Pharmacology Flashcards
What is riluzole?
Riluzole delays the onset of ventilator-dependence or tracheostomy in selected patients with ALS and may increase survival by approximately two to three months. It’s mechanism is blocking glutamatergic neurotransmission in the CNS.
What are the contraindications to tPA therapy?
SAMPLE STAGES (*=major ones)
- Stroke or head trauma within the last 3 months
- Anticoagulation with INR > 1.7 or prolonged PTT
- MI in the past 3 months
- Prior intracranial hemorrhage
- Low platelet count (< 100,000)
- Elevated BP of systolic >185 or diastolic > 110
- Major Surgery in the past 14 days
- TIA within 6 months
- GI or urinary bleeding the past 21 days
- Elevated (> 400) or decreased (< 50) blood glucose
- Seizures present at onset of stroke
Note that tPA can be considered if lab values/vitals are normalized within the 3 hour time period
What medication should be given to prevent vasospasm after an SAH?
Nimodipine, or another CCB
What antibiotics are best for treating cavernous sinus thrombosis?
Penicillinase-resistant penicillin (e.g. nafcillin or oxacillin) plus a 3rd or 4th generation cephalosporin (e.g. ceftriaxone or cefipime). Metronidazole can be added for anaerobic coverage and vancomycin for MRSA. Add an antifungal if fungal infection is suspected. Do IV antibiotics for 3-4 weeks, may need surgical drainage.
What three things should be administered to a presenting patient with decreased consciousness of unknown etiology?
Naloxone, thiamine, and dextrose
What eye drops can be used to test for Horner syndrome?
Cocaine eye drops will fail to dilate the affected pupil in all causes of Horner syndrome (inhibits reuptake of NE). Apraclonidine (alpha 1 and 2 agonist) will dilate the pupil regardless of cause. Hydroxyamphetamine will only dilate the eye if it is a preganglionic lesion (1st or 2nd order neurons)
What medications may be used to treat a spastic bladder (urge incontinence)?
Anticholingeric agents (e.g. tolterdine, oxybutynin), tricyclic antidepressants, desmopressin, and intravesicular capsaicin. Can also use sildenafil, and botox
How does intravesicular capsaicin help with urge incontience?
Used for intractable detrusor hyperreflexia - has neurotoxic effects on afferent C fibers that are involved in detrusor contraction (effects may last up to 6 months)
What is the single best treatment for REM sleep behavior disorder?
Clonazepam (Klonopin)
What medications are use to treat cataplexy?
Sodium oxybate and antidepressants (e.g. venlafaxine, SSRIs, clomipramine)
What are the features of Phenytoin (Dilantin)?
Mxn: Na+ channel blocker
Seizure type: Partial
Side effects: Gingival hyperplasia, coarsening of facial features, ataxia, diplopia, SJS, DRESS syndrome
What are the features of Carbamazepine (Tegretol)?
Mxn: Na+ channel blocker
Seizure type: partial
Side effects: hyponatremia, agranulocytosis, diplopia, SJS, DRESS syndrome
What are features of vlaproic acid (Depakote)?
Mxn: Na+ channel blocker, activates GABA receptor
Seizure type: partial and generalized
Side effects: GI symptoms, tremor, weight gain, hair loss, hepatoxicity, thrombocytopenia
What are features of tiagabine (Gabitril)?
Mxn: Inhibits GABA reuptake
Seizure type: partial
Side effects: sedation
What are features of levetiracetam (Keppra)?
Mxn: unknown
Seizure type: partial and generalized
Side effects: insomnia, anxiety, irritability
What are features of oxcarbazepine (Trileptal)?
Mxn: Na+ channel blocker
Seizure type: partial
Side effects: sedation, hyponatremia