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Pharmacology Exam 4 > Neurology > Flashcards

Neurology Flashcards

(55 cards)

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1
Q

Anticonvulsants work by

A
  • Reduce nerve’s ability to be stimulated
  • Suppress transmission of impulses from one nerve to the next
  • Decrease speed of nerve impulse conduction within a neuron
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2
Q

Hydantoins

A
  • Ethotoin (Peganone)
  • Fosphenytoin (Cerebyx) NOT for primary care
    Available only in intramuscular (IM) or intravenous (IV) dosing
    Given only for about 5 days (loading dose), then will start PO drug (Dilantin)
  • Phenytoin (Dilantin)
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3
Q

Fosphenytoin (Cerebyx)

A

Hydantoin
NOT for primary care
Available only in intramuscular (IM) or intravenous (IV) dosing
Given only for about 5 days (loading dose), then will start PO drug (Dilantin)

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4
Q

Phenytoin (Dilantin)

A

Hydantoin

Note that phenytoin is not interchangeable with Dilantin

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5
Q

Hydantoins

A

Uses: Tonic-clonic (aka grand mal), partial complex seizures

90% plasma bound (be careful with drug-drug interactions; hypoalbuminemia -> seizures or toxicity)

Metabolism in liver

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6
Q

Hydantoins drug interaction

A

Effect of drug is increased: ETOH (short-term)
Effect of drug is reduced: ETOH (chronic use)
Reduce effectiveness of oral contraception pills, thyroid hormone

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7
Q

Hydantoin ADRs

A

Nystagmus, diplopia, dizziness, sedation, ataxia
Gingival hyperplasia, hirsutism
SJS, toxic epidermal necrolysis
Lymphadenopathy, hepatitis
Hypotension
Reddish-brown urine
Megaloblastic anemia - treat with folic acid

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8
Q

Signs of Hydantoin Toxicity

A

20-30 Nystagmus = Early sign
30-40 Ataxia = Early sign
> 40 decreased LOC

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9
Q

Hydantoins contraindicated in:

A

Pregnancy

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10
Q

Iminostilbenes

A

Carbamazepine (Tegretol)
Oxcarbazepine (Trileptal)
Valproic acid (Depakote)

Uses: tonic clonic seizure, complex partial seizure, mood stabilizer (treat mania in bipolar), trigeminal neuralgia

Highly protein bound
Metabolized in the liver

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11
Q

Carbamazepine (Tegretol)

A

Iminostilbene
May experience autoinduction
Warning for Fetal Carbamazepine Syndrome

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12
Q

Oxcarbazepine (Trileptal)

A

Iminostilbene

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13
Q

Valproic acid (Depakote)

A

Iminostilbene
Carboxylic acid derivative
Thought increase GABA, an inhibitory neurotransmitter, as well as having a direct membrane-stabilizing effect

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14
Q

Iminostilbene ADRs

A

Decrease bone marrow, aplastic anemia (monitor CBC)
Impaired liver function, impaired thyroid function
Dizziness, nystagmus, ataxia, N/V, dry mouth, diplopia, HA
Blood dycrasias
Black Box: SJS, toxic epidermal necrolysis

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15
Q

Black Box Warning for Iminostilbenes

A

Skin rash
SJS
Toxic epidermal necrolysis
Blood dyscrasias

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16
Q

S/S of Blood Dyscrasias

A

Fever, sore throat, Easy bruising

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17
Q

Succinimides

A 
DOC for absence seizures
Ethosuximide (Zarontin)
Methsuximide (Celontin)
ADRs GI, somnolence, fatigue, ataxia
Long 1/2-life
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18
Q

Ehosuximide (Zarontin)

A

Succinimide

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19
Q

Methsuximide (Celontin)

A

Succinimide

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20
Q

Lamotrigine (Lamictal)

A

Adjunctive therapy for tonic-clonic, partial, absence
Used with phenytoin or valproic acid
BBW: rash, SJS

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21
Q

Black Box Warning for Lamotrigine (Lamictal)

A

Rash

SJS

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22
Q

Leviteracetam (Keppra)

A 
Uses: tonic-clonic, myoclonic seizures
Adjunctive therapy to treat partial seizures
ADRs: dizziness, weakness, sedation
Generally well tolerated
NOT metabolized by CYP enzymes
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23
Q

1-(aminomethyl) cyclohexane acetic acid

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A

Gabapentin (Neurontin)
Topiramate (Topamax)

Thought to elevate GABA in the brain

Uses: Adjuvantive therapy for partial seizures

24
Q

Gabapentin (Neurontin)

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A

1-(aminomethyl) cyclohexane acetic acid

Adjuvantive therapy for partial seizures

Used widely for neuropathic pain; approved for post-herpetic neuralgia

25
Topiramate (Topamax)
1-(aminomethyl) cyclohexane acetic acid Adjuvantive therapy for partial seizures Treats migraines ADRs: confusion/cognitive problems, difficulty in concentration and speech; may decrease sweating; may increase body temp
26
Benzodiazepines
clonazepam (Klonopin) lorazepam (Ativan) diazepam (Valium)
27
Clonazepam (Klonopin)
Only drug approved for long term use of seizure control | ADR: drowsiness, lethargy (37%)
28
Status epilepticus
Treat with IV lorazepam (Ativan) or diazepam (Valium)
29
Parkinson's Symptoms
``` TRAP T: Tremor (resting and pill-rolling) R: Rigidity (cogwheel movement) A: Akinesia/bradykinesia P: Postural instabilit (shuffling gait) ```
30
Goals of drug therapy for Parkinson's
Correct the imbalance of neurotransmitters by increasing Dopamine and decreasing Acetylcholine (Ach) Two major categories: Dopaminergic agents Anticholinergic agents
31
Levodopa
Most effective for symptomatic treatment of PD DOC for bradykinesia Increases dopamine concentration, enhances the neurotransmission of dopamine Full therapeutic effect can take months Highly effective, but benefits diminish over time Food delays absorption – take on empty stomach High fat/ high protein meals compete with levodopa for absorption
32
Levadopa ADRs
``` Large doses of levodopa = High peripheral levels of dopamine = Increased adverse effects GI distress (N/V), postural hypotension, CV dysrhythmias, dyskinesias, psychosis, confusion Thus, levodopa is given with carbidopa, a peripheral decarboxylase inhibitor (“car that drops off levodopa in the brain”) ```
33
Sinemet
Levodopa/Carbidopa Available in immediate or sustained release Most effective drug for Parkinson’s, and good choice for elderly
34
Parcopa
Levodopa/Carbidopa Dissolves on tongue Most effective drug for Parkinson’s, and good choice for elderly
35
Two types of Dopamine agonists
Derivatives of ergot – less selective; more s/e | Nonergot derivatives – highly selective for Dopamine
36
pramipexole (Mirapex)
Nonergot derivative; Dopa agonist
37
ropinirole (Requip)
Nonergot derivative; Dopa agonist
38
Nonergot derivatives
First-line drug for younger patients with mild-moderate PD Used alone in early PD (< 60 yo) and with levodopa in advancing PD Maximal benefits take several weeks to develop. Adverse effects Monotherapy –daytime somnolence (“sleep attacks” esp older pts), nausea, dizziness, insomnia, constipation, weakness, and hallucinations Combined w/ levodopa – increases effect of levodopa (orthostatic hypotension, dyskinesias, etc.) Causing rare instances of worse behavioral impulse patterns: pathologic gambling and other compulsive self-rewarding behaviors; alcoholism
39
ADRs of nonergot derivatives
"Sleep Attacks" = daytime sleepiness; esp. older patients May increase ADRs of levodopa when combined therapy (orthostatic hypotension, dyskinesias) Causes rare instances of worse behavioral impulse patterns: pathologic gambling and other compulsive self-rewarding behaviors; alcoholism
40
COMT inhibitors
Inhibit metabolism of levodopa in the periphery Prolongs time that levodopa is available to the brain No direct therapeutic effects of their own Entacapone Tolcapone
41
Entacapone
COMT inhibitor
42
Tolcapone
COMT inhibitor
43
Warning about COMT Inhibitors
Rapid withdrawal of COMT inhibitors may lead to Parkinsonian crisis: syndrome of muscle rigidity, high fevers, tachycardia, confusion, elevated CK levels = similar to neuroleptic malignant syndrome
44
Black Box Warning for Tolcapone
Hepatotoxicity
45
MAO-B Inhibitors
Inhibit MAO-B in the brain Increases dopaminergic activity Can reduce wearing off of levodopa Selegiline (Eldepryl, Zelapar) Rasagiline (Azilect)
46
Selegiline (Eldepryl, Zelapar)
MAO-B Inhibitor | Older; converted to amphetamine or methamphetamine
47
Rasagiline (Azilect)
MAO-B Inhibitor
48
Dopamine Modulator
Treats early mild/moderate PD in younger pts Amantadine (Symmetrel)
49
Amantadine (Symmetrel)
Dopamine Modulator
50
Anticholinergic Drugs
Inhibits cholinergic effects Treats: tremors, rigidity (cogwheeling), drooling; used in younger pts Benztropine (Cogentin) Biperiden (Akineton) procyclidine trihexyphenidyl
51
ADRs of Anticholinergic Drugs
Dry mouth, confusion, drowsiness, tachycardia, constipation | Central anticholinergic syndrome if taking multiple anticholinergics
52
Benztropine (Cogentin)
Anticholinergic Drug
53
Biperiden (Akineton)
Anticholinergic Drug
54
procyclidine
Anticholinergic Drug
55
trihexyphenidyl
Anticholinergic Drug

Pharmacology Exam 4 (4 decks)

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