Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm II > seizures and parkinson > Flashcards

seizures and parkinson Flashcards

1
Q

parkinson’s is the loss of dopamine continuing neurons in the _____ where they

A

substantia nigra inhibit the firing of cholinergic neurons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

three broad mechanisms of parkinsons drugs

A

dopamine replacement
dopamine agonist therapy
anticholinergic

all of which aim to correct the imbalance of the cholinergic neurons in the striatum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

this drug is a metabolic precursor of dopamine that crosses the bbb

A

levodopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

why are large doses of levodopa necessary in tx

what is the problem with this

A

because the drug is decarboxylated to dopamine in the periphery

this causes side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

carbidopa

A

dopamine decarboxylated inhibitor that does not cross the BBB

this reduced the peripheral metabolism of levodopa and increases the amount that reaches the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Selegiline/deprenyl MOA

A

inhibitor of monoamine oxidase

this is the enzyme that metabolizes dopamin in the CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Rasagiline

A

newer monoamine oxidase inhibitor similar to selegiline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

this drug is known for disabiling response fluctuations over time

A

levadopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

mnemonics for parkinson’s tremor

A

MAIN- bradykinesia (slowness)

TRAP-motor

tremor at rest
rigidity
akinesia
postural stability

SOAP-non motor

sleep disturbances
other: nausea fatigue, speech
autonomic
psychologic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

two classes of medications that cause parkinsonism

A

anti-psychotics

anti-nausea

both result in the loss of dopamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

7 categories of anti parkinsons drugs

A 
Anticholinergic
Amantadine 
COMT
Dopamine
Dopamine agonists
MAO-B inhibitors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

name the two anithcholinergic drugs used for parkinsons

A

benztropine

trihexyphenidryl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

COMT inhibitors

A

entacapone

tolcapone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

dopamine agonsits

A

apomorphine
bromocriptine
praipexole
ropinirole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

MAO inhibitors

A

rasagiline

selegiline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the PK issues with levadopa

A

do not take with high protein meal because its absorption is affected by the diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

LAAD inhibitor

A

L-amino acid decarboxylase inhibitor

carbidopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CI or carvidopa levodopa

A

narrow angle glaucoma

non-selective MAOIs- hypertensive cris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

drug resistant off periods with levodopa carbidopa are due to

A

delayed gastric emptying or decreased GI absorption

GIVE ON EMPTY STOMACH

try to avoid control released products

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what drugs would you not want to give with a pt on levodopa

A

dopamine antagonists: antipsychotics and antiemetic
non-selective MAOI

buproprion:increased side effects
protease inhibitors:toxcitiy
phenytoin, ion: reduce the IO-dope efficacy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

AE to levodopa

A

GI effects common: nausea vomiting
postural hypotension and unstable balance
arrhythmias (low incidence)
sedation/vidi dreams/

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

why do we see the end of dose effect with levodopa

what can you do to help prevent this

A

increasing loss of neuronal dopamine storage
relying on exogenous source (med)

can increase dosing frequency
change to long acting
add short acting regimen to long acting
add other durgs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

COMT

A

methylates levadopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

entacapone and

tolcapone both target what pathway

A

COMT methylation of L dopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

how doe tolcapone differ from decarboxylase inhibitors

A

blocks COMT in the brain and helps to increase the levlels of dopamine and

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

tolcapone SE

A

cna increase liver enzymes causing failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

how does MOA B differ from antidepressants

A

selective targets dopamine degradation therefore MOABI like selegiline and rasaligine slectively target this and prevent degradation in the CNS

these durgs only have minor effects when given alone and are used mostly in conjungtion with levadopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

MOA of ropinarole

A

D2 receptor agonist similar to bromocriptine

paramipexole (D3)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

viral agetn that increase dopamine release and uptake and can be used for parkinson’s

A

amantadine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

benztropine

trihexyphenidryl

how do thye work

A

benztropine

trihexyphenidryl

antimuscarninic agent

help restore balance of dopamernergic and cholinergic activity

centrally acting antimuscarinic that effect tremor but not effect of brady

help with parkinsonism effects of drugs

used if tremor is a big side effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

vomiting before abdominal pain think

A

medical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

pain before vomiting think

A

surgical

but be prepared for either or both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

if you see hmg drop by

A

more than a point in a week you check occult blood three time

sometimes the bleeding is proxismal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

SIRS

A

criteria that they
defined as at least 2

heart rate >90
RR >20 <32
temperatrue <96.8 (36) or >38 > 100.4
WBC>12 or <4 or with >10% bands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

SE with parmipexole ropinorle and bromocriptine

A

common nausea confusion hallucinations light headedness LE edema
postural hypotension
sedation

serious: compulsive behavior physchosis, sleep attacks, pleuropulmonary fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what is a side effect that is exclusive to ergot derivatives

A

pleuropulmonary fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

drug interactions with bromocriptine

A

w/ bromocriptine

azole
antifungals
protease inhibitors
erythromyocin

increase bromocriptine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

DI with ropinirole

A

altered metbaolism with CYP1A2 inducers and inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

this drugs provides rapid effective temporary relief of off period akinesia

A

apomorphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

apomorphine

A

effective temporary relief of off period akinesia

SI

N/V

premedicate with trimethobenzamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

trimethobenzamide

A

used for N/V associated with apomorphone (off period akinesia)

can cause dizziness hallucinations an ink site irritation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

trimethobenzamide CI

A

5HT3 receptor blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

rotigotine

A

row to go tin

dopamine agonist patch also used in RLS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what is special about apomorphine

A

the first dose of apomorphine must be given in a clinic setting. The patient should not take apomorphine if he is allergic to metabisulfite.

The dose should be re-titrated if he has not taken apomorphine for 1 week.

Apomorphine causes severe nausea and vomiting.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

two COMT inhibitors and the differences between their side effects

A

entacapone: peripheral SE
tolcapone: central and peripheral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

of the two COMT I which one can cause hepatotoxcity

A

tolcapone:

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

COMT

A

degrades dopamine in periphery AND CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

if the pt is taking levodopa and about to start a COMT what should be done first

A

reduced levodopa by 30% in first 48 hours to avoid ADE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

other than hepatotoxicty with tolcapone what SE would we expect to see with COMT I

A

orange brown urine delayed onset diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

COMT I interact with

A

NONSELECTIVE :

MOAIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

the uses of COMTI

A

reduced off time and increase l-dopa AUC by 35%

allow for reductions in L-dopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

1st line for managing motor fluctuations with pts on L dopa

A

entacapone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

when would we used tolcapone

A

reserved for pts with fluctuations that are not responding to other therapies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

MAOB inhibitors work selectively in the

A

CNS

increases dopamine in the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

MAOBI

A

rasagiline
safinamide
selegiline

safari
and giline MOUSE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

when would we use MAOBI transdermal patch

A

depression only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Adverse effects of selegiline

A

SILLY rat
the same as everything else

+ DIZZINESS HA

rare: atrial fibb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Adverse effects of rasagiline

A

red rat
same as every other parkinsonian drug

+vomiting
depression
dyskinesia
orthostatic hypotension

rare: GI hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Adverse effects of safinaminde

A

safari rat

same as other PD drugs except for fall

rare: hypertension and hallucinations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

what kind of drugs are CI with MAOB

A 
other MAOIS
Isocarboxazid (Marplan)
Phenelzine (Nardil)
Selegiline (Emsam)
Tranylcypromine (Parnate)
and opiods and OTC cold 
meperidine
methadone
tramadol
porpoxyphene
dextromethrophan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

what should you advise a pt ot MAOI

A

avoid all OTC cold prep
don’t take with other MAOIS

Serotonin syndrome :use in caution with pts on antidepressants

avoid NON SELECTIVE MAO inhibitors -hypertensive crisis life trhreatening

(accumulation of NE )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

which MOA B I can be used as monotherapy

A

rasagiline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

this is thought to be the MOA of amantainde

A

may potentiate dopaminergic function

NDMA antagonis–> anti-dyskinetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

why don’t we use amantadine regualrly

A

short lived

less effective than l-dopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

amantadineSE

A

most of the mental

depression
irritability
excitability 
agitation
confusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

livedo reticularis

A

reversible duffuse skin mottling and often LE edema

seen with amantadine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

these types of medications are used for symptomatic control of tremors only

A

anticholinergics
bextropine (cogentin)
trihexyphenidyl (artane)

trihex benz car aretan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

what population do you want to be weary of with anticholinergics

A

geriatric lower doses and titrate slowely

worried about confusion

constipation
dry mouth
urinary retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

what is your first approach to the pt with IPD

A

non pharmacologic: education, exercise, nutrition, psychosocial

or consider rasagiline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

what do you do for a pt on rasagiline who needs additional tremor control

A

if under 65 anticholinergic or amantadine

if over 65 amantadine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

what do you do for a pt on rasagiline who continues to experience symptoms of bradykinesia rigidity or tremor

A

add amantadine

DA agonist

or Carbidopa L-dopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

delayed onset fluctuations seen as bradykinesia at the beginning of dosing intervals is known as

A

delayed onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

what is peak-dose dyskinesia

A

involuntary movement at peak levodopa levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

how do you treat response fluctuations

A

keep extra dose with you in case meds wear off while out
longer acting meds
maximize on time
minimize off time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

what can you do for a pt that experiences wearing off

A

ass MAO BI
ADD COMT I
ADD DOPAMINE AGNOSIT
ADj dosing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

what to do for on-off phenomenon

A

add entacapone rasagiline pramipexole ropinirole or selegiline

redistribute dietary preotein and space meds 2 hours from a meal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

focal seizures are defined as

what are the three categories

A

arising from localized regions of the brain and can be

simple (focal aware)
complex (focal impaired awareness)
secondary generalized (focal to bilateral)

78
Q

generalized seizures definition and categories

A

involve both hemispheres LOC and may be convulsive or non-convulsive

absence (petit mal)
tonic-clonic (grand mal) : both phases
myoclonic
atonic (loss of muscle tone)

79
Q

ion channel phsyiology in seixures

A

selective pores for Na, K, Cl, Ca

ATP dependent Na/K pump that maintains resting membrane potential at -70 mV
concentration gradient: K inside Na outside
when opened Na movies in and K moves out

charges change confirmational state of voltage gated chanels and Na and Ca depolarize the membrane

80
Q

four broad classifications for the MOA of anti seizure drugs

A

(1) modulation of voltage-gated sodium, calcium, or potassium channels

2) enhancement of fast GABA-mediated synaptic inhibition
(inhibitory GABA)

(3) modification of synaptic release processes
(4) diminution of fast glutamate-mediated excitation.

81
Q

when would you start therapy for individuals experiencing seizures

A

first seizure for high risk pts

all pts at seocnd seizure

82
Q

when pt is still experiencing seizures despite medication regimen

A

if not decreasing in frequency
switch to second med with taper

if decreasing in frequency

maximize dose
add second agent
could potentially taper first

83
Q

seizure medication options for pregnant women

A

oxclamotrigine, levetiracetam, zonisamide

84
Q

seizure medication options for elderly with focal epilepsy

A

levetiracetam, lomotrigine

85
Q

primary generalized med options

A

ethosuximide (absence only)

levetiracetam, lomotrigine, topiramate, valproate, zonisamide

86
Q

partial onset (focal) with or w/ot secondary generalized properties meds

A

topiramate, levetiracetam, lomotrigine, oxclamotrigine, zonisamide

carbamazepine
oxacarbazepine
lacosamide

87
Q

drugs to avoid in primary generalized

A

gabapentin
pregabalin
tiagabine
vigabatrin

88
Q

what would you never want to use in a woman of childbearing potential

A 
valproate (d)
Phenytoin
Carbamezapine
 Oxcarbazepine 
Phenobarbital

ALL category D

89
Q

CBZ

A

carbamazepine

carbatrol
epitol
equetro
tegretol
tegretol-XR
90
Q

PB

A

phenobarbital

91
Q

PHT

A

phenytoin

dilantin
phenytek

92
Q

VPA

A

VPA -valproate

depacon
depakaene
depakote
SPRINKLES
Stavzor
93
Q

ESM

A

zarontin

ethosuximide

94
Q

PB MOA

A

enhances GABA evoked Cl- currents

barber taking up GABA

95
Q

PHT MOA

A

blocks Na channels

towing car and carba both throwing out salty chips

96
Q

CBZ

A

blocks Na channels

97
Q

VPA

A

Valerie wearing her sprinkle coat is not about to eat salty chips either

or tea flavored ice cream

VPA blocks Na channels and T type Ca channels

98
Q

ethosuximide/ESM MOA

A

aaron trying to be zaro still sux

he isn’t eating tea ice cream either and he is skinny af

99
Q

major drug old epi drug approved for JME

A

PB

100
Q

which drug can be used off label for post-taumatic seizures following TBI

A

PHT

101
Q

what is the main older epi med that can be used for status epi

A

PHT
phenytoin

my care is dying tow me call and check the STATUS of the tow truck

102
Q

usual dosage of PB

A

Dzz-Mzz (100-300)

103
Q

normal dosage and initial dosage of CBZ

A

Dzz-Nzz (100-200 BID)

800-1200 max
Fuzz- thinzz

104
Q

see d think

A

2

105
Q

see m think

A

3

106
Q

8

A

F V

107
Q

1

A

t or d

108
Q

ESM dosage

A

Ethosuxamide

Start LESS of Aaron like half (250-500)

At the max you have to Tells him
TELSS 1500

109
Q

VPA dosage

A

dL
15mg

max

shes

mx: 60

110
Q

PB dose adj

A

hepatic and renal

barbershop with the kidney and the liver

111
Q

PHT adjustments needed

A

need to monitor free unbound levels for liver

112
Q

CBZ need what adjustment

A

use caution in liver
CrCL<10
dz

113
Q

VPA adjustments

A

hepatic adjustment for moderate to severe

NO RENAL
val likes to drink but her kidneys are fine

114
Q

ESM dosage adjustments

A

use caution in liver and kidney

115
Q

which anti seizure meds are CYP inducers

A

PB
PHT
CBZ

116
Q

cbz cns DEPRESSION se

A

Diplopia and drowsiness

117
Q

dose related SE CBZ

A

HA

N/V

118
Q

idiopathic SE CBZ

A

Rashes
hyponatremia
bloody dyscrasias

119
Q

VPA CNS SE

A

somnolence

120
Q

VPA Dose-related SE

A

weight gain
N/V
alopecia
throbocytopenia

Val is gaining wait and bald playing the trombone

121
Q

ESM CNS SE

A

drowsiness

aaron is tired

122
Q

ESM dose related SE

A

anorexia
weight loss
abd cramps

123
Q

ESM Idiopathic SE

A 
leukopenia
eosinophilia
psychiatric
sleep disturbances
aggression
124
Q

VPA idiopathic SE

A

drug rashes
hepatotox
pancreatitis
thrombocytopenia

drinking
playing the trombone epigastric pain
rash

125
Q

what are some common ASE shared between

PB PRM PHT CBZ VPA and ETH

A

drowsiness
GI
hepatic dose
all renal dose except: VPA and PB

126
Q

VPA most significant adverse SE

A

thrombocytopenia

127
Q

ESM most significant SE

A

aggression

128
Q

when to draw blood for PHT

whats the range

A

about every 2 weeks

MS (30) you’re getting towed

you want to be between TOSS and NICE

129
Q

CBZ therapeutic range

A

R - tin
greater than

TL you’re done

130
Q

VPA range

A

L- TNL

5-125

Over TNS 150 not good

131
Q

CBZ blood draw

A

4-6

RaaSH

132
Q

LTG

A

lamotrigine

lamictal

133
Q

GBP

A

gabapentin

neurontin

134
Q

TPM

A

Topiramate

topamax

135
Q

LEV

A

levetiracetam

keppra

136
Q

OXC

A

oxcarbazepine

trileptal

137
Q

PGM

A

pregablin lyrica

138
Q

ZNS

A

zonisamide

conegram

139
Q

LTG MOA

A

blocks Na channles

140
Q

GBP MOA

A

Unknown but probably increases gaba synth

141
Q

TPM

A

blocks Na channels

142
Q

PGB MOA

A

modulates the influx of Ca by binding to presynaptic voltage gated channels

gabling lyrica is fucking with the wires on the ice cream truck

143
Q

OXC MOA

A

blocks Na channels

144
Q

ZNS MOA

A

blocks Na and T-type Ca

similar to VPA

145
Q

Lacosamide MOA

A

vimpat

binds to collapsing response mediated protein 2 to enhance inactivation of Na

Waco pat isn’t letting the potato chip truck arrive

146
Q

LTG is indicated for

A

partial
GTC
LGS

off label absence

147
Q

when would you use GBP

A

ADJ for partial

148
Q

rare and severe kind of epilepsy that starts in childhood

A

LGS

149
Q

what two drugs can you use for LGS

A

GBP

LTG

150
Q

what new epi meds can be used as an adjunct for children under the age of two

A

OXC

151
Q

PGM and ZNS are both used as

A

partial adjunct

152
Q

what new epi drugs would you see dose related weight gain with

A

GBP

PGB

153
Q

what new epi drugs would you see dose related weight loss

A

ZNS

TPM

154
Q

N/V are common with every single new epi drug except

A

GBP ‘

only SE are somnolence and weight gain

155
Q

acute angle glaucoma is a idiopathic SE of what antiepi med

A

TPM

156
Q

TPM idiopathic SE

A

glaucoma
acute-angle glaucoma
oligohydrosis
hyperthermia

157
Q

systemic life threatening rash and hepatic failure are idiopathic SE of this antiepi drug

A

LTG

158
Q

what anti epi drugs would you see associated with blood dyscrasias

A

CBZ and OXC

159
Q

peripheral edema and thrombocytopenia are associated with this new antiepi

A

PGB

160
Q

this new anti epi is associated with sulf allergies

A

ZNS

161
Q

all newer antiepi casue drowsiness except

A

lacosamide

162
Q

all new epi cause GI effects except

A

GBP and PGB

163
Q

all new anti epi drugs require hepatic dose adj except for

A

GBP
PGB
LEV

ALL REQUIRE RENAL

164
Q

slowing psychomotor disturbances and significant CI are all associated with what newer ant epi

A

TPM

165
Q

mood changes are associated with what newer epi

A

LEV/ keepra

166
Q

status epilepticus

A

any seizure lasting longer than 30 minutes with or without LOC
recurrent seizures with no intervening period of consciousness

may be convulsive or non-convulsive

167
Q

tx of status

A

oxygenation preservation of cardioresperatory function

Benzos: IV push of lorazepam or diazepam

or
PHT/fosphenytoin IV loading dosed followed by PO maintenance
alt: PB

168
Q

Monitoring needed for PB

A

CBC w/ diff and LFTs anually

serum Ca and bone scan periodically

169
Q

PHT monitoring

A

ALBUMIN huge deal and LFT anually
CBC with differential every 6 -12 mo
Ca and vitamins levels as well as DEXA scan

170
Q

monitoring with CBZ and VPA

A

CBC with differential and platelets q3mo and then every 6 mo
LFTs

for CBZ also need CMP every 6 mo

171
Q

when should you consdier stopping therapy

A

no seizure >2 years
IQ, neurological test
no previous unsuccessful attempts at drug discontinuation
normal neurologic examination
consider risk vs benefits
normal EEG
single type of partial or generalized with mixed there is a heightened ris

172
Q

what is the major teratogenic drug we worry about anti-epileptics

A

valproate

as well as 
CBZ
PB
PHT
TPM

LMT

173
Q

these drugs have known transfers to breast milk

A 
LMT
primidone
LVT
GBP
TPM
174
Q

common AE with clonazepam

A

disinhibition
ataxia

severe
respiratory depression
physical dependence

175
Q

these two antiepis have decreased clearance in geri population

A

CBZ

LMT

176
Q

decreased protein binding seen with these two anti epi in geri populations

A

PHT

VPA

177
Q

increased half life in geriatrics with this antiepi med

A

Diazepam

178
Q

fewer AED in geriatic pop with this drug

A

LMT
low dose TPM
GBP
and LCT

179
Q

poly
oligo
normal
AFI

A

8-18 = normal

, AFI ≤5 cm = oligohydramnios,

AFI ≥24 = POLY

180
Q

causes of oligp

A

Urethral obstruction (e.g., posterior urethral valves)
Bilateral renal agenesis
Autosomal recessive polycystic kidney disease (ARPKD)
Chromosomal aberrations (e.g., trisomy 18)

Intrauterine infections (e.g., congenital TORCH infections)

In multiple pregnancies: twin-to-twin transfusion syndrome

Late or post-term pregnancies (> 42 weeks of gestation) 
Placental insufficiency
Preeclampsia
Premature rupture of membranes
Idiopathic
181
Q

PCN allergy GBS treatment

A

cephazolin

super severe PNC ampicillin allergy
clinda
vanco

182
Q

Tx for mom with hep b

A

C section to avoid maternal mixing of blood

need to give baby hep B ivig and hep B vaccine (first day of life)

ideally you vaccinate mom prior to pregnancy

183
Q

HIV

A

baby cares about viral load increase in viral loas means increase in infectious risk

CD4 count–> risk of opportunistic infection (think TORCH)

DOES NOT CROSS PLACENTA

184
Q

Is mom immune to hep B or infected

A

Antigen wins –> infexted
INFECTED

e–> INFECTIOUS

ab–> immune

surface ab—> immune through vaccination of exposure

185
Q

diagnoses in HIV

A

ELISA

viral blot

if she shows up with no testing

2+1
2 NTRI+1 NNRTI
1PI

186
Q

NNRTI

A

nevirapine (c)

187
Q

protease inhibitor

A

atazanavir (b)

188
Q

When can you delivery vaginally with HIV

A

delivery VL<1000 and on HARRT

189
Q

don’t know mom’s HIV status

A

AZT

AZT (zidovudine),

190
Q

charcot’s triad sx

A

Most patients have fever, jaundice, and right upper quadrant pain (Charcot triad).

Pharm II (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions