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Pharmacology > Parkinson's, Alzheimer's, ADD/ADHD, Anticonvulsants > Flashcards

Parkinson's, Alzheimer's, ADD/ADHD, Anticonvulsants Flashcards

1
Q

Parkinson’s PATHO

A

movement disorder

TRAP: tremor, rigidity, bradykinesia, postural dysfunction, abnormal gait

GOAL: symptom control

Must balance AE of drug therapy

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2
Q

Carbidopa-Levodopa USES

A

Sinemet or Parcopa

Combo drug to tx Parkinson’s

Levodopa = precursor dopamine; cross BBB

combo cross BBB more effectively

MOA: improves nerve impulses by changing the dopamine/acetylcholine balance

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3
Q

Carbidopa-Levodopa ADMINISTRATION

A

oral administration starts to take effect in 1-2 months, but may take 6 months for noticeable effects

duration: 6-12 hrs
half life: 1-2 hrs

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4
Q

Carbidopa-Levodopa CONTRA/CAUTIONS

A

CONTRA: Hx sensitivity, undiagnosed pigmented lesions or Hx melanoma, closed angle glaucoma

CAUTION: cardiac disease, MI, pulmonary, DM, PUD, Hx psychiatric disorder

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5
Q

Carbidopa-Levodopa INTERACTIONS

A

MAOI, TCA, phenothiazines, pyridoxine

AVOID high protein diet

AVOID food w/ large amounts pyridoxine

manage body weight

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6
Q

Carbidopa-Levodopa AEs

A

GI, orthostatic hypotension

abnormal movements: bruxism, ballismus

Bradykinetic episodes: on-off

NMS

Hyperventilation, bizarre breathing patterns, hoarseness, INC nasal secretions

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7
Q

Carbidopa-Levodopa DOSAGE

A

dose for adults

25/100mg tabs BID to QID for maximum dose of 200/2000 mg daily

Lose effectiveness after 2-5 yrs of therapy

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8
Q

Parkinson’s: Non-Ergot Derived Dopamine Agonists

A

Ropinierole, pramipexole

Monotherapy to control sx and delay use of levodopa

May also be used in pts who experience levodopa “wearing off”

CAUTION: renal, hepatic impairment

extensive first pass; 40% protein bound

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9
Q

Parkinson’s: Non-Ergot Derived

AEs/INTERACTIONS

A

AE: GI, postural hypotension, dyskinesias, somnolence, dizziness, unsteadiness, hallucinations, confusion

Interactions:
1. pramipexole: cimetidine
2. ropinirole: a lot

AVOID St. John’s wort, Kava, Valerian

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10
Q

Parkinson’s: Anticholinergics

A

Benztropine (cogentin) and Trihexyphenidyl (Artane)

Alter relative balance of cholinergic and dopaminergic influences in the EPS by inhibiting the cholinergic neurons

MOA: DEC acetylcholine = blocking acetylcholine

DEC EPS symptoms

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11
Q

Parkinson’s: Amantadine

A

antiviral agent

used to tx: mild PD, drug induced parkinsonism, late stage PD

Effective for resting tremors and in combo w/ levodopa

MOA: block reuptake of dopamine and stimulate dopamine release from nerve storage sites

Do NOT recommend for parkinson’s pt w/ flu = double dosing

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12
Q

Alzheimer’s PATHO

A

senile dementia

slow progressive decline in cognition

drug therapy is to slow the progression of the disease

confirmed only by autopsy

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13
Q

Alzheimer’s Drug GOAL

A

Maintain and maximize the patient’s functional ability, quality of life, and independence for as long as possible

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14
Q

Alzheimer’s DRUGS

A
  1. Donepezil
  2. Galantamine
  3. Memantine
  4. Rivastigmine
  5. Tacrine
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15
Q

Cholinesterase inhibitors MOA/USES

A

Used to inhibit one or both types of cholinesterase enzymes

Reduce apathy, psychosis, anxiety, depression, agitation

MOA: SLOW the progression of cognitive, functional and behavior symptoms

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16
Q

Cholinesterase Inhibitors ADMINISTRATION

A

effect usually seen in 3-6 wks

peak 1-3
half life 7-70

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17
Q

Cholinesterase Inhibitor CONTRA/AEs/CAUTION

A

CONTRA: prev sensitivity

CAUTION: liver or kidney dysfunction, PUD

AE: GI, N/V/D- dose dependent; bradycardia, HA, fatigue, weight loss

do NOT smoke, low intake of charcoal broiled foods

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18
Q

Cholinesterase Inhibitors INTERACTIONS

A

anticholinergic agents, acetylcholinesterase inhibitors, cholinergic agonists

St. John’s wort, Gingko biloba

MONITOR: weight loss, hypotension

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19
Q

Cholinesterase Inhibitor DOSAGE: Tacrine

A

10mg QID max 160mg

Onset rapid
peak 1-2 hrs
half life 2-4 hrs

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20
Q

Cholinesterase Inhibitor DOSAGE: Rivastigmine

A

3-6mg BID max 12mg

Onset intermediate
duration 10 hrs
half life 1.5hrs

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21
Q

Cholinesterase Inhibitor DOSAGE: Donepezil

A

5-10mg daily

Onset and duration unknown
half life 70hrs

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22
Q

Cholinesterase Inhibitor DOSAGE: Galantamine

A

regular 4mg BID 12-24mg

ER 8mg QID, max 24mg

Peak 1-4.5hrs
half life 7hrs

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23
Q

Memantine MOA/USES

A

Namenda

MOA: block receptors involved in learning and memory and excessive stimulation of NMDA receptors is believed to be involved in Alzheimer’s

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24
Q

Memantine CONTRA/CAUTION

A

CONTRA: prev sensitivity

CAUTION: seizure disorders, hepatic dysfunction, severe renal dysfunction

Clearance is significantly reduced by alkaline urine

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25
Q

Memantine AEs/INTERACTIONS

A

AE: dizziness, confusion, HA, hallucinations, somnolence, constipation, vomiting, weight loss

HTN- monitor BP

Interactions: drugs cause alkaline urine, carbonic anhydrase inhibitors, sodium bicarb

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26
Q

Memantine DOSAGE

A

Start 5mg per day and target dose of 20mg

Dose oral 2mg/mL or 5-10mg tabs

Peak 3-7hrs
Half life 60-80hrs

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27
Q

Selegiline MOA/USE

A

selective MAOI

5mg BID

Some evidence shows it may delay progression and possibly improve cognition

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28
Q

Selegiline AEs/INTERACTIONS

A

AE: orthostatic hypotension, hallucinations, agitation, insomnia

INC BP w/ tyramine containing foods

Interactions: carbamazepine, SSRI, TCA, SNRI, meperidine

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29
Q

Alzheimer’s Other Agents

A
  1. ergoloid mesylates
  2. NSAIDs and estrogen replacement: lack well-designed efficacy studies
  3. statins: theory DEC cholesterol in brain will reduce plaque formation
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30
Q

Alzheimer’s Noncognitive Sx Management

A

used to manage sx of AD:
1. antipsychotics
2. benzos
3. antidepressants

FIRST line: cholinesterase inhibitor, DONEPEZIL

SECOND line: Add vit E or Selegiline

THIRD line: switch cholinesterase inhibitor

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31
Q

Alzheimer’s MONITORING

A
  1. follow-up every 3-6 months to monitor cognitive and behavioral sx. Switch if no improvement
  2. add memantine if MMSE score <10
  3. Assess ADL’s
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32
Q

ADHD Drug Therapy

A
  1. Stimulants
  2. Non-Stimulants
  3. Antidepressants
  4. Clonidine
33
Q

Stimulant: Dextroamphetamine USES/MOA

A

Schedule II
PREG C

Adults: narcolepsy, exogenous obesity
Peds: narcolepsy, ADHD

ASSESS: psychopathology, homicidal, suicidal, or addiction

34
Q

Stimulant: Dextroamphetamine AEs/CONTRA

A

AVOID ETOH, caffeine, OTC meds

Can cause physical dependency

Taper dose when d/c

AE: dry mouth, N/V/D, altered libido

DM: monitor BG

REPORT: CNS changes, abd distress, changes in sexual behavior, blurred vision

35
Q

Stimulant: Methylphenidate USES/MOA

A

Schedule II
PREG C

Adults: narcolepsy, ADHD
Peds (>6yo): ADHD

36
Q

Stimulant: Methylphenidate CONTRA/CAUTION

A

AVOID ETOH, CNS drugs, take on empty stomach

CAUTION: seizure disorders

MONITOR BP, CBC, growth

37
Q

Stimulant: Methylphenidate AE/INTERACTIONS

A

AE: cardiovascular events, HA, insomnia, anorexia, N/V, tics, weight loss, EPS, NMS

Interactions: Alpha2-agonists, anticonvulsants, anticoagulants, TCA, SSRI, ETOH

38
Q

Stimulant: Dexmethylphenidate HCl USES/MOA

A

Schedule II
PREG C

Adults/peds (>6yo): ADHD

39
Q

Stimulant: Dexmethylphenidate HCl CONTRA/CAUTION

A

CONTRA: marked anxiety, tension, agitation, glaucoma, Hx of tics or Tourette’s in patient/family, use of MAOI

CAUTION: seizure disorders, paradoxical symptoms, HTN, heart disease, hyperthyroidism

40
Q

Stimulant: Dexmethylphenidate HCl AEs/MONITOR

A

AE: HA, anorexia, abd pain, insomnia, weight loss, nausea, dizziness, dyskinesia, HTN, tics, psychosis, seizures, blood dyscrasias

MONITOR: Ht/Wt, emotional instability, behavior disturbance, thought disorders, BP, CBC

41
Q

Stimulant: Lisdexamfetamine BLACK BOX

A

Schedule II
PREG C

Black box: serious cardiovascular events including SUDDEN DEATH in patients w/ pre-existing cardiac abnormalities or other serious heart problems

Black box: potential for drug dependency w/ prolonged use

42
Q

Stimulant: Lisdexamfetamine CONTRA/CAUTION

A

CONTRA: Hx drug abuse, use of MAOI, glaucoma, agitation, hypersensitivity or use of sympathomimetics

CAUTION: bipolar disorder, psychosis, tics, tourette’s, seizure, impaired renal, hepatic, thyroid

43
Q

Stimulant: Lisdexamfetamine AEs/INTERACTIONS

A

AE: DEC appetite, weight loss, dry mouth, irritability, jitteriness, dizziness, HA, anxiety, fatigue, insomnia, upper abd pain, GI upset, HTN, blurred vision, psychosis, tics, rash

Interactions:
1. risk serotonin syndrome w/ SSRI
2. TCA may cause hypertensive crisis
3. NO ETOH or other CNS stimulants

May take w/ or w/o food

44
Q

Non-Stimulant: Atomoxetine USES/MOA

A

Non-stimulant
PREG C

Black Box: may INC risk of suicide ideation in peds patients

cardiac risk

dose adjustment w/ hepatic impairment

Adults: ADHD
Peds (>6yo): ADHD based on weight

45
Q

Non-Stimulant: Atomoxetine CONTRA/CAUTION

A

CONTRA: MAOI, glaucoma

CAUTION: HTN, cardiac disease, hepatic dysfunction, psychosis, bipolar, depression

46
Q

Non-Stimulant: Atomoxetine AEs/MONITOR/INTERACTIONS

A

AE: HA, insomnia, xerostomia, abd pain, N/V, anorexia, cough

MONITOR: growth, BP, pulse, suicidal ideation, aggressive behavior or hostility, depression

NO ETOH

47
Q

Guanfacine USE/MOA

A

Newest drug

TX: ADHD in children and adolescents 6-17 yo

Selective alpha-2 adrenergic receptor agonist

Same drug as HTN med Tenex

48
Q

Guanfacine AE/INTERACTIONS

A

AE: somnolence, sedation, abd pain, dizziness, constipation, hypotension

CAUTION: hypotension, bradycardia, syncope

Dose adjustment w/ hepatic or renal impairment

Do NOT stop abruptly

49
Q

ADHD Other Treatment

A

TCA is SECOND-LINE tx

Bupropion efficacy not different from methylphenidate

Clonidine used for mood, activity level, cooperation and frustration

50
Q

Anticonvulsants GOALS of THERAPY

A
  1. DEC # of seizures
  2. Completely control seizures IDEAL
  3. Improved QOL
  4. Return to normal ADLs
51
Q

Phenytoin MOA/USES

A

Dilantin
oldest and most effective

FIRST LINE MONOTHERAPY

Use: generalized tonic-clonic (grand mal), any seizure type

Prevents seizure post head trauma, neurosurgery, hemorrhagic stroke

MOA: DEC influx Na ions across cell membrane, inhibit Ca conduction

52
Q

Phenytoin CONTRA/AEs

A

Dosage: loading dose followed by normal maintenance dose based on weight in adults, age in children

MONITOR: serum levels
PROTEIN BOUND

CONTRA: allergies

AE: hypotension, bradycardia, arrhythmias, CV collapse, thrombophlebitis, GINGIVAL HYPERPLASIA, SJS

53
Q

Fosphenytoin (Cerebyx) MOA/USES

A

Prodrug of phenytoin

parenteral

short-term use when phenytoin unavailable, inappropriate, or less advantageous

WARNING: do NOT confuse w/ celebrex

54
Q

Carbamazepine (Tegretol) MOA/USES

A

FIRST LINE MONOTHERAPY: simple/complex partial sz

MOA: limit influx of Na ions

Start LOW and INC weekly

Drug monitoring

55
Q

Carbamazepine CONTRA/AEs

A

CONTRA: allergy to drug or TCA, bone marrow suppression, recent MAOI

AE: hematologic abnormalities, drowsiness, fatigue, SIADH, rash, GI upset, confusion

May exacerbate myoclonic sz

INC risk SJS in Asians

AE (concentration related): dizziness, drowsiness, N/V, tremors, agitation, arrhythmias, coma, resp depression

56
Q

Oxcarbazepine (Trileptal) MOA/USES

A

Monotherapy or adjunctive: partial szs

MOA: block Na channels to stabilize hyper neural membranes

Also used: bipolar disorder, trigeminal neuralgia

57
Q

Oxcarbazepine CONTRA/AEs

A

CONTRA: allergy

AE: dizziness, somnolence, diplopia, N/V, ataxia, abd pain

58
Q

Valproic Acid (Depakote) MOA/USES

A

FIRST LINE: generalized tonic clonic, simple partial, complex partial, absence

Monotherapy or adjunctive: complex partial & complex absence sz

MOA: work on GABA

Also used: bipolar disorder-manic, migraine prophylaxis

59
Q

Valproic Acid CONTRA/AE

A

CONTRA: hepatic disease, urea cycle disorders

AE: fatigue, tremor, GI upset, behavioral changes, weight gain

Severe AE: thrombocytopenia, pancreatitis, encephalopathy, hepatotoxicity

60
Q

Ethosuximide (Zarontin) MOA/USES

A

DOC: absence szs

Always in combo w/ another drug

MOA: unknown

CONTRA: allergy

AE: GI upset, fatigue

61
Q

Barbiturates (Phenobarbital) MOA/USES

A

broad spectrum activity

Alternative monotherapy: generalized tonic-clonic

Sedating

long-term cognitive, memory, and behavioral effects

dependency issues

phenobarb most commonly used

MOA: binds to GABA

CHEAP
Loading dose, followed by maintenance dose

frequent drug monitoring

62
Q

Barbiturates CONTRA/AE

A

CONTRA: severe liver disease, resp disease, Hx of sedative or hypnotic addiction

AE: drowsiness, fatigue, ataxia, N/V, blurred vision, constipation, cognitive impairment, arrhythmias, dizziness

63
Q

Barbiturates OVER DOSAGE/INTERACTIONS

A

Over dosage: unsteady gait, slurred speech, confusion, jaundice, hypothermia, hypotension, resp depression, coma

Interactions: INC toxicity w/ benzos, CNS depressants, methylphenidate

64
Q

Gabapentin (Neurontin) MOA/USES

A

Adjunct therapy: complex partial sz, generalized tonic-clonic

MOA: DEC presynaptic GABA release

mainly used in neuropathic pain control

65
Q

Gabapentin CONTRA/AE/ INTERACTIONS

A

CONTRA: hypersensitivity

AE: fatigue, dizziness, blurred vision. May resolve over time. Some reports of weight gain

Interactions: Antacids may block absorption

66
Q

Pregabalin (Lyrica) MOA/USES

A

one of newest

adjunctive therapy: partial onset sz

MOA: binds to Ca channels to inhibit excitatory neurotrans release

Other uses: fibromyalgias, post-herpetic neuralgia, neuropathic pain

67
Q

Pregabalin CONTRA/AE/ INTERACTIONS

A

CONTRA: hypersensitivity

AE: peripheral edema, weight gain

Interactions: enhance sedative effect of CNS depressants

68
Q

Lamotrigine (Lamictal) MOA/USES

A

Generalized tonic-clonic, absence, complex partial

MOA: stabilizes neuronal membranes by acting on amino acid release and Na channels

Also used: bipolar maintenance

69
Q

Lamotrigine CONTRA/AE

A

CONTRA: hypersensitivity

AE: N/V, fatigue, dizziness

70
Q

Levetiracetam (Keppra) MOA/USES

A

adjunctive partial onset or primary generalized tonic-clonic

MOA: facilitate GABA transmission, reduce K+ currents

71
Q

Levetiracetam CONTRA/AE

A

CONTRA: hypersensitivity

AE: somnolence, HA, infection, usually within first 4 wks, behavioral changes

72
Q

Topiramate (Topamax) MOA/USES

A

Monotherapy or adjunctive: partial onset sz, generalized tonic-clonic

MOA: block Na channels by enhancing GABA activity

Do NOT stop abruptly

Also used: migraine prophylaxis

73
Q

Topiramate CONTRA/AE

A

CONTRA: hepatic or renal impairment, pregnancy, breast-feeding

AE: fatigue, dizziness, somnolence, psychomotor slowing (stupidimate), memory difficulty, nausea, weight loss, change in taste

74
Q

Weight loss: Who Qualifies

A
  1. 20% of more over ideal body weight
  2. BMI >27 w/ 1 comorbid condition
  3. BMI >30
75
Q

Weight loss: Amphetamines

A

Not widely used

HIGH risk abuse and cardiovascular SEs

Schedule II

Dextroamphetamine and methamphetamine

MOA: INC release Norepi

Use at lowest effective dose

76
Q

Appetite Suppressants: Nonamphetamine Derivatives

diethylpropion (tenuate), phendimetrazine (bontril), phentermine (adipex)

A

tolerance may develop after a few weeks

MOA: DEC appetite by stimulating hypothalamus to release catecholamines norepi and dopamine

Schedule II

potential for abuse

CONTRA: MAOIs

AE: CNS stimulation, dry mouth, nausea, INC BP, tachycardia

CAUTION in DM

77
Q

Lipase Inhibitor (Orlistat)

A

work locally in GI

blocks absorption of fats

take during or 1 hr after fat containing meal, meal should contain less than 30% fat

CONTRA: malabsorption syndrome, cholestasis

AE: diarrhea, fatty stools, flatulence, leakage, nausea, abd pain, DEC absorption fat soluble vitamins

TAKE multivitamin

CAUTION w/ coumadin b/c changes in Vit K

78
Q

Weight loss: Other Agents

A
  1. Antidepressants: bupropion
  2. Diabetes: metformin, byetta, januvia
  3. Antiseizure meds: topirimate, aonisamide
79
Q

Weight loss: Qsymia (phentermine and topiramate)

A

Newest

Combo appetite suppressant and antiseizure med

PREG X

Warning/Precaution: tachycardia, suicidal behavior/ideation, glaucoma, mood and sleep disorder, cognitive impairment, metabolic acidosis

Potential seizure w/ abrupt withdrawal of med

AE: tachycardia, suicidal ideation, acute angle glaucoma, mood and sleep disorder, cognitive impairment, metabolic acidosis

Pharmacology (12 decks)

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