Week 6 - CNS Disorders and Associated Drugs Flashcards
What is abortive therapy and when is it used?
To abort an ongoing attack
- Goal is to eliminate headache pain and associated N/V
- Treatment should commence at the earliest sign of an attack
- Oral therapy can be ineffective once attack has started due to GI symptoms
* Injection, intranasal or rectal suppository may provide better relief
What is the first-line treatment for migraine prevention?
Beta blockers – propranolol, metoprolol, timolol, atenolol, nadolol
What is the first-line treatment for acute, mild to moderate migraine without nausea or vomiting
NSAIDS
When would someone would be appropriate for preventative therapy for migraines?
Patients who have frequent attacks, 3 or more a month, attacks that are especially severe or attacks that do not respond adequately to abortive agents.
What are some examples of opioid analgesics reserved for severe migraines that don’t respond to first-line medications?
Butorphanol nasal spray
- oxycontin
- vicodin
- percocet
What is the MOA for sumatriptan?
*Binds to 5-HT receptors on intracranial blood vessels causing vasoconstriction. Also binds to 5-HT receptors on trigeminal nerves to suppress release of CGRP which reduces inflammation by restricting release of inflammatory neuropeptides.
What are the contraindications for triptans?
- Patients with a history of ischemic heart disease
- MI
- uncontrolled hypertension or other heart disease.
- Pregnancy
How should the first dose of a triptan be administered?
Under direct supervision in case of any unknown underlying cardiac disease.
What patient teaching is required for Rivastigmine?
Helps with cognition in dementia.
- Does not work for everyone
- Lightheadedness may occur increasing risk for falls – lie or sit down until it passes, move slowly when standing up (sudden movement may make it worse)
- Ensure adqueate intake with supplemental meals and snacks to maintain optimal weigh
- Patient to keep list of new symptoms and problems to be disussed at each encounter
When would it be appropriate to increase the dose of Donepezil?
Dose would need to be increased if patient is taking CYP450 enzyme inducers
Used to treat Alzheimer’s Disease.
What are the side effects of cholinesterase inhibitors?
- GI effects
- Dizziness
- Headache
- Bronchoconstriction
Used in Alzheimer’s disease
What do you do when a patient is on medication for Alzheimer’s Disease and symptoms worsen?
Better to increase the AD medication rather than to add things like herbal medications,
vitamins, or NSAIDs
What are the most common adverse effects of Pramipexole?
- Nausea
- Dizziness
- somnolence
- Insomnia
- Constipation
- Weakness
- Hallucinations
Used to treat Parkinson’s Disease.
When is the best time to prescribe Pramipexole in treatment of Parkinson’s Disease?
Early stage or late stage when combined with levodopa.
When do we prescribe COMT inhibitors?
Especially beneficial for patients who experience a wearing off of the effects of levodopa/carbidopa. Used if safer agents are ineffective or inappropriate.
What are sleep attacks associated with related to PD treatment?
Sleep attacks – overwhelming and irresistible sleepiness that comes on without warning. Happens with pramipexole and other non-ergot derivatives
How do we manage the side effects of Bromocriptine?
- Adverse effects are dose dependent, reducing the dosage can help reduce symptoms
Treatment for Parkinson’s
How is levodopa/caridopa used in the treatment/diagnosis of Parkinson’s Disease?
- First line drug or used to supplement dopamine agonist
- Used for patients with more severe symptoms
- Preferred for primary objective of improving motor function
- Most effective drug for PD
- May take weeks to months to become effective
What patient teaching is needed when prescribing phenytoin to patients using oral contraceptives?
Phenytoin can decrease the effects of oral contraceptives, oral contraceptive dosage may need to be increased or patient should switch to an alternate form of birth control
How do we monitor antiepileptic drugs for effectiveness?
Monitor serum plasma levels and have patients keep a record of seizure history including date, time, nature of all seizures
Which anticonvulsant would be given for someone with epilepsy needing adjunctive therapy for partial seizures with or without secondary generalization?
Gabapentin
Adverse effects of Phenytoin?
- CNS effects
- CV effects
- Gingival hyperplasia
- Hirsuitism
- Hypersensitivity Reaction
- Measles like rash
- Stevens-Johnson syndrome
Patient teaching for phenytoin
- finding optimal dose takes time
- take drug exactly as prescribed
- withdrawal risk if not taking regularly (refill prescriptions on time, take extra on vacation)
- keep a seizure frequency chart
- lab monitoring of drug levels
- no driving until seizures are controlled
- inform of CNS depression
- inform of suicidal
