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Neuro Pharm Flashcards

1
Q

Dilantin-action

A

Stabilize nerve membranes to control/prevent seizures

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2
Q

CNS stimulants that are used to treat neonatal apnea and post op respiratory depression.

A

Analeptics Doxapram (Dopram)

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2
Q

Before starting ADHD meds to kids, record

A

Baseline height and weight Meds can affect growth

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2
Q

Antihistamines are used as PD treatment meds because they

A

Have anticholinergic activity

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3
Q

Long-acting Benzos

A

Lorazepam (Ativan) Diazepam (Valium)

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3
Q

Sedative AEs

A

R/F falls Withdrawal HA, drowsiness, hangover effect Paradoxical reaction-agitation, insomnia

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3
Q

Short-acting barbiturates-indications and examples

A

Sedation/sleep Convulsions Pentobarbital (Nembutal)

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3
Q

Long-acting barbiturates-indications and example

A

Sleep induction Seizure prophylaxis Phenobarbital (Luminal)

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3
Q

Danger with ADHD stimulants

A

Suicidal thinking and behavior

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3
Q

Levodopa AE

A

Drowsiness N/v Dyskinesia Orthostatic hypotension CV effects d/t B1stimulation Discolor sweat and urine Psychosis

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4
Q

Benzo/non-Benzo indications-5

A

Insomnia Procedural sedation Muscle relaxation Anticonvulsant Alcohol withdrawal

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5
Q

Zarontin therapeutic level

A

40-100 mcg/mL

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6
Q

AE of CNS stimulants

A

Insomnia Restlessness Weight loss Chest pain, HTN Withdrawal (taper to d/c)

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7
Q

Cholinergic effects

A

SLUDGE Salivation, sweating Lacrimation Urination Diarrhea GI motility increased Emesis Also: pupil constriction, hypotension, bradycardia, bronchi constriction and increased secretions

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8
Q

Antidote for atropine OD

A

Physostigmine

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9
Q

Benzos don’t suppress REM sleep as much as

A

Barbiturates

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9
Q

CI/precaution for anti migraine SSRAs

A

Cardiovascular disease, die to vasodilating effect

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9
Q

Assess before giving CNS stimulants

A

Abnormal heart rhythms, palpitations Seizures Liver problems

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9
Q

Drug of choice for generalized seizures

A

Diazepam (Valium)

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10
Q

LFTs must be monitored with this anti epileptic med because it can be toxic to the liver

A

Valproic acid (Depakote)

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10
Q

Two types of cholinergic medications

A

Direct-acting cholinergics-bind and activate ACh receptors Indirect-acting cholinergics=cholinesterase inhibitors-some reversible, some irreversible

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11
Q

Barbiturate anticonvulsants-action and example

A

Decrease conduction in lower brainstem, cortex, and decrease motor conduction Phenobarbital (Luminal)

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12
Q

This anti PD med is used early in disease (6-12 mos) to cause release of dopamine from still intact nerves and block reuptake

A

Amantidine (Symmetrel)

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15
Q

Selegiline dose over 10 mg/dL can cause

A

Hypertensive crisis

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16
Tegretol CIs
Do not take with grapefruit enzyme inducer-decreases effects of Coumadin, OCPs
17
CNS stimulants taken with MAOIs can cause
Hypertensive crisis
17
Phenobarbital therapeutic level
15-40 mcg/mL
18
In addition to seizures, Tegretol treats
Trigeminal neuralgia
20
This anti epileptic med is the first line treatment for partial and tonic clonic seizures but worsens myoclonus and absence seizures
Carbamazepine (Tegretol)
21
Zarontin contraindications
Porphyria Impaired renal/liver function Pregnancy
22
Hypnotics-action
Induce sleep Many sedatives act as hypnotics at high enough doses
23
COMT inhibitor that has an immediate effect in smoothing out and sustaining levodopa levels; AE include brown urine, GI upset, dyskinesia
Entacapone (Comtan)
24
COMT inhibitor that is a last resort med, can destroy the liver
Tolcapone (Tasmar)
25
5 types of antiparkinsonian meds
Indirect-acting dopaminergics (MAO-B inhibitors, presynaptic dopamine release enhancer, and COMT INHIBITORS) Nondopamine dopamine-receptor agonists (ergot and non ergot) Dopamine replacement meds Anticholinergics Antihistamines
27
Sedative-hypnotics and/or anxiolytics Relatively few AEs, effective
Benzodiazepines
29
Anticholinergic action
Competitive antagonist; block nerve transmission by binding ACh receptors (muscarinic, that control smooth muscle); allows SNS to dominate
30
Avoid tyramine foods with these CNS stimulants
SSRAs
31
Prevents peripheral breakdown of levodopa so that more levodopa crosses BBB
Carbidopa
33
AE of muscle relaxants
CNS depression Orthostatic hypotension
34
Donepezil (Aricept) and rivastigmine (Exelon) are examples of anti cholinesterase meds used to treat
Alzheimer's dementia
35
Barbiturate AE (7)
Sedation, hangover, depression Paradoxical restlessness Decreased REM sleep GI upset--N/v/d/c Respiratory depression Bronchi spasm Hypotension, vasodilation
36
ADHD med admin (3)
Last daily dose 4-6 hours before bed Take on an empty stomach, 30-45 min before meals Med "holidays" as ordered
36
Anticholinergic AEs
Tachycardia, dysrhythmias Irritability, hallucinations, delirium Increased IOP, pupil dilation, blurred vision Dry mouth, constipation Urinary retention Decreased sweating-r/f heat stroke in elderly
37
Benzodiazepine advantages over Barbiturates
Less suppression of REM sleep Don't effect liver metabolism of other drugs Don't cause hypotension or respiratory depression Barbiturates are more habit forming and have a low TI-can become toxic
39
This type of medicationis often used to decrease secretions and in end of life care
Anticholinergics
40
Hydantoin anti epileptics-Interactions
CNS depressants Enzyme inducers-cause decreased effects of Coumadin, steroids, and steroids
41
Benzodiazepine interactions
Other CNS depressants (barbiturates, alcohol, opioids)--respiratory depression Grapefruit alters absorption
41
Non ergot dopamine receptor agonist, stimulates production of dopamine and treats RLS
Ropinirole (Requip)
42
Antidote for Benzodiazepine OD
Flumazenil OD rarely fatal unless combined with alcohol
43
Bromocriptine action
Ergot alkaloid that directly stimulates production of dopamine (PD treatment) and inhibits production of prolactin (treats galactorrhea)
45
Two types of muscle relaxants
Central-acting: similar in action and structure to CNS depressants, act on CNS Direct-acting: act on skeletal muscle, resemble GABA
46
Alter absorption of Benzodizepines
Grapefruit
47
How anticholinergics treat PD
Decrease tremors and muscle rigidity caused by excessive ACh activity; does not relieve bradykinesia
48
Barbiturates-Interactions
Additive effects with other CNS depressants MAOIs prolong effects Enzyme inducer--decrease effects of anticoagulants, steroids, OCPs
50
Levodopa taken with MAOIs can cause
Hypertensive crisis
51
Antidote for cholinergics
Atropine
52
Dilantin therapeutic level
10-20 mcg/mL
53
Long term benzodiazepine or barbiturate use can cause
Withdrawal Syndrome Rebound insomnia, anxiety dizziness, tremors
53
Use anti epileptic meds with caution in patients with
Elderly Pregnancy Impaired liver/renal function
54
Use caution in giving anticholinergic meds to glaucoma pts because
They increase IOP
56
Direct-acting muscle relaxant, also treats malignant hyperthermia
Dantrolene
57
S/s of barbiturate OD
Respiratory depression, arrest CNS depression: Ataxia, sleep, coma, death Pinpoint pupils HoTN
58
Direct acting cholinergics that treat glaucoma and/or intraocular surgery
Carbachol Pilocarpine (topical)
59
Anticholinergics PD treatment, also a treatment for extra pyramidal side effects of antipsychotics
Benztropine (Cogentin)
60
Sedatives-action
Decrease nervousness and irritability, relax skeletal muscles by enhancing the effects of GABA (CNS inhibitory NT) DONT induce sleep
62
High tyramine foods
Cheese, red wine, beer, yogurt
64
Urination should occur within this time of bethanechol admin
60 minutes
65
Succinimide anticonvulsant; action unknown
Ethosuximide (Zarontin)
66
Prophylactic use of this drug with levodopa can decrease development of debilitating PD 9-18 years
Selegiline Allows lower dose of levodopa, which has many AEs
67
CNS depressants that act on enhance action of GABA on the reticular formation of the brain stem; raise the seizure threshold
Barbiturates
68
Short-acting Benzos
Alprazolam (Xanax) Midazolam (Versed)
70
Indirect acting dopamine receptor agonists that Block enzyme breakdown of levodopa (dopamine precursor); prolong duration of action of levodopa
COMT inhibitors: Tolcapone (Tasmar) Entacapone (Comtan)
71
Anti cholinesterase meds-action
Cause skeletal muscle contraction by making ACh available at NMJ; reverse neuromuscular blockade and anticholinergic OD; treat MG Ex: physostigmine, pyridostigmine
72
Zarontin AE
CNSdepression Bone marrow suppression Skin reactions
73
Ultrashort acting barbiturates-indications and examples
Short anesthesia Convulsions Decrease ICP Methohexital (Brevital) Thiopental (Pentothal)
74
Anti epileptic adjunct therapy that can be given IV
Levetiracetam (Keppra)
76
Central-acting muscle relaxants
Baclofen (Lioresal) Cyclobenzaprine (Flexeril) Metaxalone (Skelaxin)
77
Anti epileptic adjunct therapy, GABA analogues
Gabapentin (Neurontin): also treats neuropathic pain Pregabalin (Lyrica): treats nerve pain and post-heretic neuralgia
79
Non-benzodiazepine hypnotics
Sonata Ambien Lunesta
80
MAO-B inhibitors-action
Inhibit breakdown of catecholamines (Dop, E, NE) by MAO-B enzyme, increasing dopamine level Adjunct therapy to increase response to levodopa Selegiline Rasagiline
81
SSRA-action and examples
CNS stimulant, abortive therapy for migraines. Vasoconstrict dilated bvs in brain Sumatriptan (Imitrex) Zolmitriptan (Zomig)
82
CNS stimulant treatments for ADHD, increase mental alertness
Amphetamine (Adderal) Methylphenidate (Concerta, Ritalin) Atomoxetine (Strattera)
83
Crosses BBB and is converted to dopamine; large doses are needed, many AE result
Levodopa
84
Direct acting cholinergic used for treatment of hypotonic bladder, post op bladder atony and urinary retention; increases tone and motility of bladder and relaxes sphincter to cause urination
Bethanechol
85
Anticholinergic side effects
Sedation Constipation, n/v Urinary retention Blurred vision, dilated pupils, photophobia Dry mouth, dry skin
86
CNS stimulant/anorexiant, suppresses appetite center in the brain
Sibitramine (Meridia)
87
AE of hydantoin antiepileptics
CNS depression-ataxia, lethargy Liver toxicity Bone marrow suppression Gingival hyperplasia Skin reactions-SJS
88
CNS stimulant treatment for narcolepsy
Modafinil (Provigil)
89
Treatment of barbiturate OD
Vent/O2 Fluids, pressors NG admin of activated charcoal

Advanced Med Surg (6 decks)

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