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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
What are absence seizures?
A type of generalized seizure that is a very brief alteration of consciousness and only lasts a few seconds
26
What is a status epilepticus seizure
It’s a life threatening emergency Basically a tonic clonic that doesn’t stop after a few minutes.
27
Why are status epilepticus seizures so severe
Since the patient doesn’t stop seizing it can cause hypotension, hypoxia, permanent brain damage, leading up to death
28
What is the tonic clonic seizure?
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
Prototype for barbiturates
Phenobarbital
30
MOA for phenobarbital
Inhibits conduction of impulses
31
Uses for phenobarbital
Tonic clonic seizures **IV formulation for status epilepticus**
32
Side effects for phenobarbital
BBW: risk of suicide ideation Stevens- Johnson syndrome Most common: CNS depression, cognitive impairment
33
What is Stevens Johnson syndrome
A severe allergic reaction
34
Prototype benzodiazepine for epilepsy
Diazepam
35
Mechanism of action for diazepam
Increases effects of GABA
36
Uses for diazepam
Adjunct in most types of seizures **IV Formulation for status epilepticus**
37
Nursing considerations for benzodiazepine
BBW: CNS depression when combined with opioid which causes respiratory failure
38
Key drug for gamma aminobutyric acid (GABA) structural analogs
Vigabatrin
39
Uses for vigabatrin
Infantile spasms Partial seizures
40
Adverse effects for vigabatrin
Can cause permanent bilateral concentric visual field constriction (tunnel vision, damage to central retina)
41
Prototype for hydantoins
Phenytoin
42
Uses for phenytoin
Tonic clonic seizures **IV for status epilepticus**
43
Side effects for phenytoin
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
What is gingival hyperplasia?
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
What do you use carbamazepine for
Prevent partial seizures Tonic clonic seizures Bipolar disorders
46
Side effects for carbamazepine
BBW: aplastic anemia and agranulocytosis Hematological assessments are important Stevens Johnson syndrome
47
What is aplastic anemia
The body stops producing new blood cells
48
What is agranulocytosis
When the body has a lowered white blood cell count
49
What is magnesium sulfate used for?
Provides fetal neuroprotection to pregnant women Delays preterm birth Decreases maternal seizure risk
50
MOA for valproate
Increases GABA effects
51
Uses for valproate
Absence, mixed, and partial seizures
52
What is GABA
Inhibitory neurotransmitter
53
Side effects and nursing considerations for valproate
—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
MOA for lamotrigine
Reduces release of glutamate, an excitatory neurotransmitter
55
Uses for lamotrigine
Adjunct for partial seizures Lennox- Gastaut syndrome
56
Nursing considerations for lamotrigine
BBW: dermatological reactions Start with low dose Discontinue if any rash develops Main drug that can progress to Stevens Johnson syndrome
57
Uses for levetiracetam
Tonic clonic seizures Partial seizures
58
Side effects for levetiracetam
CNS effects- ranging from drowsiness, fatigue to emotional swings and hostility **IV Formulation only for short term basis** Risk of acute psychosis
59
How do we taper anti-epilepsy drugs?
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
Therapeutic effects of zolpidem
Improved sleep
61
Teachings for zolpidem
Do not open, chew or crush time release tablets Timing: take just before bed Short term use
62
Adverse effects for zolpidem
GI: mild nausea, diarrhea CNS: daytime drowsiness Sleep walking/ sleep eating Mental changes (rare)
63
Therapeutics effects for methylphenidate
Decreases signs and symptoms of ADHD such as: Lowers impulsiveness Lowers hyperactivity Lowers disruptive behavior Increases psychosocial interactions Increases academic performances
64
Other uses for methylphenidate
Narcolepsy Obesity- weight loss Mood elevation
65
Teachings for methylphenidate
Takes 2 to 3 weeks to achieve full effects Consider drug holidays Timing: do not take after 4 PM
66
Therapeutic affects of phenobarbital as a CNS depressant
Decrease anxiety, fatigue, and restlessness Decreases fearful feelings, or feelings of dread, and decrease in difficulty of concentrating Increases sleep
67
General teaching of phenobarbital as a CNS depressant
Do not abruptly stop Do not take alcohol or other CNS depressants Avoid herbal preparation’s like Saint johns wort
68
Therapeutic effect for dantrolene
Decrease in muscle spasticity Decrease pain Increase in ROM Other uses: Treats malignant hyperthermia
69
MOA for amantadine
Dopamine releasers- activate dopamine reuptake

Pharm Exam 2 (7 decks)

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