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NEURO Flashcards

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1
Q

What are Alzheimer’s medications?

A

Donepezil (Aricept), Rivastigmine (Exelon), Memantine (Namenda)

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2
Q

What are cholinesterase inhibitors?

A

Cholinesterase inhibitors block the normal breakdown of acetylcholine, increasing its levels in the synaptic cleft.

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3
Q

What is a potential necessary reversal of therapy for Alzheimer’s?

A

Potentially doing a trial of different medications to see the efficacy because there are not ways to measure it.

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4
Q

What are esterase enzymes?

A

An esterase is an enzyme that hydrolyzes (breaks down) another chemical, such as acetylcholine.

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5
Q

Where is acetylcholine released?

A

Acetylcholine is released by motor neurons to activate muscles and plays a role in arousal, attention, learning, memory, and motivation.

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6
Q

How does acetylcholine affect the brain in Alzheimer’s?

A

People with Alzheimer’s disease have reduced levels of acetylcholine in the brain. Cholinesterase inhibitors have a modest effect on dementia symptoms such as cognition.

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7
Q

What is the pathophysiology of the way that antiepileptic medications work?

A

GABA is an inhibitory neurotransmitter, causes a blunted response in the postsynaptic cell
Glutamate is a stimulatory neurotransmitter. Keeping a cell over excited wears it out

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8
Q

What is the pathophysiology of the way Ach works in the brain?

A
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9
Q

What are the two ways that antiepileptic medications work?

A
  1. Altering electrical activity in neurons by affecting ion (sodium, potassium, calcium, chloride) channels in the cell membrane.
  2. Altering chemical transmission between neurons by affecting neurotransmitters (GABA, glutamate) in the synapse.
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10
Q

What are the benzodiazepine medications?

A

Alprazolam (Xanax), Clonazepam (Klonopin), Lorazepam (Ativan), Diazepam (Valium)

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11
Q

What are Benzodiazepines?

A

Benzodiazepines (BZD, BDZ, BZs), sometimes called ‘benzos’, are a class of psychoactive drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring.

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12
Q

How do Benzodiazepines work?

A

Enhance the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABA receptor, resulting in sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant, and muscle relaxant properties.

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13
Q

How are benzodiazepines categorized?

A

Categorized as either short, intermediary, or long-acting. Short- and intermediate-acting benzodiazepines are preferred for the treatment of insomnia; longer-acting benzodiazepines are recommended for the treatment of anxiety.

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14
Q

What is the pathophysiology of the way benzodiazepines work?

A
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15
Q

What are the migraine medications?

A

Zolmitriptan (Zomig) and Sumatriptan (Imitrex)

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16
Q

How do migraine medications work?

A

Triptans are selective 5-hydroxytryptamine (5-HT) receptor agonists with high affinity for 5-HT1B and 5-HT1D receptors. Stimulation of the 5-HT1B receptors on smooth muscle cells of blood vessels causes cranial vasoconstriction.

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17
Q

What is the pathophysiology of the way migraine medications work?

A

VIP= vasoactive intestinal peptide. Even though it says intestinal it works everywhere
Sub P and CGRP facilitate facilitate pain receptors
They work directly on the cerebral vessels

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18
Q

What are the multiple sclerosis medications?

A

Glatiramer (Copaxone) and Interferon beta-1B (Betaseron)

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19
Q

What do the glatiramer acetate (GA) interact with?

A

Myelin-basic proteins (MBP) → major histocompatibility complex (MHC) molecule → the T-cells and T-cell receptors

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20
Q

What is the effect of glatiramer acetate on the myelin sheath?

A

Limits the effect on the myelin sheath

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21
Q

What do the interferon beta-1B (Betaseron) interact with?

A

Balances the expression of pro- and anti-inflammatory agents in the brain → reduces the number of inflammatory cells that cross the blood-brain barrier → reduction of neuron inflammation.

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22
Q

What are the medications for Parkinson’s?

A

Benztropine (Cogentin) and Carbidopa/Levodopa (Sinemet)

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23
Q

How do benzodiazepines work for Parkinson’s disease?

A

Has anticholinergic effects. Anticholinergic drugs block the action of acetylcholine, which lowers the levels of acetylcholine in the synaptic cleft.

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24
Q

How does carbidopa/Levodopa work in the brain?

A

Levodopa, the metabolic precursor of dopamine, crosses the blood-brain barrier and is converted to dopamine in the brain.

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25
Pathophysiology of carbidopa/Levodopa
26
What are the medications for restless leg syndrome?
Gabapentin enacarbil (Horizant) and Ropinirole (Requip)
27
What is the MOA of Gabapentin?
Is an extended-release formulation of gabapentin enacarbil, a prodrug of gabapentin. Gabapentin is structurally related to the neurotransmitter gamma-aminobutyric acid (GABA) but has no effect on GABA binding, uptake, or degradation.
28
What is the MOA of Ropinirole?
A ***dopamine agonist***. Dopamine is both a hormone and a neurotransmitter.
29
inhbitory neurotransmitter
GABA
30
Stimulatory/Excitatory neurotransmitters
Glutamate
31
Role of Carbidopa
inhibits DOPA decarboxylase
32
Role of Levodopa
is a precursor to dopamine to allow it to cross the cell membrane
33
How does gabapentin effects GABA receptors?
It actually has nothing to do with GABA
34
What 3 medications are used for Alzheimers?
Donepezil (Aricept), Rivastigimine (Exelon), Memantine (Namenda)
35
What is the MOA of Donepezil and Rivastigimine?
Reversibly binds to and inactivates acetylcholinesterase (cholinesterase inhibitor)
36
What are the important serious reactions for Donepezil?
AV block, bradycardia, syncope, seizures, GI bleeding (increased gastritis and PUD),
37
What is the advantage to using Rivastigimine?
COMES IN A PATCH
38
What is the MOA of Memantine?
Binds N-methyl-D-aspartate receptors, may slow Ca++ influx and nerve damage (NMDA receptor antagonist) reduces damage to post synpatic cell
39
What are the divisions of dementia?
40
What is an important note for anticonvulsant medications?
Note: See package insert for starting dose and titration. This med requires experience to properly administer
41
Why is patient education for benzodiazepines critical?
There are many adverse reactions, including the risk of suicidality. Patients should not operate heavy machinery and must use extreme caution with alcohol or drugs due to dependency risks.
42
What does A-LCD stand for in benzodiazepines?
A-LCD = Shortest to Longest (Half-Life) ## Footnote A = Alprazolam, L = Lorazepam, C = Clonazepam, D = Diazepam.
43
What are the symptoms of acute benzodiazepine withdrawal?
Acute benzodiazepine withdrawal can cause tremor, anxiety, tachycardia, hallucinations, and life-threatening seizures.
44
Which drug is a competitive inhibitor of benzodiazepines?
Flumazenil is a competitive inhibitor of benzodiazepines and will quickly reverse its effects, sometimes inducing withdrawal symptoms.
45
What is the appropriate dose for Ativan in status epilepticus?
4 mg IV x1, may repeat x1 after 10-15 minutes.
46
Levodopa is a precursor to what?
Levodopa is a precursor to dopamine, which is needed because dopamine cannot enter the cell due to the action of the enzyme DOPA decarboxylase.
47
What does carbidopa limit?
Carbidopa limits the action of the enzyme DOPA decarboxylase.
48
What are the big side effects of cholinesterase inhibitors?
increase stomach acid and cause GI bleeding
49
What is a common combination medication regimine for Alzheimers?
cholinesterase inhibitor + Memantine
50
What is the MOA of Carbamazepine (Tegretol)?
reduces post-tetanic potentiation, decreasing seizure spread; exact mechanism of action in trigeminal neuralgia or bipolar disorder unknown
51
What are the uses of Carbamazepine (Tegretol)?
Reduces post-tetanic potentiation, decreasing seizure spread; exact mechanism of action in trigeminal neuralgia or bipolar disorder unknown
52
What is the BBW associated with Carbamazepine (Tegretol)?
BB WARNING: Dermatologic Rxns and HLA- B*1502 Allele (most prevalent in patients of asian descent. Have to screen for this gene before prescribing, because it greatly increases the risk for SJS).
53
What is the MOA for Lamotrigine (Lamictal)?
exact mechanism of action unknown; inhibits voltage-dependent sodium channels,decreasing presynaptic glutamate and aspartate release
54
What are the uses for Lamotrigine (Lamictal)?
partial seizures, seizures, Lennox- Gastaut syndrome (children with epilepsy may develop this), bipolar I disorder,maintenance migraine headache w/ aura prophylaxis
55
What BBW is associated with Lamotrigine (Lamictal)?
BB Warning: Serious Rash Stevens-Johnson syndrome, rare cases of toxic epidermal necrolysis, andrash-related deaths
56
What is the MOA of Oxcarbazepine (Trileptal)?
blocks voltage-sensitive Na channels, stabilizes neural membranes, inhibits repetitive firing, and decr. synaptic impulse propagation
57
What are the uses for Oxcarbazepine (Trileptal)?
partial seizures trigeminal neuralgia bipolar disorder
58
What are the side effects Oxcarbazepine (Trileptal)?
Hyponatremia, Toxic epidermal necrolysis, SIADH
59
What is the MOA of Phenobarbital?
alters sensory cortex, cerebellar, and motor activities; produces sedation,hypnosis, and anesthesia (barbiturate)
60
What are the uses of Phenobarbital?
seizure disorder, status epilepticus, sedation, *acute alcohol withdrawal, adjunct tx most commonly used for cerebral palsy
61
What is the odd note about the use of Phenobarbital?
No BB Warning but MANY interactions: with CYP genes, UGT genes, P-gp inducer, CNS depression, increases thyroid hormone clearance, methemoglobinemia, urine pH sensitive
62
Generalized seizures means
no specific location
63
Patients with staus epilepticus commonly recieve
benzodiazepines
64
What is the most common serious reaction of Phenobarbital?
respiratory depression hyperactivity effect in children
65
What is the MOA of Pregabalin (Lyrica)?
binds alpha2-delta subunit of calcium channels reducing neurotransmitter release; produces antinociceptive and antiseizure effects
66
What are the uses of Pregabalin (Lyrica)?
partial seizures, adjunct tx, **Neuropathic pain (Diabetics),** post-herpetic neuralgia, fibromyalgia
67
Pregabalin (Lyrica) in pregnancy
Consider avoiding in pregnancy in lactation
68
What are the uses of Gabapentin (Neurontin)?
partial seizures, post-herpetic neuralgia, **neuropathic pain, fibromyalgia, alcohol dependence**
69
What is the MOA of Gabapentin (Neurontin)?
blocks voltage-dependent calcium channels,modulating excitatory neurotransmitter release
70
What organ system is most commonly effected with anticonvulsants?
Skin/dermatologist
71
What is the first line treatment for neuropathic pain?
Gabapentin (Neurontin)
72
What are the serious reactions for Gabapentin?
depression, suicidality
73
Uses of Keppra
partial seizures, Juvenile myoclonic epilepsy, adjunct tx, primary generalized tonic clonic seizures, adjunct tx
74
Side Effects of Keppra
depression, hostility, aggressive behavior, psychosis, suicidality, leukopenia
75
MOA of Phenytoin (Dilantin)
modulates neuronal voltage-dependent sodium and calcium channels
76
Uses of Phenytoin (Dilantin)
seizure disorder, seizure prophylaxis, neurosurgery Assoc. Status epilepticus
77
Side Effects of Phenytoin (Dilantin)
hirsutism, and gingival hyperplasia in children (up to 50%).
78
What BBW is associated with Phenytoin?
BB Warning: Cardiovascular risk w/ rapid infusion
79
What is the MOA of Valpric acid (Depakote)?
increases GABA effects, may inhibit glutamate/NMDA receptor-mediated neuronal excitation
80
MOA of Keppra
selectively prevent hypersynchronization of epileptiform burst firing
81
Uses for Depakote
partial seizures, complex, Absence seizures, simple and complex, bipolar disorder both acute and manic, migraine headache prophylaxis
82
Serious Reactions of Phenytoin
ventricular fibrillation (IV use), hypotension, severe (IV use), cardiac arrest, AV conduction
83
Serious Reactions for Valproic Acid
Hepatotoxicity, pancreatitis, SIADH, hyponatremia,
84
Depakote in pregnancy
contraindicated
85
BBW for Valproic Acid
BB WARNING: Hepatotoxicity, Fetal Risk, Pancreatitis
86
What are the 4 Benzodiazepine medications?
Lorazepam (Ativan), Clonazepam (Klonopin), Alprazolam (Xanax), Diazepam (Valium)
87
What is the MOA of the Benzodiazepine medications?
binds to benzodiazepine receptors; enhances GABA effects
88
What are the uses for Lorazepam (Ativan)?
**status epilepticus (drug of first choice)**, anxiety, **insomnia, short-term tx**, *nausea/vomiting, chemo- related, *preoperative sedation, *alcohol withdrawal, *delirium treatment, *neuroleptic malignant syndrome
89
What are the uses for Clonazepam (Klonopin)?
seizure disorder, panic disorder, **anxiety, restless legs syndrome, confusional arousals, sleep terrors, sleepwalking, rapid eye movement sleep behavior disorder, burning mouth syndrome, Tourette syndrome**
90
What are the uses of Alprazolam (Xanax)?
Anxiety, Panic Disorder NOT: Seizure Disorder
91
What are the two migraine medications?
Zolmitriptan (Zomig), Sumatriptan (Imitrex)
92
What is the MOA of migraine medications?
activates vascular serotonin 5-HT1 receptors, producing vasoconstriction(selective serotonin agonist
93
What are the uses for Zolmitriptan (Zomig)?
migraine headache, ***menstrual migraine headache prophylaxis**
94
What are the uses for Sumatriptan (Imitrex)?
migraine headache, acute, cluster headache, acute
95
BBW for Benzodiazepines
BB Warning: Risks from Concomitant Opioid Use may cause profound sedation and death
96
We don't want to use benzodiazepines in combinationw with what?
No ETOH or opioids!
97
What are the contraindications and cautions for migraine medications?
Contraindications/cautions: Cerebrovascular dz, Ischemic heart dz, Coronary vasospasm Caution if cardiac dz risk
98
Diazepam is most commonly used for?
alcohol withdrawl
99
Alcohol withdrawl can be
fatal 25% of the time
100
Benzodiapzepine withdrawl
can be fatal if untreated
101
Uses of Valium
status epilepticus seizure disorder, adjunct tx muscle spasm alcohol withdrawal, acute sedation, procedural sedation, preop anxiety
102
What is the most commonly abused benzodiazepine?
Alprazolam
103
MOA of Glatramer (Copaxone)
induces and activates suppressor T-cells, modifying immune processes
104
MS Medications
Glatramer (Copaxone), Interferon beta-1B (Betaseron)
105
Serious reactions with migraine medications
coronary vasospasm, myocardial ischemia, MI, ventricular tachycardia, ventricular fibrillation, arrhythmias, life-threatening, HTN, severe
106
MOA of Interferon beta-1B (Betaseron)
binds to type 1 interferon receptors and activates tyrosine kinase, producing antiviral, antiproliferative, and immunomodulatory effects
107
What is the storage safety warnings for Glatramer?
Store the prefilled syringes in the refrigerator. Do not freeze. Take the medicine out of the refrigerator and let it reach room temperature for 20 minutes before injecting your dose. If refrigeration is not available, a prefilled syringe will keep for up to 30 days if stored at room temperature. Protect from moisture, light, and high heat.
108
MOA of Carbidopa/Levodopa (Sinemet)
inhibits peripheral dopamine decarboxylation; crosses the blood-brain barrier and serves as dopamine precursor.. The concomitant administration of carbidopa decreases the peripheral metabolism of l-dopa by up to 80 percent.
109
What is the MOA of Benzotropine
antagonizes acetylcholine and histamine receptors
110
What are the Parkinson Disease medications?
Benztropine (Cogentin), Carbidopa/Levodopa (Sinemet)
111
Uses of Benztropine (Cogentin)
Parkinsonism, extrapyramidal sx dystonic rxns, acute
112
Uses of Carbidopa/Levodopa (Sinemet)
Parkinsonism, **sleep-related eating disorder, restless legs syndrome**
113
Saftey warning with Carbidopa/Levodopa
Caution with High Protein Diets (can change the metabolism of the med and can cause GI upset
114
Parkinson Medications in pregnancy
Pregnancy: Caution Advised Lactation Caution Advised
115
Most commonly used Parkinson meds
Carbidopa/Levodopa (Sinemet)
116
What are the 2 medications for restless leg?
Gabapentin enacarbil (Horizant), Ropinirole (Requip)
117
Serious rxns for Carbidopa/Levodopa
dyskinesia, bradykinesia
118
MOA of Gabapentin enacarbil (Horizant)
exact mechanism of action unknown; prevents pain-related responses
119
Uses of Gabapentin enacarbil (Horizant)
Mod-severe restless legs syndrome, post-herpetic neuralgia
120
MOA of Ropinirole (Requip)
stimulates dopamine receptors (dopamine agonist)
121
Uses of Ropinirole (Requip)
restless legs syndrome, mod-severe primary, Parkinson dz (adjunct) sleep-related eating disorder rapid eye movement sleep behavior disorder
122
What restless leg med can cause dependence and sudden sleep episodes?
Ropinirole (Requip)

Pharm II (8 decks)

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