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Pharmacology > HA/Seizure/MDD/Anxiety > Flashcards

HA/Seizure/MDD/Anxiety Flashcards

1
Q

characteristics of tension HA

A

dull with pain that radiates from forehead to occiput in a band-like fashion. Often radiates down the neck and sometimes into the trapezius muscle

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2
Q

characteristics of migraine HA

A

throbing head pain and often nausea, appetite change, photophobia, phonophobia

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3
Q

characteristics of cluster HA

A

disabling, burning, or boring and centered around one eye. Unilateral. Refer to neurologist or HA specialist

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4
Q

main inhibitory neurotransmitter in the CNA

A

GABA

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5
Q

excitatory neurotransmitters in CNA

A

glutamate

aspartate

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6
Q

2 major groups of seizures

A

partial

generalized

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7
Q

focal seizures (simple partial)

A

no alteration of consciousness
symptoms determined by anatomical location of seizure in the brain and may be motor, sensory, autonomic, or psychic
may evolve into complex partial or generalized tonic-clonic

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8
Q

complex partial seizure (psychomotor)

A

impaired consciousness with some sort of automatic behavior

may be proceeded by an aura

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9
Q

types of generalized seizures

A 
absence
atypical absence
tonic-clonic
clonic
atonic
myoclonic
tonic
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10
Q

absence seizures (petit mal)

A

sudden onset, brief, disrupt ongoing activity, no postictal state
blank stare and nonresponsive when spoken to

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11
Q

tonic-clonic seizures (grand mal)

A

abrupt loss of consciousness. bilateral jerking movements, increased salivation, frothing at the mouth, deep respiration and relaxation of muscles. Vague, ill-defined warning sign but no true aura. Postictal period with depressed consciousness that can be prolonged

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12
Q

clonic seizures

A

rapidly repetitive bilateral jerking movements of extremities and facial muscles with short postictal state

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13
Q

atonic seizures (drop attacks)

A

sudden loss of muscle tone which may be only fragmentary. May be brief and not associated with loss of consciousness

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14
Q

myoclonic seizures

A

sudden, brief, shock like muscular contractions

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15
Q

tonic seizures

A

brief, generalized tonic contractions with associated head extension, possible stiffening of back and stiffening or all 4 extremities

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16
Q

status epilepticus

A

life threatening emergency. Seizure activity lasting longer than 30 minutes or two sequential seizures with no recovery between

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17
Q

precipitating factors for status epilepticus

A 
drug noncompliance
sudden withdrawal from antiepileptic drugs
withdrawal from alcohol/sedative drugs
CNS infection
metabolic disturbances
sleep deprivation
stroke
trauma
encephalitis
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18
Q

apparent unprovoked first seizure

A

EEG, CT or MRI

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19
Q

phenytoin use

A

one of the most commonly used for tonic-clonic as well as simple and complex partial seizures. Also used to prevent early posttraumatic seizures after TBI

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20
Q

does phenytoin require a loading dose

A

yes

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21
Q

contraindications to phenytoin

A

no absolutes

black box warning for severe cardiac events with rapid IV admin

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22
Q

dosage titration of carbamazepine

A

don’t decrease due to slightly elevated level during 1st month as it will likely decrease as a result of autoinduction. If it is decreased it will likely continue to decrease and dosage should be increased

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23
Q

carbamazepine for myoclonic seizures

A

not effective and may in fact exacerbate

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24
Q

self-interaction of carbamazepine

A

can induce its own metabolism resulting in decreased serum concentrations over time (induces and is metabolized by CYP3A4)

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25
Q

what else does oxcarbazepine interact with

A

oral contraceptives

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26
Q

black box warning for valproic acid

A

potential for hepatic failure
risk of hepatotoxicity with known mitochondrial disorders
spina bifida (do not give to pregnant patients)
severe life-threatening pancreatitis

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27
Q

symptoms of hepatotoxicity

A

malaise, weakness, facial edema, anorexia, jaundice, and vomiting

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28
Q

Valproic acid and carbapenems

A

rapid decline in valproate plasma concentrations

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29
Q

does phenobarbital require a loading dose

A

yes

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30
Q

black box warning for ezogabine

A

may cause retinal abnormalities which can loss loss of visual acuity

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31
Q

contraindications to pregabalin

A

hx of angioedema, HF, HTN, DM

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32
Q

dosage of topiramate in relation to creatinine clearance

A

<70 dosage should be lowered by 50%

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33
Q

black box warning for felbamate

A

100-fold increased risk for aplastic anemia (avoid use in patients with history of blood dyscrasias)

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34
Q

black box warning for vigabatrin

A

may cause permanent bilateral concentric visual field constriction

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35
Q

visual assessment with vigabatrin use

A

baseline, week 4, then q3mo

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36
Q

rufinamide administration

A

give with food for increased absorption

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37
Q

dosing of clobazam

A

based on patient weight

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38
Q

clobazam interactions

A

alcohol can increase concentration by as much as 50%

can reduce effectiveness of birth control

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39
Q

benzodiaepines for seizure control

A

clobazam
clonazepam
lorazepam
diazepam

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40
Q

clonazepam contraindications

A 
narrow-angle glaucoma
severe liver disease
chronic respiratory disease
impaired renal function
mentally challenged
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41
Q

medications that greatly increase diazepam levels by altering clearance

A

SSRIs
sertraline
paroxetine

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42
Q

first line treatment for SE

A

benzodiazepines

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43
Q

most common seizure syndrome in pediatrics

A

Lennox-Gastaut syndrome ( usually associated with mental retardation)
poor prognosis for seizure control

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44
Q

geriatric considerations for antiepileptic drugs

A

decreased liver/renal function

lower albumin levels can caus higher free drug concentrations increasing likelihood of adverse reactions

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45
Q

AEDs that can lead to contraceptive failure

A

topiramate, oxcarbazepine, and lamotrigine

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46
Q

whn AED is started or changed, how many half-lives to reach steady state

A

5 elimination half-lives

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47
Q

which AEDs limit their own half0life when given chronically

A

carbamazepine and valproic acid

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48
Q

postpartum depression onset

A

within 6 weeks of childbirth and can persist for 3-14 months

49
Q

acute treatment phase of depression

A

6-8 (potentially up to 12) weeks

full assessment of effectiveness at weeks 4-6

50
Q

continuation phase of depression tx

A

usually 9mo-1yr

continue therapy for 4-6 months after symptom resolution

51
Q

when is maintenance therapy considered for depression

A 
3+ prior episodes
2 episodes in 5 yrs
comorbid substance abuse or anxiety disorder
family hx
onset earlier than 20 or later than 40
52
Q

adequate trial of antidepressant medication

A

6-12 weeks

53
Q

antidepressant drug classes

A 
SSRIs
SNRIs
TCAs
MAOIs
atypical agents
54
Q

administration of SSRIs

A

take in am d/t potential to induce anxiety and/or insomnia

55
Q

SSRI drugs

A 
citalopram (Celexa)
fluoxetine (Prozac)
fluvoxamine (Luvox)
paroxetine (Paxil)
sertraline (Zoloft)
escitalopram (Lexapro)
56
Q

SNRI drugs

A

venlafaxine (Effexor)
desvenlefaxine (Pristiq)
duloxetine (Cymbalta)
levomilnacipran (Fetzima)

57
Q

MAOI drug

A

phenelzine (Nardil)

58
Q

Atypical antidepressant drugs

A

bupropion (Wellbutrin)
mirtazapine (Remeron)
trazadone (Desyrel)

59
Q

why are SSRIs ideal for elderly

A

no potential to induce orthostatic hypotension or cardiac conduction abnormailities
use caution with seizure disorders as lowers seizure threshold

60
Q

symptoms of “discontinuation syndrome” with SSRIs

A

return and worsening of depressive symptoms with a flu-like presentation, insomnia, irritability, GI effects, and anxiety

61
Q

most frequently reported SSRI adverse effect

A

pervasive sexual dysfunction

Wellbutrin has been utilized to mitigate

62
Q

symptoms of serotonin syndrome

A

heat stroke
vascular collapse
fever
tachycardia

63
Q

abrupt discontinuation of SNRIs

A

also produces discontinuation syndrome

64
Q

what may be an appropriate option is depression is characterized by insomnia

A

TCA as they can cause sedation

65
Q

TCAs that are advantageous for elderly

A

nortriptyline and desipramine (Norpramin) d/t less potential to cause orthostatic hypotension

66
Q

contraindications to TCAs

A

preexisting epilepsy and cardiac conduction abnormalities (may contribute to AV block and QT prolongation)

67
Q

TCA mech of action

A

inhibits reuptake of norepinephrine and serotonin

68
Q

Atypical antidepressant drugs

A

bupropion
trazadone
nefazodone
mirtazapine

69
Q

what makes bupropion different from all other available antidepressants

A

Inhibits reuptake of norepinephrine and dopamine. Does not affect the serotonergic system

70
Q

benefits of bupropion over other antidepressants

A

virtual absence of sexual side effects

less somnolence, fatigue, and weight gain

71
Q

adverse effect of bupropion

A

lowers seizure threshold

72
Q

why is trazadone highly sedating

A

secondary to its antihistamine properties

73
Q

what else can trazadone be used for

A

comorbid anxiety disorders

off label sleep aid

74
Q

SSRI wash out period

A

4-5 days for zoloft and paxil and several weeks for prozac

75
Q

mirtazapine appetite stimulation

A

may make it a good option for low-weight elderly or ill patients

76
Q

Novel antidepressant drugs

A

vilazodone

vortioxetine

77
Q

vilazodone and vortioxetine onset of effect

A

significantly earlier than other antidepressants (as early as 1 week)

78
Q

what risks serotonin syndrome when coadministered with vortioxetine

A

bupropion or buspirone

79
Q

MAOI orthostatic hypotension

A

attempts to counteract this include support stockings, prescribing stimulants (methylphenidate), or adding the mineralocorticoid

80
Q

MAOI diet

A

strictly eliminate tyramine-containing foods (may cause hypertensive crisis)

81
Q

first line therapy for MDD

A

SSRIs or SNRIs unless contraindications

82
Q

second line therapy for MDD

A

increase dose, augmentation, or switching

83
Q

typical agents used to augment antidepressant therapy

A

lithium
thyroid hormone
stimulant medications

84
Q

when switching medication classes for MDD what should be chosen prior to TCAs

A

atypical antidepressants

85
Q

MDD medications commonly added to initial medication for combo therapy

A 
trazadone
bupropion
mirtazapine
buspirone
atypical antipsychotics
86
Q

why should venlafaxine (effexor) be avoided with uncontrolled HTN

A

potential to increase BP

87
Q

depression presentation in children

A

early childhood: acting out, changes in eating/sleeping, social withdrawal
5-8: low self-esteem, underachievement at school, aggressive or antisocial behavior (including stealing and lying)

88
Q

MDD medication approved for use in children

A

Prozac is the only SSRI for children 8+

Lexapro approved for 12+

89
Q

MDD presentation in elderly patients

A

more vegetative symptoms and cognitive disturbances than subjective dysphoria

90
Q

St. John’s wort for MDD

A

do not take in combo with any other antidepressant d/t risk of serotonin syndrome
can decrease serum levels of warfarin and oral contraceptives

91
Q

anxiety disorders

A

generalized anxiety disorder (GAD)
panic disorder (PD)
social anxiety disorder (SAD)

92
Q

GAD must be present for at least 6 months and have at least 3 of what 6 arousal symptoms

A 
restlessness
fatigue
muscle tension
irritability
concentration deficit
sleep disturbance
93
Q

how long should tx of anxiety disorders continue after resolution of symptoms

A

12 months

94
Q

SSRIs used to tx anxiety

A 
citalopram (Celexa)
escitalopram (Lexapro)
fluvoxamine (Luvox)
paroxetine (Paxil)
sertraline (Zoloft)
95
Q

TCA used to tx anxiety

A

Imipramine (Tofranil)

96
Q

SNRI used to tx anxiety

A

venlafaxine (Effexor)

duloxetine (Cymbalta)

97
Q

what else can Cymbalta tx other than anxiety and depression

A

somatic pain

98
Q

indication for benzodiazepine tx in anxiety disorders

A

short term usage (2-4 weeks) while long term therapy takes effects
or on as as-needed basis for panic attacks

99
Q

high potency BZDs

A

alprazolam (Xanax)
clonazepam (Klonopin)
lorazepam (Ativan)

100
Q

preferred drugs for tx of anxiety in the elderly and people with liver disease

A

oxazepam and lorazepam due to one-step inactivation

101
Q

highly lipid soluble BZD

A

diazepam (Valium)

102
Q

reported possible adverse effects of BZDs in children, elderly, and brain-injury patients

A

rage
excitement
hostility

103
Q

drug to tx BZD OD

A

flumazenil (Mazicon)

104
Q

Buspirone

A

primarily used as adjunctive therapy (delayed onset of action, lack of efficacy in relation to most comorbid conditions)
effect may take 2-3 weeks

105
Q

examples of tyramine-containing foods

A

cheese, liver, yogurt, yeast, soy sauce, red wine, beer

106
Q

1st line therapy for GAD

A

SSRIs/SNRIs with BZD to use until therapeutic effect is realized

107
Q

2nd line therapy for GAD

A

imipramine or buspirone (may be the best choice for patients with a hx of substance abuse, personality disorder, or sleep apnea)

108
Q

3rd line therapy for GAD

A

TCA alone or buspirone

109
Q

4th line therapy strategies for GAD

A

SSRI/SNRI with an AAP
SSRI/SNRI with antihistamine (hydroxyzine)
SSRI with imipramine
SSRI with a BZD

110
Q

1st line therapy for panic disorder

A

SSRIs or venlafaxine (Effexor)
Xanax is only BZD approved by the FDA but Klonopin and Ativan are also used
CBT is very important

111
Q

2nd line therapy for panic disorder

A

may change to another SSRI or venlafaxine

112
Q

3rd line therapy for panic disorder

A

may switch to yet another SSRI, imipramine, or MAOI

113
Q

1st line therapy for social anxiety disorder

A

SSRIs or venlafaxine

CBT

114
Q

2nd line therapy for social anxiety disorder

A

MAOI phenelzine can be attempted in select patients

115
Q

BZDs approved for tx of anxiety in children

A

clorazepate
chlordiazepoxide
diazepam
alprazolam

116
Q

MDD/anxiety meds associated with fetal heart defects and other teratogenicities

A

fluoxetine (Prozac)

paroxetine (Paxil)

117
Q

pregnancy category of antidepressants

A

most are C
bupropion is B
paroxetine is D

118
Q

3 components of withdrawal syndrome

A

relapse: return to symptoms
rebound: worse symptoms than originally experienced
withdrawal: appearance of new symptoms

119
Q

monitoring patients on long term BZD therapy

A

periodic CBC, LFT, thyroid function tests

Pharmacology (11 decks)

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