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PHARM EX2 > NEURO MEDS > Flashcards

NEURO MEDS Flashcards

1
Q

This is associated with the build up of beta-amyloid plaques and neurofibrillary tangles in the brain

A

Alzheimer’s Disease

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2
Q

Explain the genetic risk factor for Alzheimer’s Disease

A

one or two copies of Apolipo-protein E4)

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3
Q

What happens to the acetylcholine in Alzheimer’s Disease?

A

DECREASES

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4
Q

What neurotransmitter increases with Alzheimer’s Disease?

A

Glutamate

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5
Q

What happens during the mild stage of the Alzheimer’s Disease? (3)

A

-Short Term Memory Loss
-Lost in familiar event
-Lose Self management skills

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6
Q

What happens during the moderate stage of the Alzheimer’s Disease? (3)

A

-Client is at risk of injury

-Lost the ability to recognize family and friends

-Unconsciously fill in memory gaps with imaginary event

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7
Q

What happens during the severe stage of the Alzheimer’s Disease?

A

-Lose the ability to eat, speak, understand language, ambulate, and control elimination

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8
Q

What are the 3 medical options for the Alzheimer’s Disease?

A

Cholinesterase Inhibitor
Memantine
Atypical Antipsychotics
(Risperidone + Olanzapine)

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9
Q

Most common cholinesterase inhibitor?

A

DONEPEZIL

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10
Q

When is Donepezil prescribed?

A

All stages of the Alzheimer’s Disease

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11
Q

What is the mechanism of action of the Alzheimer’s Disease?

A

Alzheimer’s Disease damages neurons that releases acetylcholine

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12
Q

What does Donezepil do?

A

it breaks the enzyme that breaks down acetylcholine

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13
Q

What happens to acetycholine when you take Donepezil?

A

INCREASES

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14
Q

Does alzheimer’s disease slows the progression of disease?

A

NO
-it only temporarily improves clients memories = neurons keep dying

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15
Q

How is Donepezil differ from other cholinesterase inhibitor?

A

It crosses BBB

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16
Q

True or False? Donepezil is a cholinergic medication

A

TRUE

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17
Q

What are the adverse effect of taking Donepezil

A

-Urinary Frequency

-Nausea

-Vomiting

-Diarrhea

-GI issues

-Watery Eyes

-Too much Saliva

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18
Q

What is the rare effect of taking Donepezil?

A

Bradycardia

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19
Q

Patient taking Donepezil would experience Bardycardia when ______

A

Patient is taking medication that decreases the heart rate

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20
Q

What kind of medication should you take with Donepezil?

A

Anticholinergic medications

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21
Q

What medications should the client avoid when taking Donepezil

A

TCA
Oxybutynin
Older antihistamines

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22
Q

True or False? Donepezil does not stop or slow down the progression of Alzheimer’s Disease

A

True

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23
Q

Why is Donepezil prescribed?

A

-Cheap

-Well tolerated

-Patient can experience a period of improvement

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24
Q

How is Memantine prescribed?

A

For moderate and severe stages of Alzheimer’s Disease

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25
What does Myasthenia Gravis do to acetylcholine receptors?
Attacks it on skeletal muscle
26
What happens during Myasthenic Crisis?
Client experience EXTREME muscle wellness and may stop breathing
27
What are the 2 Medication Option for Myasthenia gravis?
1. Cholinesterase Inhibitor 2. Immunosuppressive Drugs (Prednisone)
28
What are the 2 Cholinesterase Inhibitor for Myasthenia Gravis?
1. Neostigmine 2. Pyridostigmine
29
Aside from treating Myasthenia Gravis, what does neostigmine and pyridostigmine do?
Reverse Nondepolarizing Neuromascular blocking agents AFTER SURGERY
30
What releases acetylcholine?
Motor Neurons = causes Muscle Contraction
31
In Myasthenia Gravis, what happens after the acetylcholine is released
Cholinesterase (enzyme) QUICKLY breaks down acetylcholine
32
What does cholinesterase inhibitor do to cholinesterase?
TEMPORARILY binds to cholinesterase, SLOWING IT DOWN
33
What happens when there is an increase in acetylcholine?
STRONG MSUCULAR CONTRACTION
34
Cholinesterase I. can be give PO, what should you asses before giving it?
Person’s ability to swallow -Ask the client to take few sips of water, If the client has difficulty, request PARENTERAL Form
35
What are the signs of UNDER MEDICATION of Cholinesterase Inhibiotr (MG)
-Ptosis -Difficulty Swallowing
36
What are the signs of OVERMEDICATION for Cholinesterase I. (MG)
Excessive Salivation
37
SYMPTOPMS of CHOLINERGIC CRISIS
S - salivation L - lacrimation (excessive tearing) U - urination D - diaphoresis / diarrhea G - gastrointestinal cramping E - emesis (vomitting) 3B’s 1. Bradycardia 2. Bronchospasm 3. Bronchorrhea
38
Which part of the brain does Alzheimer's disease begin to damage?
Hippocampus - associated with LEARNING and MEMORY
39
what happens to the cerebral cortex of a person with Alzheimer's disease?
Cortex is Dying = neuronal death
40
What are the 2 common things that happen in a patient with MODERATE STAGE of Alzheimer's disease?
1. Wandering 2. Emotional Instability ---> increase risk of injury
41
What 2 atypical antipyschotic medications are prescribed for patient with late stages Alzheimer's Disease?
1. Risperidone 2. Olanzapine ---> manage aggression and psychosis
42
Far patient who develops Bradycardia while taking Cholinergic medication, the nurse should watch out for?
Risk of falls?
43
What should you remember for drugs that lowers the HR?
-Increase risk of fall -Dizziness
44
What kind of neurotransmitter does Memantine regulate?
Glutamate leves
45
What happens to a patient when there is too much GLUTAMATE?
Toxicity
46
What are the major symptoms of Myasthenia Gravis?
-Diplopia (double vision) -Ptosis (drooping eyelids) -skeletal muscle weakness
47
What should you encourage a patient to wear if they are taking medications for Myasthenia Gravis?
Medic Alert Bracelet
48
What is the antidote for Cholinergic Crisis?
ATROPINE ---> pt might also need mechanical ventilation
49
Which part of the brain is damaged for a person with Parkinson's disease?
Substantia Nigra
50
What does substantia nigra release?
Dopamine
51
What neurotransmitter has imbalance for patient with Parkinson's Disease?
Dopamine (LOW) Acetycholine (HIGH)
52
Signs and Symptoms of Parkinson's Disease?
T - tremor R - rigidity A - akinesia P -postural instability
53
True or False: Parkinson's Disease include Depression, Dementia, Sleep DIsturbances, and Difficulty Smelling
TRUE
54
What is Dopamine Agonist?
drugs that stimulates DOPAMINE
55
3 Dopamine Agonists
1. CARBIdopa / LEVOdopa 2. PRAMIPEXole 3. ROPINIRole
56
Aside from treating Parkinson's Dx, what else are these drugs prescribed for?
Restless Leg Syndrome (RLS) ---> Prescribed only at night
57
Why does Dopamine do not work with Parkinson's Disease?
1. Quickly Metabolize 2. Does not cross BBB
58
What is the only dopamine antagonist that crosess BBB?
Levodopa
59
What is the mechanism action of LEVODOPA?
It crosses BBB and it is converted into DOPAMINE ---> IT GETS CONVERTED TO DOPAMINE BEFORE CROSSING BBB
60
Why do we add CARBIDOPA with LEVODOPA?
To keep the dose LOW
61
What is the role of CARBIDOPA to LEVODOPA?
LEVODOPA GETS CONVERTED (in thw bloodstream) TO DOPAMINE BEFORE CROSSING BBB, CARBIDOPA prevents this from happening
62
What is the advantage of combing Carbidopa and Levodopa?
-Lower Dose -Fewer Side Effects
63
What should you limit when taking Carbidopa/Levodopa?
-Protein -Vitamin B6 (green vegetables, banana, legumes) -Iron (iron supplements) ---> prevents the absorption of these medications
64
What should you lookout for when taking Carbidopa/Levodopa?
O.H
65
Why does Pramipexole and Ropinirole may lead to Schrizophenia?
Because they are dopamine antagonist = they increase the level of dopamine Schrizophenia is caused by too much dopamine!
66
What psychiatric issues a patient may experience while taking dopamine antagosnist?
-Paranoia -Visual Hallucinations
67
What are the RARE side effects of taking Pramipexole and Ropinirole
Impulse Control Issues ---> addicted to gambling, shopping, binge eating
68
This medication is an MAO-B used for treating Parkinson's Dx
SELEGILINE
69
Describe the use of Selegiline in 1. ORAL formulation 2. TRANSDERMAL
Oral - Parkinson's Dx Transdermal - Depression
70
How is Selegiline different from MAO-I?
It only prevents the breaks down of the dopamine
71
What food should you avoid when taking SELEGILINE?
Food rich in TYRAMINE
72
What drugs should you avoid when taking Selegiline (MAO-B)
Other drugs that increase monoamine -ANTIDEPRESSANTS -MEPERIDINE -PSEUDOPHEDRINE
73
What does anticholinergic do?
Lowers the ACETYLCHOLINE level in your body
74
What are the 2 types of anticholinergic medications used to treat Parkinson's Dx
1. Benztropine 2. Trihexyphenidyl
75
Aside from treating Parkinson's DX, what does anticholinergic medications treat?
EPS! (caused by antipyschotic medications)
76
How does anticholinergic medication work?
It blocks the acetylcholine receptor (lowering acetylcholine) =BALANCE between dopamine and acetylcholine
77
What could be the side effects of Benztropine and Trihexyphenidyl?
Anticholinergic Effects + DROWSINESS
78
What happens to neurons when a patient experience a SEIZURE?
their neurons become hyperexcitable
79
What do you call the are of the brain that initiates SEIZURE
FOCUS
80
What could cause hyperexcitable of the neurons?
Hypoxia Head Trauma Infection Stroke Tumor Genetic Factors Medications (Bupropion and Morphine)
81
How do you diagnose a patient with EPILEPSY
If they experience 2 or more seizures seperated by 24 hrs that are not provoked by typical causes (high fvr, drug withdrawal, injury)
82
What are the 2 medication options that can treat SEIZURE?
1. Antiepileptics 2. Benzodiazepines (Diazepam, Lorazepam = stops status epilepticus)
83
What are the 6 antiepileptic medications?
1. Carbamazepine 2. Lamotrigine 3. Valproic Acis 4. Levetiracetam 5. Phenytoin 6. Topiramate
84
Valproic Acid, Carbamezapine, and Lamotrigine also treats?
Bipolar Disorder
85
what is the mechanism of action of Antiepileptic medication?
Slows down CNS ---> CNS DEPRESSANT
86
What is the side effects of Antiepileptic medications?
-Sedation -Ataxia -Double Vision -Cognitive Impairment
87
True or False? Antiepileptics has CYP P450 interactions?
TRUE
88
What is an example of CYP P450 interaction with antiepileptic?
Carbamazepine and Phenytoin decrease the effect of 1. Warfarin 2. Oral Contraceptives
89
True or False? Many antiepileptic are TETRATOGENIC?
True -they can cause birth defects
90
Give me two things that you should know about phenytoin
-Most Dangerous -Narrow Therapeutic Index
91
What is the therapeutic range of the Phenytoin?
10-20 ALWAYS CHECK PHENYTOIN SERUM LEVEL <10 = subtherapeutic >20 = toxic
92
What could be the 3 side effect of a Phenytoin?
1. Gingival Hyperplasia 2. Hirsutism 3. Interfere with Vitamin D (bone health) and Vitamin K (blood clot)
93
What could be the side effect of a Carbamazepine?
1. Bone Marrow Supression (decreased rbc, wbc, plt)
94
What should you look out for if a patient is taking Carbamazepine?
-Infection -Bleeding -Hyponatremia
95
What could be the side effect of a Valproic Acid?
-Weight Gain -Hair Loss -Hepatoxicity ---> remember JAUNDICE ---> remember simpson!
96
What should you look out for if a patient is taking Lamotrigine?
STEVENS JOHN SYNDROME
97
How should Lamotrigine be taken?
DOSE LOW, INCREASE SLOW
98
What could you teach the client taking Lamotrigine?
Report any new rushes Do not change hygienic products when taking Lamotrigine!
99
What makes Levetiracetam different from other antiepileptic drugs? (4)
It is well tolerated Little CNS Depression Wider Therapeutic Range It does not interact with any medication? ---> most commonly prescrives

PHARM EX2 (4 decks)

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