Week 10 (drugs of abuse and CNS) Flashcards
Differences between Pramipexole, Ropinrole, and Rotigotine
Pramipexole is used w/ mild PD, or w/ levodopa in severe PD
Side effects are more common with Ropinrole, but less common when combined with L-dopa
Mechanism of action for Rotigotine is not known, probably in the substantia nigra (not D2 and D3 receptor binding like the other ones)
Another name for Non ergot alkaloids
dopamine agonists
Contraindications for non ergot alkaloids
if N/V occurs can’t give with seratonin antagonists like zofran (orthostatic hypotension) or dopamine receptor antagonists (opposite effects)
AE of apomorphine
Injection site rxns (no PO dosing) hallucinations,
drowsiness,
dyskinesia,
N/V.
4% serious CV events
Difference between Selegiline and Rasagline
Metabolites of Selegiline are amphetamine and methamphetamine, so they can cause CNS excitation and insomnia
Rasagiline may increase risk for malignant hyperthermia, assess skin
What is amantadine used for?
helps manage dyskinesias with L-dopa
rapid response that decreases within 3-6 mo
What is the benefit of entacapone with L-dopa
It helps L-dopa reach the brain so it can work, also causing less peripheral side effects d/t conversion to dopamine
How do dopamine agonists work and what are they used for
Dopamine agonists (ergot alkaloids and non ergot alkaloids) work by direct agonism of dopamine receptors in striatum. They are used for PD
When giving any medications that suppress immune responses, what are points of patient education? (hint: re: illness, infection, vaccines)
Before starting treatment, patients should become up to date on vaccines, since once the immune system is suppressed, it will be hard for the immune system to create new antibodies, and person will need increased immunity because they have less of an ability to fight infections
Once treatments are started the person is considered immunocompromised, so they should avoid sick people and encourage loved ones to get vaccinated to prevent giving them illnesses
Avoid concurrent administration of multiple immunosuppressants
These meds can also be very expensive, and are sometimes not covered by insurance
What is benzotropine used for
PD, as a second line drug for tremor
it is less effective than L-dopa or dopamine agonists but is better tolerated
AE of benzotropine
CNS (sedation, confusion, hallucinations)
peripheral: anticholonergic effects
What is Mitoxantrone used for and how does it work?
mitoxantrone is used as a immunosuppressant to slow the progression of MS, it works by inhibiting DNA repair and synthesis (decreased immune cell proliferation/activation, decreased myelin destruction)
List the three MAJOR adverse effects of mitoxantrone.
Myelosuppression (neutropenia, anemia, thrombocytopenia)
Irreversible cardiotoxicity, can occur years after drug has been stopped
Fetal injury (even in low doses, r/o pregnancy before each dose)
Knowing that Na+ channel receptors have 3 states (open, inactivated, and closed) how do these types of antiseizure drugs prevent neuronal transmission on some neurons, but not all neurons?
Slows progression from inactive to closed, so action potential only in hyperactive neurons are suppressed
Discuss PK variances of antiseizure medications
Phenobarbital – CYP450 inducer
carbamazepine – CYP 450 inducer, is metabolized by CYP450
Oxycarbemazepine – Induces CYP450, can increase metabolism of oral contraceptives
Lamotrigine – estrogen lowers drug levels
topiramate w/ phenytoin – lowered drug levels of both
tiagabine – metabolized by CYP 450
What is ethosuximide used for?
Absence seizures
AE of Oxcarbazepine
CNS depression
Hyponatremia
Hypothyroidism
Skin rxns and hypersensitivity
