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Pharm Exam 2 > Lecture 3 > Flashcards

Lecture 3 Flashcards

1
Q

What causes Parkinson’s

A

An imbalance of dopamine and acetylcholine in the brain

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2
Q

Where do we see the decrease in dopamine for Parkinson’s

A

We see a decrease in dopamine production in the substantia nigra and basal ganglia (midbrain)

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3
Q

What is the role of the substantia nigra

A

In charge of controlling smooth muscle voluntary movement

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4
Q

What happens to acetylcholine during Parkinson’s

A

Relative increase

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5
Q

What are the signs and symptoms of Parkinson’s

A

Resting tremor or “pill rolling” movements

Bradykinesia: difficulty moving

Rigidity

Postural instability which is characterized by a shuffling gait

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6
Q

What is the main dopamine agonist

A

Levodopa- carbidopa

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7
Q

What is the MOA for levodopa-carbidopa?

A

Increases amount of dopamine in the brain

Carbidopa increases availability of levodopa

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8
Q

What is levadopa

A

The precursor for dopamine

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9
Q

What are the nursing considerations for levadopa-carbidopa

A

Hypertensive crisis

Postural hypotension aka orthostatic hypotension

Reserved for patients with significant symptoms because symptoms can return after a few years of therapy

Improvement may not occur for several weeks

Pyridoxine (vitamin B6) decreases drug effect

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10
Q

What is the hypertensive crisis associated with levodopa- carbidopa

A

Separate drugs that fall into the class of non selective MOA inhibitors by at least 14 days because if taken with levodopa-carbidopa they can cause an extreme rise in blood pressure

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11
Q

When would we use apomorphine hydrochloride

A

Given for “off time” in Parkinson’s disease.. meaning in between doses of another drug

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12
Q

What is the prototype for a COMT inhibitor?

A

Tolcapone

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13
Q

What is MOA of tolcapone

A

Inhibit levodopa metabolism in bloodstream.

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14
Q

When do we use a COMT inhibitor

A

For Parkinson’s disease

It’s only given with levodopa - carbidopa

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15
Q

What is the adverse effects for COMT inhibitors?

A

BBW: potentially fatal fulminant liver failure

So we monitor liver function tests (LFTs) before treatment and every 2 weeks after

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16
Q

Nursing considerations for tolcapone

A

Discontinue if no improvement after 3 weeks

Do not take with MAO inhibitors (hypertensive crisis)

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17
Q

What is the prototype for the centrally acting anticholinergics

A

Benztropine mesylate

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18
Q

What is the MOA of benztropine mesylate

A

Decreases acetylcholine activity in the brain

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19
Q

When do we use benztropine mesylate

A

Adjunct Parkinson’s treatment

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20
Q

What is the antidote for anticholinergic drugs

A

Physostigmine salicylate (IV)

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21
Q

What are partial seizures?

A

These originate from a specific area of the brain and often indicate a brain lesion such as a birth injury, trauma, stroke, or tumor.

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22
Q

How would partial seizures present?

A

As inappropriate and repetitive movements such as chewing or swallowing.

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23
Q

What are the main types of generalized seizures?

A

Tonic clonic (most common)

Status epilepticus (most severe)

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24
Q

What are generalized seizures

A

They have no discernible point of origin and effect the entire brain.

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25
Q

What are absence seizures?

A

A type of generalized seizure that is a very brief alteration of consciousness and only lasts a few seconds

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26
Q

What is a status epilepticus seizure

A

It’s a life threatening emergency

Basically a tonic clonic that doesn’t stop after a few minutes.

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27
Q

Why are status epilepticus seizures so severe

A

Since the patient doesn’t stop seizing it can cause hypotension, hypoxia, permanent brain damage, leading up to death

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28
Q

What is the tonic clonic seizure?

A

Tonic phase:

Body stiffens, falls to floor
Loss of consciousness
May bite tongue or cheek

Clonic phase:

Rhythmical jerking of arms and/or legs
Lasts 1-3 minutes

Relaxation of muscles:
Return of consciousness (slowly)

29
Q

Prototype for barbiturates

A

Phenobarbital

30
Q

MOA for phenobarbital

A

Inhibits conduction of impulses

31
Q

Uses for phenobarbital

A

Tonic clonic seizures

IV formulation for status epilepticus

32
Q

Side effects for phenobarbital

A

BBW: risk of suicide ideation

Stevens- Johnson syndrome

Most common: CNS depression, cognitive impairment

33
Q

What is Stevens Johnson syndrome

A

A severe allergic reaction

34
Q

Prototype benzodiazepine for epilepsy

A

Diazepam

35
Q

Mechanism of action for diazepam

A

Increases effects of GABA

36
Q

Uses for diazepam

A

Adjunct in most types of seizures

IV Formulation for status epilepticus

37
Q

Nursing considerations for benzodiazepine

A

BBW: CNS depression when combined with opioid which causes respiratory failure

38
Q

Key drug for gamma aminobutyric acid (GABA) structural analogs

A

Vigabatrin

39
Q

Uses for vigabatrin

A

Infantile spasms

Partial seizures

40
Q

Adverse effects for vigabatrin

A

Can cause permanent bilateral concentric visual field constriction (tunnel vision, damage to central retina)

41
Q

Prototype for hydantoins

A

Phenytoin

42
Q

Uses for phenytoin

A

Tonic clonic seizures

IV for status epilepticus

43
Q

Side effects for phenytoin

A

Gingival hyperplasia

Caution if switching between brand and generic- monitor serum drug levels

Use contraception because it causes birth defects

IV only compatible with normal saline

44
Q

What is gingival hyperplasia?

A

The tissue around the teeth and the jaw become inflated and it looks like they’re having an allergic reaction

Over growth of gum tissue.. looks swollen

45
Q

What do you use carbamazepine for

A

Prevent partial seizures

Tonic clonic seizures

Bipolar disorders

46
Q

Side effects for carbamazepine

A

BBW: aplastic anemia and agranulocytosis

Hematological assessments are important

Stevens Johnson syndrome

47
Q

What is aplastic anemia

A

The body stops producing new blood cells

48
Q

What is agranulocytosis

A

When the body has a lowered white blood cell count

49
Q

What is magnesium sulfate used for?

A

Provides fetal neuroprotection to pregnant women

Delays preterm birth

Decreases maternal seizure risk

50
Q

MOA for valproate

A

Increases GABA effects

51
Q

Uses for valproate

A

Absence, mixed, and partial seizures

52
Q

What is GABA

A

Inhibitory neurotransmitter

53
Q

Side effects and nursing considerations for valproate

A

—Several BBW:
1) If pancreatitis develops, then discontinue use

2) teratogenic

3) altered bleeding times (bleeding risk)

— May open and sprinkle contents for children (like on apple sauce or yogurt)

54
Q

MOA for lamotrigine

A

Reduces release of glutamate, an excitatory neurotransmitter

55
Q

Uses for lamotrigine

A

Adjunct for partial seizures

Lennox- Gastaut syndrome

56
Q

Nursing considerations for lamotrigine

A

BBW: dermatological reactions
Start with low dose
Discontinue if any rash develops

Main drug that can progress to Stevens Johnson syndrome

57
Q

Uses for levetiracetam

A

Tonic clonic seizures

Partial seizures

58
Q

Side effects for levetiracetam

A

CNS effects- ranging from drowsiness, fatigue to emotional swings and hostility

IV Formulation only for short term basis
Risk of acute psychosis

59
Q

How do we taper anti-epilepsy drugs?

A

When discontinuing an AED, the dose needs to be tapered gradually
Over 1-3 months

Abruptly stopping can exacerbate seizures or cause status epilepticus

60
Q

Therapeutic effects of zolpidem

A

Improved sleep

61
Q

Teachings for zolpidem

A

Do not open, chew or crush time release tablets

Timing: take just before bed

Short term use

62
Q

Adverse effects for zolpidem

A

GI: mild nausea, diarrhea

CNS: daytime drowsiness

Sleep walking/ sleep eating

Mental changes (rare)

63
Q

Therapeutics effects for methylphenidate

A

Decreases signs and symptoms of ADHD such as:

Lowers impulsiveness

Lowers hyperactivity

Lowers disruptive behavior

Increases psychosocial interactions

Increases academic performances

64
Q

Other uses for methylphenidate

A

Narcolepsy

Obesity- weight loss

Mood elevation

65
Q

Teachings for methylphenidate

A

Takes 2 to 3 weeks to achieve full effects

Consider drug holidays

Timing: do not take after 4 PM

66
Q

Therapeutic affects of phenobarbital as a CNS depressant

A

Decrease anxiety, fatigue, and restlessness

Decreases fearful feelings, or feelings of dread, and decrease in difficulty of concentrating

Increases sleep

67
Q

General teaching of phenobarbital as a CNS depressant

A

Do not abruptly stop

Do not take alcohol or other CNS depressants

Avoid herbal preparation’s like Saint johns wort

68
Q

Therapeutic effect for dantrolene

A

Decrease in muscle spasticity

Decrease pain

Increase in ROM

Other uses:
Treats malignant hyperthermia

69
Q

MOA for amantadine

A

Dopamine releasers- activate dopamine reuptake

Pharm Exam 2 (7 decks)

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