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Neurology Flashcards

1
Q

What is used to treat ACUTE relapses of MS?

A

Corticosteroids

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2
Q

what are the AEs of corticosteroids

A

GI upset
insomnia
mood disturbace

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3
Q

which type of MS is disease-modifying therapy most effective for?

A

relapsing and remitting

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4
Q

Teriflunomide has a long 1/2 life, and takes ___ months to reach a steady state

A

3 months

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5
Q

Cholestyramine reduces the half life of which MS drug?

A

Teriflunomide

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6
Q

Which MS drug’s MOA is characterized by shifting cytokines from proinflammatory state, preventing immune cells from entering the CNS, reducing oxidative stress?

A

Dimethyl Fumarate

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7
Q

What are some AEs of Dimethyl Fumarate?

A

Flushing
itching
GI effects
Leukopenia/lymphopenia

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8
Q

of the MS medications, which 3 reduces relapse rates, but DO NOT slow MS progression?

A

Interferon Beta
Glatiramer Acetate
Teriflunomide

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9
Q

Which MS drug has a risk of Progressive Multifocal Leukoencephalopathy, and is only allowed if MS is rapidly advancing WITH failed all other therapies?

A

Natalizumab

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10
Q

T or F: MS symptoms increase in 2nd and 3rd trimester of pregnancy

A

FALSE - relapses decrease in 2nd and 3rd trimesters (but increase in first 3 months post-partum)

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11
Q

which 3 MS drugs to use in pregnancy

A

interferon beta
Glatiramer acetate
Natalizumab

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12
Q

a patient wants to conceive in 2 months; which MS meds must you D/C due to their long 1/2 lives?

A

Fingolimod

Teriflunomide

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13
Q

Which MS med is contraindicated in Men?

A

Teriflunomide

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14
Q

which MS meds are contraindicated in pregnancy?

A

Mitoxantrone

Teriflunomide

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15
Q

Symptomatic treatment is often used in MS. What is best to treat focal spasticity?

A

Botox

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16
Q

What is often used to treat systemic spasticity in patients with MS?

A

Baclofen

Tizanidine

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17
Q

What 2 medications are often used to treat fatigue in patients with MS?

A

Amantadine

Methylphenidate

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18
Q

what are the Neurotransmitters involved in seizures?

A

Glutamate

GABA

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19
Q

which anticonvulsant works as an autoinducer?

A

Carbamazepine

increases metabolism of itself and other drugs

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20
Q

this anticonvulsant has an interesting pharmacokinetic property; it is NOT capacity-limited, so it can process extra unbound drug better`

A

Valproate

(Valproic acid/Divalproex) - this means less severe dose related AEs

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21
Q

which 3 anticonvulsants are used in emergent situations?

A

Phenytoin
Phenobarbital
Valproic Acid

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22
Q

which seizure medication has a risk for Purple Glove Syndrome?

A

phenytoin

infusion causes tissue discoloration, edema, pain, necrosis

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23
Q

this anticonvulsant is capacity-limited; small changes in dose lead to LARGE changes in serum concentration

A

phenytoin

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24
Q

what is the major caution with phenobarbital?

A

respiratory depression possible!

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25
Q

which GABA enhancing anticonvulsant quickly terminates seizures

A

Benzodiazepines

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26
Q

which GABA enhancing anticonvulsant is also used to treat nerve pain?

A

Gabapentin, Pregabalin

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27
Q

What 2 anticonvulsants do not fit into either the Calcium/sodium channel or GABA receptor classification?

A

Levetiracetam

Topiramate

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28
Q

why don’t we want to D/C the 1st anticonvulsant medication too soon?

A

may cause breakthrough seizures; start new drug on low dose and increase gradually while slowly decreasing old drug.

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29
Q

May be able to D/C seizure medication after how long if they have a low risk of recurrence?

A

2-5 years

D/C over 1-3 months (slowly)

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30
Q

which 2 anticonvulsants are protein bound?

A

valproate and phenytoin

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31
Q

what is the preferred class of medication to stop seizure IMMEDIATELY (acute seizure)

A

Benzodiazepines

Midazolam, Lorazepam, Diazepam

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32
Q

Benzos are used emergently to STOP seizures, but what is used for the suppression of seizures?

A

Phenytoin
Phenobarbital
Valproate

(Infuse SLOWLY)

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33
Q

what 3 medications are used in REFRACTORY-STATUS epilepticus?

A

Midazolam (benzo)
Propofol
Phenobarbital - only if others fail

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34
Q

Which medication is NOT recommended in treating headaches in a patient also taking anticonvulsants(seizures):
Valproate
Lamotrigine
Topiramate

A

Lamotrigine - WORSENS headaches

other 2 are preferred for treating headaches

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35
Q

which antidepressant INCREASES seizure risk in a patient who is taking anticonvulsants

A

Bupropion

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36
Q

T or F: you can use Lamotrigine to treat headaches in patients who are prone to seizures, but you must avoid it in treating their depression

A

False - ok to use for depression, DO NOT use for headaches!

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37
Q

What treatment time frame must you follow before switching an Alzheimer’s patient to a different Cholinesterase inhibitor?

A

do a 3-6 month trial on MAXIMUM tolerated dose before switching

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38
Q

which cholinesterase inhibitor also inhibits butyryl cholinesterase?

A

Rivastigmine

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39
Q

of the ChE inhibitors for alzheimers, which may increase synaptic ACh the most?

A

Rivastigmine

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40
Q

how does Memantine (NMDA antagonist) work in the brain?

A

controls amount of calcium allowed into the nerve, regulating info storage (too much Calcium = disrupted info processing)

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41
Q

Which medications might help alzheimers patients with their aggression and agitation?

A

Buspirone
Trazadone
Selegiline

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42
Q

T or F: benzos are ok to use in Alzheimers patients for their anxiety

A

FALSE: increased risk of falls

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43
Q

pharmacological goal of treating parkinsons is to increase _____ concentrations in the substantia nigra

A

Dopamine

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44
Q

what do we most often start with when treating Parkinsons?

A

Levodopa/Carbidopa

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45
Q

T or F: the SNRIs (Venlafaxine, Desvenlafaxine, Duloxetine) all have short 1/2 lives

A

True - missed doses can cause withdrawal symptoms

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46
Q

Of the SSRIs, which has the longest 1/2 life?

A

Fluoxetine

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47
Q

Of the SSRIs, which has the shortest 1/2 life

A

Paroxetine

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48
Q

Of the SSRIs, which has risk of QT prolongation

A

Citalopram

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49
Q

Fluoxetine has a 1/2 life of ____ days

A

5-9

5-week washout before starting MAOI or 2 weeks before switching to another SSRI/SNRI

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50
Q

What is the MOA of SNRIs

A

serotonin and NE reuptake inhibition

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51
Q

SNRIs are contraindicated in what type of person?

A

Hepatic injury - alcohol abuse or chronic liver disease

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52
Q

What is Serotonin syndrome?

A

SSRI/SNRI + MAOI

SSRI/SNRI + SSRI/SNRI = confusion, restlessness, fever, hyperreflexia, diarrhea, shivering

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53
Q

MAO is an enzyme that is inhibited by MAOIs. What is the role of MAO in depression?

A

MAO breaks down 5-HT (serotonin, NE, DA).

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54
Q

Which class of depression medication must you be mindful of drug/food interactions, due to high risk of hypertensive crisis

A

MAOIs

avoid MAOI + sympathomimetic (pseudoephedrine, amphetamines, foods rich in tyramine)

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55
Q

Tricyclic antidepressant have many adverse effects. Which 2 give high risk for sedation and anticholinergic effects

A

Amitriptyline

Imipramine

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56
Q

If you Rx amitriptyline or imipramine (antidepressant), when should the patient take them?

A

at night - sedative effect, helps with sleep.

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57
Q

TCAs have a high risk of overdose, and significant additive effects with drugs that cause _______

A

sedation, hypotension, anticholinergic

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58
Q

Bupropion is what class of depression medication?

A

NE and DA reuptake inhibitor

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59
Q

When should patient take their daily dose of Bupropion?

A

Late afternoon - NOT AT NIGHT! Adverse effect is insomnia

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60
Q

Bupropion contraindication

A

CNS lesion
seizures
head trauma
bulimia

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61
Q

Of the 5-HT antagonists, which has higher risk of causing sedation and priapism

A

Trazodone

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62
Q

Prescribe this 5-HT antagonist for sleep, but add onto other antidepressants

A

Trazodone

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63
Q

Nefazodone isn’t used often for depression because of its risk for ______

A

hepatotoxicity

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64
Q

What are the partial 5-HT agonists?

A

Vortioxetine

Vilazodone

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65
Q

what are the adverse effects of Vortioxetine and Vilazodone that limits their use?

A

GI upset

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66
Q

St. Johns wort is commonly used to treat depression. What type does it work for and not work for?

A

works for mild depression

NOT effective for moderate-severe

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67
Q

Trazodone can treat depression but is mainly used for ____

A

sleep, due to its sedative effects

68
Q

Which class of antidepressant is best for Depression + panic disorder?

69
Q

which SSRI is best used for treating depression + OCD

A

Fluvoxamine

70
Q

physical symptoms of depression improve in ______ weeks while emotional symptoms take _____ weeks

A

1-2 weeks

2-4 weeks

(6-8 weeks for full effect)

71
Q

T or F: If you add a 2nd antidepressant, add in the same class

A

False - add in a different class

72
Q

Treatment of Acute phase of depression is how long?

A

6-12 weeks

73
Q

the continuation phase of treating depression is how long

A

4-9 months

74
Q

maintenance phase of treating depression is how long?

A

12 months - lifetime

75
Q

what are the safest antidepressants in pregnancy?

A

Sertraline
Fluoxetine
Citalopram
TCAs

76
Q

What are the best meds to treat geriatric patients with?

A

SSRI/SNRI
Bupropion
Mirtazepine

77
Q

avoid this antidepressant in geriatric patients

A

TCAs

MAOIs

78
Q

what are the only FDA-approved antidepressants for kids?

A

Fluoxetine

Escitalopram

79
Q

Avoid this type of antidepressant in kids

A

Desipramine (TCA)

80
Q

What is the drug of choice for General anxiety disorder, social anxiety disorder, panic disorder?

A

SSRIs (or SNRIs)

81
Q

When starting a patient on SSRI for anxiety, what is the onset?

82
Q

specifically which SSRI/SNRI meds are used in treating anxiety

A 
Venlafaxine
Duloxetine
Paroxetine
Escitalopram
Sertraline
83
Q

what is used in short term management of anxiety, when immediate relief is desired

A

Benzodiazepines

also used as adjunct to initiating anxiety meds

84
Q

Are benzodiazepines effective in treating both somatic and psychic symptoms of anxiety?

85
Q

are benzodiazepines effective in treating anxiety AND depression?

A

not depression - only prn anxiety

86
Q 
Which of the following benzodiazepines is NOT short-lasting:
Oxazepam
Diazepam
Lorazepam
Temazepam
Alprazolam
A

Diazepam (long lasting)

87
Q

what are the 2 longer lasting benzodiazepines?

A

Clonazepam

Diazepam

88
Q

which is the fastest-onset benzo for anxiety?

89
Q

which benzodiazepines bypass the CYP3A4 system and are to be used in hepatic dysfunction?

A

Oxazepam

Lorazepam

90
Q

why should you never use benzos for long term anxiety treatment?

A

risk of addiction

91
Q

how do you D/C benzos for anxiety if patient has been taking them for 2-6 months?

A

2-8 week taper

92
Q

how do you D/C benzos for anxiety if patient has been taking them for 12 months?

A

2-4 month TAPER

93
Q

what is an alternative treatment option for generalized anxiety disorder WITHOUT depression?

94
Q

This medication is a good option for GAD, because it does not have abuse/addiction potential

95
Q

what is the onset for buspirone, which is why benzos are still preferred treatment for acute anxiety?

A

2 weeks

less effective if patient previously treated with benzos

96
Q 
Verapamil
Diltiazem
Itraconazole
Fluvoxamine
Erythromycin all do WHAT to levels of buspirone?
A

INCREASE them

97
Q

this is an alternative agent for treating anxiety, and is also an H1 blocker, not addictive

A

Hydroxyzine

98
Q

T or F: hydroxyzine is effective for somatic and psychic symptoms of anxiety?

A

FALSE - only effective for SOMATIC symptoms

99
Q

T or F: you can use hydroxyzine prn OR scheduledq

100
Q

what is first line therapy for preschoolers with ADHD?

A

behavioral therapy

101
Q

what class of medication is 1st line in treating ADHD?

A

Stimulants

102
Q

stimulants for ADHD are a controlled substance - what does this mean?

A

potential for abuse

103
Q

what is the onset for stimulants to work?

A

30 minutes

104
Q

how long to trial stimulants for ADHD before determining they are ineffective and switching?

A

trial for 3 months; try different stimulant.

105
Q

Stimulant Contraindications

A 
Glaucoma
Severe HTN
CV disease
Hyperthyroidism
previous drug abuse
106
Q

Of all the adverse effects of stimulants, which 2 are a cause to D/C the med?

A

hallucinations

abnormal movements

107
Q

Your patient was started on a stimulant 1 month ago. He reports experiencing hallucinations. What do you do?

A

D/C the med!

108
Q

have patients take stimulant ______ min before meals to avoid drug-food interactions

A

30-60min - to avoid interactions

109
Q

what “nonstimulants” can be used 2nd line for treatment of ADHD

A

Atomoxetine
Bupropion
Clonidine
Guanfacine

110
Q

are nonstimulants controlled substances?

A

no - no abuse potential

111
Q

this medication can be used as a nonstimulant for ADHD as well as an antidepressant - it is best chosen to treat a patient with ADHD + depression

A

Bupropion

onset 1-2 months

112
Q

Bupropion CONTRAINDICATIONS

A

seizure

eating disorder

113
Q

these 2 medications are nonstimulants; their MOA is alpha2 agonists

A

clonidine

guanfacine

114
Q

these nonstimulants are less effective at treating ADHD, but are used as ADJUNCT to stimulants to control disruptive behavior

A

clonidine

guanfacine

115
Q

you start your patient on a stimulant for is new diagnosis of ADHD. how often do you follow up?

A

every 2-4 weeks, and then every 3 months when stable

116
Q

psychosis is caused by an excess in what neurotransmitter in the brain?

117
Q

which generation antipsychotics are preferred?

A

2nd - less likely to cause EPS, tardive dyskinesia

118
Q

which SGA has greatest efficacy in treatment-resistant patients

119
Q

what 3 main adverse effects are associated with SGAs

A

weight gain
glucose/lipid abnormalities
metabolic syndrome

120
Q

Which 1st line SGA has potential for the most adverse effects?

A

Risperidone (binds all the receptors)

-EPS, prolactin and lipid/glucose elevations, weight gain

121
Q

which SGA is the active metabolite of Risperidone

A

Palperidone

122
Q

Which SGA do you prescribe your patient with liver dysfunction?

A

Palperidone

123
Q

which SGA is the worst culprit of metabolic syndrome in SGAs

A

Olanzapine

124
Q

which SGA is the best choice to treat a patient who has ANXIETY AND DEPRESSION (as well as schizophrenia)

A

Quetiapine

125
Q

Major adverse effect of Quetiapine

A

Prolongs QT interval

126
Q

which 2 SGAs have a risk of QT prolongation

A

quetiapine

ziprasidone

127
Q

Which SGA has the unique MOA, which addresses both hyper and hypo-DA levels in brain

A

Aripiprazole

128
Q

what are the 3 most dangerous adverse effects of using first generation antipsychotics?

A

EPS
Tardive Dyskinesia
Neuroleptic malignant syndrome

129
Q

you started a patient on a FGA, and 10 days later they report motor restlessness and muscle spasms. What is going on?

A

Extrapyramidal symptoms

130
Q

what is EPS treated with?

A

IV Anticholinergics

131
Q

T or F: Neuroleptic malignant syndrome is a life-threatening emergency

A

True

severe muscular rigidity, altered consciousness

132
Q

this bad habit DECREASES concentration of clozapine and olanzapine

A

cigarette smoking

133
Q

your patient has failed 2 antipsychotic trials with SGAs, and reports aggression and suicidality. Which treatment do you turn to?

134
Q

Adverse effects that limit clozapine’s use

A

Seizures
myocarditis
Agranulocytosis

135
Q

what do you need to monitor closely in your patients taking clozapine

A

hematology (risk of agranulocytosis)

136
Q

what is an option for administration in patients who are high risk of nonadherence?

A

IM injections

137
Q

what antipsychotics are recommended for treating kids?

A

SGA

avoid sedating, anticholinergic effects

138
Q

this social activity is a risk factor for tardive dyskinesia

A

alcohol use

139
Q

you are seeing a pregnant patient who has schizophrenia. What do you tell her regarding her medication and carrying a baby?

A

relapse is a greater risk for birth complications, STAY ON THE ANTIPSYCHOTIC

140
Q

in an acutely psychotic patient, what do you administer?

A

intramuscular SGA
or
IM benzodiazepines

141
Q

what do you NEVER treat bipolar patients with

A

antidepressants (may precipitate rapid cycling/manic episode)

142
Q

what is the 1st line agent for classic bipolar?

143
Q

does Lithium have a wide or narrow therapeutic index?

A

NARROW - monitor!

goal is 0.6-1.4

144
Q

commondrug interactions of Lithium

A

NSAIDs
Thiazides
ACE/ARB

145
Q

what is lithium toxicity?

A

fluid loss from exersize, patient is vomiting, diarrhea, has deterioration in motor coordination and seizure. LIFE THREATENING!

146
Q

at what serum level does lithium toxicity occur?

A

> 2 mEq/L

d/c lithium, may need gastric lavage

147
Q

Lithium is not the best choice for someone with rapid cycling bipolar disorder. Instead, give this drug, which works like lithium but is better for rapid cycling

A

Valproic acid

148
Q

T or F valproic acid has a narrow therapeutic index

A

false - WIDE

149
Q

If your patient is taking Devalproex (valproic acid), what could happen if you also give them LAMOTRIGINE?

A

DANGEROUS RASH

150
Q

which 2 mood disorder meds can contribute to agranulocytosis?

A

Clozapine

Carbamazepine

151
Q

why might oxcarbazepine be favored over carbamazepine in treating bipolar?

A

no routine monitoring of serum concentration or hematology (anemia/agranulocytosis)

152
Q

the risk of rash/SJS is HUGE when Lamotrigine and divalproex are combined. If you absolutely MUST use the 2, do you change the dose?

A

yes - lower Lamotrigine dose

153
Q

can you use Lithium on a child?

A

yes, at lower doses.

154
Q

which bipolar medication causes “floppy baby syndrome”

155
Q

what drug classes work for sleep aids?

A

benzodiazepine receptor agonists

Sedating antidepressants

156
Q

What sedating antidepressant is the best option for elderly patients?

157
Q

instead of stimulating pathways that cause sleepiness, this sleep aid turns OFF wakefulness

A

Suvorexant

158
Q

only this sedating antidepressant has a sleep dose adequate to helping with depression (all others require lower dose for sleep)

A

Mirtazapine

159
Q

What 2 meds reduce sleepiness? (Wake aids)

A

Modafinil

Armodafinil

160
Q

when using Lithium, this organ needs to be monitored VERY closely

A

KIDNEY FUNCTION! decrease dose for renal impairment

161
Q

what part of the brain is affected in Parkinsons?

A

Substantia nigra

lack of Dopamine neurons

162
Q

A patient with Parkinsons has a depletion of DA, and it can cause motor fluctuations, akathisia, and dyskinesias. A drug that treats Parkinsons also does this. What is it?

A

Levodopa/carbidopa

163
Q

although Levodopa/carbidopa is 1st line in treating PD, what is typically prescribed first to delay needing Levo/carb

A

DA agonists

Bromocriptine, Rotigotine, Pramipexole, Ropinirole, apomorphine

164
Q

which classes of drugs are ONLY used in MILD Parkinsons disease?

A

Amantadine, Anticholinergics, MAO-B inhibitors, COMT inhibitors

165
Q

benzo + olanzapine = ?

A

cardiorespiratory failure

Pharmacology (12 decks)

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