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NEURO MOD > PHARMMM > Flashcards

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
Q

which AED can cause aggression and should be titrated slowly?

A

levetiracetam

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26
Q

why should you be careful with dosing Phenytoin (AED)?

A

it has non-linear saturable kinetics so doubling dose doesnt just double the concentration, it is even higher!!

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27
Q

what does a high protein binding mean with AEDs?

A

take extra caution when prescribing to patients with low albumin, pregnant, liver/kidney dz; they will have a higher concentration of free/active drug

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28
Q

which 2 AEDs have the high protein binding?

A

phenytoin
valproic acid

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29
Q

which AEDs are active metabolites in liver & require caution in patients w/ liver issues?

A

carbamazepine
oxcarbazepine
valproic acid
Ethosuximide

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30
Q

AED w/ the highest half-life

A

phenobarbital

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31
Q

which 5 AEDs cause failure of other meds by inducing CYP?

A

carbamazepine
oxcarbazepine
phenobarbital
phenytoin
topiramate

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32
Q

which 3 AEDs cause toxicity of other others by blocking CYP

A

oxcarbazepine
topiramate
valproic acid

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33
Q

________ + ________ = SJS
Which two meds when mixed causes SJS

A

valproic acid
lamotrigine

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34
Q

which AEDs can be given oIV?

A

levetiracetam
valproic acid
BZD

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35
Q

other uses of topiramate

A

chronic weight loss
essential tremor
HA prophylaxis

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36
Q

common ADR of AEDs

A

sedation, drowsiness

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37
Q

which AED cause ataxia or tremors?

A

ataxia– CBZ, phenytoin, gabapentin
tremor– VPA, oxcarbazepine

38
Q

name the 2 AEDs with worst cognitive side effect

A

phenobarbital
topiramate

39
Q

which AEDs can cause SJS

A
  1. CBZ, lamotrigine
  2. levetiracetam, phenytoin
40
Q

name the AED that can cause gingival hyperplasia

A

phenytoin

41
Q

which AEDs have tetratogenicity?

A

VPA
CBZ
Phenytoin
phenobarbital

42
Q

what meds can you give for acute management of tension HA?

A

NSAIDs
acetaminophen

43
Q

what is the monthly limit for NSAIDs to avoid rebound HA?

A

15 days/month

44
Q

what is the monthly limit to avoid rebound HAs with combination HA medication?

A

8 days/month

45
Q

Name 4 non-specific pain meds/groups can be used to acutely treat migraines

A

NSAIDS- Ibuprofen, naproxone
combo pills– excedrin
Midrin
Acetaminophen

46
Q

When do you use migraine specific medications?

A

moderate-severe migraines
HA that don’t respond to NSAIDs or analgesics

47
Q

Name 3 triptan medications. Which ones are available via nasal spray? via injection?

A

Sumatriptan–nasal spray & injection
Rizatriptan
Zolmitriptan— nasal spray

48
Q

How do triptans work– what is their target and consequence?

A

they are 5-HT agonists that cause vasoconstriction

49
Q

which groups of people should you be cautions w/ prescribing NSAIDs?

A

people with CV and GI diseases
people with kidney impairments
people with bleeding d/o

50
Q

what are contraindications for prescribing Triptans?

A

Cardio-, cerebro-, or peripheral vascular diseases
HTN or ischemic bowel diseases

51
Q

what are common SE of Triptans?

A

nausea, dizziness, sedation, CHEST PAIN/TIGHTNESS, jaw tightness, flushing

52
Q

what SPECIFIC class of medications can be used to acutely manage migraines?

A

triptans
ergotamines
antiemetics

53
Q

what is unique about the ROA of DHE?

A

it is non-oral. it is only available in intra-nasal, injectable and IV forms.

54
Q

what are SE of DHEs?

A

RHINITIS (w/ intra-nasal application)
VOMITING, dizziness, flushing

55
Q

which two drug groups of specific migraine medications should not be mixed in 24 hrs?

A

Triptans and DHE

56
Q

name the 3 antiemetics used to treat nausea/vomiting w/ migraines.

A

prochlorperazine
promethazine
metoclopramide

57
Q

Name 3 treatments (in order) to manage Cluster HA acutely.

A

Inhaled Oxygen
Sub-Q sumatriptan or nasal triptan

57
Q

Name 3 treatments (in order) to manage Cluster HA acutely.

A

Inhaled Oxygen
Sub-Q sumatriptan or nasal triptan
IV DHE or intranasal lidocaine

58
Q

when do start HA prophylaxis?

A

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
Q

what are the 4 classes of meds used for HA prophylaxis?

A

AED
antidepressants
beta-blockers
calcium-channel blockers

60
Q

which AED is widely used as first line prophylaxis for HAs? what are its SE?

A

topiramate
SE– cognitive slowing, anorexia, irritability, loss of taste

61
Q

What are the two AEDs that are also used for HA prophylaxis?

A

topiramate
valproate

62
Q

which AED that is also used in HA prophylaxis, is highly teratogenic? what are its SE?

A

valproate
SE– somnolence, wt gain, hair loss, possible hepatotoxicity and thrombocytopenia

63
Q

what two antidepressants can be used for both migraine & tension HA prophylaxis? what are their SE?

A

amitriptyline– weight gain, sedation
venlafaxine– nausea (take w food), sexual issues
BOTH have QT prolongation

64
Q

what must be given simultaneously with antiemetics? why?

A

IV Diphenhydramine must be given to reduce dystonic reactions from the antiemetics

65
Q

which of the two antidepressants used in migraine/tension prophylaxis is contraindicated in pregnancy?

A

amitriptyline & other TCAs

66
Q

what is the treatment of choice for cluster HA prophylaxis? its SE?

A

Verapamil– calcium channel blocker
SE- constipation

67
Q

what are your options for cluster HA prophylaxis?

A

verapamil for ppl w/ continuous HA or <3 months between HA
Glucocorticoids for shorter active cluster periods

68
Q

how is propanolol (beta blocker) used in HA prophylaxis? what are its SE? contraindications?

A

used for migraine prophylaxis
Se– fatigue, wt gain, hypotension
contraindications– DM 1, heart failure, asthma

69
Q

what is the first line treatment for essential tremors? its SE? Contraindications?

A

beta blockers–propanolol
SE– hypotension, fatigue, depression
Contra– DM 1, heart failure, asthma

70
Q

what 3 classes of meds can be used to treat essential tremors?

A

beta blockers
anticonvulsants
BZD

71
Q

what is the second line treatment for essential tremors?

A

Primidone
topiramate
gabapentin
these are AEDs

72
Q

what is third line treatment for essential tremors?

A

BZD– clonazepam & alprazolam

73
Q

what meds can treat restless legs syndrome?

A

iron supplement
dopamine agonists– pramipexole, ropinirole
carbidopa-levodopa PRN
gabapentin

74
Q

what medications are used for Parkinsons?

A

C SALAD
COMT Inhibitors
Selegine
Anticholinergics
Levodopa
Amantadine
Dopamine agonist

75
Q

what is the gold standard treatment for parkinsons disease? what is its MOA? SE?

A

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
Q

what do you do to minimize dyskinesia when giving a patient w/ parkinson’s Levodopa? its SE?

A

give amantadine. it can also be used as monotherapy for parkinson’s w/ early disease and tremor dominant disease
SE– hallucinations, sedation, edema

77
Q

what can you give to minimize motor fluctuations caused by Levodopa?

A

use a rescue dopamine
add COMT inhibitor to extend life of Levodopa

78
Q

List the 2 COMT Inhibitors. What are their SE?

A

Tolcapone and entacapone
SE– HEPATOTOXICITY(need labs), impulsive, more dyskinesia, brown urine/saliva, cognitive changes

79
Q

In which parkinson’s patient are dopamine agonists mostly used?

A

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
Q

List the 4 dopamine agonist medications

A

pramipexole
ropinirole
bromocriptine (rare)
apomorphine

81
Q

SE & contraindications of dopamine agonists?

A

SE– IMPULSIVITY, sudden sleep attack, psychosis, peripheral edema, sedation, hypotension
Contra– ppl w/ active peptic ulcer disease

82
Q

how does amantadine work?

A

increases presynaptic dopamine release & inhibits its reuptake

83
Q

when do you use MOA-B inhibitors? SE? CONTRA? cautions?

A

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
Q

when are anticholinergics most useful with parkinson’s? when should you avoid them?

A

as monotherapy in < 70 with TREMOR AS PREDOMINANT OR advanced case where tremor persists; but they don’t improve bradykinesia
avoid in elderly

85
Q

List the 2 anticholinergic medications.

A

Benztropine
Trihexyphenidyl

86
Q

what cautions should you take w/ ethosuximide?

A

caution in ppl w/ liver & kidney failure
monitor CBC, UA, LFTs

87
Q

Which AED has increased risk of SJS in Asians?

A

Carbamazepine

88
Q

What are the broad spectrum AEDs?

A

LLV
Lamotrigine
Levetiracetam
Valproic acid

89
Q

Which 3 meds have highest risk of SJS?

A

Carbamazepine
Lamotrigine
Phenytoin

90
Q

2nd gen AEDs

A

gabapentin
lamotrigine
levetiracetam
oxcarbazepine
topiramate

NEURO MOD (8 decks)

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