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Pharmacology > CNS Part 2 > Flashcards

CNS Part 2 Flashcards

1
Q

Focal (partial) seizures

A

Only affect one part of the brain/ typically one cerebellar hemisphere

May progress to affect the whole brain

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2
Q

Generalized seizures

A

Subclassifications include tonic-clonic (“grand mal”) and absence

Affects the whole brain

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3
Q

Barbiturates role in therapy

A

Phenobarbital, Primidone

Limited by Side Effects
For resistant seizures as IV therapy
Treats a wide variety of seizure types

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4
Q

Benzodiazepines role in therapy

A

First line for acute termination of seizures / status epilepticus

Long term use- role limited to specific types of seizures

Alcohol withdrawal seizures

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5
Q

Phenytoin / Fosphenytoin side effects

A

Confusion, sedation, nystagmus, ataxia, dysarthria

Toxicity Risk- narrow therapeutic index

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6
Q

Phenytoin / Fosphenytoin role in therapy

A

Acute termination (IV)
Chronic seizure therapy in resistant patients (PO)

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7
Q

Carbamazepine / Oxcarbazepine side effects

A

Dizziness, drowsiness, ataxia, blurred vision, cardiac arrhythmias

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8
Q

Carbamazepine / Oxcarbazepine role in therapy

A

Chronic seizure management (PO)
Off-label: trigeminal neuralgia

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9
Q

Valproates side effects

A

Depakote, valproic acid

GI distress, impaired platelet function

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10
Q

Valproates role in therapy

A

Acute Seizure management (Inpatient)

Chronic seizure management (PO)(Outpatient)

Other indications: Bipolar disorder, migraines (off-label)

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11
Q

Levetiracetam

A

Traumatic brain injury seizure, very well tolerated, used for TBI to prevent seizures

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12
Q

Gabapentin (Neurontin)

A

Neuropathic pain, postherpetic neuralgia, anxiety, restless leg, vasomotor sx in menopause

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13
Q

Pregabalin (Lyrica)

A

Fibromyalgia, neuropathic pain, diabetic neuropathy, restless leg, chronic cough*

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14
Q

Lamotrigine (Lamictal)

A

Bipolar, migraine, trigeminal neuralgia

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15
Q

Topiramate (Topamax)

A

Migraines, tremor, cluster headache

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16
Q

First vs Second Generation AEDs

A

First: more effective

Second: more favorable kinetics, milder side effects

-Doses administered late can increase risk of seizure occurring

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17
Q

Gabapentin side effects

A

sedation, fatigue, dizziness

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18
Q

Lacosamide side effects

A

dizziness, HA, double vision

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19
Q

Lamotrigine side effects

A

ataxia, skin reactions (SJS)

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20
Q

Levetiracetam side effects

A

sedation, dizziness, well tolerated

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21
Q

Pregabalin side effects

A

peripheral edema (temporary)

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22
Q

Tiagabine side effects

A

rare depression,anxiety

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23
Q

Topiramate side effects

A

sedation, dizziness, ataxia

24
Q

Zonisamide side effects

A

sedation, loss of appetite

25
Q

AEDs in Pregnancy

A

Birth defects incidence is generally higher in women who take AEDs compared to those without exposure

Avoid valproic acid and derivatives (can cause spina bifida

26
Q

Status Epilepticus

A

Seizure lasting > 5 minutes or
Lack of recovery between seizures

27
Q

Status Epilepticus management

A

1st line: BENZOS

2nd therapy: levetiracetam, fosphenytoin, valproic acid, lacosamide

If untreated, can lead to permeant brain damage even death
Gets harder to treat, the longer the seizure lasts

28
Q

Levodopa

A

Cornerstone of therapy
Improves bradykinesia and rigidity
Most effective drug therapy
Limited by:
Adverse effects
Diminished response over time

29
Q

Levodopa-carbidopa (Sinemet)

A

Erratic absorption & short half life

Absorption delayed if taken with high protein meal

Peak effects: 1 hour after administration

Dosed frequently: >4 times daily

30
Q

Levodopa ADEs

A

arrhythmias, OH, Confusion

31
Q

Dopamine Agonists (Pramipexole, Ropinirole, Rotigotine)

A

Indications: 1st line alternative agent or in combo with levodopa

Helpful for end-of-dose akinesias & on-off phenomenon

ADE: N/V, orthostatic hypotension

32
Q

Anticholinergic Drugs: Benztropine (Cogentin), Diphenhydramine (Benadryl)

A

Indications: tremor; adjunct to levodopa

ADE: confusion, decreased cognition, drowsiness, urinary retention, blurred vision

Avoid in pts 65 or older

33
Q

Amantadine

A

Indications: tremor, mild dyskinesias

ADE: orthostatic hypotension, CNS disturbances (hallucinations, depression, confusion), lower extremity skin discoloration

Well tolerated, stimulating (take in early AM and early PM), effects wear off around 1 year

34
Q

Monoamine Oxidase B inhibitors (Rasagiline, Selegillene)

A

Indication: Early in disease prior to levodopa or adjunct to levodopa wearing off
ADE: Dizziness, GI distress, HA, sleep disturbances (S>R)

35
Q

Catechol-O-Methyltransferase (COMT) Inhibitors (Entacapone, tolcapone)

A

2nd line therapy for ‘wearing off’ of levodopa

Adverse Effects:
Muscle cramps
Dyskinesias (at initiation)

36
Q

Special Considerations for Physical Therapist

A

Coordinate therapies with peak drug
effects (levodopa ~1 hr post-dose)

Morning hours may be ideal given late day fatigue

May encounter ‘drug holiday’ patients
Need to maintain as much mobility as possible.

Monitorblood pressure
-Orthostatic hypotension
-Dizziness, confusion, sleep disturbance

Careful guarding given fall risk
Gait training, balance activities are essential to quality of life

37
Q

Benzonatate

A

Local anesthetic

38
Q

Diphenhydramine

A

Antihistamine

causes sedation, dizziness

39
Q

Dextromethorphan

A

Inhibits cough reflux via direct effects on the brainstem

causes sedation, dizziness, GI upset

40
Q

Codeine / Hydrocodone

A

Inhibits cough reflux via direct effects on brainstem

causes sedation, dizziness, GI upset, dependence risk

41
Q

Decongestants

A

Bind alpha receptors in blood vessels of nasal mucosa =Vasoconstriction

Increased BP
Cardiac abnormalities
Dizziness
Palpitations

42
Q

first generation Antihistamines side effects

A

Sedation
Fatigue
Dizziness
GI Distress

43
Q

Mucolytics

A

decrease viscosity of respiratory secretions

side effects: Nausea, vomiting, Oral mucosa, inflammation

44
Q

Expectorants

A

facilitate production and ejection of mucus

side effects: GI upset

45
Q

SABA

A

Short Acting Beta Agonist

Albuterol
Levalbuterol

46
Q

LABA

A

Long Acting Beta Agonist

Salmeterol
Formoterol
Vilanterol

47
Q

Beta-Adrenergic Agonists (Beta Agonist)

A

Beta Agonists stimulate beta 2 receptors resulting in relaxation of bronchiole smooth muscles producing bronchodilation

Side effects:
Tachycardia
Nervousness
Tremor
Airway irritation (only with excessive use)

48
Q

Albuterol (SABA)

A

Acute Symptoms
Onset: 5-15 minutes
Duration of action: 4-6 hours
“Bring with you to PT”

49
Q

SAMA

A

Short Acting Muscarinic Antagonist

50
Q

LAMA

A

Long Acting Muscarinic Antagonist

51
Q

Anticholinergic Drugs side effects (Ipratropium, Tiotropium)

A

Tachycardia
Confusion

52
Q

Glucocorticoids / Corticosteroids / ‘Steroids’

A

inhibits inflammatory response

Side Effects – short term
*Oral Thrush (inhalation)
* Hyperglycemia
* Psychiatric disturbances

Side Effects – long term
* Osteoporosis
* Skin breakdown
* Loss of adrenal function

53
Q

Cromones

A

Help PREVENT bronchospasm
Taken prophylactically
Prevent release of histamine
Example: Cromolyn

54
Q

Leukotriene Inhibitors

A

Leukotriene are inflammatory mediators in resp tissue
Example: Montelukast (Singular) – blocks the receptor for leukotrienes on resp tissue
-Tablet, taken daily

55
Q

Physical Therapy & Respiratory Drugs

A

Chest PT scheduling – 30 min/1hr after respiratory med treatments (SABA/SAMAs)
Bring Albuterol to therapy

Pharmacology (4 decks)

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