Neurologic Flashcards
What is Namzaric?
Donepezil + memantine once daily capsule
What is Adlarity?
Donepezil once weekly patch
What is the maximum daily dose of galantamine in a patient with creatinine clearance less than 60 mL/min?
16 mg/ day
Which acetylcholinesterase inhibitor is FDA approved for Parkinson’s disease dementia?
Rivastigmine
What is the maximum dose of memantine for a patient w creatinine clearance less than 30 mL/min?
5 mg bid (XR 14 mg/day)
What is the indication for Aduhelm?
Mild cognitive impairment with beta-amyloid positive PET or CSF findings
What is the dose of aducanumab?
10 mg/kg IV every four weeks after titration
What is the clinical efficacy of Leqembi?
Lower brain levels of beta amyloid and moderately slow cognitive and functional decline in early stage Alzheimer’s disease
What are the target serum levels for Carbamazepine?
4-12 mcg/mL
Carbamazepine is a potent inducer of which enzymes?
CYP3A4, CYP2C9, UGT
What are the target serum levels for phenobarbital?
15-40 mcg/mL
What are the target serum levels for phenytoin?
10-20 mcg/mL (free: 1-2 mcg/mL)
What percent dose reduction is needed for topiramate in a patient with creatinine clearance less than 70 mL/min?
50%
What are the target serum levels for valproic acid?
50-100 mcg/mL
Carbipenems decrease Serum concentrations of which anticonvulsant?
Valproic acid
Which enzyme systems does valproic acid inhibit?
UGT and Epoxide hydrolase
Which three antipsychotics may be used in Parkinson’s disease?
Pimavanserin, clozapine, quetiapine
Which antipsychotic is a CYP3A4 substrate?
Pimavanserin
What dosing conversion ratio is used to switch from oral tabs to intestinal gel of levodopa/carbidopa?
1:1
Which medication for Parkinson’s disease interacts with ondansetron?
Apomorphine
How many PD rescue doses per day can be used?
5
What rescue treatments are available for Parkinson’s disease?
1) Apomorphine subcutaneous pen
2) Apomorphine sublingual film
3) levodopa inhalation powder
Is the onset of action of PD rescue therapy?
15-20min
What is the most effective medication in PD for control of motor symptoms?
Levodopa/carbidopa
What are the three non-ergot dopamine agonists?
Pramipexole, ropinirole, rotigotine
What is the only FDA approved non-oral rescue therapy for PD?
Apomorphine
What are management strategies for off periods in PD (involving how CD/LD is used)? (3)
1) Separate CD/LD from high-protein meals
2) Change CD/LD dose, dose frequency or timing
3) change CD/LD formulation to more continuous release
What are management strategies for off periods in PD (other than CD/ LD dosing)? (4)
1) Include medications that increase levodopa brain bioavailability
2) Add another oral medication
3) Add rescue therapy or switch to non-oral formulations
4) Deep brain simulation
How is peak dose dyskinesia managed? (CD/LD adjustments-3)
1) Reduce CD/LD dosing (maintain frequency)
2) switch to longer acting (CR)
3) switch oral CD/LD to parenteral
How is peak dose dyskinesia managed? (Non CD/LD strategies-3)
1) add Amantadine
2) add clozapine
3) deep brain stimulation
In a patient with PD who develops dementia, what is the order of stepwise discontinuation of PD drugs?
Anticholinergics -> amantadine -> MAO-B inhibitors - > dopamine agonists -> COMT inhibitors - > CD/LD
Top 6 medications that reduce the Seizure threshold
Diphenhydramine, tramadol, bupropion, meperidine, clozapine, haloperidol
Which of the three preferred Anti-seizure medications in older adults?
Lamotrigine, levetiracetam, gabapentin
Which anticonvulsant requires an ECG prior to initiation and interacts with PR interval, prolonging agents?
 Lacosamide
Which anticonvulsant is a sulfonamide?
Zonisamide
Which anticonvulsants have the highest risk of osteoporosis?
Carbamazepine, phenytoin, phenobarbital, primidone, valproic acid > oxcarbazepine
What is the target vitamin D (25(OHD) level? 
> = 30 ng/mL
Which Anticonvulsant should be avoided in patients with depression?
Levetiracetam
What daily dose of carbidopa saturates dopa decarboxylase?
70-100mg
Predisposing factors for levodopa – induced dyskinesia
Younger age at disease onset
Lower body weigh
female sex
Increased disease severity
Predisposing patient characteristics for impulse control disorder
Male sex
Younger age
History of Impulse control disorder
History of mood disorders
Apathy
Family history of impulse control disorder & Addiction
