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336 Pharmacology > Exam 4- Neuro, seizures, mental disorders, + depression > Flashcards

Exam 4- Neuro, seizures, mental disorders, + depression Flashcards

1
Q

seizure-def

A

brief episode abnorm electrical act in brain cells

can be recurrent (epilepsy)

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2
Q

cause seizures

A

largely idiopathic
genetic predispos.
2ndary causes- etoh withdrawl, dev defects, metabolic dis, fever (kids), birth injury, acquired neuro dis (tumor or inc icp), hypoglycemia

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3
Q

partial seizure

A

simple or complex

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4
Q

simple seizure

A

partcial
have awareness/memory and conciousness
20-60 seconds

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5
Q

complex seizures

A 
partial
consciousness impaired (stare/motionless)
45-90 sec.- longer
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6
Q

generalized seizure

A

no specific part of brain (affects both sides)

tonic- clonic or absence (disconnect from world- common in kids)

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7
Q

status epilepticus

A

constant convulsions
life threatening- med immergency
tonic-clonic- several min at close intervals

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8
Q

status epilepticus complications

A

hypotension, hypoxia, cardiac dysrhythmias

high-risk brain damage

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9
Q

status epilep- causes

A 
abrupt d/c anti-seizure drug
brain tumor/trauma
systemic or cns infection
etoh withdrawl
drug overdose
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10
Q

tonic v clonic

A

tonic- stiff

clonic- jerking

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11
Q

general anti-epileptic drugs (AEDs)- moa, therap effect

A

control act but do not cure disorder
moa- dec mvmnt ions into nerve cells (block na= dec excitability and inc stability of cells (higher seiz. threshold))
inc act. neurotrans (gaba- dec excitability)

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12
Q

aed- phenotoyin- indications, routes

A

indications- prevent/trt seziures, bipolar, neuropathic pain
routes- oral/ng- dec absorption w/ tube feeds (stop feed 1h b4 and 1h after, can dec absorb by 70%)- can lead to malnutrition
IV- lots d-d interactions, only compatible w/ ns (have to piggyb)
assess iv site before admin (can cause phlebitis)
no IM- poor absorb

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13
Q

aed- phenytoin- therap range and role of protein

A

protein bound (ng interaction), only unbound drug is active (protein or malnourished ppl need dec dose bc less drug is taken out of circulation)
5-20mcg/ml or 0.8-2.0 mcg/ml unbound
checked after start of therapy

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14
Q

aed- phenytoin- d-d interactions

A

enzyme inducer- inc activity of metab enzymes

inc metab drugs= inc rate inactive form= dec effect bc shorter half life

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15
Q

aed phenytoin- ae and rare rxns

A

ae- ataxia, nystagmus, diplopia, n/v w/ po, hypotension
serious- allergic rxn (dress, sjs, angioedema)
dress- skin rash + muc. mem.
sjs- skin peeling
hepatic failure (LFTs)
bone marrow depression (agranulocy, aplastic anemia)
cardiac arrest (suppress elect act of heart)
suicidal thoughts

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16
Q

aed phenytoin- s/s toxicity

A

dizziness, nystagmus, slurred speech, aphasia, confusion, ataxia

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17
Q

aed- phenytoin- contraindications/ cautions

A 
hypersen (angioedema and epith dis)
preg (terratogenic)
heart block (dec conduction= dec hr)
cns depression
hepatic impairment
15:02 allele (assoc. w/ epith hypersen rxns)
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18
Q

aed- treats what type seizures

A

generalized seizures (tonic clonic or absence)

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19
Q

aed- fosphenytoin (cerebyx)

A

safer IV version phenyotin (less irritation and d-d rxns than phenytoin)
converted to phenytoin after IV injection (prodrug)
activated after liver metab

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20
Q

aed- carbamazepine (tegretol)

A

narrow therapeutic range (high risk toxicity)
black box warning- aplastic anemia and agranulocytosis (bone marrow dec)
assoc. w/ 15:02 allele disposition

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21
Q

aed- valpronic acid (depakote)

A

highest risk birth defects (avoid in women pregnant or planning to be)

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22
Q

aed- diazepam (valium), lorazepam (ativan)

A

pams
benzodiazepines
shorter acting
physical dependence w/ chronic admin (lead to w/drawl s/s)

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23
Q

aed-clonazepam (klonipin)- benzodiazepines

A

longer acting
inc gaba act
taper if long term use to avoid s/s withdrawl

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24
Q

aed- phenobarbital

A

long half life
3-4wks to reach steady state
can cause cns depression

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25
Q

aed- partial seizure- gabapentin or pregabalin- def and ae

A

trt neuropathic pain
half life inc w/ dec renal fun
ae- dizziness, drowsy, fatigue, tremor, n/v (dec overtime)
1st dose given at bedtime d/t dizziness

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26
Q

aed- partial seizure- lemotrigine-ae

A

dizzy, drowsy, ataxia, blurred vision, n/v, headachd

adjunct med

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27
Q

aed- partial seizure- levetiracetam (keppra)

A

used in combo therapy
less d-d interactions w/ o/ aed
*not metab in liver

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28
Q

aed- general assessment

A

hx seiz/drugs
monitor serum drug lvls (esp tegretol)
describe seizure

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29
Q

what to document- seizure

A 
characteristics
duration
loss consciousness
loss bowel/bladder control
post-seizure beh
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30
Q

aed- intraseizure precautions

A

pillow underhead, do not restrain mvmnts, loosen tight clothing (neck or chest)
elevate hob, turn on side, have suction ready to dec aspiration
prevent hypoxia- o2 and resucu equip avaliable

31
Q

aed- fast acting IV antiseizure drugs

A

trtmnt status epilepticus

IV benzos- lorazepam- followed by phenytoin or fosphenytoin

32
Q

aed- pt ed

A

take meds as scheduled (maintain blood levels to prevent w/drawl (status epilep))
do not d/c meds abruptly
driving- 6m-1yr free and then at least 3mon free
d-d interactions
pregnancy- try taper if planning to be preg, if not possible, do not d/c meds, weight risk of birth defects v seizure
prevent falls- drugs cause ataxia and dizziness
brush and floss avoid gingival hyperplasia (phenyotin)
do not switch btw generic and brand names

33
Q

aed- therapy goal

A

minimize seziure act. w/ miniimal ae

monotherapy preferred to dec risk d-d interactions

34
Q

time span to d/c aed

A

if free 2yrs

slowly taper off

35
Q

seizures- non-drug therapies- vagal nerve stimulator

A

if combo med therapy not working
can prevent / stop seizures (inc gaba)
expensive and high risks!
pulse generator under collarbone

36
Q

seizures- non-drug therapies- keto

A

high fat, low cho or carbs

causes ketoacidosis, can dec act by 50%

37
Q

seizures- non-drug therapies- cannabinoids

A

limited safety in adults v animals

ae- drowsy and diarrhea

38
Q

schizophrenia- def

A

chronic psychotic illness
disordered thinking, dec ability compared reality
emerges during adolescence or early adulthood
*altered reality

39
Q

schizophrenia- s/s- positive

A

exagger of norm function

hallucinations, paranoia, agitation

40
Q

schizophrenia- s/s- negative

A

dec of norm function

lack motivation, blunt affect, withdrawl

41
Q

schizophrenia- 1st and 2nd gen

A

1st- haloperiodol

2nd- clozapine, risperidone

42
Q

schizophrenia- med duration

A

at least 12 mon. (tapered if no episodes)

25% not require additional trtmnt after 1st episode

43
Q

schizophrenia- therapy goals

A

prevent acute episodes, maintain highest lvl function

44
Q

schizophrenia- First gen (FGA)- haloperidol- action and indication

A

indic- trt schizophr, mania, severe agression

moa- supress dopamine, acetylcholine, histamine and norepinephrine

45
Q

schizophrenia- First gen (FGA)- haloperidol-ae

A 
extrapyramidal symptoms (EPS)- APAT
acute dystonia (muscle rigidity, joint dislocation)
parkinsonism (shuffling, tremors, drooling)
akathisia (constant need move)
tardive dyskinesia (abnorm mvmnt mouth toungue -chronic)
neuroleptic maliignant syndrome
anticholinergic effects (blurred vision, dry mouth, urinary retention)
orthostatic hypotension
46
Q

schizophrenia- First gen (FGA)- haloperidol-ae- others

A

seizures, agrandulocy, severe dysrhytmias (qt prolong), inc risk stroke, mi or death if used for dementia-related s/s)

47
Q

neuroleptic malignant syndrome (NMS)- manif

A 
rare rxn to FGAs
lead pipe rigidity
sudden high fever, sweating, autonomic instability (dysrhythmias, fluctuations in bp)
raise and fall LOC (confused or mute)
seizure, coma
48
Q

neuroleptic malignant syndrome (NMS)- complications

A

death d/t respir failure
cv collapse
dysrhythmias
renal failure d/t rhabdomyolysis

49
Q

neuroleptic malignant syndrome (NMS)- trtmnt

A

withdrawl med, trt hyperthermia w/ antiphyretics and cooling blankets
benzos, muscle relaxants, iv fluids

50
Q

schizophrenia- second gen (SGA)- clozapine- action and indication

A

indic- trt schizo
moa- block serotonin and dopamine recep, lower affinity for dopamine
*fewer extrapyramidal side effects

51
Q

schizophrenia- 2nd gen (SGA)- ae

A

agranulocytosis- usually from spesis
EPS- APAT (dec compared to FGA)
metab effects- weight gain, dm, dyslipidemia
myocarditis (chest pain, inflamm)
seizures
ortho hypotension
dizziness, sedation
antichol effects (dry mouth, blurred v, constip)
inc risk stroke, mi, death when used for dementia
ventricular dysrhythmias (qt prolong)
neuroleptic malignant sydrome

52
Q

antipsychotic considerations-1st gen

A

assess for eps - acute dystonia

parkinsonism, akathisia, tardive dyskinesia

53
Q

antipsychotic considerations- 2nd gen

A

encourage reg exercise, monitor caloric intake
monitor weight, s/s hyperglycemia
assess bg, lipid panel, wbc and anc (agranulocy)
assess s/s infection r/t dm
notify provider immedi if s/s infection

54
Q

antipsychotic considerations- 1st and 2nd gen

A

assess orthostatic hypotension and sedation
employ fall prevention
avoid use in elderly for dementia
assess for seizures
assess for neuroleptic malignant syndrome ( lead pipe rigidity, fever, loc)
cardiac monitoring for iv admin

55
Q

antipsychotic- promote adherence

A

check for cheeking
involve family members on care
provide written and verbal instructions (dose size, timing)
* take as scheduled
ae and how to minimize
establish rapport
consider IM depot preparation for long-term therapy (q 2-3 wks or monthly)

56
Q

antipsychotic- non drug trtmnt

A

behavioral therapy, vocational therapy

hospitalization for protection, support and high lvls care

57
Q

depression- cause

A

monoamine deficiency hypothesis

dec monoamine neurotrans (norepi and serotonin)

58
Q

depression- SSRI- fluoxetine

A

selective serotonin reuptake inhibitors

ex. sertraline and citalopram

59
Q

depression- TCA- amitriptyline

A

tricyclic antidep

60
Q

depression- maois- selegiline

A

monamine oxidase inhib

61
Q

suicide risk w/ antidep

A

highest in 1st 2 wks after start

inc risk suicide if already suicidal bc in energy

62
Q

depression and women

A

2x incidence underdiagnosed and trted

63
Q

ssri- fluoxetine (prozac)- action, indication, pharmaco

A

moa- inhib serotonin reuptakes, inc transmission serotonergic synapses
indication- depression
pharm- metab liver, excreted kid
*4wks reach steady conc

64
Q

ssri- ae

A 
safer than tca or maois
sexual dysfunction
anxiety, tremor
serotonin syndrome
neuroleptic malignant syndrome
suicidal thoughts
seizures
65
Q

serotonin syndrome

A

onset < 12hr after 1st dose
manifestations- altered mental status, incoord, myoclonus, hyperrefl, sweating, tremor and fever
death
inc risk w/ moais

66
Q

ssri- considerations

A

assess suicide risk, avoid concurrent use moai (SS), educate pt on s/s of SS
monitor for NMS
assess sexual side e

67
Q

tca- amitriptyline- action, indication

A

action- block reuptake norepi and serotonin (monoamine neurotrans)
indic- depression, bipolar dis, fibromyalgia, neuropathic pain
*not commonly used for depression

68
Q

tca- amitriptyline-ae

A 
orthostatic hypoten (blocks alpha recep)
antichol effects 
sedation
cardiac toxicity (qt prolong)
suicidal thoughts
highest risk death if OD
69
Q

tca- amitriptyline- considerations

A 
assess suicide risk
ass orthostatic hypoten
asse sedation (Falls)
implement safety precautions
monitor for dysrhythmias
70
Q

maoi- selegiline- moa, indication

A

moa- inc amnt norepi and serotonin in nerve terminals
indication- not used anymore
risk htn crisis w/ foods high tyramine
d-d interactions w/ tca, ssris and indirect acting sympathomimetic drugs

71
Q

maoi- selegiline- tyramine- patho and foods

A

inhib enzyme breakdown of med (accumulates)
foods high- aged cheese, beer, sausage, soy sauce, overripe avocados, bananas, meat
patho- tyramine unable be metabolized- inc norepinephrine- vasoconstriction- high bp

72
Q

maoi- selegiline- ae

A

seizures, dizziness, headache, blurred vision, orthostatic hypotension
htn crisis

73
Q

htn crisis- s/s and trtmnt

A

s/s- headache, tachycardia, palpitations, n/v, sweating
can lead to stroke and death
trtmnt- iv vasodilators (nitroprusside and labetalol)

74
Q

maoi- selegiline- considerations and pt ed

A

consid- assess suicide risk, assess bp (htn crisis of orthostatic)
tyramine free diet

pt ed- foods to avoid, s/s htn crisis- seek immed med attention
orthostatic hypotension
drug interactions

336 Pharmacology (5 decks)

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