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PHARMMM Flashcards

1
Q

How to treat acute attacks of MS

A

glucocorticoids

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2
Q

Corticosteroid that shortens recovery time from mod-severe MS relapses

A

Methylprednisolone
– must rule out infection before starting this
–no more than 3 IV courses a year

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3
Q

methylprednisolone ADR

A

mental status changes
GI issues
increased infection & fracture risk

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4
Q

3 medications for managing MS

A

methylprednisolone
beta interferon
glatiramer acetate

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5
Q

Halts/reverses progression of MS

A

Beta interferon
– decreases inflammation & new lesions

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6
Q

Beta interferon ADR

A

injection site necrosis
flu-like sx
liver dysfx
antibody neutralization

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7
Q

Mimics myelin and decreases CNS inflammation

A

glatiramer acetate

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8
Q

glatiramer acetate ADR

A

injection site rxn
post-injection rxn

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9
Q

Treatment for acute seizure

A

BZD
1. lorazepam
2. midazolam
3. diazepam

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10
Q

What is first line for focal seizures

A

CLLO—
carbamazepine
lamotrigine
levetiracetam
oxcarbazepine

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11
Q

first line for elderly focal seizures

A

LG—-
lamotrigine
gabapentin

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12
Q

first line for absence seizure

A

ethosuximide

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13
Q

first line for tonic-clonic seizure

A

lamotrigine
levetiracetam

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14
Q

first line for atonic or myoclonic seizures

A

lamotrigine
levetiracetam

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15
Q

alternative tx for status epilepticus

A

IV phenobarbital

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16
Q

first line for status epilepticus

A

IV/IM BZD or rectal diazepam
IV fosphenytoin

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17
Q

first line for infantile spasm

A

vigabatrin

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18
Q

first line for Lennox-gestaut syndrome

A

lamotrigine
topiramate

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19
Q

Name 4 AEDs that block sodium channels to decrease excitation

A

phenytoin
carbamazepine
oxcarbazepine
lamotrigine

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20
Q

name the 1 AED that block glutamate receptors to antagonize it & decrease excitation

A

topiramate

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21
Q

Name 3 medications that enhance GABA to increase inhibition

A

BZD
phenobarbital
valproic acid

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22
Q

which med binds to SV2A to stop NT release

A

levetiracetam

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23
Q

name the AED that blocks calcium to stop NT release

A

gabapentin

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24
Q

which AED depresses the motor cortex and increases CNS seizure threshold

A

ethosuximide

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25
which AED can cause aggression and should be titrated slowly?
levetiracetam
26
why should you be careful with dosing Phenytoin (AED)?
it has non-linear saturable kinetics so doubling dose doesnt just double the concentration, it is even higher!!
27
what does a high protein binding mean with AEDs?
take extra caution when prescribing to patients with low albumin, pregnant, liver/kidney dz; they will have a higher concentration of free/active drug
28
which 2 AEDs have the high protein binding?
phenytoin valproic acid
29
which AEDs are active metabolites in liver & require caution in patients w/ liver issues?
carbamazepine oxcarbazepine valproic acid Ethosuximide
30
AED w/ the highest half-life
phenobarbital
31
which 5 AEDs cause failure of other meds by inducing CYP?
carbamazepine oxcarbazepine phenobarbital phenytoin topiramate
32
which 3 AEDs cause toxicity of other others by blocking CYP
oxcarbazepine topiramate valproic acid
33
________ + ________ = SJS Which two meds when mixed causes SJS
valproic acid lamotrigine
34
which AEDs can be given oIV?
levetiracetam valproic acid BZD
35
other uses of topiramate
chronic weight loss essential tremor HA prophylaxis
36
common ADR of AEDs
sedation, drowsiness
37
which AED cause ataxia or tremors?
ataxia-- CBZ, phenytoin, gabapentin tremor-- VPA, oxcarbazepine
38
name the 2 AEDs with worst cognitive side effect
phenobarbital topiramate
39
which AEDs can cause SJS
1. CBZ, lamotrigine 2. levetiracetam, phenytoin
40
name the AED that can cause gingival hyperplasia
phenytoin
41
which AEDs have tetratogenicity?
VPA CBZ Phenytoin phenobarbital
42
what meds can you give for acute management of tension HA?
NSAIDs acetaminophen
43
what is the monthly limit for NSAIDs to avoid rebound HA?
15 days/month
44
what is the monthly limit to avoid rebound HAs with combination HA medication?
8 days/month
45
Name 4 non-specific pain meds/groups can be used to acutely treat migraines
NSAIDS- Ibuprofen, naproxone combo pills-- excedrin Midrin Acetaminophen
46
When do you use migraine specific medications?
moderate-severe migraines HA that don't respond to NSAIDs or analgesics
47
Name 3 triptan medications. Which ones are available via nasal spray? via injection?
Sumatriptan--nasal spray & injection Rizatriptan Zolmitriptan--- nasal spray
48
How do triptans work-- what is their target and consequence?
they are 5-HT agonists that cause vasoconstriction
49
which groups of people should you be cautions w/ prescribing NSAIDs?
people with CV and GI diseases people with kidney impairments people with bleeding d/o
50
what are contraindications for prescribing Triptans?
Cardio-, cerebro-, or peripheral vascular diseases HTN or ischemic bowel diseases
51
what are common SE of Triptans?
nausea, dizziness, sedation, CHEST PAIN/TIGHTNESS, jaw tightness, flushing
52
what SPECIFIC class of medications can be used to acutely manage migraines?
triptans ergotamines antiemetics
53
what is unique about the ROA of DHE?
it is non-oral. it is only available in intra-nasal, injectable and IV forms.
54
what are SE of DHEs?
RHINITIS (w/ intra-nasal application) VOMITING, dizziness, flushing
55
which two drug groups of specific migraine medications should not be mixed in 24 hrs?
Triptans and DHE
56
name the 3 antiemetics used to treat nausea/vomiting w/ migraines.
prochlorperazine promethazine metoclopramide
57
Name 3 treatments (in order) to manage Cluster HA acutely.
Inhaled Oxygen Sub-Q sumatriptan or nasal triptan
57
Name 3 treatments (in order) to manage Cluster HA acutely.
Inhaled Oxygen Sub-Q sumatriptan or nasal triptan IV DHE or intranasal lidocaine
58
when do start HA prophylaxis?
2 severe attacks/month OR 4 less severe attacks/month rebound HA is superimposed sx are too short for acute treatment but affects life acute meds aren't tolerated or contraindicated in patient
59
what are the 4 classes of meds used for HA prophylaxis?
AED antidepressants beta-blockers calcium-channel blockers
60
which AED is widely used as first line prophylaxis for HAs? what are its SE?
topiramate SE-- cognitive slowing, anorexia, irritability, loss of taste
61
What are the two AEDs that are also used for HA prophylaxis?
topiramate valproate
62
which AED that is also used in HA prophylaxis, is highly teratogenic? what are its SE?
valproate SE-- somnolence, wt gain, hair loss, possible hepatotoxicity and thrombocytopenia
63
what two antidepressants can be used for both migraine & tension HA prophylaxis? what are their SE?
amitriptyline-- weight gain, sedation venlafaxine-- nausea (take w food), sexual issues BOTH have QT prolongation
64
what must be given simultaneously with antiemetics? why?
IV Diphenhydramine must be given to reduce dystonic reactions from the antiemetics
65
which of the two antidepressants used in migraine/tension prophylaxis is contraindicated in pregnancy?
amitriptyline & other TCAs
66
what is the treatment of choice for cluster HA prophylaxis? its SE?
Verapamil-- calcium channel blocker SE- constipation
67
what are your options for cluster HA prophylaxis?
verapamil for ppl w/ continuous HA or <3 months between HA Glucocorticoids for shorter active cluster periods
68
how is propanolol (beta blocker) used in HA prophylaxis? what are its SE? contraindications?
used for migraine prophylaxis Se-- fatigue, wt gain, hypotension contraindications-- DM 1, heart failure, asthma
69
what is the first line treatment for essential tremors? its SE? Contraindications?
beta blockers--propanolol SE-- hypotension, fatigue, depression Contra-- DM 1, heart failure, asthma
70
what 3 classes of meds can be used to treat essential tremors?
beta blockers anticonvulsants BZD
71
what is the second line treatment for essential tremors?
Primidone topiramate gabapentin these are AEDs
72
what is third line treatment for essential tremors?
BZD-- clonazepam & alprazolam
73
what meds can treat restless legs syndrome?
iron supplement dopamine agonists-- pramipexole, ropinirole carbidopa-levodopa PRN gabapentin
74
what medications are used for Parkinsons?
C SALAD COMT Inhibitors Selegine Anticholinergics Levodopa Amantadine Dopamine agonist
75
what is the gold standard treatment for parkinsons disease? what is its MOA? SE?
carbidopa/levodopa passes BBB to become dopamine. MOA--as the disease progresses, timing between doses shortens SE-- DYSKINESIA, MOTOR FLUCTUATIONS, PSYCHOSIS/HALLUCINATIONS, anorexia, nausea/vomiting
76
what do you do to minimize dyskinesia when giving a patient w/ parkinson's Levodopa? its SE?
give amantadine. it can also be used as monotherapy for parkinson's w/ early disease and tremor dominant disease SE-- hallucinations, sedation, edema
77
what can you give to minimize motor fluctuations caused by Levodopa?
use a rescue dopamine add COMT inhibitor to extend life of Levodopa
78
List the 2 COMT Inhibitors. What are their SE?
Tolcapone and entacapone SE-- HEPATOTOXICITY(need labs), impulsive, more dyskinesia, brown urine/saliva, cognitive changes
79
In which parkinson's patient are dopamine agonists mostly used?
can be used as first line in <65yrs old parkinson's patient has less motor SE than levodopa but not as effective can be used with levodopa
80
List the 4 dopamine agonist medications
pramipexole ropinirole bromocriptine (rare) apomorphine
81
SE & contraindications of dopamine agonists?
SE-- IMPULSIVITY, sudden sleep attack, psychosis, peripheral edema, sedation, hypotension Contra-- ppl w/ active peptic ulcer disease
82
how does amantadine work?
increases presynaptic dopamine release & inhibits its reuptake
83
when do you use MOA-B inhibitors? SE? CONTRA? cautions?
first line for mild sx bc its only moderately effective can be used with levodopa to improve motor fluctuations CAUTION- potential for serotonin syndrome SE-- nausea, headache, confusion, hallucinations, joint pain, insomnia CONTRA-- MAOi use, mod-severe liver impairment
84
when are anticholinergics most useful with parkinson's? when should you avoid them?
as monotherapy in < 70 with TREMOR AS PREDOMINANT OR advanced case where tremor persists; but they don't improve bradykinesia avoid in elderly
85
List the 2 anticholinergic medications.
Benztropine Trihexyphenidyl
86
what cautions should you take w/ ethosuximide?
caution in ppl w/ liver & kidney failure monitor CBC, UA, LFTs
87
Which AED has increased risk of SJS in Asians?
Carbamazepine
88
What are the broad spectrum AEDs?
LLV Lamotrigine Levetiracetam Valproic acid
89
Which 3 meds have highest risk of SJS?
Carbamazepine Lamotrigine Phenytoin
90
2nd gen AEDs
gabapentin lamotrigine levetiracetam oxcarbazepine topiramate

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