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NPLEX 2.0 > Nervous System Pharm II > Flashcards

Nervous System Pharm II Flashcards

1
Q

What meds are used to treat epilepsy?

A

i. Diazepam (also psychiatric)
ii. Phenytoin
iii. Lamotrigine
iv. Topiramate
v. Valproate

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2
Q

What is the primary action of Phenytoin?

A

Modulates neuronal voltage-dependent sodium and calcium channels

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3
Q

What are the indications of Phenytoin?

A

Control of generalized tonic-clonic and complex partial seizures

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4
Q

What are the AEs of Phenytoin?

A

i. Hepatotoxicity
ii. Pancytopenia
iii. Dizziness
iv. N/V
v. Megaloblastic anemia

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5
Q

What is the black box warning for Phenytoin?

A

Severe hypotension and cardiac arrhythmias with injectable form

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6
Q

What are the CIs for Phenytoin?

A

Abrupt withdrawal

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7
Q

What interacts with Phenytoin that is important to know?

A

Very long list
CYP3A4 Inducers

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8
Q

Do blood levels need to be moinitored in pts on Phenytoin?

A

Yes

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9
Q

What nutrients need to be supplemented with Phenytoin?

A

Vitamin D, B2, B6, B12, folic acid

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10
Q

What is the primary action of Lamotrigine?

A

Inhibition of voltage-dependent sodium channels, decreasing presynaptic glutamate and aspartate release

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11
Q

What are the indications of Lamotrigine?

A

Bipolar I
Epilepsy

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12
Q

What are some of the AEs of Lamotrigine?

A

Nausea
Insomnia
SI
Headache
Depression, anxiety
Speech and vision disturbance

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13
Q

What is the black box warning for Lamotrigine?

A

Serious rashes included Stevens-Johnson Syndrome

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14
Q

What are the CIs for Lamotrigine?

A

Abrupt Withdrawal

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15
Q

What interacts with Lamotrigine that is important to know?

A

Progestins
OCPs
Hypericum perforatum

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16
Q

What is the primary action of Topiramate?

A

Carbonic anhydrase inhibitor

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17
Q

What are the indications of Topiramate?

A

Generalized tonic-clonic, partial, Lennox-Gastaut seizures

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18
Q

What are some of the AEs of Topiramate?

A

Metabolic acidosis
Nephrolithiasis
Osteoporosis
Hypokalemia
Glaucoma
Mood disturbance
Many more

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19
Q

What are the CIs for Topiramate?

A

Avoid abrupt withdrawal

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20
Q

What interacts with Topiramate?

A

Alcohol
OCPs
Metformin

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21
Q

What is the primary action of Valproate?

A

Increases GABA effects

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22
Q

What are the indications of Valproate?

A

Partial and absence seizures

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23
Q

What are the AEs of Valproate?

A

Many
encephalopathy
Headache
Tremor
N/V
Diarrhea

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24
Q

What is the black box warning for Valproate?

A

Hepatotoxic
Pancreatitis
Teratogenic

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25
What are the CIs for Valproate?
LV Disease Mitochondrial disorders **Pregnancy**
26
What are other uses of Valproate that you should know?
Migriane Prophylaxix Bipolar disorder
27
What is the protype anti-Parinsonism drug?
Levodopa and carbidopa
28
What other drugs also have anti-Parkinsonism effects?
Amantadine
29
How does levodopa work as an anti-Parkinsonism drug?
It's decarboxylated to dopamine in the brain, improves motor, neurological and altered mood sxs of Parkinson's dx
30
How does carbidopa work as an anti-Parkinsonism drug?
It works by decreasing the peripheral breakdown of levodopa by dopamine carboxylase
31
What are the AEs of Levodopa and Carbidopa?
Anorexia NV via stimulation of the emetic center Depression Mood changes and anxiety Long term : hallucinations, dyskinesia
32
What anti-Parkinson's drug is also used to treat restless leg syndrome?
Pramipexole
33
What are some of the AEs of Pramipexole?
Hypotension Extrapyramidal symptoms Rhabdomyolysis Hallucinatioins HA
34
What is the primary action of Benztropine?
Antagonizes acetylcholine and histamine receptors
35
What are the indications of Benztropine?
Parkinsonsim Extrapyramidal sx
36
What are some of the AEs of Benztropine?
Tachycardia Dry mouth Urinary retention Edema Sedation
37
What are some of the CIs for Benztropine?
Use in children <3 yo Glaucoma BPH Tardive dyskinesia
38
What interacts with Benztropine?
Other acetylcholine inhibitors
39
What are some of the indications for Bromocriptine?
Hyperprolactinemia Acromegaly Parkinson's dx
40
What is the primary action of Bromocriptine?
Selective dopamine agonist in the pituitary
41
What are the AEs of Bromocriptine?
GI upset : N/V Dizziness, HA Hallucinations Nasal congestion Involuntary movements
42
What do you not what to do if using bromocriptine to treat Parkinson's disease?
Abrupt discontinuation
43
What are the CIs for using Modafinil?
44
In what condition would it be dangerous to use atropine?
Acute closed angle glaucoma
45
What drug is used to treat cholinesterase inhibitor poisoning? How?
Atopine It acts as a parasympatholytic or muscarinic antagonist drug and will help decrease the increased levels of Ach in the body
46
What are some of the AEs of sympathomimetic drugs?
i. CV : Tachycardia, palpitations, arrhythmias, HTN ii. CNS : tremors, HA, restelessness, insomnia, appetite suppressioin iii. Urinary : retention of urine, difficult or painful urination
47
What is the primary action of Carbamazepine?
Anticonvulsant
48
What are the indications of Carbamazepine?
Epilepsy, trigeminal neuralgia
49
What are the AEs of Carbamazepine?
Fatigue Dizziness Headache Nausea Aplastic Anemia
50
What is the black box warning of Carbamazepine?
Serious Dermatologic Rxns HLA-B*1502 Allele and Aplastic anemia/Agranulocytosis
51
CI for Carbamazepine
Bone marrow suppression MAO inhibitor use within 14 days
52
What interacts with Carbamazepine?
Phenelzine and others
53
Amantadine
Mechanism: 1. Antagonizes excitatory N-Methyl-D-Aspartate (NMDA) receptors to down regulate the glutamate system 2. Increases release of dopamine 3. Anticholinergic Effects Uses: treat levodopa-induced dyskinesias late in the disease as well as influenza-A (rarely) S/E: **may exacerbate mental illness in patients with psychiatric illness or substance abuse problems**; insomnia, dizziness, hallucinations, agitation, orthostatic hypotension, peripheral edema, dyspepsia; neuroleptic malignant syndrome Pregnancy category C
54
Scopolamine
Mechanism: Belladonna alkaloid that blocks cholinergic transmission from the vestibular nuclei to higher CNS centers Uses: certain types of muscle problems (e.g., some Parkinson-like conditions, certain muscle spasm problems) and certain stomach or intestinal problems (e.g., irritable colon syndrome), preventing nausea and vomiting associated with motion sickness Has a transdermal formulation Pregnancy category C
55
Classes and Drugs to treat Alzheimer’s Disease
**Indirect Cholinergic Agonists (AchE Inhibitors)** Donepezil Rivastigmine **NMDA glutamate receptor antagonist** Memantine
56
Donepezil and Rivastigmine
Mechanism: increase acetylcholine activity in the CNS by inhibiting acetylcholinesterase (AchE) as acetylcholine contributes to cognition and memory. Uses: for symptom control only in mild-moderate disease - Dementia associated with Parkinson’s disease (rivastigmine) - Mild-severe Alzheimer’s (donepezil) Pregnancy category c (donepezil)/category B (rivastigmine)
57
Memantine
Mechanism: Acts on the glutamatergic system by blocking NMDA-type glutamate receptors Uses: moderate to severe Alzheimer’s disease and Lewy Body Dementia Usually given with AchE Inhibitor S/E: confusion, dizziness, drowsiness, HA, insomnia, agitation, hallucationations, vomiting, anxiety, hypertonia, cystitis, increased libido Pregnancy category B
58
Drugs and classes to treat Multiple Sclerosis
**Reduce neuronal inflammation** Fingolimod Glatiramer acetate Interferon beta 1 **Reduce muscle spasticity** Baclofen Botulinum toxin Tizanidine
59
Interferon beta 1
Mechanism: Immunomodulatory. alters the expression and response to surface antigens and can enhance immune cell activities; how it works in MS is unknown Uses: relapsing forms of MS Warnings: hyper/hypothyroidism, bone marrow suppression, flu-like symptoms, severe hepatic injury, severe injection site injury, neuropsychiatric manifestations, thrombotic microangiopathy IM formulation only Pregnancy category C
60
Glatiramer Acetate
L-Glutamic acid polymer with l-alanine, l-lysine, and l-tyrosine and acetate Mechanism: unknown, studies suggest it activates glatiramer-specific Treg cells that migrate into the CNS and down-regulate inflammation to myelin antigens in the periphery Uses: Relapsing-remitting Multiple Sclerosis Warnings: hypersensitivity reactions, immediate post-injection reactions, chest pain, lipoatrophy and skin necrosis, “interference with useful immune function” IM formulation only Pregnancy category B
61
Fingolimod
Sphingosine 1-Phosphate (S1P) Receptor Modulator Mechanism: blocks the lymphocytes' ability to emerge from lymph nodes; therefore, the amount of lymphocytes available to the central nervous system is decreased, which reduces central inflammation Uses: Multiple Sclerosis, relapsing forms CI: MI, unstable angina, stroke, transient ischemic attack, decompensated heart failure requiring hospitalization, or New York Heart Association (NYHA) class III/IV heart failure in the past 6 months; Mobitz Type II second- or third-degree atrioventricular (AV) block or sick sinus syndrome (unless patient has a functioning pacemaker); baseline QTc interval ≥500 msec; concurrent use of a class Ia or III antiarrhythmic SE: headache, nausea, diarrhea, abdominal pain, increased liver enzymes, flu, back pain, cough, sinusitis, hypertension, AV block, depression, dizziness, migraine, increased triglycerides, bronchitis, HSV PO formulation Pregnancy category C
62
Botulinum Toxin
MoA: acetylcholine release inhibitor Treats : upper/lower limb spasticity
63
Baclofen
MoA unknown Uses: spasticity of MS, spinal cord injury, rheumatic disorders. NOT indicated for stroke, cerebral palsy, and Parkinson’s disease has not been established and, therefore, it is not recommended for these conditions TAPER off if discontinuing (hallucinations/seizures) SE: drowsiness, asthenia, dizziness, headache, nausea Pregnancy category C
64
Tizanidine
Alpha-2-adrenergic agonist (centrally acting); presumably reduces spasticity by increasing presynaptic inhibition of motor neurons SE: hypotension, sedation, risk of liver injury, hallucinations, interactions with CYP1A2 inhibitors (ciprofloxacin) Pregnancy category C
65
Classes and Drugs of Anticonvulsants
**Na-channel inhibitors** Carbamazapine Phenytoin **GABA-analogues** Gabapentin Pregabalin **Others** Valproate Topiramate Lamotrigine (Psych lecture) Alprazolam (Psych lecture) Diazepam (Psych lecture)

NPLEX 2.0 (6 decks)

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