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Pharm 2 Exam 2 > Neuro 2 > Flashcards

Neuro 2 Flashcards

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1
Q

What do anticonvulsants do to tx sz?

A

suppress the rapid firing of neurons that start a seizure

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2
Q

MCC of status epilepticus

A

D/c of anticonvulsants

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3
Q

Status epilepticus management

A

Assessment and supportive treatment
Initial pharmacologic therapy with a benzodiazepine
Urgent therapy that achieves long-term control using a nonbenzodiazepine antiseizure drug such as fosphenytoin

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4
Q

What is the initial med used to tx status epilepticus?

A

Benzos (preferably IV)

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5
Q

What is the weaning protocol of anticonvulsants?

A

weaned from the use of anticonvulsants after being seizure free for 2 years and having three normal EEGs separated by at least 1 year

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6
Q

Which labs should be checked prior to starting a pt on hydantoins?

A

Baseline liver function, urinalysis, and blood counts need to be taken as well as periodic plasma levels for hydantoins

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7
Q

Hydantoin examples

A

Fosphenytoin and phenytoin

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8
Q

Hydantoin MOA

A

Stabilizes neuronal membranes and decreases seizure activity by increasing efflux or decreasing influx of sodium ions

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9
Q

Hydantoin use

A

generalized tonic- clonic (grand mal) and simple complex and simple partial seizures

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10
Q

Hydantoin SE

A

Hypotension and arrythmias (with rapid phenytoin infusion), Skin rashes, stevens-johnson syndrome, gingival hyperplasia (very common), agranulocytosis and aplastic anemia, Phenytoin-induced hepatitis, ataxia, confusion, nystagmus, Hyperglycemia

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11
Q

What should be monitored in a pt taking hydantoin?

A

Therapeutic plasma levels

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12
Q

What can lower hydantoin levels and decrease their efficacy?

A

Drugs that induce the CYP P450 enzyme system - Rifampin, St. Johns wort

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13
Q

The flu vaccine interacts with which drugs?

A

phenytoin, theophylline, and warfarin

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14
Q

Which drugs raise hydantoin levels?

A

Drugs that inhibit the CYP P450 enzyme system will raise serum levels of hydantoins - Macrolides, azole antifungals, grapefruit juice

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15
Q

Hydantoins can impair the efficacy of this drug?

A

oral contraceptives

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16
Q

Patients with this heart condition should not be on hydrantoins?

A

bradycardia and heart block

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17
Q

Black box warning for hydantoins

A

IV injection quickly can cause severe hypotension

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18
Q

In which pts should hydantoins be used carefully?

A

Pts with hx of MI or hypotension

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19
Q

When dosed slowly over a long time, hydantoins can cause what?

A

Hyperglycemia and DKA

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20
Q

What can hydantoins do to urine?

A

Turn it red/ brown

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21
Q

Iminostilbenes examples

A

Carbamazepine
Oxcarbazepine

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22
Q

Iminostilbenes MOA

A

they inhibit voltage-gated sodium channels in neurons in the thamalus

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23
Q

Iminostilbenes use

A

monotherapy or adjunctive therapy for partial complex seizures
Neuropathic pain (trigeminal neuralgia)
Bipolar affective disorder

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24
Q

Iminostilbenes SE

A

stevens-Johnson syndrome, toxic epidermal necrolysis, Nausea, vomiting, Agranulocytosis, aplastic anemia, impaired antidiuretic hormone release (ADH) leading to water retention, Ataxia, tremor

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25
Iminostilbenes (carbamazepine)black box warning
Genetic testing can be used to see if a person is at risk of developing serious SE (Asian descent)
26
What drink can increase Iminostilbenes serum levels?
Grapefruit juice will interact with these drugs, causing serum drug levels of these drugs to increase.
27
Which herbs reduce the sz threshold?
Evening primrose tea, St. John’s wort, valerian, and kava kava have all reduced the seizure threshold
28
Hypersensitivity to TCAs means that this drug is also contraindicated in pts
Iminostilbenes
29
In which pts should Iminostilbenes be avoided?
Any history of blood disorders, especially bone marrow suppression Pregnancy
30
Which 2 things should be monitored regularly in pts on Iminostilbenes?
Therapeutic drug levels and IOP
31
Succinimides examples
ethosuximide
32
Succinimides MOA
blocking T-type voltage-gated calcium channels in thalamic neurons
33
Succinimides use
Control of absence (petit mal) seizures in children and adults that are refractory to other drugs
34
Succinimides SE
Rash, pruritus, Stevens-Johnson syndrome, gingival hyperplasia, Agranulocytosis, Increased libido, hirsutism
35
In which pts should Succinimides be used in w/ caution?
Use cautiously in patients who have liver or kidney issues or any kind of blood dyscrasia.
36
Succinimides GI distress can be resolved by taking what?
Glass of milk
37
What is valproate used for?
Sz, manic phases of bipolar disorder and prophylaxis of migraine headaches
38
What is gabapentin used for?
Sz, Used for restless leg syndrome, postherpetic neuralgia (PHN), and seizures
39
What is lamotrigine used for?
Sz
40
What is clonazepam used for?
Sz
41
What is pregabalin used for?
Sz
42
What is locosamide used for?
Sz
43
What is topiramate used for?
Sz
44
What is levetiracetam used for?
Sz
45
clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan) MOA
make abnormal electrical activity less likely by slowing CNS activity
46
GABA enhancers are gabapentin (Neurontin), tiagabine (Gabitril), valproate (Depakote), and vigabatrin (Sabril) use
treatment of refractory complex partial seizures in adults
47
Vigabatrin SE
Loss of vision
48
When is the used of Vigabatrin (Sabril) recommended?
after other options have proven ineffective in treating the seizures
49
Valproic acid/ valproate sodium SE
Significant weight gain
50
Valproic acid/ valproate sodium high plasma levels
severe tremors as well as liver damage, which has been fatal in children
51
Valproic acid/ valproate sodium MOA
blocking voltage-gated sodium channels and T-type calcium channels,
52
Which drug classes are used to tx peripheral neuropathy?
Pain relievers (NSAIDS, anticonvulsants (gabapentin), warming agents, topical anesthetics, TCAs, and TENS
53
MS drugs
Interferon, glatiramer, natalizumab, fingolimod
54
Interferon SE
Flu like sxs
55
Fingolimod is unique in treating MS because?
Its available PO
56
Which frugs have the most evidence for treating Alzheimers?
mild-to-moderate AD, cholinesterase inhibitors have the strongest evidence of treating cognitive symptoms
57
Which drug is approved to use for moderate to severe Alzheimers?
Memantine
58
MC Alzheimer drug SE
GI se
59
What increases the risk of adverse SE in alzheimer's drugs?
Higher dose
60
What safety measures should be taken in pts on antidementia meds?
Safety measures to prevent falls should be taken because the patient may experience dizziness.
61
Acetylcholinesterase Inhibitors examples
donepezil, tacrine, galantamine, rivastigmine
62
Acetylcholinesterase Inhibitors MOA
Impede the breakdown of what little acetylcholine remains in the brain of an AD patient
63
Which Acetylcholinesterase Inhibitors has the longest acting profile?
Donepezil has the longest-acting profile
64
Acetylcholinesterase Inhibitors use
Symptomatic treatment of mild to moderate dementia of the Alzheimer type
65
Acetylcholinesterase Inhibitors SE
hypertension, Increased secretions, abdominal cramps, nausea, vomiting, diarrhea, loss of appetite, weight loss, Muscle aches/cramps, Abnormal dreams, dizziness, depression, insomnia
66
Acetylcholinesterase Inhibitors interactions
These drugs are metabolized by the CYP-450 system, thus drug levels and effects may be altered by other drugs that affect this metabolic pathway
67
Overdosing of Acetylcholinesterase Inhibitors can lead to what?
cholinergic crisis
68
Sxs of cholinergic crisis
slowed HR, muscle weakness, paralysis along with respiratory depression, salivation, sweating, diarrhea, blurred vision and vomiting

Pharm 2 Exam 2 (8 decks)

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