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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
Triptan indications
1. acute migraine
26
triptan CIs
1. ischemic or vasospastic CAD 2. uncontrolled HTN 3. MAOIs 4. severe hepatic or renal impairment (naratriptan only)
27
Triptan examples
1. sumatriptan / imitrex | 2. rizatriptan / maxalt
28
When should you add on NSAID after taking triptan?
If not completely headache free in 2 hours or less
29
when should you take a triptan
as soon as headache starts
30
typical onset of triptans by route of administration
1. tablets: 20-30 min 2. injection: 5 min 3. nasal spray: 12-25 min
31
Triptan MOA
agonists of 5-HT1B and 5-HT1D --> causes vasoconstriction of cerebral blood vessels
32
formulations of triptans
injection, nasal spray, tablet, oral disintegrating tablet
33
benefit of sumatriptan
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
34
patient education on triptan nasal sprays
do not snort! sit down, lean forward, spray, hold nose and breathe through mouth and count to 10
35
triptan SE
1. serotonin syndrome | 2. cardiac events (coronary artery vasospasm, transient myocardial ischemia, arrhythmias, MI)
36
ergot alkaloid indications
1. migraine | 2. postpartum hemorrhage
37
ergot alkaloid examples
1. Dihydroergotamine; DHE / Migranal | 2. Methylergonovine / Methergine
38
ergot alkaloid MOA
vasoconstrictors
39
ergot alkaloid CI
1. CAD 2. severe/uncontrolled HTN 3. peripheral vascular disease 4. triptans 5. pregnancy 6. complicated migraine 7. potent CYP3A inhibitors (macrolides, fluconazole)
40
ergot alkaloid SE
1. N/V 2. diarrhea 3. paresthesias 4. chest pain 5. HTN 6. muscle cramping
41
Topiramate / Topamax indications
1. seizure disorders (prevention) | 2. migraine prevention
42
Topiramate CIs
1. phosphate kidney stone | 2. pregnancy (category D)
43
Topiramate MOA
1. potentiation of GABA 2. Na channel blockade 3. glutamate antagonist 4. Ca channel blockade 5. inhibits carbonic anhydrase isoenzymes
44
Special considerations with topiramate
may reduce levels of estrogen component of oral contraceptives - may have breakthrough bleeding, need appropriate protection for pregnancy
45
Topiramate serious SE
1. cognitive impairment (memory loss, concentration, comprehension problems) 2. renal calculi
46
Topiramate other SE
1. paresthesia 2. fatigue and sedation 3. dizziness 4. weight loss 5. metabolic acidosis
47
valproate indications
1. absence seizures 2. partial seizures 3. generalized tonic-clonic seizures 4. bipolar disorder (mood stabilizer) 5. migraine prophylaxis
48
valproate CI
1. significant hepatic dysfunction | 2. pregnancy
49
patient education for prescribing valproate to women of childbearing age
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
Examples of valproate
valproic acid / Depakote
51
valproic acid MOA
Na channel blocker
52
Valproate CI
1. caution with phenytoin and phenobarbital 2. PCOS 3. not typically used in infants or children d/t higher risk of hepatotoxicity
53
valproate SE
1. N/V (common) 2. tremor (common) 3. decrease mental clarity 4. weight gain 5. may worse symptoms of PCOS
54
valproate serious SE
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
Lamotrigine / Lamictal indications
1. Seizure disorders (partial seizures) 2. secondarily generalized seizures 3. bipolar disorder (mood stabilizer)
56
Lamotrigine / Lamictal MOA
stabilize neuronal membranes and suppress excitatory activity at Na and Ca channels
57
Lamotrigine drug interactions
1. phenytoin 2. carbamazepine 3. phenobarbital ^reduce half life 4. valproate (inhibits metabolism)
58
Lamotrigine / Lamictal SE
1. CNS - dizziness, ataxia, blurred vision, diplopia 2. N/V 3. rash - mild to Stevens Johnsons syndrome and toxic epidermal necrolysis
59
Levetiracetam / Keppra Indications
1. Seizure disorder - myoclonic seizure (adjunct) - partial seizure - tonic-clonic seizure
60
Levetiracetam / Keppra CI
hypersensitivity
61
Levetiracetam / Keppra MOA
unknown - opposes activity of negative modulators of GABA- and glycine-gated currents & partially inhibits N-type Ca currents in neuronal cells
62
Levetiracetam / Keppra SE
1. decreased appetite 2. bone loss 3. dizziness 4. headache 5. irritability 6. fatigue
63
Levetiracetam / Keppra serious SE
1. Steven Johnson Syndrome 2. decreased WBCs 3. Liver failure 4. suicidal ideation
64
What must you monitor with Levetiracetam / Keppra and who should you monitor
renal function in elderly and renally impaired patients
65
GABA analogue example
1. gabapentin | 2. pregabalin / lyrica (don't need to know)
66
gabapentin indications
1. seizure disorders (adjunctive) 2. management of neuropathic pain * post-op backs or necks 3. lyrica - fibromyalgia
67
Gabapentin SE
1. fatigue 2. dizziness 3. ataxia
68
Gabapentin CI
renal impairment?
69
Carbamazepine / Tegretol Indications
1. partial seizures 2. generalized tonic-clonic seizures 3. trigeminal neuralgia 4. bipolar disorder
70
Carbamazepine / Tegretol CI
1. hepatic disease 2. bone marrow suppression 3. AV block 4. MAOIs 5. pregnancy 6. hypersensitivity to TCAs
71
Carbamazepine / Tegretol MOA
stabilizes inactive form of sodium channel --> referred to as Na channel blocker
72
special consideration with Carbamazepine / Tegretol
auto inducer: half life decreases after prolonged therapy (should check blood levels)
73
Carbamazepine / Tegretol SE
1. drowsiness 2. dizziness 3. ataxia 4. blurred vision 5. N/V
74
Carbamazepine / Tegretol serious S/E
1. SJS, toxic epidermal necrolysis 2. hematologic 3. hepatic - cholestatic jaundice and hepatitis
75
labs to check with Carbamazepine / Tegretol
CMP, CBC w/ diff, blood levels of carbamazepine | *also get baseline
76
Phenytoin / Dilantin Indications
1. Seizure prophylaxis in pts with head injuries 2. partial seizures 3. generalized tonic-clonic seizures
77
Phenytoin / Dilantin CI
1. cardiac conduction abnormalities (bradycardia, heart block) 2. caution with hypotension 3. pregnancy (category D)
78
Phenytoin / Dilantin MOA
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
special considerations with Phenytoin / Dilantin
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
Phenytoin / Dilantin SE
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
patient ed when giving Phenytoin / Dilantin to woman of childbearing age
increases metabolism of OCPs and category D medication --> establish adequate birth control plan
82
barbiturates indications
1. seizure disorders | 2. sedation (although replaced by BZDs)
83
barbiturates CI
porphyria
84
barbiturates example
phenobarbital
85
barbiturates SE
1. sedation 2. addiction 3. hypotension
86
barbiturates MOA
CNS depressant
87
barbiturates special considerations
1. auto inducer so requires increased doses over time | 2. tolerance and addiction can develop
88
Barbiturate withdrawal
like alcohol withdrawal 1. agitation 2. sleep disturbance 3. seizures 4. tachycardia 5. HTN 6. sweating
89
barbiturate toxicity
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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