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Pharmacology > HA/Seizure/MDD/Anxiety > Flashcards

HA/Seizure/MDD/Anxiety Flashcards

(119 cards)

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1
Q

characteristics of tension HA

A

dull with pain that radiates from forehead to occiput in a band-like fashion. Often radiates down the neck and sometimes into the trapezius muscle

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2
Q

characteristics of migraine HA

A

throbing head pain and often nausea, appetite change, photophobia, phonophobia

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3
Q

characteristics of cluster HA

A

disabling, burning, or boring and centered around one eye. Unilateral. Refer to neurologist or HA specialist

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4
Q

main inhibitory neurotransmitter in the CNA

A

GABA

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5
Q

excitatory neurotransmitters in CNA

A

glutamate

aspartate

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6
Q

2 major groups of seizures

A

partial

generalized

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7
Q

focal seizures (simple partial)

A

no alteration of consciousness
symptoms determined by anatomical location of seizure in the brain and may be motor, sensory, autonomic, or psychic
may evolve into complex partial or generalized tonic-clonic

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8
Q

complex partial seizure (psychomotor)

A

impaired consciousness with some sort of automatic behavior

may be proceeded by an aura

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9
Q

types of generalized seizures

A 
absence
atypical absence
tonic-clonic
clonic
atonic
myoclonic
tonic
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10
Q

absence seizures (petit mal)

A

sudden onset, brief, disrupt ongoing activity, no postictal state
blank stare and nonresponsive when spoken to

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11
Q

tonic-clonic seizures (grand mal)

A

abrupt loss of consciousness. bilateral jerking movements, increased salivation, frothing at the mouth, deep respiration and relaxation of muscles. Vague, ill-defined warning sign but no true aura. Postictal period with depressed consciousness that can be prolonged

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12
Q

clonic seizures

A

rapidly repetitive bilateral jerking movements of extremities and facial muscles with short postictal state

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13
Q

atonic seizures (drop attacks)

A

sudden loss of muscle tone which may be only fragmentary. May be brief and not associated with loss of consciousness

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14
Q

myoclonic seizures

A

sudden, brief, shock like muscular contractions

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15
Q

tonic seizures

A

brief, generalized tonic contractions with associated head extension, possible stiffening of back and stiffening or all 4 extremities

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16
Q

status epilepticus

A

life threatening emergency. Seizure activity lasting longer than 30 minutes or two sequential seizures with no recovery between

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17
Q

precipitating factors for status epilepticus

A 
drug noncompliance
sudden withdrawal from antiepileptic drugs
withdrawal from alcohol/sedative drugs
CNS infection
metabolic disturbances
sleep deprivation
stroke
trauma
encephalitis
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18
Q

apparent unprovoked first seizure

A

EEG, CT or MRI

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19
Q

phenytoin use

A

one of the most commonly used for tonic-clonic as well as simple and complex partial seizures. Also used to prevent early posttraumatic seizures after TBI

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20
Q

does phenytoin require a loading dose

A

yes

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21
Q

contraindications to phenytoin

A

no absolutes

black box warning for severe cardiac events with rapid IV admin

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22
Q

dosage titration of carbamazepine

A

don’t decrease due to slightly elevated level during 1st month as it will likely decrease as a result of autoinduction. If it is decreased it will likely continue to decrease and dosage should be increased

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23
Q

carbamazepine for myoclonic seizures

A

not effective and may in fact exacerbate

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24
Q

self-interaction of carbamazepine

A

can induce its own metabolism resulting in decreased serum concentrations over time (induces and is metabolized by CYP3A4)

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25
what else does oxcarbazepine interact with
oral contraceptives
26
black box warning for valproic acid
potential for hepatic failure risk of hepatotoxicity with known mitochondrial disorders spina bifida (do not give to pregnant patients) severe life-threatening pancreatitis
27
symptoms of hepatotoxicity
malaise, weakness, facial edema, anorexia, jaundice, and vomiting
28
Valproic acid and carbapenems
rapid decline in valproate plasma concentrations
29
does phenobarbital require a loading dose
yes
30
black box warning for ezogabine
may cause retinal abnormalities which can loss loss of visual acuity
31
contraindications to pregabalin
hx of angioedema, HF, HTN, DM
32
dosage of topiramate in relation to creatinine clearance
<70 dosage should be lowered by 50%
33
black box warning for felbamate
100-fold increased risk for aplastic anemia (avoid use in patients with history of blood dyscrasias)
34
black box warning for vigabatrin
may cause permanent bilateral concentric visual field constriction
35
visual assessment with vigabatrin use
baseline, week 4, then q3mo
36
rufinamide administration
give with food for increased absorption
37
dosing of clobazam
based on patient weight
38
clobazam interactions
alcohol can increase concentration by as much as 50% | can reduce effectiveness of birth control
39
benzodiaepines for seizure control
clobazam clonazepam lorazepam diazepam
40
clonazepam contraindications
``` narrow-angle glaucoma severe liver disease chronic respiratory disease impaired renal function mentally challenged ```
41
medications that greatly increase diazepam levels by altering clearance
SSRIs sertraline paroxetine
42
first line treatment for SE
benzodiazepines
43
most common seizure syndrome in pediatrics
Lennox-Gastaut syndrome ( usually associated with mental retardation) poor prognosis for seizure control
44
geriatric considerations for antiepileptic drugs
decreased liver/renal function | lower albumin levels can caus higher free drug concentrations increasing likelihood of adverse reactions
45
AEDs that can lead to contraceptive failure
topiramate, oxcarbazepine, and lamotrigine
46
whn AED is started or changed, how many half-lives to reach steady state
5 elimination half-lives
47
which AEDs limit their own half0life when given chronically
carbamazepine and valproic acid
48
postpartum depression onset
within 6 weeks of childbirth and can persist for 3-14 months
49
acute treatment phase of depression
6-8 (potentially up to 12) weeks | full assessment of effectiveness at weeks 4-6
50
continuation phase of depression tx
usually 9mo-1yr | continue therapy for 4-6 months after symptom resolution
51
when is maintenance therapy considered for depression
``` 3+ prior episodes 2 episodes in 5 yrs comorbid substance abuse or anxiety disorder family hx onset earlier than 20 or later than 40 ```
52
adequate trial of antidepressant medication
6-12 weeks
53
antidepressant drug classes
``` SSRIs SNRIs TCAs MAOIs atypical agents ```
54
administration of SSRIs
take in am d/t potential to induce anxiety and/or insomnia
55
SSRI drugs
``` citalopram (Celexa) fluoxetine (Prozac) fluvoxamine (Luvox) paroxetine (Paxil) sertraline (Zoloft) escitalopram (Lexapro) ```
56
SNRI drugs
venlafaxine (Effexor) desvenlefaxine (Pristiq) duloxetine (Cymbalta) levomilnacipran (Fetzima)
57
MAOI drug
phenelzine (Nardil)
58
Atypical antidepressant drugs
bupropion (Wellbutrin) mirtazapine (Remeron) trazadone (Desyrel)
59
why are SSRIs ideal for elderly
no potential to induce orthostatic hypotension or cardiac conduction abnormailities *use caution with seizure disorders as lowers seizure threshold*
60
symptoms of "discontinuation syndrome" with SSRIs
return and worsening of depressive symptoms with a flu-like presentation, insomnia, irritability, GI effects, and anxiety
61
most frequently reported SSRI adverse effect
pervasive sexual dysfunction | Wellbutrin has been utilized to mitigate
62
symptoms of serotonin syndrome
heat stroke vascular collapse fever tachycardia
63
abrupt discontinuation of SNRIs
also produces discontinuation syndrome
64
what may be an appropriate option is depression is characterized by insomnia
TCA as they can cause sedation
65
TCAs that are advantageous for elderly
nortriptyline and desipramine (Norpramin) d/t less potential to cause orthostatic hypotension
66
contraindications to TCAs
preexisting epilepsy and cardiac conduction abnormalities (may contribute to AV block and QT prolongation)
67
TCA mech of action
inhibits reuptake of norepinephrine and serotonin
68
Atypical antidepressant drugs
bupropion trazadone nefazodone mirtazapine
69
what makes bupropion different from all other available antidepressants
Inhibits reuptake of norepinephrine and dopamine. Does not affect the serotonergic system
70
benefits of bupropion over other antidepressants
virtual absence of sexual side effects | less somnolence, fatigue, and weight gain
71
adverse effect of bupropion
lowers seizure threshold
72
why is trazadone highly sedating
secondary to its antihistamine properties
73
what else can trazadone be used for
comorbid anxiety disorders | off label sleep aid
74
SSRI wash out period
4-5 days for zoloft and paxil and several weeks for prozac
75
mirtazapine appetite stimulation
may make it a good option for low-weight elderly or ill patients
76
Novel antidepressant drugs
vilazodone | vortioxetine
77
vilazodone and vortioxetine onset of effect
significantly earlier than other antidepressants (as early as 1 week)
78
what risks serotonin syndrome when coadministered with vortioxetine
bupropion or buspirone
79
MAOI orthostatic hypotension
attempts to counteract this include support stockings, prescribing stimulants (methylphenidate), or adding the mineralocorticoid
80
MAOI diet
strictly eliminate tyramine-containing foods (may cause hypertensive crisis)
81
first line therapy for MDD
SSRIs or SNRIs unless contraindications
82
second line therapy for MDD
increase dose, augmentation, or switching
83
typical agents used to augment antidepressant therapy
lithium thyroid hormone stimulant medications
84
when switching medication classes for MDD what should be chosen prior to TCAs
atypical antidepressants
85
MDD medications commonly added to initial medication for combo therapy
``` trazadone bupropion mirtazapine buspirone atypical antipsychotics ```
86
why should venlafaxine (effexor) be avoided with uncontrolled HTN
potential to increase BP
87
depression presentation in children
early childhood: acting out, changes in eating/sleeping, social withdrawal 5-8: low self-esteem, underachievement at school, aggressive or antisocial behavior (including stealing and lying)
88
MDD medication approved for use in children
Prozac is the only SSRI for children 8+ | Lexapro approved for 12+
89
MDD presentation in elderly patients
more vegetative symptoms and cognitive disturbances than subjective dysphoria
90
St. John's wort for MDD
do not take in combo with any other antidepressant d/t risk of serotonin syndrome can decrease serum levels of warfarin and oral contraceptives
91
anxiety disorders
generalized anxiety disorder (GAD) panic disorder (PD) social anxiety disorder (SAD)
92
GAD must be present for at least 6 months and have at least 3 of what 6 arousal symptoms
``` restlessness fatigue muscle tension irritability concentration deficit sleep disturbance ```
93
how long should tx of anxiety disorders continue after resolution of symptoms
12 months
94
SSRIs used to tx anxiety
``` citalopram (Celexa) escitalopram (Lexapro) fluvoxamine (Luvox) paroxetine (Paxil) sertraline (Zoloft) ```
95
TCA used to tx anxiety
Imipramine (Tofranil)
96
SNRI used to tx anxiety
venlafaxine (Effexor) | duloxetine (Cymbalta)
97
what else can Cymbalta tx other than anxiety and depression
somatic pain
98
indication for benzodiazepine tx in anxiety disorders
short term usage (2-4 weeks) while long term therapy takes effects or on as as-needed basis for panic attacks
99
high potency BZDs
alprazolam (Xanax) clonazepam (Klonopin) lorazepam (Ativan)
100
preferred drugs for tx of anxiety in the elderly and people with liver disease
oxazepam and lorazepam due to one-step inactivation
101
highly lipid soluble BZD
diazepam (Valium)
102
reported possible adverse effects of BZDs in children, elderly, and brain-injury patients
rage excitement hostility
103
drug to tx BZD OD
flumazenil (Mazicon)
104
Buspirone
primarily used as adjunctive therapy (delayed onset of action, lack of efficacy in relation to most comorbid conditions) effect may take 2-3 weeks
105
examples of tyramine-containing foods
cheese, liver, yogurt, yeast, soy sauce, red wine, beer
106
1st line therapy for GAD
SSRIs/SNRIs with BZD to use until therapeutic effect is realized
107
2nd line therapy for GAD
imipramine or buspirone (may be the best choice for patients with a hx of substance abuse, personality disorder, or sleep apnea)
108
3rd line therapy for GAD
TCA alone or buspirone
109
4th line therapy strategies for GAD
SSRI/SNRI with an AAP SSRI/SNRI with antihistamine (hydroxyzine) SSRI with imipramine SSRI with a BZD
110
1st line therapy for panic disorder
SSRIs or venlafaxine (Effexor) Xanax is only BZD approved by the FDA but Klonopin and Ativan are also used CBT is very important
111
2nd line therapy for panic disorder
may change to another SSRI or venlafaxine
112
3rd line therapy for panic disorder
may switch to yet another SSRI, imipramine, or MAOI
113
1st line therapy for social anxiety disorder
SSRIs or venlafaxine | CBT
114
2nd line therapy for social anxiety disorder
MAOI phenelzine can be attempted in select patients
115
BZDs approved for tx of anxiety in children
clorazepate chlordiazepoxide diazepam alprazolam
116
MDD/anxiety meds associated with fetal heart defects and other teratogenicities
fluoxetine (Prozac) | paroxetine (Paxil)
117
pregnancy category of antidepressants
most are C bupropion is B paroxetine is D
118
3 components of withdrawal syndrome
relapse: return to symptoms rebound: worse symptoms than originally experienced withdrawal: appearance of new symptoms
119
monitoring patients on long term BZD therapy
periodic CBC, LFT, thyroid function tests

Pharmacology (11 decks)

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