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Week 4 - Neuro > Week 4 - Neuro Drugs > Flashcards

Week 4 - Neuro Drugs Flashcards

1
Q

nimodipine

A

Ca++ channel blocker, CNS, dilates small vessels preserving cerebral perfusion

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2
Q

tissue plasminogen activator (TPA) - alteplase - activase

A

Tx for ischemic or embolism strokes, contraindicated in hemorrhagic strokes, dissolves blood clots, given within 3-4.5 hours of stroke onset, thrombolytic

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3
Q

tissue plasminogen activator mechanism

A

IV, made with recombinant DNA technology, restores patency of thrombosed vessels, binds to fibrin in clot and causes plasminogen to turn into plasmin which causes fibrinolysis

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4
Q

tissue plasminogen contraindications

A

intracranial or subarachnoid hemorrhage, high BP (>185/110), rapidly resolving, MI/stroke/head injury in last 3 months, surgery in past 2 weeks, active bleeding, acute trauma (fracture), anticoagulation therapy, GI bleed (look for occult blood)

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5
Q

aspirin

A

antiplatelet, 24-48 hrs after ischemic or transient ischemic stroke, 24 hrs after thrombolysis, prevents stroke recurrence

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6
Q

clopidogrel

A

antiplatelet, for pts allergic to aspirin

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7
Q

antihypertensive drugs and stroke

A

high BP with stroke often, antihypertensive Tx if BP >220/120, risk - lowering BP will decrease cerebral perfusion

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8
Q

mechanism of ganiciclovir

A

prodrug phosphorylated by viral thymidine kinase, inhibits viral DNA synthesis, competitive DNA poly binding and chain termination, not effective against latent virus, tx for CMV

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9
Q

mechanism of acyclovir

A

prodrug phosphorylated by viral thymidine kinase, inhibits viral DNA synthesis, competitive DNA poly binding and chain termination, not effective against latent virus, tx for HSV1 and HSV2

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10
Q

mechanism of trifluridine

A

progrud that must be phosphorylated by host kinases (higher toxicity), inhibits viral DNA synthesis, competitively binds DNA pol and chain termination, topical tx for HSV keratoconjunctivitis

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11
Q

mechanism of penicillin

A

cell wall inhibitor, binds penicillin binding proteins, can cause seizures at high levels by blocking binding of inhibitory GABA to receptors

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12
Q

mechanism of albendazole

A

microtubule inhibitor, tx for taenia solium (neurocysticerosis) - good for roundworms and tapeworms

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13
Q

mechanism of sulfadiazine + pyrimethamine

A

folate synthesis inhibitor, tx for toxoplasmosis

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14
Q

tx huntington depression

A

common, SSRIs / tricyclics, counseling

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15
Q

tx huntington psychosis / agitation

A

atypical antipsychotics, quetiapine (does not worsen motor), risperidone / haloperidol / olanzapine (may help chorea too)

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16
Q

tx huntington cognitive decline

A

none, compensatory strategies, social supports, OT for independence, assistance with driving, finances, personal care

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17
Q

non-pharm tx huntington chorea

A

non-pharm - may not be bothersome / reduce stress / reduce anxiety / reduce depression / calm environment / adaptive equipment

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18
Q

tetrabenazine

A

tx huntington chorea, monoamine-depleting agent - inhibits presynaptic dopamine release and blocks CNS dopamine receptors, reduces mild chorea, may worsen suicidal thoughts/depression/cognitive/psychiatric, if not tolerated can give amantadine which is an NMDA receptor antagonist

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19
Q

neuroleptics

A

tx huntington chorea, block post-synaptic dopamine receptors, treats both psychiatric and motor

20
Q

atypical antipsychotics

A

tx for mild to moderate huntington chorea, olanzapine, risperidone, clozapine, aripirazole, quetiapine

21
Q

typical antipsychotics

A

tx moderate to severe huntington chorea, haloperidol, fluphenazine

22
Q

deep brain stimulation

A

tx for severe chorea, worsens bradykinesia

23
Q

huntington investigational tx

A

memantine - slow cognitive effects, creatine/HUFA/minocycline - slow apoptosis

24
Q

haloperidol

A

typical anti-psychotic, dopamine DA2 receptor antagonist, causes parkinsonism motor effect

25
Q

clozapine

A

atypical anti-psychotic, dopamine DA2 receptor antagonist with faster off-rate, 5TH serotonin receptor antagonist, increases NMDA receptor activity

26
Q

monoamine oxidase (MAO) inhibitor

A

anti-depressant, monoamine oxidase degrades norepinephrine and serotonin, blocking MOA increases NE and 5HT at synapse

27
Q

tricyclics (imipramine)

A

anti-depressant, decreases norepinephrine and serotonin reuptake, increasing NE and 5HT at synapse

28
Q

specific serotonin reuptake inhibitors (SSRI)

A

anti-depressant, decrease serotonin reuptake, increasing 5HT at synapse

29
Q

anti-depressants

A

long latency for effective tx (weeks/months), possibly due to neural plasticity and time needed to change gene expression

30
Q

deep brain stimulation

A

anti-depressant, used in pts who do not respond to drugs, stimulate the nucleus accumbens

31
Q

carbidopa / levodopa (sinernet - 1:10 or 1:4)

A

empiric tx for parkinson

32
Q

carbidopa

A

prevents peripheral metabolism of levodopa, means more gets into CNS, tx for parkinson, increased to prevent nausea / vomiting side effect of excess peripheral dopamine

33
Q

levodopa

A

naturally metabolized to dopamine, tx for parkinson, side effect induced dyskinesia, decreases akinesia, rigidity, tremor - if pt responds to drug then confirms parkinson

34
Q

ropinirole

A

additional tx for parkinson, D2 / D3 dopamine receptor agonist in putamen, given for increased cogwheel rigidity without spasticity, side effect sleep attacks and edema, high dopamine levels can cause psychosis (hallucinations)

35
Q

pallidotomy

A

removed globus pallidus internus on one side, done to reduce tremor, rigidity, akinesia in late parkinson, removes GPi over inhibition of thamalus

36
Q

adverse effects of levodopa tx for parkinson

A

orthostatic hypotension, nausea / vomiting due to stimulation at chemoreceptor trigger zone, involuntary dyskinesia, psychosis (high dopamine in limbic system) - all due to high levels of dopamine in CNS

37
Q

drug interaction with levodopa

A

pyridoxine (vit B6), coenzyme to peripheral l-aromatic amino acid decarboxylase enzyme that metabolizes levodopa to dopamine - caution multivitamins

38
Q

carbodopa

A

inhibits l-aromatic amino acid decarboxylase, prevents peripheral metabolism of levodopa - more gets into CNS

39
Q

trihexyphenidyl (artane)

A

alternative tx for parkinson, CNS muscarinic receptor antagonist, anticholinergic

40
Q

amanradine (symmetrel)

A

antiviral, parkinson tx, NMDA receptor antagonist, used with levodopa

41
Q

COMT inhibitors (stalevo)

A

tx parkinson, decreases L-DOPA metabolism, given with l-dopa/carbodopa

42
Q

pramipexole (mirapex)

A

tx parkinson, partial receptor of D2 dopamine receptor

43
Q

selegiline (eldepryl)

A

tx parkinson, inhibits monamine oxidase that breaks down dopamine, allows for lower levodopa dosage

44
Q

levodopa

A

amino acid that can cross BBB, dopamine can not cross BBB, 95% is metabolized in gut need large doses to reach brain, must give with carbodopa enzyme inhibitor

45
Q

chlorpromazine

A

dopamine antagonist, will worsen Parkinson

46
Q

bromocriptine

A

dopamine agonist that inhibits prolactin release, can treat amenorrhea with galactorrhea caused by pituitary tumor

Week 4 - Neuro (5 decks)

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