406 E2 drugs Flashcards
what class is sumatriptan
serotonin receptor agonists
sumatriptan MOA
-constrict intracranial blood vessels
-suppress release of inflam. neuropeptides
-block brain pathways for pain
sumatriptan routes
subq, PO, intranasal
sumatriptan SE
injection site rx
chest pressure
flushing
weakness
headache
bad taste (nasal)
sumatriptan nursing considerations
avoid w/ ischemic stroke, heart disease & angina
what class is rimegepant
CGRP antagonists
rimegepant MOA
mediates pain transmission
rimegepant SE
GI upset
rimegepant considerations
CYP substrate
dopaminergic drugs
enhance dopamine
anticholinergic drugs
block the effects of ACH
levodopa/carbidopa MOA
-levodopa: converts to dopamine in the brain and activates dopamine receptors
-carbidopa: blocks destruction of levodopa
levodopa/carbidopa advantages
most effective drug for PD
levodopa/carbidopa disadvantages
-several months to see improvement
-does not work long term
-adverse effects
levodopa/carbidopa key teaching points
-“on-off” phenomenon
-avoid high proteins meals
levodopa/carbidopa SE
-N/v
-dyskinesias
-postural hypotension
-dysrhythmias
-psychosis/hallucinations/nightmares
-paranoia
-darken sweat & urine
-activate malignant melanoma
what decreases the effects of levodopa
vitamin B6
antipsychotics
protein
what increases the effects of levodopa
carbidopa
anticholinergics
MAOIs (can lead to toxicity)
duopa
-G or J tube infusion levodopa/carbidopa
-gel form
-infuse up to 16hr/d
duopa teaching points
-do not take within 2 weeks of nonselective MAOI
-avoid high protein foods
duopa SE
-falling asleep w/o warning
-orthostatic hypotension
-hallucinations
-unusual urges
-depression
-dyskinesia
what class is pramipexole
dopamine receptor agonist
pramipexole MOA
binds w/ D2 receptors
pramipexole indications
-monotherapy in early PD
-combo w/ sinemet w/ advanced PD
-restless leg syndrome
pramipexole SE
-nausea
-sleep attacks
-pathologic gambling & compulsive behaviors
pramipexole + levodopa SE
-orhtostatic hypotension
-dyskinesias
-hallucination risk doubles
what class is ropinirole
dopamine receptor agonist
ropinirole MOA
increase in nerve impulses within the substantia nigra
ropinirole SE
long term use cause increased risk for DM and acromegaly
rotigotine
-dopamine agonist
-once daily patch
apomorphine
-dopamine agonist
-short acting subq for fast relief of PD sx during “off phase”
how do cholinesterase inhibitors work
prevent inactivation of ACH by cholinesterase and intensifies the effect of ACH released from motor neurons which increases muscle strength
what class is neostigmine
cholinesterase inhibitors
neostigmine indication
MG
neostigmine MOA
enhances cholinergic action by facilitating transmission of impulses across neuromuscular junctions
neostigmine SE
-cholinergic effects
-toxic doses reduce muscle contraction and can lead to cholinergic crisis
neostigmine / cholinergic crisis antidote
atropine
what med can test between MG or Chol crisis
edrophonium, a short acting cholinesterase inhibitor
another name for interferon beta
avonex
another name for glatiramer acetate
copaxone
interferon beta MOA
inhibit pro inflammatory WBCs from cross BBB
decrease relapse rate by up to 30%
interferon beta SE
-flu like rx
-liver toxicity
-bone marrow suppression
-depression
-drug interactions
glatiramer acetate MOA
increased production of anti inflammatory T cells which cross the BBB and suppress inflammation
glatiramer acetate SE
-injection site rx
-flushing, palpitaitons, chest pain, rash, laryngeal constriction
do not need to treat, resolves in 15-20 mins
glatiramer acetate & interferon beta indication
MS
fingolimod (oral MS agent)
retain lymphocytes in the lymph nodes, preventing them from crossing the BBB which decreases inflammation
good for RRMS
dimethyl fumarate (oral MS agent)
thought to inhibit immune cells and may have anti oxidant properties
natalizumab MOA
Prevents circulating T cells from leaving the vasculature and crossing blood-brain barrier
natalizumab indications
MS
Crohn’s
natalizumab nursing considerations
monotherapy
only available through TOUCH program
natalizumab SE
headache & fatigue
-hepatotoxicity
-hypersensitivity
-progressive multifocal leukoencephalopathy (PML)
what med do you give for fatigue related to MS
amantadine
what med do you give for cognitive dysfunction related to MS
donepezil
what class is riluzole
glutamate inhibitor
riluzole indication
ALS
riluzole MOA
glutamate antagonist
reduces damage to motor neurons
riluzole SE
dizziness, GI upset, hepatotoxicity
pharm for GBS
steroids
high dose immunoglobulin therapy
pharm for bacterial meningitis
IV ceftriaxone or vancomycin
acyclovir
steroids
prophylaxis vaccine
encephalitis pharm
acyclovir
anti-seizure meds
treat sx w/ Tylenol & antiemetics
TIA pharm
ASA
clopidogrel
heparin and warfarin in cardiac related
alteplase class
thrombolytics / fibrinolytics
alteplase MOA
promotes conversion of plasminogen to plasmin
remove thrombi after they have formed
alteplase indications
acute MI
PE
ischemic stroke
alteplase SE
increased risk of intracranial bleeding
alteplase antidote
aminocaproic acid