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Neuro Flashcards

1
Q

What are the major symptoms of Parkinson’s disease?

A

TRAP:
Tremor
Rigidity
Akinesia/bradykinesia
Postural instability

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2
Q

Drugs that can worsen Parkinson’s disease

A

Phenothiazines (prochlorperazine, etc.)
Butyrophenones (haloperidol, droperidol)
1st and 2nd gen antipsychotics
Metoclopramide

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3
Q

Which med is preferred for the treatment of PD-associated psychosis?

A

Quetiapine

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4
Q

Rapid withdrawal of levodopa or dopamine agonists can cause what condition?

A

Neuroleptic malignant syndrome

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5
Q

What is the active metabolite of levodopa?

A

Dopamine

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6
Q

Why is carbidopa given in combo with levodopa?

A

Prevents the peripheral metabolism of levodopa that would destroy most of the drug before it crosses the BBB

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7
Q

What drug is 1st line for the treatment of PD?

A

Carbidopa/levodopa (Sinemet)

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8
Q

Which PD drugs are used to reduce “off” periods and to limit dyskinesias?

A

COMT inhibtors and MAO-B inhibitors

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9
Q

What drug can be used in younger PD pts to treat tremor-predominant disease?

A

Centrally-acting anticholinergics (benztropine)
Amantadine is also an option

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10
Q

Key points for carbidopa/levodopa

A

Starting IR dose = 25/100 mg tid
CI w/ non-selective MAOi and narrow angle glaucoma
SE: Nausea, dizziness, orthostasis, dyskinesias, hallucinations, psychosis, unusual sexual urges, pripism
Can cause brown/black urine discoloration
must d/c if positive Coombs test
Response worsens with long-term use
Must taper if stopping

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11
Q

Examples of catechol-O-methyltransferase (COMT) inhibitors

A

Entacapone (Comtan)
Opicapone (Ongentys)
Tolcapone (Tasmar)

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12
Q

When can COMT inhibitors be used?

A

Must be used in combo with levodopa - increases the duration of action of levodopa (prevents peripheral conversion)

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13
Q

Examples of dopamine agonists

A

Pramipexole (Mirapex)
Ropinirole (Requip)

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14
Q

Key points for dopamine agonists

A

Warnings for somnolence, orthostasis, hallucinations, dyskinesias
Must be tapered if stopping
For patch, cannot use same site for 14 days after use (daily patch)
Cannot use patch with sulfite allergy

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15
Q

What drug can be used as a rescue drug for off-periods for PD?

A

Apomorphine
Must be started in medical office

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16
Q

Key points for amantadine

A

Blocks dopamine reuptake and increases dopamine release from presynaptic fibers
Warnings for somnolence and psychosis
SE: Dizziness, orthostatic hypotension, livedo reticularis (reddish skin mottling)

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17
Q

Examples of selective MAO-B inhibtors

A

Selegiline
Rasagiline
Safinamide

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18
Q

Key points for MAO-B inhibitors

A

CI w/ MAOi, SSRIs/SNRIs, linezolid, opioids, TCAs
Same food interactions as MAOi’s
Risk of serotonin syndrome and HTN
Selegiline can be activating - do not take at night

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19
Q

Key points for benztropine (Cogentin)

A

Has anticholinergic and antihistamine effects
SE: dry mouth, constipation, urinary retention, blurred vision. mydriasis, somnolence, confusion
Avoid in elderly pts

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20
Q

Drugs that can worsen dementia

A

Antiemetics (promethazine)
Antihistamines (benadryl, doxyalamine)
Antipsychotics (chlorpromazine, aripiprazole)
Barbituates (phenobarb)
BZDs
Anticholinergics
Skeletal muscle relaxants (baclofen)
CNS depressants

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21
Q

What test is used to diagnose dementia?

A

Mini-Mental State Exam (MMSE)
Score <24 = memory disorder

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22
Q

What supplements have shown possible benefit for Alzheimer’s dementia?

A

Vit E and ginkgo
Both increase bleed risk

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23
Q

What drug(s) are first line for the treatment of Alzheimer’s disease?

A

Acetylcholinesterase inhibitors (donepezil)
+/- memantine

24
Q

What time of day should donepezil be taken at?

A

Bedtime (decreases nausea)
Can take in AM if causes insomnia

25
Examples of acetylcholinesterase inhibitors
Donepezil (Aricept) Rivastigmine (Exelon) Galantamine (Razadyne)
26
Key points for acetylcholinesterase inhibitors
Warnings for bradycardia and QT prolongation SE: N/D Rivastigmine patch = daily dosing, same site cannot be used for 14 days
27
Key points for memantine (Namenda)
Blocks NMDA receptors SE: Dizziness, confusion, HA
28
Drugs that can lower the seizure threshold
Bupropion Clozapine Theophylline Varenicline Carbapenems (esp imipenem) Lithium Meperidine Penicillin Quinolones Tramadol Acyclovir/Valacyclovir
29
Focal vs generalized seizures
Focal = starts on one side of the brain Generalized = starts on both sides of the brain
30
Define status epilepticus
Seizure that lasts 5 mins or more Medical emergency
31
Initial management for status epilepticus
Benzodiazepine injection - can also use diazepam rectal gel
32
What diet can benefit some patients with refractory seizures?
Ketogenic diet
33
Which drug is used for absence seizures?
Ethosuximide
34
Which neurotransmitter abnormalities can lead to seizures?
High glutamate Low GABA
35
Which antiepileptic drugs are Na channel blockers?
Carbamazepine Lamotrigine Phenytoin/fosphenytoin Topiramate Oxcarbazepine
36
Key points for lamotrigine
Warnings for serious skin rxns SE: alopecia (give Se and Zn), rash Different colored starting dose boxes: - red: normal dose - blue: low dose, use if taking valproic acid/inhibitors - green: high dose, use if taking inducers (phenytoin)
37
Key points for levetiracetam
IV:PO is 1:1 Warnings for psych rxns (psychotic symptoms), somnolence, fatigue No significant drug interactions Max 3g per day
38
Key points for topiramate
Warnings for metabolic acidosis, oligohidrosis, hyperthermia, nephrolithiasis, glaucoma, hyperammonemia, visual problems, fetal harm SE: somnolence, memory/concentration/attention difficulty, weight loss, anorexia Must monitor bicarb and intraocular pressure Can decrease OC efficacy
39
Key points for valproic acid/divalproex
Therapeutic range = 50-100 mcg/mL Warnings for hepatic failure, fetal harm, hyperammonemia, thrombocytopenia SE: alopecia (give Se and Zn), weight gain Serious rash can occur w/ valproic acid + lamotrigine
40
Key points for carbamazepine
Therapeutic range = 4-12 mcg/mL Warnings for serious skin rxns, testing for HLA-B*1502 allele prior to starting, aplastic anemia, agranulocytosis, SIADH, fetal harm CI w/ myelosuppression Enzyme inducer and autoinducer (lowers own drug levels) Many DDIs, decreases OC efficacy
41
Key points for lacosamide
Warnings for PR prolongation and arrhythmias Max 400 mg per day IV:PO is 1:1
42
Key points for oxcarbazepine
Warnings for severe skin reactions, test for HLA0B*1502 and hyponatremia XR must take on empty stomach Not an autoinducer Can decrease OC efficacy
43
Phenobarbital key points
Therapeutic range = 20-40 mcg/mL (adult) Warnings: habit forming, resp depression, fetal harm SE: physiological dependence, tolerance, hangover effect Can decrease OC efficacy, strong inducer
44
Which drug is a prodrug of phenobarbital?
Primidone
45
Key points for phenytoin and fosphenytoin
Total range = 10-20 mcg/mL Free range = 1-2.5 mcg/mL IV:PO = 1:1 Arrhythmias associated with fast drip rates Warnings for extravasation (purple glove syndrome), avoid in HLA-B*1520 + pts, fetal harm SE: nystagmus, ataxia, diplopia, gingival hyperplasia, hepatotoxicity, hair growth Strong inducers, high protein binding Can decrease OC efficacy Requires a filter IV requires BP, resp, and ECG monitoring Enteral feeds decrease phenytoin absorption
46
What is the max administration rate for IV phenytoin?
50 mg/min
47
What is the max administration rate for IV fosphenytoin?
150 mg PE/min
48
What is the active metabolite of eslicarbazepine?
Oxcarbazepine
49
Main side effect for vigabatrin
Permanent vision loss (30% of pts)
50
What allergy has cross reactivity with zonisamide?
Sulfonamide allergy
51
When must the phenytoin correction calculation be used?
If albumin <3.5 and CrCl >10 mL/min
52
All antiepileptic drugs cause what SE?
CNS depression Bone loss (must supplement VitD and Ca) Warning for suicide risk
53
Antiepileptic drugs that are enzyme inducers
Carbamazepine Oxcarbazepine Phenytoin Fosphenytoin Phenobarbital Primidone
54
Antiepileptic drug that is an enzyme inhibitor
Valproic acid
55
Which antiepileptic meds have higher risks when used in children?
Topiramate (hyperthermia) Zonisamide (hyperthermia) Lamotrigine (rash)

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