding
GI ulcer
Anemia
Nausea

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31
Q

Contraindications: asthma, rhinitis, nasal polyps, NSAID allergy

A

Aspirin

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32
Q

Dont use aspirin within ?

A

24 hours of alteplase

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33
Q

Avoid aspirin in?

A

Severe renal or hepatic impairments

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34
Q

Aspirin over the counter?

A

YES

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35
Q

Caution with what allergy for aspirin?

A

NSAID allergy

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36
Q

What’s the standard of care Tx for antiplatelets?

A

Aspirin

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37
Q

Initiated after a thrombotic stroke

A

Clopidogrel (plavix)

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38
Q

Blocks P2Y12 components on ADP receptors

A

Plavix

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39
Q

Side effects of plavix

A 
Bleeding
Bruising
Itching
Diarrhea
Rash (first 2 weeks)
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40
Q

Common drug interaction for plavix

A

Omeprazole

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41
Q

Grapefruit juice

A

More than 1 cup no good with taking plavix

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42
Q

Some people have an allele that can play a role in how this drug works

A

Plavix

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43
Q

Prescription only drug

A

Dipyridamole/aspirin (aggrenox)

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44
Q

Used in secondary prevention of stroke

A

Aggrenox

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45
Q

Inhibits phosphodiesterase and augments prostacyclin related platelet aggregation

A

Aggrenox

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46
Q

Side effects of aggrenox

A 
Bleeding
Bruising
Headache
GI upset
Fatigue
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47
Q

With antiplatelets what should you caution?

A

Increased risk of bleeding

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48
Q

What’s stronger than antiplatelets?

A

Anticoagulants

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49
Q

avoid alcohol due to increased bleeding risk

A

Aggrenox

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50
Q

Only available in capsules that have to be swallowed whole

A

Aggrenox

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51
Q

Ultimate goal of coagulation cascade

A

Conversion from pro thrombin to thrombin

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52
Q

Warfarin
Dabigatran
Rivaroxaban
Apixaban

A

Oral anticoagulants

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53
Q

Enoxaparin
Fondapurinux
Dalteparin
Heparin

A

Injectable anticoagulants

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54
Q

Warfarin is aka

A

Coumadin

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55
Q

Inhibits the vitamin K dependent synthesis of clotting factors

A

Warfarin

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56
Q

Side effects of warfarin

A 
Bleeding
Bruising
Skin necrosis
“Purple toe syndrome”
Hemorrhage
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57
Q

T or F: warfarin has many drug interactions

A

TRUE

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58
Q

Hemorrhagic tendencies (active GI/CNS bleed), pregnancy

A

Contraindications of warfarin

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59
Q

Requires therapeutic monitoring of INR, can be started 24 hours post stroke

A

Warfarin

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60
Q

Must have consistent what with warfarin?

A

Must have consistent vitamin K

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61
Q

Pregnancy category for warfarin

A

X

62
Q

What beverages increase bleeding risk with warfarin?

A

Alcohol

Cranberry juice

63
Q

What does INR tell you?

A

How thick/thin blood is

64
Q

Average INR ?

A

1

65
Q

Therapeutic range for INR?

A

Between 2-3

66
Q

Therapeutic range of INR for mitral valve replacement?

A

2.5 - 3.5

67
Q

DOACs

A

Direct acting oral anticoagulants

68
Q

2 types of DOACs

A

Factor Xa inhibitors

Rectus thrombin inhibitors

69
Q

Example of direct thrombin inhibitor

A

Dabigatran

70
Q

Started within 2-14 days after onset of stroke;

Started immediately for A fib

A

DOAC

71
Q

Side effects of DOAC

A 
Bleeding 
Bruising
Headache
Ab pain
Diarrhea
Heartburn
Nausea
Tinnitus
72
Q

Anticoagulants
NSAID
St. John’s wort
Protesting

A

DOAC drug interaction, avoid!!

73
Q

Contraindication for DOAC

A

Active pathological bleeding

74
Q

Pregnancy category for DOAC

A

B - C

75
Q

DOACs are primarily metabolized by?

A

Kidneys

76
Q

Pros of DOACs

A

Don’t require routine monitoring

No diet restrictions

77
Q

Cons of DOACs

A

Less clinical experience
Cost
No antidote (except for dabigatran)

78
Q

Includes variety of medication that inhibit synthesis and function of clotting factors (thrombin, IXa, Xa)

A

Heparin

79
Q

2 types of LMWH

A

Enoxaparin

Dalteparin

80
Q

2 types of heparin

A

UFH (unfractionates heparin)

LMWH

81
Q

•Used to prevent or treat deep vein thrombosis (DVT)following stroke

A

Heparin

82
Q

Inhibit synthesis and function of clotting factors (thrombin, IXa, Xa)

A

MoA for heparin

83
Q

Bleeding, osteoporosis (chronic therapy), hemorrhage,heparin-induced thrombocytopenia (HIT)

A

Side effects for heparin

84
Q

Anticoagulants, estrogen derivatives, NSAIDs

A

Drug interactions for heparin

85
Q

Severe thrombocytopenia or history of HIT, uncontrolledactive bleeding, pork products (LMWH)

A

Contraindications for heparin

86
Q

Clinical consideration for heparin

A

Subcutaneous administration

87
Q

Pregnancy category for heparin

A

B - C

88
Q

Low-dose aspirin may be given up to ?

A

The day of procedure

89
Q

Ibuprofen, naproxen, diclofenac, indomethacin

A

NSAIDs that are NOT recommended for pain with anticoagulants

90
Q

What is recommended for ppl who have pain with antocoagulation?

A

Acetaminophen (Tylenol)

Opioids

91
Q

Used for moderate to severe pain with anticoagulation

A

Opioids

92
Q

The primary side effects from anticoagulants involves ?

A

Bleeding and bruising

93
Q

? requires strict dietary considerations to maintain appropriate monitoring levels

A

Warfarin

94
Q

? should not be recommended for pain management in patients on anticoagulants (acetaminophen and opioids better option)

A

NSAIDs

95
Q

Are anticoagulants and antiplatelets used together?

A

Yes sometimes like warfarin and aspirin

96
Q

When would you use combo of antis?

A

Pt on warfarin but they still have clot. This is very short term.

97
Q

Avoid drugs that increase risk of bleeding like? (3)

A

NSAIDs
Antidepressants
Herbals

98
Q
  • Avoid drugs that increase risk of bleeding
  • Avoid alcohol
  • Avoid contact sports
  • Wear properly fitted shoes
  • Avoid drugs that can cause dizziness
A

Decrease bleeding risk

99
Q

Pain in back, abdomen, or joints may indicate ?

A

Internal bleeding

100
Q

Secondary stroke prevention

A

1] anticoag and antiplatelets therapy
2] blood pressure reduction
3] cholesterol management
4] lifestyle changes

101
Q

Post stroke spasticity signs

A 
Flexed elbow
Bent wrist
Pronated forearm
Clenched fist
Thumb in palm
102
Q

Occurs in 65% of patients post-stroke

In

A

Spasticity

103
Q

Characterized by increased muscle tone

A

Spasticity

104
Q

Baclofen
• Diazepam
• Tizanidine

A

Centrally acting agents for spasticity

105
Q

Peripherally acting agent for spasticity

A

Don’t role even

106
Q

More effective in treating spasticity resulting from spinal cord lesions

A

Baclofen (Lioresal®)

107
Q

Agonizes GABA-b receptors at the spinal cord

A

MoA for baclofen

108
Q

Transient drowsiness, confusion, hallucinations, fatigue,nausea/vomiting, muscle weakness, and headache

A

Side effects for baclofen

109
Q

Opioids, zolpidem, azelastine (nasal), buprenorphine

A

Drug interactions for baclofen

110
Q

Effectiveness is limited by systemic side effects

A

Baclofen

111
Q

Limited ability to cross the blood brain barrier

A

Baclofen

112
Q

May lower seizure threshold

A

Baclofen

113
Q

Withdrawal symptoms with abrupt discontinuation

A

Baclofen

114
Q

Severe, intractable spasticity
unresponsive to oral agents
• Intolerable side effects at effective oraldoses

A

Indications for intrathecal baclofen

115
Q

Black box warning for intrathecal baclofen

A

Abrupt discontinuation may lead to organ failure or death

116
Q

Disruption in the delivery system
• Infection
• Dislodged pump or a blocked or twisted catheter
• Pump failure leading to overdose

A

Complications for intrathecal baclofen

117
Q

Is intrathecal baclofen expensive?

A

$$$ yep.

118
Q

Spasticity resulting from cord lesions

A

Diazepam

119
Q

Side effects of diazepam

A

Sedation, decreased walking speed, muscle weakness, hypotension, ataxia, constipation

120
Q

Opioids, zolpidem, azelastine (nasal), buprenorphine, St. John’s Wort

A

Drug interaction for diazepam

121
Q

Acute narrow-angle or untreated open-angle glaucoma, myasthenia gravis, severe hepatic or respiratory impairment, sleep apnea

A

Contraindications for diazepam

122
Q

Class IV controlled substance
Long half-life; not recommended in elderlyAvoid alcohol
Tolerance and dependence can develop

A

Clinical considerations for diazepam

123
Q

Pregnancy category for diazepam

A

D

124
Q

Spasticity due to cerebral lesions

A

Tizanidine

125
Q

MoA for tizanidine

A

Binds to alpha 2 adrenergic receptors in CNS and stimulates them

126
Q

Sedation, dizziness, hypotension, dry mouth, hepatotoxicity

A

Side effects of tizanidine

127
Q

Ciprofloxacin, opiods, azelastine, zolpidem, tricyclic antidepressants

A

Drug interaction for tizanidine

128
Q

Contraindication for tizanidine

A

Concomitant therapy with ciprofloxacin or fluvoxamine

129
Q

Avoid tizanidine in what kind of patients?

A

Liver disease patients

130
Q

Withdrawal symptoms upon abrupt discontinuation

A

Clinical consideration for tizanidine

131
Q

Pregnancy category for tizanidine

A

C

132
Q

Spasticity that limits rehabilitation progression, or severe spasticity

A

Dantrolene

133
Q

Directly acts on skeletal muscle, interfering with calcium stores

A

MoA for dantrolene

134
Q

Generalized muscle weakness, drowsiness, hepatotoxicity, dizziness, nausea/diarrhea

A

Dantrolene side effects

135
Q

Opioids, zolpidem, azelastine (nasal), buprenorphine, St. John’s Wort

A

Drug interactions for dantrolene

136
Q

Black box warning for dantrolene

A

Hepatic disease

137
Q

Less cognitive side effects- clinical consideration

A

Dantrolene

138
Q

Pregnancy category for dantrolene

A

C

139
Q

Approved for upper limb spasticity

A

Botulinum toxin

140
Q

Recommended in patients with painful spasticity that limits skin hygiene and
daily functioning

A

Bot tox

141
Q

Effects of bot tox

A

Decreased muscle tone

Increased ROM

142
Q

Black box warning for bot tox

A

Injected toxins may
spread to distal sites
and cause symptoms of botulism (potentially
fatal)

143
Q 
Fatigue
• Nausea
• Bronchitis
• Pain at injection site
• Weakness
A

Side effects of bot tox

144
Q

Very effective for severe spasticity and focal dystonias

A

Pro of bot tox

145
Q

Can be used in conjunction with PT toimprove voluntary motor function

A

Pro of bot tox

146
Q

Treatment limited to 1-2 muscle
groups/session
Effects are often temporary (2-3 months)Not a cure

A

Cons of bot tox

147
Q

? used to treat spasticity that occurs followinglesions in the CNS

A

Muscle relaxants

148
Q

Most are easily absorbed from the GI tract, and oral route isfrequently used (other routes available)

A

Muscle relaxants

149
Q

Long-term use is not optimal given side effect profile (especially sedation!)

A

Muscle relaxants

150
Q

Concomitant use with physical therapy can produce optimalbenefits

A

Muscle relaxants

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