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PHARM > Week 10 - Migraine/Neurologic > Flashcards

Week 10 - Migraine/Neurologic Flashcards

1
Q

What is the difference between the Phenytoin (Dilantin) blood level and free phenytoin blood levels?

A

Blood level = bound + unbound
Free = unbound
Because phenytoin is very highly protein bound with a narrow therapeutic range, if the patient has low albumin, they can experience symptoms of toxicity even if their total phenytoin result falls within therapeutic range

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2
Q 
Phenytoin (Dilantin) 
Class: 
Mechanism: 
Uses: 
Contraindication:
A

Class: Anticonvulsant, Hydantoin
Mechanism: Suppresses abnormal neuron firing by suppressing the sodium influx – returns nerve cells to a stable resting potential and limits excitability
Uses: Seizure treatment/prophylaxis
Contraindication: Pregnancy (teratogen!) - monitor serum levels closely in pregnancy as seizures become more frequent due to increased metabolic rates

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3
Q

Phenytoin (Dilantin)
Serum level:
Side/Adverse Effects (13):

A

Serum level: 10-20 mcg/mL
Effects: gingivitis, gingival hyperplasia, nystagmus, diplopia, H/A, dizziness, slurred speech, decreased coordination, alopecia, Thrombocytopenia, Steven Johnson, hypotension, liver toxicity

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4
Q

Phenytoin (Dilantin) Drug Interactions:

-With Cimetidine (Tagamet), Isoniazid, Sulfonamides

A

Increased effects WITH Cimetidine (Tagamet), Isoniazid, Sulfonamides)

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5
Q

Phenytoin (Dilantin) Drug Interactions:

-With folic acid, antacids, calcium, sucralafate, antineoplastics, antipsychotics, primrose, gingko

A

Decreased effects with folic acid, antacids, calcium sucralafate, antineoplastics, antipsychotics, primrose, gingko

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6
Q

Primrose effect on Phenytoin

A

Lowers seizure threshold

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7
Q

Gingko effect on Phenytoin

A

Decreases phenytoin effectiveness

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8
Q

Phenytoin (Dilantin) Drug Interactions

–Anticoagulants, oral contraceptives

A

Decreased effects OF anticoagulants, oral contraceptives, antihistamines, dopamine, theophyline

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9
Q

Phenytoin effect on heart

A

Has anti-arhythmic properties

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10
Q

Phenytoin effect on Insulin

A

Inhibits insulin release – increases glucose level

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11
Q

Phenytoin (Dilantin) Nursing Interventions

A
  • Shake suspension well for 5 min
  • Monitor serum levels
  • Safety
  • Warn females taking oral contraceptives to use additional contraception
  • Avoid herbs, alcohol, and CNS depressants
  • Don’t stop abruptly
  • Frequent oral hygiene and checkups (r/t gingivitis, gingival hyperplasia)
  • Monitor glucose levels in diabetics (can increase glucose)
  • Report sore throat, bruising, nose bleeds
  • Medical alert ID
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12
Q

What can you mix Dilantin IV with?

A

ONLY normal saline

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13
Q

Migraines

A

Unilateral or bilateral steady throbbing head pain + photophobia + N/V

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14
Q

Symptoms of Migraine (4)

A
  • Persist for 4-24 days, or multiple days
  • Triggered by food, hormones, stress, meds, fatigue
  • decreased or asymptomatic in pregnancy and menopause
  • aura and prodromal symptoms
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15
Q

Classic migraine

A

aura

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16
Q

Common migraine

A

no aura

17
Q

Drug treatment for MILD migraine

A

Analgesics - Aspirin, Tylenol, Ibuprofen

  • ASA alone or with caffeine (potentiates effect)
  • Chronic daily dosing of Tylenol can cause liver damage so watch out
18
Q

Drug treatment for MODERATE TO SEVERE migraine

A

Selective Serotonin (5-HT) Receptor Agonists (Triptans)

19
Q 
Sumatriptan (Imitrex)
Class: 
Mechanism: 
Use: 
Routes (3):
A

Class: Selective Serotonin (5-HT) Receptor Agonist
Mechanism: Binds to selective serotonin receptor sites to cause VASOCONSTRICTION of cranial vessels
Use: Acute migraine treatment
Routes (3): PO, SC, nasal spray

20
Q

Sumatriptan (Imitrex)
Contraindications (2):
Side effects (8):
Adverse (12):

A 
Contraindications (2): CAD, vascular disease (b/c it vasoconstricts)
Side effects (8): Dizziness, tingling, warm sensations, numbness, drowsiness, cramps, N/V diarrhea 
Adverse (12): HTN, hypotension, heart block, angina, dysrhythmia, thromboembolism, seizures, CNS hemorrhage, stroke, coronary vasospasm, MI, cardiac arrest
21
Q

Carbidopa-Levodopa (Sinemet)
Class:
Mechanism:
Uses:

A

Class: Dopaminergic (restores dopaminergic levels)
Mechanism: Carbidopa inhibits dopa decarboxylase to reduce metabolism of levodopa, increase amount of levodopa available for dopamine conversion, and reduce the amount of levodopa needed
Uses: Parkinsons

22
Q 
Carbidopa-Levodopa (Sinemet) 
Side Effects (10):
A
  • Fatigue, insomnia
  • Dyskinesia, orthostatic hypotension
  • Dry mouth, blurred vision, urinary retention
  • N/V, dysrhythmia, palpitations
23
Q

Groups of drugs used in Alzheimer’s

A

ACh inhibitors and N-Methyl-D-asparate Inhibitor (NMDA)

24
Q 
ACh inhibitors for AZ 
Mechanism:
Side effects (12):
A

Mechanism: blocks acetylcholinisterase to increase Ach levels (Cholinergic agonist)
Side Effects: H/A, dizziness, depression, GI distress, dehydration, dry mouth, constipation, blurred vision, insomnia, hyper/hypotension, dysrhythmia, hepatotoxicity

25
Q

N-Methyl-D-Aspartate Inhibitor (NMDA) for AZ

Mechanism

A

Block NMDA receptors (which overstimulation of causes neurodegeneration) to reduce crate of clinical deterioration in patients with AZ

26
Q 
Methylphenidate (Ritalin) 
Class:
Mechanism:
Uses (3):
Interactions (3):
A

Class: Amphetamine-like
Mechanism: Acts on cerebral cortex and reticular activity system to stimulate RAS/AROUSAL
Uses (3): ADHD, fatigue, narcolepsy, behavioral syndromes
Interactions (3):
-increased effects with caffeine
-decreased with decongestants, antihypertensives, barbituates
-may alter insulin effects

27
Q 
Methylphenidate (Ritalin)
Side effects (17):
A
  • Tachycardia, palpitations, HTN, dizziness
  • sleeplessness, restlessness, nervousness, tremors, irritability, blurred vision
  • Rash
  • Increased hyperactivity
  • Anorexia, dry mouth, vomiting, diarrhea, weight loss
  • Thrombocytopenia
28
Q

Methylphenidate (Ritalin)

Caution and interventions

A
  • Risk for physical and psychological dependence
  • Avoid concomitant use of MAO inhibitors (increased risk of toxicity)
  • Give before breakfast and lunch, before 6pm
  • Monitor CBC
  • Avoid caffeine, alcohol
  • Record height, weight, and growth of children
  • Relieve dry mouth with sugarless gum
  • Taper (don’t stop abruptly to avoid withdrawal)
29
Q

Phenytoin PB

Free Dilantin range

A

85-95%

Free dilantin range: 1.0-2.0 mcg/mL

30
Q

Too low dilantin symptom

A

Too low - seizure

PHARM (11 decks)

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