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Pharm > CNS > Flashcards

CNS Flashcards

1
Q

Management for: Parkinson’s Disease (PD) - Etiology of how to correct PD

A

Achieved by correcting the imbalance of neurotransmitters by Dopamine and Ach
We need more dopamine and less Ach

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2
Q

4 Hallmark s/s of Parkinson’s Disease

A

Tremor
Bradykinesia
Rigidity
Postural Instability (Cogwheel Rigidity)

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3
Q

Which drug is most effective for symptomatic treatment of PD & DOC if symptoms are R/T bradykinesia

A

Levodopa

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4
Q

Levodopa MOA

A

It is a dopamine precursor - therefore Increases dopamine concentration & Enhances the neurotransmission of dopamine

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5
Q

Problems from giving levodopa alone?

A

Levodopa is broken down outside of CNS (gut) by the enzyme decarboxylase… Thus need large doses to get adequate levels in the CNS
Large doses of levodopa -> High peripheral levels of dopamine ->  Increased adverse effects

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6
Q

On-Off Phenomenon is associated with which drug involved in treatment of PD

A

Levodopa

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7
Q

Levodopa usually given with ______

Why?

A

Carbidopa

A peripheral decarboxylase inhibitor - therefore inhibiting breakdown of levodopa

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8
Q

A/E and Contraindications of Sinemet (Levodopa/Carbidopa)

A

A/E - Psychosis (20%) and Dyskinesias (80% in first year)

Contraindications - Angle-closure glaucoma (increased intra-ocular pressure)

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9
Q

Main 2 Teaching aspects of Sinemet

A

Forewarn patients about possible abrupt loss of therapeutic effects; tell to notify HCP if occurs
If patient is taking levodopa alone, discontinue the drug at least 8 hours before starting levodopa/carbidopa

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10
Q

Two types (classes) of dopamine agonists

A

Derivatives of ergot

Nonergot derivatives

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11
Q

Used alone in early PD (< 60 yo)
First-line drug for motor symptoms
Name the class and common drug

A

Nonergot Dopamine Agonist

Pramipexole (Mirapex)

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12
Q

Name drug class with suffix -apone

A

COMT Inhibitors

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13
Q

COMT Inhibitor “-apone” MOA

A

Blocks the enzyme COMT which breaks down dopamine

Only for use with levodopa -> reduced wearing off of levodopa

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14
Q

Rapid withdrawl of COMT inhibitors “-apone” may lead to which two syndromes

A

Parkinsonian crisis & may cause a syndrome of muscle rigidity, high fevers, tachycardia, confusion, & elevated CK levels -> similar to neuroleptic malignant syndrome

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15
Q

Two A/E of COMT Inhibitors

A

brown-orange urine discoloration, hypo or hyper kinesia

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16
Q

MOA of MAO-B Inhibitors

A

selective irreversible inhibition of MAO-B in the brain increases dopaminergic activity by interfering with dopamine reuptake at synapse

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17
Q

Suffix of MAO-B inhibitors

A

-giline

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18
Q

A/E of MAO-B Inhibitors “-giline”

A

hypertensive crisis
Arthralgias
Depression

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19
Q

Anticholinergic Drugs for Parkinson’s Disease - Give common drug name

A

Benztropine (Cogentin)

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20
Q

Ach causes increased SLUDGE. What is SLUDGE?

A 
Salivation
Lacrimation
Urination
Diarrhea
GI Motility
Emesis (possibly)
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21
Q

A/E of Benzotropine (Anticholinergic)

A 
Constipation
N/V
Urine retention
IOP
Agitation
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22
Q

All patients (regardless of age) should receive _______ in management of Multiple Sclerosis

A

Immunomodulators

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23
Q

Drugs given in treating an acute episode of MS

A

1 - Short course of high-dose IV glucocorticoid (steroid) for 3-5d
(can elevate blood glucose)
2 - IV gamma globulin – IF intolerant/unresponsive to steroids

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24
Q

Immunomodulator A/E - Interferon Beta

A

Myelosuppression
Hepatotoxic
Flu-like symptomes

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25
Q

Immunomodulator - Glatiramer Acetate (Copaxone) MOA

A

: Protects myelin by inhibiting immune response to myelin basic protein
- decreases production of proinflammatory cells (T-Helper1) & increases production of anti-inflamm cells (TH2)

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26
Q

Three mechanisms anti-convulsants can work by

A

1 - Reduce nerve’s ability to be stimulated
2 - Suppress transmission of impulses from one nerve to the next
3 - Decrease speed of nerve impulse conduction within a neuron

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27
Q

Uses for Phenytoin

A

Complex partial seizures
Tonic-clonic seizures
Status Epilepticus (Fosphenytoin-converts to phenytoin after admin)
Generalized Seizures (Fosphenytoin-converts to phenytoin after admin)
(All seizure types EXCEPT absence)

28
Q

Why avoid giving phenytoin by IV push into veins on back of the hand?

A

discoloration known as “purple glove syndrome

29
Q

Give elevated levels of Phenytoin and s/s associated with each stage

A

Elevated Blood levels
20-30: nystagmus
30-40: ataxia
> 40 - dec. LOC

30
Q

Are phenytoin & Dilantin interchangeable?

A

No

31
Q

All drugs causing Stevens Johnson Syndrome

A 
PCP LAPSE
Phenytoin 
Carbazapine
Phenobarbital
Lamotrigine
Allopurinol
Penicillin
Sulfa Drugs
Erythromycin
32
Q

Given Uses, name drug class and drug associated
Used For: Complex partial seizures (DOC) Relieves pain r/t trigeminal neuralgia
Bipolar disorder

A

Class - Iminostilbenes

Drug - Carbamazepine

33
Q

Carpamazepine (Tegretol) Contraindications/Monitoring

A

Monitor for S/E - diplopia, blurred vision, N/V, leukopenia which is checked q 3-6 mo.
Can cause SIADH -> monitor Na+
Can cause photosensitivity
Can depress bone marrow
Contraindication if glaucoma, cardiac or renal, or hepatic disease

34
Q

Benzodiazepines suffix

A

-azepam

35
Q

DOC for status epilepticus

A

Lorazepam (Ativan)

36
Q

only drug approved for long term use of seizure control

A

Clonazepam (Klonopin)

37
Q

Valporic Acid MOA

A

increase GABA, an inhibitory neurotransmitter, as well as having a direct membrane-stabilizing effect.

38
Q

Valporic acid uses

A

All sorts of seizures and bipolar disorder

39
Q

Gabapentin MOA

A

thought to bind to a carrier protein & act at a unique receptor resulting in elevated GABA in the brain.

40
Q

Gabapentin uses

A

Partial seizures and neuropathic pain

41
Q

Absence seizures (DOC)

A

Class - Succinimides

Drug - Ethosuximide (Zarontin)

42
Q

Three Drugs for Spasticity

A

Baclofen (Lioresal) - Acts in the CNS
Diazepam (Valium) - Acts in the CNS (mimics GABA)
Dantrolene (Dantrium) - Acts directly on smooth muscle to suppress Ca+ release from SR

43
Q

Baclofen withdrawal: Classic symptoms of baclofen withdrawal are a sudden increase or return of your spasticity or tone, profuse sweating, and itching without an associated rash
Name drug used to offset s/s

A

Diazepam

44
Q 
Malignant hyperthermia include: 
A dramatic rise in body temperature
Flushed Skin
Tachy/HTN
Inc Muscle Rigidity/Contraction
Name DOC for treating
A

Dantrolene

45
Q

DOC for manic episodes & long-term prophylaxis & preventing suicide. Known as “mood stabilizers”

A

Lithium - MOA:Increasing norepinephrine & serotonin uptake

46
Q

Lithium/Salt interaction

A

“Lithium is a simple salt and is similar to table salt. Salt consumption can cause fluctuations in serum lithium levels. While taking lithium, do not make sudden changes to your salt intake. A sudden decrease in sodium intake may result in higher serum lithium levels, while a sudden increase in sodium might prompt your lithium levels to fall.

47
Q

4 A/E to lithium (LITH)

A

Leukocytosis
Tremors
Insipidus (Polyuria/thirst)
Hypothyroidism

48
Q

MOA for antipsychotic agents

A

Block dopamine receptors in the brain (limbic system, basal ganglia)—areas associated with emotion, cognitive function, motor function
Results in tranquilizing effect

49
Q

A/E to conventional (1st generation) antipsychotic drugs

A

Extrapyramidal Symptoms
(4 types)
Neuroleptic Malignant Syndrome
gynecomastia, galactorrhea, agranulocytosis

50
Q

4 Types of extrapyramidal symptoms

A

1 - Acute dystonia - muscle spasm of face (eyes), neck or back (opisthotonus) – tx with Benadryl & benztropine
2 - Parkinsonism – Tx with Anti-ACh drugs (benzotropine)
3 - Akathisia – pacing & squirming; tx w/ anti-ChE drugs (Benzotropine)
4 - Tardive dyskinesia late onset (facial grimacing, slow involuntary tongue rolling, lip smacking, and pill rolling) – tx by switching to SGA

51
Q

Cardinal features of Neuroleptic Malignant Syndrome

A

Severe muscular rigidity
Hyperthermia (temperature >38°C)
Autonomic instability
Changes in the level of consciousness

52
Q

Neuroleptic Malignant Syndrome and Malignant Hyperthermia are only different in etiology. Tx both with ___

A

Dantrolene

53
Q

1st generation anti-psyc drugs

A

Low potency: ex. chlorpromazine HCl (Thorazine)
Medium potency: ex. loxapine (Loxitane)
High potency: ex. haloperidol (Haldol)

54
Q

(2nd Gen) Atypical Antipsyc Drugs used to tx ____ and _____

A

Schizophrenia and levodopa induced psychosis

55
Q

2nd Gen Atypical Anti-psyc drugs MOA

A 
Blocks dopamine (low affinity – lower EPS)
Blocks serotonin
56
Q

A/E to atypical (2nd gen) anti-psyc drugs

A

Fatal agranulocytosis – monitor WBCs before & post
Seizures
EPS (extrapyramidal sympt-not as much a risk as 1st gen tho)

57
Q

4 Antidepressive drug classes

A

Monoamine Oxidase (MAO) Inhibitors
Tricyclic Antidepressant (TCA)
Selective Serotonin Reuptake Inhibitors (SSRI)
Serotonin Norepinephrine Reuptake (SNRI) Inhibitors

58
Q

“No Popular Meds” - MAO Inhibitors drug names

A

Nardil
Parnate
Marplan

59
Q

Tricyclic Anti-depressive - Effective for major depression; name a/e

A

Sedation
Cardiac Toxicity (lethal w/ OD)
Seizure

60
Q

Tricyclic Anti-depressive Toxicity and antidote

A

Toxicity - hyperthermia, flushing, dry mouth & dilation of pupils
Antidote - Physostigime

61
Q

Which of 4 antipsyc drugs is as effective as TCA but with fewer s/e?

A

SSRI (Selective Serotonin Reuptake Inhibitors)

62
Q

Most widely prescribed SSRI in the United States

A

Fluoxetine (Prozac, Sarafem)

63
Q

SSRI A/E

A 
Insomnia	
Nervousness
Agitation			
Neonatal abstinence syndrome (NAS) and persistent pulmonary hypertension of the newborn 
Serotonin Syndrome
64
Q

-afaxine is suffix for which of 4 classes of drugs used for depression tx

A

Serotonin Norepinephrine Reuptake Inhibitors

65
Q

Atypical antidepressive that acts as stimulant and suppresses appetite

A

Wellbutrin

66
Q

(sedative) DOC to treat anxiety, insomnia, and muscle spasms

A

Benzodiazipines / muscle spasm- diazepam

Pharm (5 decks)

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