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Pharmacology > Chapter 14: Neuro > Flashcards

Chapter 14: Neuro Flashcards

1
Q

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

A

behavior/psychiatric drugs

drugs to treat other neuro disorders

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2
Q

what are the 7 common neurotransmitters

A

​

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

what schedule are anorexiants

A

schedule IV controlled

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4
Q

clinical use of anorexiants

A

short term adjunct to weight loss program

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5
Q

what are neurotransmitters

A

chemicals that allow the transmission of nerve impulses across synapses

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6
Q

acetycholine functions

A

motor neurons: stimulate muscle, especially in GI tract

sensory neurons: plays a role in REM sleep

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7
Q

medications that affect acetylcholine are used for what?

A

Alzheimers disease (increases levels in brain)

wrinkles (blocls acetylcholine causing muscles to relax

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8
Q

examples of anorexiants

A

benzphetamine (Didrex)

diethylpropion (Tenuate)

mazindol (Mazinor)

phendimetrazine (Bontril)

phentermine (Adipex)

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9
Q

anorexiants mechanism of action

A

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

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10
Q

anorexiants and MAOIs

A

may cause life-threatening hypertensive crisis

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11
Q

anorexiants and alcohol

A

may cause depression

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12
Q

anorexiants and phenothiazines

A

may cause increased psychosis

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13
Q

anorexiant contraindications

A

substance abuse

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14
Q

recommended course of therapy for anorexiants

A

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

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15
Q

anorexiants patient education

A

dont take in evening

avoid alcohol

check pulse, BP

will need regular medical check-ups

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16
Q

Types of drugs used to treat seizures

A

hydantoins

iminostilbenes

succinimides

misc anticonvulsants

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17
Q

hydantoins mechanism of action

A

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

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18
Q

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

A

hydantoins

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19
Q

what type of seizure are hydantoins NOT used for

A

absent complex seizures

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20
Q

examples of hydantoins

A

phenytoin (Dilantin) - PO

fosphenytoin (Cerebyx) - IV

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21
Q

effective plasma levels of hydantoins

A

10-20mch/mL

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22
Q

common side effects of hydantoins

A

gingivival hyperplasia, suicida ideation, phenytin0induced hepatitis

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23
Q

drugs that decrease effect of hydantoins

A

carbamazepine

chronic alcohol use

barbituates

rifampin

antacids

flu vaccine

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24
Q

what drugs do the flu vaccine interact with

A

hydantoins

aminopyrine

theophylline

warfarin

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25
Q

drugs that increase effect of hydantoins

A

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

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26
Q

drugs that may increase OR decrease hydantoins

A

phenobarbital, valproate, valproic acid

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27
Q

what drugs are impaired BY hydantoins

A

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

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28
Q

phenytoint and tricyclic antidepressants

A

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

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29
Q

hydantoin contraindications

A

hypersensitivities

bradycardia or SA block

pregnancy

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30
Q

phenytoin hypersensitivities

A

a syndrome that may develop in 3-8 weeks

(fever, skin rash, lymphadenopathies)

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31
Q

hydantoin patient education

A

may change urine color reddish-brown

use good oral hygeine

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32
Q

when can you consider weening someone off anticonvulsants

A

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

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33
Q

labs for hydantoins

A

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

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34
Q

examples of iminostilbenes

A

carbamazepine (Tegretol)

oxycarbazepine (Trileptal)

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35
Q

which medications are iminostilbenes chemically related to

A

tricyclic antidepressants

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36
Q

iminostilbenes mechanism of action

A

inhibit voltage gated sodium channels in thalamus

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37
Q

clinical uses for aminostilbenes

A

monotherapy or adjunct for partial complex seizures

trigeminal neuralgia

bipolar disorder

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38
Q

carbamazepine (Tegretol) black box warning

A

potential to cause blood dyscrasiaas, some of which are fatal

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39
Q

drugs that increase iminostilbenes

A

acetominophen

hydantoins

cimetidine

erythromycin

verapamil

grapefruit juice

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40
Q

drugs that decrease iminostilbenes

A

phenobarbital

phenytoin

rifampin

theophylline

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41
Q

herbs that reduce the seizure threshold

A

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

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42
Q

iminostilbenes contraindications

A

hypersensitivities to tricyclic antidepressants

use with MAOIs

coadministration with nefazodone

history of blood disorders (especially bone marrow suppression)

pregnancy

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43
Q

plasma levels of iminostilbenes

A

monitor regularly

therapeutic is 4-12mcg/mL

children can develop toxicities below 12mcg/mL

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44
Q

clinical uses for succinimides

A

treatment of absent complex seizres in children and adults

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45
Q

succinimides mechanism of action

A

decrease nerve impulses and transmission in the motor cortex

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46
Q

why are succinimides the first choice for absent complex seizures

A

lacks idiosyncratic hepatotoxicity of depakote

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47
Q

example of succinimides

A

ethosuximide (Zarontin)

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48
Q

which drugs increase liklihood of CNS depression when administered with succinimides

A

tricyclic andtidepressants

phenothiazines

antihistamines

alcohol

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49
Q

succinimides contraindications

A

hypersensitivity

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50
Q

succinimide patient education

A

GI upset can be minimized by taking with milk

use backup birth control

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51
Q

examples of misc anticonvulsants

A
  • zonisamide
  • gabapentin
  • tiagabine
  • valproate
  • lamotrigine
  • felbamate
  • clonazepam
  • primidone
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52
Q

what is primidone mosty used for

A

relief of essential tremor

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53
Q

information on misc anticonvulsants

A

page 249-250

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54
Q

what are prescription sleep aides classified as

A

nonbenzodiazepine hypnotics because they act on benzo receptors in the brain

they are also called GABAergics (act on GABA receptors)

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55
Q

what drugs increase effect of sleep aids

A

benzos

alcohol

ketoconazole

erythromycin

clarithromycin

protease inhibitors

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56
Q

which medications ar made less effective BY sleep aides

A

ones that compete for CYP3A4 isoenzyme

cimetadine

rifampin, phenytoin

carbamazepine

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57
Q

sleep aide contraindications

A

hypersensitivities

pregnancy

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58
Q

active ingredient in OTC sleep aides

A

diphenhydramine and doxylamine

(older antihistamines)

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

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59
Q

sleeps aids duration of use and class schedule

A

schedule IV

recommended 2 weeks (acute)

no more than 3 months (chronic)

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60
Q

three migraine categories

A

with aura (classic)

without aura (common)

complicated (associated with focal neurological deficits)

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61
Q

what causes migraines

A

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

the throbbing vessels triggers inflammation and starts the migrane

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62
Q

treatment of mgraines is aimed at

A

preventing attacks or abort at onset

63
Q

which type of headaches respond to triptan and ergotamines

A

migraine ONLY

not tension

64
Q

medications that have been approved for migraine prophylaxis

A

topiramate (Topamax)

propanolol (Inderal)

timolol (Blocadren)

divalproex (Depakote)

botox

65
Q

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

A

if they have history of stroke

66
Q

serotonin receptor agonists (Triptans)

mechanism of action

A

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
Q

triptans and SSRIs

A

can cause serotonin syndrome

68
Q

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

A

almotriptan (Axert)

naratriptan (Amerge)

rizatriptan (Maxalt)

zolmitriptan (Zomig)

69
Q

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

A

frovotriptan (Frova)

sumatriptan (Imitrex)

70
Q

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

A

electriptan (Reelpax)

71
Q

onset of serotonin syndrome

A

minutes to hours

72
Q

symptoms of serotonin syndrome

A

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

73
Q

which triptans decrease the effect of oral contraceptives and cimetadine

A

zolmitriptan

naratriptan

74
Q

what medication class do all triptans interact with

A

MAOIs

75
Q

triptan contraindications

A

pregnancy

complicated migraine

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

76
Q

triptans and ergotamines

A

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

(may increase vasospastic reactions)

77
Q

triptan conscientious considerations

A

can be administered to children

best to administer 1st dose in clinic to gage response

78
Q

triptans patient education

A

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
Q

ergotamines mechanism of action

A

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

80
Q

examples of ergotamines

A

ergotamine (Ergostat, Ergomar)

ergot with caffeine (Cafergot)

dihydroergotamine (DHE 45, Migranol)

81
Q

medications that interact with ergotamines

A

any CYP450 drugs

82
Q

ergotamines contraindications

A

pregnancy

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

severe renal impairment

complicate migraine

83
Q

ergotamines patient education

A

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
Q

why must you start low and go slow with ergotamines

A

GI upset can cause patient nonadherence

85
Q

which neurotransmitter is MARKEDLY reduced in parkinson’s disease

A

dopamine

86
Q

what is key in treatment of parkinson’s symptoms

A

L-dopa

87
Q

4 classical features of parkinson’s

A

tremor (pill rolling is first sign)

muscle rigidity

slowness of movement

postural disturbances

88
Q

what other neurotransmitters are reduced in parkinson’s

A

serotonin, norepinephrine

89
Q

5 drug classes used to treat parkinson’s

A

anticholinergics

dopamine replacement drugs (dopamine precursors)

dopamine agonists

COMT inhibitors (catechol-O-methyltransferase)

MAOB inhibitor

90
Q

on-off syndrome

A

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
Q

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

A

dysrhythmias

psychosis

peptic ulcer disease

HTN

liver function impairment

92
Q

anticholinergics mechanism of action

A

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

93
Q

anticholinergics

clinical uses

A

antidyskinetic to treat drug-induced EPS

adjunctive treatment of PD

94
Q

examples of anticholinergics

A

benxtropine (Cogentin)

trihexyphenidyl (Artane)

95
Q

anticholinergic interactions

A

CNS depressants will have additive effect when coadministered

96
Q

anticholinergic contraindications

A

hypersensitivities

narrow-angle glaucoma

pyloric/duodenal obstruction

prostate hypertrophy or bladder neck obstruction

97
Q

anticholinergic patient education

A

use with cautionin hot weather or during exercise

98
Q

examples of dopamine agonists

A

bromocriptine (Parlodel)

pramipexole (Mirapex)

ropinirole (Requip)

99
Q

main purpose of dopamine agonists

A

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

100
Q

bromocriptine mechanism of action

A

stumulates production of dopamine by activating postsynaptic dopamine receptors

101
Q

pergolide mechanism of action

A

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

102
Q

mechanism of action for pramipexole and ropinerole

A

non-ergot dopamine receptor agonists

mechanism of action not well understood

103
Q

what is used to treat restless leg syndrome

A

ropinirole

104
Q

dopamine agonists and alcohol

A

may cause disulfiram-like reaction

105
Q

the serum levels of which medications are increased by cimetadine

A

pramipexole and ropinirole

106
Q

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

A

levodopa

107
Q

dopamine agonist contraindications

A

sensitivities to ergot alkaloids

108
Q

dopamine precursors: levodopa

A

stable form of dopamine

109
Q

dopamine precursors: carbidopa

A

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

110
Q

clinical use of dopamine precursors

A

treat idiopathic PD

111
Q

symtpoms of tardive dyskinesia

A

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

112
Q

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

A

d/t side effects and poor tolerability

113
Q

examples of dopamine precursors

A

levodopa (Larodopa, L-Dopa)

carbidopa-levodopa (Sinemet)

carbidopa-levodopa/entacapone (Stalevo)

114
Q

early sign of dopamine precursor overdose

A

eyelid twitching/spasm

115
Q

what medications reverse effects of levodopa decreasing their effectiveness

A

antipsychotics

benzodiazepines,

haloperidol

phenytoin

116
Q

dopamine precursors and antihypertensives

A

may cause additive hypotension

117
Q

what foods will reduce the effect of levodopa

A

foods with kava and pyridoxine

118
Q

what can cause hypertensive crisis if taken with levodopa alone

A

cocaine and MAOIs

(combination with carbidopa can help prevent this)

119
Q

dopamine precursor contraindications

A

hypersenitivities

narrow-angle glaucoma

undiagnosed skin lesions

safety during pregnancy and in children not established

120
Q

COMT inhibitors mechanism of action

A

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
Q

clinical uses of COMT inhibitors

A

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

122
Q

examples of COMT inhibitors

A

tolcapone (Tasmar)

entacapone (Comtan)

123
Q

COMT inhibitors effects on mental status may be increased by

A

CNS depressants and hypnotics

124
Q

COMT inibitors and MAOIs

A

concomittent use not advised as both inhibit metabolic pathways of catecholamine

125
Q

COMT inhibitor contraindications

A

hypersensitivities

children, pregnancy, lactation safety not established

126
Q

COMT inhibitors black box warning

A

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

127
Q

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

A

liver enzymes, BP, and parkinson’s symptoms

128
Q

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

A

selegiline (Eldepryl, Carbex)

129
Q

selegiline mechanism of action

A

prevents the breakdown of dopamine by blocking MAOB enzyme

130
Q

how does seleginine slow progression of PD

A

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

131
Q

clinical use of seleginine

A

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

132
Q

seleginine has serious drug reactions with

A

demerol (meperidine)

dextromethorphan

MAOIs

methadone

propoxyphene

tramadol

133
Q

seleginine can cause serotonin syndrome when given with what

A

SSRIs, TCAs

134
Q

seleginine contraindications

A

hypersensitivity

use of opiod or demerol

135
Q

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

A

increased risk for hypertensive reactions

136
Q

administration instruction for patient regarding seleginine

A

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
Q

symptoms of selegine overdose

A

hypertensive crisis, vomiting, photosensitivity, enlarged pupils

138
Q

classes of drugs used to treat Alzheimer’s

A

acetylcholinesterase inhibitors

NMDA receptor agonist

139
Q

benefit of combining memantine with a acetylcholinesterase inhibitor

A

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

140
Q

acetylcholine and alzheimer’s disease

A

cerebral roduction of choline acetyl transerfase is reduced

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

141
Q

acetylcholinesterase inhibitors mechanism of action

A

reversible, noncompetitive, and centrally acting

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

142
Q

which acetylcholinesterase inhibitor has the longest lasting profile

A

donepezil

143
Q

adverse reaction of acetylcholinesterase inhibitors are caused by

A

too much acetylcholine accumulation in the brain

144
Q

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

A

ALT because of hepatotoxicity risk

145
Q

acetylcholinesterase inhibitor interactions

A

other drugs metabolized by CYP450 system can increase toxicity risk

alcohol increases sedation and GI irritation

146
Q

acetylcholinesterase inhibitor contraindications

A

hypersensitivities

caution with history of GI bleed or NSAID use

147
Q

clinical use of acetylcholinesterase inhibitors

A

mild-moderate AD

148
Q

clinical use of NMDA receptor agonist

A

moderate to severe AD

149
Q

NMDA receptor agonist mechanism of action

A

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

150
Q

example of NMDA receptor agonist

A

memantine (Namenda)

151
Q

Namenda contraindications

A

hypersensitivity

152
Q

Namenda interactions

A

drugs that increase (alkalize) urine such as sodium bicarb

153
Q
A

Pharmacology (28 decks)

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