neuropsych Flashcards
which drug is mainly used for trigeminal neuralgia and neuropathic pain
carbamazepine
what is the treatment of choice for status epileptics?
benzos (midazolam, lorazepam, diazepam)
what is carbamazepine’s relationship to the CYP system
CYP3A4 inducer and substrate.
it induced it’s own metabolic,, reduces its own levels. has an active metabolite.
all of the “mazepines” carry a risk of _____
hyponatremia
oxycarbazepine has a ___ risk of drug/drug interactions as carbamazepine because it is a ___ inducer of CYP3A4
lower, weaker
which “mazepine” has a prodrug
eslicarbazepine
which drug can have severe cardiac side effects because it is a 1B anti arrhythmic
phenytoin
which drug has very specific fetal abnormalities including celt palate/lip, congenital heart disease, slowed growth rate, mental deficiency
phenytoin
which drug is often used in combo with depakote for mood stabilization
lamotrigine - lamictal
which drug has higher rates of true psychosis and insomnia than some of our newer safer sz meds
lamotrigine
which med is used mainly in kids for absence seizures
zonisamide
which med carries the risk of terrible skin damage (stevens johnsons)
lamotrigine & carb
which sodium channel med does not affect cyp430
lamotrigine
lacosamide is pregnancy category __
C
what is the benzo of choice for seizure prophy
clobazam (onfi)
which benzo has an incredibly high rate of benzo withdrawal
clobazam (onfi)
which benzos are very lipohillic and move into the CNS redials, good for rescue therapy, tx of tremors
diazepam, clonazepam, lorazepam
valium, clon, ativan
which benzos are used PRN for anxiety attacks
triazolam, alprazolam, temazepam
which drug is a gaba transaminase inhibitor and has the risk of permanent vision loss
vigabatrin
which ones are GABA agents
depakote lyrica neurontin`
which glutamate blocker is rarely used due to fatal hepatic failure
felbamate
which drug used for neuropathy is found to reduce post op pain and opiate requirements
gabapentin
which drug has more ataxia type side effects
pregabalin
T/F Different forms of valproic acid do not have different effects/side effects
TRUE they are just diff salt forms
which TCA is used to treat neuropathies
amitriptyline (elavil)
what kind of side effects are concerning with TCA’s
anticholinergic and cardiac (1A)
where are 5HT1 receptors located
blood vessels and CNS
which drug has diabetes-like side effects
lithium
which drug tricks the body into thinking that it is sodium and alters neuronal sodium transport thus slowing down the action potential
lithium
what is the MOA of nuplazid
5HT2A antagonist
what is the indication of nuplazid
single indication for parkinson’s but NOT a dopinergic agent.
T/F Depth of anesthesia plays a major role in post-op delirium
FALSE- insufficient evidence to show this
what did the STRIDE trial show
limiting the level of sedation provided no significant benefit in reducing incident delirium,….. subgroup showed that lighter sedation levels reduced post op delirium for LESS sick patients.
when is the only time giving benzos for post op delirium is appropriate?
etoh withdrawal
T/F PO haldol does not reduce delirium in acutely hospitalized older adults. haldol does not reduce mortality in critically ill adults at high risk of delirium.
TRUE!
the MOA of a sodium channel blocker is to stabilize them in the ____ state
INACTIVE. slowing down the firing, stop the overstimulation leading to sz, psychosis, mania
how do GABA enhancers work
increased chloride movement… continue to suppress firing off, pushing it into a more hyper polarized state.
which drugs are sodium channel blockers?
“azepine’s”, phenytoin, lamotrigine, zoninamide, lacosamide
which drugs cause stevens-johnsons
carbamazepine and lamotrigine
which “azepine” should you adjust in renal impairment
eslicarbazepine
rank the “azepines” in terms of side effects
carb>oxy>esli
which drug is metabolized with non-linear pharmacokinetics (zero order)
phenytoin
small dose changes are really important with ____ because of the narrow therapeutic index
phenytoin
which drug causes gingival hyperplasia?
dilantin - overgrowth of the gums
dilantin is a CYP ___ and ___
inducer and substrate
which sodium channel blocker is the safest
lacosamide (vimpat)
which drug is a gaba reuptake inhibitor and causes emotional lability
tiagabine
what is the MOA of pregabalin?
GABA analogue, binds alpha2 and delta receptor sites - reduced release of excitatory Its via calcium currents
___ is a category D-X because it causes lower IQ in children compared to other anti-epileptics
VPA
which drug can cause hepatotoxicity, thrombocytopenia, and hyperammonemia?
VPA
how do glutamate blockers work (felbamate, topiramate, perampanel)
glutamate is an excitatory type neurotransmitter working at NMDA receptor - so by blocking that, we slow down an excitatory process which can stop a seizure or stop a migraine in the case of topamax
which drug is rarely used in the US because of its high risk of plastic anemia and fatal hepatic failure
felbamate
which drug has a BB warning for serious or life threatening psychiatric and behavioral adverse effects? - aggression hostility, irritability, anger, homicidal ideation, threats
perampanel
what is the MOA of TCA’s?
serotonin and norepi rey-take inhibition , anticholinergic, 1A antiarrhythmic
which drug class is often used fo pain, not depression and has anticholinergic and CV side effects (QT)?
TCA’s
which SSRI has anticholinergic side effects
paroxetine (paxil)
which serotonin receptors are inhibitory?
1,5 (decreasing cMAP)
serotonin receptors are primarily ____, but ___ is ion chenneled
g-coupled, 5HT3
T/F if you hold an SSRI you need to restart ASAP
true
T/F SSRI’s can cause platelet aggregation, thrombocytopenia, GI upset, hyponatremia
TRUE
s/s of serotonin syndrome
rigidity, elevated temps, accelerated htn , mass confusion
duloxetine, venlafaxine, desvenlafaxine, levomilnacipran are all examples of
SNRI’s
SNRI’s have all the potential serotonin effects with added ___ effects
norepi - hypertension
an example of a DNRI is ____
bupropion (wellbutrin)
which drug is used for depression as well as a modulator with ADHD meds to promote attention
bupropion
mirtazepine, nefazodone, trazodone, vilazodone are examples of
5HT2A antagonists
what is the main concern with nuedexta (dextromethophan/quinidine)
drug interactions! quinidine is a 2D6 inhibitor
Which drug is used for pseudobulbar affect (laughing or crying in response to inappropriate stimuli)
neudexta
which drug has lupus side effects that present as chest pain, costrocondritis
neudexta
you should not give NSAIDs with ____
lithium
what is the diff between first and second gen antipsychotics?
first gen are very sedating bc they are dopaminergic only blockers
second gen are S2D2 blockers
what dopamine pathway do positive symptoms come from?
mesolimbic
what dopamine pathway do negative symptoms come from?
mesocortical
what dopamine pathway do EPS, TD symptoms come from?
nigrostriatal
what dopamine pathway does hyperprolactinemia come from?
tuberohypophyseal
too little dopamine cause ___
parkinsons
what is the black box warning with antipsychotics
dementia related death and agranulocytosis
why do you give carbidopa with levodopa
because If we give levodopa alone, the majority of it is broken down before it can even get to the CNS. so by giving carbidopa, we are trying to trick the enzymes into breaking down the carbidopa instead of the levodopa
which drug is a COMT inhibitor
entacapone. given in combo:
carbidopa/levodopa/entacapone (stalevo)
levodopa is a
dopamine precursor
carbidopa is
false dopamine
T/F. dopamine analongs have the side effects of too much dopamine. agitation, psychosis, insomnia, hallucinations, hypotension.
TRUE
which drugs are used second line for movement disorders and parkinsons
anticholinergics - benztropine & trihexyphenidyl
which drug class is commonly used for restless leg syndrome
dopamine agonists. (think parkinson’s is from too little dopamine).. pramipexole, ropinirole, rotigotine, bromoriptine, apomorphine
how do MOAB inhibitors work?
increase DA availability via enzyme inhibition - therefore more dopamine in circulation to prevent the side effects that come with lack of dopamine
which drug is indicated for parkinson’s but is not a dopinergic agent
nuplazid
which drug is a 5HT2A antagonist
nuplazid
donepezil, galantamine, and rivastigmine are examples of
acetylcholinesterase inhbitors
which drug is a NMDA receptor antagonist (slows down excitatory process)
namenda
do acheEi have fight/flight or rest/digest side effects
rest/digest
achei ____ succs and ___ roc
potentiates with succs, reduced blockade with roc.
T/F The 2014 AGS Guidelines for Older Adults stated that post-op delirium may be fatal, is preventable in up to 40% of cases. may be hypo or hyperactive or mixed presentation, and almost 50% not reported (particularly hypoactive)
TRUE
how does hypoactive delirium present?
slow reflexes, slow to respond, mass confusion
delirium vs dementia
delirium: rapid onset, quick confusion, potential agitation
demential: long term cognitive decline and reduced function
which med has a drug interaction with VPA
lamotrigine
T/F Depth of anesthesia plays a major role in post op delirium
FALSE
T/F Regional anesthesia plays a major role in reducing post op delirium
FALSE
T/F Lighter sedation levels benefit post op delirium proven only for less sick patients
true
T/F Haldol does not reduce mortality in critically ill adults at high risk of delirium
TRUE
when is the only time you should use benzos post op
ETOH withdrawal
