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PHARM EXAM 2 > anticonvulsants, parkinsons, alzheimers, muscle relaxants > Flashcards

anticonvulsants, parkinsons, alzheimers, muscle relaxants Flashcards

1
Q

What are seizures?

A

Seizures are abnormal electrical discharges from cerebral neurons, characterized by loss or disturbance of consciousness usually by a convulsion.

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2
Q

What percentage of seizures are primary or idiopathic?

A

75% of seizures are primary or idiopathic.

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3
Q

What causes the remaining 25% of seizures?

A

The remaining 25% are due to brain trauma, anoxia, infections, cerebral vascular disorders, metabolic disorders, or alcohol.

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4
Q

What is epilepsy?

A

Epilepsy is a chronic lifelong seizure disorder.

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5
Q

What is the typical age for the first seizure in epilepsy?

A

The first seizure typically occurs before 20 years old.

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6
Q

What can recurrent seizures not related to epilepsy result from?

A

Recurrent seizures not related to epilepsy may result from brain tumors, birth or perinatal injuries, head trauma, or idiopathic causes.

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7
Q

What are some types of anticonvulsants?

A

Types of anticonvulsants include hydantoins (phenytoin), long-acting barbiturates (phenobarbital), succinimides (ethosuximide), benzodiazepines (diazepam, clonazepam), carbamazepine, and valproate (valproic acid).

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8
Q

What are the three modes of action for anticonvulsants?

A

The three modes of action are suppressing sodium influx, suppressing calcium influx, and increasing GABA.

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9
Q

What is the prototype hydantoin?

A

The prototype hydantoin is phenytoin (Dilantin).

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10
Q

What is the mechanism of action of hydantoins?

A

Hydantoins inhibit sodium influx, stabilizing cell membranes, and reducing repetitive neuronal firing, consequently limiting seizures.

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11
Q

What is a significant contraindication for hydantoins?

A

Hydantoins should not be used during pregnancy as they are teratogenic to the fetus.

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12
Q

What is the therapeutic range for phenytoin?

A

The therapeutic range for phenytoin is 10-20 mcg/ml.

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13
Q

What are some side effects of phenytoin?

A

Side effects include headache, diplopia, confusion, dizziness, sluggishness, decreased coordination, ataxia, slurred speech, rash, anorexia, nausea/vomiting, hypotension (after IV administration), pink-red/brown color of urine, and fevers.

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14
Q

What are some adverse reactions associated with phenytoin?

A

Adverse reactions include leukopenia, hepatitis, depression, gingival hyperplasia, gingivitis, nystagmus, hirsutism, and osteoporosis.

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15
Q

What drug interactions are associated with phenytoin?

A

Phenytoin increases effects with cimetidine, isoniazid, chloramphenicol, and decreases effects with folic acid, calcium, antacids, sucralfate, vinblastine, and cisplatin.

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16
Q

What is the half-life of phenytoin?

A

The half-life of phenytoin is 6-45 hours.

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17
Q

What nursing considerations should be taken for phenytoin?

A

Nursing considerations include utilizing seizure precautions, advising female patients on backup contraception, monitoring CBC, shaking suspension well before dispensing, advising against driving or hazardous activities, avoiding alcohol and CNS depressants, and not stopping the drug abruptly.

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18
Q

What is the mechanism of action for phenobarbital?

A

Phenobarbital reduces seizures by increasing GABA.

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19
Q

What is the therapeutic range for ethosuximide?

A

The therapeutic range for ethosuximide is 40-100 mcg/ml.

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20
Q

What is the mechanism of action for benzodiazepines?

A

Benzodiazepines increase GABA.

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21
Q

What is a significant interaction for carbamazepine?

A

Carbamazepine interacts with grapefruit juice, which may cause toxicity.

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22
Q

What precautions should be taken for valproate?

A

Avoid use in children under 2 and patients with liver disease, and monitor liver function tests.

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23
Q

What is a potential risk during pregnancy for women with epilepsy?

A

25% of women with epilepsy may experience increased seizures while pregnant.

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24
Q

What are febrile seizures?

A

Febrile seizures occur in children between 3 months and 5 years.

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25
Q

What is a common effect of all anticonvulsant medications?

A

All anticonvulsant medications commonly cause symptoms of drowsiness, decreased coordination, dizziness, sluggishness, and confusion.

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26
Q

What is Parkinsonism?

A

A chronic neurologic disorder affecting extrapyramidal motor tract, balance, coordination, and locomotion.

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27
Q

What are the three major features of Parkinsonism?

A
  1. Bradykinesia: slow movement and tremors.
  2. Rigidity: increased muscle tone with increased movement.
  3. Posture: forward leaning and shuffle gait.
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28
Q

What is the pathophysiology of Parkinsonism?

A

Imbalance of dopamine and acetylcholine. Dopamine production is inhibited, leading to increased acetylcholine and progression of movement disorder.

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29
Q

What are non-pharmacologic treatments for Parkinsonism?

A

Therapeutic exercise, diet with fiber and adequate hydration, and support groups.

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30
Q

What are anticholinergics used for in Parkinsonism?

A

To decrease rigidity and tremors, with little effect on bradykinesia due to drug-induced parkinsonism.

31
Q

What are examples of anticholinergics?

A

Artane, Cogentin, Akineton, Parisdol, Norflex, occasionally Benadryl.

32
Q

What are common side effects of anticholinergics?

A

Dry mouth, dry secretions, urinary retention, constipation, blurred vision, increased heart rate, restlessness, confusion.

33
Q

What is the prototype drug for dopaminergics?

A

Carbidopa-levodopa (Sinemet).

34
Q

What are the therapeutic effects of carbidopa-levodopa?

A

Treats parkinsonism and relieves tremors and rigidity.

35
Q

What are the contraindications for carbidopa-levodopa?

A

Narrow-angle glaucoma, severe cardiac, renal or hepatic disease, suspicious skin lesions.

36
Q

What are common side effects of carbidopa-levodopa?

A

Anorexia, nausea, vomiting, dysphagia, fatigue, dizziness, headache, dry mouth, bitter taste, twitching, blurred vision, insomnia, dark urine.

37
Q

What are life-threatening adverse reactions of carbidopa-levodopa?

A

Agranulocytosis, hemolytic anemia, thrombocytopenia, cardiac dysrhythmias, neuroleptic malignant syndrome.

38
Q

What are nursing considerations for carbidopa-levodopa?

A

Symptoms of parkinsonism will decrease or be absent after 1-4 weeks of therapy. Instruct clients to rise slowly to avoid orthostatic hypotension.

39
Q

What are dopamine agents?

A

Examples include amantadine hydrochloride (Symmetrel), which is an antiviral dopamine agonist used to treat symptoms of Parkinson’s or drug-induced symptoms.

40
Q

What are side effects of dopamine agents?

A

Well tolerated but may include orthostatic hypotension, confusion, urinary retention, and constipation.

41
Q

What are MAO-B inhibitors used for?

A

To prolong the action of levodopa and are used for newly diagnosed parkinsonism.

42
Q

What is the effect of COMT inhibitors?

A

They increase the amount of levodopa in the brain.

43
Q

What is Tasmar?

A

The first COMT inhibitor used for advanced Parkinson’s, requiring monitoring of liver function tests.

44
Q

What is the combination drug Stalevo?

A

A combination of carbidopa-levodopa and entacapone.

45
Q

What is Alzheimer’s disease?

A

A chronic degenerative dementia, progressive neurodegenerative condition with marked cognitive dysfunction.

46
Q

What is the typical onset age for Alzheimer’s disease?

A

Onset is typically between 45-65 years old.

47
Q

How many Americans are affected by Alzheimer’s disease?

A

Approximately 4 million Americans are affected.

48
Q

What percentage of nursing home patients are admitted with Alzheimer’s?

A

50% of patients in nursing homes are admitted with Alzheimer’s.

49
Q

What is the prototype acetylcholinesterase inhibitor for Alzheimer’s?

A

Rivastigmine (Exelon).

50
Q

What is the pregnancy category for rivastigmine?

A

Pregnancy category B.

51
Q

What are the contraindications for rivastigmine?

A

Liver/renal disease, urinary tract obstruction, orthostatic hypotension, bradycardia.

52
Q

What is the onset time for rivastigmine?

A

Onset is 30-90 minutes.

53
Q

What are the therapeutic effects of rivastigmine?

A

Improves memory loss with mild to moderate Alzheimer’s.

54
Q

What is the mechanism of action (MOA) for rivastigmine?

A

Elevates acetylcholine concentration.

55
Q

What are common side effects of rivastigmine?

A

Anorexia, nausea/vomiting/diarrhea/constipation, headache, dizziness, rhinitis, depression, myalgia, peripheral edema, dry mouth, restless leg, dehydration.

56
Q

What are life-threatening adverse reactions of rivastigmine?

A

Hepatotoxicity, suicidal ideation, Stevens-Johnson syndrome.

57
Q

What is Myasthenia Gravis?

A

A chronic autoimmune disorder that affects neuromuscular transmission.

58
Q

How many people are affected by Myasthenia Gravis?

A

Affects 14 in 100,000 people.

59
Q

What is the typical demographic for Myasthenia Gravis?

A

Commonly in women younger than 30 and men older than 50.

60
Q

What is the prototype drug for Myasthenia Gravis?

A

Pyridostigmine bromide (Mestinon).

61
Q

What is the pregnancy category for pyridostigmine?

A

Pregnancy category C.

62
Q

What are the therapeutic effects of pyridostigmine?

A

To control and treat Myasthenia Gravis.

63
Q

What is the mechanism of action (MOA) for pyridostigmine?

A

Prevents destruction of acetylcholine, enhancing neuromuscular transmission.

64
Q

What are common side effects of pyridostigmine?

A

Nausea/vomiting/diarrhea, headache, dizziness, abdominal cramps, excessive saliva, sweating, rash, miosis.

65
Q

What are life-threatening adverse reactions of pyridostigmine?

A

Respiratory depression, bronchospasm, seizures.

66
Q

What is multiple sclerosis?

A

An autoimmune disorder that attacks myelin sheath fibers in the brain and spinal cord.

67
Q

What demographic is most affected by multiple sclerosis?

A

Affects Caucasian women between 20-40 years old.

68
Q

What are common symptoms of multiple sclerosis?

A

Diplopia, weakness, or spasticity.

69
Q

What is the goal of treatment for multiple sclerosis?

A

To decrease inflammation and improve conduction of demyelinating axons.

70
Q

What drugs should be avoided in multiple sclerosis?

A

Histamine 2 H2 blockers, indomethacin, beta-blockers.

71
Q

What is the prototype muscle relaxant for muscle spasms?

A

Cyclobenzaprine (Flexeril).

72
Q

What are the contraindications for cyclobenzaprine?

A

Acute MI, BBB, AV block, cardiac arrhythmias, HF, hypothyroid, paralytic ileus, MAOI use within 14 days.

73
Q

What are common side effects of cyclobenzaprine?

A

Anticholinergic effects such as drowsiness, dizziness, headache, constipation, dry mouth, tachycardia, urinary retention.

74
Q

What are nursing considerations for cyclobenzaprine?

A

Do not stop abruptly, taper over 1 week, avoid driving or operating machinery, do not take for longer than 3 weeks, avoid alcohol and CNS depressants.

PHARM EXAM 2 (10 decks)

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