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NPLEX 2.0 > Nervous System Pharm II > Flashcards

Nervous System Pharm II Flashcards

1
Q

What meds are used to treat epilepsy?

A

i. Diazepam (also psychiatric)
ii. Phenytoin
iii. Lamotrigine
iv. Topiramate
v. Valproate

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2
Q

What is the primary action of Phenytoin?

A

Modulates neuronal voltage-dependent sodium and calcium channels

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3
Q

What are the indications of Phenytoin?

A

Control of generalized tonic-clonic and complex partial seizures

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4
Q

What are the AEs of Phenytoin?

A

i. Hepatotoxicity
ii. Pancytopenia
iii. Dizziness
iv. N/V
v. Megaloblastic anemia

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5
Q

What is the black box warning for Phenytoin?

A

Severe hypotension and cardiac arrhythmias with injectable form

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6
Q

What are the CIs for Phenytoin?

A

Abrupt withdrawal

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7
Q

What interacts with Phenytoin that is important to know?

A

Very long list
CYP3A4 Inducers

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8
Q

Do blood levels need to be moinitored in pts on Phenytoin?

A

Yes

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9
Q

What nutrients need to be supplemented with Phenytoin?

A

Vitamin D, B2, B6, B12, folic acid

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10
Q

What is the primary action of Lamotrigine?

A

Inhibition of voltage-dependent sodium channels, decreasing presynaptic glutamate and aspartate release

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11
Q

What are the indications of Lamotrigine?

A

Bipolar I
Epilepsy

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12
Q

What are some of the AEs of Lamotrigine?

A

Nausea
Insomnia
SI
Headache
Depression, anxiety
Speech and vision disturbance

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13
Q

What is the black box warning for Lamotrigine?

A

Serious rashes included Stevens-Johnson Syndrome

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14
Q

What are the CIs for Lamotrigine?

A

Abrupt Withdrawal

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15
Q

What interacts with Lamotrigine that is important to know?

A

Progestins
OCPs
Hypericum perforatum

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16
Q

What is the primary action of Topiramate?

A

Carbonic anhydrase inhibitor

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17
Q

What are the indications of Topiramate?

A

Generalized tonic-clonic, partial, Lennox-Gastaut seizures

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18
Q

What are some of the AEs of Topiramate?

A

Metabolic acidosis
Nephrolithiasis
Osteoporosis
Hypokalemia
Glaucoma
Mood disturbance
Many more

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19
Q

What are the CIs for Topiramate?

A

Avoid abrupt withdrawal

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20
Q

What interacts with Topiramate?

A

Alcohol
OCPs
Metformin

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21
Q

What is the primary action of Valproate?

A

Increases GABA effects

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22
Q

What are the indications of Valproate?

A

Partial and absence seizures

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23
Q

What are the AEs of Valproate?

A

Many
encephalopathy
Headache
Tremor
N/V
Diarrhea

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24
Q

What is the black box warning for Valproate?

A

Hepatotoxic
Pancreatitis
Teratogenic

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25
Q

What are the CIs for Valproate?

A

LV Disease
Mitochondrial disorders
Pregnancy

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26
Q

What are other uses of Valproate that you should know?

A

Migriane Prophylaxix
Bipolar disorder

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27
Q

What is the protype anti-Parinsonism drug?

A

Levodopa and carbidopa

28
Q

What other drugs also have anti-Parkinsonism effects?

A

Amantadine

29
Q

How does levodopa work as an anti-Parkinsonism drug?

A

It’s decarboxylated to dopamine in the brain, improves motor, neurological and altered mood sxs of Parkinson’s dx

30
Q

How does carbidopa work as an anti-Parkinsonism drug?

A

It works by decreasing the peripheral breakdown of levodopa by dopamine carboxylase

31
Q

What are the AEs of Levodopa and Carbidopa?

A

Anorexia
NV via stimulation of the emetic center
Depression
Mood changes and anxiety
Long term : hallucinations, dyskinesia

32
Q

What anti-Parkinson’s drug is also used to treat restless leg syndrome?

A

Pramipexole

33
Q

What are some of the AEs of Pramipexole?

A

Hypotension
Extrapyramidal symptoms
Rhabdomyolysis
Hallucinatioins
HA

34
Q

What is the primary action of Benztropine?

A

Antagonizes acetylcholine and histamine receptors

35
Q

What are the indications of Benztropine?

A

Parkinsonsim
Extrapyramidal sx

36
Q

What are some of the AEs of Benztropine?

A

Tachycardia
Dry mouth
Urinary retention
Edema
Sedation

37
Q

What are some of the CIs for Benztropine?

A

Use in children <3 yo
Glaucoma
BPH
Tardive dyskinesia

38
Q

What interacts with Benztropine?

A

Other acetylcholine inhibitors

39
Q

What are some of the indications for Bromocriptine?

A

Hyperprolactinemia
Acromegaly
Parkinson’s dx

40
Q

What is the primary action of Bromocriptine?

A

Selective dopamine agonist in the pituitary

41
Q

What are the AEs of Bromocriptine?

A

GI upset : N/V
Dizziness, HA
Hallucinations
Nasal congestion
Involuntary movements

42
Q

What do you not what to do if using bromocriptine to treat Parkinson’s disease?

A

Abrupt discontinuation

43
Q

What are the CIs for using Modafinil?

A
44
Q

In what condition would it be dangerous to use atropine?

A

Acute closed angle glaucoma

45
Q

What drug is used to treat cholinesterase inhibitor poisoning? How?

A

Atopine
It acts as a parasympatholytic or muscarinic antagonist drug and will help decrease the increased levels of Ach in the body

46
Q

What are some of the AEs of sympathomimetic drugs?

A

i. CV : Tachycardia, palpitations, arrhythmias, HTN
ii. CNS : tremors, HA, restelessness, insomnia, appetite suppressioin
iii. Urinary : retention of urine, difficult or painful urination

47
Q

What is the primary action of Carbamazepine?

A

Anticonvulsant

48
Q

What are the indications of Carbamazepine?

A

Epilepsy, trigeminal neuralgia

49
Q

What are the AEs of Carbamazepine?

A

Fatigue
Dizziness
Headache
Nausea
Aplastic Anemia

50
Q

What is the black box warning of Carbamazepine?

A

Serious Dermatologic Rxns
HLA-B*1502 Allele and Aplastic anemia/Agranulocytosis

51
Q

CI for Carbamazepine

A

Bone marrow suppression
MAO inhibitor use within 14 days

52
Q

What interacts with Carbamazepine?

A

Phenelzine and others

53
Q

Amantadine

A

Mechanism:
1. Antagonizes excitatory N-Methyl-D-Aspartate (NMDA) receptors to down regulate the glutamate system
2. Increases release of dopamine
3. Anticholinergic Effects

Uses: treat levodopa-induced dyskinesias late in the disease as well as influenza-A (rarely)

S/E: may exacerbate mental illness in patients with psychiatric illness or substance abuse problems; insomnia, dizziness, hallucinations, agitation, orthostatic hypotension, peripheral edema, dyspepsia; neuroleptic malignant syndrome

Pregnancy category C

54
Q

Scopolamine

A

Mechanism: Belladonna alkaloid that blocks cholinergic transmission from the vestibular nuclei to higher CNS centers

Uses: certain types of muscle problems (e.g., some Parkinson-like conditions, certain muscle spasm problems) and certain stomach or intestinal problems (e.g., irritable colon syndrome), preventing nausea and vomiting associated with motion sickness

Has a transdermal formulation

Pregnancy category C

55
Q

Classes and Drugs to treat Alzheimer’s Disease

A

Indirect Cholinergic Agonists (AchE Inhibitors)
Donepezil
Rivastigmine

NMDA glutamate receptor antagonist
Memantine

56
Q

Donepezil and Rivastigmine

A

Mechanism: increase acetylcholine activity in the CNS by inhibiting acetylcholinesterase (AchE) as acetylcholine contributes to cognition and memory.

Uses: for symptom control only in mild-moderate disease
- Dementia associated with Parkinson’s disease (rivastigmine)
- Mild-severe Alzheimer’s (donepezil)

Pregnancy category c (donepezil)/category B (rivastigmine)

57
Q

Memantine

A

Mechanism: Acts on the glutamatergic system by blocking NMDA-type glutamate receptors

Uses: moderate to severe Alzheimer’s disease and Lewy Body Dementia

Usually given with AchE Inhibitor

S/E: confusion, dizziness, drowsiness, HA, insomnia, agitation, hallucationations, vomiting, anxiety, hypertonia, cystitis, increased libido

Pregnancy category B

58
Q

Drugs and classes to treat Multiple Sclerosis

A

Reduce neuronal inflammation
Fingolimod
Glatiramer acetate
Interferon beta 1

Reduce muscle spasticity
Baclofen
Botulinum toxin
Tizanidine

59
Q

Interferon beta 1

A

Mechanism: Immunomodulatory. alters the expression and response to surface antigens and can enhance immune cell activities; how it works in MS is unknown

Uses: relapsing forms of MS

Warnings: hyper/hypothyroidism, bone marrow suppression, flu-like symptoms, severe hepatic injury, severe injection site injury, neuropsychiatric manifestations, thrombotic microangiopathy

IM formulation only

Pregnancy category C

60
Q

Glatiramer Acetate

A

L-Glutamic acid polymer with l-alanine, l-lysine, and l-tyrosine and acetate

Mechanism: unknown, studies suggest it activates glatiramer-specific Treg cells that migrate into the CNS and down-regulate inflammation to myelin antigens in the periphery

Uses: Relapsing-remitting Multiple Sclerosis

Warnings: hypersensitivity reactions, immediate post-injection reactions, chest pain, lipoatrophy and skin necrosis, “interference with useful immune function”

IM formulation only

Pregnancy category B

61
Q

Fingolimod

A

Sphingosine 1-Phosphate (S1P) Receptor Modulator

Mechanism: blocks the lymphocytes’ ability to emerge from lymph nodes; therefore, the amount of lymphocytes available to the central nervous system is decreased, which reduces central inflammation

Uses: Multiple Sclerosis, relapsing forms

CI: MI, unstable angina, stroke, transient ischemic attack, decompensated heart failure requiring hospitalization, or New York Heart Association (NYHA) class III/IV heart failure in the past 6 months; Mobitz Type II second- or third-degree atrioventricular (AV) block or sick sinus syndrome (unless patient has a functioning pacemaker); baseline QTc interval ≥500 msec; concurrent use of a class Ia or III antiarrhythmic

SE: headache, nausea, diarrhea, abdominal pain, increased liver enzymes, flu, back pain, cough, sinusitis, hypertension, AV block, depression, dizziness, migraine, increased triglycerides, bronchitis, HSV

PO formulation

Pregnancy category C

62
Q

Botulinum Toxin

A

MoA: acetylcholine release inhibitor

Treats : upper/lower limb spasticity

63
Q

Baclofen

A

MoA unknown

Uses: spasticity of MS, spinal cord injury, rheumatic disorders. NOT indicated for stroke, cerebral palsy, and Parkinson’s disease has not been established and, therefore, it is not recommended for these conditions

TAPER off if discontinuing (hallucinations/seizures)

SE: drowsiness, asthenia, dizziness, headache, nausea

Pregnancy category C

64
Q

Tizanidine

A

Alpha-2-adrenergic agonist (centrally acting); presumably reduces spasticity by increasing presynaptic inhibition of motor neurons

SE: hypotension, sedation, risk of liver injury, hallucinations, interactions with CYP1A2 inhibitors (ciprofloxacin)

Pregnancy category C

65
Q

Classes and Drugs of Anticonvulsants

A

Na-channel inhibitors
Carbamazapine
Phenytoin

GABA-analogues
Gabapentin
Pregabalin

Others
Valproate
Topiramate
Lamotrigine (Psych lecture)
Alprazolam (Psych lecture)
Diazepam (Psych lecture)

NPLEX 2.0 (6 decks)

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