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Pharm Exam III > Neuro > Flashcards

Neuro Flashcards

1
Q

what are the cholinergic effects?

A 
constricted pupils
increased saliva
bronchoconstriction
increased GI mucous
bladder fundus contraction
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2
Q

what are the adrenergic (anticholinergic) effects?

A 
dry mouth
dilated pupils
increased contractility
increased HR
bronchodilation
bladder fundus relaxes, sphincter contracts
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3
Q

what are the parasympathetic effects on the autonomic nervous system?

A 
pupils constrict
eyes become dry
mouth waters
heart rate slows down
breathing sloes
bronchial passages constrict
digestive functions stimulated
stomach/intestine activity increases
bladder contracts
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4
Q

what are the sympathetic effects on the autonomic nervous system?

A 
pupils dilate
eyes water, tears form
mouth becomes dry
sweating increases
heart rate increases
adrenaline rush
breathing quickens
bronchial passages dilate
digestive functions inhibited
stomach/intestine activity decreases
bladder relaxes
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5
Q

what are the classifications of cholinergic drugs?

A

parasympathomimetic

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6
Q

what are the classifications of cholinergic blocking drugs?

A

parasympatholytic
anticholinergic
antimuscarinic

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7
Q

what are the classifications of adrenergic drugs?

A

sympathomimetic

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8
Q

what are the classifications of adrenergic blocking drugs?

A

sympatholytic

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9
Q

what are the main uses of cholinergic drugs?

A

decreases IOP in glaucoma
treat atony of GI tract and urinary bladder
diagnose and treat myasthenia gravis
physostigmine used to treat anticholinergic toxicity
not organ specific- other organs not targeted become ADR

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10
Q

what are the cholinesterase inhibitors used to treat MG?

A

neostigmine

pyridostigmine

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11
Q

what are the cholinesterase inhibitors used to treat Alzheimer’s?

A

donepezil (Aricept)
galantamine (Razadyne)
rivastigmine (Exelon)
memantine (Namenda)- not a cholinesterase inhibitor

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12
Q

what is the mainstay of MG treatment?

A

reversible cholinesterase inhibitors

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13
Q

is MG treatment for symptom management or curative?

A

symptom management

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14
Q

which medications are used to treat MG?

A

neostigmine

pyridostigmine

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15
Q

which medications are used to treat Alzheimer’s?

A

donepezil (Aricept)
rivastigmine (Exelon)
memantine (Namenda)

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16
Q

what are the benefits to taking donepezil (Aricept) in comparison to other AD drugs?

A

has a better side effect profile
longer duration of action
GI effects are usually self resolving

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17
Q

which forms is rivastigmine (Exelon) available in?

A

patch and liquid

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18
Q

which class of drugs are the treatment of choice for Parkinson’s disease?

A

dopaminergics

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19
Q

what is the MOA of dopaminergics?

A

attempt to restore the functional balance of dopamine and acetylcholine in the corpus striatum of the brain

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20
Q

which medications are used in the treatment of Parkinson’s?

A 
amantadine (Symmetrel)
bromocriptine (Parlodel)
levodopa (L-dopa, Larodopa)
carbidopa-levodopa (Sinemet)
pramipexole (Mirapex)
ropinirole (Requip)
rotigotine (Nuepro)
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21
Q

what are the ADRs of dopaminergics?

A

N/V
hallucinations
confusion

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22
Q

when using dopaminergics, how long does it take for there to be therapeutic effects?

A

may need up to 6 months to achieve maximum effects

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23
Q

dopaminergics have many drug interactions and the variation depends on what?

A

variations with each drug

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24
Q

what kind of education would you give to patients taking dopaminergics?

A

avoid abrupt d/c
drug interactions
TCA’s decrease the effects
may increase effects of HTN drugs

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25
Q

what should be monitored in pts taking dopaminergics?

A

lab tests pertaining to hepatic and renal function

“on-off” phenomenon (suddenly symptoms worsen/improve)

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26
Q

what are the FIRST LINE drugs for treatment of PD?

A

Bromocriptine (Parlodel)
Pergolide (Permax)
Pramipexole (Mirapex)
Ropinirole (Requip)

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27
Q

when symptoms of PD worsen, what should be introduced?

A

levodopa

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28
Q

which drugs are used to control tremors in PD by relaxing smooth muscle?

A

cholinergic blockers

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29
Q

what are factors that precipitate seizures?

A 
sleep deprivation
high caffeine intake
hyperventilation
stress
hormonal changes
sensory stimuli
drug/alcohol use
infections
fever
metabolic disorders
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30
Q

which off-label use are anticonvulsants being used for?

A

treatment of mood disorders

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31
Q

what is the MOA of antiseizure medications?

A

stimulating an influx of chloride ions (usually associated with GABA)
delaying an influx of Na
delaying an influx of Ca

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32
Q

which anticonvulsant medications fall under the classification of hydantoins?

A

Ethotoin (Peganone)- not common
Fosphenytoin (Cerebyx)- NOT for primary care (available only in IM or IV dosing)
Phenytoin (Dilantin)- (capsules (ER), chewable tablets, suspension, injection)

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33
Q

hydantoins are first line treatment for what?

A

tonic-clonic seizures

partial complex seizures

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34
Q

what is the MOA of hydantoins?

A

Works by stabilizing neuronal membranes and decreasing seizure activity by increasing efflux or decreasing efflux of sodium ions across cell membranes in the motor cortex
(onset and duration vary)

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35
Q

since hydantoins are metabolized in the liver, what will cause the levels of the drug to increase?

A 
cimetidine
diazepam
acute alcohol intake
valproic acid
allopurinol
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36
Q

since hydantoins are metabolized in the liver, what will cause the levels of the drug to decrease?

A

barbituates
antacids
calcium
chronic alcohol use

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37
Q

what are the drug interactions for hydantoins?

A 
decreased effect of:
carbamazepine
estrogens
acetaminophen
corticosteroids
levodopa
sulfonylureas
cardiac glycosides
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38
Q

what are the MOST COMMON ADRs of hydantoins?

A 
nystagmus
dizziness
pruritus
paresthesia
HA
somnolence
ataxia
confusion
HYPOtension
tachycardia
N/V
anorexia
constipation
dry mouth
gingival hyperplasia
urinary retention 
urine discoloration
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39
Q

which patients should be monitored closely when taking hydantoins?

A

patients with renal and liver disease

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40
Q

which routes should hydantoins never be administered in a primary care setting?

A

IV or IM

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41
Q

in regards to monitoring for hydantoins, what should be monitored?

A

baseline labs, plasma levels, & TSH

need to assess OTC drugs (ibuprofen, antacids)

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42
Q

which anticonvulsant medications fall under the classification of iminostilbenes?

A

Carbazepine (Tegretol, Tegretol XR, Carbatrol)
Oxcarbazepine: (Trileptal)
Valproic acid (Depakote, Depakene)

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43
Q

what is the MOA for iminostilbenes?

A

depresses neuron transmission in the neucleus ventralis anterior of the thalmus; has the ability to induce its own metabolism

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44
Q

why do iminostilbenes have a black box warning?

A

for causing blood dyscrasias

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45
Q

how are iminostilbenes absorbed/metabolized?

A

absorbed through the stomach

metabolized in the liver

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46
Q

what are the ADRs of iminostilbenes?

A 
depression of bone marrow
liver damage
impairs thyroid function
drowsiness
dizziness
blurred vision
N/V
dry mouth 
diplopia 
HA
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47
Q

the levels of iminostilbenes increases with concurrent use of which medications?

A 
propoxyphene (Darvocet)
cimetidine
erythromycyn
clarithromycin
verapamil
hydantoins
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48
Q

the plasma levels of which drugs decrease with concurrent use of iminostilbenes?

A 
beta blockers
warfarin
doxycycline
succinimides
heloperidol
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49
Q

which food/beverage should be avoided when taking iminostilbenes?

A

grapefruit

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50
Q

when are succinimides used?

A

for treatment of absence seizures in children and adults

51
Q

which anticonvulsant medications fall under the classification of succinimides?

A

Ethosuzimide (Zarontin)

Methsuximide (Celontin)

52
Q

what is the MOA of succinimides?

A

suppress seizures by delaying calcium influx into neurons

decreases nerve impulses and transmission in the motor cortex

53
Q

how are succinimides absorbed/metabolized?

A

absorbed in the GI tract

metabolized in the liver

54
Q

what are the ADRs of succinimides?

A 
GI most common
somnolence fatigue
ataxia
agranulcytosis
aplastic anemia
granulocytopenia
55
Q

which anticonvulsant medications fall under the classification of GABA?

A

Gabapentin (Neurontin)
Tiagibine (Gabitril)
Topiramate (Topamax)

56
Q

GABAs are pregnancy category what?

A

D

57
Q

what are the most common ADRs of GABA?

A

somnolence

other CNS efects

58
Q

what should be monitored in patients taking GABA?

A 
frequency/severity of seizure activity
mood changes
depression
anxiety
DO NOT d/c abruptly
59
Q

which anticonvulsant medications fall under the classification of levetiracetam?

A

Leviracetam (Keppra)

60
Q

when is levetiracetam used?

A

adjunct partial onset seizures

61
Q

what is the possible neuropsychiatric ADR of Keppra?

A

suicidality

62
Q

when is lemotrigine (Lamictal) used?

A

in the adjunctive treatment of primary generalized tonic-clonic seizures and partial seizures in adults and children greater than or equal to 2 yrs

63
Q

lamotrigine is used concurrently with what medications?

A

valproic acid

phenytoin

64
Q

the levels of lamotrigine are decreased by what?

A

barbituates
estrogens
phenytoin

65
Q

the levels of lamotrigine are increased by what?

A

alcohol
carbabazepine
CNS depressants
valproic acid

66
Q

where is lamotrigine metabolized?

A

in the liver and kidneys

67
Q

what are the ADRs of lamotrigine?

A 
mostly GI
N/V
constipation
chest pain
peripheral edema
somnolence 
fatigue
dizziness
anxiety
insomnia
HA
amblyopia
nystagmus
68
Q

why does lamotrigine have a black box warning?

A

SJS

69
Q

what should patients taking lamotrigine be educated about?

A 
adherence
avoid alcohol
avoid OTC meds
adequate hydration
report any new drugs
report ADRs
70
Q

what are the classes of sedative hypnotics?

A

nonbenzodiazepine
benzodiazepine
ramelteon (Rozerem)

71
Q

what are the non-benzodiazepine medications?

A

zolpiden (Ambien)
zaleplon (Sonata)
eszopiclone (Lunesta)

72
Q

what are the benzodiazepine medications?

A

flurazepam (Dalmane)
temazepam (Restoril)
triazolam (Halcion)

73
Q

which medications are considered stimulants?

A

amphetamine
dextroamphetamine
adderall (mix of amphetamine & dextro salts)
non-amphetamine: atomoxetine (Strattera)

74
Q

which of the stimulant medications is not considered a schedule II drug?

A

Strattera

75
Q

when dosing stimulants, what is usually the starting dosage FORM?

A

IR

76
Q

what is the peak incidence of migraine headaches?

A

age 25 to 34 yrs

77
Q

what are the four types of migraines?

A

complex, multifactoral
migraine with aura (classic migraine)
migraine without aura (common migraine)
complicated migraine

78
Q

what is the pathophysiology of migraine HAs?

A

changes in serotonin causes release of vasoactive neurotransmitters
causes inflammatory response
excitatory serotonin receptors activated
serotonin receptor agonists abort migraines by stimulating inhibitory serotonin receptors

79
Q

what are the goals of migraine treatment therapy?

A

minimize the impact on quality of life

avoid medication overuse

80
Q

what are the OTC analgesics (work best early in migraine) used to treat migraines?

A

ibuprofen
naproxen
migraine formulas- OTC combinations

81
Q

what are the mid-range analgesics used to treat migraines?

A

Butalbital/ASA or APAP (Fiorinal or Fioricet)- controlled substance
Isometheptene/acetaminophen/dichloralphenazone (Midrin)- schedule IV

82
Q

what are the high-range analgesics (opioids) used to treat migraines?

A

PO codeine combined with ASA or APAP
IM meperidine – not a good option
Intranasal butorphanol (Stadol)

83
Q

when are high-range analgesics the drug of choice to treat migraines?

A

in pregnancy
when vasoconstrictors are contrindicated
when pt is non-responsive to ergotamine or serotonin agonsits

84
Q

which vasoconstrictor (ergots) medications are used to treat migraines?

A

ergotamine

DHE

85
Q

how is DHE administered?

A

IM or intranasal

86
Q

which serotonin 5-HT antagonists or triptans are used to treat migraines?

A 
Almotriptan (Axert)
Eletriptan (Relpax)
Frovatriptan (Frova)
Naratriptan (Amerge)
Rizatriptan (Maxalt)
SUMAtriptan (Imitrex) 
ZOLMitriptan (Zomig)
87
Q

what are the contraindications to taking to triptans?

A

CAD
uncontrolled HTN
pregnancy

88
Q

triptans have drug interactions with which medications?

A

ergotamines
MAOIs
SSRIs

89
Q

when are triptans taken?

A

at the onset of migraine

90
Q

why are antiemetics co-administered with migraines?

A

N/V common in migraines

co-administer with abortive medication

91
Q

which antiemetics are used with migraines?

A

Metoclopramide (Reglan)

Prochlorperazine (Compazine)

92
Q

when is preventative therapy for migraine patients considered?

A

for patients with more than 2 migraines per month

93
Q

which medications are used in preventative therapy?

A

Beta Blockers (propranolol, timolol – FDA approved, nadolol, metoprolol and atenolol are also used)
Tricyclic antidepressants
Antiepileptic drugs

94
Q

which is the beta-blocker of choice in migraine prevention?

A

propanolol

95
Q

which beta-blockers should be used in pts with asthma or respiratory concerns?

A

metoprolol

atenolol

96
Q

what are the ADRs of propanolol?

A

fatigue
lethargy
depression

97
Q

which TCAs are used for migraine prevention?

A

Amitriptyline (Elavil)

98
Q

what are the ADRs of Elavil?

A

drowsiness
weight gain
constipation

99
Q

which antiepileptics are used for migraine prophylaxis?

A

Divalproex (Depakote)
Gapapentin (Neuronton)
Topiramate (Topamax)

100
Q

how does Depakote help in migraine prophylaxis?

A

decreases the number and intensity of the migraine

101
Q

depakote is pregnancy category what?

A

D

102
Q

how should neuronton be dosed?

A

start low and titrate up over 4 weeks to target dose

103
Q

how should topiramate be dosed?

A

dose titrated up over 4 weeks

104
Q

what are the ADRs of topiramate?

A

weight loss
somnolence
kidney stones

105
Q

which NSAIDs are used to treat menstrual migraines?

A

naproxen BID (started a week before menses and continued for a week later)

106
Q

which CCBs can be used to treat migraines?

A

verapamil for pts with HTN who cannot tolerate beta-blockers

107
Q

what are the nonpharmacological forms of tx for migraines?

A

identifying triggers
alternative therapies
ice biofeedback

108
Q

what are the alternative therapies used in migraine treatment?

A 
migranol (feverfew, riboflavin, magnesium, vitamins)
acupuncture
aromatherapy
hypnosis
reflexology
massage
yoga
109
Q

how can migraines be monitored?

A

HA diary
medication refills
BP monitoring
if on divalproex, need liver function and CBC tested

110
Q

what are tension HAs?

A

band-like pressure, persistent dull pain
not worsened by exercise
last from 30 minutes to days

111
Q

what is the preventative therapy for tension HAs?

A

beta-blockers
TCAs
non-pharmacologic therapy

112
Q

when is preventative therapy considered for tension HAs?

A

considered if more than one or two HA per week

113
Q

what are the non-pharmacologic therapies used for tension HAs?

A

stress management
biofeedback
exercise
acupuncture

114
Q

tension HAs do not respond to which medications?

A

triptans

ergots

115
Q

what is the cause of transformed migraines?

A

overuse of analgesics

coexisting psychopathology

116
Q

which medications are used to treat cluster HAs?

A

100% O2
ergotamine derivatives
intranasal lidocaine
sumatriptan

117
Q

which medications are used in preventative therapy for cluster HAs?

A

ergotamine
verapamil
divalproex
lithium

118
Q

what should be avoided to decrease cluster HAs?

A

all alcohol
tobacco
stress
vigorous activity

119
Q

what should be monitored with cluster HAs?

A

for suicidal thoughts

keep HA diary

120
Q

what is medication overuse HA?

A

drug rebound HA reclassified by the IHS as medication overuse

121
Q

what are the criteria for medication overuse HA?

A

HA present >15 days/mth
regular overuse of drugs for acute HA for >3 mths
HA has gotten worse during therapy
resolves or reverts to previous pattern after overused medication d/c

122
Q

what are the stages of therapy in medication overuse HAs?

A

withdrawal from offending drugs
transition and support during detoxification
preventative therapy

123
Q

when should preventative therapy start for medication overuse HAs?

A

at beginning of withdrawal
2 to 3 weeks before
after withdrawal

Pharm Exam III (4 decks)

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