Chapter 14: Neuro Flashcards Preview

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Flashcards in Chapter 14: Neuro Deck (153):
1

 

 

What are the 2 broad classifications of drugs used to treat neurological conditions

 

 

behavior/psychiatric drugs

drugs to treat other neuro disorders

2

 

 

what are the 7 common neurotransmitters

  1. acetylcholine
  2. norepinephrine
  3. dopamine
  4. GABA
  5. glutamate
  6. serotonin
  7. endorphin

3

 

 

what schedule are anorexiants

 

 

schedule IV controlled

4

 

 

clinical use of anorexiants

 

 

short term adjunct to weight loss program

5

 

 

what are neurotransmitters

 

 

chemicals that allow the transmission of nerve impulses across synapses

6

 

 

acetycholine functions

 

 

motor neurons: stimulate muscle, especially in GI tract

sensory neurons: plays a role in REM sleep

 

7

 

 

medications that affect acetylcholine are used for what?

 

 

Alzheimers disease (increases levels in brain)

wrinkles (blocls acetylcholine causing muscles to relax

8

 

 

examples of anorexiants

 

benzphetamine (Didrex)

diethylpropion (Tenuate)

mazindol (Mazinor)

phendimetrazine (Bontril)

phentermine (Adipex)

9

 

 

anorexiants mechanism of action

 

 

sympathommetic amines that stimulate the centers in the hypothalamus and limbic regions of the brain to tell the body it is satisfied

10

 

 

anorexiants and MAOIs

 

 

may cause life-threatening hypertensive crisis

11

 

 

anorexiants and alcohol

 

 

may cause depression

12

 

 

anorexiants and phenothiazines

 

 

may cause increased psychosis

13

 

 

anorexiant contraindications

 

 

substance abuse

14

 

 

recommended course of therapy for anorexiants

 

 

2 weeks on, 2 weeks off, use for no longer than 6 months

15

 

 

anorexiants patient education

 

dont take in evening

avoid alcohol

check pulse, BP

will need regular medical check-ups

16

 

 

Types of drugs used to treat seizures

 

 

hydantoins

iminostilbenes

succinimides

misc anticonvulsants

17

 

 

hydantoins mechanism of action

 

 

inhibit and stabalize electric discharges from neurons in the crtex of the brain

18

 

 

what is the first-line treatment for patients with generalized tonic-clonic and simple/partial complex seizures

 

 

hydantoins

19

 

 

what type of seizure are hydantoins NOT used for

 

 

absent complex seizures

20

 

 

examples of hydantoins

 

 

phenytoin (Dilantin) - PO

fosphenytoin (Cerebyx) - IV

21

 

 

effective plasma levels of hydantoins

 

 

10-20mch/mL

22

 

 

common side effects of hydantoins

 

 

gingivival hyperplasia, suicida ideation, phenytin0induced hepatitis

23

 

 

drugs that decrease effect of hydantoins

 

carbamazepine

chronic alcohol use

barbituates

rifampin

antacids

flu vaccine

24

 

 

what drugs do the flu vaccine interact with

 

hydantoins

aminopyrine

theophylline

warfarin

25

 

 

drugs that increase effect of hydantoins

 

alcohol, amiodarone, chloramphenicol, chlordiazepoxide, diazepam, isoniazid, methylphenidate, phenothiazines, phenylbutazone, saicylates, succinimides, sulfonamides, tolbutamide, trazadone

 

26

 

 

drugs that may increase OR decrease hydantoins

 

 

phenobarbital, valproate, valproic acid

27

 

 

what drugs are impaired BY hydantoins

 

corticosteroids, coumarin anticoagulants, digoxin, doxycycline, estrogens, furosemide, oral contraceptives, quinidine, rifampin, sulfonylureas, theophylline, and vitamin D

28

 

 

phenytoint and tricyclic antidepressants

 

 

tricyclics have been known to cause seizures so phenytoin dosages may need adjusted

29

 

 

hydantoin contraindications

 

 

hypersensitivities

bradycardia or SA block

pregnancy

30

 

 

phenytoin hypersensitivities

 

 

 

 

a syndrome that may develop in 3-8 weeks

(fever, skin rash, lymphadenopathies)

31

 

 

hydantoin patient education

 

 

may change urine color reddish-brown

use good oral hygeine

32

 

 

when can you consider weening someone off anticonvulsants

 

seizure free for 2 years with nirmal EEGs separated by at least 1 year 

95% chance seizures WILL NOT reoccur if slowly weened off med

33

 

 

labs for hydantoins

 

baseline liver function, UA, blood counts and periodic pasma levels

34

 

 

examples of iminostilbenes

 

 

carbamazepine (Tegretol)

oxycarbazepine (Trileptal)

35

 

 

which medications are iminostilbenes chemically related to

 

 

tricyclic antidepressants

36

 

 

iminostilbenes mechanism of action

 

 

inhibit voltage gated sodium channels in thalamus

37

 

 

clinical uses for aminostilbenes

 

 

monotherapy or adjunct for partial complex seizures

trigeminal neuralgia 

bipolar disorder

38

 

 

carbamazepine (Tegretol) black box warning

 

 

potential to cause blood dyscrasiaas, some of which are fatal

39

 

 

drugs that increase iminostilbenes

 

acetominophen

hydantoins

cimetidine

erythromycin

verapamil

grapefruit juice

40

 

 

drugs that decrease iminostilbenes

 

phenobarbital

phenytoin

rifampin

theophylline

41

 

 

herbs that reduce the seizure threshold

 

 

evening primrose, St. John's wort, valerian, kava

42

 

 

iminostilbenes contraindications

 

hypersensitivities to tricyclic antidepressants

use with MAOIs

coadministration with nefazodone

history of blood disorders (especially bone marrow suppression)

pregnancy

43

 

 

plasma levels of iminostilbenes

 

monitor regularly

therapeutic is 4-12mcg/mL

children can develop toxicities below 12mcg/mL

44

 

 

clinical uses for succinimides

 

 

treatment of absent complex seizres in children and adults

45

 

 

succinimides mechanism of action

 

 

decrease nerve impulses and transmission in the motor cortex

46

 

 

why are succinimides the first choice for  absent complex seizures

 

 

lacks idiosyncratic hepatotoxicity of depakote

47

 

 

example of succinimides

 

 

ethosuximide (Zarontin)

48

 

 

which drugs increase liklihood of CNS depression when administered with succinimides

 

tricyclic andtidepressants

phenothiazines

antihistamines

alcohol

49

 

 

succinimides contraindications

 

 

hypersensitivity

50

 

 

succinimide patient education

 

GI upset can be minimized by taking with milk

use backup birth control

51

 

 

examples of misc anticonvulsants

  • zonisamide
  • gabapentin
  • tiagabine
  • valproate
  • lamotrigine
  • felbamate
  • clonazepam
  • primidone

52

 

 

what is primidone mosty used for

 

 

relief of essential tremor

53

 

 

information on misc anticonvulsants

 

 

page 249-250

54

 

 

what are prescription sleep aides classified as

 

 

nonbenzodiazepine hypnotics because they act on benzo receptors in the brain

they are also called GABAergics (act on GABA receptors)

55

 

 

 

what drugs increase effect of sleep aids

 

benzos

alcohol

ketoconazole

erythromycin

clarithromycin

protease inhibitors

56

 

 

which medications ar made less effective BY sleep aides

 

ones that compete for CYP3A4 isoenzyme

cimetadine

rifampin, phenytoin

carbamazepine

57

 

 

sleep aide contraindications

 

 

hypersensitivities

pregnancy

58

 

 

active ingredient in OTC sleep aides

 

 

diphenhydramine and doxylamine 

(older antihistamines)

some are combined with ASA or acetominophen and one of the two antihistamines

59

 

 

sleeps aids duration of use and class schedule

 

schedule IV

recommended 2 weeks (acute)

no more than 3 months (chronic)

60

 

 

three migraine categories

 

with aura (classic)

without aura (common)

complicated (associated with focal neurological deficits)

61

 

 

what causes migraines

 

 

high serotonin levels that drop causing expansion of brain blood vessels and throbbing pain

the throbbing vessels triggers inflammation and starts the migrane

62

 

 

treatment of mgraines is aimed at

 

 

preventing attacks or abort at onset

63

 

 

which type of headaches respond to triptan and ergotamines

 

 

migraine ONLY

not tension

64

 

 

medications that have been approved for migraine prophylaxis

 

topiramate (Topamax)

propanolol (Inderal)

timolol (Blocadren)

divalproex (Depakote)

botox

65

 

 

when should patients NOT be placed on beta blockers for migraine prevention

 

 

if they have history of stroke

66

 

 

serotonin receptor agonists (Triptans)

mechanism of action

 

 

 

 

act selectively on serotonin (5-HT10) receptors in cranial ateries, causing vasoconstriction and blockage of the release of vasoactive substance that cause sterile inflammation associated with migraine

67

 

 

triptans and SSRIs

 

 

can cause serotonin syndrome

68

 

 

examples of triptans that bind to 5-HT-1B AND -1D receptors

 

almotriptan (Axert)

naratriptan (Amerge)

rizatriptan (Maxalt)

zolmitriptan (Zomig)

69

 

 

examples of triptans that bind to 5HT-1D receptors

 

 

frovotriptan (Frova)

sumatriptan (Imitrex)

70

 

 

examples of triptans that bind to 5-HT-1B, -1D, and -1F receptors

 

 

electriptan (Reelpax)

71

 

 

onset of serotonin syndrome

 

 

minutes to hours

72

 

 

symptoms of serotonin syndrome

 

agitation or restlessness, diarrhea, fast heart beat, hallucinations, increased body temp, loss of coordination, nausea, overactive reflexes, labile BP, vomiting

73

 

 

which triptans decrease the effect of oral contraceptives and cimetadine

 

 

zolmitriptan

naratriptan

74

 

 

what medication class do all triptans interact with

 

 

MAOIs

75

 

 

triptan contraindications

 

pregnancy

complicated migraine

ischemic heart disease, cerebral vascular syndromes, uncontrolled HTN (because they constrict CA vessels)

76

 

 

triptans and ergotamines

 

 

no triptan can be used if ergotamine derivatives have been used in preceding 24 hours

(may increase vasospastic reactions)

77

 

 

triptan conscientious considerations

 

 

can be administered to children

best to administer 1st dose in clinic to gage response

78

 

 

triptans patient education

 

take at signs of impending attack, can take again after 1-2 hours if symptoms return

no more than 2 doses in a 24 hour period

79

 

 

ergotamines mechanism of action

 

 

stimulate vascular smooth muscle which decreases the amplitude of extracranial artery pulses and the hyperfusion of the basilar artery area

80

 

 

examples of ergotamines

 

ergotamine (Ergostat, Ergomar)

ergot with caffeine (Cafergot)

dihydroergotamine (DHE 45, Migranol)

81

 

 

medications that interact with ergotamines

 

 

any CYP450 drugs

82

 

 

ergotamines contraindications

 

pregnancy

uncontrolled HTN, hemiplegic or basilar migraine. peripheral or cerebral vasoconstricotrs, ischemic heart disease

severe renal impairment

complicate migraine

83

 

 

ergotamines patient education

 

grapefruit juice will increase toxicity

avoid caffeine cause it can increase absorption and effects

repeating dose will not mitigate migraine if initial dose failed

84

 

 

why must you start low and go slow with ergotamines

 

 

GI upset can cause patient nonadherence

85

 

 

which neurotransmitter is MARKEDLY reduced in parkinson's disease

 

                                                                                                  

 

 

dopamine

86

 

 

what is key in treatment of parkinson's symptoms

 

 

L-dopa

87

 

 

4 classical features of parkinson's

 

 

tremor (pill rolling is first sign)

muscle rigidity

slowness of movement

postural disturbances

 

88

 

 

what other neurotransmitters are reduced in parkinson's

 

 

serotonin, norepinephrine

89

 

 

5 drug classes used to treat parkinson's

 

anticholinergics

dopamine replacement drugs (dopamine precursors)

dopamine agonists

COMT inhibitors (catechol-O-methyltransferase)

MAOB inhibitor

90

 

 

on-off syndrome

 

 

patient swings from being totally symptom free to presenting with a full blown case of PD symptoms

happens after more than 2 years of levodopa therapy

91

 

 

parkinson's meds should be used with caution in patients with which conditions

 

dysrhythmias

psychosis

peptic ulcer disease

HTN

liver function impairment

92

 

 

anticholinergics mechanism of action

 

 

allows dopamine/acetylcholine balance in brain to return to normal by blocking the excitability of central neuron pathways of the parasympathetic nervous system

93

 

 

anticholinergics

clinical uses

 

 

antidyskinetic to treat drug-induced EPS

adjunctive treatment of PD

94

 

 

examples of anticholinergics

 

 

benxtropine (Cogentin)

trihexyphenidyl (Artane)

95

 

 

anticholinergic interactions

 

 

CNS depressants will have additive effect when coadministered

96

 

 

anticholinergic contraindications

 

hypersensitivities

narrow-angle glaucoma

pyloric/duodenal obstruction

prostate hypertrophy or bladder neck obstruction

97

 

 

anticholinergic patient education

 

 

use with cautionin hot weather or during exercise

98

 

 

examples of dopamine agonists

 

bromocriptine (Parlodel)

pramipexole (Mirapex)

ropinirole (Requip)

99

 

 

main purpose of dopamine agonists

 

 

correct brain's dopamine/acetylcholine imbalance to minimize or correct dyskenesia and tremor

100

 

 

bromocriptine mechanism of action

 

 

stumulates production of dopamine by activating postsynaptic dopamine receptors

101

 

 

pergolide mechanism of action

 

 

stimulates dopamine receptors in the nigrostriatal area and acts independently of dopamine synthesis

102

 

 

mechanism of action for pramipexole and ropinerole

 

 

non-ergot dopamine receptor agonists

mechanism of action not well understood

103

 

 

what is used to treat restless leg syndrome

 

 

ropinirole

104

 

 

dopamine agonists and alcohol

 

 

may cause disulfiram-like reaction

105

 

 

the serum levels of which medications are increased by cimetadine

 

 

pramipexole and ropinirole

106

 

 

which medication increases the risk of hallucinations and dyskinesia if taken with dopamine agonists

 

 

levodopa

107

 

 

dopamine agonist contraindications

 

 

sensitivities to ergot alkaloids

108

 

 

dopamine precursors: levodopa

 

 

stable form of dopamine

109

 

 

dopamine precursors: carbidopa

 

 

decarboxylase inhibitor that helps reduce the dosage required to meet therapeutic level of levodopa

110

 

 

clinical use of dopamine precursors

 

 

treat idiopathic PD

111

 

 

symtpoms of tardive dyskinesia

 

 

uncontrollable movements of body, face, tongue, arms, hand, and head

112

 

 

why does treatment with dopamine precursors begin with low doses that build slowly over weeks

 

 

d/t side effects and poor tolerability

113

 

 

examples of dopamine precursors

 

levodopa (Larodopa, L-Dopa)

carbidopa-levodopa (Sinemet)

carbidopa-levodopa/entacapone (Stalevo)

114

 

 

early sign of dopamine precursor overdose

 

 

eyelid twitching/spasm

115

 

 

what medications reverse effects of levodopa decreasing their effectiveness

 

antipsychotics

benzodiazepines,

haloperidol

phenytoin

116

 

 

dopamine precursors and antihypertensives

 

 

may cause additive hypotension

117

 

 

what foods will reduce the effect of levodopa

 

 

foods with kava and pyridoxine

118

 

 

what can cause hypertensive crisis if taken with levodopa alone

 

 

cocaine and MAOIs

(combination with carbidopa can help prevent this)

119

 

 

dopamine precursor contraindications

 

 

hypersenitivities

narrow-angle glaucoma

undiagnosed skin lesions

safety during pregnancy and in children not established

120

 

 

COMT inhibitors mechanism of action

 

 

metabolizes catechol compounds (dopamine and levodopa) and converts them to inactive compounds

inhibition of peripheral COMT results in an increase in plasma level of levodopa

121

 

 

clinical uses of COMT inhibitors

 

 

adjunt to levodopa therapy in patients who experience a wearning off of the effects of levodopa/carbadopa

122

 

 

examples of COMT inhibitors

 

 

tolcapone (Tasmar)

entacapone (Comtan)

123

 

 

COMT inhibitors effects on mental status may be increased by

 

 

CNS depressants and hypnotics

124

 

 

COMT inibitors and MAOIs

 

 

concomittent use not advised as both inhibit metabolic pathways of catecholamine

125

 

 

COMT inhibitor contraindications

 

hypersensitivities

children, pregnancy, lactation safety not established

126

 

 

COMT inhibitors black box warning

 

 

tolcapone (Tasmar) can cause fatal liver toxicities and should be reserved for those who have not responded to other parkinson's drugs

127

 

 

what must be closely monitored for the first 6 months of therapy with COMT inhibitors

 

 

liver enzymes, BP, and parkinson's symptoms

128

 

 

selective MAOB inhibitor that may prevent progression of PD by serving as a neuro-protectant

 

 

selegiline (Eldepryl, Carbex)

129

 

 

selegiline mechanism of action

 

 

prevents the breakdown of dopamine by blocking MAOB enzyme

130

 

 

how does seleginine slow progression of PD

 

 

by reducing the formation of toxic fe radicals produced during the metabolism of dopamine

131

 

 

clinical use of seleginine

 

 

adjunct to levodopa/carbidopa if patient has failed to respond to levodopa/carbidopa alone

132

 

 

seleginine has serious drug reactions with 

 

demerol (meperidine)

dextromethorphan

MAOIs

methadone

propoxyphene

tramadol

133

 

 

seleginine can cause serotonin syndrome when given with what

 

 

SSRIs, TCAs

134

 

 

seleginine contraindications

 

 

hypersensitivity

use of opiod or demerol

135

 

 

what if the patient taking seleginine is ingesting foods high in tyramine

 

 

increased risk for hypertensive reactions

136

 

 

administration instruction for patient regarding seleginine

 

 

let tablet disolve on the top of tongue and don't eat or drinkfor 5 minutes before

dose should be taken at breakfast or breakfast and lunch (if 2 doses)

137

 

 

symptoms of selegine overdose

 

 

hypertensive crisis, vomiting, photosensitivity, enlarged pupils

138

 

 

classes of drugs used to treat Alzheimer's

 

 

acetylcholinesterase inhibitors

NMDA receptor agonist

139

 

 

benefit of combining memantine with a acetylcholinesterase inhibitor

 

 

has been shown to extend time before a patient requires institutional care

140

 

 

acetylcholine and alzheimer's disease

 

cerebral roduction of choline acetyl transerfase is reduced 

this causes a decrease in acetylcholine synthesis which causes impaired cortical cholinergic function

141

 

 

acetylcholinesterase inhibitors mechanism of action

 

 

reversible, noncompetitive, and centrally acting 

impede he breakdown of acetylcholine allowing it to accumulate in the brain

142

 

 

which acetylcholinesterase inhibitor has the longest lasting profile

 

 

donepezil

143

 

 

adverse reaction of acetylcholinesterase inhibitors are caused by

 

 

too much acetylcholine accumulation in the brain

144

 

 

what needs to be tested frequently in patients taking acetylcholinesterase inhibitors and why

 

 

ALT because of hepatotoxicity risk

145

 

 

acetylcholinesterase inhibitor interactions

 

 

other drugs metabolized by CYP450 system can increase toxicity risk

alcohol increases sedation and GI irritation

146

 

 

acetylcholinesterase inhibitor contraindications

 

 

hypersensitivities

caution with history of GI bleed or NSAID use

147

 

 

clinical use of acetylcholinesterase inhibitors

 

 

mild-moderate AD

148

 

 

clinical use of NMDA receptor agonist

 

 

moderate to severe AD

149

 

 

NMDA receptor agonist mechanism of action

 

 

regulates glutamine by attaching to NMDA receptors, protecting them from overstimulation

150

 

 

example of NMDA receptor agonist

 

 

memantine (Namenda)

151

 

 

Namenda contraindications

 

 

hypersensitivity

152

 

 

Namenda interactions

 

 

drugs that increase (alkalize) urine such as sodium bicarb

153