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Advanced Med Surg > Neuro Pharm > Flashcards

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
Q

Tegretol CIs

A

Do not take with grapefruit enzyme inducer-decreases effects of Coumadin, OCPs

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17
Q

CNS stimulants taken with MAOIs can cause

A

Hypertensive crisis

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17
Q

Phenobarbital therapeutic level

A

15-40 mcg/mL

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18
Q

In addition to seizures, Tegretol treats

A

Trigeminal neuralgia

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20
Q

This anti epileptic med is the first line treatment for partial and tonic clonic seizures but worsens myoclonus and absence seizures

A

Carbamazepine (Tegretol)

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21
Q

Zarontin contraindications

A

Porphyria Impaired renal/liver function Pregnancy

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22
Q

Hypnotics-action

A

Induce sleep Many sedatives act as hypnotics at high enough doses

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23
Q

COMT inhibitor that has an immediate effect in smoothing out and sustaining levodopa levels; AE include brown urine, GI upset, dyskinesia

A

Entacapone (Comtan)

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24
Q

COMT inhibitor that is a last resort med, can destroy the liver

A

Tolcapone (Tasmar)

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25
Q

5 types of antiparkinsonian meds

A

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

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27
Q

Sedative-hypnotics and/or anxiolytics Relatively few AEs, effective

A

Benzodiazepines

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29
Q

Anticholinergic action

A

Competitive antagonist; block nerve transmission by binding ACh receptors (muscarinic, that control smooth muscle); allows SNS to dominate

30
Q

Avoid tyramine foods with these CNS stimulants

A

SSRAs

31
Q

Prevents peripheral breakdown of levodopa so that more levodopa crosses BBB

A

Carbidopa

33
Q

AE of muscle relaxants

A

CNS depression Orthostatic hypotension

34
Q

Donepezil (Aricept) and rivastigmine (Exelon) are examples of anti cholinesterase meds used to treat

A

Alzheimer’s dementia

35
Q

Barbiturate AE (7)

A

Sedation, hangover, depression Paradoxical restlessness Decreased REM sleep GI upset–N/v/d/c Respiratory depression Bronchi spasm Hypotension, vasodilation

36
Q

ADHD med admin (3)

A

Last daily dose 4-6 hours before bed Take on an empty stomach, 30-45 min before meals Med “holidays” as ordered

36
Q

Anticholinergic AEs

A

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
Q

Benzodiazepine advantages over Barbiturates

A

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
Q

This type of medicationis often used to decrease secretions and in end of life care

A

Anticholinergics

40
Q

Hydantoin anti epileptics-Interactions

A

CNS depressants Enzyme inducers-cause decreased effects of Coumadin, steroids, and steroids

41
Q

Benzodiazepine interactions

A

Other CNS depressants (barbiturates, alcohol, opioids)–respiratory depression Grapefruit alters absorption

41
Q

Non ergot dopamine receptor agonist, stimulates production of dopamine and treats RLS

A

Ropinirole (Requip)

42
Q

Antidote for Benzodiazepine OD

A

Flumazenil OD rarely fatal unless combined with alcohol

43
Q

Bromocriptine action

A

Ergot alkaloid that directly stimulates production of dopamine (PD treatment) and inhibits production of prolactin (treats galactorrhea)

45
Q

Two types of muscle relaxants

A

Central-acting: similar in action and structure to CNS depressants, act on CNS Direct-acting: act on skeletal muscle, resemble GABA

46
Q

Alter absorption of Benzodizepines

A

Grapefruit

47
Q

How anticholinergics treat PD

A

Decrease tremors and muscle rigidity caused by excessive ACh activity; does not relieve bradykinesia

48
Q

Barbiturates-Interactions

A

Additive effects with other CNS depressants MAOIs prolong effects Enzyme inducer–decrease effects of anticoagulants, steroids, OCPs

50
Q

Levodopa taken with MAOIs can cause

A

Hypertensive crisis

51
Q

Antidote for cholinergics

A

Atropine

52
Q

Dilantin therapeutic level

A

10-20 mcg/mL

53
Q

Long term benzodiazepine or barbiturate use can cause

A

Withdrawal Syndrome Rebound insomnia, anxiety dizziness, tremors

53
Q

Use anti epileptic meds with caution in patients with

A

Elderly Pregnancy Impaired liver/renal function

54
Q

Use caution in giving anticholinergic meds to glaucoma pts because

A

They increase IOP

56
Q

Direct-acting muscle relaxant, also treats malignant hyperthermia

A

Dantrolene

57
Q

S/s of barbiturate OD

A

Respiratory depression, arrest CNS depression: Ataxia, sleep, coma, death Pinpoint pupils HoTN

58
Q

Direct acting cholinergics that treat glaucoma and/or intraocular surgery

A

Carbachol Pilocarpine (topical)

59
Q

Anticholinergics PD treatment, also a treatment for extra pyramidal side effects of antipsychotics

A

Benztropine (Cogentin)

60
Q

Sedatives-action

A

Decrease nervousness and irritability, relax skeletal muscles by enhancing the effects of GABA (CNS inhibitory NT) DONT induce sleep

62
Q

High tyramine foods

A

Cheese, red wine, beer, yogurt

64
Q

Urination should occur within this time of bethanechol admin

A

60 minutes

65
Q

Succinimide anticonvulsant; action unknown

A

Ethosuximide (Zarontin)

66
Q

Prophylactic use of this drug with levodopa can decrease development of debilitating PD 9-18 years

A

Selegiline Allows lower dose of levodopa, which has many AEs

67
Q

CNS depressants that act on enhance action of GABA on the reticular formation of the brain stem; raise the seizure threshold

A

Barbiturates

68
Q

Short-acting Benzos

A

Alprazolam (Xanax) Midazolam (Versed)

70
Q

Indirect acting dopamine receptor agonists that Block enzyme breakdown of levodopa (dopamine precursor); prolong duration of action of levodopa

A

COMT inhibitors: Tolcapone (Tasmar) Entacapone (Comtan)

71
Q

Anti cholinesterase meds-action

A

Cause skeletal muscle contraction by making ACh available at NMJ; reverse neuromuscular blockade and anticholinergic OD; treat MG Ex: physostigmine, pyridostigmine

72
Q

Zarontin AE

A

CNSdepression Bone marrow suppression Skin reactions

73
Q

Ultrashort acting barbiturates-indications and examples

A

Short anesthesia Convulsions Decrease ICP Methohexital (Brevital) Thiopental (Pentothal)

74
Q

Anti epileptic adjunct therapy that can be given IV

A

Levetiracetam (Keppra)

76
Q

Central-acting muscle relaxants

A

Baclofen (Lioresal) Cyclobenzaprine (Flexeril) Metaxalone (Skelaxin)

77
Q

Anti epileptic adjunct therapy, GABA analogues

A

Gabapentin (Neurontin): also treats neuropathic pain Pregabalin (Lyrica): treats nerve pain and post-heretic neuralgia

79
Q

Non-benzodiazepine hypnotics

A

Sonata Ambien Lunesta

80
Q

MAO-B inhibitors-action

A

Inhibit breakdown of catecholamines (Dop, E, NE) by MAO-B enzyme, increasing dopamine level Adjunct therapy to increase response to levodopa Selegiline Rasagiline

81
Q

SSRA-action and examples

A

CNS stimulant, abortive therapy for migraines. Vasoconstrict dilated bvs in brain Sumatriptan (Imitrex) Zolmitriptan (Zomig)

82
Q

CNS stimulant treatments for ADHD, increase mental alertness

A

Amphetamine (Adderal) Methylphenidate (Concerta, Ritalin) Atomoxetine (Strattera)

83
Q

Crosses BBB and is converted to dopamine; large doses are needed, many AE result

A

Levodopa

84
Q

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

A

Bethanechol

85
Q

Anticholinergic side effects

A

Sedation Constipation, n/v Urinary retention Blurred vision, dilated pupils, photophobia Dry mouth, dry skin

86
Q

CNS stimulant/anorexiant, suppresses appetite center in the brain

A

Sibitramine (Meridia)

87
Q

AE of hydantoin antiepileptics

A

CNS depression-ataxia, lethargy Liver toxicity Bone marrow suppression Gingival hyperplasia Skin reactions-SJS

88
Q

CNS stimulant treatment for narcolepsy

A

Modafinil (Provigil)

89
Q

Treatment of barbiturate OD

A

Vent/O2 Fluids, pressors NG admin of activated charcoal

Advanced Med Surg (6 decks)

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