Drugs affecting CNS

Question 1

appetite suppressant medications education

Answer 1

short term use only- 8-12 weeks
-monitor thyroid and hormone levels
only for those with BMI 30 or greater
-works by stimulating satiety centers of the hypothalamus

Question 2

monitoring of appetite suppresants

Answer 2

• thyroid levels

- controlled substance d/t its abuse and dependence levels

Question 3

anorexiants ADRs:

Answer 3

CNS overtstimulation: agitation, confusion, palpitations, arrythmias, sudden withdrawal can cause withdrawal symptoms, inc glucose in pts with diabetes

Question 4

avoid anorexiants in patients with

Answer 4

heart problems, drug history, eldcerly

Question 5

lipase inhibitors: ex of drug and facts

Answer 5

-Orlistat: taken orally with meals
works by preventing absorption of fats in the intestine; therefore, fat gets excreted quick out into feces

side effect: fatty oily stools, fecal urgency

Question 6

epilepsy vs seizure

Answer 6

epilepsy- 2 or more unprovoked seizures

seizures- may be provoked (stressor, dehydration, chock, etc), if provoked, doesn’t count as the one tally for epilepsy

Question 7

Anticonvulsant medications also being used in the treatment of mood disorders

Answer 7

gabapentin and Lamotrigine

Question 8

drug choices for anticonvulsants

Answer 8

Hydantoins
Carbamazepines (Tegretol)
Succinimides
Drugs that affect GABA (Neurontin

Question 9

hydantoin drug example

Answer 9

dilantin:

Question 10

special dilantin consideration

Answer 10

unlike phenobarbitals, where doubling dose where you double dose, it doubles serum level), Dilantin does not work that way. Dilantin as its doubled, you can sometimes triple serum level , or slightly inc therapeutic effect. Does and therap effects are not 1:1 relationship like phenobarb
-can interact with antacid, valium use

Question 11

First-line treatment for tonic-clonic and partial complex seizures

Answer 11

hydantoins

Question 12

MoA of hydantoins

Answer 12

increasing influx of sodium ions across cell membranes in the motor cortex

Question 13

anti-seizure meds consideration and talk to PCP when takin

Answer 13

birth control meds

Question 14

common side effects of dilantin

Answer 14

itching, paresthesias, gingival hyperplasia, urinary retention,

Question 15

monitoring of hydantoins

Answer 15

monitor liver labs, thyroid tests, kidney fx, OTC meds (antacids and nsaids)

Question 16

driving and seizures

Answer 16

cannot drive if had seizure within a year

Question 17

carbamezapine class drug

Answer 17

tegretol: black box warning: Steven Johnson syndrome (esp in asian ppl)

Question 18

teaching for pt taking carbamezapine (tegretol)

Answer 18

teach about S/S of bone marrow suppression

Question 19

Succinimide drug class:

Answer 19

Used for treatment of absence seizures in children and adults
Ethosuximide (Zarontin)

Question 20

Ethosuximide (zarontin)-

Answer 20

Suppresses seizures by delaying calcium influx into neuron

Side effects: GI most common; somnolence

Question 21

Lamictal (lamotrigine)

Answer 21

tonic clonic seizures, mood disorders, and absence disorders

can be used with valproic acid and phenytoin

Question 22

Levateracitam (keppra)

Answer 22

few drug interactions (cleaner drug for seizure)

Question 23

Gabapentin (Neurontin)

Answer 23

gaba working in body; suicidal thinking; can be used for neuropathic pain assoc with diabetic neuropathy, herpes zoster

Question 24

gabapentin lab monitoring

Answer 24

renal fx:

if GFR too low, renal dosing may be required

Question 25

Inhibits excitatory neurotransmitter release in the CNS Used in treatment of focal onset seizures, diabetic peripheral neuropathy, post herpetic neuralgia, and fbromyalgia Excreted unchanged by kidneys – reduced dosing in renal disease required

Answer 25

lyrica

Question 26

TCA's (first ones in the market)

Answer 26

Slavic, tofranil; overdose can lead to death, EKG changes, ortho hypotension, and anticholinergic effects pt education: report chest pain, suicidal thinking, don't drive, no alchohol

Question 27

Most commonly prescribed antidepressant and well tolerated

Answer 27

ssri's; inc levels of serotonin in body; ADRs: CNS, GI, sexual dysfunction , weight gain * can't take up to 3-4 weeks to start working - taper between 2-3 weeks

Question 28

sari warnings

Answer 28

Suicide ideation and increased suicide risk- especially with children early in treatment

Question 29

serotonin syndrome

Answer 29

diarrhea, tremor, sweating, restlessness, hyperreflexia - if untreated leads to disorientation, fever, rigidity, coma, seizures, and death – 10% mortality rate

Question 30

SNRI's examples

Answer 30

duloxetine (Cymbalta) and vanlafaxine (Effexor)

Question 31

sari's and children

Answer 31

NOT approved

Question 32

SNRI's monitoring

Answer 32

watch with antibiotic : quinolones

Question 33

Decreased alertness and low energy and depressed-

Answer 33

snri's

Question 34

depression with pain or fibromyalgia ->

Answer 34

Cymbalta

Question 35

Inhibits reuptake of both norepinephrine and dopamine

Answer 35

bupropion (Wellbutrin): dec attention span, dec motivation, -few sexual side effects -contrindicated in siezure disorders can be used with smoking cessation too; decide when they want to quit, then start wellbutrin 10-15 days before

Question 36

thorazine and haldol side efects

Answer 36

Parkinsonism, eps syndrome, inc mortality with old people monitor: prolactin levels and aim scale

Question 37

These drugs attempt to restore the functional balance of dopamine and acetylcholine (ACh) in the corpus striatum of the brain.

Answer 37

``` dopaminergic: good for parkinson's Amantadine (Symmetrel) Bromocriptine (Parlodel) Levodopa (L-Dopa, Larodopa) Carbidopa-levodopa (Sinemet) Pramipexole (Mirapex) – also used for RLS Ropinirole (Requip) – also used for RLS ```

Question 38

Must better to treat anxiety with ssri’s than anxiolytics and hypnotics d/t

Answer 38

phys/psych dependence and abuse potential

Question 39

anxiety drugs : short acting

Answer 39

lorazepam (Ativan) and alprazolam (xanax)

Question 40

anxiety drugs: long acting

Answer 40

clonazepam (klonipin) and diazepam (valium)

Question 41

Long term treatment of general anxiety disorder Exerts effect by enhancing serotonin; no CNS depression Little risk of dependence and few drug interactions Pharmacokinetics: reduced first-pass affect, has many metabolites, one has noradrenergic effects, NOT used with panic attacks Takes up to 2 weeks for onset to occur and up to 6 weeks for maximum effect Needs to be taken daily – not prn

Answer 41

busperone (buspar)

Question 42

3rd class of anxiolytics: barbiturates

Answer 42

Used today for pre-anesthesia sedation; seizure disorders; status epilepticus (phenobarbitals)

Question 43

sedative hypnotics: | Benzos and nonbenzos

Answer 43

Benzos: high tolerance nonbenzos: take immediately before bed and sleep for 6-7 hrs of sleep

Question 44

High incidence of drug-drug and drug-food interactions, especially with foods containing tyramine with this drug

Answer 44

maoi's (Nardil marplan) low safety margin

Question 45

lithium (mood stablizer)

Answer 45

bipolar disorder, very low therapy index at toxic levels: neuro changes (ataxia, tremors, confusion)

Question 46

2 types of muscle relaxants/antispasmodics

Answer 46

centrally-acting and direct acting

Question 47

centrally acting muscle relaxant

Answer 47

CNS depression likely; flexeril take at night;

Question 48

direct acting antispasmodics:

Answer 48

dantrolene treats spasticity in upper neurons | -pt education: titration schedule

Question 49

amphetamines vs strattera

Answer 49

schedules vs nonscheduled substance; no amphetamine side effects for Strattera; ampetamines can take drug holidays, not straterra, as it takes forever to start working

Question 50

Modafinil (Provigil) | Amodafinil (Nuvigil)

Answer 50

used to treat narcolepsy and SWCD (sleep wake cycle disorder)

Question 51

xanthine

Answer 51

coffee