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Pharmacology Exam 4 > Neurology > Flashcards

Neurology Flashcards

1
Q

Anticonvulsants work by

A
  • Reduce nerve’s ability to be stimulated
  • Suppress transmission of impulses from one nerve to the next
  • Decrease speed of nerve impulse conduction within a neuron
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2
Q

Hydantoins

A
  • Ethotoin (Peganone)
  • Fosphenytoin (Cerebyx) NOT for primary care
    Available only in intramuscular (IM) or intravenous (IV) dosing
    Given only for about 5 days (loading dose), then will start PO drug (Dilantin)
  • Phenytoin (Dilantin)
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3
Q

Fosphenytoin (Cerebyx)

A

Hydantoin
NOT for primary care
Available only in intramuscular (IM) or intravenous (IV) dosing
Given only for about 5 days (loading dose), then will start PO drug (Dilantin)

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4
Q

Phenytoin (Dilantin)

A

Hydantoin

Note that phenytoin is not interchangeable with Dilantin

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5
Q

Hydantoins

A

Uses: Tonic-clonic (aka grand mal), partial complex seizures

90% plasma bound (be careful with drug-drug interactions; hypoalbuminemia -> seizures or toxicity)

Metabolism in liver

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6
Q

Hydantoins drug interaction

A

Effect of drug is increased: ETOH (short-term)
Effect of drug is reduced: ETOH (chronic use)
Reduce effectiveness of oral contraception pills, thyroid hormone

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7
Q

Hydantoin ADRs

A

Nystagmus, diplopia, dizziness, sedation, ataxia
Gingival hyperplasia, hirsutism
SJS, toxic epidermal necrolysis
Lymphadenopathy, hepatitis
Hypotension
Reddish-brown urine
Megaloblastic anemia - treat with folic acid

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8
Q

Signs of Hydantoin Toxicity

A

20-30 Nystagmus = Early sign
30-40 Ataxia = Early sign
> 40 decreased LOC

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9
Q

Hydantoins contraindicated in:

A

Pregnancy

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10
Q

Iminostilbenes

A

Carbamazepine (Tegretol)
Oxcarbazepine (Trileptal)
Valproic acid (Depakote)

Uses: tonic clonic seizure, complex partial seizure, mood stabilizer (treat mania in bipolar), trigeminal neuralgia

Highly protein bound
Metabolized in the liver

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11
Q

Carbamazepine (Tegretol)

A

Iminostilbene
May experience autoinduction
Warning for Fetal Carbamazepine Syndrome

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12
Q

Oxcarbazepine (Trileptal)

A

Iminostilbene

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13
Q

Valproic acid (Depakote)

A

Iminostilbene
Carboxylic acid derivative
Thought increase GABA, an inhibitory neurotransmitter, as well as having a direct membrane-stabilizing effect

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14
Q

Iminostilbene ADRs

A

Decrease bone marrow, aplastic anemia (monitor CBC)
Impaired liver function, impaired thyroid function
Dizziness, nystagmus, ataxia, N/V, dry mouth, diplopia, HA
Blood dycrasias
Black Box: SJS, toxic epidermal necrolysis

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15
Q

Black Box Warning for Iminostilbenes

A

Skin rash
SJS
Toxic epidermal necrolysis
Blood dyscrasias

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16
Q

S/S of Blood Dyscrasias

A

Fever, sore throat, Easy bruising

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17
Q

Succinimides

A 
DOC for absence seizures
Ethosuximide (Zarontin)
Methsuximide (Celontin)
ADRs GI, somnolence, fatigue, ataxia
Long 1/2-life
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18
Q

Ehosuximide (Zarontin)

A

Succinimide

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19
Q

Methsuximide (Celontin)

A

Succinimide

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20
Q

Lamotrigine (Lamictal)

A

Adjunctive therapy for tonic-clonic, partial, absence
Used with phenytoin or valproic acid
BBW: rash, SJS

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21
Q

Black Box Warning for Lamotrigine (Lamictal)

A

Rash

SJS

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22
Q

Leviteracetam (Keppra)

A 
Uses: tonic-clonic, myoclonic seizures
Adjunctive therapy to treat partial seizures
ADRs: dizziness, weakness, sedation
Generally well tolerated
NOT metabolized by CYP enzymes
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23
Q

1-(aminomethyl) cyclohexane acetic acid

A

Gabapentin (Neurontin)
Topiramate (Topamax)

Thought to elevate GABA in the brain

Uses: Adjuvantive therapy for partial seizures

24
Q

Gabapentin (Neurontin)

A

1-(aminomethyl) cyclohexane acetic acid

Adjuvantive therapy for partial seizures

Used widely for neuropathic pain; approved for post-herpetic neuralgia

25
Q

Topiramate (Topamax)

A

1-(aminomethyl) cyclohexane acetic acid

Adjuvantive therapy for partial seizures

Treats migraines

ADRs: confusion/cognitive problems, difficulty in concentration and speech; may decrease sweating; may increase body temp

26
Q

Benzodiazepines

A

clonazepam (Klonopin)
lorazepam (Ativan)
diazepam (Valium)

27
Q

Clonazepam (Klonopin)

A

Only drug approved for long term use of seizure control

ADR: drowsiness, lethargy (37%)

28
Q

Status epilepticus

A

Treat with IV lorazepam (Ativan) or diazepam (Valium)

29
Q

Parkinson’s Symptoms

A 
TRAP
T: Tremor (resting and pill-rolling)
R: Rigidity (cogwheel movement)
A: Akinesia/bradykinesia
P: Postural instabilit (shuffling gait)
30
Q

Goals of drug therapy for Parkinson’s

A

Correct the imbalance of neurotransmitters by increasing Dopamine and decreasing Acetylcholine (Ach)

Two major categories:
Dopaminergic agents
Anticholinergic agents

31
Q

Levodopa

A

Most effective for symptomatic treatment of PD
DOC for bradykinesia

Increases dopamine concentration, enhances the neurotransmission of dopamine

Full therapeutic effect can take months
Highly effective, but benefits diminish over time

Food delays absorption – take on empty stomach
High fat/ high protein meals compete with levodopa for absorption

32
Q

Levadopa ADRs

A 
Large doses of levodopa = High peripheral levels of dopamine = Increased adverse effects
GI distress (N/V), postural hypotension, CV dysrhythmias, dyskinesias, psychosis, confusion
Thus, levodopa is given with carbidopa, a peripheral decarboxylase inhibitor (“car that drops off levodopa in the brain”)
33
Q

Sinemet

A

Levodopa/Carbidopa
Available in immediate or sustained release
Most effective drug for Parkinson’s, and good choice for elderly

34
Q

Parcopa

A

Levodopa/Carbidopa
Dissolves on tongue
Most effective drug for Parkinson’s, and good choice for elderly

35
Q

Two types of Dopamine agonists

A

Derivatives of ergot – less selective; more s/e

Nonergot derivatives – highly selective for Dopamine

36
Q

pramipexole (Mirapex)

A

Nonergot derivative; Dopa agonist

37
Q

ropinirole (Requip)

A

Nonergot derivative; Dopa agonist

38
Q

Nonergot derivatives

A

First-line drug for younger patients with mild-moderate PD
Used alone in early PD (< 60 yo) and with levodopa in advancing PD
Maximal benefits take several weeks to develop.
Adverse effects
Monotherapy –daytime somnolence (“sleep attacks” esp older pts), nausea, dizziness, insomnia, constipation, weakness, and hallucinations
Combined w/ levodopa – increases effect of levodopa (orthostatic hypotension, dyskinesias, etc.)
Causing rare instances of worse behavioral impulse patterns: pathologic gambling and other compulsive self-rewarding behaviors; alcoholism

39
Q

ADRs of nonergot derivatives

A

“Sleep Attacks” = daytime sleepiness; esp. older patients

May increase ADRs of levodopa when combined therapy (orthostatic hypotension, dyskinesias)

Causes rare instances of worse behavioral impulse patterns: pathologic gambling and other compulsive self-rewarding behaviors; alcoholism

40
Q

COMT inhibitors

A

Inhibit metabolism of levodopa in the periphery
Prolongs time that levodopa is available to the brain
No direct therapeutic effects of their own

Entacapone
Tolcapone

41
Q

Entacapone

A

COMT inhibitor

42
Q

Tolcapone

A

COMT inhibitor

43
Q

Warning about COMT Inhibitors

A

Rapid withdrawal of COMT inhibitors may lead to Parkinsonian crisis: syndrome of muscle rigidity, high fevers, tachycardia, confusion, elevated CK levels = similar to neuroleptic malignant syndrome

44
Q

Black Box Warning for Tolcapone

A

Hepatotoxicity

45
Q

MAO-B Inhibitors

A

Inhibit MAO-B in the brain
Increases dopaminergic activity
Can reduce wearing off of levodopa

Selegiline (Eldepryl, Zelapar)
Rasagiline (Azilect)

46
Q

Selegiline (Eldepryl, Zelapar)

A

MAO-B Inhibitor

Older; converted to amphetamine or methamphetamine

47
Q

Rasagiline (Azilect)

A

MAO-B Inhibitor

48
Q

Dopamine Modulator

A

Treats early mild/moderate PD in younger pts

Amantadine (Symmetrel)

49
Q

Amantadine (Symmetrel)

A

Dopamine Modulator

50
Q

Anticholinergic Drugs

A

Inhibits cholinergic effects

Treats: tremors, rigidity (cogwheeling), drooling; used in younger pts

Benztropine (Cogentin)
Biperiden (Akineton)
procyclidine
trihexyphenidyl

51
Q

ADRs of Anticholinergic Drugs

A

Dry mouth, confusion, drowsiness, tachycardia, constipation

Central anticholinergic syndrome if taking multiple anticholinergics

52
Q

Benztropine (Cogentin)

A

Anticholinergic Drug

53
Q

Biperiden (Akineton)

A

Anticholinergic Drug

54
Q

procyclidine

A

Anticholinergic Drug

55
Q

trihexyphenidyl

A

Anticholinergic Drug

Pharmacology Exam 4 (4 decks)

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