Exam 3 Neuro Part 1 Drugs

Question 1

Epilepsy treatment types

Answer 1

daily medication : anticonvulsants
surgery : remove cause of seizure (tumor)
nerve stimulation : stimulate vagus nerve
ketogenic diet : resurgence in treatment of refractory epilepsy

Question 2

antiepileptic medications MOA

Answer 2

not fully known
- work on multiple pathways
decrease expiatory OR increase inhibitory signaling

Question 3

antiepileptic medications acute AE

Answer 3

may be concentration dependent or idiosyncratic

Question 4

antiepileptic medications chronic AE

Answer 4

due to duration of use

ex. phenytoin- induced gingival hyperplasia

Question 5

antiepileptic medications common AE

Answer 5

• neurotoxicity * associated with all*
• sedation, ataxia, confusion, dizziness, blurred vision
• weight gain
• hypothyroidism
• rash
• mild to severe hypersensitivity reaction (may have more severe stevens-johnson syndrome rash
• require monitoring
• some are NTI
• MANY DDIs

Question 6

what are the 2 main treatments of ADHD

Answer 6

stimulants

atomoxetine

Question 7

stimulant drugs

Answer 7

methylphenidate (Ritalin, Concerta)

mixed amphetamine salts (Adderral)

Question 8

methylphenidate (Ritalin, Concerta) MOA

Answer 8

block dopamine and NE reuptake

Question 9

mixed amphetamine salts (Adderral) MOA

Answer 9

block dopamine and NE reuptake

increase dopamine and NE release

Question 10

stimulant meds dosing

Answer 10

IR: onset 15-20 min duration 2-6 hours
XR: duration 8-10 hours

if you take with food it will slow onset and absorption, but may decrease AEs

Question 11

stimulant med common AEs

Answer 11

decrease appetite/weight loss
stomachache
insomnia
headache
rebound sx
irritability/jitteriness

Question 12

stimulant med uncommon/rare AEs

Answer 12

• dysphoria
• “spacey”
• tics
• htn, hr fluctuations
• hallucinations
• skin discoloration w patch

Question 13

stimulant meds boxed warnings

CV risk

Answer 13

misuse may cause sudden death and CV AE
use w caution if baseline CV disease
generally safe if no base line CV and use as directed

Question 14

stimulant med boxed warnings

abuse potential

Answer 14

high abuse potential and dependence

Question 15

atomoxetine (Starttera) MOA

Answer 15

SNRI

selective NE reuptake inhibitor

Question 16

atomoxetine (Starttera) indication

Answer 16

ADHD

less effective but less potential for abuse and sleep disturbance

Question 17

atomoxetine (Starttera) role

Answer 17

mono therapy +/- a stimulant

Question 18

atomoxetine (Starttera) onsent

Answer 18

2-4 weeks

full benefit in 6-12

Question 19

atomoxetine (Starttera) AE

Answer 19

similar to stimulants

- more fatigue, sedation, and dizziness

Question 20

atomoxetine (Starttera) Boxed Warning

Answer 20

increase suicidal ideation in children/adolescents

MONITOR FOR MOOD CHANGES IN CHILD

Question 21

a2 adrenergic agonist indication

Answer 21

ADHD

Question 22

a2 adrenergic agonist MOA

Answer 22

binds postsynaptic alpha 2 adrenorecepors (mimic NE)

less effective than stimulants but less AEs

Question 23

a2 adrenergic agonist role

Answer 23

mono therapy +/- adjunct tx to reduce disruptive behavior, control aggression or improve sleep in youth

Question 24

a2 adrenergic agonist common AE

Answer 24

dose-dependent sedation (usually improves w time)
hypotension
constipation

Question 25

when would bupropion be used in ADHD

Answer 25

if concomitant depression

Question 26

when would lithium be used in ADHD

Answer 26

to control agression or explosive behavior

Question 27

when would antipsychotics be used in ADHD

Answer 27

refractory cases of severe regression