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Pharm Flashcards

0
Q

What worsens Parkinsons?

A

meds (antinauseua)

increasing Ach, decreasing Dopamine

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1
Q

Drugs for Parkinson?

A

Benztropine

Levodopa/Carbidopa

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2
Q

What is the goal of Parkinson pts?

A

Increasing Dopamine

Decreasing Ach

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3
Q

Parkinson-What is the last resort drug?

A

Levodopa/Carbidopa

issue b/c if used early on, there is no tx for long term

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4
Q

Parkinson - BBB issue?

A

Dopamine itself does NOT pass the BBB - drugs must pass the BBB and THEN convert to dopamine

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5
Q

What drugs for rigidity and akinesia?

A

Amontadine

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6
Q

What drug helps w/ tremors?

A

Anticholingeric (Benztropine)

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7
Q

What does GABA do?

A

slows neurological movement down

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8
Q

Parkinson - What happens to GABA?

A

There is no dopamine so there is a GREAT increase of Ach –> hypokinesia

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9
Q

What is Benztropine doing to GABA?

A

blocks Ach so it can decrease Ach –> improve movement (tremor and drooling)

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10
Q

Is Benztropine better or Levodopa?

A

Benztropine is not as effective as Levodopa BUT “start low and slow” (Levodopa is NOT first line)

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11
Q

Benztropine MOA?

A 
mostly anticholinergic (dec Ach) but may also incr dopamine
helps w/ tremors NOT rigdity and akinesia
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12
Q

Benztropine ADR?

A 
DO NOT USE IN ELDERLY (cognitive probs - over 70yo) - use Levodopa instead
orthostasis
delirium
constipation 
"mad as a hatter"
"blind as a bat"
"dry as bone"
"red as a beet"
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13
Q

Benztropine - how to dec ADRs?

A

titration is needed “start low and slow”

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14
Q

Benztropine - who do you avoid?

A

Alzheimer’s
Dementia
Cognitive issues
Elderly

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15
Q

Benztropine - DI?

A

ADR duplication

anything w/ anticholinergic effect (benadryl)

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16
Q

Amantdaine?

A
  • antiviral
  • helps promote Dopamine from the synapse and inhibits reuptake
  • increasing Dopamine and decreasing Dopamine that is reabsorbed
  • neuroprotective benefits
  • helps w/ Parkinson sx
  • can be used w/ Levodopa (helps w/the fluctuation of the half life)
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17
Q

Amantadine ADR?

A
  • pts can build a tolerance –> drug holiday (bursts of the drug)
  • MUST taper off (esp during the drug holiday)- do not stop abruptly
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18
Q

What is the point of using Benztropine and Amantadine?

A

to delay the use of Levodopa

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19
Q

Monoamine Oxidase inhibitors?

A
  • parkinson
  • can increase dopamine levels
  • prevent free radicals
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20
Q

MAO - B inhibitors ADR?

A

CNS irritation (sleepiness, depression)
N&V&D
Constipation
syncope

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21
Q

Apomorphine, Bromocriptine, cabergoline?

A
  • bind to dopamine receptors
  • dopamine agonist
  • metabolized differently
  • can be used alone or supplemental (use less Levodopa if used together)
  • young pts
  • helps w/ fluctuations of levodopa
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22
Q

Dopamine agonist -ADR?

A 
CNS issues (hallucination, confusion, fainting, syncope)
constipation, diarrhea
peripheral edema (thiazide)
drink w/ water
RLS if removed abruptly
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23
Q

Levodopa/Carbidopa?

A

prodrug (not active until metabolized)
metabolized in GI
given w/ carbidopa

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24
Q

How does Levodopa and Carbidopa work together?

A

Levodopa - 1-3% to the brain

+ Carbidopa - 10% to the brain

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25
Q

Levodopa/Carbidopa population?

A

cognitive impairment
elderly
motor skills are impaired
intitaion of therapy is individualized

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26
Q

Levodopa ADR?

A 
GI issues (N&V) - can take w/ food but efficacy goes down
postural hypotension
irreversible dyskinesias
behavioral effects (depression, anxiety)
resistance of the drug
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27
Q

Levodopa half life?

A

90 min
wearing off (efficacy goes away) –> “on and off” motor fluctuations
can give together w/ MAO B inhibitor

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28
Q

Levodopa timeline?

A

honey moon (no sx) - 3 yrs
wearing off - 3-5 yrs
on - off dyskinesia -5-10yrs
*drug holidays does not help-DO NOT DO

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29
Q

Levodopa DI?

A

dopamine agonist can worsen ADR
ADR duplication
MAO I used for depression

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30
Q

COMT inhibitors?

A

increases dopamine in the brain
increases Levodopa to the brain
prevents breakdown of dopamine in the brain
helps fluctuations of Levodopa

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31
Q

COMT inhibitors - labs?

A

watch liver enzymes

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32
Q

Tension headache - sx?

A 
upper back and neck
base of head
ears, above ears
jaw
above the eyes
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33
Q

What to keep in mind when tx HA and drugs?

A

episodic HA can turn into chronic headache - d/t meds (rebound)

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34
Q

HA -cx?

A

DRUGS!

can be drug withdrawal headache

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35
Q

Acetaminophen ADR?

A

alcohol

hypersensitivity

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36
Q

Migraine tx?

A

earlier the better
OTC: excedrin extra strength - first line
triptan (sumatriptan, rizatriptan) - “second line” but first line w/ migraine is severe

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37
Q

Sumatriptan ADR?

A

N&V

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38
Q

Triptan MOA?

A

abortive NOT prophylactic
faster the better
selective 5HT 1D and 2B agonist –> interrupts the pain signal through the trigeminal nerve)

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39
Q

Sumatriptan MOA?

A

first triptan, cheapest

not as effective as Rizatriptan

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40
Q

Rizatriptan MOA?

A

more lipophilic than sumatriptan, more effective

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41
Q

Sumatriptan and Rizatriptan ADR?

A 
bad taste
GI upset
dizziness
vasoconstrictor: coronary artery spasm, MI, CVA
seizure 
blindness
hypersensitivity
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42
Q

Sumatriptan and Rizatriptan DI?

A

ADR duplication

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43
Q

Triptan forms?

A

oral (cheapest)

skip the GI absorption, etc –> sublingual, nasal

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44
Q

Ergot alkaloids?

A 
abortive
vasoconstricts - decreased blood flow to extremities and decreases pulsatile headache 
like triptan but not as effective 
faster, better
add caffeine  to increase efficacy
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45
Q

Ergot Alkaloids ADR?

A

rebound HA
toxicity (Nausea, diarrhea, constipation, etc)
do not use in pregnancy

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46
Q

Ergo alkaloid forms?

A

oral

47
Q

Migraine prophylactic management criteria?

A

migraine is so bad that it disrupts daily activities

more than 2x/mo

48
Q

Migraine prophylactic goal?

A

GOAL:

reduce 15%

49
Q

Migraine prophylactic management - is it working?

A

1 mo

50
Q

Migraine prophylactic drugs?

A

Propranolol
Nortiptyline
SSRI (venlafaxine)
Gabapentin (anticonvulsants)

51
Q

Cluster HA - tx?

A

abortive - triptans, erogtamines
100% if avail
NO narcotics

52
Q

Prophylactic cluster HA drugs?

A

Topiramate

53
Q

Prevention of recurrent stroke?

A

Tx RF: HTN, diabetes, lipids
antiplatelet therapy (ASA)
lifestyle modification
statins

54
Q

Ischemic stroke - tx?

A

tPA - if able to use

55
Q

TIA - tx?

A

do not jump to tPA - unless you can prove to be a stroke
ASA! - long term
statin

56
Q

Common cx of bacterial meningitis?

A

ALL PREVENTABLE
1) Neisseria Meningitidis (places w/ mold and high humidity) - multiply in nasal mucous
2)
3)

57
Q

Population of the bacterial meningitis?

A

immunosuppressed
young
old

58
Q

Polio - sx?

A

variable (some people are asymptomatic)
aseptic menigitis
paralytic
CONTAGIOUS

59
Q

Meningococcal vaccination?

A

two doses are reommended

60
Q

Polio vaccination?

A

now is inactive vaccine (live vaccine is out)

total of 4 doses

61
Q

Neuropathic pain - cx?

A

inflammation of infxn
surgery
trauma
genetically

62
Q

Neurological pain?

A

not like regular pain

can cause damage to nerves

63
Q

Neurological pain - tx?

A

mitigate the pain, not completely tx (tolerable pain)
start low and slow
ibuprofen, acetaminophen, et do not work
TCAs, SNRIs, topical lidocaine, opioids, NA ch blockers, anticonvulsants - Gabapentin* and Pregabalin*

64
Q

Gabapentin?

A

neuropathic pain - esp postherpetic neuralgia and polyneuropathies
relieve atypical pain
insomnia (can help w/ comorbidities)

65
Q

Gabapentin and Pregabalin ADR?

A

peripheral edema
sedating
well tolerated
hypersensitivity rxn

66
Q

Pregabalin?

A

used for diabetics
fibromyalgia
insomnia and anxiety (helps w/ comorbidities)

67
Q

tPA is good until?

A

4.5 hrs

68
Q

neuropathetic pain -tx?

A

NOT NSAID, acetaminophen

YES anticulvansts

69
Q

Low Ach levels?

A

cognitive impairment

70
Q

Parkinson AND dementia?

A

parkinson - give anticholinergic (brings down Ach)
BUT dementia too? (you want to increase Ach)
teeter totter - balance!

71
Q

Antiepileptic drugs used for?

A

prevent epilepsy (unprovoked)

72
Q

1st seizure? Then 2nd one will occur..?

A

within the next 2 yrs

73
Q

Goal of epilepsy?

A

tx underlying trigger and avoid

74
Q

Keppra?

A

well tolerated

well used in peds

75
Q

Most effective anticonvulsants?

A

Valproic acid but not well tolerated

76
Q

Well tolerated anticonvulsants?

A

Lamatrigine but not as effective as valproic acid

77
Q

What to keep in mind for pts taking anticonvulsants?

A

depresses CNS so suicide rate goes up

78
Q

Acute seizure-tx?

A

diazepam and lorazepam

79
Q

How does anticonvulsant work?

A

enhancing GABA abilities

opens up Cl channels –> slows down the signaling (inhibitory) –> enhances GABA effects

80
Q

Drug classification foor Diazepam and Lorazepam?

A

benzodiazepine

81
Q

Does benzodiazepine increase GABA?

A

no, just enhances the effectiveness of GABA

82
Q

How does benzodiazepine work?

A

dose based
anxiety - small dose
sedation - little more
loss of consciousness/hypnosis - heavy dose

83
Q

Benzodiazepine - ADR?

A

CNS depression - sedation, drowsiness
dependence: NOT GOOD FOR LONG TERM; ONLY FOR SHORT TERM
CARDIOPULM pts - respiratory/cardio depression

84
Q

Benzodiazepine - DI?

A

ETOH
other CNS depressants
CYP 450 - liver

85
Q

Carbamazepine?

A

anticonvulsant - first gen

inhibits repetitive firing by blocking Na channels

86
Q

Carbamazepine - important labs to check?

A

check HLA in asians

87
Q

Carbamazepine - what kind of characteristics does it have?

A 
anticholinergic
antidiuretic
antiarrhythmic
muscle relaxant
anti depressant
sedative
88
Q

Carbamezpine - ADR?

A

GI
rash/itchy
CNS disturbances
bone marrow depression

89
Q

Carbamazepine - DI?

A

CYP450 and inducer (speeds up metabolism) - CHECK OTHER DRUGS
ADR duplication

90
Q

Phenytoin-drug use?

A

do not stop abruptly

used for partial seizures

91
Q

Phenytoin- labs?

A

serum levels - CBCs, LFTs (liver toxicity) HLA

92
Q

Phenytoin - ADR?

A

GI upset
gingival hyperplasia
CNS irritability

93
Q

Phenytoin - DI

A

CYP 450 and inducer

94
Q

Valproate (Valporic acid) - drug use?

A

MHA
seizure
first generation anticonvulsant

95
Q

Valproate - labs?

A

serum levels - LFT CBC

96
Q

Valproate - ADR?

A 
do not chew meds
GI upset
hepatoxcity
hyperammonemia (encephalopathy can occur)
thrombocytopenia
97
Q

Topiramate?

A 
anticonvulsant second generation 
seizures
MHA 
prophylactic for cluster HA 
Na channel blocker
*glutamiate (opp of GABA - excitatory part of the brain) inhibitor 
enhances GABA
98
Q

Topiramate - ADR?

A

flushing
loss of appetite
epistaxis
metabolic acidosis

99
Q

Topiramate - DI?

A

CYP 450 inducer

100
Q

Lamotrigine -ADR?

A

RASH!
aspetic meningitis
DIC
hypersensitivity (esp if they’re young and HD)

101
Q

Lamotrigine - DI?

A

OCP

102
Q

Alzheimer’s Dz?

A

decrease in Ach

103
Q

Alzheimer dz drugs?

A

acetyl cholinesterease inhibitor

104
Q

Donezepil -drug use?

A

reversible acetyl cholinesterase inhibitor
dementia
dose dependent

105
Q

Donezepil - when to take? what to monitor?

A

bedtime

HR and BP

106
Q

Donezepil - ADR?

A

GI - diarrhea, loss of appetite

HTN –> AV block, seizures, syncope

107
Q

Donezepil - DI?

A

anticholinergic
CYP450
ADR duplication

108
Q

Memantine?

A

used for severe Alzheimer
Glutimate inhibitor - blocks the excitatory part of the brain
helps w/ memory fxn

109
Q

MS tx?

A

methotrexate
baclofen
SSRi
gabapentin

110
Q

MS sx?

A 
balance and coordination
fatigue
bladder probs
bowel probs
pain
sensory
depression
111
Q

Modafinil?

A

antinarcoleptic stimulant

112
Q

Modafinil?

A

can be addictive

113
Q

Modafinil -monitor?

A

BP

114
Q

Modafinil -ADR/

A 
rash
G upset
dizziness
CNS irritation
HTN

Neurology (13 decks)

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