NCS Pharmacology Flashcards
Absorption, distribution, metabolism, and excretion all have to do with what pharmacological principle?
a. pharmacokinetics
b. pharmacodynamics
c. dose response
a. pharmacokinetics
what organ metabolizes medications for the body
the liver
what organ is in charge of medication excretion
the kidneys
how does exercise affect pharmacokinetics
head increases absorption and can shunt blood away from the liver and kidneys
exercise affects all parts of pharmacokinetics except
a. absorption
b. distribution
c. metabolism
d. excretion
b. distribution
the dose response relationship and therapeutic index of a drug is an example of what pharmacological principle
a. pharmacokinetics
b. pharmacodynamics
b. pharmacodynamics
what neurotransmitter is associated with Alzheimer’s
a. Acetylcholine
b. Dopamine
c. Norepinephrine
d. GABA
a. acetylcholine
what neurotransmitter is associated with psychosis
a. Acetylcholine
b. Dopamine
c. Norepinephrine
d. GABA
b. dopamine
what neurotransmitter is associated with depression
a. Acetylcholine
b. Dopamine
c. Norepinephrine
d. GABA
c. norepinephrine
what neurotransmitter is associated with anxiety
a. Acetylcholine
b. Dopamine
c. Norepinephrine
d. GABA
d. GABA
what neurotransmitter is associated with seizures
a. Acetylcholine
b. Dopamine
c. Norepinephrine
d. GABA
d. GABA
what neurotransmitter is associated with spasticity
a. Acetylcholine
b. Dopamine
c. Norepinephrine
d. GABA
d. GABA
what neurotransmitter is associated with Parkinsons
a. Acetylcholine
b. Dopamine
c. Norepinephrine
d. GABA
b. and d. (ACh and DA do opposite things in the brain)
Bob is a 55yo man recently diagnosed with Parkinsons. his symptoms currently include tremor and some brady/akinesia. what medication is he likely prescribed
A. sinemet
b. parlodel (dopamine agonist)
c. selegiline (MAOB inhibitor)
d. Tasmar (COMT inhibitor)
e. anticholinergic
b. dopamine agonist as this is the primary monotherapy for persons with PD under 65 when symptoms are more than just a tremor
Bob is a 55yo man recently diagnosed with Parkinsons. his symptoms currently include tremor and some brady/akinesia. what medication is he likely prescribed
A. sinemet
b. parlodel (dopamine agonist)
c. selegiline (MAOB inhibitor)
d. Tasmar (COMT inhibitor)
e. anticholinergic
e. anticholinergic as this is the monotherapy for persons with PD under 70 with only tremor
Bob is a 72yo man recently diagnosed with Parkinsons. his symptoms are significant and include tremor and some brady/akinesia. what primary medication is he likely prescribed
A. sinemet
b. parlodel (dopamine agonist)
c. selegiline (MAOB inhibitor)
d. Tasmar (COMT inhibitor)
e. anticholineric
a. sinement
Bob is a 72yo man recently diagnosed with Parkinsons. his symptoms are significant and include tremor and some brady/akinesia. what medication(s) is he not likely to take
A. sinemet
b. parlodel (dopamine agonist)
c. selegiline (MAOB inhibitor)
d. Tasmar (COMT inhibitor)
e. anticholineric
b. dopamine agonist and e. anticholinergic as these are for younger persons <66 and <70
Bob is a 65yo man recently diagnosed with Parkinsons. his symptoms currently include tremor but he does not want to start sinemet to hold off on the side effects with prolonged use. which drug(s) is he likely to be prescribed
A. sinemet
b. parlodel (dopamine agonist)
c. selegiline (MAOB inhibitor)
d. Tasmar (COMT inhibitor)
e. anticholineric
c. MAOB inhibitor to reduce motor symptoms and delay need for sinemet
e. anticholinergic as <70 and no other symptoms besides tremor
Bob is a 63yo man recently diagnosed with Parkinsons. he is currently taking a dopamine agonist to manage his symptoms. which of the following is the correct list of side effects associated with this medication?
a. GI distress, N/V, postural hypotension, arrhythmia, anxiety/depression/confusion/hallucination, dyskinesia and choreoathetoid movements after 5 years
b. impulse control disorders
c. GI distress
d. liver damage
e. dry mouth and skin, tachycardia, dilated pupils, slowed GI
b. impulse control disorders
Bob is a 63yo man recently diagnosed with Parkinsons. he is currently taking a dopamine agonist to manage his symptoms. his wife has noticed that he has started to gamble again and has had increased online shopping habits. what do you tell her
a. this is common with persons with parkinson
b. this is a coping mechanism as he was recently diagnosed
c. this is a side effect of the dopamine agonist
d. he likely was suppressing these habits and the parkinsons is preventing the suppression
c. this is a side effect of the dopamine agonist
Bob is a 66yo man recently diagnosed with Parkinsons. he is currently taking sinemet to manage his symptoms. which of the following is the correct list of side effects associated with this medication?
a. GI distress, N/V, postural hypotension, arrhythmia, anxiety/depression/confusion/hallucination, dyskinesia and choreoathetoid movements after 5 years
b. impulse control disorders
c. GI distress
d. liver damage
e. dry mouth and skin, tachycardia, dilated pupils, slowed GI
a. GI distress, N/V, postural hypotension, arrhythmia, anxiety/depression/confusion/hallucination, dyskinesia and choreoathetoid movements after 5 years
Bob is a 66yo man recently diagnosed with Parkinsons. he is currently taking amantadine to manage his symptoms. which of the following is the correct list of side effects associated with this medication?
a. GI distress, N/V, postural hypotension, arrhythmia, anxiety/depression/confusion/hallucination, dyskinesia and choreoathetoid movements after 5 years
b. impulse control disorders
c. GI distress
d. liver damage
e. dry mouth and skin, tachycardia, dilated pupils, slowed GI
a. GI distress, N/V, postural hypotension, arrhythmia, anxiety/depression/confusion/hallucination, dyskinesia and choreoathetoid movements after 5 years
Bob is a 66yo man recently diagnosed with Parkinsons. he is currently taking anticholinergics to manage his symptoms. which of the following is the correct list of side effects associated with this medication?
a. GI distress, N/V, postural hypotension, arrhythmia, anxiety/depression/confusion/hallucination, dyskinesia and choreoathetoid movements after 5 years
b. impulse control disorders
c. GI distress
d. liver damage
e. dry mouth and skin, tachycardia, dilated pupils, slowed GI
e. dry mouth and skin, tachycardia, dilated pupils, slowed GI
Bob is a 66yo man recently diagnosed with Parkinsons. he is currently taking MAOB inhibitors to manage his symptoms. which of the following is the correct list of side effects associated with this medication?
a. GI distress, N/V, postural hypotension, arrhythmia, anxiety/depression/confusion/hallucination, dyskinesia and choreoathetoid movements after 5 years
b. impulse control disorders
c. GI distress
d. liver damage
e. dry mouth and skin, tachycardia, dilated pupils, slowed GI
c. GI distress
Bob is a 66yo man recently diagnosed with Parkinsons. he is currently taking COMT inhibitors to manage his symptoms. which of the following is the correct list of side effects associated with this medication?
a. GI distress, N/V, postural hypotension, arrhythmia, anxiety/depression/confusion/hallucination, dyskinesia and choreoathetoid movements after 5 years
b. impulse control disorders
c. GI distress
d. liver damage
e. dry mouth and skin, tachycardia, dilated pupils, slowed GI
d. liver damage
Bob is a 72yo man diagnosed with mild cognitive impairment. He asks you why his doctor prescribed him statins. what is your response
a. statins are neuroprotective
b. persons with MCI are not typically physically active so he is trying to minimize comorbidities
a. statins are neuroprotective
Bob is a 72yo man diagnosed with Alzheimers. he is currently taking donepezil (cholinesterase inhibitor) to slow the progression of the disease. is this drug associated with significant side effects?
yes - nausea, vomiting, weight loss, GI distress, generalized pain, fatigue, dizziness
Bob is a 72yo man diagnosed with Alzheimers. he is currently taking memantine (Namenda) to slow the progression of the disease. is this drug associated with significant side effects?
no
Bob is a 72yo man diagnosed with moderate to severe Alzheimers. what medication is likely in his chart
memantine (Namenda)
Bob is a 72yo man diagnosed with mild Alzheimers. what medication is likely in his chart
cholinesterase inhibitor
what are the cholinesterase inhibitors for Alzheimer’s
donepezil (Aricept)
galantamine (Razadyne)
rivastigmine (Exelon - daily transdermal patch)
Bob is having a hard time taking his Alzheimer’s medications regularly. what do you tell the pt and caregiver
as the MD about rivastigmine (Exelon - daily transdermal patch)
what are the anticholinergics for Parkinsons
trihexyphenidyl, benztropine (Cogentin)
what are the COMT inhibitors for Parkinsons
entacapone (Comtan), tolcapone (Tasmar)
what are the MAOB inhibitors for Parkinsons
selegiline (Eldepryl, Emsam)
what are the dopamine agonists for parkinsons
bromocriptine (Parlodel), pramipexole (Mirapex), ropinirole (Requip)
what medications are prescribed for anxiety
benzodiazepines such as Alprazolam (Xanax), chlodiazepoxide (Librium), diazepam (Valium), lorazepam (Ativan)
a patient you have been seeing has started to take a new anti anxiety medication what side effects are you looking for and what concerns do you have for their function/PT implications
dizziness, sedation, ataxia difficulty with speed and accuracy
risk for falls
what are the 2 classes of psychosis meds and what do they do
typical and atypical
typical treats the positive psychotic symptoms such as presence of hallucinations delusions or paranoia
atypical treats the negative psychotic symptoms such as inability to experience pleasure in normal activity, social interaction, and limited speech
what are the typical antipsychosis meds
Chlorpromazine (Thorazine), haloperidol (haldol), fluphenazine (prolixin), thioridazine (Mellaril)
what are the side effects for the typical antipsychosis meds
they depend on what kind of drug they are
SE for anticholinergic: dry mouth, blur vision, constipation, urinary retention, tachycardia
SE for antiadrenergic: orthostatic hypotension, dizziness, sedation
SE for histamine: sedation, weight gain
what are the PT implications for typical anti psychosis meds
monitor vitals, promote hydration, watch for tartive dyskinesia (repetitive involuntary movement of the face)
what are the atypical antipsychosis meds
Clozapine (clozaril), olanzapine (Zyprexa), quetiapine (seroquel), risperidone (risperdal), aripiprazole* (Abilify*)
what are the side effects of the atypical antipsychosis meds
SE: weight gain, hyperglycemia, lipid abnormalities (except for Abilify *)
what are the PT implications for the typical antipsychosis meds
monitor vitals, promote hydration, watch for tartive dyskinesia (repetitive involuntary movement of the face)
what are the 2 generations of anti depression meds
first generation are MAOI and tricyclics
second generation are SSRIs and SNRIs
why are second generation anti depression meds prescribed more frequently
they are just as effective and have less adverse side effects
what is the mechanism of action for tricyclics
inhibits the reuptake of norepinephrine and serotonin in the brain
what are the tricyclics
Amitriptyline (Elavil), desipramine (Norpramin), imipramine (Tofranil)
what are the side effects of tricyclics
think about what would happen since they block NE aka adrenergic, ACh and histamine
dry mouth, blur vision, constipation, urinary retention, tachycardia; orthostatic hypotension, dizziness; sedation, weight gain
why are tricyclic anti depressants potentially so dangerous
it has a narrow therapeutic index thus needs close monitoring as there is a risk of adverse effects/poisoning
what is the mechanism of action of MAOIs
inhibit MAOa and MAOb to prevent breakdown of norepinephrine, dopamine, serotonin
what are the MAOI drugs
Isocaroxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate)
why are MAOIs potentially so dangerous
food drug interaction causing increased blood pressure resulting in headache or stroke
nkwhat are the side effects of MAOIs
think about CNS excitation
restlessness, irritability, sleep loss, orthostatic hypotension, dry mouth
what is the most widely used type of anti depression med
SSRIs
what is the most widely used anti depression med and why
citalopram or Celxa as there are less drug drug interactions
what are the SSRI drugs
Citalopram (Celxa), fluoxetine (prozac), fluvoxamine (luxor), paroxetine (paxil), sertraline (zoloft), escitalopram (lexapro)
does SSRI increase your risk for suicide
no definite answer
what is the mechanism of action for SSRIs
serotonin reuptake inhibitor
what is the mechanism of action of SNRIs
serotonin and norepinephrine reuptake inhibitor
what are the SNRIs
Venlafazine (Effexor), duloxetine (Cymbalta), desvenlafaxine (Pristiq)
what are the PT implications for SNRIs
think about the NT it is affecting
monitor cardiovascular changes particularly blood pressure
true or false: all seizures are a result of reduced inhibition of a brain area
false - it is either reduced inhibition or over excitation
how do you describe seizures
partial aka focal or generalized
simple aka consciousness intact or complex where there is a loss of consciousness
tonic-clonic, tonic, clonic, absence, atonic, myoclinic
what is the most common type of seizure
tonic clonic (generalized) seizure
what anti seizure medication is the primary and most commonly prescribed drug for all seizures except absence seizures
Phentoin aka dilantin
what is the mechanism for phentoin aka dilantin
blocks sodium current
what are the side effects for phentoin
this is the most commonly prescribed seizure med because the side effects do not induce CNS depression
rash, excessive hair growth, hepatitis, gingival hyperplasia, coarsening of facial features, hyperglycemia, osteomalacia, arrhythmia, hypotension, excitation of cerebellar vestibular system resulting in nystagmus
what is the second most commonly prescribed seizure medication
carbamazepine aka tegretol
true or false: tegretol aka carbamazepine is effective for generalized seizures
false - effective for partial seizures
what is the mechanism of action for carbamazepine aka tegretol
blocks sodium current
what are the side effects of carbamazepine aka tegretol
drowsiness, fatigue, vertigo, ataxia, diplopia, hyperirritability, respiratory depression, GI N/V, dry mouth, rash, hypernatremia so heart failure and syncope, hypo or hypertension
what are the drugs prescribed as anti seizure medications
Phenytoin (dilantin), Carbamazepine (tegretol), Phenobarbital (luminal) (barbiturate), Valproate (depakene), Ethosuzimide (Zarontin), Lamotrigine (Lamictal), Gabapentin (neurontin), Tiagabine (gabitril), Topiramate (topamax), Zonisamide (zonegran), Levetiracetam (keppra)
if a patient is taking an antiseizure medication, what drug drug interactions do you have to look out for
warfarin, oral contraceptives, calcium channel blockers, some chemo drugs
what is status epilepticus
when the pt has 30min of continuous seizures or multiple in 30min without regaining consciousness
this is a medical emergency
your patient with TBI had a bout of seziures while in the hospital and is now medically managed with an anti seizure medication. they ask you typically how long people have to take it. what do you say
you must be seizure free for 2-5 years with normal EEG or neuro exam testing
what is the mechanism of action of phenobarbital
increases the threshold for neuronal firing and enhances GABA inhibition
what is a pro of phenobarbital
longer half life so do not need to take as frequently
what are the side effects of phenobarbital
CNS depression
what is the drug of choice for absence seizures
valproate aka depakene
what is the mechanism of action for valproate aka depakene
increases GABA and inhibits its reuptake
what are the side effects of valproate aka depakene
drowsiness, dizziness, sedation, HA
what is the mechanism of action of ethosuzimide aka zarontin
blocks calcium channels in the thalamus
blocks current that generates absences seizures
what are the side effects of ethosuzimide aka zarontin
headache, fatigue, GI distress
your patient begins to have absences seizures that originate from the thalamus. what medication is the neurologist likely to prescribe
ethosuzimide aka zarontin
your patient who is being medicated for partial seizures is not having good management. what medication can be used as an adjucnt
lamotrigine aka lamictal
tiagabine aka gabitril
what is the mechanism of action for lamotrigine aka lamictal
unknown but may block sodium channels
what is the mechanism of action for tiagabine aka gabitril
inhibition of the uptake of GABA
what is the mechanism of action for topiramate aka topamax
blocks sodium current and enhances action of GABA
what is the mechanism of action for zonisamide aka zonegran
inactivates sodium channels and delays reopening
what is the mechanism of action for levetiracetam aka keppra
mechanism unknown
why do a lot of neurologist prescribe keppra
fewer drug drug interactions
what are the types of agents for spasticity management
central agents and peripheral agents
what are the central agents for spasticity management
diazepam aka valium
baclofen aka lioresal
tizanidine aka zanaflex
what are the peripheral agents for spasticity management
dantrolene sodium aka dantrium
botox
what is the mechanism of action for diazepam aka valium
CNS depression
increases response time for muscles by binding to chloride GABA channels
what are the side effects of diazepam aka valium
drowsiness, fatigue, ataxia
what is the mechanism of action for baclofen aka lioresal
similar to GABA but does not bind to receptors
influences release of monoamines
CNS depression
what are the side effects for baclofen aka lioresal
CNS depression, somnolence, ataxia, cardiovascular depression
what are the risks for intrathecal baclofen
infection, overdose, withdrawal
during an intrathecal trial, what is the expected response in order to determine success
there should be a 1 point MAS change in 1 hour of bolus administration
what is the mechanism of action for tizanidine aka zanaflex
alpha 2 adrenergic agonist
increases inhibition of motor neurons
what are the side effects of tizanidine aka zanaflex
somnolence, asthenia or abnormal weakness, dizziness, dry mouth, hypotension within 1 hour peaking 2-3 hours after administration
your patient is taking tizanidine aka zanaflex for spasticity management. knowing the time of effects of the drug, what should you educate the patient about and what should you be looking for?
BP will be reduced 1 hour after taking the medication but will peak 2-3 hours after administration
monitor vitals
what is the mechanism of action for dantrolene sodium aka dantrium
interferes with calcium flux at sarcoplasmic reticulum altering excitation contraction coupling
what are the side effects of dantrolene sodium aka dantrium
drowsiness, dizziness, generalized weakness
your patient has recently been newly prescribed dantrolene sodium aka dantrium for spasticity management. you know this affects specific muscles. what change in muscle function should you expect?
a. this affects LE over UE
b. this affects UE over LE
c. this affects fast twitch over slow twitch
d. this affects slow twitch over fast twitch
c. this affects fast twitch over slow twitch
what is the mechanism of action for botox
blocks ACh release at the neuromuscular junction
true or false: botox provides temporary change
false - botox creates permanent change however pt often need more than one injection as new junctions grow
your patient is going to get a botox injection for the first time. they if this is going to provide permanent effects. what do you tell them?
a. it causes permanent changes with permanent effects
b. it causes permanent changes with temporary effects for 3-8 months
c. it causes permanent changes with temporary effects for 1-2 years
d. it causes permanent changes with temporary effects for 3-8 weeks
b. it causes permanent changes with temporary effects for 3-8 months
your patient began taking baclofen for spasticity management 2 days ago. they complain that they are not seeing any benefit. what do you tell them?
a. keep taking it as prescribed as new drug takes 4-7 days to show effects
b. keep taking it but double the dose to increase effects
c. return to your doctor and tell them its not working
a. keep taking it as prescribed as new drug takes 4-7 days to show effects
your patient began taking baclofen for spasticity management 45 days ago. they complain that they are not seeing any benefit. what do you tell them?
a. keep taking it as prescribed as new drug takes 4-7 days to show effects
b. keep taking it but double the dose to increase effects
c. return to your doctor and tell them its not working
c. return to your doctor and tell them its not working
