Neurology Flashcards
(28 cards)
AUTONOMIC NERVOUS SYSTEM
Myasthenia gravis drugs
Cholinergic, cholinergic blocking, adrenergic, adrenergic blocking drugs
(Myasthenia gravis, alzheimers- anticholintererace inhibitors
Reversible cholintesterase inhibitors
Neostigmine
Pyridostigmine
ANS DRUGS
Alzheimers drugs
Donezepil (aricept)
Galantamine (Razadyne)
Rivastigmine (Exelon)
Memantine (Namenda)- not cholinesterace indhibitor
ANS DRUGS
Donepizil (aricept)
rivastigmine (exelon)
Memantine
given less frequently
GI- self resolving, titrate up slowly
available as liquid, patch- esp if difficulty swallowing
NMDA antagonist
CNS
Which disease?
Drugs used?
ADRS
dopaminergics- balance dopamine and acetylcholine
Parkinson Amantadine, Bromocriptine (older) Mainstay- carbidopa-Levodopa Newer drugs- pramipexole, ropinirole better SE profiles rotigotine- not really used
n/v, hallucinations/confusion (bc targeting nervous system)
CNS DRUGS
Dopaminergics CONTINUED
How long does it take to work?
Interactions?
D/c?
Testing??
Phenomenon?
carbidopa-levodopa, amantadine, bromocriptine, pramipexole, ropinorole, rotigotine
can take up to 6 months for maximum effect
MANY INTERACTIONS
Titrate down- withdrawal effects
hepatic/renal function
On/off- unpredictable, not dose dependent
CNS DRUGS
Which drugs are primarily used for parkinsons disease?
Pramiprexole, ropinirole more commonly used bc of better SE profiles
Symptoms worsen go to levodopa-carbidopa
control smooth muscle tremor- cholinergic blockers
ANTICONVULSANTS
Hydantoins
First line for
Metabolized
Interactions
Ethotoin- not really used
Fosphenytoin- urgent care
Phenytoin (dilantin)***
-oral and injection, many forms (dosing different for each)
first line for tonic clonic and partial complex seizures
liver, CYP
many- ALCOHOL, increased levels Valproic acid allopurinol barbiturates, antacids, calcium
acute alcohol- increase chronic alcohol- decrease effects
ANTICONVULSANTS
phenytoin
ADRS
Careful with?
Use for
Patient education
LONG LIST- confusion, CV, GI, gingival hyperplasia, GU: urinary retention
Careful with hepatic and renal
Grandmal psychomotor seizures
OTC drug interactions- ibuprofen, antacids, good oral hygiene, avoid driving if not seizure free for > 1 year
ANTICONVULSANTS Iminostilbenes - - -
Important:
tegretol
trileptal
depakote
Black box- blood dyscrasias
Drug interactions
Induce own metabolism
Metabolized by liver
Iminostilbenes continued
patient education
Interactions
ADR
tegretol, trileptal, depakote
Grapefruit juice
Drug levels increase (cimetidine- available otc) erythromycin clarithromycin, verapamil, hydantoins
decrease levels- beta blockers, warfarin, doxycycline, haloperidol
Dry mouth, headache, depression bone marrow* liver, thyroid damage
-
what kind of seizures
Metabolized
ADR
Zarontin (more common) Celontin
absence seizures
liver
somnolence, fatigue, GI most common, blood dyscrasias
ANTICONVULSANTS GABA - - -
Topamax pregnancy
Neurontin, Gabitril, Topamax
D
GABA continued
ADRS
if d/c
Neurontin, Gabitril, Topamax
somnolence- bigger dose at night
mood- depression, anxiety
slowly
ANTICONVULSANTS
levetiracetam (keppra)
ADR- caution
adjunct- partial onset seizures
neuropsychiatric- suicidality
ANTICONVULSANTS
Lamotrigine (lamictal)
used for
Interactions
Metabolized
ADRS
primary generalized tonic-clonic seizures and partial seizures in adults and children <2
Decrease- barbiturates, estrogen, phenytoin
increase- alcohol, carbabazepine, CNS depressants, valproic acid
may be used concurrently with valproic acid and phenytoin
liver and kidneys
GI, somnolence/fatigue (all generally)- BB warning stevens johnson
Sedative Hypnotics Nonbenzodiazepine - - - Benzodiapeine - - -
Ramelteon
Ambien- lower dosing recommendations esp. elderly and female patients (is controlled release formulation)
Sonata
Lunesta- shorter duration of action
Flurazepam
Temazepam
Triazolam
- fast onset short duration (could use ativan)
Romelteon- removed rems, melatonin, potent agent, have to be on it for time, if addict this is option
Stimulants - - - -
start with?
Nonamphetamine
amphetamine
dextroamphetamine
methylphenidate
adderall- amphetamine/dextroamphetamine
always start IR then ER, all schedule II
Strattera- norepinephrine reuptake inhibitor
HEADACHE TREATMENT
Midrange analgesics
High range- recommendations
Butalbital/ASA (fiorinal)- controlled, came to market first
Butalbital/APAP (fioricet)- not controlled
Isometheptene/acetaminophen/dichloralphenazone (Midrin)- schedule IV
Opiods- Not recommended except in pregnancy, consider in pregnancy, vasoconstrictors contraindicated, nonresponsive to ergotamine or serotonin agonists
-IM meperidine- not good option, intransal (stadol)
MIGRAINES
Ergots
Pregnancy
vasoconstrictors Ergotamine tablets not available but are suppositories category X DHE safer than ergotamine, IM or intranasal
not widely used
MIGRAINES
Serotonin 5-HT antagonists
which is the typical one?
How many times a month?
Contraindications
Interactions
TRIPTANS
Sumatriptan- typically start with
no recommendation one or other really depends on insurance
if more than 4 tablets a month- explore whats going on
CAD, uncontrolled HTN, pregnancy*
Ergotamines, MAOIS, SSRIS
orally, injection, nasal
MIGRAINES
Antiemetics
Preventive therapy for Migraine Considerations
Drugs:
reglan, compazine
more than 2 a month - consider these txs
goal 50% reduction
minimum 4 weeks for them to work
Beta blockers- propanolol, timolol (these have FDA use) used for migraine prophylaxis also metoprolol, atenolol
TCAS
Antiepileptics
try for at least 3 months
fatigue, lethargy, depression
failure to respond- try another bb
metoprolol/atenolol if asthma (selective)
MIGRAINES
TCAS
amitriptyline- lower doses, or nortiptyline
ADRs- drowsiness, weight gain, constipation
probably consulting at this point
-
-
Depakote- pregnancy D, liver function and CBC
Gabapentin-
Topamax- kidney stones
titrate up
no indication one over other
these are complicated patients
MIGRAINE MISC
naproxen- menstural
CCB- verapamil- patients with HTN who cannot tolerate BB
