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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
How does Levodopa and Carbidopa work together?
Levodopa - 1-3% to the brain | + Carbidopa - 10% to the brain
25
Levodopa/Carbidopa population?
cognitive impairment elderly motor skills are impaired intitaion of therapy is individualized
26
Levodopa ADR?
``` GI issues (N&V) - can take w/ food but efficacy goes down postural hypotension irreversible dyskinesias behavioral effects (depression, anxiety) resistance of the drug ```
27
Levodopa half life?
90 min wearing off (efficacy goes away) --> "on and off" motor fluctuations can give together w/ MAO B inhibitor
28
Levodopa timeline?
honey moon (no sx) - 3 yrs wearing off - 3-5 yrs on - off dyskinesia -5-10yrs *drug holidays does not help-DO NOT DO
29
Levodopa DI?
dopamine agonist can worsen ADR ADR duplication MAO I used for depression
30
COMT inhibitors?
increases dopamine in the brain increases Levodopa to the brain prevents breakdown of dopamine in the brain helps fluctuations of Levodopa
31
COMT inhibitors - labs?
watch liver enzymes
32
Tension headache - sx?
``` upper back and neck base of head ears, above ears jaw above the eyes ```
33
What to keep in mind when tx HA and drugs?
episodic HA can turn into chronic headache - d/t meds (rebound)
34
HA -cx?
DRUGS! | can be drug withdrawal headache
35
Acetaminophen ADR?
alcohol | hypersensitivity
36
Migraine tx?
earlier the better OTC: excedrin extra strength - first line triptan (sumatriptan, rizatriptan) - "second line" but first line w/ migraine is severe
37
Sumatriptan ADR?
N&V
38
Triptan MOA?
abortive NOT prophylactic faster the better selective 5HT 1D and 2B agonist --> interrupts the pain signal through the trigeminal nerve)
39
Sumatriptan MOA?
first triptan, cheapest | not as effective as Rizatriptan
40
Rizatriptan MOA?
more lipophilic than sumatriptan, more effective
41
Sumatriptan and Rizatriptan ADR?
``` bad taste GI upset dizziness vasoconstrictor: coronary artery spasm, MI, CVA seizure blindness hypersensitivity ```
42
Sumatriptan and Rizatriptan DI?
ADR duplication
43
Triptan forms?
oral (cheapest) | skip the GI absorption, etc --> sublingual, nasal
44
Ergot alkaloids?
``` abortive vasoconstricts - decreased blood flow to extremities and decreases pulsatile headache like triptan but not as effective faster, better add caffeine to increase efficacy ```
45
Ergot Alkaloids ADR?
rebound HA toxicity (Nausea, diarrhea, constipation, etc) do not use in pregnancy
46
Ergo alkaloid forms?
oral
47
Migraine prophylactic management criteria?
migraine is so bad that it disrupts daily activities | more than 2x/mo
48
Migraine prophylactic goal?
GOAL: | reduce 15%
49
Migraine prophylactic management - is it working?
1 mo
50
Migraine prophylactic drugs?
Propranolol Nortiptyline SSRI (venlafaxine) Gabapentin (anticonvulsants)
51
Cluster HA - tx?
abortive - triptans, erogtamines 100% if avail NO narcotics
52
Prophylactic cluster HA drugs?
Topiramate
53
Prevention of recurrent stroke?
Tx RF: HTN, diabetes, lipids antiplatelet therapy (ASA) lifestyle modification statins
54
Ischemic stroke - tx?
tPA - if able to use
55
TIA - tx?
do not jump to tPA - unless you can prove to be a stroke ASA! - long term statin
56
Common cx of bacterial meningitis?
ALL PREVENTABLE 1) Neisseria Meningitidis (places w/ mold and high humidity) - multiply in nasal mucous 2) 3)
57
Population of the bacterial meningitis?
immunosuppressed young old
58
Polio - sx?
variable (some people are asymptomatic) aseptic menigitis paralytic CONTAGIOUS
59
Meningococcal vaccination?
two doses are reommended
60
Polio vaccination?
now is inactive vaccine (live vaccine is out) | total of 4 doses
61
Neuropathic pain - cx?
inflammation of infxn surgery trauma genetically
62
Neurological pain?
not like regular pain | can cause damage to nerves
63
Neurological pain - tx?
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
Gabapentin?
neuropathic pain - esp postherpetic neuralgia and polyneuropathies relieve atypical pain insomnia (can help w/ comorbidities)
65
Gabapentin and Pregabalin ADR?
peripheral edema sedating well tolerated hypersensitivity rxn
66
Pregabalin?
used for diabetics fibromyalgia insomnia and anxiety (helps w/ comorbidities)
67
tPA is good until?
4.5 hrs
68
neuropathetic pain -tx?
NOT NSAID, acetaminophen | YES anticulvansts
69
Low Ach levels?
cognitive impairment
70
Parkinson AND dementia?
parkinson - give anticholinergic (brings down Ach) BUT dementia too? (you want to increase Ach) teeter totter - balance!
71
Antiepileptic drugs used for?
prevent epilepsy (unprovoked)
72
1st seizure? Then 2nd one will occur..?
within the next 2 yrs
73
Goal of epilepsy?
tx underlying trigger and avoid
74
Keppra?
well tolerated | well used in peds
75
Most effective anticonvulsants?
Valproic acid but not well tolerated
76
Well tolerated anticonvulsants?
Lamatrigine but not as effective as valproic acid
77
What to keep in mind for pts taking anticonvulsants?
depresses CNS so suicide rate goes up
78
Acute seizure-tx?
diazepam and lorazepam
79
How does anticonvulsant work?
enhancing GABA abilities | opens up Cl channels --> slows down the signaling (inhibitory) --> enhances GABA effects
80
Drug classification foor Diazepam and Lorazepam?
benzodiazepine
81
Does benzodiazepine increase GABA?
no, just enhances the effectiveness of GABA
82
How does benzodiazepine work?
dose based anxiety - small dose sedation - little more loss of consciousness/hypnosis - heavy dose
83
Benzodiazepine - ADR?
CNS depression - sedation, drowsiness dependence: NOT GOOD FOR LONG TERM; ONLY FOR SHORT TERM CARDIOPULM pts - respiratory/cardio depression
84
Benzodiazepine - DI?
ETOH other CNS depressants CYP 450 - liver
85
Carbamazepine?
anticonvulsant - first gen | inhibits repetitive firing by blocking Na channels
86
Carbamazepine - important labs to check?
check HLA in asians
87
Carbamazepine - what kind of characteristics does it have?
``` anticholinergic antidiuretic antiarrhythmic muscle relaxant anti depressant sedative ```
88
Carbamezpine - ADR?
GI rash/itchy CNS disturbances bone marrow depression
89
Carbamazepine - DI?
CYP450 and inducer (speeds up metabolism) - CHECK OTHER DRUGS ADR duplication
90
Phenytoin-drug use?
do not stop abruptly | used for partial seizures
91
Phenytoin- labs?
serum levels - CBCs, LFTs (liver toxicity) HLA
92
Phenytoin - ADR?
GI upset gingival hyperplasia CNS irritability
93
Phenytoin - DI
CYP 450 and inducer
94
Valproate (Valporic acid) - drug use?
MHA seizure first generation anticonvulsant
95
Valproate - labs?
serum levels - LFT CBC
96
Valproate - ADR?
``` do not chew meds GI upset hepatoxcity hyperammonemia (encephalopathy can occur) thrombocytopenia ```
97
Topiramate?
``` 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
Topiramate - ADR?
flushing loss of appetite epistaxis metabolic acidosis
99
Topiramate - DI?
CYP 450 inducer
100
Lamotrigine -ADR?
RASH! aspetic meningitis DIC hypersensitivity (esp if they're young and HD)
101
Lamotrigine - DI?
OCP
102
Alzheimer's Dz?
decrease in Ach
103
Alzheimer dz drugs?
acetyl cholinesterease inhibitor
104
Donezepil -drug use?
reversible acetyl cholinesterase inhibitor dementia dose dependent
105
Donezepil - when to take? what to monitor?
bedtime | HR and BP
106
Donezepil - ADR?
GI - diarrhea, loss of appetite | HTN --> AV block, seizures, syncope
107
Donezepil - DI?
anticholinergic CYP450 ADR duplication
108
Memantine?
used for severe Alzheimer Glutimate inhibitor - blocks the excitatory part of the brain helps w/ memory fxn
109
MS tx?
methotrexate baclofen SSRi gabapentin
110
MS sx?
``` balance and coordination fatigue bladder probs bowel probs pain sensory depression ```
111
Modafinil?
antinarcoleptic stimulant
112
Modafinil?
can be addictive
113
Modafinil -monitor?
BP
114
Modafinil -ADR/
``` rash G upset dizziness CNS irritation HTN ```

Neurology (13 decks)

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