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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
What is Lamotrigine most often used for?
Mood stabilizer
26
What 2 medications in combination can cause Steven-Johnson's syndrome?
Lamictal and Depakote
27
This Na channel blocker is often used for absence seizures in children
zonisamide *Can cause SE of oligohidrosis in children
28
This Na channel blocker is not used much, and is a pregnancy category C with ongoing pregnancy register
Lacosamide (Vimpat0
29
What 3 meds are GABA agonists?
Benzodiazepines Phenobarbital Primidone (Mysoline)
30
What Medication is a GABA reuptake inhibitor?
Tiagabine (Gabitril)
31
What type of GABA agent is Vigabatrin (Sabril)?
GABA transaminase inhibitor
32
What are 3 other GABA agents?
Gabapentin (Neurontin) pregabalin (Lyrica) Valproate (Depakote)
33
What is the DOC for seizure prevention?
Clobazam (Onfi)
34
What Benzos are often used as rescue meds bc they're more lipophilic, have the fastest onset and longest DOA?
Diazepam (Valium) Clonazepan (Klonapin) Lorazepan (Ativan)
35
What prodrug that is metabolized to phenobarbital?
Primidone
36
What GABA agent has a risk of permanent vision loss?
Vigabtrin
37
What GABA agent given 30min pre-op can improve post-op pain and decrease opioid requirements?
Gabapentin
38
What is the "stronger version" of Neurontin?
Pregabalin - Lyrica
39
What drug is eliminated 90% unchanged in urine, absorption is slowed by food, and has not notable drug interactions?
Pregabalin
40
T/F: Valproic acid has an uncertain MOA
TRUE | may increase GABA synthesis, selective modulation of Na channels
41
In utero exposure to this anti-epileptic can lower IQ of children
Valproic acid
42
Name the 3 glutamate blockers
Felbamate (Felbatol) Topiramate (Topamax) Perampanel (Fycompa)
43
What glutamate blocker has a high risk of aplastic anemia and fatal hepatic failure?
Felbamate | *very limited use in the US
44
This glutamate blocker has multiple potential MOAs
Topiramate
45
What glutamate blocker is a noncompetitive agonist of AMPA?
Perampanel
46
What glutamate blocker has a BB warning of serious or life threatening psychiatric and behavioral adverse effects?
Perampanel
47
What are 3 meds with "other" MOAs?
Levetiracetam (Keppra) Brivaracetam (Briviact) Ezogabine (Potiga)
48
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
synaptic vesicle protein 2A (SV2A)
49
T/F: there are significant side effects and drug interaction with keppra
FALSE
50
What are the sedative hypnotics?
- Z-drugs: zolpidem (ambien), zaleplon (sonata), Eszopiclone (Lunesta) - Ramelteon (rozerem) - suvorexant (belsomra) - Melatonin & Valerian root
51
Name the 6 groups of antidepressants
1. Tricyclic antidepressants 2. SSRIs 3. SNRIs 4. DNRIs 5. 5HT2A antagonists 6. Nuedexta
52
What are some examples of tricyclic antidepressants?
``` amitriptyline (Elavil) Clomipramine (Anafranil) Desipramine (Norpramin) Doxepin (Sinequan) Imiparmine (Tofranil) Nortriptyline (Pamelor) ```
53
What is the MOA for tricyclic antidepressants?
Serotonin and NE reuptake inhibition, anticholinergic, 1A antiarrhyhmic
54
T/F: TCAs can cause QT prolongation
TRUE
55
What do you administer if an OD of a TCA?
NaHCO3 | due to metabolic acidosis
56
What are some examples of SSRIs?
``` Citalopram (Celexa) Fluoxetine (Prozac) Paroxetine (Paxil) Sertraline (Zoloft) Escitalopram (Lexapro) Fluvoxamine (Luvox) ```
57
Do you need to taper SSRIs when d/c-ing?
Yes
58
Which serotonin receptors are excitatory?
2, 3, 4, 6, 7
59
Which serotonin receptors are inhibitory?
1, 5
60
All serotonin receptors are g-coupled except which one?
3: Na/K ion channel
61
Where are 1:serotonin receptors located primarily?
Blood vessels and CNS
62
Where are 2:serotonin receptors located primarily?
Blood vessels, CNS, GI tract, platelets, PNS, smooth muscles
63
Where are 3:serotonin receptors located primarily?
CNS, GI tract, PNS
64
What is serotonin syndrome?
If block re-uptake, more serotonin available to act on receptors. When have excess serotonin can see rigidity, mass confusion, elevated temperatures, HTN
65
What are examples of SNRIs?
Duloxetine (Cymbalta) Venlafaxine (Effexor) Desvenlafaxine (Pristiq) Levomilnacipran (Fetzima)
66
What is the MOA of SNRIs?
Serotonin and NE reuptake inhibition
67
What type of symptoms will you see more with SNRIs than SSRIs?
Cardiovascular symptoms, like HTN
68
What is an example of a DNRI?
Bupropion (Wellbutrin)
69
What is the MOA of DNRI?
Dopamine and NE reuptake inhibitor
70
What are some 5HT2A antagonists?
Mirtazapine (Remeron) Nerazodone (Serzone) Trazodone (Desryl) Vilazodone (Viibryd)
71
What are some side effects of 5HT2A antagonists?
Highly sedating, increased appetite, hepatoxicity
72
Nuedexta can cause what side effects?
Pseudobulbar effect: laugh/cry at inappropriate times | QT prolongation, lupus, thrombocytopenia
73
What is the MOA for lithium?
alters neuronal sodium transport
74
What are some SE of lithium?
Narrow therapeutic index DI: polyruria, polydipsia hypothyroidism coma, seizures, sycope
75
What type medication should you avoid with lithium and why?
NSAIDS | Can cause lithium levels to increase
76
What are some examples of 1st generation antipsychotic meds?
Thorazine, Compazine, Haldol
77
What are some examples of 2nd generation antipsychotic meds?
Abilify, Clozaril, Zyprexa, Seroquel, geodon
78
What are the 4 pathways of dopamine in the CNS?
1. Mesolimbic: positive symptoms of schizophrenia and psychosis 2. Mesocortical: negative symptoms, cognitive and affective sx 3. Nigrostriatal: EPS, TD 4. Tuberohypophyseal: hyperprolactinemia
79
What is the MOA of antipsychotics?
S2/D2 blockade
80
What is the black box warning for antipsychotics?
Dementia related deaths
81
What are the 5 types of Parkinson's meds?
``` Dopamine analogs Dopamine agonists anticholinergics MAOB inhibitors Other ```
82
What are some dopamine analogs?
Carbidopa/Levodopa (Sinemet) | Carbidopa/Levodopa/Entacopone (Stalevo)
83
What some side effects of dopamine analogs?
``` Basically SE of having too much dopamine CNS: hallucinations, psychosis, MDD, +II CV: hypotension, sycope Heme: blood dyscrasias, GIB GI: n/v, constipation ```
84
What are some dopamine agonists?
``` Pramipexole (Mirapex) Ropinirole (Requip) Rotigotine (Parlodel) Bromocriptine (Parlodel) Apomorphine (Apokyn) ```
85
This group of meds is the 2nd line for movement and Parkinson's disorders
Anticholinergics - Benztropine (Cogentin) - Trihexyphenidyl (Artane)
86
What is the MOA of MAOB inhibitors?
Increase dopamine availability via enzyme inhibition
87
What are2 MAOB inhibitors?
Rasaligine (Azilect) | Selegiline (Eldepryl)
88
What are 2 "other" meds?
Amantadine (Symmetrel) | Nuplazid (Pimavanserin)
89
What are 2 classes of Alzheimer's medications?
``` Acetylcholinesterase inhibitors -donepezil (Aricept) -Galantamine (Razadyne) -Rivastigmine (Exelon) NMDA receptor antagonists -Mamantine (Namenda) ```
90
What can anticholinergic meds do to NMBs?
Can potentiate succinylcholine | Reduce blockade of NMBs
91
T/F: You need to taper dementia meds prior to stopping.
FALSE
92
What is the difference between dementia and delirium?
Dementia: long-term cognitive decline Delirium: rapid onset of confusion
93
T/F: According to JAMA, limiting the level of sedation provided no significant benefit in reducing the incident of post-op delirium
TRUE

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