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Pharmacology > CNS Part 2 > Flashcards

CNS Part 2 Flashcards

1
Q

Focal (partial) seizures

A

Only affect one part of the brain/ typically one cerebellar hemisphere

May progress to affect the whole brain

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2
Q

Generalized seizures

A

Subclassifications include tonic-clonic (“grand mal”) and absence

Affects the whole brain

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3
Q

Barbiturates role in therapy

A

Phenobarbital, Primidone

Limited by Side Effects
For resistant seizures as IV therapy
Treats a wide variety of seizure types

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4
Q

Benzodiazepines role in therapy

A

First line for acute termination of seizures / status epilepticus

Long term use- role limited to specific types of seizures

Alcohol withdrawal seizures

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5
Q

Phenytoin / Fosphenytoin side effects

A

Confusion, sedation, nystagmus, ataxia, dysarthria

Toxicity Risk- narrow therapeutic index

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6
Q

Phenytoin / Fosphenytoin role in therapy

A

Acute termination (IV)
Chronic seizure therapy in resistant patients (PO)

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7
Q

Carbamazepine / Oxcarbazepine side effects

A

Dizziness, drowsiness, ataxia, blurred vision, cardiac arrhythmias

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8
Q

Carbamazepine / Oxcarbazepine role in therapy

A

Chronic seizure management (PO)
Off-label: trigeminal neuralgia

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9
Q

Valproates side effects

A

Depakote, valproic acid

GI distress, impaired platelet function

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10
Q

Valproates role in therapy

A

Acute Seizure management (Inpatient)

Chronic seizure management (PO)(Outpatient)

Other indications: Bipolar disorder, migraines (off-label)

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11
Q

Levetiracetam

A

Traumatic brain injury seizure, very well tolerated, used for TBI to prevent seizures

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12
Q

Gabapentin (Neurontin)

A

Neuropathic pain, postherpetic neuralgia, anxiety, restless leg, vasomotor sx in menopause

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13
Q

Pregabalin (Lyrica)

A

Fibromyalgia, neuropathic pain, diabetic neuropathy, restless leg, chronic cough*

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14
Q

Lamotrigine (Lamictal)

A

Bipolar, migraine, trigeminal neuralgia

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15
Q

Topiramate (Topamax)

A

Migraines, tremor, cluster headache

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16
Q

First vs Second Generation AEDs

A

First: more effective

Second: more favorable kinetics, milder side effects

-Doses administered late can increase risk of seizure occurring

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17
Q

Gabapentin side effects

A

sedation, fatigue, dizziness

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18
Q

Lacosamide side effects

A

dizziness, HA, double vision

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19
Q

Lamotrigine side effects

A

ataxia, skin reactions (SJS)

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20
Q

Levetiracetam side effects

A

sedation, dizziness, well tolerated

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21
Q

Pregabalin side effects

A

peripheral edema (temporary)

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22
Q

Tiagabine side effects

A

rare depression,anxiety

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23
Q

Topiramate side effects

A

sedation, dizziness, ataxia

24
Q

Zonisamide side effects

A

sedation, loss of appetite

25
AEDs in Pregnancy
Birth defects incidence is generally higher in women who take AEDs compared to those without exposure Avoid valproic acid and derivatives (can cause spina bifida
26
Status Epilepticus
Seizure lasting > 5 minutes or Lack of recovery between seizures
27
Status Epilepticus management
1st line: BENZOS 2nd therapy: levetiracetam, fosphenytoin, valproic acid, lacosamide If untreated, can lead to permeant brain damage even death Gets harder to treat, the longer the seizure lasts
28
Levodopa
Cornerstone of therapy Improves bradykinesia and rigidity Most effective drug therapy Limited by: Adverse effects Diminished response over time
29
Levodopa-carbidopa (Sinemet)
Erratic absorption & short half life Absorption delayed if taken with high protein meal Peak effects: 1 hour after administration Dosed frequently: >4 times daily
30
Levodopa ADEs
arrhythmias, OH, Confusion
31
Dopamine Agonists (Pramipexole, Ropinirole, Rotigotine)
Indications: 1st line alternative agent or in combo with levodopa Helpful for end-of-dose akinesias & on-off phenomenon ADE: N/V, orthostatic hypotension
32
Anticholinergic Drugs: Benztropine (Cogentin), Diphenhydramine (Benadryl)
Indications: tremor; adjunct to levodopa ADE: confusion, decreased cognition, drowsiness, urinary retention, blurred vision Avoid in pts 65 or older
33
Amantadine
Indications: tremor, mild dyskinesias ADE: orthostatic hypotension, CNS disturbances (hallucinations, depression, confusion), lower extremity skin discoloration Well tolerated, stimulating (take in early AM and early PM), effects wear off around 1 year
34
Monoamine Oxidase B inhibitors (Rasagiline, Selegillene)
Indication: Early in disease prior to levodopa or adjunct to levodopa wearing off ADE: Dizziness, GI distress, HA, sleep disturbances (S>R)
35
Catechol-O-Methyltransferase (COMT) Inhibitors (Entacapone, tolcapone)
2nd line therapy for ‘wearing off’ of levodopa Adverse Effects: Muscle cramps Dyskinesias (at initiation)
36
Special Considerations for Physical Therapist
Coordinate therapies with peak drug effects (levodopa ~1 hr post-dose) Morning hours may be ideal given late day fatigue May encounter 'drug holiday' patients Need to maintain as much mobility as possible. Monitor blood pressure -Orthostatic hypotension -Dizziness, confusion, sleep disturbance Careful guarding given fall risk Gait training, balance activities are essential to quality of life
37
Benzonatate
Local anesthetic
38
Diphenhydramine
Antihistamine causes sedation, dizziness
39
Dextromethorphan
Inhibits cough reflux via direct effects on the brainstem causes sedation, dizziness, GI upset
40
Codeine / Hydrocodone
Inhibits cough reflux via direct effects on brainstem causes sedation, dizziness, GI upset, dependence risk
41
Decongestants
Bind alpha receptors in blood vessels of nasal mucosa =Vasoconstriction Increased BP Cardiac abnormalities Dizziness Palpitations
42
first generation Antihistamines side effects
Sedation Fatigue Dizziness GI Distress
43
Mucolytics
decrease viscosity of respiratory secretions side effects: Nausea, vomiting, Oral mucosa, inflammation
44
Expectorants
facilitate production and ejection of mucus side effects: GI upset
45
SABA
Short Acting Beta Agonist Albuterol Levalbuterol
46
LABA
Long Acting Beta Agonist Salmeterol Formoterol Vilanterol
47
Beta-Adrenergic Agonists (Beta Agonist)
Beta Agonists stimulate beta 2 receptors resulting in relaxation of bronchiole smooth muscles producing bronchodilation Side effects: Tachycardia Nervousness Tremor Airway irritation (only with excessive use)
48
Albuterol (SABA)
Acute Symptoms Onset: 5-15 minutes Duration of action: 4-6 hours “Bring with you to PT”
49
SAMA
Short Acting Muscarinic Antagonist
50
LAMA
Long Acting Muscarinic Antagonist
51
Anticholinergic Drugs side effects (Ipratropium, Tiotropium)
Tachycardia Confusion
52
Glucocorticoids / Corticosteroids / ‘Steroids’
inhibits inflammatory response Side Effects – short term *Oral Thrush (inhalation) * Hyperglycemia * Psychiatric disturbances Side Effects – long term * Osteoporosis * Skin breakdown * Loss of adrenal function
53
Cromones
Help PREVENT bronchospasm Taken prophylactically Prevent release of histamine Example: Cromolyn
54
Leukotriene Inhibitors
Leukotriene are inflammatory mediators in resp tissue Example: Montelukast (Singular) – blocks the receptor for leukotrienes on resp tissue -Tablet, taken daily
55
Physical Therapy & Respiratory Drugs
Chest PT scheduling – 30 min/1hr after respiratory med treatments (SABA/SAMAs) Bring Albuterol to therapy

Pharmacology (10 decks)

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