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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
aed- partial seizure- gabapentin or pregabalin- def and ae
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
26
aed- partial seizure- lemotrigine-ae
dizzy, drowsy, ataxia, blurred vision, n/v, headachd | adjunct med
27
aed- partial seizure- levetiracetam (keppra)
used in combo therapy less d-d interactions w/ o/ aed *not metab in liver
28
aed- general assessment
hx seiz/drugs monitor serum drug lvls (esp tegretol) describe seizure
29
what to document- seizure
``` characteristics duration loss consciousness loss bowel/bladder control post-seizure beh ```
30
aed- intraseizure precautions
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
aed- fast acting IV antiseizure drugs
trtmnt status epilepticus | IV benzos- lorazepam- followed by phenytoin or fosphenytoin
32
aed- pt ed
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
aed- therapy goal
minimize seziure act. w/ miniimal ae | monotherapy preferred to dec risk d-d interactions
34
time span to d/c aed
if free 2yrs | slowly taper off
35
seizures- non-drug therapies- vagal nerve stimulator
if combo med therapy not working can prevent / stop seizures (inc gaba) expensive and high risks! pulse generator under collarbone
36
seizures- non-drug therapies- keto
high fat, low cho or carbs | causes ketoacidosis, can dec act by 50%
37
seizures- non-drug therapies- cannabinoids
limited safety in adults v animals | ae- drowsy and diarrhea
38
schizophrenia- def
chronic psychotic illness disordered thinking, dec ability compared reality emerges during adolescence or early adulthood *altered reality
39
schizophrenia- s/s- positive
exagger of norm function | hallucinations, paranoia, agitation
40
schizophrenia- s/s- negative
dec of norm function | lack motivation, blunt affect, withdrawl
41
schizophrenia- 1st and 2nd gen
1st- haloperiodol | 2nd- clozapine, risperidone
42
schizophrenia- med duration
at least 12 mon. (tapered if no episodes) | 25% not require additional trtmnt after 1st episode
43
schizophrenia- therapy goals
prevent acute episodes, maintain highest lvl function
44
schizophrenia- First gen (FGA)- haloperidol- action and indication
indic- trt schizophr, mania, severe agression | moa- supress dopamine, acetylcholine, histamine and norepinephrine
45
schizophrenia- First gen (FGA)- haloperidol-ae
``` 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
schizophrenia- First gen (FGA)- haloperidol-ae- others
seizures, agrandulocy, severe dysrhytmias (qt prolong), inc risk stroke, mi or death if used for dementia-related s/s)
47
neuroleptic malignant syndrome (NMS)- manif
``` 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
neuroleptic malignant syndrome (NMS)- complications
death d/t respir failure cv collapse dysrhythmias renal failure d/t rhabdomyolysis
49
neuroleptic malignant syndrome (NMS)- trtmnt
withdrawl med, trt hyperthermia w/ antiphyretics and cooling blankets benzos, muscle relaxants, iv fluids
50
schizophrenia- second gen (SGA)- clozapine- action and indication
indic- trt schizo moa- block serotonin and dopamine recep, lower affinity for dopamine *fewer extrapyramidal side effects
51
schizophrenia- 2nd gen (SGA)- ae
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
antipsychotic considerations-1st gen
assess for eps - acute dystonia | parkinsonism, akathisia, tardive dyskinesia
53
antipsychotic considerations- 2nd gen
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
antipsychotic considerations- 1st and 2nd gen
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
antipsychotic- promote adherence
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
antipsychotic- non drug trtmnt
behavioral therapy, vocational therapy | hospitalization for protection, support and high lvls care
57
depression- cause
monoamine deficiency hypothesis | dec monoamine neurotrans (norepi and serotonin)
58
depression- SSRI- fluoxetine
selective serotonin reuptake inhibitors | ex. sertraline and citalopram
59
depression- TCA- amitriptyline
tricyclic antidep
60
depression- maois- selegiline
monamine oxidase inhib
61
suicide risk w/ antidep
highest in 1st 2 wks after start | inc risk suicide if already suicidal bc in energy
62
depression and women
2x incidence underdiagnosed and trted
63
ssri- fluoxetine (prozac)- action, indication, pharmaco
moa- inhib serotonin reuptakes, inc transmission serotonergic synapses indication- depression pharm- metab liver, excreted kid *4wks reach steady conc
64
ssri- ae
``` safer than tca or maois sexual dysfunction anxiety, tremor serotonin syndrome neuroleptic malignant syndrome suicidal thoughts seizures ```
65
serotonin syndrome
onset < 12hr after 1st dose manifestations- altered mental status, incoord, myoclonus, hyperrefl, sweating, tremor and fever death inc risk w/ moais
66
ssri- considerations
assess suicide risk, avoid concurrent use moai (SS), educate pt on s/s of SS monitor for NMS assess sexual side e
67
tca- amitriptyline- action, indication
action- block reuptake norepi and serotonin (monoamine neurotrans) indic- depression, bipolar dis, fibromyalgia, neuropathic pain *not commonly used for depression
68
tca- amitriptyline-ae
``` orthostatic hypoten (blocks alpha recep) antichol effects sedation cardiac toxicity (qt prolong) suicidal thoughts highest risk death if OD ```
69
tca- amitriptyline- considerations
``` assess suicide risk ass orthostatic hypoten asse sedation (Falls) implement safety precautions monitor for dysrhythmias ```
70
maoi- selegiline- moa, indication
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
maoi- selegiline- tyramine- patho and foods
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
maoi- selegiline- ae
seizures, dizziness, headache, blurred vision, orthostatic hypotension htn crisis
73
htn crisis- s/s and trtmnt
s/s- headache, tachycardia, palpitations, n/v, sweating can lead to stroke and death trtmnt- iv vasodilators (nitroprusside and labetalol)
74
maoi- selegiline- considerations and pt ed
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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