GI, CNS Flashcards

Question

Polycarbophil/methycellulose/psyllium

Answer 1

bulk forming laxatives Natural fibrous substance - promote large, soft stools MOA same as dietary fiber - indigestible/nonabsorbable first line treatment - reduces risk of colon cancer ADRs: can solidify in the GI --> obstructions with insuff fluid intake xindic- people who cannot drink lots of fluid **(HF)**

Answer 2

Surfactant Laxative - MOA - inc intestinal fluid secretion & inhibits fluid absorption - retain fluid in stool considered "lubricants" and "stool softeners" often rx'ed with opioids prophylaxis - p/s MI, surgery, vaginal delivery beneficial for elderly who cannot drink adequate fluids for bulk laxatives

Answer 3

Stimulant Laxative MOA: irritating sensory nerve endings in the mucosa to stimulate motility and fluid movement xind: diarhea should be rx'ed PRN onset of action 6-8 hrs - crampy and water discharge ADRs: Associated with fluid loss and can lead to dependency Frequently used and abused - Especially Dulcolax and Ex Lax

Answer 4

saline laxatives - osmototic laxatives - poorly absorbed salts -osmotic draw water into int milk of mag ADRs: can cause significant loss of water, pt should inc fluid intake. small amounts of mg or na will be absorbed - if mg - monitor renal function, xindic kidney disease mg accumulates, if na - na can cause fluid retention xindic pts with HF/HTN pt should be encourange to drink adequate water, kidney fxn should be checked

Answer 5

saline osmotic laxative poorly absorbed - draws water into intestine to form soft stool **enhances secretion of/decreases serum ammonia** levels and may be prescribed for this purpose (hepatic encephalopathy) ADRs: flatulance, cramping

Answer 6

Osmotic Laxative indicated for **chronic constipation** ADR: nausea, bloating, cramping, flatulance eg. miralax bowel cleansing/prep - this drug + electrolyte solution - **isosmotic/nonabsorbable - ok for renal impairment/HF**

Answer 7

**treatment for IBS** selective blockade - 5-HT receptors on neurons that innervate viscera MOA- change in transit time, inc absorption of fluid/Na, increased firmness of stool ADR: constipation, impaction, obstruction, **ischemic colitis** (d/c med)

Answer 8

MOA - inhibition of gastric/pacreatic lipases - decreases absorption of fats approved >12yo ADR: oily seepage, flatulance w/ leakage, fecal urgency, dec vitamin absorption dose w/ bulk laxatives to reduce GI effects

Answer 9

Dopaminergic Converts to Dopamine- medications undergoes conversion to DA Dopamine Agonists Mimics the action of Dopamine on the Dopamine Receptors COMT Inhibitors Inhibits an enzyme that inactivates Dopamine. MAO-B Inhibitors Inhibit MAO-B enzymes that interfere with Dopamine. Prolongs the action of Dopamine. Anticholinergics Blocks Cholinergic Receptors

Answer 10

also approved for restless leg syndrome dopamine cannot cross BBB - levodopa converted to dopamine after crossing BBB c is added to l (no pharm benefit by itself) - enhances l delivery to brain, slows metabolization in intestine(w/o-2%, w/- 10%) - allows lower dosing ADRs: n/v by most pts, **dyskinesia, postural hypotension**, **dysrhythmias** (dopamine conversion in periphery leads to excess activation of beta 1), psychosis (20% of pts) - **psychosis** dark sweat/urine, can activate malignant melanoma, on-off phenomenon high protein meals can reduce therapeutic responses (reduces absorption) - may be cause of "off" d-d + FGA - decreases effectiveness + MAOI - hypertensive crisis - elevated dopamine + norepi - a1, b1&b2

Answer 11

dopamine agonists **stimulates dopamine receptors directly** drug of choice - mild symptoms, added to Levodopa/Carbidopa for elderly/advanced also approved for restless legs advantages - don't lead to dyskinesias, not dependent on enzymatic activation, don't compete with proteins for absorption and transport across BBB, lower incidence of response failure ADRs: hallucinations, daytime sleepiness, postural hypotension

Answer 12

COMT inhibitors - enzyme inactivates dopamine supports levodopo - **not monotherapy** also decreases metabolism of levodopa in periphery (thereby inc t1/2) - allows lower dosing, decreases wearing off of levodopa ADRs: primarily from inc levodopa levels - may need to decrease dose, do not stop abruptly on its own - **GI** - diarrhea, constipation, n/v, discoloration of urine

Answer 13

MAO-B inhibitors - enzyme that breaks down several chemicals in brain - inc dopamine leaves more available dopamine, modest improvement in motor sx avoid tyramine, sympathomimetics- hypertensive crisis - in large doses MAO-A will be inhibited as well + SSRI - serotonin sydnrome **can be used alone or w/ levodopa** first line drug - **may delay neurodegeneration - use early**

Answer 14

first available as antiviral, found to effective parkinsons unclear MOA not considered first line - may have + treating levodopa dyskinesias

Answer 15

**anticholinergic parkinson's** - blocks receptors in striatum reduces tremors/rigidity - does not decrease bradykinesia not as effective as levodopa or dopamine agonist, may be used early, for younger pts, avoided in older pts - intolerant of CNS side effects (sedation, confusion, delusions, hallucinations) ADRs: anticholinergic

Answer 16

Acetylcholinesterase inhibitor best tolerated **all stages of AD** ADRs:GI: N/V , diarrhea, dyspepsia- Take with food Dizziness, HA, **Respiratory: Bronchoconstriction** **CV: bradycardia ** Low cardiac output= fainting , falls , injuries avoid anticholinergics/ anticholinergic s/e - atropine, antihistamine, TCA, FGA

Answer 17

Acetylcholinesterase inhibitor **mild to moderate AD** ADRs: (same as donepezil) GI: N/V , diarrhea, dyspepsia- Take with food CNS: Dizziness, HA, Respiratory: Bronchoconstriction CV: bradycardia Low cardiac output= fainting , falls , injuries

Answer 18

NMDA receptor antagonist NMDA receptor + glutamate -> allows calcium into cell - MOA- slows influx of calcium indic for moderate to severe disease (only drug rec'ed for severe dx) ADRs: dizziness, HA, confusion, constipation, hallucination

Answer 19

monoclonal antibody - removing amyloid plaques expensive 40% of pts ADRs - cerebral swelling, brain bleeding, HA, falls

Answer 20

Suppression of sodium influx -Phenytoin, Carbamazepine Suppression of calcium influx- Ethosuximide , Valproic Acid Promotion of Potassium Efflux- Potassium leaves the cell- Ezogabine Block receptors for Glutamate - primary excitatory neurotransmitter- Topiramate Potentiate action of Gamma-aminobutyric Acid (GABA) -primary inhibitory neurotransmitter Benzodiazepines, Gabapentin **Narrow therapeutic range Take as directed and on time, each day Non-adherence accounts for @ 50% of treatment failure must be withdrawn slowly 6wks - months (abrupt w/d - rebound seizures, status epilepticus

Answer 21

traditional AED selective inhibition of sodium channels - selects for hyperactive neurons all forms of seizures except absence may be used as antidysrhythmic **narrow therapeutic range** - 10-20 mcg/mL - s/s toxicity - **nystagmus, cognitive impairment, ataxia, diplopia, sedation, cardiac depression** - **no antidote** active against partial seizures/tonic-clonic ADR: **gingival hyperplasia -20%** (soft toothbrush, continue to floss), derm - rash that can progress to SJS or TENs, **IV - tissue vessicant**, hypotension/dysrythmias,hirsutism, **teratogen + inc bleeding for newborns,

Answer 22

prodrug - converted to phenytoin admin IM/IV only parenteral mgmt of **status epilepticus**, treatment/prevention of seizures - neurosurgery ADRs: same as phenytoin + infusion reaction - itching cardiac monitoring

Answer 23

trad AED suppression of sodium influx, potentiates GABA active against partial seizures/tonic clonic + bipolar, trigeminal neuralgia, diabetic neuropathy narrow therapeutic range - nystagmus, ataxia, sedation - less cognitive impairment vs phenytoin and pentobarbital- drug of choice Tolerance can develop- minimize by giving largest dose at bedtime ADR: monitor CBC - bone marrow suppression- thromcytopenia, leukopenia, anemia fetal harm, SJ, CNS - nystagmus, ataxia, sedation (less than phenytoin) hyponatremia/osm - promotes secretion of ADH -> fluid retention - monitor Na (looks like SIADH) liver enzyme inducer - decreases effect warfarin, OCP, x grapefruit juice - inc peak and trough

Answer 24

trad AED MOA: Suppression of Na influx, Ca influx & Augments GABA V is for variety - broad spectrum effectiveness - partial/focal seizures, generalized tonic-clonic monitor for **hepatoxicity, pancreatitis** other ADRs: teratogen, **hyperamonemia - monitor neuro**, **GI most common** - min w/ enteric coating/taking with food

Answer 25

**Absence seizures**, also works in some partial seizures initial dose drowsiness, dizziness, lethargy wears off over time

Answer 26

older AED - potentiates and mimics effects of GABA still used, rarely due to adrs used in low doses for **alc w/d** generalized & partial seizures ADRs: CNS depression, learning impairment, depression misuse

Answer 27

MOA: unknown, binds GABA widely used in acute care for all ages - not effective absence offlable for migraines, bipolar, new-onset pediatric epilepsy least risk of ADRs and least risk of abuse/dependence newer - used a lot ADR: mild CNS - drowsiness, weakness, mood chgs, agitation safe in pregnancy

Answer 28

newer AED MOA: Blocks Sodium and partially Calcium Channels, and decreases Glutamate generalized, partial and absence szr ADR: CNS, derm **monitor for SI** does not induce or inhibit liver enzymes/drug metabolism

Answer 29

analog of GABA - similar to gabapentin unknown MOA- inhibits Ca influx seizures, **neuropathic pain** - DM neuropathy, fibromyalgia, neuralgia ADR: CNS -dizziness, sedation, brief blurred vision **abuse - 4-12% euphoria**, similar effect benzos **d/c slowly**- avoid insomnia, HA, s/s dependence,

Answer 30

partial seizures + broad spectrum antiszr analog of GABA 80% rx'ed offlable - neuropathic pain, neuralgia, migraine prophylaxis, fibromyalgia, meno hot flashes ADR - mild CNS, peripheral edema -disapear with continued use

Answer 31

Generalized and partial seizures monotherapy or adjunct derivative of carbamazepine - shared features, better tolerated, more expensive ADR: monitor CBC - **bone marrow suppression**- thromcytopenia, leukopenia, anemia fetal harm, SJ, CNS - nystagmus, ataxia, sedation (avoid alcohol) **hyponatremia/osm** - promotes secretion of ADH -> fluid retention - monitor Na (looks like SIADH liver enzyme inducer - decreases effect warfarin, OCP, x grapefruit juice - inc peak and trough, increases phenytoin levels

Answer 32

Immediate IV placement for labs and treatments Glucose solution infused Antiepileptic agent infused Benzodiazepines: Lorazepam (Ativan) or Diazepam (Valium) to terminate seizures - GABA agonists Effects of Ativan can last for 72 hours, so it is now the drug of choice Once the seizures have been stopped, Phenytoin (Dilantin) or Fosphenytoin (Cerebyx) may be given for long term suppression

Answer 33

dilation/inflammation intracranial blood vessels - trigeminal depolarization, increase in CGRP, decrease in serotonin mds prevent or abort

Answer 34

first line treatment - abortive therapy moa: stimulate 5-ht receptors in cranial blood vessels - vasoconstriction 15 min - subQ/intranasal. 30-60 min intranasal ADR: **50% heavy arms, chest pressure** avoid in pregnancy, xind: angina, CAD - coronary vasospasm, uncontrolled HTN seperate from ergotamine compound 24 hrs + SSRIs, SNRIs, MAOIs - SS

Answer 35

INH agent severe migraines t1/2 shorter than migraines - abuse, medication overuse headache

Answer 36

promotes vasoconstriction second line therapy r/t risk of dependency often + caffeine not safe during pregnant - cat x overdose - extreme vasoconstriction - "ergotism" - severe tissue ischemia in the periphery xind: angina, CAD - coronary vasospasm, uncontrolled HTN ADR: n/v (often + metoclopramide or procholperazine), leg weakness, myalgia, peripheral tingling, tachy, brady, angina d-d: 24 hours from triptans rebound headaches may occur - limit use 5/week or 10/week combo drug

Answer 37

Calcitonin Gene Related Protein - CGRP antagonist CYP inhibitor - may delay absorption of high fat meal

Answer 38

>15 attacks/month 31 injections helpful in some cases

Answer 39

oxygen, CCBs

Answer 40

AEDs - suppress discharge of neurons within a seizure focus AND suppress propagation of seizure activity from the focus to other areas of the brain - 60-70% are seizure free goals for treatment - reduce seizures - normal life / eliminate seizures monitor plasma levels - phenytoin (dilantin), nonadherence - 50% of treatment failures seizure meds should not be stopped abruptly take meds at same time every day ADR: CNS depression all AEDs can cause Steven's Johnsons - first flu-like, then rash

Answer 41

prevent/avoid attacks: bblkrs - stablize vascular tone TCAs - amitriptylline - blocks reuptake norepi, serotonin ADR: hypotension, anticholinergic AED - topiramate, divalproex (form of valproic acid)- strongest efficacy, gabapentin abortive therapy: nonspecific - ASA, acetaminophen, opioids specific- serotonin agonists - triptans, ergot alkaloids aspirin + metoclopromide can be as effective as sumatriptan w/ less adrs (gastric stasis common with migraine meds - good reason to add metoclopramide

GI, CNS Flashcards

(65 cards)