Exam 5 pt. 2

Question 1

Three Types Migraines ?

Answer 1

Migraine with aura (classic migraine)

Migraine without aura (common migraine)

Migraine with focal neurological deficits
-especially ocular migraines

Question 2

Goal is to minimize the impact that the ________ has on quality of life

Answer 2

headache

Question 3

Migraines treatment (general) ?

Answer 3

Abortive therapy

Prophylactically

Question 4

Migraine HEADACHES first line therapy ?

Answer 4

NSAIDS
ASA
Acetaminophen

Question 5

Only ____________ respond to triptans and ergotamine’s

Answer 5

migraine headaches

Question 6

_________ is the key to treatment is it truly a HA or a cluster HA ( M are unilateral, and usually photophobia)

Answer 6

History

Question 7

Serotonin Receptor Agonists (Triptons) examples ?

Answer 7

Rizatripton (Maxalt)
Zolmitripton (Zomig)
Sumatripton (Imatrex)
Eletripton (Reelpax)

Almotripton (Axert)
Naratriptom (Amerge)

**great for preventative and some use for abortive **

Question 8

Serotonin Receptor Agonists (Triptons) pharmacokinetics ?

Answer 8

Rapid absorption (30 min)

Metabolism by liver

Excreted urine

Half-Life 2.5-6 hours
depending on specific drug

Question 9

Serotonin Receptor Agonists (Triptons) adverse reactions ? especially in female

Answer 9

Chest pain

Hypotension

Visual disturbances

Nausea / vomiting / diarrhea
throat discomfort
-angioedema ( no)

Allergic rhinitis

Vertigo / dizziness

**women on these for a long period of time - it can cause prizmental type sxs. **

Question 10

Serotonin Receptor Agonists (Triptons) interactions ?

Answer 10

May interact with SSRI’s causing Serontonin syndrome

Do not use with MAOI’s

Zolmitriptan (Zomig) and naratripton (Amerge) interact with OCP and cimetidine (deceasing effect)

Question 11

Serotonin Receptor Agonists (Triptons) contraindicated ?

Answer 11

pregnancy / ischemic heart disease

Question 12

____________________ interact with OCP and cimetidine (deceasing effect)

Answer 12

Zolmitriptan (Zomig)

Naratripton (Amerge)

Question 13

Triptons may be used by __________ with Pediatric Neurology following, No more than ____ doses in 24 hours

Answer 13

children

two

Question 14

Alkaloids from the ergot plant ?

Answer 14

Ergotamines

Question 15

Ergotamine trade ?

Answer 15

Ergostat, Ergomar

Question 16

________________

Used in the aborting of 70% migraines

Answer 16

Dihydroergotamine (DHE45, Migranol)

Question 17

Ergotamines phramacokinetics ?

Answer 17

Oral absorption is erratic but enhanced with caffeine

Metabolized by the liver

Excreted by urine

Half-life 2 hours

Question 18

Ergotamines adverse reaction ?

Answer 18

Rhinitis from nasal spray

Nausea / vomiting

Hot flashes

Dizziness

somnolence

Question 19

Ergotamines contrindication ?

Answer 19

uncontrolled HTN,

ischemic heart disease,

renal impairment

Question 20

Avoid what when on Ergotamines ?

Answer 20

Avoid grapefruit juice, coffee, tea may increase absorption and lead to toxicity

Question 21

Ergotamines preg. cat ?

Answer 21

X

Causes constriction uterine contractions

Question 22

Helps with the dyskinesia and tremor associated with Parkinson’s disease ? Early course in middle-aged patients most successful ?

Answer 22

Dopamine pre-cursors

Anti-Parkinson’s Treatments

Question 23

Corrects the brains imbalance of dopamine to acetylcholine, what is the medication ?

Answer 23

Dopamine pre-cursors

Anti-Parkinson’s Treatments

Question 24

Carbidopa/Levodopa (Sinemet)

pharmacokinetics ?

Answer 24

Metabolized CYP=450

Excreted urine 70%, feces 30%

Half-life ¾ to 1.5 hours

Question 25

Carbidopa/Levodopa (Sinemet)

indications ?

Answer 25

Parkinson’s disease

Question 26

Carbidopa/Levodopa (Sinemet) advere effects /caution ?

Answer 26

glaucoma, angle-closure

avoid abrupt withdrawal

high-protein diet

cardiovascular disease, arrhythmias w/ MI hx

psychosis
hepatic / renal impairment

Question 27

Amantadine (Symmetrel)

Pharmacokinetics ?

Answer 27

Metabolized liver

Excreted urine

Half-life 34-51 hours

Question 28

Amantadine (Symmetrel)

adverse reactions / caution ?

Answer 28

Foods containing Kava (root, tea herbal) and pyridoxine (Vit B6) reverse effect of levodopa

Narrow angle glaucoma

Undiagnosed skin lesions (proliferation)

Twitching eye-lid early sign toxicity

Cautions with anti-psychotics and benzo’s

Question 29

Ropinirole (Requip) pharmacokinetics ?

Answer 29

Metabolized liver CYP-450

Excreted Urine

Half-life 6 hours

Question 30

Ropinirole (Requip)

adverse reactions ?

Answer 30

hypotension, orthostatic
bradycardia
syncope
mental status alterations
hallucinations
dyskinesia

Question 31

Ropinirole (Requip)

interactions ?

Answer 31

Orthostatic hypotension
bradycardia
syncope
mental status alterations / hallucinations
dyskinesia
melanoma risk

Question 32

Benztropine (Cogentin) pharmacokinetics ?

Answer 32

Poorly absorbed 28%, Only 6% reaching circulation

Metabolized Liver

Excreted urine

Half-Life 4 hours

Question 33

Benztropine (Cogentin)

adverse effects ?

Answer 33

Dry mouth
Blurred vision
Tachycardia
Psychosis (in overdose)
Urinary retention
Anorexia

very narrow therapeutic window!

Question 34

Donepezil (Aricept) and

Memantine (Namenda) pharmacokinetics ?

Answer 34

Absorbed GI tract completely

Metabolized liver CYP-450

Excreted as glucuronide in urine
-to see if they are metabolizing it off and to see if it is working or not

Half-life 60-80 hours

Question 35

Donepezil (Aricept) and

Memantine (Namenda) adverse reactions / caution ?

Answer 35

Confusion / somnolence / hallucinations

Liver Failure

Dosage adjusted for renal disease

Urine under pH 8 may lead to accumulation

HTN / AV block / cardiac failure
Cataracts / conjunctivitis
Fatigue / Back pain

**urine pH is the key

get EKG prior **