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
What are features of topiramate (Topamax)?
Mxn: Na+ channel blocker, affects GABA activity
Seizure type: partial and generalized
Side effects: word-finding difficulty, renal stones, weight loss
What are features of zonisamide (Zonegran)?
Mxn: unknown
Seizure type: partial and generalized
Side effects: sedation, renal stones, weight loss
What medications are used to treat essential tremor?
Primidone (barbiturate) and propranolol. Topiramate and gabapentin may also be helpful
What is the preferred medication for treating chorea?
haloperidol
What medication is best for treating ballism?
Dopamine-depleting or blocking agents (e.g. haloperidol). If very severe, contralateral thalamotomy or pallidotomy may be beneficial
What medications are useful for treating myoclonus?
Clonazepam and valproate
What medications are used to treat tic disorders?
Dopamine antagonists are the most effective. However, because they have less side effects, clonazepam and clonidine should be tried first
What is the treatment for Wilson disease (autosomal recessive)?
Copper chelation with D-penicillamine. There is now a trend toward using a less toxic chelator, trientine in conjunction with zinc
What is the treatment for paroxysmal dyskinesias (recurrent attacks of hyperkinesis with preserved consciousness)?
Carbamazepine
What is the best recommended treatment for Duchenne muscular dystrophy?
Glucocorticoids
What medications have been found to be helpful in Lambert-Eaton syndrome?
3,4-diaminopyridine and pyridostigmine. Steroids may also be helpful
What gene causes Rett syndrome?
MeCP2 on the long arm of chr X
Why does lamotrigine need to be titrated up over many weeks?
Risk of severe rash/SJS. Note that this makes it a poor drug choice if rapid seizure control is needed
Why should phenytoin not be administered at a rate of >50 mg/min?
Risk for cardiac arrhythmia or hypotension
What medication should be given to reduce the incidence of seizures after a severe head injury?
Phenytoin prophylactically decreases morbidity
What type of seizure is ACTH useful for treating?
Infantile spasms (e.g. caused by Tuberous sclerosis)
What medication is best indicated for absence seizures associated with generalized tonic clonic seizures?
Divalproex sodium (can also be used in children who do not tolerate ethosuximide well)
What medications are used as antispasmodics in MS?
Baclofen, tizanidine, or benzodiazepines
What are symptoms of cyclosporine/tacrolismus toxicity?
May induce a syndrome similar to hypertensive encephalopathy - Patient gets severely hypertensive. MRI may show abnormalities of the occipital and parietal lobes, and the patient may develop headache, confusion, visual loss due to occipital lobe dysfunction, and seizures.
What medications are common causes of toxic labrynthitis (inflammation of the vestibular nerve) with vertigo as a common feature?
Salicylates, quinine, aminoglycosides as well as alcohol
What is treatment for Méniere disease?
Salt restriction and diuretics
What is the treatment for Lambert-Eaton syndrome?
3,4-Diaminopyridine
What is the BEST treatment for an exacerbation of MS?
IV methylprednisolone (better than PLEX or IVIg)
What is first line treatment for acute dystonia?
Benztropine
