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Pharmacology > Neurology > Flashcards

Neurology Flashcards

1
Q

Neurotransmitter Function
* Acetylcholine ->
* Dopamine ->
* Endorphin ->
* GABA ->
* Glutamate ->
* Serotonin ->
* Epi/Norepi ->

A
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2
Q

Wt loss med indications

A
  • BMI ≥ 30
  • BMI ≥ 27 + 1 WT-related comorbidity (HTN, Dyslipidemia, DM)
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3
Q

Short-Term Anorexiants

A
  • Phentermine (Adipex-P)(C-IV)
  • Diethylpropion (Tenuate)(C-IV)
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4
Q

Long-Term Anorexiants

A
  • Phentermine/Topiramate (Qsymia)(C-IV)
  • Lorcaserin (Belviq)(C-IV)
  • Naltrexone/Bupropion (Contrave)
  • Liraglutide (Saxenda)/Semaglutide(Wegovy)
  • Orlistat (Xenical Rx only)(Alli OTC)
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5
Q

Phentermine (Adipex-P) & Diethylpropion (Tenuate):
Take _____ to prevent insomnia

A

in the morning

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5
Q

CI to CNS Sympathomimetics

  • Phentermine, Diethylpropion
  • Phentermine/Topiramate
A
  • Uncontrolled HTN
  • Hyperthryoidism
  • Glaucoma
  • Anxiety, Agitation, Psychosis
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6
Q

Diethylpropion (Tenuate)
- MOA?
- ADR?
- DOA?

A
  • MOA: Sympathomimetic effect in CNS -> decr appetite
  • SE: Tachy, agitation, incr BP, Insomnia, tremor, psychotic ss
  • DOA: 12wk, used to jumph start diets
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6
Q

Lorcaserin (Belviq)
- MOA?
- SE?

A
  • MOA: Activates serotonin receptors (5-HT2c) -> satiety
  • SE: Nausea, Fatigue, Hypoglycemia, Blood Dyscrasias

  • 17lb/yr wt loss
    • SEROTONIN SYNDROME RISK
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7
Q

Naltrexoe/Bupropion CI

A
  • Seizures
  • Uncontrolled HTN
  • Opiods
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8
Q

Diabetics should be started on a _____ dose of Liraglutide/Semaglutide if taking for wt loss

Higher or Lower?

A

LOWER

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9
Q

Orlistat brand names
- Rx only =
- OTC =

A
  • Rx only = Xenical
  • OTC = Alli
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10
Q

Orlistat
- MOA?
- SE?
- Considerations?

A
  • MOA: inhibits fat absorption from food
  • SE: abd pain, bowel uregency, bowel incontinence, freq shitting
  • MAX 30% daily kcal from fat
  • take MULTIVITAMIN bc decr vit/mineral absorption
  • Some drugs may not be absorbed as well in the GI tract
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11
Q

List the WT LOSS Meds by least to most effective (lb/yr lost)

A
  • Orlistat (Xenica, Alli) -> 13 lb/yr
  • Lorcaserin (Belviq) -> 17 lb/yr
  • Naltrexone/Bupropion (Contrave) -> 17 lb/yr
  • Liraglutide/Semaglutide -> 21 lb/yr
  • Phentermine/Topiramate -> 32 lb/yr
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12
Q

If there is little to no WT LOSS after 12wk -> consider _____

A

discontinuing med

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13
Q

OTC wt loss supplements dont work very well and incr your risk for _____

A

CVD

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14
Q

Seizure vs Epilepsy

A
  • Seizure = brief disturbance in brain electrical activity (SINGULAR INCIDENT)
  • Epilepsy = neurological condition with RECURRENT seizures
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15
Q

Define these siezures:
- Partial Seizure
- Grand mal Seizure
- Petite mal or absence Seizure

A
  • Partial Seizure = Focal onset (+ Aware or Impaired awareness)
  • Grand mal = Generalized onset + Impaired awareness + Motor
  • Petite mal or Absence Seizure = Generalized onset + Impaired Awareness + Non-motor
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16
Q

Mechanisms of Anticonvulsants

A
  • inhibit voltage-gated Na & Ca channels
  • enhance inhibitory effects of GABA
  • decr excitatory effect of Glutamate
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17
Q

Overall SE of Anticonvulsants

A
  • CNS depression -> dizzy, sleepy, slow, fatigue
  • SUICIDE
  • Avoid using with meds that decr Seziure Threshold (Bupropion, Tramadol, Varenicline, Lithium, B-lactam ABX)
  • Decr Ca & Vit D -> +/- supplememts
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18
Q

1st Line Tx options for Generalized Onset Sz:
- Motor (Grand Mal)?
- Non-motor (Absence/Petit Mal)?

A

MOTOR (GRAND MAL)
- Lamotrigine
- Levetiracetam
- Valproic acid

NON-MOTOR (ABSENCE/PETIT MAL)
- Ethosuximide
- Valproid acid

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19
Q

1st line tx options for ALL FOCAL Sz?

Same for focal motor and non-motor (partial sz) & focal = to bilateral tonic-clonic

A
  • Carbamazepine, Oxcarbazepine
  • Lamotrigine
  • Levetiracetam
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20
Q

What is Status Epilepticus?

A

Seziure lasting >5min or continguous seizures w/o full recovery of consciousness b/w Sz

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21
Q

Status Epileptical Tx
1. Initial?
2. Maintenance?
3. Refractory?

A

INITIAL Tx
- Lorazepam (Ativan) IV
- Midazolam (Versed) IM
- Diazepam (Valium) IV

MAINTENANCE Tx
- Fosphenytoin (Cerebyx)
- Valproid Acid (Depacon)
- Levetiracetam (Keppra)
- Phenobarbital (Luminal)

REFRACTORY Tx
- ADD alt from #2
- Pentobarbital (Nembutal)
- Medazolam (Versed) Infusion
- Propofol (Diprivan)

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22
Q

6 types of Na CBs used as Anticonvulsants

A
  1. Phenytoin (Dilantin), Fosphenytoin (Cerebyx)
  2. Carbamazepine (Tegretol), Oxcarbazepine (Trileptal), Eslicarbazepine (Aptiom)
  3. Lamotrigine (Lamictal)
  4. Topiramate (Topamax)
  5. Zonisamide (Zonegran)
  6. Rufinamide (Banzel)
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23
Q

Phenytoin (Dilantin) vs Fosphenytoin (Cerebyx)

A
  • Fosphenytoin is more water soluble and can be infused at a faster rate
24
Q

________ is more water soluble and can be infused at a faster rate

Phenytoin (Dilantin) or Fosphenytoin (Cerebyx)?

A

Fosphenytoin (Cerebyx)

100-150mg/min

25
Q

Chronic Phenytoin use may lead to
- ____ Syndrome
- ____ and ____ toxicity

A
  • DRESS Syndrome = drug rxn with systemic SS & Eosinophilia (TOO MANY)
  • Neuro & Cardiac toxicity
26
Q

Pt taking Phenytoin presents with gingival hyperplasia, peeling rash, and blisters of mouth and eyes. What is this complication?

A

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)

27
Q

Carbamazepine (Tegretol), Oxcarbazepine (Trileptal), and Eslicarbazepine (Aptiom) have a BBW for?

A
  • Agranulocytosis
  • Aplastic anemia
28
Q

Which of the following is a weaker inducer that causes less drug-drug interxns, is not an autoinducer, and has NO monitoring req?
- Carbamazepine (Tegretol)
- Oxcarbazepine (Trileptal)
- Eslicarbazepine (Aptiom)

A

Oxcarbazepine (Trileptal)

29
Q

Which of the following is an autoinducer, req monitoring (4-12mcg/mL), and may cause SJS/TEN?
- Carbamazepine (Tegretol)
- Oxcarbazepine (Trileptal)
- Eslicarbazepine (Aptiom)

A
  • Carbamazepine (Tegretol)
30
Q

Lamotrigine (Lamictal)
- MOA: Na CB & ____ inhibitor
- _______ incr it’s [conc] by 100%
- _______ & _____ decr it’s [conc] by 40%

A
  • MOA: Na CB & Glutamate inhibitor
  • Valproic acid -> incr [conc] by 100%
  • Phenytoin & Carbamazepine -> decr [conc] by 40%
31
Q

Which Na CB Anticonvulsant also enhances GABA, is a Glutamate inhibitor, and may cause HYPERAMMONEMIA, WT LOSS, METABOLIC ACIDOSIS, & KIDNEY STONES

A

TOPIRAMATE (TOPAMAX)

32
Q

Which Na CB Anticonvulsant is this?
- Also blocks Ca channels
- SE: decr concentration, WT loss, Hyperammonenmia, Metabolic Acidosis, Kidney stones
- AVOID IN PTS WITH SULFA ALLX

A

ZONISAMIDE (ZONEGRAN)

33
Q

Which Na CB Anticonvulsant is this?
- prolongs the inactive state of Na channels
- SE: EKG CHANGES, GI, Change in vision, Tremor, Rash
- adjunct in Tx in Lennox-Gastaut Syndrome (LGS)

A

RUFINAMIDE (BANZEL)

34
Q

4 GABA Enhancing Anticonvulsants

A
  1. Valproic acid (Depacon), Divalproex (Depakote)
  2. Benzos (Ativan, Versed, Valium, Klonopin, Onfi)
  3. Tiagabine (Gabitril)
  4. Phenobarbital (Luminal), Pentobarbital (Nembutal), Primidone (Mysoline)
35
Q

Which GABA Enhancing Anticonvulsant causes HYPERAMMONEMIA, HAIR LOSS, WT GAIN, HEPATOTOXICITY?

A

Valproic Acid (Depacon) & Divalproex (Depakote)

36
Q

Give ____ to Tx HYPERAMMONEMIA d/t Valproic Acid (Depacon) or Divalproex (Depakote)

A

Levocarnitine (Carnitor)

37
Q

ALL Benzo Anticonvulsants are schedule (C-___)

A

C-IV

38
Q

Which GABA Enhancing Anticonvulsant may incr risk for INFX?

A

Tiagabine (Gabitril)

SE: INFX, GI, Tremors, Rash

39
Q

Is Phenobarbital (Luminal) or Pentobarbital (Nembutal) higher up on the drug schedule?

which is more controlled?

A

Pentobarbital (Nembutal) = C-II
Phenobarbital (Luminal) = C-IV

40
Q

Is Phenobarbital (Luminal) hepatotoxic or nephrotoxic? is monitoring required>

A

Hepatotoxic (inducer)
Monitor: 10-40mcg/mL

41
Q

Perampanel (Fycompa)
- MOA?
- Use?
- SE?

A
  • MOA: Glutamate Inhibitor (AMPA Receptor ANTAGONIST)
  • Use: Anticonvulsant
  • SE: Psychosis, Irritable, Agitation, WT Gain
42
Q

2 Ca Channel Blocking Anticonvulsants

A
  • Ethosuximide (Zarontin)
  • Gabapentin (Neurontin), Pregabalin (Lyrica)
43
Q

Gabapentin was designed to mimic the neurotransmitter GABA. HOWEVER, it does NOT bind to GABA receptors. It works as an Anticonvulsant bc it inhibits the alpha-2-delta subunit of ____ channels

A

Calcium

44
Q

Ethosuximide (Zarontin)
- MOA
- SE

A
  • MOA: T-type CCB
  • SE: Psychosis, Irritable, Agitation, WT Gain
45
Q

Which is a controlled substance in ALL states except OHIO?
- Gabapentin (Neurontin)
- Pregabalin (Lyrica)

A

Pregabalin (C-V)

Gabapentin is only controlled in OHIO (C-V)

46
Q

Which 2 Anticonvulsants bind to the SVZA protein in the brain

A

Levetiracetam (Keppra) & Brivaracetam (Briviact)

47
Q

Lacosamide (Vimpat) - Anticonvulsant of Unknown Mechanism
- MOA?
- SE?
- Class schedule?

A
  • MOA: Modulates Na Channels
  • SE: EKG Changes, Vision Changes, GI
  • (C-V)
48
Q

What is the ONLY weed-like Med that is FDA approved for seizures?
- Schedule?

A

Cannabidiol (Epidiolex) - (C-V)

49
Q

Z-Hypnotics: Eszopiclone (Lunesta), Zolpidem (Ambien), Zaleplon (Sonata)
You must commit to ____ - ____Hr of sleep

A

7-8Hr

50
Q

“Z” Hypnotics and Benzos should only be used for ____ for sleeping DOs

A

90 days or less

51
Q

Which Antidepressant can be used as a sleep aid and causes HypoTN and Priapism?

A

Trazodone

52
Q

4 Antidepressants that can be used as sleep aids

A
  1. Trazodone (Desyrel)
  2. Amitriptyline (Elavil)
  3. Mirtazapine (Remeron)
  4. Doxepin (silenor)
53
Q

Which OTC/Herbal Sleep aid causes HEPATOTOXICITY?

A

VALERIAN ROOT

54
Q

Is melatonin better for sleep induction or regulation of sleep-wake cycle?

A

regulation of sleep-wake cycle?

it does NOT induce sleep

55
Q

Modafinil and Armodafinil MOA

A

Decr dopamine reuptake -> incr Dopamine avail
(Non-CNS stimulant)

56
Q

Sodium Oxybate (Xyrem)
- MOA?
- Must give 2nd dose when ______
- schedule?

A
  • MOA: Mimics GABA -> CNS Depression
  • Give 2nd dose a few hrs into sleep
  • C-III. C-I if used illicitly as date-rape drug
57
Q

Tx for Migraines
1. ACUTE?
2. 6/4/3 days & NO/MOD/SEVERE Disability?

A
  1. OTC -> Triptans -> Ergots
  2. Migraine Prophylaxis, Triptans or Ergots PRN
58
Q

When can you ADD biologics for migraines?

A
  • 4-7 migraine days + MOD Disability
  • 8-14 days with NO Disability + Poor response to 2 prophylaxis Tx
59
Q

Which 2 classes of Migraine meds cause Tingling/Numbness & Warm/Cold Sensations

A

Triptans
Ergots

Pharmacology (14 decks)

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