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CNS Flashcards

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1
Q

Management for: Parkinson’s Disease (PD) - Etiology of how to correct PD

A

Achieved by correcting the imbalance of neurotransmitters by Dopamine and Ach
We need more dopamine and less Ach

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2
Q

4 Hallmark s/s of Parkinson’s Disease

A

Tremor
Bradykinesia
Rigidity
Postural Instability (Cogwheel Rigidity)

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3
Q

Which drug is most effective for symptomatic treatment of PD & DOC if symptoms are R/T bradykinesia

A

Levodopa

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4
Q

Levodopa MOA

A

It is a dopamine precursor - therefore Increases dopamine concentration & Enhances the neurotransmission of dopamine

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5
Q

Problems from giving levodopa alone?

A

Levodopa is broken down outside of CNS (gut) by the enzyme decarboxylase… Thus need large doses to get adequate levels in the CNS
Large doses of levodopa -> High peripheral levels of dopamine ->  Increased adverse effects

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6
Q

On-Off Phenomenon is associated with which drug involved in treatment of PD

A

Levodopa

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7
Q

Levodopa usually given with ______

Why?

A

Carbidopa

A peripheral decarboxylase inhibitor - therefore inhibiting breakdown of levodopa

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8
Q

A/E and Contraindications of Sinemet (Levodopa/Carbidopa)

A

A/E - Psychosis (20%) and Dyskinesias (80% in first year)

Contraindications - Angle-closure glaucoma (increased intra-ocular pressure)

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9
Q

Main 2 Teaching aspects of Sinemet

A

Forewarn patients about possible abrupt loss of therapeutic effects; tell to notify HCP if occurs
If patient is taking levodopa alone, discontinue the drug at least 8 hours before starting levodopa/carbidopa

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10
Q

Two types (classes) of dopamine agonists

A

Derivatives of ergot

Nonergot derivatives

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11
Q

Used alone in early PD (< 60 yo)
First-line drug for motor symptoms
Name the class and common drug

A

Nonergot Dopamine Agonist

Pramipexole (Mirapex)

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12
Q

Name drug class with suffix -apone

A

COMT Inhibitors

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13
Q

COMT Inhibitor “-apone” MOA

A

Blocks the enzyme COMT which breaks down dopamine

Only for use with levodopa -> reduced wearing off of levodopa

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14
Q

Rapid withdrawl of COMT inhibitors “-apone” may lead to which two syndromes

A

Parkinsonian crisis & may cause a syndrome of muscle rigidity, high fevers, tachycardia, confusion, & elevated CK levels -> similar to neuroleptic malignant syndrome

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15
Q

Two A/E of COMT Inhibitors

A

brown-orange urine discoloration, hypo or hyper kinesia

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16
Q

MOA of MAO-B Inhibitors

A

selective irreversible inhibition of MAO-B in the brain increases dopaminergic activity by interfering with dopamine reuptake at synapse

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17
Q

Suffix of MAO-B inhibitors

A

-giline

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18
Q

A/E of MAO-B Inhibitors “-giline”

A

hypertensive crisis
Arthralgias
Depression

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19
Q

Anticholinergic Drugs for Parkinson’s Disease - Give common drug name

A

Benztropine (Cogentin)

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20
Q

Ach causes increased SLUDGE. What is SLUDGE?

A 
Salivation
Lacrimation
Urination
Diarrhea
GI Motility
Emesis (possibly)
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21
Q

A/E of Benzotropine (Anticholinergic)

A 
Constipation
N/V
Urine retention
IOP
Agitation
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22
Q

All patients (regardless of age) should receive _______ in management of Multiple Sclerosis

A

Immunomodulators

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23
Q

Drugs given in treating an acute episode of MS

A

1 - Short course of high-dose IV glucocorticoid (steroid) for 3-5d
(can elevate blood glucose)
2 - IV gamma globulin – IF intolerant/unresponsive to steroids

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24
Q

Immunomodulator A/E - Interferon Beta

A

Myelosuppression
Hepatotoxic
Flu-like symptomes

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25
Immunomodulator - Glatiramer Acetate (Copaxone) MOA
: Protects myelin by inhibiting immune response to myelin basic protein - decreases production of proinflammatory cells (T-Helper1) & increases production of anti-inflamm cells (TH2)
26
Three mechanisms anti-convulsants can work by
1 - Reduce nerve’s ability to be stimulated 2 - Suppress transmission of impulses from one nerve to the next 3 - Decrease speed of nerve impulse conduction within a neuron
27
Uses for Phenytoin
Complex partial seizures Tonic-clonic seizures Status Epilepticus (Fosphenytoin-converts to phenytoin after admin) Generalized Seizures (Fosphenytoin-converts to phenytoin after admin) (All seizure types EXCEPT absence)
28
Why avoid giving phenytoin by IV push into veins on back of the hand?
discoloration known as “purple glove syndrome
29
Give elevated levels of Phenytoin and s/s associated with each stage
Elevated Blood levels 20-30: nystagmus 30-40: ataxia > 40 - dec. LOC
30
Are phenytoin & Dilantin interchangeable?
No
31
All drugs causing Stevens Johnson Syndrome
``` PCP LAPSE Phenytoin Carbazapine Phenobarbital Lamotrigine Allopurinol Penicillin Sulfa Drugs Erythromycin ```
32
Given Uses, name drug class and drug associated Used For: Complex partial seizures (DOC) Relieves pain r/t trigeminal neuralgia Bipolar disorder
Class - Iminostilbenes | Drug - Carbamazepine
33
Carpamazepine (Tegretol) Contraindications/Monitoring
Monitor for S/E - diplopia, blurred vision, N/V, leukopenia which is checked q 3-6 mo. Can cause SIADH -> monitor Na+ Can cause photosensitivity Can depress bone marrow Contraindication if glaucoma, cardiac or renal, or hepatic disease
34
Benzodiazepines suffix
-azepam
35
DOC for status epilepticus
Lorazepam (Ativan)
36
only drug approved for long term use of seizure control
Clonazepam (Klonopin)
37
Valporic Acid MOA
increase GABA, an inhibitory neurotransmitter, as well as having a direct membrane-stabilizing effect.
38
Valporic acid uses
All sorts of seizures and bipolar disorder
39
Gabapentin MOA
thought to bind to a carrier protein & act at a unique receptor resulting in elevated GABA in the brain.
40
Gabapentin uses
Partial seizures and neuropathic pain
41
Absence seizures (DOC)
Class - Succinimides | Drug - Ethosuximide (Zarontin)
42
Three Drugs for Spasticity
Baclofen (Lioresal) - Acts in the CNS Diazepam (Valium) - Acts in the CNS (mimics GABA) Dantrolene (Dantrium) - Acts directly on smooth muscle to suppress Ca+ release from SR
43
Baclofen withdrawal: Classic symptoms of baclofen withdrawal are a sudden increase or return of your spasticity or tone, profuse sweating, and itching without an associated rash Name drug used to offset s/s
Diazepam
44
``` Malignant hyperthermia include: A dramatic rise in body temperature Flushed Skin Tachy/HTN Inc Muscle Rigidity/Contraction Name DOC for treating ```
Dantrolene
45
DOC for manic episodes & long-term prophylaxis & preventing suicide. Known as "mood stabilizers"
Lithium - MOA:Increasing norepinephrine & serotonin uptake
46
Lithium/Salt interaction
“Lithium is a simple salt and is similar to table salt. Salt consumption can cause fluctuations in serum lithium levels. While taking lithium, do not make sudden changes to your salt intake. A sudden decrease in sodium intake may result in higher serum lithium levels, while a sudden increase in sodium might prompt your lithium levels to fall.
47
4 A/E to lithium (LITH)
Leukocytosis Tremors Insipidus (Polyuria/thirst) Hypothyroidism
48
MOA for antipsychotic agents
Block dopamine receptors in the brain (limbic system, basal ganglia)—areas associated with emotion, cognitive function, motor function Results in tranquilizing effect
49
A/E to conventional (1st generation) antipsychotic drugs
Extrapyramidal Symptoms (4 types) Neuroleptic Malignant Syndrome gynecomastia, galactorrhea, agranulocytosis
50
4 Types of extrapyramidal symptoms
1 - Acute dystonia - muscle spasm of face (eyes), neck or back (opisthotonus) – tx with Benadryl & benztropine 2 - Parkinsonism – Tx with Anti-ACh drugs (benzotropine) 3 - Akathisia – pacing & squirming; tx w/ anti-ChE drugs (Benzotropine) 4 - Tardive dyskinesia late onset (facial grimacing, slow involuntary tongue rolling, lip smacking, and pill rolling) – tx by switching to SGA
51
Cardinal features of Neuroleptic Malignant Syndrome
Severe muscular rigidity Hyperthermia (temperature >38°C) Autonomic instability Changes in the level of consciousness
52
Neuroleptic Malignant Syndrome and Malignant Hyperthermia are only different in etiology. Tx both with ___
Dantrolene
53
1st generation anti-psyc drugs
Low potency: ex. chlorpromazine HCl (Thorazine) Medium potency: ex. loxapine (Loxitane) High potency: ex. haloperidol (Haldol)
54
(2nd Gen) Atypical Antipsyc Drugs used to tx ____ and _____
Schizophrenia and levodopa induced psychosis
55
2nd Gen Atypical Anti-psyc drugs MOA
``` Blocks dopamine (low affinity – lower EPS) Blocks serotonin ```
56
A/E to atypical (2nd gen) anti-psyc drugs
Fatal agranulocytosis – monitor WBCs before & post Seizures EPS (extrapyramidal sympt-not as much a risk as 1st gen tho)
57
4 Antidepressive drug classes
Monoamine Oxidase (MAO) Inhibitors Tricyclic Antidepressant (TCA) Selective Serotonin Reuptake Inhibitors (SSRI) Serotonin Norepinephrine Reuptake (SNRI) Inhibitors
58
"No Popular Meds" - MAO Inhibitors drug names
Nardil Parnate Marplan
59
Tricyclic Anti-depressive - Effective for major depression; name a/e
Sedation Cardiac Toxicity (lethal w/ OD) Seizure
60
Tricyclic Anti-depressive Toxicity and antidote
Toxicity - hyperthermia, flushing, dry mouth & dilation of pupils Antidote - Physostigime
61
Which of 4 antipsyc drugs is as effective as TCA but with fewer s/e?
SSRI (Selective Serotonin Reuptake Inhibitors)
62
Most widely prescribed SSRI in the United States
Fluoxetine (Prozac, Sarafem)
63
SSRI A/E
``` Insomnia Nervousness Agitation Neonatal abstinence syndrome (NAS) and persistent pulmonary hypertension of the newborn Serotonin Syndrome ```
64
-afaxine is suffix for which of 4 classes of drugs used for depression tx
Serotonin Norepinephrine Reuptake Inhibitors
65
Atypical antidepressive that acts as stimulant and suppresses appetite
Wellbutrin
66
(sedative) DOC to treat anxiety, insomnia, and muscle spasms
Benzodiazipines / muscle spasm- diazepam

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