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NAPLEX STUDY > Parkinsons, alzheimers, seziures > Flashcards

Parkinsons, alzheimers, seziures Flashcards

1
Q

pathophysiology of parkinsons

A

less dopamine –> less instructions to the brain –> movement problems

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2
Q

TRAP major symptoms

A

Tremor
Rigidity
Akinesia/bradykinesia
Posture instability

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3
Q

Dopamine blocking medications that can worsen PD

A

-phenothiazines (prochlorperazine) used for psychosis, nausea, agitation
-butyrophenones (haldol, droperidol) used for psychosis and behavior disorders for nausea
-first and second generation antipsychotics (risperidone at high doses, paliperidone)
-metoclopramide (can accumulate)

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4
Q

primary treatment of PD

A

-give precursor to dopamine that becomes dopamine in the brain (Sinemet)
-give a dopamine agonist that acts like dopamine to prevent “off” periods
-give other drugs for specific symptoms (benztropine for resting tremor)

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5
Q

Carbidopa/Levodopa (Sinemet)

A

-precursor of dopamine
-carbidopa inhibits dopa decarboxylase enzyme preventing peripheral metabolism of levodopa
-CI: non-selective MAOi w/in 14 days
-nausea, dizziness, orthostasis, dyskinesia, hallucinations, psychosis, unusual sexual urges, priapism
-can cause brown/black coloring of the urine
-COOMBs test if positive d/c
-7-10 mg/day is required to inhibit dopa decarboxylase
-do not discontinue abruptly

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6
Q

Dopamine agonists

A

-Pramipexole (Mirapex, Mirapex ER)
-Ropinirole (Requip XL)
-somnolence, orthostasis, hallucinations, dyskinesia
-do not discontinue abruptly

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7
Q

other drugs used to treat PD

A

-amantidine (blocks dopamine reuptake into presynaptic neurons and increases doapmine release)
-MAO-B inhibitors (block the breakdown of dopamine): Selegiline, Rasagiline

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8
Q

Benztropine (Cogentin)

A

-used for tremor
-anticholinergic side effects

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9
Q

Drugs that worsen dementia

A

-antiemetics (promethazine)
-antihistamines (diphenhydramine, doxylamine)
-antipsychotics (chlorpromazine, aripiprazole)
-barbiturates (phenobarbital, butabital)
-BZD (alprazolam, clonazepam)
-central acting anticholinergic (benztropine)
-peripheral anticholinergic (incontinence and IBS drugs)
-skeletal muscle relaxants (baclofen)
-other CNS depressants (opioids, sedative-hypnotics)

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10
Q

natural products for Alzheimers

A

vitamin E and ginkgo

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11
Q

mild to moderate Alzheimer’s tx

A

start anticholinesterase inhibitors (donepezil, rivastigmine, galantamine)

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12
Q

moderate to severe Alzheimer’s tx

A

start anticholinesterase inhibitors (donepezil, rivastigmine, galantamine) +/- memantine

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13
Q

if alzheimers progresses on maintenance medication or stable on donepezil 10 mg

A

switch to Namzaric (donepezil + memantine)

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14
Q

Anticholinesterase inhibitors

A

-donepezil (Aricept)
-Rivastigmine (Exelon)
-cardiac: bradycardia, syncope, QT prolongation
-nausea (donepezil dosed QHS to decrease nausea), diarrhea
-patch and ODT have less GI effects

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15
Q

NMDA blocker

A

-Memantine (Namenda)
-dizziness, confusion, headache
-do not crush or chew - can sprinkle on food

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16
Q

Drugs that lower the seizure threshold

A

bupropion
clozapine
theophylline
vareniciline
carbapenems
lithium
meperidine
penicillin
quinolones
tramadol

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17
Q

Status epilepticus treatment

A

-0-5 min (stabilization phase): stabilize with ECG, O2
-5-20 min (initial treatment phase/if seziure continues): IV lorazepam or Midazolam or rectal/buccal/nasal spray midazolam
-20-40 min (if seziure continues): IV fosphenytoin, valproic acid, levetiracetam

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18
Q

Distat Acudial Dispensing

A

-syringes must be dialed to the right dose and locked before dispensing
1. hold the barrel of the syringe in one hand with the cap facing down and the dose window visible. Do not remove the cap
2. use the other hand to grab the cap firmly and turn and adjust the dose
3. confirm the correct dose shows in the window. hold the locking ring at the bottom of the syringe barrel and push upward to lock both sides of the ring
-once locked the green band should say ready and the syringe cannot be unlocked

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19
Q

AEDs that increase GABA

A

BZD and valproic acid

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20
Q

AEDs that enhance/potentiate GABA effect

A

phenobarbital

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21
Q

AEDs that increase GABA and are a CCB

A

levetiracetam

22
Q

AEDs that are T-type CCB

A

ethosuximide

23
Q

AEDs that are CCB

A

pregabalin/gabapentin

24
Q

AEDs that are Na and Ca channel blockers

A

oxacarbazepine

25
Q

AEDs that are Na channel blockers

A

carbamazepine, lamotrigine, phenytoin/fosphenytoin, topiramate

26
Q

Carbamazepine, Oxcarbazepine, Eslicarbazepine

A

hyponatremia, rash, enzyme induction

27
Q

Gabapentin and pregabalin

A

weight gain, peripheral edema, mild euphoria

28
Q

Phenobarbital and Primedone

A

sedation, dependence/tolerance/OD risk, enzyme induction

29
Q

Topiramate and zonisamide

A

weight loss, metabolic acidosis
-nephrolithiasis and oligohidrosis/hyperthermia

30
Q

Supplementation with AEDs

A

-ALL AEDS: calcium and vitamin D
-women of bearing age: folate
-valproic acid: possibly carnitine
-lamotrigine and valproic acid: selenium and zinc (if alopecia develops)

31
Q

Lamotrigine (Lamictal, Lamictal ODT, Lamictal starter kit, lamictal XR)

A

-doses need to be just right and titrated slowly to prevent serious skin infection
-SJS/TEN
-alopecia (selenium/zinc)
-valproic acid increases lamotrigine more than 2 fold
-carbamazepine, phenytoin, phenobarb decrease lamotrigine levels by 40%

32
Q

Lamotrigine dosing

A

week 1-2: 25 mg daily
week 3-4: 50 mg daily
week 5 and on: can increase by 50 every 1-2 weeks
-start with the standard dose if no interacting medications
-start with a lower dose if using valproic acid
-start with a higher dose if taking carbamazepine, phenytoin, phenobarb and not taking valproic acid.

33
Q

Levetiracetam (Keppra)

A

-maximum: 3 g/day
-CrCl <80 mL/min
-IV:PO 1:1
-psychiatric reactions, including psychotic symptoms, somnolence, fatigue

34
Q

Topiramate (Topamax)

A

-titrate doses over 5 weeks
-max dose: 400 mg/day
-CrCl < 70 mL/min: decrease dose by 50%
-metabolic acidosis, oligohidrosis (reduced perspiration), nephrolithiasis, angle closure glaucoma, hyperammonemia, visual problems, fetal harm
-somnolence, memory/concentration/attention, weight loss, anorexia
-monitor bicarb

35
Q

Valproic acid
Divalproex (Depakote, Depakote ER, Depakote sprinkle)

A

-initial 10-15 mg/kg/day
-max: 60 mg/kg/day
-therapeutic range: 50-100 mcg/mL
-boxed warning: hepatic failure, fetal harm
-hyperammonemia (treat with carnitine), dose-related thrombocytopenia, alopecia
-LFTs, platelets

36
Q

Carbamazepine (Tegretol, Tegretol XR)

A

-max: 1600 mg/day
-therapeutic range: 4-12 mcg/mL
-serious skin reactions (test for HLA-B*1502)
-aplastic anemia and agranulocytosis, myelosuppression

37
Q

Lacosamide (Vimpat)

A

-max: 400 mg/day
-CrCl < 30 mL/min: max dose 300 mg/day
-IV to PO: 1:1
-prolongs PR interval and increases risk of arrhythmias

38
Q

Oxcarbazepine (Trileptal)

A

-max: 2400 mg/day
-carbamazepine to oxcarbazepine dose conversion 1.2-1.5x carbamazepine dose
-serious skin rxns HLA-B*1502

39
Q

Phenobarbital

A

-therapeutic range: 20-40 mcg/mL (adults)
-habit-forming, respiratory depression, fetal harm, physiological dependence, tolerance, hangover effect

40
Q

Phenytoin (Dilatin, Dilatin Infatabs)
fosphenytoin (Cerebyx)

A

-fosphenytoin is the prodrug of phenytoin
-LD: 15-20 mg/kg
-MD: 300-600 mg/day *fosphenytoin is dosed in PE (fosphenytoin 1.5 mg = 1 mg PE)
IV-PO = 1:1
-total level: 10-20 mcg/mL
-free level: 1-2.5 mcg/mL
-phenytoin IV rate should not exceed 50 mg/min and fosphenytoin should not exceed 150 mg/PE/min (hypotension/cardiac arrhythmias)
-purple glove syndrome if extravasation

41
Q

IV phenytoin

A

-do not exceed 50 mg/min
-monitor BP, respiratory function and ECG
-requires a filter
-dilute NS stable for 4 hours, do not refrigerate

42
Q

NG-tube Phenytoin

A

-enteral feedings decrease phenytoin absorption
-hold feedings 1-2 hours before and after administration

43
Q

IV fosphenytoin

A

-do not exceed 150 mg/PE/min
-monitoring BP, respiratory function, and ECG
-lower risk of purple glove syndrome than phenytoin

44
Q

ethosuximide (Zarotin)

A

-used for absence seziures , SJS/TEN, blood dyscrasias

45
Q

other drugs

A

-gabapentin (neurotin)
-Pregabalin (Lyrica)
-Primidone (mysoline) - prodrug of phenobarbital

46
Q

adjusting phenytoin doses

A

-phenytoin has michaelis-Menten kinetics also called saturable kinetics
-if the enzyme have become saturated, a small increase in dose can cause a large increase in drug level
-if albumin is low (< 3.5) and CrCl > 10 adjust the total level with the formula
-free levels do not require correction

47
Q

phenytoin correction

A

total phenytoin measured / (0.2 x albumin) + 0.1

48
Q

AEDs: enzyme inducers

A

carbamazepine, oxacarbazepine, phenytoin, fosphenytoin, phenobarbital, primidone

49
Q

AEDs: enzyme inhibitor

A

valproic acid

50
Q

AEDs are CNS depressants

A

-AEDs DEPRESS electrical activity in the brain; they are CNS-DEPRESSants, and cause dizziness, confusion, sedation, and ataxia/coordination difficulties
-increase the risk for impairment, falls, and injuries

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