Neurology Flashcards
What is used to treat ACUTE relapses of MS?
Corticosteroids
what are the AEs of corticosteroids
GI upset
insomnia
mood disturbace
which type of MS is disease-modifying therapy most effective for?
relapsing and remitting
Teriflunomide has a long 1/2 life, and takes ___ months to reach a steady state
3 months
Cholestyramine reduces the half life of which MS drug?
Teriflunomide
Which MS drug’s MOA is characterized by shifting cytokines from proinflammatory state, preventing immune cells from entering the CNS, reducing oxidative stress?
Dimethyl Fumarate
What are some AEs of Dimethyl Fumarate?
Flushing
itching
GI effects
Leukopenia/lymphopenia
of the MS medications, which 3 reduces relapse rates, but DO NOT slow MS progression?
Interferon Beta
Glatiramer Acetate
Teriflunomide
Which MS drug has a risk of Progressive Multifocal Leukoencephalopathy, and is only allowed if MS is rapidly advancing WITH failed all other therapies?
Natalizumab
T or F: MS symptoms increase in 2nd and 3rd trimester of pregnancy
FALSE - relapses decrease in 2nd and 3rd trimesters (but increase in first 3 months post-partum)
which 3 MS drugs to use in pregnancy
interferon beta
Glatiramer acetate
Natalizumab
a patient wants to conceive in 2 months; which MS meds must you D/C due to their long 1/2 lives?
Fingolimod
Teriflunomide
Which MS med is contraindicated in Men?
Teriflunomide
which MS meds are contraindicated in pregnancy?
Mitoxantrone
Teriflunomide
Symptomatic treatment is often used in MS. What is best to treat focal spasticity?
Botox
What is often used to treat systemic spasticity in patients with MS?
Baclofen
Tizanidine
What 2 medications are often used to treat fatigue in patients with MS?
Amantadine
Methylphenidate
what are the Neurotransmitters involved in seizures?
Glutamate
GABA
which anticonvulsant works as an autoinducer?
Carbamazepine
increases metabolism of itself and other drugs
this anticonvulsant has an interesting pharmacokinetic property; it is NOT capacity-limited, so it can process extra unbound drug better`
Valproate
(Valproic acid/Divalproex) - this means less severe dose related AEs
which 3 anticonvulsants are used in emergent situations?
Phenytoin
Phenobarbital
Valproic Acid
which seizure medication has a risk for Purple Glove Syndrome?
phenytoin
infusion causes tissue discoloration, edema, pain, necrosis
this anticonvulsant is capacity-limited; small changes in dose lead to LARGE changes in serum concentration
phenytoin
what is the major caution with phenobarbital?
respiratory depression possible!
which GABA enhancing anticonvulsant quickly terminates seizures
Benzodiazepines
which GABA enhancing anticonvulsant is also used to treat nerve pain?
Gabapentin, Pregabalin
What 2 anticonvulsants do not fit into either the Calcium/sodium channel or GABA receptor classification?
Levetiracetam
Topiramate
why don’t we want to D/C the 1st anticonvulsant medication too soon?
may cause breakthrough seizures; start new drug on low dose and increase gradually while slowly decreasing old drug.
May be able to D/C seizure medication after how long if they have a low risk of recurrence?
2-5 years
D/C over 1-3 months (slowly)
which 2 anticonvulsants are protein bound?
valproate and phenytoin
what is the preferred class of medication to stop seizure IMMEDIATELY (acute seizure)
Benzodiazepines
Midazolam, Lorazepam, Diazepam
Benzos are used emergently to STOP seizures, but what is used for the suppression of seizures?
Phenytoin
Phenobarbital
Valproate
(Infuse SLOWLY)
what 3 medications are used in REFRACTORY-STATUS epilepticus?
Midazolam (benzo)
Propofol
Phenobarbital - only if others fail
Which medication is NOT recommended in treating headaches in a patient also taking anticonvulsants(seizures):
Valproate
Lamotrigine
Topiramate
Lamotrigine - WORSENS headaches
other 2 are preferred for treating headaches
which antidepressant INCREASES seizure risk in a patient who is taking anticonvulsants
Bupropion
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
False - ok to use for depression, DO NOT use for headaches!
What treatment time frame must you follow before switching an Alzheimer’s patient to a different Cholinesterase inhibitor?
do a 3-6 month trial on MAXIMUM tolerated dose before switching
which cholinesterase inhibitor also inhibits butyryl cholinesterase?
Rivastigmine
of the ChE inhibitors for alzheimers, which may increase synaptic ACh the most?
Rivastigmine
how does Memantine (NMDA antagonist) work in the brain?
controls amount of calcium allowed into the nerve, regulating info storage (too much Calcium = disrupted info processing)
Which medications might help alzheimers patients with their aggression and agitation?
Buspirone
Trazadone
Selegiline
T or F: benzos are ok to use in Alzheimers patients for their anxiety
FALSE: increased risk of falls
pharmacological goal of treating parkinsons is to increase _____ concentrations in the substantia nigra
Dopamine
what do we most often start with when treating Parkinsons?
Levodopa/Carbidopa
T or F: the SNRIs (Venlafaxine, Desvenlafaxine, Duloxetine) all have short 1/2 lives
True - missed doses can cause withdrawal symptoms
Of the SSRIs, which has the longest 1/2 life?
Fluoxetine
Of the SSRIs, which has the shortest 1/2 life
Paroxetine
Of the SSRIs, which has risk of QT prolongation
Citalopram
Fluoxetine has a 1/2 life of ____ days
5-9
5-week washout before starting MAOI or 2 weeks before switching to another SSRI/SNRI
What is the MOA of SNRIs
serotonin and NE reuptake inhibition
SNRIs are contraindicated in what type of person?
Hepatic injury - alcohol abuse or chronic liver disease
What is Serotonin syndrome?
SSRI/SNRI + MAOI
SSRI/SNRI + SSRI/SNRI = confusion, restlessness, fever, hyperreflexia, diarrhea, shivering
MAO is an enzyme that is inhibited by MAOIs. What is the role of MAO in depression?
MAO breaks down 5-HT (serotonin, NE, DA).
Which class of depression medication must you be mindful of drug/food interactions, due to high risk of hypertensive crisis
MAOIs
avoid MAOI + sympathomimetic (pseudoephedrine, amphetamines, foods rich in tyramine)
Tricyclic antidepressant have many adverse effects. Which 2 give high risk for sedation and anticholinergic effects
Amitriptyline
Imipramine
If you Rx amitriptyline or imipramine (antidepressant), when should the patient take them?
at night - sedative effect, helps with sleep.
TCAs have a high risk of overdose, and significant additive effects with drugs that cause _______
sedation, hypotension, anticholinergic
Bupropion is what class of depression medication?
NE and DA reuptake inhibitor
When should patient take their daily dose of Bupropion?
Late afternoon - NOT AT NIGHT! Adverse effect is insomnia
Bupropion contraindication
CNS lesion
seizures
head trauma
bulimia
Of the 5-HT antagonists, which has higher risk of causing sedation and priapism
Trazodone
Prescribe this 5-HT antagonist for sleep, but add onto other antidepressants
Trazodone
Nefazodone isn’t used often for depression because of its risk for ______
hepatotoxicity
What are the partial 5-HT agonists?
Vortioxetine
Vilazodone
what are the adverse effects of Vortioxetine and Vilazodone that limits their use?
GI upset
St. Johns wort is commonly used to treat depression. What type does it work for and not work for?
works for mild depression
NOT effective for moderate-severe