Neurology Flashcards
1
Q
What is used to treat ACUTE relapses of MS?
A
Corticosteroids
2
Q
what are the AEs of corticosteroids
A
GI upset
insomnia
mood disturbace
3
Q
which type of MS is disease-modifying therapy most effective for?
A
relapsing and remitting
4
Q
Teriflunomide has a long 1/2 life, and takes ___ months to reach a steady state
A
3 months
5
Q
Cholestyramine reduces the half life of which MS drug?
A
Teriflunomide
6
Q
Which MS drug’s MOA is characterized by shifting cytokines from proinflammatory state, preventing immune cells from entering the CNS, reducing oxidative stress?
A
Dimethyl Fumarate
7
Q
What are some AEs of Dimethyl Fumarate?
A
Flushing
itching
GI effects
Leukopenia/lymphopenia
8
Q
of the MS medications, which 3 reduces relapse rates, but DO NOT slow MS progression?
A
Interferon Beta
Glatiramer Acetate
Teriflunomide
9
Q
Which MS drug has a risk of Progressive Multifocal Leukoencephalopathy, and is only allowed if MS is rapidly advancing WITH failed all other therapies?
A
Natalizumab
10
Q
T or F: MS symptoms increase in 2nd and 3rd trimester of pregnancy
A
FALSE - relapses decrease in 2nd and 3rd trimesters (but increase in first 3 months post-partum)
11
Q
which 3 MS drugs to use in pregnancy
A
interferon beta
Glatiramer acetate
Natalizumab
12
Q
a patient wants to conceive in 2 months; which MS meds must you D/C due to their long 1/2 lives?
A
Fingolimod
Teriflunomide
13
Q
Which MS med is contraindicated in Men?
A
Teriflunomide
14
Q
which MS meds are contraindicated in pregnancy?
A
Mitoxantrone
Teriflunomide
15
Q
Symptomatic treatment is often used in MS. What is best to treat focal spasticity?
A
Botox
16
Q
What is often used to treat systemic spasticity in patients with MS?
A
Baclofen
Tizanidine
17
Q
What 2 medications are often used to treat fatigue in patients with MS?
A
Amantadine
Methylphenidate
18
Q
what are the Neurotransmitters involved in seizures?
A
Glutamate
GABA
19
Q
which anticonvulsant works as an autoinducer?
A
Carbamazepine
increases metabolism of itself and other drugs
20
Q
this anticonvulsant has an interesting pharmacokinetic property; it is NOT capacity-limited, so it can process extra unbound drug better`
A
Valproate
(Valproic acid/Divalproex) - this means less severe dose related AEs
21
Q
which 3 anticonvulsants are used in emergent situations?
A
Phenytoin
Phenobarbital
Valproic Acid
22
Q
which seizure medication has a risk for Purple Glove Syndrome?
A
phenytoin
infusion causes tissue discoloration, edema, pain, necrosis
23
Q
this anticonvulsant is capacity-limited; small changes in dose lead to LARGE changes in serum concentration
A
phenytoin
24
Q
what is the major caution with phenobarbital?
A
respiratory depression possible!
25
which GABA enhancing anticonvulsant quickly terminates seizures
Benzodiazepines
26
which GABA enhancing anticonvulsant is also used to treat nerve pain?
Gabapentin, Pregabalin
27
What 2 anticonvulsants do not fit into either the Calcium/sodium channel or GABA receptor classification?
Levetiracetam
| Topiramate
28
why don't we want to D/C the 1st anticonvulsant medication too soon?
may cause breakthrough seizures; start new drug on low dose and increase gradually while slowly decreasing old drug.
29
May be able to D/C seizure medication after how long if they have a low risk of recurrence?
2-5 years
D/C over 1-3 months (slowly)
30
which 2 anticonvulsants are protein bound?
valproate and phenytoin
31
what is the preferred class of medication to stop seizure IMMEDIATELY (acute seizure)
Benzodiazepines
| Midazolam, Lorazepam, Diazepam
32
Benzos are used emergently to STOP seizures, but what is used for the suppression of seizures?
Phenytoin
Phenobarbital
Valproate
(Infuse SLOWLY)
33
what 3 medications are used in REFRACTORY-STATUS epilepticus?
Midazolam (benzo)
Propofol
Phenobarbital - only if others fail
34
Which medication is NOT recommended in treating headaches in a patient also taking anticonvulsants(seizures):
Valproate
Lamotrigine
Topiramate
Lamotrigine - WORSENS headaches
other 2 are preferred for treating headaches
35
which antidepressant INCREASES seizure risk in a patient who is taking anticonvulsants
Bupropion
36
T or F: you can use Lamotrigine to treat headaches in patients who are prone to seizures, but you must avoid it in treating their depression
False - ok to use for depression, DO NOT use for headaches!
37
What treatment time frame must you follow before switching an Alzheimer's patient to a different Cholinesterase inhibitor?
do a 3-6 month trial on MAXIMUM tolerated dose before switching
38
which cholinesterase inhibitor also inhibits butyryl cholinesterase?
Rivastigmine
39
of the ChE inhibitors for alzheimers, which may increase synaptic ACh the most?
Rivastigmine
40
how does Memantine (NMDA antagonist) work in the brain?
controls amount of calcium allowed into the nerve, regulating info storage (too much Calcium = disrupted info processing)
41
Which medications might help alzheimers patients with their aggression and agitation?
Buspirone
Trazadone
Selegiline
42
T or F: benzos are ok to use in Alzheimers patients for their anxiety
FALSE: increased risk of falls
43
pharmacological goal of treating parkinsons is to increase _____ concentrations in the substantia nigra
Dopamine
44
what do we most often start with when treating Parkinsons?
Levodopa/Carbidopa
45
T or F: the SNRIs (Venlafaxine, Desvenlafaxine, Duloxetine) all have short 1/2 lives
True - missed doses can cause withdrawal symptoms
46
Of the SSRIs, which has the longest 1/2 life?
Fluoxetine
47
Of the SSRIs, which has the shortest 1/2 life
Paroxetine
48
Of the SSRIs, which has risk of QT prolongation
Citalopram
49
Fluoxetine has a 1/2 life of ____ days
5-9
| 5-week washout before starting MAOI or 2 weeks before switching to another SSRI/SNRI
50
What is the MOA of SNRIs
serotonin and NE reuptake inhibition
51
SNRIs are contraindicated in what type of person?
Hepatic injury - alcohol abuse or chronic liver disease
52
What is Serotonin syndrome?
SSRI/SNRI + MAOI
| SSRI/SNRI + SSRI/SNRI = confusion, restlessness, fever, hyperreflexia, diarrhea, shivering
53
MAO is an enzyme that is inhibited by MAOIs. What is the role of MAO in depression?
MAO breaks down 5-HT (serotonin, NE, DA).
54
Which class of depression medication must you be mindful of drug/food interactions, due to high risk of hypertensive crisis
MAOIs
avoid MAOI + sympathomimetic (pseudoephedrine, amphetamines, foods rich in tyramine)
55
Tricyclic antidepressant have many adverse effects. Which 2 give high risk for sedation and anticholinergic effects
Amitriptyline
| Imipramine
56
If you Rx amitriptyline or imipramine (antidepressant), when should the patient take them?
at night - sedative effect, helps with sleep.
57
TCAs have a high risk of overdose, and significant additive effects with drugs that cause _______
sedation, hypotension, anticholinergic
58
Bupropion is what class of depression medication?
NE and DA reuptake inhibitor
59
When should patient take their daily dose of Bupropion?
Late afternoon - NOT AT NIGHT! Adverse effect is insomnia
60
Bupropion contraindication
CNS lesion
seizures
head trauma
bulimia
61
Of the 5-HT antagonists, which has higher risk of causing sedation and priapism
Trazodone
62
Prescribe this 5-HT antagonist for sleep, but add onto other antidepressants
Trazodone
63
Nefazodone isn't used often for depression because of its risk for ______
hepatotoxicity
64
What are the partial 5-HT agonists?
Vortioxetine
| Vilazodone
65
what are the adverse effects of Vortioxetine and Vilazodone that limits their use?
GI upset
66
St. Johns wort is commonly used to treat depression. What type does it work for and not work for?
works for mild depression
| NOT effective for moderate-severe
67
Trazodone can treat depression but is mainly used for ____
sleep, due to its sedative effects
68
Which class of antidepressant is best for Depression + panic disorder?
SSRI
69
which SSRI is best used for treating depression + OCD
Fluvoxamine
70
physical symptoms of depression improve in ______ weeks while emotional symptoms take _____ weeks
1-2 weeks
2-4 weeks
(6-8 weeks for full effect)
71
T or F: If you add a 2nd antidepressant, add in the same class
False - add in a different class
72
Treatment of Acute phase of depression is how long?
6-12 weeks
73
the continuation phase of treating depression is how long
4-9 months
74
maintenance phase of treating depression is how long?
12 months - lifetime
75
what are the safest antidepressants in pregnancy?
Sertraline
Fluoxetine
Citalopram
TCAs
76
What are the best meds to treat geriatric patients with?
SSRI/SNRI
Bupropion
Mirtazepine
77
avoid this antidepressant in geriatric patients
TCAs
| MAOIs
78
what are the only FDA-approved antidepressants for kids?
Fluoxetine
| Escitalopram
79
Avoid this type of antidepressant in kids
Desipramine (TCA)
80
What is the drug of choice for General anxiety disorder, social anxiety disorder, panic disorder?
SSRIs (or SNRIs)
81
When starting a patient on SSRI for anxiety, what is the onset?
2-4 weeks
82
specifically which SSRI/SNRI meds are used in treating anxiety
```
Venlafaxine
Duloxetine
Paroxetine
Escitalopram
Sertraline
```
83
what is used in short term management of anxiety, when immediate relief is desired
Benzodiazepines
| also used as adjunct to initiating anxiety meds
84
Are benzodiazepines effective in treating both somatic and psychic symptoms of anxiety?
yes
85
are benzodiazepines effective in treating anxiety AND depression?
not depression - only prn anxiety
86
```
Which of the following benzodiazepines is NOT short-lasting:
Oxazepam
Diazepam
Lorazepam
Temazepam
Alprazolam
```
Diazepam (long lasting)
87
what are the 2 longer lasting benzodiazepines?
Clonazepam
| Diazepam
88
which is the fastest-onset benzo for anxiety?
diazepam
89
which benzodiazepines bypass the CYP3A4 system and are to be used in hepatic dysfunction?
Oxazepam
| Lorazepam
90
why should you never use benzos for long term anxiety treatment?
risk of addiction
91
how do you D/C benzos for anxiety if patient has been taking them for 2-6 months?
2-8 week taper
92
how do you D/C benzos for anxiety if patient has been taking them for 12 months?
2-4 month TAPER
93
what is an alternative treatment option for generalized anxiety disorder WITHOUT depression?
Buspirone
94
This medication is a good option for GAD, because it does not have abuse/addiction potential
Buspirone
95
what is the onset for buspirone, which is why benzos are still preferred treatment for acute anxiety?
2 weeks
less effective if patient previously treated with benzos
96
```
Verapamil
Diltiazem
Itraconazole
Fluvoxamine
Erythromycin all do WHAT to levels of buspirone?
```
INCREASE them
97
this is an alternative agent for treating anxiety, and is also an H1 blocker, not addictive
Hydroxyzine
98
T or F: hydroxyzine is effective for somatic and psychic symptoms of anxiety?
FALSE - only effective for SOMATIC symptoms
99
T or F: you can use hydroxyzine prn OR scheduledq
TRUE
100
what is first line therapy for preschoolers with ADHD?
behavioral therapy
101
what class of medication is 1st line in treating ADHD?
Stimulants
102
stimulants for ADHD are a controlled substance - what does this mean?
potential for abuse
103
what is the onset for stimulants to work?
30 minutes
104
how long to trial stimulants for ADHD before determining they are ineffective and switching?
trial for 3 months; try different stimulant.
105
Stimulant Contraindications
```
Glaucoma
Severe HTN
CV disease
Hyperthyroidism
previous drug abuse
```
106
Of all the adverse effects of stimulants, which 2 are a cause to D/C the med?
hallucinations
| abnormal movements
107
Your patient was started on a stimulant 1 month ago. He reports experiencing hallucinations. What do you do?
D/C the med!
108
have patients take stimulant ______ min before meals to avoid drug-food interactions
30-60min - to avoid interactions
109
what "nonstimulants" can be used 2nd line for treatment of ADHD
Atomoxetine
Bupropion
Clonidine
Guanfacine
110
are nonstimulants controlled substances?
no - no abuse potential
111
this medication can be used as a nonstimulant for ADHD as well as an antidepressant - it is best chosen to treat a patient with ADHD + depression
Bupropion
| onset 1-2 months
112
Bupropion CONTRAINDICATIONS
seizure
| eating disorder
113
these 2 medications are nonstimulants; their MOA is alpha2 agonists
clonidine
| guanfacine
114
these nonstimulants are less effective at treating ADHD, but are used as ADJUNCT to stimulants to control disruptive behavior
clonidine
| guanfacine
115
you start your patient on a stimulant for is new diagnosis of ADHD. how often do you follow up?
every 2-4 weeks, and then every 3 months when stable
116
psychosis is caused by an excess in what neurotransmitter in the brain?
DA
117
which generation antipsychotics are preferred?
2nd - less likely to cause EPS, tardive dyskinesia
118
which SGA has greatest efficacy in treatment-resistant patients
clozapine
119
what 3 main adverse effects are associated with SGAs
weight gain
glucose/lipid abnormalities
metabolic syndrome
120
Which 1st line SGA has potential for the most adverse effects?
Risperidone (binds all the receptors)
| -EPS, prolactin and lipid/glucose elevations, weight gain
121
which SGA is the active metabolite of Risperidone
Palperidone
122
Which SGA do you prescribe your patient with liver dysfunction?
Palperidone
123
which SGA is the worst culprit of metabolic syndrome in SGAs
Olanzapine
124
which SGA is the best choice to treat a patient who has ANXIETY AND DEPRESSION (as well as schizophrenia)
Quetiapine
125
Major adverse effect of Quetiapine
Prolongs QT interval
126
which 2 SGAs have a risk of QT prolongation
quetiapine
| ziprasidone
127
Which SGA has the unique MOA, which addresses both hyper and hypo-DA levels in brain
Aripiprazole
128
what are the 3 most dangerous adverse effects of using first generation antipsychotics?
EPS
Tardive Dyskinesia
Neuroleptic malignant syndrome
129
you started a patient on a FGA, and 10 days later they report motor restlessness and muscle spasms. What is going on?
Extrapyramidal symptoms
130
what is EPS treated with?
IV Anticholinergics
131
T or F: Neuroleptic malignant syndrome is a life-threatening emergency
True
severe muscular rigidity, altered consciousness
132
this bad habit DECREASES concentration of clozapine and olanzapine
cigarette smoking
133
your patient has failed 2 antipsychotic trials with SGAs, and reports aggression and suicidality. Which treatment do you turn to?
Clozapine
134
Adverse effects that limit clozapine's use
Seizures
myocarditis
Agranulocytosis
135
what do you need to monitor closely in your patients taking clozapine
hematology (risk of agranulocytosis)
136
what is an option for administration in patients who are high risk of nonadherence?
IM injections
137
what antipsychotics are recommended for treating kids?
SGA
avoid sedating, anticholinergic effects
138
this social activity is a risk factor for tardive dyskinesia
alcohol use
139
you are seeing a pregnant patient who has schizophrenia. What do you tell her regarding her medication and carrying a baby?
relapse is a greater risk for birth complications, STAY ON THE ANTIPSYCHOTIC
140
in an acutely psychotic patient, what do you administer?
intramuscular SGA
or
IM benzodiazepines
141
what do you NEVER treat bipolar patients with
antidepressants (may precipitate rapid cycling/manic episode)
142
what is the 1st line agent for classic bipolar?
Lithium
143
does Lithium have a wide or narrow therapeutic index?
NARROW - monitor!
| goal is 0.6-1.4
144
commondrug interactions of Lithium
NSAIDs
Thiazides
ACE/ARB
145
what is lithium toxicity?
fluid loss from exersize, patient is vomiting, diarrhea, has deterioration in motor coordination and seizure. LIFE THREATENING!
146
at what serum level does lithium toxicity occur?
>2 mEq/L
| d/c lithium, may need gastric lavage
147
Lithium is not the best choice for someone with rapid cycling bipolar disorder. Instead, give this drug, which works like lithium but is better for rapid cycling
Valproic acid
148
T or F valproic acid has a narrow therapeutic index
false - WIDE
149
If your patient is taking Devalproex (valproic acid), what could happen if you also give them LAMOTRIGINE?
DANGEROUS RASH
150
which 2 mood disorder meds can contribute to agranulocytosis?
Clozapine
| Carbamazepine
151
why might oxcarbazepine be favored over carbamazepine in treating bipolar?
no routine monitoring of serum concentration or hematology (anemia/agranulocytosis)
152
the risk of rash/SJS is HUGE when Lamotrigine and divalproex are combined. If you absolutely MUST use the 2, do you change the dose?
yes - lower Lamotrigine dose
153
can you use Lithium on a child?
yes, at lower doses.
154
which bipolar medication causes "floppy baby syndrome"
Lithium
155
what drug classes work for sleep aids?
benzodiazepine receptor agonists
| Sedating antidepressants
156
What sedating antidepressant is the best option for elderly patients?
Doxepin
157
instead of stimulating pathways that cause sleepiness, this sleep aid turns OFF wakefulness
Suvorexant
158
only this sedating antidepressant has a sleep dose adequate to helping with depression (all others require lower dose for sleep)
Mirtazapine
159
What 2 meds reduce sleepiness? (Wake aids)
Modafinil
| Armodafinil
160
when using Lithium, this organ needs to be monitored VERY closely
KIDNEY FUNCTION! decrease dose for renal impairment
161
what part of the brain is affected in Parkinsons?
Substantia nigra
| lack of Dopamine neurons
162
A patient with Parkinsons has a depletion of DA, and it can cause motor fluctuations, akathisia, and dyskinesias. A drug that treats Parkinsons also does this. What is it?
Levodopa/carbidopa
163
although Levodopa/carbidopa is 1st line in treating PD, what is typically prescribed first to delay needing Levo/carb
DA agonists
| Bromocriptine, Rotigotine, Pramipexole, Ropinirole, apomorphine
164
which classes of drugs are ONLY used in MILD Parkinsons disease?
Amantadine, Anticholinergics, MAO-B inhibitors, COMT inhibitors
165
benzo + olanzapine = ?
cardiorespiratory failure
