Neurology Flashcards
Neurotransmitter Function
* Acetylcholine ->
* Dopamine ->
* Endorphin ->
* GABA ->
* Glutamate ->
* Serotonin ->
* Epi/Norepi ->
Wt loss med indications
- BMI ≥ 30
- BMI ≥ 27 + 1 WT-related comorbidity (HTN, Dyslipidemia, DM)
Short-Term Anorexiants
- Phentermine (Adipex-P)(C-IV)
- Diethylpropion (Tenuate)(C-IV)
Long-Term Anorexiants
- Phentermine/Topiramate (Qsymia)(C-IV)
- Lorcaserin (Belviq)(C-IV)
- Naltrexone/Bupropion (Contrave)
- Liraglutide (Saxenda)/Semaglutide(Wegovy)
- Orlistat (Xenical Rx only)(Alli OTC)
Phentermine (Adipex-P) & Diethylpropion (Tenuate):
Take _____ to prevent insomnia
in the morning
CI to CNS Sympathomimetics
- Phentermine, Diethylpropion
- Phentermine/Topiramate
- Uncontrolled HTN
- Hyperthryoidism
- Glaucoma
- Anxiety, Agitation, Psychosis
Diethylpropion (Tenuate)
- MOA?
- ADR?
- DOA?
- MOA: Sympathomimetic effect in CNS -> decr appetite
- SE: Tachy, agitation, incr BP, Insomnia, tremor, psychotic ss
- DOA: 12wk, used to jumph start diets
Lorcaserin (Belviq)
- MOA?
- SE?
- MOA: Activates serotonin receptors (5-HT2c) -> satiety
- SE: Nausea, Fatigue, Hypoglycemia, Blood Dyscrasias
- 17lb/yr wt loss
- SEROTONIN SYNDROME RISK
Naltrexoe/Bupropion CI
- Seizures
- Uncontrolled HTN
- Opiods
Diabetics should be started on a _____ dose of Liraglutide/Semaglutide if taking for wt loss
Higher or Lower?
LOWER
Orlistat brand names
- Rx only =
- OTC =
- Rx only = Xenical
- OTC = Alli
Orlistat
- MOA?
- SE?
- Considerations?
- MOA: inhibits fat absorption from food
- SE: abd pain, bowel uregency, bowel incontinence, freq shitting
- MAX 30% daily kcal from fat
- take MULTIVITAMIN bc decr vit/mineral absorption
- Some drugs may not be absorbed as well in the GI tract
List the WT LOSS Meds by least to most effective (lb/yr lost)
- Orlistat (Xenica, Alli) -> 13 lb/yr
- Lorcaserin (Belviq) -> 17 lb/yr
- Naltrexone/Bupropion (Contrave) -> 17 lb/yr
- Liraglutide/Semaglutide -> 21 lb/yr
- Phentermine/Topiramate -> 32 lb/yr
If there is little to no WT LOSS after 12wk -> consider _____
discontinuing med
OTC wt loss supplements dont work very well and incr your risk for _____
CVD
Seizure vs Epilepsy
- Seizure = brief disturbance in brain electrical activity (SINGULAR INCIDENT)
- Epilepsy = neurological condition with RECURRENT seizures
Define these siezures:
- Partial Seizure
- Grand mal Seizure
- Petite mal or absence Seizure
- Partial Seizure = Focal onset (+ Aware or Impaired awareness)
- Grand mal = Generalized onset + Impaired awareness + Motor
- Petite mal or Absence Seizure = Generalized onset + Impaired Awareness + Non-motor
Mechanisms of Anticonvulsants
- inhibit voltage-gated Na & Ca channels
- enhance inhibitory effects of GABA
- decr excitatory effect of Glutamate
Overall SE of Anticonvulsants
- CNS depression -> dizzy, sleepy, slow, fatigue
- SUICIDE
- Avoid using with meds that decr Seziure Threshold (Bupropion, Tramadol, Varenicline, Lithium, B-lactam ABX)
- Decr Ca & Vit D -> +/- supplememts
1st Line Tx options for Generalized Onset Sz:
- Motor (Grand Mal)?
- Non-motor (Absence/Petit Mal)?
MOTOR (GRAND MAL)
- Lamotrigine
- Levetiracetam
- Valproic acid
NON-MOTOR (ABSENCE/PETIT MAL)
- Ethosuximide
- Valproid acid
1st line tx options for ALL FOCAL Sz?
Same for focal motor and non-motor (partial sz) & focal = to bilateral tonic-clonic
- Carbamazepine, Oxcarbazepine
- Lamotrigine
- Levetiracetam
What is Status Epilepticus?
Seziure lasting >5min or continguous seizures w/o full recovery of consciousness b/w Sz
Status Epileptical Tx
1. Initial?
2. Maintenance?
3. Refractory?
INITIAL Tx
- Lorazepam (Ativan) IV
- Midazolam (Versed) IM
- Diazepam (Valium) IV
MAINTENANCE Tx
- Fosphenytoin (Cerebyx)
- Valproid Acid (Depacon)
- Levetiracetam (Keppra)
- Phenobarbital (Luminal)
REFRACTORY Tx
- ADD alt from #2
- Pentobarbital (Nembutal)
- Medazolam (Versed) Infusion
- Propofol (Diprivan)
6 types of Na CBs used as Anticonvulsants
- Phenytoin (Dilantin), Fosphenytoin (Cerebyx)
- Carbamazepine (Tegretol), Oxcarbazepine (Trileptal), Eslicarbazepine (Aptiom)
- Lamotrigine (Lamictal)
- Topiramate (Topamax)
- Zonisamide (Zonegran)
- Rufinamide (Banzel)