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PHARM 2 > Neuropsych medications > Flashcards

Neuropsych medications Flashcards

1
Q

What 3 things do you want to do during first 5 minutes of a seizure?

A
  1. ABC stabilization: check VS, O2, monitor
  2. Check BG: if <60 treat
  3. Get labs
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2
Q

What can be given to adults if BG is low to help with carbohydrate utilization?

A

Thiamine

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3
Q

What is the treatment of choice if a seizure lasts > 5min

A

Benzodiazepine

  • Midazolam
  • Lorazepam
  • Diazepam
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4
Q

During the first phase of status epilepticus (5-20min) what other meds can be given if IV benzo isn’t available?

A

Phenobarbital
rectal Diazepam
nasal or buccal Midazolam

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5
Q

During the 2nd therapy phase (20-40 min) what is the evidence based first choice medication?

A

There is none. May use any of the following:
-Fosphenytoin
-Valproic acid
-Keppra
If above not available: phenobarbital if not already used

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6
Q

What is the treatment during the 3rd phase of status epilepticus?

A

Repeat any 2nd line therapy

Anesthetic doses of thiopental, midazolam, pentobarbital, or propofol

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7
Q

What are the 5 approved and unapproved indications for anticonvulsants?

A 
Seizures
Neuropathic pain
Mood stabilization
Migraines
ETOH dependence
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8
Q

What are the 7 mechanisms of action of anticonvulsants?

A
  1. Sodium channel blockade
  2. Calcium Channel blockade
  3. GABA enhancers
  4. Glutamate blockers
  5. Carbonic Anhydrase Inhibitors
  6. Sex hormones (progesterone)
  7. Synaptic vesicle protein 2A (SV2S)
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9
Q

What are some examples of Na channel blockers?

A 
Carbamazepine (Tegretrol, Carbatrol)
Oxcarbazepine (Trileptal)
Eslicarbazepine (Aptiom)
Phenytoin/Fosphenytoin (Dilantin)
Lamotrigine (Lamictal)
Zonsamide (Zonegran)
Lacosamine (Vimpat)
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10
Q

What Na channel blocker induces it’s own metabolism?

A

Carbamazepine

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11
Q

Does Carbamazepine have an active metabolite?

A

Yes

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12
Q

T/F: It is dangerous if you miss a dose of carbamazepine

A

FALSE

half-life is 5-26 hours

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13
Q

All of the “mazepines” have a risk of what electrolyte abnormality?

A

Hyponatremia

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14
Q

What Na channel blocker has a risk of thrombocytopenia, agranulocytosis, and aplastic anemia?

A

Carbamazepine

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15
Q

This medication “looks and smells like” Carbamazepine but is not as strong and has fewer interactions/

A

Oxcarbazepine

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16
Q

T/F: Oxcarbazepine does not have an active metabolite

A

FALSE

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17
Q

What Na channel blocker is a prodrug?

A

Eslicarbazepine

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18
Q

This newer Na channel blocker has more CNS side effects, but the risk of hyponatremia is low

A

Eslicarbazepine

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19
Q

What medication can treat the widest range of seizures?

A

phenytoin/fosphenytoin

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20
Q

What order of pharmacokinetics does phenytoin/fosphenytoin use?

A

non-linear (zero-order)

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21
Q

T/F: Phenytoin has active metabolites

A

FALSE

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22
Q

What Na channel blocker is a prodrug for parenteral administration?

A

Fosphenytoin

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23
Q

Phenytoin is a _________ anti-arrhythmic

A

1B

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24
Q

T/F: is it not safe to give phenytoin during pregnancy

A

TRUE

can cause cleft palate/lip, congenital heart disease, slowed growth rate, and mental deficiency

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25
Q

What is Lamotrigine most often used for?

A

Mood stabilizer

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26
Q

What 2 medications in combination can cause Steven-Johnson’s syndrome?

A

Lamictal and Depakote

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27
Q

This Na channel blocker is often used for absence seizures in children

A

zonisamide

*Can cause SE of oligohidrosis in children

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28
Q

This Na channel blocker is not used much, and is a pregnancy category C with ongoing pregnancy register

A

Lacosamide (Vimpat0

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29
Q

What 3 meds are GABA agonists?

A

Benzodiazepines
Phenobarbital
Primidone (Mysoline)

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30
Q

What Medication is a GABA reuptake inhibitor?

A

Tiagabine (Gabitril)

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31
Q

What type of GABA agent is Vigabatrin (Sabril)?

A

GABA transaminase inhibitor

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32
Q

What are 3 other GABA agents?

A

Gabapentin (Neurontin)
pregabalin (Lyrica)
Valproate (Depakote)

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33
Q

What is the DOC for seizure prevention?

A

Clobazam (Onfi)

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34
Q

What Benzos are often used as rescue meds bc they’re more lipophilic, have the fastest onset and longest DOA?

A

Diazepam (Valium)
Clonazepan (Klonapin)
Lorazepan (Ativan)

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35
Q

What prodrug that is metabolized to phenobarbital?

A

Primidone

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36
Q

What GABA agent has a risk of permanent vision loss?

A

Vigabtrin

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37
Q

What GABA agent given 30min pre-op can improve post-op pain and decrease opioid requirements?

A

Gabapentin

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38
Q

What is the “stronger version” of Neurontin?

A

Pregabalin - Lyrica

39
Q

What drug is eliminated 90% unchanged in urine, absorption is slowed by food, and has not notable drug interactions?

A

Pregabalin

40
Q

T/F: Valproic acid has an uncertain MOA

A

TRUE

may increase GABA synthesis, selective modulation of Na channels

41
Q

In utero exposure to this anti-epileptic can lower IQ of children

A

Valproic acid

42
Q

Name the 3 glutamate blockers

A

Felbamate (Felbatol)
Topiramate (Topamax)
Perampanel (Fycompa)

43
Q

What glutamate blocker has a high risk of aplastic anemia and fatal hepatic failure?

A

Felbamate

*very limited use in the US

44
Q

This glutamate blocker has multiple potential MOAs

A

Topiramate

45
Q

What glutamate blocker is a noncompetitive agonist of AMPA?

A

Perampanel

46
Q

What glutamate blocker has a BB warning of serious or life threatening psychiatric and behavioral adverse effects?

A

Perampanel

47
Q

What are 3 meds with “other” MOAs?

A

Levetiracetam (Keppra)
Brivaracetam (Briviact)
Ezogabine (Potiga)

48
Q

Levetiracetam’s MOA is possible related to ______________ which appears to be important for the availability of Ca-dependent NT vesicles ready to release their content

A

synaptic vesicle protein 2A (SV2A)

49
Q

T/F: there are significant side effects and drug interaction with keppra

A

FALSE

50
Q

What are the sedative hypnotics?

A
  • Z-drugs: zolpidem (ambien), zaleplon (sonata), Eszopiclone (Lunesta)
  • Ramelteon (rozerem)
  • suvorexant (belsomra)
  • Melatonin & Valerian root
51
Q

Name the 6 groups of antidepressants

A
  1. Tricyclic antidepressants
  2. SSRIs
  3. SNRIs
  4. DNRIs
  5. 5HT2A antagonists
  6. Nuedexta
52
Q

What are some examples of tricyclic antidepressants?

A 
amitriptyline (Elavil)
Clomipramine (Anafranil)
Desipramine (Norpramin)
Doxepin (Sinequan)
Imiparmine (Tofranil)
Nortriptyline (Pamelor)
53
Q

What is the MOA for tricyclic antidepressants?

A

Serotonin and NE reuptake inhibition, anticholinergic, 1A antiarrhyhmic

54
Q

T/F: TCAs can cause QT prolongation

A

TRUE

55
Q

What do you administer if an OD of a TCA?

A

NaHCO3

due to metabolic acidosis

56
Q

What are some examples of SSRIs?

A 
Citalopram (Celexa)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
Escitalopram (Lexapro)
Fluvoxamine (Luvox)
57
Q

Do you need to taper SSRIs when d/c-ing?

A

Yes

58
Q

Which serotonin receptors are excitatory?

A

2, 3, 4, 6, 7

59
Q

Which serotonin receptors are inhibitory?

A

1, 5

60
Q

All serotonin receptors are g-coupled except which one?

A

3: Na/K ion channel

61
Q

Where are 1:serotonin receptors located primarily?

A

Blood vessels and CNS

62
Q

Where are 2:serotonin receptors located primarily?

A

Blood vessels, CNS, GI tract, platelets, PNS, smooth muscles

63
Q

Where are 3:serotonin receptors located primarily?

A

CNS, GI tract, PNS

64
Q

What is serotonin syndrome?

A

If block re-uptake, more serotonin available to act on receptors. When have excess serotonin can see rigidity, mass confusion, elevated temperatures, HTN

65
Q

What are examples of SNRIs?

A

Duloxetine (Cymbalta)
Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)
Levomilnacipran (Fetzima)

66
Q

What is the MOA of SNRIs?

A

Serotonin and NE reuptake inhibition

67
Q

What type of symptoms will you see more with SNRIs than SSRIs?

A

Cardiovascular symptoms, like HTN

68
Q

What is an example of a DNRI?

A

Bupropion (Wellbutrin)

69
Q

What is the MOA of DNRI?

A

Dopamine and NE reuptake inhibitor

70
Q

What are some 5HT2A antagonists?

A

Mirtazapine (Remeron)
Nerazodone (Serzone)
Trazodone (Desryl)
Vilazodone (Viibryd)

71
Q

What are some side effects of 5HT2A antagonists?

A

Highly sedating, increased appetite, hepatoxicity

72
Q

Nuedexta can cause what side effects?

A

Pseudobulbar effect: laugh/cry at inappropriate times

QT prolongation, lupus, thrombocytopenia

73
Q

What is the MOA for lithium?

A

alters neuronal sodium transport

74
Q

What are some SE of lithium?

A

Narrow therapeutic index
DI: polyruria, polydipsia
hypothyroidism
coma, seizures, sycope

75
Q

What type medication should you avoid with lithium and why?

A

NSAIDS

Can cause lithium levels to increase

76
Q

What are some examples of 1st generation antipsychotic meds?

A

Thorazine, Compazine, Haldol

77
Q

What are some examples of 2nd generation antipsychotic meds?

A

Abilify, Clozaril, Zyprexa, Seroquel, geodon

78
Q

What are the 4 pathways of dopamine in the CNS?

A
  1. Mesolimbic: positive symptoms of schizophrenia and psychosis
  2. Mesocortical: negative symptoms, cognitive and affective sx
  3. Nigrostriatal: EPS, TD
  4. Tuberohypophyseal: hyperprolactinemia
79
Q

What is the MOA of antipsychotics?

A

S2/D2 blockade

80
Q

What is the black box warning for antipsychotics?

A

Dementia related deaths

81
Q

What are the 5 types of Parkinson’s meds?

A 
Dopamine analogs
Dopamine agonists
anticholinergics
MAOB inhibitors
Other
82
Q

What are some dopamine analogs?

A

Carbidopa/Levodopa (Sinemet)

Carbidopa/Levodopa/Entacopone (Stalevo)

83
Q

What some side effects of dopamine analogs?

A 
Basically SE of having too much dopamine
CNS: hallucinations, psychosis, MDD, +II
CV: hypotension, sycope
Heme: blood dyscrasias, GIB
GI: n/v, constipation
84
Q

What are some dopamine agonists?

A 
Pramipexole (Mirapex)
Ropinirole (Requip)
Rotigotine (Parlodel)
Bromocriptine (Parlodel)
Apomorphine (Apokyn)
85
Q

This group of meds is the 2nd line for movement and Parkinson’s disorders

A

Anticholinergics

  • Benztropine (Cogentin)
  • Trihexyphenidyl (Artane)
86
Q

What is the MOA of MAOB inhibitors?

A

Increase dopamine availability via enzyme inhibition

87
Q

What are2 MAOB inhibitors?

A

Rasaligine (Azilect)

Selegiline (Eldepryl)

88
Q

What are 2 “other” meds?

A

Amantadine (Symmetrel)

Nuplazid (Pimavanserin)

89
Q

What are 2 classes of Alzheimer’s medications?

A 
Acetylcholinesterase inhibitors
-donepezil (Aricept)
-Galantamine (Razadyne)
-Rivastigmine (Exelon)
NMDA receptor antagonists
-Mamantine (Namenda)
90
Q

What can anticholinergic meds do to NMBs?

A

Can potentiate succinylcholine

Reduce blockade of NMBs

91
Q

T/F: You need to taper dementia meds prior to stopping.

A

FALSE

92
Q

What is the difference between dementia and delirium?

A

Dementia: long-term cognitive decline
Delirium: rapid onset of confusion

93
Q

T/F: According to JAMA, limiting the level of sedation provided no significant benefit in reducing the incident of post-op delirium

A

TRUE

PHARM 2 (7 decks)

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