Drugs

Question 1

Carbamazapine (Tegretol)

Answer 1

First line drug for focal / partial seizures. Ineffective against absences. May worsen myoclonic seizures. Site of action is the Na+ channel. Characteristic side effects include hyponatremia, agranulocytosis, and diplopia. It is an enzyme inducer (makes cytochrome p450 drugs get metabolized more quickly).

Question 2

Phenytoin (Dilantin)

Answer 2

Na+ channel site of action. Treats partial seizures. Causes gingival hyperplasia, coarsening of facial features, and ataxia. It is an enzyme inducer (makes cytochrome p450 drugs get metabolized more quickly).

Question 3

Valproic Acid (Depakote)

Answer 3

Na+ Channel/ GABA receptor site of action. Good for partial, generalized and absence seizures. Causes GI symptoms, tremor, weight gain, hair loss, hepatotoxicity, and thrombocyotpenia. Bad for pregnant women. CAN CAUSE NEURAL TUBE DEFECTS. Depakote is delicious to the liver–gets eaten first. Can increase levels of other hepatically metabolized drugs.

Can also cause extrapyramidal symptoms (tardive dyskinesias, parkinson-like symtoms).

Question 4

Phenobarbital

Answer 4

GABA receptor site of action. Good for partial and generalized seizures. Causes sedation. It is an enzyme inducer (makes cytochrome p450 drugs get metabolized more quickly).

Question 5

Ethosuximide

Answer 5

Type T Ca++ channel site of action. Good for absence seizures. Causes GI symptoms.

Question 6

Gabapentin (neurontin)

Answer 6

Unknown MOA. Good for partial seizures. Causes sedation, ataxia.

Question 7

Lamotrigine (Lamictal)

Answer 7

Na+ channel, glutamate receptor site of action. Good for partial and generalized seizures. Causes rash, and steven johnson syndrome. Good for pregnancy. (Lowers levels of OCPs as well.)

Question 8

Topiramate (Topamax)

Answer 8

Na+ channel, GABA activity. Good for partial & generalized seizures. Causes word-finding difficulty, renal stones and weight loss. (Can also diminish levels of OCPs.)

Question 9

Tiagabine (Gabitril)

Answer 9

GABA reuptake MOA. Good for partial seizures. Causes sedation.

Question 10

Levetiracetam (Keppra)

Answer 10

MOA unknown. Good for partial and generalized seizures. Causes insomnia, anxiety irritability and psychosis.

Question 11

Oxcabazepine (Trileptal)

Answer 11

MOA Na+ channel. Good for partial seizures. Causes sedation and HYPONATREMIA.

Question 12

Zonisamide (Zonegran)

Answer 12

Unknown MOA. Good for partial and generalized seizures. Causes sedation, renal stones and weight loss.

Question 13

Drugs to treat partial seizures (not good for generalized seizures)

Answer 13

Phenytoin (Dilantin)
Carbanazepine (Tegretol)
Gabapentin (Neurontin)
Tiagabine (Gabitril)
Oxcarbazepine (Trileptal)

Question 14

Drugs to treat partial and generalized seizures

Answer 14

Valproic Acid (Depacote)
Phenobarbital
Lamotrigine (Lamictal)
Topimarate (Topamax) 
Levetiracetam (Keppra)
Zonisamide (Zonegran)

Question 15

Drugs to treat absence seizures

Answer 15

Ethosuximide (Zarontin)
Valproic Acid (Depakote)

Question 16

Drugs to treat alzheimers

Answer 16

Donepezil (Aricept), fewer side effects than tacrine, equal efficacy.

Rivastigmine (Exelon); rare hepatic toxicity.

Tacrine: hepatic toxicity, check ALT every 2 weeks

Ibuprophen– targetting anti-inflammatory theory

Vitamin E

Question 17

drugs to treat vascular dementia

Answer 17

Warfarin, aspirin, clopidogrel, dipyramadole.

Question 18

Druges to trat Parkinson Disease

Answer 18

1) levodopa/carbidopa
2) trihexylphenidyl (anticholinergic)
3) benztropine (anticholinergic)
4) Amantadine (NMDA antagonist)
5) bromocriptine (dopamine agonist)
6) pergolide (dopamine agonist)
7) pramipexole (dopamine agonist)
8) ropinirole (dopamine agonist)
9) tolcapone (COMT inhibitor)
10) entacapone (COMT inhibitor)

Question 19

levodopa/carbidopa

Answer 19

parkinson med–dopamine precursor. – anorexia, nausea, pschosis, hallucinations, orthostatic hypotension and eventually dykinesias.

Question 20

trihexylphenidyl or benztropine

Answer 20

parkinson med. (anticholinergic)–dry mouth, constipation, urinary retention, confusion, hallucination, narrow-angle glaucoma

Question 21

Amantadine

Answer 21

parkinson med. NMDA antagonist– hallucinations, leg edema, livedo reticularis.

Question 22

bromocriptine or pergolide or pramipexole or ropinirole

Answer 22

parkinson med. Dopamine agonists. Nausea, orthostatic hypotension, psychosis, hallucinations, dyskinesia.

Question 23

tolcapone or entacapone

Answer 23

Parkinson med. COMT inhibitor. nausea, vomiting, insomnia, orthostatic hypotension, confusion, dyskinesia.

Question 24

MS drugs

Answer 24

1) Interferon beta 1a–avonex–(causes flu-like symptoms, anemia, depression, development of neutralizing antibodies)
2) Interferon beta 1 b–betaseron or rebif– (similar side effects as above, and also injection site reaction, depression, hematologic/liver abormalities.
3) glatiramer acetate– Copaxone– injection site reactions, injection related chest pain and shortness of breath.

Question 25

AED enzyme inducers

Answer 25

carbamazepime, phenytoin, phenobarb. Lamotigrine also lowers OCP levels. Valproic acid has the opposite effect. Can increase concentration of other drugs b/c is favored by the liver.

Question 26

dexamethasone, methylprednisone or prednisone

Answer 26

corticosteroids-- anti-inflammatory/antiimmune. Steroids can cause psychosis. Begins with agitation, sleep disturbance, and paranoia, and may end with the need for neuroleptics. Can cause weight gain, mood swings, acne, bloating. Chronic high dose use use also assc'd with cataracts, hypertension, diabetes, osteoperosis.

Question 27

bupropion

Answer 27

SNRI, lowers seizure threshold.

Question 28

docitaxel, pacitaxel

Answer 28

chemotherapeutic agents, most common side effect is peripheral neuropathy.

Question 29

cytosine arabinoside

Answer 29

chemotherapy agent for leukemia. Side effects include slurred speech, ataxic gait, incoordination of limbs. (Irreversible cerebellar ataxia). More common is peripheral neuropathies. May be associated with PRES.

Question 30

atorvastatin

Answer 30

statins are assc'd with a range of musculoskeletal symptoms, including a myopathy which may have a normal or elevated CK.

Question 31

halopaeridol

Answer 31

antipsychotic. Side effects can include dytonic reactions, extrapyramidal symptoms.

Question 32

diphenydramine

Answer 32

benadryl-- has anticholinergic effects (can help with dystonic reactions from medications that have anti-dopaminergic properties, like antipsychotics and antiemetics, for example.

Question 33

isonaziad

Answer 33

Abx to treat TB. Peripheral neuropathy and CNS effects are associated with the use of isoniazid and are due to pyridoxine (vitamin B6) depletion, but are uncommon at doses of 5 mg/kg.

Question 34

benztropine

Answer 34

a parkinson's drug-- anticholinergic. can cause anticholinergic excess (tachycardia, blurred vision, fever, mental status changes, voiding difficulties, etc)

Question 35

erythromycin

Answer 35

Abx. can interact with the AEDs carbamazepine, phenytoin, oxcarbazepine, etc. Elevated levels of these AEDs are assc'd with ataxia nystagmus, and at higher levels, diplopia.

Question 36

tacrolimus / cyclosporine

Answer 36

chemotherpeutic agents, also used for post-transplant immunosuppression. Can cause vascular injury with loss of autoregulation, hypertension, vasospasm, seizures, confusion and an MRI/CT picture of PRES/RPLS.

Question 37

gentamicin

Answer 37

``` an aminoglycoside antibiotic. Symptoms of gentamicin toxicity include: Balance difficulty Bouncing, unsteady vision Ringing in the ears (tinnitus) Difficulty multi-tasking, particularly when standing ```

Question 38

tolterodine

Answer 38

antimuscarinic drug to treat urinary incontinence Can cause dry mouth, upset stomach, headache, constipation, dry eyes, sleepiness. Worse side effects include: allergic reaction, tachycardia/arrythmia Xerostomia (dry mouth) Decreased gastric motility (upset stomach) Headache Constipation Dry eyes Sleepiness The following reactions have been reported in patients who have taken tolterodine since it has become available: Allergic reactions including swelling Rapid heartbeat or abnormal heartbeat Accumulation of fluid in the arms and legs Hallucinations

Question 39

5-fluoruracil

Answer 39

chemotherapeutic agent, can cause cerebellar ataxia. May be associated with PRES.

Question 40

metocloperamide

Answer 40

antiemetic, D-2 antagonist. Can cause extrapyramidal symptoms (tardive dyskinesias, parkinson-like symtoms). (Note valproic acid and amphteracin B can also cause similar symptoms.)

Question 41

fluoxetine

Answer 41

SSRI-- this is prozac.

Question 42

amitriptyline, nortriptyline, imipramine

Answer 42

tricyclic antidepressants-- can all cause significant anticholinergic effects. (mad as a hatter, hot as a hare, dry as a bone, red as a beet, etc)