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NAPLEX Study Time > Neuro > Flashcards

Neuro Flashcards

1
Q

What are the major symptoms of Parkinson’s disease?

A

TRAP:
Tremor
Rigidity
Akinesia/bradykinesia
Postural instability

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2
Q

Drugs that can worsen Parkinson’s disease

A

Phenothiazines (prochlorperazine, etc.)
Butyrophenones (haloperidol, droperidol)
1st and 2nd gen antipsychotics
Metoclopramide

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3
Q

Which med is preferred for the treatment of PD-associated psychosis?

A

Quetiapine

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4
Q

Rapid withdrawal of levodopa or dopamine agonists can cause what condition?

A

Neuroleptic malignant syndrome

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5
Q

What is the active metabolite of levodopa?

A

Dopamine

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6
Q

Why is carbidopa given in combo with levodopa?

A

Prevents the peripheral metabolism of levodopa that would destroy most of the drug before it crosses the BBB

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7
Q

What drug is 1st line for the treatment of PD?

A

Carbidopa/levodopa (Sinemet)

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8
Q

Which PD drugs are used to reduce “off” periods and to limit dyskinesias?

A

COMT inhibtors and MAO-B inhibitors

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9
Q

What drug can be used in younger PD pts to treat tremor-predominant disease?

A

Centrally-acting anticholinergics (benztropine)
Amantadine is also an option

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10
Q

Key points for carbidopa/levodopa

A

Starting IR dose = 25/100 mg tid
CI w/ non-selective MAOi and narrow angle glaucoma
SE: Nausea, dizziness, orthostasis, dyskinesias, hallucinations, psychosis, unusual sexual urges, pripism
Can cause brown/black urine discoloration
must d/c if positive Coombs test
Response worsens with long-term use
Must taper if stopping

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11
Q

Examples of catechol-O-methyltransferase (COMT) inhibitors

A

Entacapone (Comtan)
Opicapone (Ongentys)
Tolcapone (Tasmar)

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12
Q

When can COMT inhibitors be used?

A

Must be used in combo with levodopa - increases the duration of action of levodopa (prevents peripheral conversion)

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13
Q

Examples of dopamine agonists

A

Pramipexole (Mirapex)
Ropinirole (Requip)

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14
Q

Key points for dopamine agonists

A

Warnings for somnolence, orthostasis, hallucinations, dyskinesias
Must be tapered if stopping
For patch, cannot use same site for 14 days after use (daily patch)
Cannot use patch with sulfite allergy

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15
Q

What drug can be used as a rescue drug for off-periods for PD?

A

Apomorphine
Must be started in medical office

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16
Q

Key points for amantadine

A

Blocks dopamine reuptake and increases dopamine release from presynaptic fibers
Warnings for somnolence and psychosis
SE: Dizziness, orthostatic hypotension, livedo reticularis (reddish skin mottling)

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17
Q

Examples of selective MAO-B inhibtors

A

Selegiline
Rasagiline
Safinamide

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18
Q

Key points for MAO-B inhibitors

A

CI w/ MAOi, SSRIs/SNRIs, linezolid, opioids, TCAs
Same food interactions as MAOi’s
Risk of serotonin syndrome and HTN
Selegiline can be activating - do not take at night

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19
Q

Key points for benztropine (Cogentin)

A

Has anticholinergic and antihistamine effects
SE: dry mouth, constipation, urinary retention, blurred vision. mydriasis, somnolence, confusion
Avoid in elderly pts

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20
Q

Drugs that can worsen dementia

A

Antiemetics (promethazine)
Antihistamines (benadryl, doxyalamine)
Antipsychotics (chlorpromazine, aripiprazole)
Barbituates (phenobarb)
BZDs
Anticholinergics
Skeletal muscle relaxants (baclofen)
CNS depressants

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21
Q

What test is used to diagnose dementia?

A

Mini-Mental State Exam (MMSE)
Score <24 = memory disorder

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22
Q

What supplements have shown possible benefit for Alzheimer’s dementia?

A

Vit E and ginkgo
Both increase bleed risk

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23
Q

What drug(s) are first line for the treatment of Alzheimer’s disease?

A

Acetylcholinesterase inhibitors (donepezil)
+/- memantine

24
Q

What time of day should donepezil be taken at?

A

Bedtime (decreases nausea)
Can take in AM if causes insomnia

25
Q

Examples of acetylcholinesterase inhibitors

A

Donepezil (Aricept)
Rivastigmine (Exelon)
Galantamine (Razadyne)

26
Q

Key points for acetylcholinesterase inhibitors

A

Warnings for bradycardia and QT prolongation
SE: N/D
Rivastigmine patch = daily dosing, same site cannot be used for 14 days

27
Q

Key points for memantine (Namenda)

A

Blocks NMDA receptors
SE: Dizziness, confusion, HA

28
Q

Drugs that can lower the seizure threshold

A

Bupropion
Clozapine
Theophylline
Varenicline
Carbapenems (esp imipenem)
Lithium
Meperidine
Penicillin
Quinolones
Tramadol
Acyclovir/Valacyclovir

29
Q

Focal vs generalized seizures

A

Focal = starts on one side of the brain
Generalized = starts on both sides of the brain

30
Q

Define status epilepticus

A

Seizure that lasts 5 mins or more
Medical emergency

31
Q

Initial management for status epilepticus

A

Benzodiazepine injection
- can also use diazepam rectal gel

32
Q

What diet can benefit some patients with refractory seizures?

A

Ketogenic diet

33
Q

Which drug is used for absence seizures?

A

Ethosuximide

34
Q

Which neurotransmitter abnormalities can lead to seizures?

A

High glutamate
Low GABA

35
Q

Which antiepileptic drugs are Na channel blockers?

A

Carbamazepine
Lamotrigine
Phenytoin/fosphenytoin
Topiramate
Oxcarbazepine

36
Q

Key points for lamotrigine

A

Warnings for serious skin rxns
SE: alopecia (give Se and Zn), rash
Different colored starting dose boxes:
- red: normal dose
- blue: low dose, use if taking valproic acid/inhibitors
- green: high dose, use if taking inducers (phenytoin)

37
Q

Key points for levetiracetam

A

IV:PO is 1:1
Warnings for psych rxns (psychotic symptoms), somnolence, fatigue
No significant drug interactions
Max 3g per day

38
Q

Key points for topiramate

A

Warnings for metabolic acidosis, oligohidrosis, hyperthermia, nephrolithiasis, glaucoma, hyperammonemia, visual problems, fetal harm
SE: somnolence, memory/concentration/attention difficulty, weight loss, anorexia
Must monitor bicarb and intraocular pressure
Can decrease OC efficacy

39
Q

Key points for valproic acid/divalproex

A

Therapeutic range = 50-100 mcg/mL
Warnings for hepatic failure, fetal harm, hyperammonemia, thrombocytopenia
SE: alopecia (give Se and Zn), weight gain
Serious rash can occur w/ valproic acid + lamotrigine

40
Q

Key points for carbamazepine

A

Therapeutic range = 4-12 mcg/mL
Warnings for serious skin rxns, testing for HLA-B*1502 allele prior to starting, aplastic anemia, agranulocytosis, SIADH, fetal harm
CI w/ myelosuppression
Enzyme inducer and autoinducer (lowers own drug levels)
Many DDIs, decreases OC efficacy

41
Q

Key points for lacosamide

A

Warnings for PR prolongation and arrhythmias
Max 400 mg per day
IV:PO is 1:1

42
Q

Key points for oxcarbazepine

A

Warnings for severe skin reactions, test for HLA0B*1502 and hyponatremia
XR must take on empty stomach
Not an autoinducer
Can decrease OC efficacy

43
Q

Phenobarbital key points

A

Therapeutic range = 20-40 mcg/mL (adult)
Warnings: habit forming, resp depression, fetal harm
SE: physiological dependence, tolerance, hangover effect
Can decrease OC efficacy, strong inducer

44
Q

Which drug is a prodrug of phenobarbital?

A

Primidone

45
Q

Key points for phenytoin and fosphenytoin

A

Total range = 10-20 mcg/mL
Free range = 1-2.5 mcg/mL
IV:PO = 1:1
Arrhythmias associated with fast drip rates
Warnings for extravasation (purple glove syndrome), avoid in HLA-B*1520 + pts, fetal harm
SE: nystagmus, ataxia, diplopia, gingival hyperplasia, hepatotoxicity, hair growth
Strong inducers, high protein binding
Can decrease OC efficacy
Requires a filter
IV requires BP, resp, and ECG monitoring
Enteral feeds decrease phenytoin absorption

46
Q

What is the max administration rate for IV phenytoin?

A

50 mg/min

47
Q

What is the max administration rate for IV fosphenytoin?

A

150 mg PE/min

48
Q

What is the active metabolite of eslicarbazepine?

A

Oxcarbazepine

49
Q

Main side effect for vigabatrin

A

Permanent vision loss (30% of pts)

50
Q

What allergy has cross reactivity with zonisamide?

A

Sulfonamide allergy

51
Q

When must the phenytoin correction calculation be used?

A

If albumin <3.5 and CrCl >10 mL/min

52
Q

All antiepileptic drugs cause what SE?

A

CNS depression
Bone loss (must supplement VitD and Ca)
Warning for suicide risk

53
Q

Antiepileptic drugs that are enzyme inducers

A

Carbamazepine
Oxcarbazepine
Phenytoin
Fosphenytoin
Phenobarbital
Primidone

54
Q

Antiepileptic drug that is an enzyme inhibitor

A

Valproic acid

55
Q

Which antiepileptic meds have higher risks when used in children?

A

Topiramate (hyperthermia)
Zonisamide (hyperthermia)
Lamotrigine (rash)

NAPLEX Study Time (8 decks)

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