Chronic neuro

Question 1

Neostigmine: Cholinesterase inhibitors

Answer 1

-MOA: prevents cholinesterase from inactivation Ach, thus increasing Ach (helps with nerve transmission)
-helps treat MG, reverse non-depolarizing neuromuscular blocking agents
-complications: muscarinic stimulation= increased GI motility, salivation, diaphoresis, bradycardia, urinary urgency (report if becomes intolerable)

-Cholinergic crisis: treat= ventilation, O2, admin Atropine to reverse, have crash cart/resuscitation
SLUGE= Salivation, Lacrimation, Urination, Diaphoresis/Diarrhea, GI cramps, Emesis.
Killer Bs= Bradycardia, Bronchospasm, Bronchorrhea (excessive watery mucous).

Question 2

Levodopa/Carbidopa: Dopaminergic

Answer 2

-anti-parkinson’s
-increase dopamine synthesis or prevent breakdown, promote release, others
-most effective but can stop working or wear off
-can take a “drug holiday” to help work better if seeing less effects

-adverse: N/V, drowsiness, dyskinesias (head bobbing, tics, grimacing), orthostatic hypotension, tachycardia or palpitations, psychosis, harmless discoloration of sweat/urine (dark color), activation of malignant melanoma (if already)

Question 3

Antiepileptics (AEDs)

Answer 3

-controls seizures, can slow neuron firing, enhance GABA, or slow uptake of Na/Ca in neurons
-common effects: CNS effects (decreased neuron firing), toxicity (varies), n/v/d, life threatening skin rashes (Steven Johnsons), blood dyscrasias, suicidal ideation, weight gain
-lots of interactions

ed: monitor level of drug (specially Phenytoin), keep seizure diary, don’t discon suddenly, avoid activities with alertness until you know the effects, carry extra when traveling, avoid preg,

Question 4

AEDs

Answer 4

Traditional:
* Phenobarbital: partial/generalized seizures, tonic-clonic
* Primidone: partial/generalized seizures, tonic-clonic
* Phenytoin: partial/generalized seizures, tonic-clonic
* Carbamazepine: partial/generalized seizures, tonic-clonic
* Valproic Acid: partial/generalized seizures, tonic-clonic, absence, myoclonic
* Ethosuximide: absence generalized seizures

Status Epilepticus:
* Diazepam
* Lorazepam

Newer meds:
* Lamotrigine: partial/generalized seizures, tonic-clonic, absence, myoclonic
* Levetiracetam: partial/generalized seizures, tonic-clonic, myoclonic
* Topiramate: partial/generalized seizures, tonic-clonic, myoclonic
* Oxcarbazepine: partial/generalized seizures
* Gabapentin: partial/generalized seizures
* Pregabalin: partial/generalized seizures
* Tiagabine: partial/generalized seizures
* Zonisamide: partial/generalized seizures
* Lacosamide: partial/generalized seizures
* Vigabatrin: partial/generalized seizures
* Ezogabine: partial/generalized seizures