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Pharmacology > Neurology > Flashcards

Neurology Flashcards

1
Q

Medication options for Parkinson’s

A
  1. Dopamine and Dopamine Agonists

2. COMT inhibitors

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2
Q

Medication options for Alzheimer’s disease

A
  1. Cholinesterase Inhibitors

2. NMDA antagonists

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3
Q

Medication options for migraine headaches

A
  1. triptans

2. ergot alkaloids

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4
Q

Medication options for Seizure disorder

A
  1. Topiramate/Topamax
  2. Valproic Acid/Depakote
  3. Lamtrigine/Lamictal
  4. Levetiracetam Keppra
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5
Q

Dopamine example

A

Levodopa (L-dopa)

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6
Q

Dopamine agonists

A
  1. Pramipexole / Mireapex

2. Ropinirole / Requip

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7
Q

Dopamine and dopamine agonist MOA

A
  1. mimic actions of dopamine as agonists as dopamine receptors (dopamine agonist)
  2. stimulates production of dopamine (levodopa)
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8
Q

dopamine agonist CI

A

Caution with driving or engaging in other activities that require alertness b/c potential for sudden sleep

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9
Q

Dopamine and dopamine agonist SE

A
  1. Nausea - all
  2. dry mouth
  3. drowsiness
  4. hallucinations
  5. vivid dreams
  6. orthostatic hypotension
  7. sudden sleep onset!
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10
Q

COMT inhibitors indication

A

Adjunct in treatment with Parkinson’s in patient who experience wear-off effect

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11
Q

COMT inhibitor example

A

Entacapone / Comtan

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12
Q

COMT inhibitor MOA

A

selectively, reversibly inhibits COMT which normally breaks down levodopa –> results in higher, more sustained serum levels of levodopa

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13
Q

COMT inhibitor CI

A
  1. MAOIs
  2. caution w/ MAO-B selective inhibitors
  3. pheochromocytoma
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14
Q

What must you do for patient taking COMT inhibitor

A

run drug-drug interaction/safety profile when prescribing new medication

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15
Q

COMT inhibitor SE

A
  1. neuroleptic malignant syndrome
  2. rhabdomyolysis
  3. muscle cramps
  4. liver impairment
  5. dizziness
  6. confusion
  7. hypo or hypertension
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16
Q

Cholinesterase inhibitor indications

A
  1. Alzheimer’s (first line)

2. Myasthenia gravis

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17
Q

Cholinesterase inhibitor CI

A
  1. caution in pts w/ GI bleed or those who used NSAIDs

2. caution if history of asthma, COPD, liver impairment, convulsions/seizures

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18
Q

Cholinesterase inhibitor example

A

Donepezil / aricept

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19
Q

Cholinesterase inhibitor MOA

A

increase acetylcholine levels by binding to acetylcholinesterase and inhibiting its activity (reversible)

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20
Q

Cholinesterase inhibitor common SE

A
  1. N/V
  2. increased urination
  3. intestinal cramping, diarrhea
  4. increased secretions (bronchial, salivary)
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21
Q

NMDA antagonist example

A

memantine / namenda

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22
Q

NMDA antagonist indication

A

moderate to severe Alzheimer’s disease as add-on therapy or solo if did not tolerate anti-cholinesterase

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23
Q

additional management for Alzheimer’s

A
  1. structured routines
  2. pet or music therapy
  3. exercise
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24
Q

When do you give MMSE

A

people with memory loss at every visit to monitor decline

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25
Q

Triptan indications

A
  1. acute migraine
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26
Q

triptan CIs

A
  1. ischemic or vasospastic CAD
  2. uncontrolled HTN
  3. MAOIs
  4. severe hepatic or renal impairment (naratriptan only)
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27
Q

Triptan examples

A
  1. sumatriptan / imitrex

2. rizatriptan / maxalt

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28
Q

When should you add on NSAID after taking triptan?

A

If not completely headache free in 2 hours or less

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29
Q

when should you take a triptan

A

as soon as headache starts

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30
Q

typical onset of triptans by route of administration

A
  1. tablets: 20-30 min
  2. injection: 5 min
  3. nasal spray: 12-25 min
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31
Q

Triptan MOA

A

agonists of 5-HT1B and 5-HT1D –> causes vasoconstriction of cerebral blood vessels

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32
Q

formulations of triptans

A

injection, nasal spray, tablet, oral disintegrating tablet

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33
Q

benefit of sumatriptan

A

available as injection, nasal spray, and tablet - can used multiple formulations of drug so take tablet but if no relief then use injection at 2 hour mark

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34
Q

patient education on triptan nasal sprays

A

do not snort! sit down, lean forward, spray, hold nose and breathe through mouth and count to 10

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35
Q

triptan SE

A
  1. serotonin syndrome

2. cardiac events (coronary artery vasospasm, transient myocardial ischemia, arrhythmias, MI)

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36
Q

ergot alkaloid indications

A
  1. migraine

2. postpartum hemorrhage

37
Q

ergot alkaloid examples

A
  1. Dihydroergotamine; DHE / Migranal

2. Methylergonovine / Methergine

38
Q

ergot alkaloid MOA

A

vasoconstrictors

39
Q

ergot alkaloid CI

A
  1. CAD
  2. severe/uncontrolled HTN
  3. peripheral vascular disease
  4. triptans
  5. pregnancy
  6. complicated migraine
  7. potent CYP3A inhibitors (macrolides, fluconazole)
40
Q

ergot alkaloid SE

A
  1. N/V
  2. diarrhea
  3. paresthesias
  4. chest pain
  5. HTN
  6. muscle cramping
41
Q

Topiramate / Topamax indications

A
  1. seizure disorders (prevention)

2. migraine prevention

42
Q

Topiramate CIs

A
  1. phosphate kidney stone

2. pregnancy (category D)

43
Q

Topiramate MOA

A
  1. potentiation of GABA
  2. Na channel blockade
  3. glutamate antagonist
  4. Ca channel blockade
  5. inhibits carbonic anhydrase isoenzymes
44
Q

Special considerations with topiramate

A

may reduce levels of estrogen component of oral contraceptives - may have breakthrough bleeding, need appropriate protection for pregnancy

45
Q

Topiramate serious SE

A
  1. cognitive impairment (memory loss, concentration, comprehension problems)
  2. renal calculi
46
Q

Topiramate other SE

A
  1. paresthesia
  2. fatigue and sedation
  3. dizziness
  4. weight loss
  5. metabolic acidosis
47
Q

valproate indications

A
  1. absence seizures
  2. partial seizures
  3. generalized tonic-clonic seizures
  4. bipolar disorder (mood stabilizer)
  5. migraine prophylaxis
48
Q

valproate CI

A
  1. significant hepatic dysfunction

2. pregnancy

49
Q

patient education for prescribing valproate to women of childbearing age

A

should not get pregnant on this medications b/c causes neural tube defects early on - must have appropriate birth control plan - may have to increase dose of estrogen OCP

50
Q

Examples of valproate

A

valproic acid / Depakote

51
Q

valproic acid MOA

A

Na channel blocker

52
Q

Valproate CI

A
  1. caution with phenytoin and phenobarbital
  2. PCOS
  3. not typically used in infants or children d/t higher risk of hepatotoxicity
53
Q

valproate SE

A
  1. N/V (common)
  2. tremor (common)
  3. decrease mental clarity
  4. weight gain
  5. may worse symptoms of PCOS
54
Q

valproate serious SE

A
  1. hepatotoxicity (esp infants) –> check baseline LFTs prior to starting and throughout course of treatment (at 3 mo, 6 mo, then Q 3-6 mo)
55
Q

Lamotrigine / Lamictal indications

A
  1. Seizure disorders (partial seizures)
  2. secondarily generalized seizures
  3. bipolar disorder (mood stabilizer)
56
Q

Lamotrigine / Lamictal MOA

A

stabilize neuronal membranes and suppress excitatory activity at Na and Ca channels

57
Q

Lamotrigine drug interactions

A
  1. phenytoin
  2. carbamazepine
  3. phenobarbital
    ^reduce half life
  4. valproate (inhibits metabolism)
58
Q

Lamotrigine / Lamictal SE

A
  1. CNS - dizziness, ataxia, blurred vision, diplopia
  2. N/V
  3. rash - mild to Stevens Johnsons syndrome and toxic epidermal necrolysis
59
Q

Levetiracetam / Keppra Indications

A
  1. Seizure disorder
    - myoclonic seizure (adjunct)
    - partial seizure
    - tonic-clonic seizure
60
Q

Levetiracetam / Keppra CI

A

hypersensitivity

61
Q

Levetiracetam / Keppra MOA

A

unknown
- opposes activity of negative modulators of GABA- and glycine-gated currents & partially inhibits N-type Ca currents in neuronal cells

62
Q

Levetiracetam / Keppra SE

A
  1. decreased appetite
  2. bone loss
  3. dizziness
  4. headache
  5. irritability
  6. fatigue
63
Q

Levetiracetam / Keppra serious SE

A
  1. Steven Johnson Syndrome
  2. decreased WBCs
  3. Liver failure
  4. suicidal ideation
64
Q

What must you monitor with Levetiracetam / Keppra and who should you monitor

A

renal function in elderly and renally impaired patients

65
Q

GABA analogue example

A
  1. gabapentin

2. pregabalin / lyrica (don’t need to know)

66
Q

gabapentin indications

A
  1. seizure disorders (adjunctive)
  2. management of neuropathic pain
    * post-op backs or necks
  3. lyrica - fibromyalgia
67
Q

Gabapentin SE

A
  1. fatigue
  2. dizziness
  3. ataxia
68
Q

Gabapentin CI

A

renal impairment?

69
Q

Carbamazepine / Tegretol Indications

A
  1. partial seizures
  2. generalized tonic-clonic seizures
  3. trigeminal neuralgia
  4. bipolar disorder
70
Q

Carbamazepine / Tegretol CI

A
  1. hepatic disease
  2. bone marrow suppression
  3. AV block
  4. MAOIs
  5. pregnancy
  6. hypersensitivity to TCAs
71
Q

Carbamazepine / Tegretol MOA

A

stabilizes inactive form of sodium channel –> referred to as Na channel blocker

72
Q

special consideration with Carbamazepine / Tegretol

A

auto inducer: half life decreases after prolonged therapy (should check blood levels)

73
Q

Carbamazepine / Tegretol SE

A
  1. drowsiness
  2. dizziness
  3. ataxia
  4. blurred vision
  5. N/V
74
Q

Carbamazepine / Tegretol serious S/E

A
  1. SJS, toxic epidermal necrolysis
  2. hematologic
  3. hepatic - cholestatic jaundice and hepatitis
75
Q

labs to check with Carbamazepine / Tegretol

A

CMP, CBC w/ diff, blood levels of carbamazepine

*also get baseline

76
Q

Phenytoin / Dilantin Indications

A
  1. Seizure prophylaxis in pts with head injuries
  2. partial seizures
  3. generalized tonic-clonic seizures
77
Q

Phenytoin / Dilantin CI

A
  1. cardiac conduction abnormalities (bradycardia, heart block)
  2. caution with hypotension
  3. pregnancy (category D)
78
Q

Phenytoin / Dilantin MOA

A

inhibits and stabilizes electric discharges from neurons in cortex of brain by affecting ion exchange during polarization and repolarization

blocks voltage-sensitive Na channels –> inhibits excitatory neuronal transmission

79
Q

special considerations with Phenytoin / Dilantin

A
  1. monitor regularly b/c toxicity can be reached quickly
  2. CYP450 enzyme inducer –> check CMP
  3. run safety profile d/t drug interactions
80
Q

Phenytoin / Dilantin SE

A
  1. CNS - diplopia, ataxia, nystagmus, confusion, dizziness
  2. gingival hyperplasia (more frequent dental visits q3 mo)
  3. hirsutism
  4. decreased bone density (interval DEXA scans)
  5. decrease level of consciousness
  6. hypotension or hyperglycemia if IV
  7. induces metabolism of OCPs
81
Q

patient ed when giving Phenytoin / Dilantin to woman of childbearing age

A

increases metabolism of OCPs and category D medication –> establish adequate birth control plan

82
Q

barbiturates indications

A
  1. seizure disorders

2. sedation (although replaced by BZDs)

83
Q

barbiturates CI

84
Q

barbiturates example

A

phenobarbital

85
Q

barbiturates SE

A
  1. sedation
  2. addiction
  3. hypotension
86
Q

barbiturates MOA

A

CNS depressant

87
Q

barbiturates special considerations

A
  1. auto inducer so requires increased doses over time

2. tolerance and addiction can develop

88
Q

Barbiturate withdrawal

A

like alcohol withdrawal

  1. agitation
  2. sleep disturbance
  3. seizures
  4. tachycardia
  5. HTN
  6. sweating
89
Q

barbiturate toxicity

A

resembles alcohol intoxication

  1. sedation
  2. slurred speech
  3. ataxia
  4. nystagmus
  5. depressed level of consciousness
  6. hypotension
  7. respiratory depression

Pharmacology (27 decks)

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