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pharmacology > Neuro Exam 3 > Flashcards

Neuro Exam 3 Flashcards

1
Q

Pathophysiology of Parkinson Disease

A

Too little dopamine and too much acetlycholine

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2
Q

Therapeutic goal of Parkinsons

A

Provide symptomatic relief, does not delay the progression

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3
Q

Long term use of levodopa/carbidopa (Sinamet) can lead to______.

A

Dyskinesias, typically 80% of the users of the drug will experience this right after optimal dosage has been acheived

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4
Q

What are “off times associated with Levadopa/Carbidopa?

A

Periods where there is a complete loss of symptom relief

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5
Q

Adverse effects associated with Levodopa/Carbidopa

A

N/V, Dysrhythmias, postural hypotension, psychosis and dyskinesias

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6
Q

Levodopa purpose in the pill

A

Crosses the BBB and then can convert into dopamine

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7
Q

Purpose of Carbidopa in the pill

A

Carbidopa is the car that ensures levodopa gets driven past the BBB (ensures its is not broken down in the intestines/periphery).

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8
Q

Prior to giving this drug for parkinsons I will assess _____

A

Motor symptoms

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9
Q

Drugs that I shouldn’t take with Parkinson drug? (1 Hard NO)

A

Anticholinergic drugs, Selective MAO-B inhibitors

Hard NO- MAO Inhibitors

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10
Q

Take levodopa with ____ but avoid _____, when taking the drug, why?

A

food, high protein meals It can alter the absorption

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11
Q

Entacapone and Selegilline are use for what

A

The “off times” associated with taking Levadopa

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12
Q

Amantadine can be taken for

A

levodopa-induced movement disorders

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13
Q

Educate patient on this drug to except it to work in this time frame, be sure to check ____ and monitor urine for this adverse sign

A

weeks to months to work
skin assessment- can affect malignant melanoma
Darkened urine and sweat (harmless effect)

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14
Q

Why would I prescribe someone Pramipexole? (Mirapex)

A

It can be used as 1st line therapy in early stages of Parkinson (less side affects)
Also used with levadopa/carbidopa, lowers dose for Sinamet- less side affects
Also used for restless leg syndrome

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15
Q

MOA of Mirapex-Pramipexole

A

Direct activation of dopamine receptors in the striatum

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16
Q

Adverse effects of Pramipexole (Mirapex), same as Levadopa plus 2 funky ones

A

Nausea, diskinesia, postural hypotension, hallucinations

Sleep attacks and impulse controls (gambling, shopping, binge eating, etc)

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17
Q

Cautious giving Levodopa/Carbidopa to patients with ____ and _____

A

cardiac disease and psychiatric disorders

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18
Q

Prior to giving Mirapex im assessing

A

motor symptoms

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19
Q

Cautious to give Mirapex to (3)

A

older adults
Psych disorders
Kidney dysfunction

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20
Q

Selegiline will be given for what

A

MAO-B inhibitor to prevent dopamine breakdown- 1st line drug to decrease “off times”

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21
Q

Entacapone taken to do what

A

COMT inhibitor to prevent early breakdown of Levodopa in the peripheral tissues and intestines.

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22
Q

Amantadine Use and MOA

A

Only Drug recommended for diskinesias

Works by promoting release of Dopamine from remaining dopamine neurons, may block reuptake

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23
Q

Take mirapex with food or on empty stomach?

A

Food to reduce nausea and vomiting

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24
Q

Donepezil brand name

A

Aricept

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25
Q

Donepezil (aricept) use

A

Moderate to severe AD

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26
Q

MOA of Aricept

A

Prevent the breakdown of Aceylcholine by acetlycholinesterase and thereby increasing the availability of acetylcholine at cholinergic synapse

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27
Q

Severe effects of Aricept

A

Withdrawal syndrome

Prolonged Qt interval or heart block

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28
Q

Assess what prior to giving Donepezil

A

Mental status symptoms

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29
Q

Caution use of Donepezil in patients with (4)

A

Asthma or COPD
History of PUD
Urinary retention/obstruction

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30
Q

Since common side affects of Aricept are nausea and vomiting, patients can do this to reduce these symptoms

A

Take with food

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31
Q

Im administering you Donepezil Aricept I want to be sure to let you know that

A

Nausea and vomiting is common, take it with food to help, weight loss might occur but it will get better over time.

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32
Q

DO NOT DO THIS WHEN TAKING ARICEPT

A

Don’t stop medication suddenly, withdrawal symptoms include agitation, crying, and hallucinations

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33
Q

Memantine prescribed for

A

Moderate to severe AD

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34
Q

Memantine brand name

A

Namenda

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35
Q

Namenda is what type of drug

A

Neuronal receptor blocker

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36
Q

In lehman terms what does Cholinesterase inhibitors do for alzheimers disease

A

Prevent clearing of acetylcholine in junction, making more readily available

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37
Q

MOA of Memantine (Namenda) for alzheimers

A

In alzheimers, nerve cells are damaged causing too much glutamate to be produced which leads to more and more calcium being released into nerve cell- furthering cellular injury.
Memantine controls the influx of calcium, limiting the degree of damage

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38
Q

How to taper off multiple seizure drugs?

A

Taper off each individually and discontinue, one at a time

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39
Q

Pharmacologic management of Anti-eleptic drugs is highly _____

A

Individualized for each patient

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40
Q

Monitor what for AEDs

A

Monitor plasma drug levels due to tight therapeutic range

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41
Q

What do I wear if I am prone to seizures

A

Medic alert bracelet

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42
Q

What would a couple want to know about AEDs if one of them is taking the drug

A

Eight AEDs make oral contraceptives less effective and four of them can cause harm to a fetus

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43
Q

All AEDs, assess what

A

Type of seizure and how often

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44
Q

How do I get off AEDs

A

Withdraw slowly and sequentially- can lead to status epilepticus

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45
Q

Eval/Intervention/Education for patients on AEDS (4)

A

CNS depression
Signs that may preceded suicidal behavior
if pregnant take folic acid
Don’t stop suddenly

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46
Q

Difference between traditional and newer AEDs

A

Traditional AEDs are obviously more well established
Pharmacokinetics: Often complex in comparison to newer
Drug interactions: Are extensive
Safety in Pregnancy: Less safe
Cost: Less expensive in comparison to newer

The newer drugs are still figuring out their therapeutic niche

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47
Q

Phenytoin brand name

A

Dilantin

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48
Q

MOA of Dilantin

A

Delays the influx of sodium ions in neurons @ synaptic junction, consequently slowing the spread of abnormal nerve firing

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49
Q

Use of Dilantin

A

Treat all forms of epilepsy except for absent seizures

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50
Q

Phenytoin (Dilantin) Adverse reaction

A

CNS Issues- directly related to high doses
Morbilliform rash- evolve into Steven Johnson Syndrome
Teratogen
Purple Glove syndrome- Ischemic injury- due to very hard on blood vessels
Gingival hyperplasia
Hypotension and dysrhythmia with IV administration

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51
Q

MAR for Phenytoin (3)

A

Oral contraceptives, Warfarin, CNS Depressants

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52
Q

PMH for Dilantin

A

Sinus bradycardia or 2nd/3rd degree block

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53
Q

PO Dilantin

A

Take with food to avoid gastric upset

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54
Q

IV administration bewares of Dilantin

A

NEVER piggyback with dextrose solutions
Utilize a large vein with a large bore needle
There is significant extravasation risk, where the drug can leak out into the surrounding tissue

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55
Q

Toxicity S/S of Dilantin

A

Excessive sedation, diplopia, nystagmus

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56
Q

Can I go cold turkey on Dilantin If I decide its not working for me

A

No

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57
Q

What two teaching points could I include for patient taking Dilantin

A

Good oral hygiene for gingival hyperplasia and .5mg of folic acid daily

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58
Q

Brand name for Carbamazepine

A

Tegretol

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59
Q

Tegretol used for what

A

Seizures

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60
Q

Serious adverse effects of this Tegretol

A

Bone marrow suppression (Anemia, infection, bleeds)

Hypo-osmolarity and hyponatremia (increased ADH release)

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61
Q

Valproic Acid brand name

A

Depakote

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62
Q

What is Depakote used for

A

broad spectrum AED

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63
Q

Serious adverse of Depakote

A

Hepatotoxicity, pancreatitis, Teratogenic Effects

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64
Q

Avoid giving Valproic Acid to who?

A

Children less than 2 years of age and those individuals with liver issues

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65
Q

All barbiturates end in ____

A

tal

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66
Q

Use-
Thiopental
Secobarbital
Phenobarbital

A 
Ultra-short acting (seizures/anesthesia)
Short to intermediate acting (insomnia)
Long acting (seizures)
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67
Q

Barbiturates Adverse effects

A

Respiratory depression
Suicide vehicle
abuse (tolerance and dependency is common)
Acute toxicity (CPR- Coma, Pinpoint pupils, respiratory depression)

68
Q

MOA of barbiturates

A

Binds to the GABA receptor- enhancing Inhibitory effects

69
Q

Which AED works by blocking Calcium channels

A

Valproic Acid

70
Q

Which AEDs work by blocking sodium channels

A

Phenytoin (dilantin) and Carbamazepine

71
Q

Phenobarbitol PMH

A

Pregnancy

72
Q

How to give phenobarbitol

A

PO or IV slow infusion

73
Q

Is tolerance and physical dependence an issue with phenobarbitol?

A

Yes tolerance is common and dependence so you will experience withdrawal if you stop

74
Q

NEW AED

A

Oxcarbazepine

75
Q

MOA of Oxcarbazepine

A

Sodium channel blocker

76
Q

Adverse effects of Oxcarbazepine

A

Hyponatremia and Hypothyroidism
CNS effects
Blood dyscrasias

77
Q

Barbiturates high risk patients

A

Suicidal patients and geratrics

78
Q

As you build up tolerance what is something to be aware of for Barbiturates

A

Tolerance (dosage needed) will eventually catch up to serious harm dose

79
Q

Oxcarbazepine brand name

A

Trileptal

80
Q

Drug Interactions with Oxcarbazepine (4)

A

Oral contraceptives (Utilize 2 methods)
Sodium depleting drugs (Diuretics)
Alcohol
Other AEDS (Doesn’t play well with others)

81
Q

If Im allergic to Carbamazepine can I take Oxcarbazepine

A

No thats a hard no

82
Q

One assessment for lab with Oxcarbazepine

A

CBC- due to blood dyscrasias

83
Q

MAR for Trileptal (3)

Oxcarbazepine

A

Sodium depleting drugs
Oral contraceptives
Certain AEDS

84
Q

Oxcarbazepine 3 Educational points for patients
Trileptal

Blood
Skin
Salt

A

Educate on the hypo- natremia and thyroid effects
Educate on hematologic abnormalities
Severe skin reactions (SJS can occur)

85
Q

Gabapentin brand name

A

Neurontin

86
Q

MOA of Gabapentin

A

Analog of GABA

87
Q

What is gabapentin used for

A

It is a seizure drug but 80% of prescriptions are for off label use (neuropathic pain, migraine, fibromyalgia, relief of postmenopausal hot flashes)

88
Q

Be sure to educate family on what initial adverse effect of SSRI/SNRI usage

A

Can increase the risk of suicide at first

89
Q

SSRIs and SNRI use

A

Depression

90
Q

MOA of SSRIs and SNRIs

A

Blocks the reputake of serotonin and norepinephrine in the synaptic space

91
Q

Fluoxetine brand name

A

Prozac

92
Q

Venlafaxine is what type of drug

A

SNRI

93
Q

Venlafaxine also called what

A

Effexor XR

94
Q

When does serotonin syndrome begin

A

2-72 hours after treatment

95
Q

S/S of serotonin syndrome

A

altered mental status (agitation, confusion hallucinations)

incoordination, hyperreflexia, excessive sweating, tremor, fever (death)

96
Q

How will serotonin syndrome improve

A

Syndrome resolves spontaneously after discontinuing the drug

97
Q

How does risk increase for Serotonin syndrome

A

Taking multiple MAOIs and other drugs

98
Q

How to avoid withdrawal syndrome from SSRIs

A

taper dose off gradually, withdrawal can begin days to weeks of last dose
S/S include dizziness, headache, nausea, and sensory disturbances

99
Q

Lab for SSRI/SNRI prior to administration

A

Serium Na level

100
Q

MAR for SSRI/SNRIs

A

MAOIs- increase of serotonin syndrome, anti-platelet and anticoagulant drugs (increased risk for bleeds)

101
Q

Tell patient when to take the SSRI/SNRI

A

in the morning to minimize sleep disturbance

102
Q

Patient education for SSRIs and SNRIs

A
  • Dont stop suddenly
  • S/S of serotonin syndrome
  • Initial dose may cause you to feel worse (increased suicide)
  • Adverse effects could include (bruxism, GI bleeding, sexual dysfunction, dizziness and fatigue)
103
Q

Imipramine

A

TCA- Tricyclic Antidepressant

104
Q

Most serious adverse of TCAs (2)

A

serious orthostatic hypotension and Cardiac toxicity (stop taking drug)

105
Q

Adverse drug effects combined with TCAs

A

Anticholinergics, sympathomimetics (drugs that mimic sympathetic nervous system- double boost), MAO-Is

106
Q

Phenelzine

A

MAOI-I

107
Q

What can you not take in conjunction with MAOI-Is

A

SSRIs

108
Q

Any comorbidities with these 3, do not take MAOIs or be especially cautious

A

Heart, renal, liver

109
Q

MAOIs have high interaction with ____

A

All drugs

110
Q

Adverse effects of Phenelzine

A

HTN crisis, orthostatic hypotension

111
Q

Tyramine containing foods with MAOIs can cause what

A

Hypertensive crisis, promotes the release of norepinephrine

112
Q

Common tyramine containing foods

A

Avocados, figs, bananas, fermented meats, cheeses, soy sauce

113
Q

Bupropion brand name

A

Wellbutrin

114
Q

Buproprion prescribed for

A

SAD
Smoking Cessation
Major Depression

115
Q

How many weeks to feel effects of Bupropion

A

1-3 weeks

116
Q

Bupropion affect on appetitive

A

Stimulant- can suppress appetite

117
Q

Adverse effects of Wellbutrin

A

Seizures and increased risk of suicide

118
Q

Bright side of Wellbutrin

A

Doesn’t cause adverse sexual side effects

119
Q

All Benzodiazepines and Benzodiazepine receptor agonists end in what

A

PAM

120
Q

Use of Benzos

A

Manage seizure disorders, muscle spasms, panic disorder and alcohol withdrawal

121
Q

Apparently benzos have bright sides to include

A

Fewer drug interactions
lower potential for abuse
produce less tolerance and physical dependence

122
Q

Benzodiazepines are the drug of choice to treat ______ and _____.

A

Insomnia and anxiety

123
Q

Lorazepam brand name

A

Ativan

124
Q

Ativan use

A

Stop anxiety, suppress seizure, ease Alcohol

125
Q

Take oral Benzos with food?

A

Take oral with food if gastric upset occurs

126
Q

Adverse effects of Lorazepam (Ativan)

A

Daytime sedation, anterograde amnesia, respiratory depression
Paradoxical effect in older adult, children and psych patients

127
Q

Drug interactions for Ativan

A

Any other drug that can depress the CNS

128
Q

Ativan MOA

A

Potentiates the actions of GABA (inhibitory neurotransmitter)

129
Q

Zolpidem brand name

A

Ambien

130
Q

Use of Ambien

A

-Insomnia, short term management
-Don’t use for for anxiety, as a
muscle relaxant, and/or anticonvulsant action

131
Q

MOA of Zolpidem

A

Similar to benzos, enhances actions of GABA by binding specifically to Omega-1 receptors

132
Q

Adverse effects of Ambien

A

Dizziness, diarrhea, drowsiness

Sleep driving, sleep- related complex behaviors

133
Q

MAR for giving ambien

A

Any other CNS depressants and alcohol use

134
Q

How to administer Ambien

A

Oral

135
Q

Education on Ambien

A

Take right before sleep cycle and the drug can cause next day impairment

136
Q

Mainstay drugs for Bipolar disorder are _____ and _____

A

Lithium an valproic acid

137
Q

Antidepressants are given for

A

depressive episodes

138
Q

Antipsychotics are given to bipolar patients when

A

during severe manic episodes

139
Q

Mood stabilizers are given to bipolar patients for what

A

relieve symptoms during manic and depressive episodes

Stabilize both ends

140
Q

Lithium use

A

Control of acute manic episodes, prophylaxis against recurrent mania and depression

141
Q

MOA of lithium

A

Unknown, thought to alter glutamate uptake and release, blocks the binding of serotonin

142
Q

Early adverse effects of lithium

A

Gi effects, headache, confusion, muscle weakness

143
Q

Pre assessment for Lithium

A

Baseline cardiac status, CBC with diff, renal function, thyroid function, electrolytes

144
Q

MAR for lithium

A

Diuretic, NSAIDS, anticholinergics

145
Q

Hard no for lithium

A

1st semester pregnancy

146
Q

PMH be aware of or tread cautiously patients

A

Renal disease, CV disease, dehydration or sodium depletion

147
Q

Expected Lithium level should be

A

.4-1 mEq/L

148
Q

Below 1.5 lithium level

A

Nausea/Vomiting/Diarrhea/tremors

Basic stuff

149
Q

1.5-2 Lithium level

A

Hyper irritability of muscles, ECG changes, course hand tremors

150
Q

2-2.5 lithium level

A

High output of dilute urine, serious ECG changes, tinnitus, vision changes, clonic movements (seizure looking) possible coma and death

151
Q

Above 2.5 lithium level

A

Symptoms may progress rapidly to convulsions, oliguria, and death

152
Q

Migraine medications are used in two ways

A

Prevention of attack occurring

To abort an ongoing attack

153
Q

What is a migraine

A

A neurovascular disorder involving dilation and inflammation of intracranial arteries

154
Q

ERGOTS MOA

A

block inflammation associated with the trigeminal vascular system- perhaps by suppressing the release of CGRP

155
Q

MOA for TRIPANS

A

Vasoconstriction of dilated blood vessels by stimulating alpha-adrenergic and serotonergic (5-HT) receptors
- 1st line defense

156
Q

Assess what for Triptans (Sumatriptan)

A

Pain assessment, triggers, timing

157
Q

Hard nos for Triptans

A

Ergot alkaloids, other triptans, SSRIs/SNRIs, Ischemic heart disease, prior MI, Uncontrolled HTN, pregnancy

158
Q

Triptans can be given via what routes

A

Oral, subq, intranasal, transdermal

159
Q

What to evaluate after giving triptan

A

Evaluate the efficacy for an PRN medication and let provider know if any chest pain occurs

160
Q

Assessement before giving Ergots (ergomar)

A

Pain assessment, triggers, timing

161
Q

HARD NOs for Ergots (ergomar)

A

Triptans, hepatic or renal impairment, sepsis, CAD, PVD, pregnancy

162
Q

Take both Ergots and Triptans when?

A

Immediately after onset of Surgery symptoms

163
Q

Routes for Ergots

A

PO, sublingual, rectal, nasal spray, IM, IV, sub q

164
Q

Let provider know if what S/S develop with taking Ergots

A

muscle pain, paresthesias in your digits, extremities feel cold pale or numb (possible constriction)

165
Q

Many will experience this when taking Ergots

A

nausea and vomiting

pharmacology (6 decks)

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