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SUM '20 - Pharm II > Week 1 antiepileptic 4 of 4 (6/3) > Flashcards

Week 1 antiepileptic 4 of 4 (6/3) Flashcards

slide 72-94

1
Q

these three side effects are more commonly associated with bromocriptine than those treated with levodopa.

A

hypotension

auditory and visual hallucinations

dyskinesia

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2
Q

what med classification can occasionally cause pleuropulmonary fibrosis sometimes with pleural effusions?

A

synthetic dopamine agonists.

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3
Q

what med classification can cause erythromelalgia (red, edematous, tender extremities)
uncommon complication

A

synthetic dopamine agonist

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4
Q

synthetic dopamine agonists can cause an asymptomatic increases in what laboratory finding

A

serum transaminase (ALT)

alkaline phosphate (ALP)

liver enzymes

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5
Q

what side effects are occasionally associated with bromocriptine

A

vertigo and nausea

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6
Q

with respect to CNS side effects is there an advantage of non ergot alkaloids over ergot derivatives?

A

no

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7
Q

with respect to nausea and orthostatic hypotension, is it important that non ergot alkaloids cause less nausea and orthostatic hypotension than ergot derivatives

A

this is clinically INsignificant.

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8
Q

what are the effects of anticholinergic drugs such as trihexyphenidyl and benztropine on parkinson’s disease

A

blunt the effects of ACH- correcting the balance between dopamine and ACH

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9
Q

what do anticholinergic drugs specifically help control in patients with parkinson’s disease

A

tremors and decrease the excess salivation.

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10
Q

do anticholinergic drugs help parkinsons patients with their skeletal muscle rigidity and bradykinesia

A

no

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11
Q

what are the side effects of treating parkinson patients with synthetic anticholinergic drugs?

anticholinergic drugs to treat patients with parkinson’s disease has diminished.

A 
memory disturbances
hallucinations
confusion
sedation
mydriasis
cycloplegia
adynamic ileus
urinary retention
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12
Q

name the antiviral drug used for prophylaxis against infection with influenza A

A

amantadine

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13
Q

discovered by chance, this drug also produces symptomatic improvement in patients with parkinson’s disease

A

amantadine

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14
Q

amantadine is speculated to aid parkinson’s patients by these three mechanisms

A

facilitating the release of dopamine from dopaminergic terminals

delay uptake of dopamine back into nerve endings

antagonist effects at NMDA receptors.

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15
Q

amantadine is different from anticholinergics drugs for in its ability to improve what two symptoms

A

muscle rigidity

bradykinesia

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16
Q

side effects of amantadine are similar to anticholinergics but in addition can induce

A

ankle edema

livedo reticular of the legs with or without cardiac failure

Livedo reticularis is a rare skin condition caused by stagnation of blood within dilated capillaries causing a lacy, nonraised pink/purple net-like blotchy skin discoloration -google_

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17
Q

non pharmacologic treatments of parkinson’s disease include

A

deep brain stimulation

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18
Q

deep brain stimulation mechanism of action?

what specific benefit to the patient does it provide

A

unknown MOA

benefits controls symptoms resistant to medications, allows reduced reliance of drugs.

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19
Q

what type of drugs are selegiline and rasagiline

A

monoamine oxidase type B enzyme inhibitors (MAO-B)

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20
Q

MAO-B antiparkinson effect when used alone?

MAO-B antiparkinson effect when combined with carbidopa-levodopa

A

alone- weak

adjunt- moderate effect

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21
Q

name the significant side effect of selegiline

A

insomnia

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22
Q

other side effects of selegiline

A

confusion, hallucinations, mental depression paranoid ideation

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23
Q

avoidance of tyramine is ideally recommended if patient is on what class of medication

A

MAO-B

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24
Q

what two ways do analeptics increase excitability

A

blocking inhibition or by enhancing excitation

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25
Q

this class of medication was used in CNS depressions after a person deliberately overdosed on drugs- No longer used for this purpose

A

CNS stimulants

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26
Q

CNS stimulants margin of safety is___

A

low

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27
Q

This centrally acting analeptic also acts peripherally on chemoreceptors augmenting breathing efforts

A

doxapram

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28
Q

doxapram 1mg/kg IV dose is similar to that produced by a pa02 of _____ acting on the carotid bodies

A

38

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29
Q

are doxapram positive effects seen because of increasing in breathing frequency or increase in tidal volume?

A

increase in tidal volume is response for the induce increase in minute ventilation

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30
Q

doxapram increase minute ventilation- what happens to o2 consumption

A

o2 consumption increases

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31
Q

doxapram margin of safety?

A

large margin of safety

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32
Q

how many fold difference in the dose that stimulates ventilation and the dose that produces seizures for doxapram

A

20-40 fold difference

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33
Q

how long dose a single dose of doxapram last?

due to this what must we do?

A

single dose 5-10min

continuous infusion may be required

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34
Q

a continuous infusion of doxapram often results in what clinical manifestations?

A 
sub convulsive CNS stimulatiion
HPTN
tachy
cardiac dysrhythmias
vomiting
increased body temp
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35
Q

how extensive is doxapram metabolized?

what percent is excreted unchanged in the urine

A

extensively metabolized

<5%

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36
Q

doxapram iv infusion dose

A

2-3mg/min

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37
Q

this drug can be used to maintain ventilation during administration of supplemental 02 to patients with COPD who would otherwise rely on hypoxic drive to maintain

A

doxapram

38
Q

post operatively doxapram has been used to prevent { this } produced by opioids without altering analgesia

A

ventilatory depression

39
Q

other than helping patients breath- why else would we want to give doxapram to our post op patients

A

shown to be useful in stopping post op shivering

40
Q

what can we administer to neonates in the ICU in lieu of placing an advanced airway

A

doxapram used for apneic babies to delay or prevent intubation and ventilation

41
Q

what 4 conditions can we give dantrolene for

A

Thyroid storm

NMS-neuroleptic malignant syndrome

spastic disorders- associated with hepatic dysfunction

MH

42
Q

compare dantrolene to ryanodex

sterile water to reconstitute

A

dantrolene-60ml

ryanodex- 5ml

43
Q

compare dantrolene to ryanodex

shelf life

A

dantrolene 3 years

ryanodex 2 years

44
Q

compare dantrolene to ryanodex

mannitol

A

dantrolene 3000mg

ryanodex 125mg

45
Q

why do we not used ryanodex?

A

its more expensive (2,581) vial

46
Q

revonto vial contains how many mg

ryanodex vial contains how many mg

A

revonto- 20mg

ryanodex -250mg

47
Q

ryanodex has enough dantrolene in a single vial for a loading dose in what kg patient

A

100kg

48
Q

most serious complication of dantrolene use?

A

generalized muscle weakness that may result in respiratory insufficiency or aspiration PNA

49
Q

why do we use a CVL with dantrolene

A

can cause phlebitis in small peripheral veins

50
Q

dantrolene dose

A

2.5mg/kg- 10mg/kg q5min until episode has stopped

follow up with 1mg/kg q6hrs for 24-48 hrs

51
Q

dantrolene vs ryanodex time to reconstitute

A

86sec vs 20sec

52
Q

mechanism of action for dantrolene

A

DIRECTLY INTERFERES WITH MUSCLE CONTRACTION BY BINDING THE Ryr1 RECEPTOR CHANNEL AND INHIBITING CALCIUM ION RELEASE FROM THE SARCOPLASMIC RETICULUM

53
Q

per flood- half life of dantrolene

A

9 hrs

54
Q

dantrolene exerts antispasmodic effect by decrease what release from SR

A

calcium

55
Q

PO absorption of dantrolene?

A

slow and incomplete

56
Q

starting oral dose of dantrolene

A

25mg BID

57
Q

max oral dose of dantrolene

A

200mg/day

58
Q

what do we have to check prior to starting dantrolene?

A

lab investigation for liver dysfunction should be explore prior to use d/t potential hepatotoxicity

59
Q

primary indication for centrally acting muscle relaxants

A

spasticity with accompany pathologic conditions such as stroke, cerebral palsy, multi sclerosis, amyotrophic lateral sclerosis and CNS injuries.

60
Q

centrally acting muscle relaxants act where

A

on CNS or on skeletal muscles to relieve spasticity

61
Q

this medication is a chlorophenol derivative of GABA

A

baclofen

62
Q

does baclofen have any effect on the NMJ

A

no

63
Q

where does baclofen act as an agonist

A

at GABA (B) receptors in the dorsal horn of the spinal cord

64
Q

what is baclofen often administered for treatment of

A

spastic hypertonia of cerebral and spinal cord origin

65
Q

MOA- baclofen

A

activating G protein linked presynaptic gaba b receptors that hyper polarize muscles spindle afferent neurons. there by decreasing the number and amplitude of excitatory postsynaptic potentials along the dendrites of motor neurons

66
Q

baclofen is particularly effective in treatment of

A

Flexor spams

Skeletal muscle rigidity associated with spinal cord injury or MS

67
Q

which administration route may be an effective treatment of spinal spasticity that has not responded to oral adminstration

A

intrathecal

68
Q

how is baclofen absorbed in the gi tract

A

rapidly and almost completely

69
Q

elimination half time for baclofen

A

3-6hrs

70
Q

what percent of baclofen is excreted by the kidneys

A

80%

dose may need to be adjusted with renal dysfunction

71
Q

side effects of baclofen

A

sedation
skeletal muscle weakness
confusion

72
Q

if you suddenly d/c chronic use of baclofen what may occur

A

withdrawal

73
Q

therapeutic plasma concentrations of baclofen

A

80-400mg/ml

74
Q

accidental intrathecal overdose of baclofen

A

hemodynamic instability and delayed awakening following general anesthesia

75
Q

overdose of baclofen

seizure concerns

A

Threshold for initiation of seizures may be lowered in pts with epilepsy

76
Q

sudden d/c of baclofen vocal cord concerns

A

Vocal cord spasm following abrupt d/c of intrathecal infusion

77
Q

what may occur with an overdose of baclofen

A

Coma, depression of ventilation and seizures with overdose

78
Q

Sudden d/c of chronic baclofen use may result in severe withdrawal reactions:

A

Tachy
Auditory and visual hallucinations
A known case of cardiac arrest has been reported

79
Q

this CNS stimulant is a methylxanthine derived phosphodiesterase inhibitor that is present in a variety of drinks

A

CAFFEINE!!

80
Q

(3) pharmacologic uses of caffeine include

A

administration to neonates experiencing apnea of prematurity

treatment for postural puncture headache

common cold remedies to offset the sedating effects of certain antihistamines

81
Q

this medication is used for patients with excessive day time sleepiness associated with narcolepsy, OSA, shift work sleep disorder

A

modafinil

82
Q

this drugs acts on the carotid body chemoreceptors to increase minute ventilation

A

almitrine

83
Q

this drug is used to prevent one lung ventilation hypoxia

A

almitrine

84
Q

caffeine, theophylline and theobromine are called

A

methylxanthines

85
Q

methylxanthines can do what 4 things

A

stimulate CNS

produce diruesis

increase myocardial contractility

relax smooth muscle

86
Q

this drug treats ADHD

A

methylphenidate

87
Q

side effects seen with methylphenidate

A 
HTN
tachycardia
priapism
seizures
serious cardiovascular events 
stroke
MI
88
Q

carbamazepine and rifampin interaction with theophylline produce

A

enhancement of theophylline

89
Q

cimetidine, erythromycin interact with theophylline produce

A

inhibition of theophylline

90
Q

how must benzo’s be administered in the presence of theophylline

A

you must increase the dose of benzo

91
Q

what may occur in patients being treated with oral baclofen

A

mild hypotension in awake patients

92
Q

patients treated with oral baclofen given general anesthesia may experience

A

bradycardia and hypotension and delayed awakening.

SUM '20 - Pharm II (30 decks)

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