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Pharm 2 > Neuropsychiatric > Flashcards

Neuropsychiatric Flashcards

1
Q

First 5 minutes of seizure

A

ABCs, vitals
Check Blood sugar
Get labs

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2
Q

First phase: 5-20 minutes

A

Benzos!

if unavailable try phenobarbital, diazepam rectal, nasal/buccal midazolam

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3
Q

Second Therapy phase: 20-40 minutes

A

no evidence based 1st choice

-Fosphenytoin IV
-Valproic Acid IV
-Levetiracetam IV (Keppra)

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4
Q

Third phase: 40-60 minutes

A

-Repeat any 2nd line therapy

-anesthetic dose of thiopental, midaz, pentobarbital or propfol

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5
Q

Anticonvulsants uses (approved and unapproved)

A

Seizures
Neuropathic pain
Mood stabilization
Migraines
Alcohol dependence

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6
Q

Calcium channel blockade

A

T-type channels located in the thalamus

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7
Q

Example of MOA SV2A drug

A

Keppra

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8
Q

Sodium Channel Blockers

A

Carbamazepine (Tegretol, Carbatrol)
Oxcarbazepine (Trileptal)
Eslicarbazepine (Aptiom)
Phenytoin/Fosphenytoin (Dilantin)
Lamotrigine (Lamictal)
Zonisamide (Zonegran)
Lacosamide (Vimpat)
Cenobamate (Xcopri)

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9
Q

What is the treatment of choice for Trigeminal neuralgia?

A

Carbamazepine (Tegratol)

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10
Q

Things to check when taking Carbamazepine, Oxcarbazepine, and Eslicarbazepine

A

Check Na+, platelets, and drug reactions!

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11
Q

Carbamazepine PK

A

CYP3A4 inducer + substrate
-Autoinducer

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12
Q

Common side effects for all seizures meds

A

dizziness, ataxia, confusion, slowing down of CNS

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13
Q

Advantage of Oxcarbazepine vs Carbamazepine

A

Created to eliminate the auto-induction of CBZ

Similar side effect profile
Less hyponatremia

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14
Q

Normal Phenytoin level

A

10-20

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15
Q

Fosphenytoin vs Phenytoin

A

Fosphenytoin = prodrug for IV administration
-Safer, better tolerated, faster infusion rates

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16
Q

ADRs for Phenytoin/Fosphenytoin

A

Gingival hyperplasia- long term side effect

Bone marrow hypoplasia

Arrhythmias, cardiovascular depression, hypotension
Ataxia
Nystagmus

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17
Q

Which drug has most approvals for different seizure types?

A

Phenytoin/Fosphenytoin

Recommended to increase at 50mg increments.

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18
Q

Phenytoin side effects if given during pregnancy

A

cleft palate, cleft lip, congenital heart disease, slowed growth rate, mental deficiency

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19
Q

Lamotrigine (Lamictal) and Depakote drug reaction

A

Stevens-Johnson syndrome!!!!!

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20
Q

Lamotrigine (Lamictal advantages

A

Less CNS toxicity and congenital malformations (has more excitatory symptoms tho)

-Be careful about when they are held and when they are started.

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21
Q

Zonisamide side effect

A

Renal stones in 1.5% of patients

rarely used

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22
Q

Lacosamide and Cenobamate facts

A

-Newer meds and VERY SAFE
-low side effect profile
-EXPENSIVE

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23
Q

Lacosamide and Cenobamate side effects

A

QT shortening, DRESS Rxn (strong rxn eosinophils skin,

CHECK EKGs!

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24
Q

Benzo that withdrawal can be FATAL

A

Clobazam (Onfi)

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25
Q

Benzos from longest duration of action and lipophilicity

A

Clobazam (Onfi)
Diazepam (Valium)
Clonazepam (Klonopin)
Lorazepam (Ativan)
Clorazepate (Tranxene)
Triazolam (Halcion)
Oxazepam (Serax)
Alprazolam (Xanax)
Midazolam (Versed)
Temazepam (Restoril)
Chlordiazepoxide (Librium)

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26
Q

Benzo with longest duration of action

A

Clonazepam (Klonopin)

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27
Q

Vigabatrin major side effect

A

Risk of PERMANENT vision loss

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28
Q

Gabapentin is more often used for _______ than _______

A

neuropathy rather than seizure control

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29
Q

Advantages of Gabapentin

A

-No PK drug interactions
-Very well tolerated

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30
Q

Risks of Gabapentin

A

gabapentinoids in combo with opiates and severe resp distress

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31
Q

Main use of Pregabalin

A

Main use in NEUROPATHY, may be used for seizures and anxiety

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32
Q

Pregabalin main ADRs

A

Difficulty concentrating
Risk for ataxia

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33
Q

Valproic Acid pregnancy risk

A

In utero exposure- lower IQ in children compared to other anti-epileptics (category D-X)

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34
Q

Valproic Acid ADRs

A

HYPERAMMONEMIA!
Hepatotoxicity
Thrombocytopenia

LFTs, platelets, Ammonia!

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35
Q

Labs to check with Valproic Acid

A

Check LFTs, platelets, ammonia

36
Q

Most common Glutamate blocker?

A

Topiramate (Topamax)

Glutamate is excitatory

Rare monotherapy for seizures

37
Q

Glutamate blockers

A

-Perampanel (Fycompa)
-Felbamate (Felbatol)
-Topiramate (Topamax)

“PFT”

38
Q

Topiramate (Topamax) MOAs?

A

Multiple potential MOAs

-inhibitory sodium effects
-GABA
etc…

39
Q

Topiramate ADRs

A

Psychomotor slowing
CNS side effects

40
Q

Perampanel BB warning

A

-Serious or life threatening psychiatric and behavioral adverse effects
-Aggression, hostility, irritability, anger, homicidal ideation, THREATS

41
Q

Common ADR of Perampanel

A

Dizziness (43%)

42
Q

Levetiracetam (Keppra) MOA

A

related to synaptic vesicle protein 2A (SV2A) which appears to be important for the availability of Ca-dependent NT vesicles ready to release their content

43
Q

Does Keppra have any significant drug interactions?

A

No!
-Basic seizure med side effects,
-accidental injury, convulsion

44
Q

Med used for Absence Seizures

A

Ethosuximide

MOA: Depresses motor cortex calcium currents and elevated convulsive threshold

45
Q

Triad of Overdose

A

Muscle relaxants, opiates, benzos

46
Q

What kind of side effects does Cyclobenzaprine (Flexeril) have?

A

Anticholinergic Side Effects

47
Q

Baclofen withdrawal symptoms with abrupt DC?

A

hallucinations, fever, agitation, tremor, tachycardia, seizure

48
Q

How does Baclofen work?

A

Substance P inhibition into the spinal cord to reduce pain

49
Q

Tizanidine MOA

A

Centrally acting alpha 2 agonist (precedex like)

50
Q

Dantrolene MOA

A

Blocks ryanodine channel reduced Ca ++ release from SR

51
Q

BB warning for Dantrolene

A

Dose dependent diarrhea and hepatotoxicity
> 800mg/day long term

52
Q

Skeletal Muscle Relaxant general recommendation

A

Most should not be used long term due to significant ADRs and increased duration

53
Q

Sedative Hypnotics (Z drugs)

A

Zolpidem (Ambien)
Zaleplon (Sonata)
Eszopiclone (Lunesta

BENZO-like

54
Q

Amitriptyline (Elavil)

A

TCA that helps migraines and neuropathic pain

55
Q

Tricyclic Antidepressant MOA and uses

A

MOA: Serotonin and Norepinephrine reuptake inhibition, Anticholinergic, 1A antiarrhythmic
Used for pain a lot

56
Q

Tx for TCA overdose?

A

Bicarb d/t metabolic acidosis

57
Q

TCA ADRs

A

Anticholinergic side effects
QT prolongation, arrhythmias

58
Q

Most common antidepressant?

A

SSRIs

Citalopram (Celexa)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
Escitalopram (Lexapro)
Fluvoxamine (Luvox)

59
Q

SSRIs common side effects

A

-Hyponatremia (Check Na+ levels!)
-Thrombocytopenia
-Suicidality
-SEROTONIN SYNDROME

60
Q

Paxil has ________ side effects.

A

Anticholinergic

61
Q

Neuroleptic Malignant Syndrome cause

A

Dopamine Antagonists

62
Q

NMS distinct features

A

HYPOreflexia
-normal pupils
-normal or decreased bowel sounds
-LEAD PIPE rigidity in ALL muscle groups

Onset 1-3 days

63
Q

SS distinct features

A

-HYPERreflexia
-DILATED pupils
-Hyperactive bowel sounds

Faster onset < 12 hours

64
Q

Check these with SSRIs

A

Vitals, Na+, platelets

65
Q

SNRIs MOA

A

Serotonin and Norepinephrine reuptake inhibition

66
Q

SNRIs ADRs

A

Hypertension (not related to SS)

Norepi adds excitatory side effects

67
Q

Example of DNRI

A

Bupropion (Wellbutrin)

68
Q

Meds used for people who have failed 4-5 SS/SNRIs
ZERO motivation

A

DNRIs
MOA: Dopamine and NE reuptake inhibitor

69
Q

5HT2A antagonists drug names

A

Mirtazapine (Remeron) depressed, cant sleep no appetite
Nefazodone (Serzone)
Trazodone (Desyrel)
Vilazodone (Viibryd)
Think SLEEP

70
Q

5HT2A antagonist ADRs

A

ADRs: Highly sedating, increased appetite, hepatoxicity

71
Q

Nuedexta ADRs
(Dextromethorphan/Quinidine)

A

QT prolongation

72
Q

Lithium action and MOA

A

Mood stabilizer (bipolar use)
MOA: Alters neuronal sodium transport

73
Q

Lithium has ______ of ADRs!

A

LOTS! (CNS and CV toxicity)

Diabetes insipidus, polyuria, polydipsia

Long term renal damage
Toxicity
Weight gain

74
Q

Nigrostriatal side effects

A

EPS, TD, parkinsons like mvmt

75
Q

Mesocortical symptoms

A

Negative symptoms, cognitive and affective sx (depressive, hidden)

76
Q

Most serious Antipsychotic ADRs

A

EPS, TD

77
Q

BB warning for Antipsychotics

A

Dementia related death, agranulocytosis

78
Q

What is Carbidopa used for ?

A

false dopamine (similar to beta-lactamase inhibitor use)

79
Q

MAOB inhibitor MOA (“giline”)

A

Increase Dopamine availability via enzyme inhibition

Rasagiline (Azilect)
Selegiline (Eldepryl)

80
Q

Acetylcholinesterase Inhibitors ADRs

A

Rest/digest side effects:
Bradycardia
Loose stools
OAB

81
Q

Withdrawal of Meds warning

A

Never d/c a psych medication without reviewing risk of withdrawal

82
Q

Only meds that can be started and stopped?

A

Dementia meds

83
Q

Post-Op Delirium for older adults

A

-May be fatal, preventable in up to 40% of cases
-May be hypo or hyperactive or mixed presentation
-Almost 50% not reported (particularly hypoactive)

84
Q

Post-op delirium prevention

A

Cognitive re-orientation, sleep hygiene, early mobility, nutrition/fluids, pain mgmt

85
Q

Never use ______ for post-op delirium unless in the case of _______.

A

Benzos
ETOH withdrawal

86
Q
A

Pharm 2 (5 decks)

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