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)
Phenytoin (Dilantin) vs Fosphenytoin (Cerebyx)
- Fosphenytoin is more water soluble and can be infused at a faster rate
________ is more water soluble and can be infused at a faster rate
Phenytoin (Dilantin) or Fosphenytoin (Cerebyx)?
Fosphenytoin (Cerebyx)
100-150mg/min
Chronic Phenytoin use may lead to
- ____ Syndrome
- ____ and ____ toxicity
- DRESS Syndrome = drug rxn with systemic SS & Eosinophilia (TOO MANY)
- Neuro & Cardiac toxicity
Pt taking Phenytoin presents with gingival hyperplasia, peeling rash, and blisters of mouth and eyes. What is this complication?
Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)
Carbamazepine (Tegretol), Oxcarbazepine (Trileptal), and Eslicarbazepine (Aptiom) have a BBW for?
- Agranulocytosis
- Aplastic anemia
Which of the following is a weaker inducer that causes less drug-drug interxns, is not an autoinducer, and has NO monitoring req?
- Carbamazepine (Tegretol)
- Oxcarbazepine (Trileptal)
- Eslicarbazepine (Aptiom)
Oxcarbazepine (Trileptal)
Which of the following is an autoinducer, req monitoring (4-12mcg/mL), and may cause SJS/TEN?
- Carbamazepine (Tegretol)
- Oxcarbazepine (Trileptal)
- Eslicarbazepine (Aptiom)
- Carbamazepine (Tegretol)
Lamotrigine (Lamictal)
- MOA: Na CB & ____ inhibitor
- _______ incr it’s [conc] by 100%
- _______ & _____ decr it’s [conc] by 40%
- MOA: Na CB & Glutamate inhibitor
- Valproic acid -> incr [conc] by 100%
- Phenytoin & Carbamazepine -> decr [conc] by 40%
Which Na CB Anticonvulsant also enhances GABA, is a Glutamate inhibitor, and may cause HYPERAMMONEMIA, WT LOSS, METABOLIC ACIDOSIS, & KIDNEY STONES
TOPIRAMATE (TOPAMAX)
Which Na CB Anticonvulsant is this?
- Also blocks Ca channels
- SE: decr concentration, WT loss, Hyperammonenmia, Metabolic Acidosis, Kidney stones
- AVOID IN PTS WITH SULFA ALLX
ZONISAMIDE (ZONEGRAN)
Which Na CB Anticonvulsant is this?
- prolongs the inactive state of Na channels
- SE: EKG CHANGES, GI, Change in vision, Tremor, Rash
- adjunct in Tx in Lennox-Gastaut Syndrome (LGS)
RUFINAMIDE (BANZEL)
4 GABA Enhancing Anticonvulsants
- Valproic acid (Depacon), Divalproex (Depakote)
- Benzos (Ativan, Versed, Valium, Klonopin, Onfi)
- Tiagabine (Gabitril)
- Phenobarbital (Luminal), Pentobarbital (Nembutal), Primidone (Mysoline)
Which GABA Enhancing Anticonvulsant causes HYPERAMMONEMIA, HAIR LOSS, WT GAIN, HEPATOTOXICITY?
Valproic Acid (Depacon) & Divalproex (Depakote)
Give ____ to Tx HYPERAMMONEMIA d/t Valproic Acid (Depacon) or Divalproex (Depakote)
Levocarnitine (Carnitor)
ALL Benzo Anticonvulsants are schedule (C-___)
C-IV
Which GABA Enhancing Anticonvulsant may incr risk for INFX?
Tiagabine (Gabitril)
SE: INFX, GI, Tremors, Rash
Is Phenobarbital (Luminal) or Pentobarbital (Nembutal) higher up on the drug schedule?
which is more controlled?
Pentobarbital (Nembutal) = C-II
Phenobarbital (Luminal) = C-IV
Is Phenobarbital (Luminal) hepatotoxic or nephrotoxic? is monitoring required>
Hepatotoxic (inducer)
Monitor: 10-40mcg/mL
Perampanel (Fycompa)
- MOA?
- Use?
- SE?
- MOA: Glutamate Inhibitor (AMPA Receptor ANTAGONIST)
- Use: Anticonvulsant
- SE: Psychosis, Irritable, Agitation, WT Gain
2 Ca Channel Blocking Anticonvulsants
- Ethosuximide (Zarontin)
- Gabapentin (Neurontin), Pregabalin (Lyrica)
Gabapentin was designed to mimic the neurotransmitter GABA. HOWEVER, it does NOT bind to GABA receptors. It works as an Anticonvulsant bc it inhibits the alpha-2-delta subunit of ____ channels
Calcium
Ethosuximide (Zarontin)
- MOA
- SE
- MOA: T-type CCB
- SE: Psychosis, Irritable, Agitation, WT Gain
Which is a controlled substance in ALL states except OHIO?
- Gabapentin (Neurontin)
- Pregabalin (Lyrica)
Pregabalin (C-V)
Gabapentin is only controlled in OHIO (C-V)
Which 2 Anticonvulsants bind to the SVZA protein in the brain
Levetiracetam (Keppra) & Brivaracetam (Briviact)
Lacosamide (Vimpat) - Anticonvulsant of Unknown Mechanism
- MOA?
- SE?
- Class schedule?
- MOA: Modulates Na Channels
- SE: EKG Changes, Vision Changes, GI
- (C-V)
What is the ONLY weed-like Med that is FDA approved for seizures?
- Schedule?
Cannabidiol (Epidiolex) - (C-V)
Z-Hypnotics: Eszopiclone (Lunesta), Zolpidem (Ambien), Zaleplon (Sonata)
You must commit to ____ - ____Hr of sleep
7-8Hr
“Z” Hypnotics and Benzos should only be used for ____ for sleeping DOs
90 days or less
Which Antidepressant can be used as a sleep aid and causes HypoTN and Priapism?
Trazodone
4 Antidepressants that can be used as sleep aids
- Trazodone (Desyrel)
- Amitriptyline (Elavil)
- Mirtazapine (Remeron)
- Doxepin (silenor)
Which OTC/Herbal Sleep aid causes HEPATOTOXICITY?
VALERIAN ROOT
Is melatonin better for sleep induction or regulation of sleep-wake cycle?
regulation of sleep-wake cycle?
it does NOT induce sleep
Modafinil and Armodafinil MOA
Decr dopamine reuptake -> incr Dopamine avail
(Non-CNS stimulant)
Sodium Oxybate (Xyrem)
- MOA?
- Must give 2nd dose when ______
- schedule?
- MOA: Mimics GABA -> CNS Depression
- Give 2nd dose a few hrs into sleep
- C-III. C-I if used illicitly as date-rape drug
Tx for Migraines
1. ACUTE?
2. 6/4/3 days & NO/MOD/SEVERE Disability?
- OTC -> Triptans -> Ergots
- Migraine Prophylaxis, Triptans or Ergots PRN
When can you ADD biologics for migraines?
- 4-7 migraine days + MOD Disability
- 8-14 days with NO Disability + Poor response to 2 prophylaxis Tx
Which 2 classes of Migraine meds cause Tingling/Numbness & Warm/Cold Sensations
Triptans
Ergots
