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Pharm - Test 2 > CNS > Flashcards

CNS Flashcards

1
Q

What disease is characterized by decrease in dopamine and increase in acetylcholine?

A

Parkinson’s Disease

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2
Q

Site of dopamine production?

A

substantia nigra (in the basal ganglia)

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3
Q

Precursor to dopamine?

A

Levedopa

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4
Q

Enhances Levedopas effectiveness?

A

Carbidopa (1. blocks peripheral conversion of Levedopa, forcing it to be concentrated in the brain 2. decarboxilase inhibitor).

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5
Q

What does decarboxilase do?

A

It metabolizes Levedopa to a form that does not cross the BBB.

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6
Q

Dopaminergics (12)?

A 
Apokyn
Symmetrel
Azilect
Parlodel
Sinemet
Eldepryl
Miraprex
Requip
Comtan
Stalevo
Tasmir
Neupro
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7
Q

Sinemet –> talk to me…

A 
Route: PO
Indications: Parkinsons
Dose: 25/100 tab tid
25 mg Carbidopa, 100 mg Levedopa
may be titrated up to 8 tabs daily
Metabolism: GI , Kidneys, Liver
Excretion: Renal
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8
Q

Dopaminergic adverse/side effects

A 
Orthostatic hypotension
Tardive dyskenesia (involuntary purposeless motion)
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9
Q

What can happen after an abrupt discontinuation of dopaminergics?

A

Neuroleptic malignent syndrome (treatment with dopaminergics)

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10
Q

Anticholinergics for parkinsons (3)?

A

Artane
Benadryl
Cogentin

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11
Q

Anticholinergic adverse/side effects?

A

Anti- SLUDGE

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12
Q

Is Dementia a single disease?

A

It is a collection of brain disorders that impair memory, behavior, learning, and communication.

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13
Q

2 major causes of degenerative dementia?

A 
Alzheimers
Vascular Dementia (due to series of small strokes)
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14
Q

Where are the structural brain changes in Alzheimers located (2)? What are they?

A

Hippocampus.
Neurfibrilary tangles (twisted fibers of tangles tau protein).
Amyloid plaque formation (beta-amyloid protein).

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15
Q

What is the role of the Hippocampus?

A

Short-term memory and emotions (emotions part of limbic system).

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16
Q

In Alzheimers is Acetylcholine increased or decreased in the hippocampus?

A

Decreased.

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17
Q

Symptoms of Alzheimers?

A

Impaired judgement
Aggressive behavior
Psychoses

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18
Q

Can drugs cure Alzheimers?

A

They only slow the progression of the disease in mild to moderate stages.

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19
Q

Drugs for Alzheimers?

A 
Acetylcholinestirase inhibitors.
Aricept
Razadyne
Exelon
Namenda (New kid on the block)
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20
Q

Aricept –>

A

Route: PO / IV
Indication: Alzheimers
Dose: 5-10 mg hs
Metabolism: Liver
Excretion: Renal
Interactions: Succinylcholine, cholinergic agents
Adverse effects: AV block, GI bleed, Syncope, hemolytic anemia, urinary obstruction, seizures.

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21
Q

What is the difference between epileptic and non-epileptic seizures?

A

Epileptic: without reversible metabolic cause.

Non-epileptic: reversible metabolic cause.

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22
Q

Alcohol withdrawal is an example of what type of seizure?

A

Non-epileptic.

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23
Q

2 major types of seizures?

A

Generalized (begins in one area of the brain and spreads).

Partial (Stays in one part of the brain. Does not spread).

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24
Q

5 types of generalized seizures?

A

Tonic clonic (grand mal): major convulsions/rigidity/jerking.
Absence seizure (petit mal): brief duration, patient blanks out.
Myoclonic: less common. Intermittent mild jerking.
Febrile: varies, usually benign, occurs in infants / young children.
Status epilepticus: life threatening.

25
Q

Status epilepticus is characterized by what (3)?

A
  1. Prolonged seizure lasting more than 5-15 minutes
  2. Multiple seizures without regaining consciousness between seizures.
  3. Continuous series of seizures.
26
Q

Initial drugs of choice for status?

A

Ativan: 2-4 mg IV every 3-4 min. Up to 8 mg total.
Valium: 5-10 mg IV every 3-4 min. Up to 30 mg total.

27
Q

What are the 2 types of partial seizures?

A

Simple partial: single area of the brain / no loss of consciousness.
Complex partial: Larger area of the brain / altered LOC.

28
Q

Typical behaviors for complex partial seizures include?

A 
Wandering about
picking at clothes
repetitive motions
chewing motions
diarrhea
29
Q

What is the main function of anti-seizure drugs?

A

Suppresses the propagation of seizure activity.

30
Q

What are the 3 general mechanisms of anti-seizure drugs?

A
  1. Sodium channel blockade.
  2. Calcium channel blockade.
  3. GABA potentiation.
31
Q

What are the classifications of anticonvulsants?

A
  1. Hydantoin
  2. Hydantoin-like
  3. Succinimides
  4. Barbiturates.
  5. Benzodiazepens
32
Q

Hydantoins (2)?

A

Sodium Channel Blockers.

  1. Dilantin
  2. Cerebyx
33
Q

Dilantin –>

A

Route: PO
Indications: Tonic clonic, status epilepticus, neurosurgery post-op.
Dose: 50-200 mg bid - tid.
MOA: Sodium channel blocker.
Metablism: Liver
Excretion: Renal, Bile
Side effects: gingival hyperplasia, aplastic anemia, thrombocytopenia.
Excess dosage –> confusion, psychoses, delirium

34
Q

Hydantoin-like (6)?

A

Sodium Channel Blockers

  1. Felbatol
  2. Lemictal
  3. Depakene
  4. Depakote
  5. Zonegran
  6. Tegretol (also indicated for trigenminal neuralgia)
35
Q

Succinimides (1)?

A

Calcium Channel Blocker
1. Ethosuccinimide
drug of choice for absence seizure.

36
Q

Barbiturate (1)?

A

GABA potentiation

Phenobarbital

37
Q

Phenobarbital –>

A

Barbiturate
Route: IM / IV / PO
MOA: GABA potentiation
Indications: Status epilepticus, tonic clonic (grand mal), simple partial, acute seizures of unknown etiology.
Metabolism: Liver
Excretion: Renal
Dose:
Maintenance - 200-600 mg up to 20 mg/kg daily
Status epilepticus - 15-18 mg/kg single or split doses
Max daily dose: 20 mg/kg
Adverse reaction: sedation, addiction

38
Q

Benzodiazepenes (3)?

A
  1. Klonopin
  2. Ativan
  3. Valium
39
Q

Valium –>

A

Route: IM / IV / PO
MOA: GABA potentiation
Dose: varies
Status- 5-10 mg IV every 10-15 prn up to 30 mg. Can be repeated every 2-4 hrs prn
Metabolism: Liver
Excretion: Renal
Indications: anxiolytics, muscle relaxant, acute alcohol withdrawal, conscious sedation, febrile seizures, myoclonic seizures, status epilepticus.
Adverse reactions: rebound insomnia, tolerance.
If OD –> hyoptension, coma, CNS depression.

40
Q

Select adverse effect- tegretol?

A

Neutropenia

Least teratogenic

41
Q

Select adverse effect- depakene?

A

elavated LFTs

Most teratogenic

42
Q

Select adverse effect- methsuximide?

A

Bone marrow suppresion

43
Q

Are all anti-seizure meds potentially teratogenic

A

YES!

44
Q

Primary HA (3)?

A
  1. Migraine.
  2. Tension.
  3. Cluster
45
Q

Secondary (6)?

A
  1. Sinus HA.
  2. Head trauma.
  3. Hematoma.
  4. CNS infection.
  5. Space-occupying lesion.
  6. Systemic illness.
46
Q

Migraine - Pathophysiology? Characteristics?

A

Pathophysiology: Vasodilation in brain.
Seretonin likely plays a role.
Characteristics: Sensitive to light and noise / with or without aura. Onset before age 30. Varying length and interval. May become less frequent with age.

47
Q

Muscle tension - Pathophysiology? Characteristics?

A

Pathophysiology: may be associated with neurotransmitter and/or endorphine.
Characteristics: mild generalized pain. No nausea / no photophobia. Frequent / conitnuous mild pain. Last hours to days.

48
Q

Cluster HA - Pathophysiology? Characteristics?

A 
Pathophysiology: unknown.
Characteristics: intense burning pain originating in the occipital / bifrontal lobe and spreads to behind one eye.
Same time every day.
Can awaken during sleep.
Least common but most severe.
Affects men ages 20-24.
Alcohol common trigger.
Unique to cluster HA: Rhinorrhea, lacrimation, facial flushing.
49
Q

Migraine therapy - abortive?

A 
Non-narcotic analgesics
narcotics
Midrin
Ergotomine
Triptans
50
Q

Migraine therapy - prophylaxis?

A 
Beta-blockers
Calcium channel blockers
antidepressants
anticonvulsants
NSAIDS
51
Q

Ergotomine Protoype (Cafergot)–>

A 
MOA: Complex
Ergotamine --> potent vasoconstrictor
Caffiene --> mild vasoconstrictor
Indications: Abortive for migraine, cluster.
Route: PO
1 mg ergotamine / 100 mg caffiene
DOSE: 1-2 tabs every 30 min prn
Max Dose: 6 mg/d or 10 mg/wk ergotamine
Adverse effect: ergotism
52
Q

What is ergotism?

A

gangrene

53
Q

Triptan Prototype - Imitrex –>

A 
MOA: vasoconstriction.
Aborts migraine in progress.
Indications: Migraine, cluster.
Route: Oral / Subq / Nasal
Contraindications: ischemic heart disease
Adverse effect: seretonin syndrome
54
Q

What is seretonin syndrome?

A

An acute hyperseretonergic state
Cognitive/behavioral: seizures, coma
Neuromuscular: hyper-reflexia, babinski sign.
Autonomic: Diaphoreses, sinus tachycardia

55
Q

Muscle tension HA - abortive?

A

Midrin, relaxation, biofeedback

56
Q

Midrin –>

A

Isometheptene/dichoralphenazone/acetominophen (APAP).
MOA:
Isometheptene - cerebral vasoconstriction
dichralphenazone - sedation
acetominophen - analgesia
Route: PO
Indications: Migraine abortive, muscle tension abortive.
Dose:
muscle tension: 1-2 caps every 4 h , max 8/d
migraine: 2 caps at onset, then 1 cap every hr , max 5 caps / 12 hrs.
Drug interactions: MAOIs, APAPs

57
Q

Muscle tension - prophylaxis?

A

Calcium channel blockers (CCBs), selective seretonin re-uptake inhibitors (SSRIs), tricyclic antidepressents (TCAs).

58
Q

Cluster HA therapy - abortive?

A

Ergotamine
DHA
100% O2 inhilation
Triptans

59
Q

Cluster HA therapy - Prophylaxis?

A 
Lithium
calcium channel blockers (CCBs)
prednisone
ergotamine
botox

Pharm - Test 2 (2 decks)

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