Module 7 Unit D&E AED & Alzheimer/Parkinson's Flashcards by Lindy Kirk

What is an examples of a Iminostilbenes?

Carbamazepine (Tegretol)

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What is the indications for Iminostilbenes [Carbamazepine (Tegretol)]?

Partial seizures and generalized tonic-clonic seizures. Bipolar. Trigeminal neuralgia.

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What is the MOA of Iminostilbenes [Carbamazepine (Tegretol)]?

Suppress sodium influx

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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

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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.

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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

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What is an examples of a Hydantoin?

Phenytoin (Dilantin)

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What is the indication for Hydantoin [Phenytoin (Dilantin)]?

Tonic-clonic or partial seizures. Epilepsy. Seizures after head trauma, neurosurgery, and hemorrhagic stroke.

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What is the MOA of Hydantoin [Phenytoin (Dilantin)]?

Suppress sodium influx

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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

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What is the BBW associated with Hydantoin [Phenytoin (Dilantin)]?

Rapid IV administration can cause severe hypotension and cardiac dysrhythmias.

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What is an example of Succinimide?

Ethosuximide (Zarontin) 
Valproic acid (Depakote)

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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.

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What D2D interaction is associated with Valproic acid (Depakote)?

Valproic acid is reduced by two carbapenem antibiotics – meropenem and imipenem/cilastatin.

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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.

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What is an examples of Cholinesterase Inhibitors?

Donepezil (Aricept)

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What is the indication for Cholinesterase Inhibitors [Donepezil (Aricept)]?

Alzheimer’s

Mild to moderate symptoms [Improved cognition (thinking) and function for patients with AD.]

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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.

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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