CNS Flashcards
Management for: Parkinson’s Disease (PD) - Etiology of how to correct PD
Achieved by correcting the imbalance of neurotransmitters by Dopamine and Ach
We need more dopamine and less Ach
4 Hallmark s/s of Parkinson’s Disease
Tremor
Bradykinesia
Rigidity
Postural Instability (Cogwheel Rigidity)
Which drug is most effective for symptomatic treatment of PD & DOC if symptoms are R/T bradykinesia
Levodopa
Levodopa MOA
It is a dopamine precursor - therefore Increases dopamine concentration & Enhances the neurotransmission of dopamine
Problems from giving levodopa alone?
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
On-Off Phenomenon is associated with which drug involved in treatment of PD
Levodopa
Levodopa usually given with ______
Why?
Carbidopa
A peripheral decarboxylase inhibitor - therefore inhibiting breakdown of levodopa
A/E and Contraindications of Sinemet (Levodopa/Carbidopa)
A/E - Psychosis (20%) and Dyskinesias (80% in first year)
Contraindications - Angle-closure glaucoma (increased intra-ocular pressure)
Main 2 Teaching aspects of Sinemet
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
Two types (classes) of dopamine agonists
Derivatives of ergot
Nonergot derivatives
Used alone in early PD (< 60 yo)
First-line drug for motor symptoms
Name the class and common drug
Nonergot Dopamine Agonist
Pramipexole (Mirapex)
Name drug class with suffix -apone
COMT Inhibitors
COMT Inhibitor “-apone” MOA
Blocks the enzyme COMT which breaks down dopamine
Only for use with levodopa -> reduced wearing off of levodopa
Rapid withdrawl of COMT inhibitors “-apone” may lead to which two syndromes
Parkinsonian crisis & may cause a syndrome of muscle rigidity, high fevers, tachycardia, confusion, & elevated CK levels -> similar to neuroleptic malignant syndrome
Two A/E of COMT Inhibitors
brown-orange urine discoloration, hypo or hyper kinesia
MOA of MAO-B Inhibitors
selective irreversible inhibition of MAO-B in the brain increases dopaminergic activity by interfering with dopamine reuptake at synapse
Suffix of MAO-B inhibitors
-giline
A/E of MAO-B Inhibitors “-giline”
hypertensive crisis
Arthralgias
Depression
Anticholinergic Drugs for Parkinson’s Disease - Give common drug name
Benztropine (Cogentin)
Ach causes increased SLUDGE. What is SLUDGE?
Salivation Lacrimation Urination Diarrhea GI Motility Emesis (possibly)
A/E of Benzotropine (Anticholinergic)
Constipation N/V Urine retention IOP Agitation
All patients (regardless of age) should receive _______ in management of Multiple Sclerosis
Immunomodulators
Drugs given in treating an acute episode of MS
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
Immunomodulator A/E - Interferon Beta
Myelosuppression
Hepatotoxic
Flu-like symptomes
Immunomodulator - Glatiramer Acetate (Copaxone) MOA
: Protects myelin by inhibiting immune response to myelin basic protein
- decreases production of proinflammatory cells (T-Helper1) & increases production of anti-inflamm cells (TH2)
Three mechanisms anti-convulsants can work by
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
Uses for Phenytoin
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)
Why avoid giving phenytoin by IV push into veins on back of the hand?
discoloration known as “purple glove syndrome
Give elevated levels of Phenytoin and s/s associated with each stage
Elevated Blood levels
20-30: nystagmus
30-40: ataxia
> 40 - dec. LOC
Are phenytoin & Dilantin interchangeable?
No
All drugs causing Stevens Johnson Syndrome
PCP LAPSE Phenytoin Carbazapine Phenobarbital Lamotrigine Allopurinol Penicillin Sulfa Drugs Erythromycin
Given Uses, name drug class and drug associated
Used For: Complex partial seizures (DOC) Relieves pain r/t trigeminal neuralgia
Bipolar disorder
Class - Iminostilbenes
Drug - Carbamazepine
Carpamazepine (Tegretol) Contraindications/Monitoring
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
Benzodiazepines suffix
-azepam
DOC for status epilepticus
Lorazepam (Ativan)
only drug approved for long term use of seizure control
Clonazepam (Klonopin)
Valporic Acid MOA
increase GABA, an inhibitory neurotransmitter, as well as having a direct membrane-stabilizing effect.
Valporic acid uses
All sorts of seizures and bipolar disorder
Gabapentin MOA
thought to bind to a carrier protein & act at a unique receptor resulting in elevated GABA in the brain.
Gabapentin uses
Partial seizures and neuropathic pain
Absence seizures (DOC)
Class - Succinimides
Drug - Ethosuximide (Zarontin)
Three Drugs for Spasticity
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
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
Diazepam
Malignant hyperthermia include: A dramatic rise in body temperature Flushed Skin Tachy/HTN Inc Muscle Rigidity/Contraction Name DOC for treating
Dantrolene
DOC for manic episodes & long-term prophylaxis & preventing suicide. Known as “mood stabilizers”
Lithium - MOA:Increasing norepinephrine & serotonin uptake
Lithium/Salt interaction
“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.
4 A/E to lithium (LITH)
Leukocytosis
Tremors
Insipidus (Polyuria/thirst)
Hypothyroidism
MOA for antipsychotic agents
Block dopamine receptors in the brain (limbic system, basal ganglia)—areas associated with emotion, cognitive function, motor function
Results in tranquilizing effect
A/E to conventional (1st generation) antipsychotic drugs
Extrapyramidal Symptoms
(4 types)
Neuroleptic Malignant Syndrome
gynecomastia, galactorrhea, agranulocytosis
4 Types of extrapyramidal symptoms
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
Cardinal features of Neuroleptic Malignant Syndrome
Severe muscular rigidity
Hyperthermia (temperature >38°C)
Autonomic instability
Changes in the level of consciousness
Neuroleptic Malignant Syndrome and Malignant Hyperthermia are only different in etiology. Tx both with ___
Dantrolene
1st generation anti-psyc drugs
Low potency: ex. chlorpromazine HCl (Thorazine)
Medium potency: ex. loxapine (Loxitane)
High potency: ex. haloperidol (Haldol)
(2nd Gen) Atypical Antipsyc Drugs used to tx ____ and _____
Schizophrenia and levodopa induced psychosis
2nd Gen Atypical Anti-psyc drugs MOA
Blocks dopamine (low affinity – lower EPS) Blocks serotonin
A/E to atypical (2nd gen) anti-psyc drugs
Fatal agranulocytosis – monitor WBCs before & post
Seizures
EPS (extrapyramidal sympt-not as much a risk as 1st gen tho)
4 Antidepressive drug classes
Monoamine Oxidase (MAO) Inhibitors
Tricyclic Antidepressant (TCA)
Selective Serotonin Reuptake Inhibitors (SSRI)
Serotonin Norepinephrine Reuptake (SNRI) Inhibitors
“No Popular Meds” - MAO Inhibitors drug names
Nardil
Parnate
Marplan
Tricyclic Anti-depressive - Effective for major depression; name a/e
Sedation
Cardiac Toxicity (lethal w/ OD)
Seizure
Tricyclic Anti-depressive Toxicity and antidote
Toxicity - hyperthermia, flushing, dry mouth & dilation of pupils
Antidote - Physostigime
Which of 4 antipsyc drugs is as effective as TCA but with fewer s/e?
SSRI (Selective Serotonin Reuptake Inhibitors)
Most widely prescribed SSRI in the United States
Fluoxetine (Prozac, Sarafem)
SSRI A/E
Insomnia Nervousness Agitation Neonatal abstinence syndrome (NAS) and persistent pulmonary hypertension of the newborn Serotonin Syndrome
-afaxine is suffix for which of 4 classes of drugs used for depression tx
Serotonin Norepinephrine Reuptake Inhibitors
Atypical antidepressive that acts as stimulant and suppresses appetite
Wellbutrin
(sedative) DOC to treat anxiety, insomnia, and muscle spasms
Benzodiazipines / muscle spasm- diazepam
