Neuro Exam 3 Flashcards
1
Q
Pathophysiology of Parkinson Disease
A
Too little dopamine and too much acetlycholine
2
Q
Therapeutic goal of Parkinsons
A
Provide symptomatic relief, does not delay the progression
3
Q
Long term use of levodopa/carbidopa (Sinamet) can lead to______.
A
Dyskinesias, typically 80% of the users of the drug will experience this right after optimal dosage has been acheived
4
Q
What are “off times associated with Levadopa/Carbidopa?
A
Periods where there is a complete loss of symptom relief
5
Q
Adverse effects associated with Levodopa/Carbidopa
A
N/V, Dysrhythmias, postural hypotension, psychosis and dyskinesias
6
Q
Levodopa purpose in the pill
A
Crosses the BBB and then can convert into dopamine
7
Q
Purpose of Carbidopa in the pill
A
Carbidopa is the car that ensures levodopa gets driven past the BBB (ensures its is not broken down in the intestines/periphery).
8
Q
Prior to giving this drug for parkinsons I will assess _____
A
Motor symptoms
9
Q
Drugs that I shouldn’t take with Parkinson drug? (1 Hard NO)
A
Anticholinergic drugs, Selective MAO-B inhibitors
Hard NO- MAO Inhibitors
10
Q
Take levodopa with ____ but avoid _____, when taking the drug, why?
A
food, high protein meals It can alter the absorption
11
Q
Entacapone and Selegilline are use for what
A
The “off times” associated with taking Levadopa
12
Q
Amantadine can be taken for
A
levodopa-induced movement disorders
13
Q
Educate patient on this drug to except it to work in this time frame, be sure to check ____ and monitor urine for this adverse sign
A
weeks to months to work
skin assessment- can affect malignant melanoma
Darkened urine and sweat (harmless effect)
14
Q
Why would I prescribe someone Pramipexole? (Mirapex)
A
It can be used as 1st line therapy in early stages of Parkinson (less side affects)
Also used with levadopa/carbidopa, lowers dose for Sinamet- less side affects
Also used for restless leg syndrome
15
Q
MOA of Mirapex-Pramipexole
A
Direct activation of dopamine receptors in the striatum
16
Q
Adverse effects of Pramipexole (Mirapex), same as Levadopa plus 2 funky ones
A
Nausea, diskinesia, postural hypotension, hallucinations
Sleep attacks and impulse controls (gambling, shopping, binge eating, etc)
17
Q
Cautious giving Levodopa/Carbidopa to patients with ____ and _____
A
cardiac disease and psychiatric disorders
18
Q
Prior to giving Mirapex im assessing
A
motor symptoms
19
Q
Cautious to give Mirapex to (3)
A
older adults
Psych disorders
Kidney dysfunction
20
Q
Selegiline will be given for what
A
MAO-B inhibitor to prevent dopamine breakdown- 1st line drug to decrease “off times”
21
Q
Entacapone taken to do what
A
COMT inhibitor to prevent early breakdown of Levodopa in the peripheral tissues and intestines.
22
Q
Amantadine Use and MOA
A
Only Drug recommended for diskinesias
Works by promoting release of Dopamine from remaining dopamine neurons, may block reuptake
23
Q
Take mirapex with food or on empty stomach?
A
Food to reduce nausea and vomiting
24
Q
Donepezil brand name
A
Aricept
25
Donepezil (aricept) use
Moderate to severe AD
26
MOA of Aricept
Prevent the breakdown of Aceylcholine by acetlycholinesterase and thereby increasing the availability of acetylcholine at cholinergic synapse
27
Severe effects of Aricept
Withdrawal syndrome
| Prolonged Qt interval or heart block
28
Assess what prior to giving Donepezil
Mental status symptoms
29
Caution use of Donepezil in patients with (4)
Asthma or COPD
History of PUD
Urinary retention/obstruction
30
Since common side affects of Aricept are nausea and vomiting, patients can do this to reduce these symptoms
Take with food
31
Im administering you Donepezil Aricept I want to be sure to let you know that
Nausea and vomiting is common, take it with food to help, weight loss might occur but it will get better over time.
32
DO NOT DO THIS WHEN TAKING ARICEPT
Don't stop medication suddenly, withdrawal symptoms include agitation, crying, and hallucinations
33
Memantine prescribed for
Moderate to severe AD
34
Memantine brand name
Namenda
35
Namenda is what type of drug
Neuronal receptor blocker
36
In lehman terms what does Cholinesterase inhibitors do for alzheimers disease
Prevent clearing of acetylcholine in junction, making more readily available
37
MOA of Memantine (Namenda) for alzheimers
In alzheimers, nerve cells are damaged causing too much glutamate to be produced which leads to more and more calcium being released into nerve cell- furthering cellular injury.
Memantine controls the influx of calcium, limiting the degree of damage
38
How to taper off multiple seizure drugs?
Taper off each individually and discontinue, one at a time
39
Pharmacologic management of Anti-eleptic drugs is highly _____
Individualized for each patient
40
Monitor what for AEDs
Monitor plasma drug levels due to tight therapeutic range
41
What do I wear if I am prone to seizures
Medic alert bracelet
42
What would a couple want to know about AEDs if one of them is taking the drug
Eight AEDs make oral contraceptives less effective and four of them can cause harm to a fetus
43
All AEDs, assess what
Type of seizure and how often
44
How do I get off AEDs
Withdraw slowly and sequentially- can lead to status epilepticus
45
Eval/Intervention/Education for patients on AEDS (4)
CNS depression
Signs that may preceded suicidal behavior
if pregnant take folic acid
Don't stop suddenly
46
Difference between traditional and newer AEDs
Traditional AEDs are obviously more well established
Pharmacokinetics: Often complex in comparison to newer
Drug interactions: Are extensive
Safety in Pregnancy: Less safe
Cost: Less expensive in comparison to newer
The newer drugs are still figuring out their therapeutic niche
47
Phenytoin brand name
Dilantin
48
MOA of Dilantin
Delays the influx of sodium ions in neurons @ synaptic junction, consequently slowing the spread of abnormal nerve firing
49
Use of Dilantin
Treat all forms of epilepsy except for absent seizures
50
Phenytoin (Dilantin) Adverse reaction
CNS Issues- directly related to high doses
Morbilliform rash- evolve into Steven Johnson Syndrome
Teratogen
Purple Glove syndrome- Ischemic injury- due to very hard on blood vessels
Gingival hyperplasia
Hypotension and dysrhythmia with IV administration
51
MAR for Phenytoin (3)
Oral contraceptives, Warfarin, CNS Depressants
52
PMH for Dilantin
Sinus bradycardia or 2nd/3rd degree block
53
PO Dilantin
Take with food to avoid gastric upset
54
IV administration bewares of Dilantin
NEVER piggyback with dextrose solutions
Utilize a large vein with a large bore needle
There is significant extravasation risk, where the drug can leak out into the surrounding tissue
55
Toxicity S/S of Dilantin
Excessive sedation, diplopia, nystagmus
56
Can I go cold turkey on Dilantin If I decide its not working for me
No
57
What two teaching points could I include for patient taking Dilantin
Good oral hygiene for gingival hyperplasia and .5mg of folic acid daily
58
Brand name for Carbamazepine
Tegretol
59
Tegretol used for what
Seizures
60
Serious adverse effects of this Tegretol
Bone marrow suppression (Anemia, infection, bleeds)
| Hypo-osmolarity and hyponatremia (increased ADH release)
61
Valproic Acid brand name
Depakote
62
What is Depakote used for
broad spectrum AED
63
Serious adverse of Depakote
Hepatotoxicity, pancreatitis, Teratogenic Effects
64
Avoid giving Valproic Acid to who?
Children less than 2 years of age and those individuals with liver issues
65
All barbiturates end in ____
tal
66
Use-
Thiopental
Secobarbital
Phenobarbital
```
Ultra-short acting (seizures/anesthesia)
Short to intermediate acting (insomnia)
Long acting (seizures)
```
67
Barbiturates Adverse effects
Respiratory depression
Suicide vehicle
abuse (tolerance and dependency is common)
Acute toxicity (CPR- Coma, Pinpoint pupils, respiratory depression)
68
MOA of barbiturates
Binds to the GABA receptor- enhancing Inhibitory effects
69
Which AED works by blocking Calcium channels
Valproic Acid
70
Which AEDs work by blocking sodium channels
Phenytoin (dilantin) and Carbamazepine
71
Phenobarbitol PMH
Pregnancy
72
How to give phenobarbitol
PO or IV slow infusion
73
Is tolerance and physical dependence an issue with phenobarbitol?
Yes tolerance is common and dependence so you will experience withdrawal if you stop
74
NEW AED
Oxcarbazepine
75
MOA of Oxcarbazepine
Sodium channel blocker
76
Adverse effects of Oxcarbazepine
Hyponatremia and Hypothyroidism
CNS effects
Blood dyscrasias
77
Barbiturates high risk patients
Suicidal patients and geratrics
78
As you build up tolerance what is something to be aware of for Barbiturates
Tolerance (dosage needed) will eventually catch up to serious harm dose
79
Oxcarbazepine brand name
Trileptal
80
Drug Interactions with Oxcarbazepine (4)
Oral contraceptives (Utilize 2 methods)
Sodium depleting drugs (Diuretics)
Alcohol
Other AEDS (Doesn't play well with others)
81
If Im allergic to Carbamazepine can I take Oxcarbazepine
No thats a hard no
82
One assessment for lab with Oxcarbazepine
CBC- due to blood dyscrasias
83
MAR for Trileptal (3)
| Oxcarbazepine
Sodium depleting drugs
Oral contraceptives
Certain AEDS
84
Oxcarbazepine 3 Educational points for patients
Trileptal
Blood
Skin
Salt
Educate on the hypo- natremia and thyroid effects
Educate on hematologic abnormalities
Severe skin reactions (SJS can occur)
85
Gabapentin brand name
Neurontin
86
MOA of Gabapentin
Analog of GABA
87
What is gabapentin used for
It is a seizure drug but 80% of prescriptions are for off label use (neuropathic pain, migraine, fibromyalgia, relief of postmenopausal hot flashes)
88
Be sure to educate family on what initial adverse effect of SSRI/SNRI usage
Can increase the risk of suicide at first
89
SSRIs and SNRI use
Depression
90
MOA of SSRIs and SNRIs
Blocks the reputake of serotonin and norepinephrine in the synaptic space
91
Fluoxetine brand name
Prozac
92
Venlafaxine is what type of drug
SNRI
93
Venlafaxine also called what
Effexor XR
94
When does serotonin syndrome begin
2-72 hours after treatment
95
S/S of serotonin syndrome
altered mental status (agitation, confusion hallucinations)
| incoordination, hyperreflexia, excessive sweating, tremor, fever (death)
96
How will serotonin syndrome improve
Syndrome resolves spontaneously after discontinuing the drug
97
How does risk increase for Serotonin syndrome
Taking multiple MAOIs and other drugs
98
How to avoid withdrawal syndrome from SSRIs
taper dose off gradually, withdrawal can begin days to weeks of last dose
S/S include dizziness, headache, nausea, and sensory disturbances
99
Lab for SSRI/SNRI prior to administration
Serium Na level
100
MAR for SSRI/SNRIs
MAOIs- increase of serotonin syndrome, anti-platelet and anticoagulant drugs (increased risk for bleeds)
101
Tell patient when to take the SSRI/SNRI
in the morning to minimize sleep disturbance
102
Patient education for SSRIs and SNRIs
- Dont stop suddenly
- S/S of serotonin syndrome
- Initial dose may cause you to feel worse (increased suicide)
- Adverse effects could include (bruxism, GI bleeding, sexual dysfunction, dizziness and fatigue)
103
Imipramine
TCA- Tricyclic Antidepressant
104
Most serious adverse of TCAs (2)
serious orthostatic hypotension and Cardiac toxicity (stop taking drug)
105
Adverse drug effects combined with TCAs
Anticholinergics, sympathomimetics (drugs that mimic sympathetic nervous system- double boost), MAO-Is
106
Phenelzine
MAOI-I
107
What can you not take in conjunction with MAOI-Is
SSRIs
108
Any comorbidities with these 3, do not take MAOIs or be especially cautious
Heart, renal, liver
109
MAOIs have high interaction with ____
All drugs
110
Adverse effects of Phenelzine
HTN crisis, orthostatic hypotension
111
Tyramine containing foods with MAOIs can cause what
Hypertensive crisis, promotes the release of norepinephrine
112
Common tyramine containing foods
Avocados, figs, bananas, fermented meats, cheeses, soy sauce
113
Bupropion brand name
Wellbutrin
114
Buproprion prescribed for
SAD
Smoking Cessation
Major Depression
115
How many weeks to feel effects of Bupropion
1-3 weeks
116
Bupropion affect on appetitive
Stimulant- can suppress appetite
117
Adverse effects of Wellbutrin
Seizures and increased risk of suicide
118
Bright side of Wellbutrin
Doesn't cause adverse sexual side effects
119
All Benzodiazepines and Benzodiazepine receptor agonists end in what
PAM
120
Use of Benzos
Manage seizure disorders, muscle spasms, panic disorder and alcohol withdrawal
121
Apparently benzos have bright sides to include
Fewer drug interactions
lower potential for abuse
produce less tolerance and physical dependence
122
Benzodiazepines are the drug of choice to treat ______ and _____.
Insomnia and anxiety
123
Lorazepam brand name
Ativan
124
Ativan use
Stop anxiety, suppress seizure, ease Alcohol
125
Take oral Benzos with food?
Take oral with food if gastric upset occurs
126
Adverse effects of Lorazepam (Ativan)
Daytime sedation, anterograde amnesia, respiratory depression
**Paradoxical effect in older adult, children and psych patients**
127
Drug interactions for Ativan
Any other drug that can depress the CNS
128
Ativan MOA
Potentiates the actions of GABA (inhibitory neurotransmitter)
129
Zolpidem brand name
Ambien
130
Use of Ambien
-Insomnia, short term management
-Don’t use for for anxiety, as a
muscle relaxant, and/or anticonvulsant action
131
MOA of Zolpidem
Similar to benzos, enhances actions of GABA by binding specifically to Omega-1 receptors
132
Adverse effects of Ambien
Dizziness, diarrhea, drowsiness
| Sleep driving, sleep- related complex behaviors
133
MAR for giving ambien
Any other CNS depressants and alcohol use
134
How to administer Ambien
Oral
135
Education on Ambien
Take right before sleep cycle and the drug can cause next day impairment
136
Mainstay drugs for Bipolar disorder are _____ and _____
Lithium an valproic acid
137
Antidepressants are given for
depressive episodes
138
Antipsychotics are given to bipolar patients when
during severe manic episodes
139
Mood stabilizers are given to bipolar patients for what
relieve symptoms during manic and depressive episodes
| Stabilize both ends
140
Lithium use
Control of acute manic episodes, prophylaxis against recurrent mania and depression
141
MOA of lithium
Unknown, thought to alter glutamate uptake and release, blocks the binding of serotonin
142
Early adverse effects of lithium
Gi effects, headache, confusion, muscle weakness
143
Pre assessment for Lithium
Baseline cardiac status, CBC with diff, renal function, thyroid function, electrolytes
144
MAR for lithium
Diuretic, NSAIDS, anticholinergics
145
Hard no for lithium
1st semester pregnancy
146
PMH be aware of or tread cautiously patients
Renal disease, CV disease, dehydration or sodium depletion
147
Expected Lithium level should be
.4-1 mEq/L
148
Below 1.5 lithium level
Nausea/Vomiting/Diarrhea/tremors
| Basic stuff
149
1.5-2 Lithium level
Hyper irritability of muscles, ECG changes, course hand tremors
150
2-2.5 lithium level
High output of dilute urine, serious ECG changes, tinnitus, vision changes, clonic movements (seizure looking) possible coma and death
151
Above 2.5 lithium level
Symptoms may progress rapidly to convulsions, oliguria, and death
152
Migraine medications are used in two ways
Prevention of attack occurring
| To abort an ongoing attack
153
What is a migraine
A neurovascular disorder involving dilation and inflammation of intracranial arteries
154
ERGOTS MOA
block inflammation associated with the trigeminal vascular system- perhaps by suppressing the release of CGRP
155
MOA for TRIPANS
Vasoconstriction of dilated blood vessels by stimulating alpha-adrenergic and serotonergic (5-HT) receptors
- 1st line defense
156
Assess what for Triptans (Sumatriptan)
Pain assessment, triggers, timing
157
Hard nos for Triptans
Ergot alkaloids, other triptans, SSRIs/SNRIs, Ischemic heart disease, prior MI, Uncontrolled HTN, pregnancy
158
Triptans can be given via what routes
Oral, subq, intranasal, transdermal
159
What to evaluate after giving triptan
Evaluate the efficacy for an PRN medication and let provider know if any chest pain occurs
160
Assessement before giving Ergots (ergomar)
Pain assessment, triggers, timing
161
HARD NOs for Ergots (ergomar)
Triptans, hepatic or renal impairment, sepsis, CAD, PVD, pregnancy
162
Take both Ergots and Triptans when?
Immediately after onset of Surgery symptoms
163
Routes for Ergots
PO, sublingual, rectal, nasal spray, IM, IV, sub q
164
Let provider know if what S/S develop with taking Ergots
muscle pain, paresthesias in your digits, extremities feel cold pale or numb (possible constriction)
165
Many will experience this when taking Ergots
nausea and vomiting
