Neuro Flashcards
1
Q
what are the cholinergic effects?
A
constricted pupils increased saliva bronchoconstriction increased GI mucous bladder fundus contraction
2
Q
what are the adrenergic (anticholinergic) effects?
A
dry mouth dilated pupils increased contractility increased HR bronchodilation bladder fundus relaxes, sphincter contracts
3
Q
what are the parasympathetic effects on the autonomic nervous system?
A
pupils constrict eyes become dry mouth waters heart rate slows down breathing sloes bronchial passages constrict digestive functions stimulated stomach/intestine activity increases bladder contracts
4
Q
what are the sympathetic effects on the autonomic nervous system?
A
pupils dilate eyes water, tears form mouth becomes dry sweating increases heart rate increases adrenaline rush breathing quickens bronchial passages dilate digestive functions inhibited stomach/intestine activity decreases bladder relaxes
5
Q
what are the classifications of cholinergic drugs?
A
parasympathomimetic
6
Q
what are the classifications of cholinergic blocking drugs?
A
parasympatholytic
anticholinergic
antimuscarinic
7
Q
what are the classifications of adrenergic drugs?
A
sympathomimetic
8
Q
what are the classifications of adrenergic blocking drugs?
A
sympatholytic
9
Q
what are the main uses of cholinergic drugs?
A
decreases IOP in glaucoma
treat atony of GI tract and urinary bladder
diagnose and treat myasthenia gravis
physostigmine used to treat anticholinergic toxicity
not organ specific- other organs not targeted become ADR
10
Q
what are the cholinesterase inhibitors used to treat MG?
A
neostigmine
pyridostigmine
11
Q
what are the cholinesterase inhibitors used to treat Alzheimer’s?
A
donepezil (Aricept)
galantamine (Razadyne)
rivastigmine (Exelon)
memantine (Namenda)- not a cholinesterase inhibitor
12
Q
what is the mainstay of MG treatment?
A
reversible cholinesterase inhibitors
13
Q
is MG treatment for symptom management or curative?
A
symptom management
14
Q
which medications are used to treat MG?
A
neostigmine
pyridostigmine
15
Q
which medications are used to treat Alzheimer’s?
A
donepezil (Aricept)
rivastigmine (Exelon)
memantine (Namenda)
16
Q
what are the benefits to taking donepezil (Aricept) in comparison to other AD drugs?
A
has a better side effect profile
longer duration of action
GI effects are usually self resolving
17
Q
which forms is rivastigmine (Exelon) available in?
A
patch and liquid
18
Q
which class of drugs are the treatment of choice for Parkinson’s disease?
A
dopaminergics
19
Q
what is the MOA of dopaminergics?
A
attempt to restore the functional balance of dopamine and acetylcholine in the corpus striatum of the brain
20
Q
which medications are used in the treatment of Parkinson’s?
A
amantadine (Symmetrel) bromocriptine (Parlodel) levodopa (L-dopa, Larodopa) carbidopa-levodopa (Sinemet) pramipexole (Mirapex) ropinirole (Requip) rotigotine (Nuepro)
21
Q
what are the ADRs of dopaminergics?
A
N/V
hallucinations
confusion
22
Q
when using dopaminergics, how long does it take for there to be therapeutic effects?
A
may need up to 6 months to achieve maximum effects
23
Q
dopaminergics have many drug interactions and the variation depends on what?
A
variations with each drug
24
Q
what kind of education would you give to patients taking dopaminergics?
A
avoid abrupt d/c
drug interactions
TCA’s decrease the effects
may increase effects of HTN drugs
25
what should be monitored in pts taking dopaminergics?
lab tests pertaining to hepatic and renal function
| "on-off" phenomenon (suddenly symptoms worsen/improve)
26
what are the FIRST LINE drugs for treatment of PD?
Bromocriptine (Parlodel)
Pergolide (Permax)
Pramipexole (Mirapex)
Ropinirole (Requip)
27
when symptoms of PD worsen, what should be introduced?
levodopa
28
which drugs are used to control tremors in PD by relaxing smooth muscle?
cholinergic blockers
29
what are factors that precipitate seizures?
```
sleep deprivation
high caffeine intake
hyperventilation
stress
hormonal changes
sensory stimuli
drug/alcohol use
infections
fever
metabolic disorders
```
30
which off-label use are anticonvulsants being used for?
treatment of mood disorders
31
what is the MOA of antiseizure medications?
stimulating an influx of chloride ions (usually associated with GABA)
delaying an influx of Na
delaying an influx of Ca
32
which anticonvulsant medications fall under the classification of hydantoins?
Ethotoin (Peganone)- not common
Fosphenytoin (Cerebyx)- NOT for primary care (available only in IM or IV dosing)
Phenytoin (Dilantin)- (capsules (ER), chewable tablets, suspension, injection)
33
hydantoins are first line treatment for what?
tonic-clonic seizures
| partial complex seizures
34
what is the MOA of hydantoins?
Works by stabilizing neuronal membranes and decreasing seizure activity by increasing efflux or decreasing efflux of sodium ions across cell membranes in the motor cortex
(onset and duration vary)
35
since hydantoins are metabolized in the liver, what will cause the levels of the drug to increase?
```
cimetidine
diazepam
acute alcohol intake
valproic acid
allopurinol
```
36
since hydantoins are metabolized in the liver, what will cause the levels of the drug to decrease?
barbituates
antacids
calcium
chronic alcohol use
37
what are the drug interactions for hydantoins?
```
decreased effect of:
carbamazepine
estrogens
acetaminophen
corticosteroids
levodopa
sulfonylureas
cardiac glycosides
```
38
what are the MOST COMMON ADRs of hydantoins?
```
nystagmus
dizziness
pruritus
paresthesia
HA
somnolence
ataxia
confusion
HYPOtension
tachycardia
N/V
anorexia
constipation
dry mouth
gingival hyperplasia
urinary retention
urine discoloration
```
39
which patients should be monitored closely when taking hydantoins?
patients with renal and liver disease
40
which routes should hydantoins never be administered in a primary care setting?
IV or IM
41
in regards to monitoring for hydantoins, what should be monitored?
baseline labs, plasma levels, & TSH
| need to assess OTC drugs (ibuprofen, antacids)
42
which anticonvulsant medications fall under the classification of iminostilbenes?
Carbazepine (Tegretol, Tegretol XR, Carbatrol)
Oxcarbazepine: (Trileptal)
Valproic acid (Depakote, Depakene)
43
what is the MOA for iminostilbenes?
depresses neuron transmission in the neucleus ventralis anterior of the thalmus; has the ability to induce its own metabolism
44
why do iminostilbenes have a black box warning?
for causing blood dyscrasias
45
how are iminostilbenes absorbed/metabolized?
absorbed through the stomach
| metabolized in the liver
46
what are the ADRs of iminostilbenes?
```
depression of bone marrow
liver damage
impairs thyroid function
drowsiness
dizziness
blurred vision
N/V
dry mouth
diplopia
HA
```
47
the levels of iminostilbenes increases with concurrent use of which medications?
```
propoxyphene (Darvocet)
cimetidine
erythromycyn
clarithromycin
verapamil
hydantoins
```
48
the plasma levels of which drugs decrease with concurrent use of iminostilbenes?
```
beta blockers
warfarin
doxycycline
succinimides
heloperidol
```
49
which food/beverage should be avoided when taking iminostilbenes?
grapefruit
50
when are succinimides used?
for treatment of absence seizures in children and adults
51
which anticonvulsant medications fall under the classification of succinimides?
Ethosuzimide (Zarontin)
| Methsuximide (Celontin)
52
what is the MOA of succinimides?
suppress seizures by delaying calcium influx into neurons
| decreases nerve impulses and transmission in the motor cortex
53
how are succinimides absorbed/metabolized?
absorbed in the GI tract
| metabolized in the liver
54
what are the ADRs of succinimides?
```
GI most common
somnolence fatigue
ataxia
agranulcytosis
aplastic anemia
granulocytopenia
```
55
which anticonvulsant medications fall under the classification of GABA?
Gabapentin (Neurontin)
Tiagibine (Gabitril)
Topiramate (Topamax)
56
GABAs are pregnancy category what?
D
57
what are the most common ADRs of GABA?
somnolence
| other CNS efects
58
what should be monitored in patients taking GABA?
```
frequency/severity of seizure activity
mood changes
depression
anxiety
DO NOT d/c abruptly
```
59
which anticonvulsant medications fall under the classification of levetiracetam?
Leviracetam (Keppra)
60
when is levetiracetam used?
adjunct partial onset seizures
61
what is the possible neuropsychiatric ADR of Keppra?
suicidality
62
when is lemotrigine (Lamictal) used?
in the adjunctive treatment of primary generalized tonic-clonic seizures and partial seizures in adults and children greater than or equal to 2 yrs
63
lamotrigine is used concurrently with what medications?
valproic acid
| phenytoin
64
the levels of lamotrigine are decreased by what?
barbituates
estrogens
phenytoin
65
the levels of lamotrigine are increased by what?
alcohol
carbabazepine
CNS depressants
valproic acid
66
where is lamotrigine metabolized?
in the liver and kidneys
67
what are the ADRs of lamotrigine?
```
mostly GI
N/V
constipation
chest pain
peripheral edema
somnolence
fatigue
dizziness
anxiety
insomnia
HA
amblyopia
nystagmus
```
68
why does lamotrigine have a black box warning?
SJS
69
what should patients taking lamotrigine be educated about?
```
adherence
avoid alcohol
avoid OTC meds
adequate hydration
report any new drugs
report ADRs
```
70
what are the classes of sedative hypnotics?
nonbenzodiazepine
benzodiazepine
ramelteon (Rozerem)
71
what are the non-benzodiazepine medications?
zolpiden (Ambien)
zaleplon (Sonata)
eszopiclone (Lunesta)
72
what are the benzodiazepine medications?
flurazepam (Dalmane)
temazepam (Restoril)
triazolam (Halcion)
73
which medications are considered stimulants?
amphetamine
dextroamphetamine
adderall (mix of amphetamine & dextro salts)
non-amphetamine: atomoxetine (Strattera)
74
which of the stimulant medications is not considered a schedule II drug?
Strattera
75
when dosing stimulants, what is usually the starting dosage FORM?
IR
76
what is the peak incidence of migraine headaches?
age 25 to 34 yrs
77
what are the four types of migraines?
complex, multifactoral
migraine with aura (classic migraine)
migraine without aura (common migraine)
complicated migraine
78
what is the pathophysiology of migraine HAs?
changes in serotonin causes release of vasoactive neurotransmitters
causes inflammatory response
excitatory serotonin receptors activated
serotonin receptor agonists abort migraines by stimulating inhibitory serotonin receptors
79
what are the goals of migraine treatment therapy?
minimize the impact on quality of life
| avoid medication overuse
80
what are the OTC analgesics (work best early in migraine) used to treat migraines?
ibuprofen
naproxen
migraine formulas- OTC combinations
81
what are the mid-range analgesics used to treat migraines?
Butalbital/ASA or APAP (Fiorinal or Fioricet)- controlled substance
Isometheptene/acetaminophen/dichloralphenazone (Midrin)- schedule IV
82
what are the high-range analgesics (opioids) used to treat migraines?
PO codeine combined with ASA or APAP
IM meperidine – not a good option
Intranasal butorphanol (Stadol)
83
when are high-range analgesics the drug of choice to treat migraines?
in pregnancy
when vasoconstrictors are contrindicated
when pt is non-responsive to ergotamine or serotonin agonsits
84
which vasoconstrictor (ergots) medications are used to treat migraines?
ergotamine
| DHE
85
how is DHE administered?
IM or intranasal
86
which serotonin 5-HT antagonists or triptans are used to treat migraines?
```
Almotriptan (Axert)
Eletriptan (Relpax)
Frovatriptan (Frova)
Naratriptan (Amerge)
Rizatriptan (Maxalt)
SUMAtriptan (Imitrex)
ZOLMitriptan (Zomig)
```
87
what are the contraindications to taking to triptans?
CAD
uncontrolled HTN
pregnancy
88
triptans have drug interactions with which medications?
ergotamines
MAOIs
SSRIs
89
when are triptans taken?
at the onset of migraine
90
why are antiemetics co-administered with migraines?
N/V common in migraines
| co-administer with abortive medication
91
which antiemetics are used with migraines?
Metoclopramide (Reglan)
| Prochlorperazine (Compazine)
92
when is preventative therapy for migraine patients considered?
for patients with more than 2 migraines per month
93
which medications are used in preventative therapy?
Beta Blockers (propranolol, timolol – FDA approved, nadolol, metoprolol and atenolol are also used)
Tricyclic antidepressants
Antiepileptic drugs
94
which is the beta-blocker of choice in migraine prevention?
propanolol
95
which beta-blockers should be used in pts with asthma or respiratory concerns?
metoprolol
| atenolol
96
what are the ADRs of propanolol?
fatigue
lethargy
depression
97
which TCAs are used for migraine prevention?
Amitriptyline (Elavil)
98
what are the ADRs of Elavil?
drowsiness
weight gain
constipation
99
which antiepileptics are used for migraine prophylaxis?
Divalproex (Depakote)
Gapapentin (Neuronton)
Topiramate (Topamax)
100
how does Depakote help in migraine prophylaxis?
decreases the number and intensity of the migraine
101
depakote is pregnancy category what?
D
102
how should neuronton be dosed?
start low and titrate up over 4 weeks to target dose
103
how should topiramate be dosed?
dose titrated up over 4 weeks
104
what are the ADRs of topiramate?
weight loss
somnolence
kidney stones
105
which NSAIDs are used to treat menstrual migraines?
naproxen BID (started a week before menses and continued for a week later)
106
which CCBs can be used to treat migraines?
verapamil for pts with HTN who cannot tolerate beta-blockers
107
what are the nonpharmacological forms of tx for migraines?
identifying triggers
alternative therapies
ice biofeedback
108
what are the alternative therapies used in migraine treatment?
```
migranol (feverfew, riboflavin, magnesium, vitamins)
acupuncture
aromatherapy
hypnosis
reflexology
massage
yoga
```
109
how can migraines be monitored?
HA diary
medication refills
BP monitoring
if on divalproex, need liver function and CBC tested
110
what are tension HAs?
band-like pressure, persistent dull pain
not worsened by exercise
last from 30 minutes to days
111
what is the preventative therapy for tension HAs?
beta-blockers
TCAs
non-pharmacologic therapy
112
when is preventative therapy considered for tension HAs?
considered if more than one or two HA per week
113
what are the non-pharmacologic therapies used for tension HAs?
stress management
biofeedback
exercise
acupuncture
114
tension HAs do not respond to which medications?
triptans
| ergots
115
what is the cause of transformed migraines?
overuse of analgesics
| coexisting psychopathology
116
which medications are used to treat cluster HAs?
100% O2
ergotamine derivatives
intranasal lidocaine
sumatriptan
117
which medications are used in preventative therapy for cluster HAs?
ergotamine
verapamil
divalproex
lithium
118
what should be avoided to decrease cluster HAs?
all alcohol
tobacco
stress
vigorous activity
119
what should be monitored with cluster HAs?
for suicidal thoughts
| keep HA diary
120
what is medication overuse HA?
drug rebound HA reclassified by the IHS as medication overuse
121
what are the criteria for medication overuse HA?
HA present >15 days/mth
regular overuse of drugs for acute HA for >3 mths
HA has gotten worse during therapy
resolves or reverts to previous pattern after overused medication d/c
122
what are the stages of therapy in medication overuse HAs?
withdrawal from offending drugs
transition and support during detoxification
preventative therapy
123
when should preventative therapy start for medication overuse HAs?
at beginning of withdrawal
2 to 3 weeks before
after withdrawal
