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Pharmacology Exam 3 > Neurologic Drugs > Flashcards

Neurologic Drugs Flashcards

1
Q

Name two changes in neurotransmitter levels that favor a reduction in seizure threshold

A

Excess glutamate (excitatory), deficiency of GABA (inhibitory)

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2
Q

List risk factors for seizure (eight possible)

A

Trauma, surgery, electrolyte disturbances (hyponatremia), drug toxicity/withdrawal, stroke, infection, fever, genetics, idiopathic

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3
Q

Which electrolyte disturbance causes the greatest risk for seizures?

A

Hyponatremia

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4
Q

Describe goals of epilepsy treatment

A

Reduce seizure frequency, avoid medicine related adverse effects

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5
Q

List two drug agents that have a wide spectrum effects against several types of seizure

A

VPA (valproic acid) and Lamotrigine

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6
Q

How many antiepileptics do most patients take to control symptoms?

A

Most achieve control with monotherapy (one drug)

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7
Q

When are drug levels in the blood checked?

A

Checked as trough right before dose

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8
Q

Name an antiepileptic agent reserved for refractory generalized seizures due to highly sedating effects

A

Phenobarbital

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9
Q

How are eclampsia seizures treated?

A

Magnesium sulfate

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10
Q

Describe the use of BDZ’s and antiepileptics in seizure control

A

Benzos terminate seizures, antiepileptics are maintenance drugs

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11
Q

List three drugs given to status epilepticus patients

A

Lorazepam (short half-life) diazepam (long half-life) fosphenytoin

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12
Q

How does Phenytoin (Dilantin) work to treat seizures?

A

Promotes sodium efflux from neurons to stabilize cell and reduce hyperexcitability

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13
Q

Name dose related adverse affects of phenytoin

A

Nystagmus (sign of toxicity) Headache, nausea, rash, confusion

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14
Q

Name non-dose related adverse effects of phenytoin

A

Gingival hyperplasia, acne, coarsening of facial features

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15
Q

Which two drugs studied so far cause gingival hyperplasia?

A

Phenytoin and nifedipine

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16
Q

Name two interactions of phenytoin

A

Vitamin D (increases metabolism to cause osteomalacia), folate wasting

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17
Q

Why is Fosphenytoin preferred to IV phenytoin?

A

IV phenytoin is unstable, must be combined with propylene glycol, and risks hypotension

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18
Q

How often must fosphenytoin be taken and what is the therapeutic level?

A

TID or QID

10–20 mcg/mL

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19
Q

When would a free phenytoin level test be ordered?

A

When hypoalbuminemia is suspected (drug is highly ppb)

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20
Q

What pregnancy category is phenytoin and why?

A

Category D: Folate wasting causes neural tube defects

21
Q

Define seizure

A

Excessive neuronal activity in cerebral cortex with disrupted or lost consciousness, possible confusion and hallucinations

22
Q

How does valproic acid work to treat seizure?

A

Increases bioavailability of GABA, enhances activity of GABA, or mimics action of GABA at receptor sites

23
Q

List three other indications of valproic acid

A

Migraines, bipolar disorder, agitation

24
Q

What is the benefit of using valproic acid (rather than the usual benzo or narcotic) to treat agitation?

A

Valproic acid won’t cause respiratory depression

25
Q

List adverse affects of valproic acid (six possible)

A

Hepatotoxicity, pancreatitis, thrombocytopenia, drowsiness, alopecia, weight gain

26
Q

List some dosage forms of valproic acid

A

Sprinkle caps, tablets, capsules, delayed release, extended release, syrup, injection

27
Q

What is the therapeutic level for valproic acid?

A

50-100 mcg/ml

28
Q

What pregnancy category is valproic acid?

A

Category D

29
Q

What type of drug is carbamazepine (Tegretol) related to?

A

TCA

30
Q

How is the overdose of Tegretol and TCA treated?

A

Bicarb

31
Q

How does carbamazepine work to treat seizures?

A

Reduces post synaptic transmission and response

32
Q

Three other indications for carbamazepine?

A

Trigeminal neuralgia, bipolar, migraine prophylaxis

33
Q

What is the therapeutic level of carbamazepine?

A

4 – 12 mcg/mL

34
Q

List adverse affects of carbamazepine

A

Stevens Johnson syndrome, SIADH, hepatotoxicity

35
Q

What is an autoinducer?

A

Revs up own metabolism over time causing increased dose requirements after several weeks

36
Q

What is the analog of carbamazepine with fewer hepatic adverse effects called?

A

Oxycarbazepine (Trileptal)

37
Q

What is the pregnancy category of carbamazepine and why?

A

Category D – causes folate wasting and spina bifida

38
Q

What is gabapentin used for?

A

Neuropathy (in HIV, diabetics, spinal cord, slipped discs)

39
Q

What is gabapentin the precursor to? How do these drugs differ?

A

Pregabalin (Lyrica): has greater addictive potential therefore C5 controlled substance

40
Q

How is gabapentin eliminated?

A

Renally (extremely hydrophilic)

41
Q

How does topiramate work to prevent seizures?

A

Block sodium channels, enhances GABA activity, weak carbonic anhydrase inhibitor

42
Q

Name an off label use of topiramate

A

Weight loss

43
Q

List adverse effects of topiramate

A

Anorexia, nephrolithiasis, psychomotor slowing (Topa makes you a dope-a)

44
Q

What pregnancy category is Topiramate?

A

Category C

45
Q

Which two antiepileptic drugs cause Stevens-Johnson syndrome?

A

Carbamazepine and Lamotrigine

46
Q

List adverse affects of Levitracetam (keppra)

A

Somnolence (behavior changes)

47
Q

Which two antiepileptics cause somnolence?

A

Levetiracetam (Keppra) and carbamazepine

48
Q

List two cautions of all antiepileptics

A

Suicide risk (second generation) Avoid generic substitution

49
Q

List the three first-generation AED’s

A

Carbamazepine, phenytoin, valproic acid

Pharmacology Exam 3 (8 decks)

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