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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
Q

What does Myasthenia Gravis do to acetylcholine receptors?

A

Attacks it on skeletal muscle

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26
Q

What happens during Myasthenic Crisis?

A

Client experience EXTREME muscle wellness and may stop breathing

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27
Q

What are the 2 Medication Option for Myasthenia gravis?

A
  1. Cholinesterase Inhibitor
  2. Immunosuppressive Drugs (Prednisone)
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28
Q

What are the 2 Cholinesterase Inhibitor for Myasthenia Gravis?

A
  1. Neostigmine
  2. Pyridostigmine
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29
Q

Aside from treating Myasthenia Gravis, what does neostigmine and pyridostigmine do?

A

Reverse Nondepolarizing Neuromascular blocking agents AFTER SURGERY

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30
Q

What releases acetylcholine?

A

Motor Neurons = causes Muscle Contraction

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31
Q

In Myasthenia Gravis, what happens after the acetylcholine is released

A

Cholinesterase (enzyme) QUICKLY breaks down acetylcholine

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32
Q

What does cholinesterase inhibitor do to cholinesterase?

A

TEMPORARILY binds to cholinesterase, SLOWING IT DOWN

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33
Q

What happens when there is an increase in acetylcholine?

A

STRONG MSUCULAR CONTRACTION

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34
Q

Cholinesterase I. can be give PO, what should you asses before giving it?

A

Person’s ability to swallow

-Ask the client to take few sips of water, If the client has difficulty, request PARENTERAL Form

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35
Q

What are the signs of UNDER MEDICATION of Cholinesterase Inhibiotr (MG)

A

-Ptosis

-Difficulty Swallowing

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36
Q

What are the signs of OVERMEDICATION for Cholinesterase I. (MG)

A

Excessive Salivation

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37
Q

SYMPTOPMS of CHOLINERGIC CRISIS

A

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

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38
Q

Which part of the brain does Alzheimer’s disease begin to damage?

A

Hippocampus - associated with LEARNING and MEMORY

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39
Q

what happens to the cerebral cortex of a person with Alzheimer’s disease?

A

Cortex is Dying = neuronal death

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40
Q

What are the 2 common things that happen in a patient with MODERATE STAGE of Alzheimer’s disease?

A
  1. Wandering
  2. Emotional Instability

—> increase risk of injury

41
Q

What 2 atypical antipyschotic medications are prescribed for patient with late stages Alzheimer’s Disease?

A
  1. Risperidone
  2. Olanzapine

—> manage aggression and psychosis

42
Q

Far patient who develops Bradycardia while taking Cholinergic medication, the nurse should watch out for?

A

Risk of falls?

43
Q

What should you remember for drugs that lowers the HR?

A

-Increase risk of fall

-Dizziness

44
Q

What kind of neurotransmitter does Memantine regulate?

A

Glutamate leves

45
Q

What happens to a patient when there is too much GLUTAMATE?

46
Q

What are the major symptoms of Myasthenia Gravis?

A

-Diplopia (double vision)

-Ptosis (drooping eyelids)

-skeletal muscle weakness

47
Q

What should you encourage a patient to wear if they are taking medications for Myasthenia Gravis?

A

Medic Alert Bracelet

48
Q

What is the antidote for Cholinergic Crisis?

A

ATROPINE

—> pt might also need mechanical ventilation

49
Q

Which part of the brain is damaged for a person with Parkinson’s disease?

A

Substantia Nigra

50
Q

What does substantia nigra release?

51
Q

What neurotransmitter has imbalance for patient with Parkinson’s Disease?

A

Dopamine (LOW)

Acetycholine (HIGH)

52
Q

Signs and Symptoms of Parkinson’s Disease?

A

T - tremor
R - rigidity
A - akinesia
P -postural instability

53
Q

True or False: Parkinson’s Disease include Depression, Dementia, Sleep DIsturbances, and Difficulty Smelling

54
Q

What is Dopamine Agonist?

A

drugs that stimulates DOPAMINE

55
Q

3 Dopamine Agonists

A
  1. CARBIdopa / LEVOdopa
  2. PRAMIPEXole
  3. ROPINIRole
56
Q

Aside from treating Parkinson’s Dx, what else are these drugs prescribed for?

A

Restless Leg Syndrome (RLS)

—> Prescribed only at night

57
Q

Why does Dopamine do not work with Parkinson’s Disease?

A
  1. Quickly Metabolize
  2. Does not cross BBB
58
Q

What is the only dopamine antagonist that crosess BBB?

59
Q

What is the mechanism action of LEVODOPA?

A

It crosses BBB and it is converted into DOPAMINE

—> IT GETS CONVERTED TO DOPAMINE BEFORE CROSSING BBB

60
Q

Why do we add CARBIDOPA with LEVODOPA?

A

To keep the dose LOW

61
Q

What is the role of CARBIDOPA to LEVODOPA?

A

LEVODOPA GETS CONVERTED (in thw bloodstream) TO DOPAMINE BEFORE CROSSING BBB, CARBIDOPA prevents this from happening

62
Q

What is the advantage of combing Carbidopa and Levodopa?

A

-Lower Dose

-Fewer Side Effects

63
Q

What should you limit when taking Carbidopa/Levodopa?

A

-Protein

-Vitamin B6 (green vegetables, banana, legumes)

-Iron (iron supplements)

—> prevents the absorption of these medications

64
Q

What should you lookout for when taking Carbidopa/Levodopa?

65
Q

Why does Pramipexole and Ropinirole may lead to Schrizophenia?

A

Because they are dopamine antagonist = they increase the level of dopamine

Schrizophenia is caused by too much dopamine!

66
Q

What psychiatric issues a patient may experience while taking dopamine antagosnist?

A

-Paranoia

-Visual Hallucinations

67
Q

What are the RARE side effects of taking Pramipexole and Ropinirole

A

Impulse Control Issues

—> addicted to gambling, shopping, binge eating

68
Q

This medication is an MAO-B used for treating Parkinson’s Dx

A

SELEGILINE

69
Q

Describe the use of Selegiline in

  1. ORAL formulation
  2. TRANSDERMAL
A

Oral - Parkinson’s Dx

Transdermal - Depression

70
Q

How is Selegiline different from MAO-I?

A

It only prevents the breaks down of the dopamine

71
Q

What food should you avoid when taking SELEGILINE?

A

Food rich in TYRAMINE

72
Q

What drugs should you avoid when taking Selegiline (MAO-B)

A

Other drugs that increase monoamine

-ANTIDEPRESSANTS

-MEPERIDINE

-PSEUDOPHEDRINE

73
Q

What does anticholinergic do?

A

Lowers the ACETYLCHOLINE level in your body

74
Q

What are the 2 types of anticholinergic medications used to treat Parkinson’s Dx

A
  1. Benztropine
  2. Trihexyphenidyl
75
Q

Aside from treating Parkinson’s DX, what does anticholinergic medications treat?

A

EPS!

(caused by antipyschotic medications)

76
Q

How does anticholinergic medication work?

A

It blocks the acetylcholine receptor (lowering acetylcholine)

=BALANCE between dopamine and acetylcholine

77
Q

What could be the side effects of Benztropine and Trihexyphenidyl?

A

Anticholinergic Effects + DROWSINESS

78
Q

What happens to neurons when a patient experience a SEIZURE?

A

their neurons become hyperexcitable

79
Q

What do you call the are of the brain that initiates SEIZURE

80
Q

What could cause hyperexcitable of the neurons?

A

Hypoxia

Head Trauma

Infection

Stroke

Tumor

Genetic Factors

Medications (Bupropion and Morphine)

81
Q

How do you diagnose a patient with EPILEPSY

A

If they experience 2 or more seizures seperated by 24 hrs that are not provoked by typical causes (high fvr, drug withdrawal, injury)

82
Q

What are the 2 medication options that can treat SEIZURE?

A
  1. Antiepileptics
  2. Benzodiazepines (Diazepam, Lorazepam = stops status epilepticus)
83
Q

What are the 6 antiepileptic medications?

A
  1. Carbamazepine
  2. Lamotrigine
  3. Valproic Acis
  4. Levetiracetam
  5. Phenytoin
  6. Topiramate
84
Q

Valproic Acid, Carbamezapine, and Lamotrigine also treats?

A

Bipolar Disorder

85
Q

what is the mechanism of action of Antiepileptic medication?

A

Slows down CNS

—> CNS DEPRESSANT

86
Q

What is the side effects of Antiepileptic medications?

A

-Sedation

-Ataxia

-Double Vision

-Cognitive Impairment

87
Q

True or False? Antiepileptics has CYP P450 interactions?

88
Q

What is an example of CYP P450 interaction with antiepileptic?

A

Carbamazepine and Phenytoin decrease the effect of

  1. Warfarin
  2. Oral Contraceptives
89
Q

True or False? Many antiepileptic are TETRATOGENIC?

A

True

-they can cause birth defects

90
Q

Give me two things that you should know about phenytoin

A

-Most Dangerous

-Narrow Therapeutic Index

91
Q

What is the therapeutic range of the Phenytoin?

A

10-20

ALWAYS CHECK PHENYTOIN SERUM LEVEL

<10 = subtherapeutic
>20 = toxic

92
Q

What could be the 3 side effect of a Phenytoin?

A
  1. Gingival Hyperplasia
  2. Hirsutism
  3. Interfere with Vitamin D (bone health) and Vitamin K (blood clot)
93
Q

What could be the side effect of a Carbamazepine?

A
  1. Bone Marrow Supression (decreased rbc, wbc, plt)
94
Q

What should you look out for if a patient is taking Carbamazepine?

A

-Infection

-Bleeding

-Hyponatremia

95
Q

What could be the side effect of a Valproic Acid?

A

-Weight Gain

-Hair Loss

-Hepatoxicity

—> remember JAUNDICE
—> remember simpson!

96
Q

What should you look out for if a patient is taking Lamotrigine?

A

STEVENS JOHN SYNDROME

97
Q

How should Lamotrigine be taken?

A

DOSE LOW, INCREASE SLOW

98
Q

What could you teach the client taking Lamotrigine?

A

Report any new rushes

Do not change hygienic products when taking Lamotrigine!

99
Q

What makes Levetiracetam different from other antiepileptic drugs? (4)

A

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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