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Clinical Medicine > Pharmacology- Neuro > Flashcards

Pharmacology- Neuro Flashcards

1
Q

What are some first generation AEDs??

A

Phenobarbital
phenytoin
primidone
ethosuximide
diazepam
lorazepam
carbamazepine
Valproic acid, divalproex

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2
Q

What are considered broad spectrum, second generation AEDs?

A

Lamotrigine
levetiracetam
oxcarbazepine
Zonisamide

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3
Q

broad spectrum AED medications means?

A

They can be used for generalized and focal seizures

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4
Q

Benefits of 2nd generation AEDs?

A

they are equally as effective as first generation AEDs
they are considered clean drugs- less drug interactions, less symptoms

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5
Q

what are some very important second generation AED medications?

A

Gabapentin
lamotrigine
levetiracetam
oxcabazepine
zonasimide

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6
Q

What are some things to think about when choosing an AED?

A

seizure type(most important)
mechanism of action
pharmacokinetics
concomitant medical/psychiatric conditions
adverse side effects
cost

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7
Q

Why is it important to know the seizure type?

A

picking the wrong drug can cause seizure to get worse

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8
Q

What are some first line medications for focal seizures, either impaired aware, with or without secondary generalization)

A

Carbamazepine- MOST common
lamotragine
levetiracetam
oxcarbazepine
perampanel

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9
Q

what are some medications that are first line for ELDERLY patients w/ focal aware or impaired awareness (partial seizures)

A

Lamotrigine
gabapentin

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10
Q

what is first line treatment for non-motor (Absence)

A

Ethosuximide
Divalproex

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11
Q

what are alternative or add-on therapies that should be considered for Absence seizures

A

Clonazepam
lamotrigine
levetiracetam
zonisamide

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12
Q

What is first line treatment for Tonic Clonic seizures?

A

Divalproex
lamotrigine
levetiracetam
* broad spectrum medication*

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13
Q

what is first line treatment for generalized onset motor (atonic or myoclonic)

A

Divalproex
lamotrigine
levetriacetam

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14
Q

First line treatment for status epilepticus (*medical emergerncy)

A

1st. IV/IM/BZD
(diazempam, lorazepam, or midazolam)
OR rectal diazepam (very fast onset)
2nd. IV Fosphenytoin

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15
Q

Alternative line treatment for status epilepticus (*medical emergerncy)

A

IV phernobarbital

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16
Q

first line medication for Infantile spasms (may be focalized or generalized onset epileptic spasms)

A

vigabatrin

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17
Q

What is the mechanism of seizures

A

seizures are a mismatch of excitation and inhibition

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18
Q

what is the culprit of excitation in seizures?

A

glutamate

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19
Q

AEDs for seizures often target?

A

glutamate or GABA

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20
Q

what helps to provide inhibition

A

Gaba

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21
Q

A majority of AEDs block what?

A

Sodium

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22
Q

What are possible mechanisms of actions for AEDs to decrease excitation

A

-inhibit voltage gated Na+ channels to prevent release of neurotransmitters
-inhibit voltage-gated Ca2+ channels to prevent release of neurotransmitters
-inhiber neurotransmitter release by binding to SV2A
-antagonize glutamate activity at receptor sites

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23
Q

what are the possible mechanisms of actions for AEDS to increase inhibtion

A

-enhance GABA action by increasing concentration (block reuptake, block metabolism)
-enhance GABA action by modulating GABA receptor mediated Cl- current
-activation of K+ channels by ezogabine

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24
Q

what AEDs are sodium channel blockers

A

phenytoin
carbamazepine
oxcarbazepine
lamotrigine
lacosamide
rufinamide

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25
Q

what AEDs are glutamate receptor blockers

A

topiramate
zonisamide

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26
Q

what AEDs are GABA enhancers?

A

Benzodiazepines
barbituates
valproic acid
vigabatrin
tiagabine

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27
Q

Something to know about Lamotrigine

A

Must start with low dose and titrate slowly to avoid steven johnsons syndrome

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28
Q

which AEDs are CYP enzyme inducers? What does that mean?

A

carbamazepine
oxcarbazepine
phenobarbital
pheytoin
topiramate
* lower concentration of other drugs- causing failure

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29
Q

Which AEDs are CYP inhibitors? what does that mean?

A

Oxcabazepine
topiramate
valproic acid
* may inhibit enzyme causing toxicity.

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30
Q

which medications put you at risk for stevens-johnson syndrome?

A

Carbamazepine, lamotrigine (TOP TWO)
Levetiracetam, phenytoin, zonisamide

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31
Q

what is the first line treatment for tension-type headache? what should you keep in mind?

A

Over the counter NSAIDs and Acetaminophen as needed
* medication overuse headache may superimpose if treatment is used too often

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32
Q

what are non-specific treatments of migraines- specific treatments? who is this medication for?

A

Triptans
ergotamines

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33
Q

which medications are triptans?

A

sumatriptan
rizatriptan
zomiitriptan

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34
Q

how do you pick which triptan to prescribe?

A

consider migraine attack duration? Longer lasting attack may be treated better with a longer half life
if patient is vomiting- choose non-oral formulation may be better
rapid onset attacks may benefit from nasal/subcutaneous route

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35
Q

which medication is an ergotamine?

A

dihydroergotamine

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36
Q

MOA: selective 5-hydroxtryptamine, serotonin (5-HT) agonists

A

triptans

37
Q

5-HT receptor agonist. Non-oral treatment that is available in intra-nasal, injectable and IV forumulations

A

Dihydroergotamine

38
Q

which medications are anti-emetic medications?

A

ondansetron
metoclopramide, prochlorperazine, promethazine

39
Q

antiemetics such as metoclopramide, procholorperazine and promethazine need to be used with benadryl… why?

A

to reduce the risk of extrapyramidal side effects

40
Q

what is the MOA of metoclopramide and procholoperazine?

A

dopamine receptor blocker

41
Q

promethazine has what mechanism of action?

A

H1 receptor blocker and weak dopamine antagonist

42
Q

what treatments are used for cluster headache?

A

-inhaled oxygen
-subcutaneous imitrex

43
Q

what classes of medications can be used for headache prevention?

A

Antiepileptic drugs
antidepressant drugs
beta-blockers
calcium-channel blockers

44
Q

what is widely used as a first line preventative (mostly for migraine)

A

topiramate

45
Q

which medication is highly terotogenic, so it is not give to reproductive age females?

A

valproate

46
Q

what antidepressants can be used as preventative treatments for headache?

A

amitriptyline and other tricyclic antidepressants (star at lower dose)
venlafaxine ( very good for migraine prevention; start at lower dose)

47
Q

Beta-blockers are often a great option for long-term prevention of migraines. What medication is a beta-blocker?

A

propranolol

48
Q

what is considered the treatment of choice for cluster headaches

A

verapamil

49
Q

what are preventative treatments for tension type headache?

A

amitriptyline
venlafaxine

50
Q

what is a good alternative to verapamil used for cluster headaches when the patient has shorter active cluster periods?

A

glucocorticoids (prednisone, etc)

51
Q

What is the preferred treatment Guillain-Barre syndrome?

A

plasma exchange (removes antibodies from the blood)
IVIG (intravenouse immuge globulin)

52
Q

what medication could you prescribe for bell’s palsy patients?

A

steroids (prednisone) to reduce inflammation are associated with good facial functional recovery
*antiviral medications

53
Q

what are treatment options for myasthenia gravis?

A

Treatment is acetylcholinesterase inhibitors, immunosuppressants or thymectomy

54
Q

what is the preferred treatment option for acute attacks in a patient with MS?

A

glucocorticoids (for functionally disabling symptoms associated with relapse)

55
Q

How is methylprednisolone used for MS care

A

it is used as IV short course to shorten the recovery time from moderate to severe relapses

56
Q

what are some adverse reactions seen from the use of methylprednisolone?

A

mental status changes
increased infection
fracture risk

57
Q

what is a form of platform injection therapy

A

interferon beta

58
Q

which drug decreases inflammation in the CNS by preventing inflammatory leukocytes from entering the CNS?
It also decreases the number of lesions found on MRI

A

Interferon Beta

59
Q

what are are some adverse reactions the treatment with interferon beta?

A

injection site necrosis
flue like sxs
liver dysfunction
development of neutralizing antibodies

60
Q

what is a platform injection therapy?

A

Glatiramer acetate

61
Q

which drug is a synthetic protein that mimics the structure of myelin, blocking the damaging T cell.
it also decreases inflammation, working primarily inside the CNS to promote anti-inflammatory activity

A

glatiramer acetate

62
Q

what drugs are considered monoclonal antibodies?

A

natalizumab & mixoantrone

63
Q

which drug blocks the molecular pathway involving cell adhesion that draws the lymphocytes into the CNS

A

natalizulamab

64
Q

which drug is antineoplastic agent that supresses the activity of T cells, B cells and macrophages that lead the attack on myelin

A

mitoxantrone

65
Q

What should you know about monoclonal antibodies as therapy of MS?

A
  • both of these have high side effect profiles and serious safety issues
    -also the highest efficacy therapy
66
Q

what is the first line treatment of essential tremor? What class of drug is it?

A

Propranolol
beta blocker

67
Q

What is another medication treatment alternative for essential tremor?

A

Primidone(2nd line)
topiramate (3rd line)
gabapentin (4th line)
anticonvulsants

  • clonazepam and alprazolam- benzodiazepam (4th line)
68
Q

what are other treatment options for essential tremor?

A

occupational therapy
assistive devices
deep brain stimulation
MRI guided focused ultrasound

69
Q

what are the treatment options for restless leg syndrome

A

Iron supplementation
eliminate/replace offending medications
dopamine agonists (pramipexole, ropinirole)
carbidopa-levodopa
gabapentin

70
Q

what is the gold standard for treating Parkinson’s disorder?

A

carbidopa/levodopa

71
Q

what are positives and negatives of carbidopa/levodopa

A

positives: effectively controls motor symptoms
negatives: short half life- eventually the effectiveness decreases, so timing between doses shortens

72
Q

what side effects standout with Carbidopa/levodopa?

A

dyskinesia- (often times due to overmedication)
motor fluctuations

73
Q

What drug can you give with carbidopa/levodopa to help with dyskinesia?

A

amantadine

74
Q

when would you use amantadine as a monotherapy for parkinson’s?

A

In early disease course and when tremor is the predominant symptom

75
Q

what drug can you give with carbidopa/levodopa to help with motor fluctuations?

A

COMT inhibitors (Entacapone, Tolcapone)

76
Q

What option can you give a patient who needs a COMT inhibitor and carbidopa/levodopa?

A

stalevo (combined pill of Carbidopa/levodopa and Entacapone)

77
Q

what is the benefit of COMT inhibitors

A

Extends the life of levodopa by stopping the breakdown of levodopa before it reaches the brain

78
Q

why can’t you use a COMT inhibitor by itself?

A

it has no no benefit as a monotherapy

79
Q

which medications are dopamine agonists?

A

pramipexole
ropinirole
rotigitine
bromocriptine

80
Q

what is a side effect that is very concerning with dopamine agonists?

A

Impulse control issues
* pathological gambling, compulsive eating, compulsive shopping, hypersexuality

81
Q

what is often a first line treatment for mild symptoms of parkinson’s?

A

MAO-B inhibitors

82
Q

which drug class breaksdown dopamine by monoamine oxidase B

A

MAO-B inhibitors

83
Q

what drugs are MAO-B inhibitors

A

Rasagiline
selegiline

84
Q

what is the benefit of using MOA-B inhibitors with carbidopa/ levodopa?

A

prolongs the effectiveness of dopamine, so improves motor fluctuations

85
Q

what drugs are anticholinergics?

A

trihexyphenidyl
benzotropine

86
Q

when is the use of anticholinergics beneficial? when should you not use it?

A

can be useful in younger patients with tremor predominant disease OR in more advanced cases where tremor is still present despite other treatments

Avoid- in the elderly-confusion, hallucinations

87
Q

what are nonmedical treatments for parkinson’s

A

physical therapy and occupational therapy
exercise like rock steady therapy
surgical treatments like ablative surgery, deep brain stimulation

88
Q

what medication should always be given to treat gram positive bacterial meningitis ?

A

ceftriaxone

89
Q

what else can be given to treat gram-positive infections?

A

vancomycin

Clinical Medicine (5 decks)

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