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Q2 Flashcards

1
Q

What is Parkinson’s Disease?

A

Chronic, progressive, degenerative disorder of the CNS

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2
Q

Symptoms of Parkinson’s Disease

A

Resting tremor
Bradykinesia
Rigidity
Postural instability

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3
Q

Risk Factors of Parkinson’s

A

Age
Genetics
Sex
Exposure to Toxins

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4
Q

Is there a reciprocal relationship between Dopamine and Acetylcholine?

A

Yes

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5
Q

Vasodilator

A

Widening of the blood vessels in the cardiovascular system, allowing blood to flow more easily

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6
Q

T/F - increasing acetylcholine activity by reducing dopamine increases the risk of EPS

A

True

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7
Q

Bromocriptine (Parlodel)

A

Effective in the urgent treatment of NMS

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8
Q

Dosage of Bromocriptine

A

1.25-40 mg

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9
Q

What do Dopamine Receptor Agonists do?

A

Increase dopamine activity in the brain

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10
Q

What do MAO-B Inhibitors do?

A

Prevent breakdown of brain dopamine by inhibiting the brain enzyme monoamine oxidase B

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11
Q

Benztropine is used for?

A

Dystonia, Parkinsonism, Akinesia, Akathisia

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12
Q

Benztropine dosage?

A

1-2 mg BID

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13
Q

B blockers are?

A

Competes to bind at adrenergic receptors and has an antagonist effect on certain serotonin receptors

Used to reduce symptoms of Tardive Dyskinesia

Reduce blood pressure

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14
Q

Example of a beta blocker

A

Propranolol

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15
Q

Dosage of Propranolol

A

60-120 mg

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16
Q

Antiparkinsonian Medications are absorbed where?

A

GI Tract

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17
Q

Antiparkinsonian - Distribution

A

Throughout the body

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18
Q

Antiparkinsonian - Metabolism

A

Liver

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19
Q

Antiparkinsonian - Excretion

A

Urine and bile
Cross the placenta and enter breast milk

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20
Q

What should be used to monitor side effects while on antipsychotic medication?

A

AIMS

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21
Q

EMERGENCY - Antiparkinsonian

A

Dystonic Reactions (benztropine - oculogyric crisis, torticollis, opisthotonos)
NMS (bromocriptine - discontinue)

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22
Q

DiphenhyDRAMINE

A

Benadryl

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23
Q

DimenhyDRINATE

A

Gravol

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24
Q

Common Side Effects of Antiparkinsonian Drugs - Autonomic

A

Dry mouth
Blurred vision
Constipation
Stomach irritation
Tachycardia
Urinary retention
Paralytic ileus

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25
Q

Common Side Effects - Antiparkinsonian - Behavioural

A

Confusion
Giddiness
Listlessness
Depression
Visual Hallucinations

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26
Q

Side effects of Propranolol

A

Congestive Heart Failure, Decreased Libido, Raynaud’s syndrome

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27
Q

Side effect of Benadryl

A

Sedation

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28
Q

Amantadine

A

Orthostatic hypotension, livido reticularis (purple mottling to the skin), abnormal dreams

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29
Q

Biperiden

A

Fewer Ach effects, but can cause euphoria and increased tremor

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30
Q

Anticholinergic Withdrawal Symptoms

A

Nausea
Vomiting
Dyskinesia
Restlessness
Sweating
Anxiety
Depression

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31
Q

Anticholinergic Crisis

A

Dilated pupils
Increased thirst
Urinary retention
Paralytic ileus
Tachycardia

“hot as a hare, blind as a bat, mad as a hatter, dry as a bone”

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32
Q

Drug Interactions - Dopamine Receptor Agonists

A

Cholinesterase inhibitors
- used to slow the symptom progression of Alzheimer’s - combination will produce an antagonistic action

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33
Q

Specifications of Benadryl

A

Drug of choice for children over the age of 6 and more than 9 kg

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34
Q

Monoamine Neurotransmitter Dysfunction

A

Deficiency of norepinephrine and/or serotonin

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35
Q

What are three biogenic amines?

A

Norepinephrine
Dopamine
Serotonin

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36
Q

What is monoamine oxidase?

A

Enzymes that catalyzes the breakdown of monoamines such as serotonin, dopamine and norepinephrine

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37
Q

Treatment of Depressive Disorders

A

First Generation - tricyclic antidepressants, monoamine oxidase inhibitors

Second Generation - selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors, atypical antidepressants

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38
Q

What do tricyclic antidepressants do?

A

Reduce the reuptake of 5HT and NE into nerves
Blocks dopamine and acetylcholine and histamine receptors

39
Q

Tricyclic Antidepressants - Medications

A

Amitriptyline (50-300 mg)
Clomipramine (75-300 mg)

Nortiriptyline
Imipramine

40
Q

Monoamine Oxidase Inhibitors

A

Inhibit Monoamine oxidase (MAO)
Allows accumulation of NE, 5HT, and dopamine in the synaptic cleft

41
Q

Selective Serotonin Reuptake Inhibitors

A

Blocks 5HT with little effect on NE
Less adverse effects

42
Q

Selective Serotonin Norepinephrine Reuptake Inhibitors

A

Prevent the reuptake if 5HT and NE
Weakly inhibit dopamine reuptake

43
Q

Atypical Antidepressants

A

Bupropion (150-300mg)
Mirtazapine (15-60 mg)
Trazadone (150-600mg)

44
Q

Antidepressants - Pharmacokinetics

A

A - GI Tract
D - Throughout body
M - Liver
E - Kidneys, cross placenta and enter breast milk

45
Q

Considerations in Dosing for Antidepressants - Switching meds

A
  • Usually switch to an antidepressant in a different chemical category
    MAOIs are not trialed until two other chemical classes have failed
    First drug is tapered off while second is started
    MAOI and RIMA need a 2 week WASH OUT PERIOD
46
Q

Adverse Effects - TCA & MAOI

A

Toxic effects if OD

47
Q

Adverse Effect - SSRI and SSNRI

A

Sexual side effects (both)

SSNRI - Palpitations

48
Q

Adverse Effect - ALL Anti-depressants

A

Serotonin syndrome
Antidepressant discontinuation syndrome (except fluoxetine)

49
Q

ADS

A

If stopped suddenly
- flu like symptoms
- emotional lability
- anxiety and agitation
- dysesthesia (electric shock sensations)
- vivid dreams/nightmares

50
Q

EMERGENCY - Serotonin Syndrome

A

Excessive serotonin in the synaptic cleft, caused by; combining medications that increase CNS serotonin levels

Cause: hyperthermia, seizures, rhabdomyolysis

51
Q

Risk Factors of Serotonin Syndrome

A

Recent start or increase of medication
Polypharmacy that increases serotonin

Prevention
- provide person-centered education
- assess all medications, supplements, foods and recreational drugs

52
Q

TCAS and Suicidal Ideation (EMERGENCY)

A

Lethal doses of TCAs are close to accepted dose range
Overdose is high
Death - hypotension, uncontrollable seizures, cardiac arrhythmia

SHOULD NOT BE PRESCRIBED FOR CLIENTS WITH RISK OF SUICIDE, OR HISTORY

53
Q

MAOI and Risk of Hypertension

A

Sometimes termed irreversible MAOI
NE is a potent vasoconstrictor
- if there is a sudden release of NE, it can significantly increase blood pressure
- first symptom is occipital headache (severe), stiff neck, dizziness, incoordination

54
Q

MAOI and Tyramine

A

Dried sausages - salami, pepperoni, pastrami
Alcoholic beverages - beer, unpasteurized beer

55
Q

Antidepressant - Precautions

A

Suicidal ideation - high risk TCAs, MAOIs, SSRIs
Hypotension
Cerebral vascular disorder
Seizure disorder

56
Q

Antidepressant Contraindications

A

Known hypersensitivity
Alcohol misuse
Mania

TCA - myocardial infarction or congestive heart failure

57
Q

Theories of Mood Disorders

A

Biogenic Amine Hypothesis
Chronobiologic Theories
Sensitization and Kindling Theory
Genetic Factors

58
Q

Treatment of Bipolar Disorders

A

Anti-Mania Medications
Anticonvulsant medications
Antipsychotic medication

59
Q

Anti-Mania Medication

60
Q

Anticonvulsants

A

Carbamazepine
Lamotrigine
Valproic Acid/divalproex sodium

61
Q

Antidepressants need to be administered with mood stabilizer because?

A

It will prevent rapid cycling from depression to mania

62
Q

Pharmacokinetics - Mood Stabilizers - Lithium Carbonate

A

A - GI Tract
D - Same as water, crosses the blood brain barrier slowly
M - Liver
E - Kidneys, usually 80% of filtered lithium is re-absorbed

63
Q

Lithium Carbonate - Dosage

A

Acute: 900-2400 mg
Maintenance: 400-1200 mg

64
Q

Mood Stabilizers - Medication Dosage

A

Carbamazepine - 300-1600 mg
Iamotrigine - 100 - 500 mg
Valproic avid - 750 - 3000 mg
Divalproex sodium - 750 - 3000 mg

65
Q

Lithium Carbonate

A

Serum Drug levels are required with lithium carbonate
Baseline bloodwork
- renal
- cardiac
- thyroid
- electrolytes

66
Q

Therapeutic Range of Lithium Carbonate

A

0.6 - 1.0 mEq/L (mmol/L)

67
Q

Maintenance Range for LiCO3

A

0.6-1.0 mEq/L

68
Q

Lithium Carbonate and Sodium Intake

A

Sodium levels need to be maintained to avoid overhydration and dehydration

69
Q

Overhydration

A

Decreases lithium level

70
Q

Dehydration

A

Increases lithium level

71
Q

Lithium Toxicity

A

Includes: GI discomfort, tremor, confusion, fatigue

Treatment: notify prescriber, withhold lithium, obtain a blood sample to measure lithium, emergency medical treatment, IV hydration

72
Q

Lithium Contraindications

A

Renal impairment
Brain damage
Cardiac impairment

73
Q

Lithium Precautions

A

NSAIDS
Thyroid conditions
Psoriasis
Hypercalcemia

74
Q

Lithium Carbonate Interactions

A

Alcohol/diuretics - increase dehydration/fluctuating sodium levels

Haldol - increase encephalopathy syndrome

75
Q

Lithium Carbonate - Older Adult Considerations

A

Caution with clients that have critical illness, renal, hepatic impairment
Lithium levels are 0.4-0.6 in older adults

76
Q

Epilepsy

A

Prevalent of neurological disorders
Recurrent seizures that are not caused by secondary sources

77
Q

Sx of Epilepsy

A

Loss of consciousness
Sensory disturbances
Chorea
Fainting

Partial - involves one hemisphere
Generalized - bilateral

78
Q

Secondary cause of Seizures

A

Infectious disease
Trauma
Metabolic disorders
Vascular diseases
Neoplastic disease
OD
Withdrawal

79
Q

Idiopathic Seizures

A

Alteration in cell membrane permeability
Altered distribution of ions
Imbalances in neurotransmitters
- GABA
- Acetylcholine

80
Q

Anti-Seizure Medication

A

Drugs that potentiate GABA action
Drugs that suppress sodium influx
Drugs that suppress calcium influx

81
Q

GABA is used for?

A

Calming effect
Helps control anxiety

82
Q

Diazepam Use & Dosage

A

2-40 mg
Regularly used for treatment of alcohol withdrawal

83
Q

Lorazepam Use and Dosage

A

0.5-4mg (max 6mg/day)
Alcohol withdrawal

84
Q

Drugs that Suppress Sodium Influx

A

Delaying sodium ions from crossing the neuronal membranes
NA+ channels are temporarily inactivated

85
Q

Drugs that Suppress Sodium Influx

A

Carbamazepine - 300-1600mg
Iamotrigine - 100-700 mg
Valproic Acid - 750-3000 mg
- toxic (150+)

86
Q

Drugs that Suppress Calcium Influx

A

Delaying the entry of calcium into the neurons by blocking low-threshold Ca^2+ channels
Reduces the likelihood of an AP occurring

87
Q

Anti-Seizure Medications - Pharmacokinetics

A

A - GI Tract
D - Widely & cross the placenta and enter breast milk
M - Liver
E - Kidneys

88
Q

Status Epilepticus - EMERGENCY

A

Withdrawal of barbiturates, benzodiazepine, alcohol, infections, drug overdoses

Treatment:
Phenytoin - first line drug in treatment of status epilepticus
Phenobarbital - 20 mg/kg in single or divided doses
Diazepam - 5mg/min IV Push
Lorazepam - 2 mg/min IM or IV push

89
Q

Seizure - Timing

A

5+ = status epilepticus
10+ = brain damage

90
Q

Anticonvulsant Medications

A

Common Adverse Effects
CNS - Drowsiness, dizziness, diplopia
GI - Nausea, vomiting, indigestion
Other - vitamin deficiencies, hair loss

91
Q

Serious Adverse Effects - AC Medications

A

Agranulocytosis
CNS Depression
Laryngospasm
Angioedema

92
Q

AC Medication - Contraindications and Cautions

A

HS
CNS Depression
Phenobarbital - severe uncontrolled pain

Caution
Hepatic dysfunction
History of myocardial infarction
Pregnancy and breast feeding

93
Q

Drug Interactions - AC medications - Hormonal contraceptives

A

Decrease effectiveness

94
Q

DI - AC Med - Herbal - Gingko and Oil or Primrose

A

Increase severity and likelihood of seizures

Pharmacology (3 decks)

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