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Pharm module 5 > epilepsy / parkinsons / migraines > Flashcards

epilepsy / parkinsons / migraines Flashcards

(126 cards)

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1
Q

What are the common symptoms with parkinsons

A

tremor of rest
bradykinesia
tendency to stoop
mortality

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2
Q

What is the cause of parkinsons

A

degeneration of neurons in the substantial nigra

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3
Q

Which dopamine receptor is excitatory

A

D1

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4
Q

Which dopamine receptor is inhibitory

A

D2

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5
Q

What does a decrease in neurons cause

A

a decrease in cortical stimulation

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6
Q

What is the direct pathway in the brain dominated by

A

D1 receptors

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7
Q

What is a dopamine precursor

A

L-Dopa

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8
Q

What does levodopa do

A

crosses the BBB
actively taken up into neurons
converted into dopamine

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9
Q

Which enzyme converts L-dopa in dopamine

A

DA decarboxylase

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10
Q

What are the adverse affects of levodopa

A

Dyskinesia
hallucinations/confusion

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11
Q

Why can L-dopa cause hallucinations or confusion

A

when dopamine levels in the brain are disrupted in any way, it can cause forms of psychosis

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12
Q

If someone on L-dopa has symptoms of psychosis, how would you treat them

A

with antipsychotics (do so cautiously)

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13
Q

What is always given with L-dopa and why

A

carbidopa

allows L-dopa to fully cross the BBB without being converted to DA too early

Reduces peripheral side effects

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14
Q

What is the MOA of carbidopa

A

peripheral inhibitor of L-aa decarboxylase

Prevents conversion to DA in periphery

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15
Q

What is entacapone

A

Levodopa adjunct therapy

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16
Q

What is the MOA of entacapone

A

inhibits COMT

prevents degradation of levodopa

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17
Q

What is COMT

A

secondary pathway to metabolize levodopa, DA, and NE

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18
Q

What are the adverse effects of entacapone

A

dyskinesia
nausea
diarrhea

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19
Q

When is entacapone used for parkinsons treatment

A

When the disease progresses and the L-dopa/Carbidopa combo is no longer sufficient

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20
Q

When does L-dopa work the best in parkinsons treatment

A

The earlier in the disease you treat the better

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21
Q

What happens when someone is on L-dopa for a long time

A

motor fluctuation from receptor adaptation
-on/off effect

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22
Q

What is an example of an MAO B inhibitor

A

selegiline

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23
Q

What is the MOA for selegiline

A

Prevents metabolism of DA, NE, and serotonin

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24
Q

What is 5-HT

A

seretonin

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25
What is the benefit of using Selegiline
Reduces the dose of levodopa needed
26
What drug is interchangeable with Selegiline
Rasagiline
27
What are the adverse effects of selegiline
Amphetamine - like side effects Seretonin syndrome sweating arrhythmia diarrhea
28
What is selegiline metabolized by and what is the product
Metabolized in the liver by CYP450 turns partially into amphetamine
29
What is a dopamine receptor agonist that is used in parkinsons treatment
Bromocriptine Ropinorole
30
What is the MOA for Bromocriptine
Delay the need for L-Dopa or in advanced parkinsons
31
What is the adverse effect of bromocriptine
cardiac valve fibrosis
32
How is Ropinorole different from bromocriptine
Rompinirole is less selective Rompinirole is also useful for restless leg syndrome Ropinirole has less adverse effects
33
What are alternatives to Ropinirole
Pramipexole
34
How is Ropinirole metabolized
CYP450
35
What are adverse effects for ropinirole
Increased risky behavior
36
What is the MOA for Trihexyphenidyl
mACh receptor antagonist will allow for DA to work in the striatum Helps reduce dyskinetic movement and spastic contraction
37
What are the adverse effects on Trihexyphenidyl
Anticholinergic effect (sedation/confusion/constipation/urinary retention) Pharmakinetics: gets excreted unchanged
38
How is Trihexyphenidyl often administered
In combination with DA agonists
39
What is Benzotropine
A non-DA parkinsons treatment Helps with excess amounts of dopamine
40
What can excessive dopamine cause
rigidity
41
What is amantadine
Antiviral
42
What is the MOA of Amantadine
Increases DA release and blocked the NMDA glutamate receptors
43
What are the adverse effects of amantadine
confusion psychosis
44
Where is the neuronal loss in Huntingtons disease
Caudate/putamen Striatum Loss of GABA function
45
What is treatment for Huntingtons based on
The most pronounced symptoms
46
What is the mainstay therapy for Huntingtons
Neuroleptic D2 blockers
47
What is an example of a neuroleptic D2 blocker
Haloperidol
48
What is a drug that can be given for the treatment of chorea
deutetrabenazine
49
What is the MOA of deutetrabenazine
Inhibits neurotransmitter storage which reduces uncontrolled hyperkinetic movements
50
How is duetetrabenazine metabolized
CYP450
51
What is the primary damage done to the brain with Alzheimers
Cholinergic damage -loss of enzymes for ACh synthesis -loss of cholinergic neurons in basal forebrain
52
What are acetylcholinesterase inhibitors that are used for Alzheimers
Donezepil Rivastigmine
53
What are the adverse affects of Donezepil
N/V Diarrhea Sleep disturbances (vivd dreams)
54
What is an NMDA receptor agonist that is used for Alzheimers treatment
Memantine
55
How is Memantine usually given
With dozenepil b/c it works on different receptors OR If a patient cannot take dozenepil
56
What is the MOA for memantine
Thought to reduce excitotoxicity by blocking the activation for NMDA receptors
57
What are common side effects to Memantine
Dizziness headache constipation confusion
58
What is a simple partial seizure
Hyperactive neurons exhibiting abnormal electrical activity in a single locus in the brain No LOC and usually will exhibit abnormal activity of a single limb or muscle group controlled by that area
59
What is a partial complex seizure
Exhibit complex sensory hallucination and mental distortion Will generally start locally and then progress
60
What are the different types of generalized seizures
Tonic-clonic Absence Myoclonic Infantile spasm Status epilepticus
61
What is a tonic-clonic seizure
LOC followed by convulsions
62
What is an absence seizure
Brief, abrupt, self limiting LOC -may start or have rapid eye blinking lasting 3-5 second
63
Why is a myoclonic seizure
short episodes of muscle contractions that may reoccur within several minutes
64
What is status epilepticus
two or more seizures that occur without recovery of full consciousness between them
65
What are the 3 mechanisms that ASM can work
Blocking Na+ or Ca2+ gated channels enhancing GABA impulses Interfering with glutamate transmission
66
What is the MOA of blocking Na+ gated channels
Prevents sodium from entering the cell which will cause the depolarization for muscle contraction
67
What is the MOA for the calcium channel blockade
Prevent the release of internal calcium stores into the cell
68
What is the MOA for GABA enhancers
The drug will irreversible bind to and inhibit GABA transaminase which breaks down GABA Keeping GABA within the cell keeps it hyper-polarized (more negative) so a muscle contraction cannot occur
69
What are the GABA inhibitory drugs
Benzodiazepines -diazepam -Lorazepam
70
How are diazepam and lorazepam different
Lorazepam has a shorter half life but remains in the brain longer Diazepam can be used rectally
71
What is the MOA of Cabamazepine
Blocks Na+ channels -effective for partial seizures *DO NOT PERSCRIBE FOR ABSENCE SEIZURE->CAN INCREASE SEIZURES
72
What is an adverse effect of carbamazepine
Induces CYP enzymes, make sure other drugs aren't metabolized by these enzymes
73
What is the MOA for ethosuximide
Blocks Ca2+ Reduces propagation of abnormal electrical activity in the brain
74
What is ethosuximide used for
treating generalized absence seizures
75
What is gabapentin used for
Adjunct therapy for partial seizures and postherpetic neuralgia Tolerated well in the elderly
76
What are the side effects of gabapentin
Sedating effects renal dose adjustment
77
How does gabapentin relate to GABA
It is an analog but does not act on GABA in any way
78
What is the MOA for Lamotrigine
Blocks Na+ channels and Ca2+ channels
79
What is lamotrigine used for
Partial seizures, generalized seizures, typical absence seizures, and Lennox gastaut syndrome Bi-polar disorder
80
What are the adverse effect of lamatrogine
Rapid titration has been known to lead to SJS
81
What can you combine Lamatrogine with and why
Valproate->reduces drug degradation when given together *must reduce dosage with combination
82
What is the DOC with seizure disorders
Levetiracetam (Keppra)
83
When is Levetriacetam used
adjunct therapy for partial onset seizures, myoclonic seizures, primary generalized. tonic-clonic seizures
84
What are the dose effects of Levetiracetam
Dizziness sleep disturbance headache weakness
85
What type of drug is Oxcarbazepine
A pro-drug *reduces to MHD which has anticonvulsant activity
86
What is the MOA for Oxcarbazepine
Blocks Na+ and Ca2+ Chanels
87
What seizures is Oxcarbazepine used for
Adults and children with partial onset seizures
88
What are the adverse effects of Oxcarbazepine
N/V Headache Visual disturbances
89
What is the MOA for Phenobarbital
Enhances inhibitory effects of GABA mediated neurons
90
When should phenobarbital be used
Status epilepticus treatment alcohol withdrawal
91
What has to happen with phenobarbital is used
Taper drug off when discontinued Monitor phenobarbital levels in the body
92
What is the MOA for phenytoin and Fosphenytoin
blocks Na+ channels by selectively binding in the channels inactive state and slowing its recovery
93
When are phenytoin and Fosphenytoin used
Partial seizures status generalized tonic-clonic
94
What are phenytoin and Fosphenytoin bound to
albumin
95
What are the adverse effects of Phenytoin and Fosphenytoin
Small increases in daily dose can cause large increases in serum concentration Nystagmus and ataxia Induces CYP metabolism
96
What is the difference between phenytoin and fosphenytoin
Phenytoin can NOT be given IM/IV Phenytoin can cause purple hand syndrome
97
What is a major side effect of phenytoin
Gingival hyperplasia peripheral neuropathies osteoporosis
98
What happens when Fosphenytoin is administered
Rapidly get converted to phenytoin in the blood, reaching high levels in minutes
99
What is the MOA of pregabalin
Binds to a subunit of Ca2+ channels that inhibit release of excitatory neurotransmitters
100
When is pregabalin used
Partial onset seizures neuralgia neuropathic pain fibromyalgia postherpetic pain
101
What are the adverse effects of pregabalin
Drowsiness (fogginess) Blurred vision weight gain LE peripheral edema
102
What is the MOA of Topiramate
Blocks Na+ channels Increases Cl- channel opening by binding with GABA Ca2+ current is reduced Carbonic anyhrase inhibitor that may act on NMDA
103
What is Topiramate used for
migraines partial and primarily generalized epilepsy
104
What are the adverse effects of topiramate
Somnolence weight loss paresthesia Kindly stones Glaucoma oligohydrosis=hyperthermia
105
What would be a positive effect of co-administering topiramate
Reduction of ethinyl estradiol
106
What happens when you give a patient divalproex
It will be converted into valproate when it reaches the GI tract *developed to improve GI tolerance of valproate
107
What is the MOA of Valproate
Na+ blocker GABA transaminase blocker Activation of T-type calcium channels *inhibits CYP enzymes
108
What are valproate / divalproex used for
partial and primary generalized epilepsies
109
How does valproate travel in the body
bound to albumin
110
What are the adverse effects of valproate
Hepatic toxicity teratogenicity
111
What is Zonisamide
Sulfonamide derivative
112
What is the MOA for Zonisamide
Blocks Na+ and Ca2+ limited amount of carbonic anhydrase activity
113
When can zonisamide be used
Patients with partial seizures
114
What are the adverse effects of zonisamide
Kidney stones oligohydrosis typical CNS side effects
115
What drugs should be avoided in pregnant women with epilepsy
valproate/Divalproex Barbituates
116
What is the first like treatment for migraines
NSAIDs
117
What drugs can be used to abort migraines
5-HT 1D receptor agonists -triptans -dihydreoergotamine
118
What is the MOA of 5-HT 1D receptor agonists
Leads to either vasoconstriction of inhibition of the release of proinflammatory neuropeptides on the trigeminal nerve
119
What is a therapy used to prevent migraines and when is it indicated
Propanolol When 2+ attacks occur in a month
120
How is sumatriptan given and why
SQ usually for a 20 minute onset vs. the 1-2 hours if taken orally
121
How long does sumatriptan last
2 hour half life
122
How many doses is typically required to abort the headache with sumatriptan
2
123
What type of headache is sumatriptan typically used for
cluster headaches
124
What is the adverse effects of sumatriptan
High BP Cardiac events * avoid in those with CAD Pain/pressure in chest/neck/throat/jaw
125
How is ergotamine administered
IV with similar efficacy to sumatriptan
126
What is the MOA for ergotamine
Constricts intracranial extracerebral blood vessels and inhibits trigeminal neurotransmission

Pharm module 5 (1 decks)

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