Module 7 Unit D&E AED & Alzheimer/Parkinson's Flashcards
What is an examples of a Iminostilbenes?
Carbamazepine (Tegretol)
What is the indications for Iminostilbenes [Carbamazepine (Tegretol)]?
Partial seizures and generalized tonic-clonic seizures. Bipolar. Trigeminal neuralgia.
What is the MOA of Iminostilbenes [Carbamazepine (Tegretol)]?
Suppress sodium influx
What adverse effects may be seen with Iminostilbenes [Carbamazepine (Tegretol)]?
Depression is a concern for all antiseizure drugs. Bone marrow suppression.
BBW: SJS, allele, agranulocytosis, aplastic anemia
What D2D and food interactions are associated with Iminostilbenes [Carbamazepine (Tegretol)]?
Many D2D interactions, particularly OCs and folic acid.
Grapefruit juice can increase the peak and trough of carbamazepine.
What is the BBW associated with Iminostilbenes [Carbamazepine (Tegretol)]?
It may cause SJS and TEN. Aplastic anemia and agranulocytosis.
High incidence of SJS in Asian people
What is an examples of a Hydantoin?
Phenytoin (Dilantin)
What is the indication for Hydantoin [Phenytoin (Dilantin)]?
Tonic-clonic or partial seizures. Epilepsy. Seizures after head trauma, neurosurgery, and hemorrhagic stroke.
What is the MOA of Hydantoin [Phenytoin (Dilantin)]?
Suppress sodium influx
What are some safety considerations of Hydantoin [Phenytoin (Dilantin)]?
Many drug-to-drug interactions (Decrease BC, warfarin, gluccocorticoids).
Hepatitis.
Teratogenic.
SJS.
Contraindicated in patients with sinus bradycardia, SA block, second and third-degree AV block, and Stokes-Adams Syndrome
What is the BBW associated with Hydantoin [Phenytoin (Dilantin)]?
Rapid IV administration can cause severe hypotension and cardiac dysrhythmias.
What is an example of Succinimide?
Ethosuximide (Zarontin) Valproic acid (Depakote)
What is the MOA of Succinimide [Ethosuximide (Zarontin) & Valproic acid (Depakote)]?
Unknown. May increase GABA concentration in the brain or augment the inhibitory influence of GABA.
What D2D interaction is associated with Valproic acid (Depakote)?
Valproic acid is reduced by two carbapenem antibiotics – meropenem and imipenem/cilastatin.
What BBW is associated with Valproic acid (Depakote)?
Valproate & valproic acid – fatal hepatic failure risk. Fatal and rapidly progressing pancreatitis. Valproate is highly teratogenic.
Increased fetal neural tube defects.
What is an examples of Cholinesterase Inhibitors?
Donepezil (Aricept)
What is the indication for Cholinesterase Inhibitors [Donepezil (Aricept)]?
Alzheimer’s
Mild to moderate symptoms [Improved cognition (thinking) and function for patients with AD.]
What is the MOA of Cholinesterase Inhibitors [Donepezil (Aricept)]?
Prevent the breakdown of acetylcholine by AChE and increase the availability of acetylcholine at cholinergic synapses.
What D2D interactions are associated with Cholinesterase Inhibitors [Donepezil (Aricept)]?
Anticholinergics (first-generation antihistamines, TCAs) reduce effectiveness
NSAIDs, increase risk of GI bleed
antifungals, inhibit metabolism increasing levels
What side effect is associated with Cholinesterase Inhibitors [Donepezil (Aricept)]?
It may cause dizziness.
What is an examples of a NMDA receptor antagonists?
Memantine (Namenda)
What is the indication for NMDA receptor antagonists [Memantine (Namenda)]?
Alzheimer’s Moderate or severe
Helps treat symptoms of AD but no evidence that it modifies the underlying disease process.
What is the MOA of NMDA receptor antagonists [Memantine (Namenda)]?
Blocks glutamate from excessive excitation of NMDA (glumate excitation is cytotoxic)
What side effect is associated with NMDA receptor antagonists [Memantine (Namenda)]?
Dizziness – risk for falls.
headache
constipation
What D2D interactions are associated with NMDA receptor antagonists [Memantine (Namenda)]?
Drugs with memantine and sodium bicarb may have an undesired additive effect.
What is an example of a Dopamine replacement?
Levodopa & Carbidopa
What is the MOA of Dopamine replacements (Levodopa&Carbidopa)?
Undergoes conversion to DA in the brain and activates DA receptors (Carbidopa blocks destruction of Levodopa in the periphery.
What is the indication for Dopamine replacements (Levodopa&Carbidopa)?
Parkinson’s-Good for initial treatment of PD.
First-line drug, or used as a supplement to a dopamine agonist.
What side effects are associated with Dopamine replacements (Levodopa&Carbidopa)?
n/v, tremor, palpitations, dizziness. Possible psychosis.
What patient education should be reviewed with Dopamine replacements (Levodopa&Carbidopa)?
*Must avoid high protein meals.
What are examples of non-ergot derivate dopamine agonists?
Apomorphine
Ropinirole
Rotigotin
What are examples of ergot derivate dopamine agonists?
Bromocriptine
What is the indication for dopamine agonists (Apomorphine, Ropinirole, Rotigotin, & Bromocriptine)?
It may be used as a supplement to Levodopa.
What is theMOA of dopamine agonists (Apomorphine, Ropinirole, Rotigotin, & Bromocriptine)?
Activate dopamine receptors in the striatum
What side effects are associated with dopamine agonists (Apomorphine, Ropinirole, Rotigotin, & Bromocriptine)?
Hallucinations, sleep attacks, postural hypotension
BBW Selegiline (dopamine agonist)
contraindicated in patients less than 12 years of age because of the potential for a hypertensive crisis
What is the indication for the Anticholinergic Drug [Benztropine (Cogentin)]?
Supplement to Levodopa-Increase benefits of Levodopa
What is the MOA of the Anticholinergic Drug [Benztropine (Cogentin)]?
Block cholinergic receptors in the CNS; help restore the balance between dopamine and ACh.
What side effects are associated with the anticholinergic drug [Benztropine (Cogentin)]?
Dry mouth, blurred vision, photophobia, urinary retention, constipation, tachycardia.
Contraindications of Dilantin
Contraindicated in patients with sinus bradycardia, SA block, second and third-degree AV block, and Stokes-Adams Syndrome
Patient teaching with dilantin
Avoid taking with high protein meals (may reduce absorption).
Lab monitoring with depakote
Plt count
Avoid using Aricept with these conditions:
bradycardia, conduction defects, asthma, COPD,
Side effects ARicept
GI-related: Weight loss, nausea, vomiting, diarrhea,
dizziness, muscle cramps, may increase seizure risk (rare)
Caution using NMDAs with this condition
renal impairment
D2D with levadopa
first-generation antipsychotic drugs, MAOIs, anticholinergics, and pyridoxine
