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Pharm 2 Exam 2 > Neuro 2 > Flashcards

Neuro 2 Flashcards

1
Q

What do anticonvulsants do to tx sz?

A

suppress the rapid firing of neurons that start a seizure

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2
Q

MCC of status epilepticus

A

D/c of anticonvulsants

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3
Q

Status epilepticus management

A

Assessment and supportive treatment
Initial pharmacologic therapy with a benzodiazepine
Urgent therapy that achieves long-term control using a nonbenzodiazepine antiseizure drug such as fosphenytoin

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4
Q

What is the initial med used to tx status epilepticus?

A

Benzos (preferably IV)

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5
Q

What is the weaning protocol of anticonvulsants?

A

weaned from the use of anticonvulsants after being seizure free for 2 years and having three normal EEGs separated by at least 1 year

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6
Q

Which labs should be checked prior to starting a pt on hydantoins?

A

Baseline liver function, urinalysis, and blood counts need to be taken as well as periodic plasma levels for hydantoins

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7
Q

Hydantoin examples

A

Fosphenytoin and phenytoin

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8
Q

Hydantoin MOA

A

Stabilizes neuronal membranes and decreases seizure activity by increasing efflux or decreasing influx of sodium ions

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9
Q

Hydantoin use

A

generalized tonic- clonic (grand mal) and simple complex and simple partial seizures

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10
Q

Hydantoin SE

A

Hypotension and arrythmias (with rapid phenytoin infusion), Skin rashes, stevens-johnson syndrome, gingival hyperplasia (very common), agranulocytosis and aplastic anemia, Phenytoin-induced hepatitis, ataxia, confusion, nystagmus, Hyperglycemia

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11
Q

What should be monitored in a pt taking hydantoin?

A

Therapeutic plasma levels

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12
Q

What can lower hydantoin levels and decrease their efficacy?

A

Drugs that induce the CYP P450 enzyme system - Rifampin, St. Johns wort

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13
Q

The flu vaccine interacts with which drugs?

A

phenytoin, theophylline, and warfarin

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14
Q

Which drugs raise hydantoin levels?

A

Drugs that inhibit the CYP P450 enzyme system will raise serum levels of hydantoins - Macrolides, azole antifungals, grapefruit juice

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15
Q

Hydantoins can impair the efficacy of this drug?

A

oral contraceptives

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16
Q

Patients with this heart condition should not be on hydrantoins?

A

bradycardia and heart block

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17
Q

Black box warning for hydantoins

A

IV injection quickly can cause severe hypotension

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18
Q

In which pts should hydantoins be used carefully?

A

Pts with hx of MI or hypotension

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19
Q

When dosed slowly over a long time, hydantoins can cause what?

A

Hyperglycemia and DKA

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20
Q

What can hydantoins do to urine?

A

Turn it red/ brown

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21
Q

Iminostilbenes examples

A

Carbamazepine
Oxcarbazepine

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22
Q

Iminostilbenes MOA

A

they inhibit voltage-gated sodium channels in neurons in the thamalus

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23
Q

Iminostilbenes use

A

monotherapy or adjunctive therapy for partial complex seizures
Neuropathic pain (trigeminal neuralgia)
Bipolar affective disorder

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24
Q

Iminostilbenes SE

A

stevens-Johnson syndrome, toxic epidermal necrolysis, Nausea, vomiting, Agranulocytosis, aplastic anemia, impaired antidiuretic hormone release (ADH) leading to water retention, Ataxia, tremor

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25
Q

Iminostilbenes (carbamazepine)black box warning

A

Genetic testing can be used to see if a person is at risk of developing serious SE (Asian descent)

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26
Q

What drink can increase Iminostilbenes serum levels?

A

Grapefruit juice will interact with these drugs, causing serum drug levels of these drugs to increase.

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27
Q

Which herbs reduce the sz threshold?

A

Evening primrose tea, St. John’s wort, valerian, and kava kava have all reduced the seizure threshold

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28
Q

Hypersensitivity to TCAs means that this drug is also contraindicated in pts

A

Iminostilbenes

29
Q

In which pts should Iminostilbenes be avoided?

A

Any history of blood disorders, especially bone marrow suppression
Pregnancy

30
Q

Which 2 things should be monitored regularly in pts on Iminostilbenes?

A

Therapeutic drug levels and IOP

31
Q

Succinimides examples

A

ethosuximide

32
Q

Succinimides MOA

A

blocking T-type voltage-gated calcium channels in thalamic neurons

33
Q

Succinimides use

A

Control of absence (petit mal) seizures in children and adults that are refractory to other drugs

34
Q

Succinimides SE

A

Rash, pruritus, Stevens-Johnson syndrome, gingival hyperplasia, Agranulocytosis, Increased libido, hirsutism

35
Q

In which pts should Succinimides be used in w/ caution?

A

Use cautiously in patients who have liver or kidney issues or any kind of blood dyscrasia.

36
Q

Succinimides GI distress can be resolved by taking what?

A

Glass of milk

37
Q

What is valproate used for?

A

Sz, manic phases of bipolar disorder and prophylaxis of migraine headaches

38
Q

What is gabapentin used for?

A

Sz, Used for restless leg syndrome, postherpetic neuralgia (PHN), and seizures

39
Q

What is lamotrigine used for?

A

Sz

40
Q

What is clonazepam used for?

A

Sz

41
Q

What is pregabalin used for?

A

Sz

42
Q

What is locosamide used for?

A

Sz

43
Q

What is topiramate used for?

A

Sz

44
Q

What is levetiracetam used for?

A

Sz

45
Q

clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan) MOA

A

make abnormal electrical activity less likely by slowing CNS activity

46
Q

GABA enhancers are gabapentin (Neurontin), tiagabine (Gabitril), valproate (Depakote), and vigabatrin (Sabril) use

A

treatment of refractory complex partial seizures in adults

47
Q

Vigabatrin SE

A

Loss of vision

48
Q

When is the used of Vigabatrin (Sabril) recommended?

A

after other options have proven ineffective in treating the seizures

49
Q

Valproic acid/ valproate sodium SE

A

Significant weight gain

50
Q

Valproic acid/ valproate sodium high plasma levels

A

severe tremors as well as liver damage, which has been fatal in children

51
Q

Valproic acid/ valproate sodium MOA

A

blocking voltage-gated sodium channels and T-type calcium channels,

52
Q

Which drug classes are used to tx peripheral neuropathy?

A

Pain relievers (NSAIDS, anticonvulsants (gabapentin), warming agents, topical anesthetics, TCAs, and TENS

53
Q

MS drugs

A

Interferon, glatiramer, natalizumab, fingolimod

54
Q

Interferon SE

A

Flu like sxs

55
Q

Fingolimod is unique in treating MS because?

A

Its available PO

56
Q

Which frugs have the most evidence for treating Alzheimers?

A

mild-to-moderate AD, cholinesterase inhibitors have the strongest evidence of treating cognitive symptoms

57
Q

Which drug is approved to use for moderate to severe Alzheimers?

A

Memantine

58
Q

MC Alzheimer drug SE

A

GI se

59
Q

What increases the risk of adverse SE in alzheimer’s drugs?

A

Higher dose

60
Q

What safety measures should be taken in pts on antidementia meds?

A

Safety measures to prevent falls should be taken because the patient may experience dizziness.

61
Q

Acetylcholinesterase Inhibitors examples

A

donepezil, tacrine, galantamine, rivastigmine

62
Q

Acetylcholinesterase Inhibitors MOA

A

Impede the breakdown of what little acetylcholine remains in the brain of an AD patient

63
Q

Which Acetylcholinesterase Inhibitors has the longest acting profile?

A

Donepezil has the longest-acting profile

64
Q

Acetylcholinesterase Inhibitors use

A

Symptomatic treatment of mild to moderate dementia of the Alzheimer type

65
Q

Acetylcholinesterase Inhibitors SE

A

hypertension, Increased secretions, abdominal cramps, nausea, vomiting, diarrhea, loss of appetite, weight loss, Muscle aches/cramps, Abnormal dreams, dizziness, depression, insomnia

66
Q

Acetylcholinesterase Inhibitors interactions

A

These drugs are metabolized by the CYP-450 system, thus drug levels and effects may be altered by other drugs that affect this metabolic pathway

67
Q

Overdosing of Acetylcholinesterase Inhibitors can lead to what?

A

cholinergic crisis

68
Q

Sxs of cholinergic crisis

A

slowed HR, muscle weakness, paralysis along with respiratory depression, salivation, sweating, diarrhea, blurred vision and vomiting

Pharm 2 Exam 2 (8 decks)

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