Exam 2 Pharmacology Flashcards by Isaiah Smith

Migraine Abortive Therapy

First:
-Aspirin like drugs (NSAIDS - ASA-Acetaminophen)

Can add:
-Serotonin Receptors Agonists (triptans) (sumatriptan)

For people you can not tolerate Triptans:
-Calcitonin Gene-related Peptide (CGRP) Antagonist

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Serotonin Receptor Agonist

sumatriptan

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sumatriptan: MOA

Constrict intracranial blood vessels

Suppress release of inflammatory neuropeptides

Block brain pathways for pain

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sumatriptan: Indication

Migraine

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sumatriptan: Adverse Effects

-Injection site reaction (SQ)

-Chest pressure

-Flushing

-Weakness

-Headache

-Bad taste

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sumatriptan: NSG consideration

-Avoid with history of ischemic stroke or heart disease

-Avoid with angina

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CGRP Antagonist

rimegepant

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rimegapnat: Indication

Used for Acute Migraines with triptans are not effective / contraindicated

-CAD or Stroke or Angina

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rimegapnat: Adverse Effects

GI problems

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Migraine Preventive Therapy

Beta Blockers
-propranolol

Tricyclic Antidepressants
-Amitriptyline

Antiepileptic drugs
-divalproex
-topiramate

Estrogens
-menstrual migraine

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Sinemet

levodopa/carbidopa

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levodopa/carbidopa (Sinemet): MOA

Levodopa = Converts to dopamine in the brain and activates dopamine receptors (increase dopamine)

Carbidopa = Blocks destruction of levodopa

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levodopa/carbidopa (Sinemet): NSG consideration

Takes MONTHS to see improvement

Loss of effect with time

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levodopa/carbidopa (Sinemet): Adverse Effects

Related to levodopa

N/V
-Give with food
-Will decrease absorption

Dyskinesias (80%)
-Range from annoying to disabling

Cardiovascular
-Postural Hypotension
-Dysrhythmias

Psychosis (20%)
-Hallucinations
-Nightmares
-Paranoia

Darken sweat and urine

Activate malignant melanoma
(good skin assessments beforehand)

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Doupa: Adverse Effects

Falling asleep without warning

Orthostatic hypotension

Hallucinations

Unusual urges

Depression

Dyskinesia

PLACEMENT OF PEJ

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Dopamine Receptor Agonist

pramipexole

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pramipexole: MOA

Binds with D2 receptors and stimulates the receptors

D2 = Dopamine receptors

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pramipexole: Indications

Monotherapy in early PD

Combined with sinemet in advanced PD

Restless leg syndrome

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pramipexole: Adverse Effects

Nausea

Sleep attacks

Pathologic gambling and other compulsive behaviors

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Cholinesterase Inhibitor

neostigmine

neostigmine: Indication

Myasthenia Gravis

neostigmine: MOA

Neostigmine is a parasympathomimetic reversible cholinesterase inhibitor

The drug inhibits acetylcholinesterase which is responsible for degradation of ACH

More ACH is present by interfering with breakdown of ACH

Allows for more muscle contraction

neostigmine: Adverse Effects (Muscarinic)

Increased Secretions (GI)

Urinary urgency

Bradycardia

Bronchial Constriction

Miosis (near sightnedness)

Neostigmine: Adverse Effects (Nicotinic)

Therapeutic Doses = Increased Muscle contraction

Toxic doses = Reduced Contraction (overstimulation of muscle)

Toxic dose can lead to cholinergic crisis

neostigmine: Major Adverse Reaction

Cholinergic Crisis Extreme Muscle Weakness or Paralysis Excessive Muscarinic Stimulation (Diarrhea-Cramping-Bradycardia)

Edrophonium

-short acting cholinesterase inhibitor -increases acetylcholine temporarily If they are in a MG crisis they will improve because there is an increase in acetylcholine If they are in a cholinergic crisis they will worsen because they already have too much acetylcholine

neostigmine: Cholinergic Crisis Anitdote

Atropine

interferon beta-1A Injectable

Avonex

avonex: MOA

Inhibit Inflammatory WBCS from crossing the BBB Decrease relapse rate in MS by up to 30%

avonex: Adverse Reaction

Flu like reactions Liver toxicity Bone marrow suppression

avonex: Indication

Multiple sclerosis

Glatiramer Acetate Injection

copaxone

copaxone: MOA

Increase production of anti-inflammatory T cells which cross the BBB and suppress inflammation

copaxone: Adverse Effects

Post injection: -Flushing -Palpitation -Chest pain -Laryngeal constriction (Only last 12-20 min so do not need treatment unless laryngeal constriction)

fingolimod: Indication

Oral medication for MS

fingolimod: MOA

Retain lymphocytes in the lymph nodes, preventing them from crossing the BBB - decreasing inflammation

dimethyl fumarate: Indication and MOA

Oral for MS Thought to inhibit immune cells and may have anti-oxidant properties

natalizumab

Infusion medication for multiple sclerosis

natalizumab: MOA

Infusion that prevents circulation T cells from leaving the vasculature and crossing the BBB

natalizumab: Adverse Effects

Most Common: -Headache -Fatigue -Progressive Multifocal leukoencephalopathy (PML) -Hepatotoxicity

Preferred Treatment of ACUTE RELAPSE of MS

High dose of IV glucocorticoid: -500 mgs to 1 gm of methylprednisolone daily x 3-5 days (pulse dose) -Frequent use or long term use should be avoided IV gamma globulin: -patient intolerant to glucocorticoid therapy ACTH (H.P acthar Gel): -adrenocorticotropin hormone in gel form -Prolonged release of ACTH after injection -For people who are unable to tolerate steroids or they have not been effective

Glutamate Inhibitor

riluzole

riluzole: Indication

Only drug for ALS

riluzole: MOA

Glutamate antagonist Reduces damage to motor neurons

riluzole: Adverse effects

Dizziness GI upset Hepatotoxicity

Pharmacotherapy for GBS

NO SURE -Steroid therapy (start high and taper down as they recover) Or -High-dose immunoglobulin therapy (IV) = Shorten severity and duration of symptoms

Bacterial Meningitis Pharmacotherapy

-Ceftriaxone (common) -Vancomycin (for MRSA form) -Acyclovir (Prevent encephalopathy just incase it is viral cause ) Aggressive Intravenous + multiple drugs

Encephalitis: Pharmacotherapy

Viral infection = Acyclovir -Reduces mortality -Does not reduce neurological complications Seizure disorders -Antiseizure medications

TIA Pharmacotherapy

-ASA (small doses) -clopidogrel (Plavix) -Heparin and warfarin if cardiac related