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NAPLEx > neurological condtions > Flashcards

neurological condtions Flashcards

1
Q

Pathophysiology of Parkinson’s

A

less dopamine-> less instructions to the brain -> movement problems (called TRAP major symptoms)

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2
Q

TRAP

A

Tremor: when resting
Rigidity: in legs, arms, trunk, and face (mask-like face)
Akinesia/bradykinesia: lack of/slow start in movement
Postural instability: imbalance, falls

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3
Q

dopamine-blocking drugs that can worsen PD

A
  • Phenothiazines (prochlorperazine) used for psychosis, nausea, agitation
  • Butyrophenones (haloperidol, droperidol) used for psychosis and behavior disorder or nausea
  • first and second gen antipsych (risperidone at higher dose, paliperidone); lowest risk is quetiapine
  • metoclopramide, a renally-cleared drug that can accumulate in elderly pt
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4
Q

PD pt also depresssion

A

Depression common in PD pts
concerns w/ SSRI and SNRI but TCAs (secondary os desipramine and nortriptyline), and dopamine agonists like pramipexole provide antidepressants effects

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5
Q

quetiapine in PD

A

quetiapine is preferred in psychosis PD pts
low risk of movement disorders but can cause metabolic complications

clozapine has a low risk of worsening movement disorders but has a high risk of seizures and agranulocytosis

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6
Q

hallucinations and delusions in PD

A

pimavanserin (Nuplazid)

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7
Q

rapid withdrawal of levodopa or dopamine agonists

A

can lead to neuroleptic malignant syndrome (NMMS)… tapper off slowly

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8
Q

levodopa
carbidopa

A

levodopa- prodrug of dopamine, is the most effective agent
carbidopa: prevents peripheral metabolism of levodopa - to work 70-100 dose

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9
Q

PD primary tx

A

primary tx: replace dopamine
- give a precursor to dopamine that becomes dopamine in the brain (that’s levodopa in Sinemet)
- give dopamine agonist that act like dopamine
- give other drugs for specific symptoms (benztropine for resting tremor)

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10
Q

tremor-predominants disease in younger pts

A

can be tx w/centrally-acting anticholinergic (e.g. benztropine)

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11
Q

carbidopa/levodopa

A

Sinemet
- contra w/non-selective MOA (14 day washout)
70-100 mg of carbidopa required
- coombs test: positive d/c (hemodialysis risk)

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12
Q

COMT inhibitors

A

increase the duration of action of levodopa by inhibiting the enzyme COMT (catechol-O-methyltransferase) to prevent peripheral conversation of levodopa.

COMT should only be sued w/ levodopa

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13
Q

entacapone

+ carbidopa/levodopa

A

Comtan

Stalevo

  • COMT inhibitor
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14
Q

Pramipexole

A

Mirapex
warning: somnolence (including sudden daytime sleep attacks)
impulsive disorder…
postural deformity
- dopamine agonist

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15
Q

Ropinirole

A

Requip XL
- dopamine agonist

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16
Q

Rotigotine

A

Neupro
patch!
- dopamine agonist

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17
Q

apomorphine

A

apokyn
- contra: w/ 5Ht-3 agonist (ondansetron) due to severe hypotension
- QT prolongation
severe nausea/vomiting
for emesis prevention give trimethobenzamide (Tigan)

  • dopamine agonist use as a “rescue” movement drug for “off” periods
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18
Q

Amantadine

A
  • blocks dopamine reuptake and also increase release of dopamine in presynaptic
  • primarily used to tx dyskinesia associated w/ peak-dose of carbidopa/levodopa

warning: somnolence (including falling asleep w/out warning during activities of daily living, psychosis!

SE: hypotension, dizziness… also livedo reticularis (reddish skin mottling!)

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19
Q

selective MAO-B inhibitors

A

block the breakdown of dopamine, primarily used as adjunctive tx to carbidopa/levodopa; rasagiline has a indication for monotherapy

selegiline (capsule genetic)
- Zelapar- ODT
- Emsam- patch only indicated for depression

rasagiline (azilect)
Safinamide (Xadago)

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20
Q

benzatropine

A

Cogentin
centrally acting anticholinergic: have anticholinergic and antihistamine effects: primarily used for tremors

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21
Q

natural products for memory-related lol

A

viatmine E (2,000 IU dialy)
ginkgo

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22
Q

MMSE

A

mini-mental state exam, max 30 and less than 24 is a memory disorder

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23
Q

key drugs that can worsen dementia

A
  • antiemetics (e.g. promethazine)
  • antihistamine (e.g. diphenhydramine, doxylamine)
  • antipsychotics (e.g. chlorpromazine, aripiprazole)
  • barbiturates (e.g. phenobarbital, butalbital)
  • benzodiazepines (e.g. alprazolam, clonazepam)
  • centrally acting anticholinergic (e.g. benztropine)
  • peripheral anticholinergics (including incontinence and IBS drugs)
  • Skeletal muscle relaxants (e.g. baclofen)
  • Other CNS depressants (e.g. opioids, sedative-hypnotics)
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24
Q

mild-moderate Alzheimer’s disease

A

donepezil, rivastigmine, galantamine
(acetylcholinesterase inhibitor)

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25
Q

moderate-severe

A

donepezil, rivastigmine, galantamine
(acetylcholinesterase inhibitor)

and/or memantine

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26
Q

donepezil
+ memantine

A

aricept
Namzaric
QHS to decrease nausea
if stable on 10mg donepezil, can switch to namzaric
- acetylcholinesterase inhibitor

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27
Q

Rivastigmine

A

exelon
- patch form has less nausea! does not contain metal so do not have to remove for MRI
- acetylcholinesterase inhibitor

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28
Q

memantine

A

Namenda
ER capsules and numeric can be sprinkled on apple sauce after the opened

  • blocks NMDA receptor, which inhibits glutamate from binding and decreases abnormal neuron activation
29
Q

key drugs that can lower seizure threshold

A
  • bupropion
  • clozapine
  • theophylline
  • varenicline
  • carbapenems (esp. imipenem)*
  • lithium*
  • meperidine*
  • quinolones*
  • tramadol*

*High doses and renal impairment

30
Q

diastat acudial dispensing

A
  • Each package contains two rectal syringes and prefilled w/ diazepam rectal gel

syringes MUST be dialed to the right dose and locked BEFORE DISPENSING. Syringes come in 2.5, 10, and 20mg

31
Q

Pharmacist instructions for locking diastat acudial

A
  1. Hold the barrel of the syringe in one hand w/ the cap facing down and some window visible. Do not remove cap
  2. Use the other hand to grab the cap firmly and turn to adjust the dose
  3. confirm the correct dose in the window, hold the locking ring at the bottom of the syringe barrel and push upward to lock both sides of the ring
  4. Repeat these steps w/ he second syringe in the case

once locked, the green band should say “READY”

32
Q

benzo
AED mechanism of action

A

increase GABA
AED= antiepileptic drugs

33
Q

Valproic acid
AED mechanism of action

A

increase GABA

34
Q

phenobarbital
AED mechanism of action

A

enhance/potentiate GABA efects

35
Q

levetiracetam
AED mechanism of action

A

Ca channel blocker and increase GABA

36
Q

ethosuximide
AED mechanism of action

A

t-type Ca channel blocker

37
Q

pregaba/ gaba
AED mechanism of action

A

Ca channel blocker

38
Q

oxcarbazepine
AED mechanism of action

A

Na and Ca channel blocker

39
Q

carbamazepine
AED mechanism of action

A

Na channel blocker

40
Q

lamotrigine
AED mechanism of action

A

Na channel blocker

41
Q

phenytoin/fosphenytoin
AED mechanism of action

A

Na channel blocker

42
Q

topiramate

A

Na channel blocker

43
Q

carbamazepine, oxcarbazepine, eslicarbazepine
AED cousins SE

A

hyponatremia, rash, enzyme induction

44
Q

gaba and pregaba
AED cousins SE

A
  • weight gain, peripheral edema, mild euphoria
  • used primarily for neuropathic pain
45
Q

phenobarbital and primidone
AED cousins SE

A

primidone (prodrug of phenobarbital)
- sedation, dependence/tolerance/overdose risk, enzyme induction

46
Q

topiramate and zonisamide
AED cousins SE

A
  • weight loss, metabolic acidosis
  • nephrolithiasis and oligohidrosis/hyperthermia (in children)
47
Q

supplement w/ AEDs

A
  • all AEDs: Ca and Vitamin D
  • women of childbearing age: folate
  • Valproic acid: possibly carnitine
  • lamotrigine and valproic acid: if alopecia develops, supplement w/ selenium and zinc
48
Q

lamotrigine

A

lamictal
- SJS/TEN severe

49
Q

levetiracetam

A

Keppra
Warning: psychiatric reactions, including psychotic symptoms, somnolence, fatigue

50
Q

topiramate

A

topamax
- metabolic acidosis, oligohidrosis (reduced perspiration), nephrolititasis (kideny stones) , fetal harm, visual problem
- also used for migraine proplyaxis

51
Q

valproic acid
divalproex

A

depakote, ER and sprinkle form
- hepatic failure, fetal harm
- hyperammonemia (tx w/carnitine only in adults)
also used for bipolar and migraine prophylaxis

52
Q

carbamazepine

A

tegretol
equetro for bipolar
also used for trigeminal neuraliga
- HLA-B testing.. especially if Asian descent
contra: myelosuppression, hypersensitive to TCAs, use of MAO in past 14 days
- autoinducer

53
Q

lacosamide

A

vimpat
- prolonged PR interval and increased risk of arrhythmias

54
Q

oxcarbazepine

A

trileptal
- HLA-B considers for Asian pts
- not an autoinducer

55
Q

phenobarbital

A

severe hepatic impairment contra… habit forming, respiratory depression, fetal harm….

56
Q

phenytoin

A

Dilantin
IV rate should not exceed 50mg/min

57
Q

fosphenytoin

A

cerebyx
fosphenytoin IV rate should not exceed 150mg PE/min
dosed in PE, phenytoin equivalents. 1mg PE= 1 mg of phenytoin
1.5mg of fosphenytoin= 1 PE

58
Q

IV phenytoin admin…

A
  • do not exceed 50mh/ min (slow infusion)
  • Monitor BP, respiratory function and ECG
  • requires filter
  • Dilute in NS, stable for 4 hrs, do not refrigerate
59
Q

NG-tube phenytoin admin

A
  • eternal feedings (e.g. tube feeds) decrease phenytoin absorption
  • Hold feeding 1-2 hrs before and after admin
60
Q

IV fosphenytoin admin

A
  • Do not exceed 150mg PE/min
  • monitoring same as above
  • lower risk of purple glove syndrome than phenytoin
61
Q

ethosuximide

A

zarontin

62
Q

pregabalin

A

lyrica

63
Q

gabapentin

A

neurontin

64
Q

vigabatrin

A

sabril, igadrone
- permanent vision loss >30% of pt….

65
Q

primidone

A

mysoline
prodrug of phenobarbital

66
Q

phenytoin correction

A

total phenytoin measured/
[(0.2xalbumin)+0.1]

67
Q

AEDs enzyme inducers

A

carbamazepine
oxcarbamazepine
phenytoin
fosphenytoin
phenobarbital
primidone

68
Q

AED enzyme inhibitors

A

valproic acid (increases lamotrigine dose so remember when dosing lamotrigine)

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