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Pharm 2 > Neuropsychiatric > Flashcards

Neuropsychiatric Flashcards

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1
Q

First 5 minutes of seizure

A

ABCs, vitals
Check Blood sugar
Get labs

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2
Q

First phase: 5-20 minutes

A

Benzos!

if unavailable try phenobarbital, diazepam rectal, nasal/buccal midazolam

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3
Q

Second Therapy phase: 20-40 minutes

A

no evidence based 1st choice

-Fosphenytoin IV
-Valproic Acid IV
-Levetiracetam IV (Keppra)

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4
Q

Third phase: 40-60 minutes

A

-Repeat any 2nd line therapy

-anesthetic dose of thiopental, midaz, pentobarbital or propfol

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5
Q

Anticonvulsants uses (approved and unapproved)

A

Seizures
Neuropathic pain
Mood stabilization
Migraines
Alcohol dependence

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6
Q

Calcium channel blockade

A

T-type channels located in the thalamus

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7
Q

Example of MOA SV2A drug

A

Keppra

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8
Q

Sodium Channel Blockers

A

Carbamazepine (Tegretol, Carbatrol)
Oxcarbazepine (Trileptal)
Eslicarbazepine (Aptiom)
Phenytoin/Fosphenytoin (Dilantin)
Lamotrigine (Lamictal)
Zonisamide (Zonegran)
Lacosamide (Vimpat)
Cenobamate (Xcopri)

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9
Q

What is the treatment of choice for Trigeminal neuralgia?

A

Carbamazepine (Tegratol)

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10
Q

Things to check when taking Carbamazepine, Oxcarbazepine, and Eslicarbazepine

A

Check Na+, platelets, and drug reactions!

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11
Q

Carbamazepine PK

A

CYP3A4 inducer + substrate
-Autoinducer

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12
Q

Common side effects for all seizures meds

A

dizziness, ataxia, confusion, slowing down of CNS

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13
Q

Advantage of Oxcarbazepine vs Carbamazepine

A

Created to eliminate the auto-induction of CBZ

Similar side effect profile
Less hyponatremia

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14
Q

Normal Phenytoin level

A

10-20

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15
Q

Fosphenytoin vs Phenytoin

A

Fosphenytoin = prodrug for IV administration
-Safer, better tolerated, faster infusion rates

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16
Q

ADRs for Phenytoin/Fosphenytoin

A

Gingival hyperplasia- long term side effect

Bone marrow hypoplasia

Arrhythmias, cardiovascular depression, hypotension
Ataxia
Nystagmus

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17
Q

Which drug has most approvals for different seizure types?

A

Phenytoin/Fosphenytoin

Recommended to increase at 50mg increments.

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18
Q

Phenytoin side effects if given during pregnancy

A

cleft palate, cleft lip, congenital heart disease, slowed growth rate, mental deficiency

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19
Q

Lamotrigine (Lamictal) and Depakote drug reaction

A

Stevens-Johnson syndrome!!!!!

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20
Q

Lamotrigine (Lamictal advantages

A

Less CNS toxicity and congenital malformations (has more excitatory symptoms tho)

-Be careful about when they are held and when they are started.

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21
Q

Zonisamide side effect

A

Renal stones in 1.5% of patients

rarely used

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22
Q

Lacosamide and Cenobamate facts

A

-Newer meds and VERY SAFE
-low side effect profile
-EXPENSIVE

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23
Q

Lacosamide and Cenobamate side effects

A

QT shortening, DRESS Rxn (strong rxn eosinophils skin,

CHECK EKGs!

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24
Q

Benzo that withdrawal can be FATAL

A

Clobazam (Onfi)

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25
Benzos from longest duration of action and lipophilicity
Clobazam (Onfi) Diazepam (Valium) Clonazepam (Klonopin) Lorazepam (Ativan) Clorazepate (Tranxene) Triazolam (Halcion) Oxazepam (Serax) Alprazolam (Xanax) Midazolam (Versed) Temazepam (Restoril) Chlordiazepoxide (Librium)
26
Benzo with longest duration of action
Clonazepam (Klonopin)
27
Vigabatrin major side effect
Risk of PERMANENT vision loss
28
Gabapentin is more often used for _______ than _______
neuropathy rather than seizure control
29
Advantages of Gabapentin
-No PK drug interactions -Very well tolerated
30
Risks of Gabapentin
gabapentinoids in combo with opiates and severe resp distress
31
Main use of Pregabalin
Main use in NEUROPATHY, may be used for seizures and anxiety
32
Pregabalin main ADRs
Difficulty concentrating Risk for ataxia
33
Valproic Acid pregnancy risk
In utero exposure- lower IQ in children compared to other anti-epileptics (category D-X)
34
Valproic Acid ADRs
HYPERAMMONEMIA! Hepatotoxicity Thrombocytopenia LFTs, platelets, Ammonia!
35
Labs to check with Valproic Acid
Check LFTs, platelets, ammonia
36
Most common Glutamate blocker?
Topiramate (Topamax) Glutamate is excitatory Rare monotherapy for seizures
37
Glutamate blockers
-Perampanel (Fycompa) -Felbamate (Felbatol) -Topiramate (Topamax) "PFT"
38
Topiramate (Topamax) MOAs?
Multiple potential MOAs -inhibitory sodium effects -GABA etc...
39
Topiramate ADRs
Psychomotor slowing CNS side effects
40
Perampanel BB warning
-Serious or life threatening psychiatric and behavioral adverse effects -Aggression, hostility, irritability, anger, homicidal ideation, THREATS
41
Common ADR of Perampanel
Dizziness (43%)
42
Levetiracetam (Keppra) MOA
related to synaptic vesicle protein 2A (SV2A) which appears to be important for the availability of Ca-dependent NT vesicles ready to release their content
43
Does Keppra have any significant drug interactions?
No! -Basic seizure med side effects, -accidental injury, convulsion
44
Med used for Absence Seizures
Ethosuximide MOA: Depresses motor cortex calcium currents and elevated convulsive threshold
45
Triad of Overdose
Muscle relaxants, opiates, benzos
46
What kind of side effects does Cyclobenzaprine (Flexeril) have?
Anticholinergic Side Effects
47
Baclofen withdrawal symptoms with abrupt DC?
hallucinations, fever, agitation, tremor, tachycardia, seizure
48
How does Baclofen work?
Substance P inhibition into the spinal cord to reduce pain
49
Tizanidine MOA
Centrally acting alpha 2 agonist (precedex like)
50
Dantrolene MOA
Blocks ryanodine channel reduced Ca ++ release from SR
51
BB warning for Dantrolene
Dose dependent diarrhea and hepatotoxicity > 800mg/day long term
52
Skeletal Muscle Relaxant general recommendation
Most should not be used long term due to significant ADRs and increased duration
53
Sedative Hypnotics (Z drugs)
Zolpidem (Ambien) Zaleplon (Sonata) Eszopiclone (Lunesta BENZO-like
54
Amitriptyline (Elavil)
TCA that helps migraines and neuropathic pain
55
Tricyclic Antidepressant MOA and uses
MOA: Serotonin and Norepinephrine reuptake inhibition, Anticholinergic, 1A antiarrhythmic Used for pain a lot
56
Tx for TCA overdose?
Bicarb d/t metabolic acidosis
57
TCA ADRs
Anticholinergic side effects QT prolongation, arrhythmias
58
Most common antidepressant?
SSRIs Citalopram (Celexa) Fluoxetine (Prozac) Paroxetine (Paxil) Sertraline (Zoloft) Escitalopram (Lexapro) Fluvoxamine (Luvox)
59
SSRIs common side effects
-Hyponatremia (Check Na+ levels!) -Thrombocytopenia -Suicidality -SEROTONIN SYNDROME
60
Paxil has ________ side effects.
Anticholinergic
61
Neuroleptic Malignant Syndrome cause
Dopamine Antagonists
62
NMS distinct features
HYPOreflexia -normal pupils -normal or decreased bowel sounds -LEAD PIPE rigidity in ALL muscle groups Onset 1-3 days
63
SS distinct features
-HYPERreflexia -DILATED pupils -Hyperactive bowel sounds Faster onset < 12 hours
64
Check these with SSRIs
Vitals, Na+, platelets
65
SNRIs MOA
Serotonin and Norepinephrine reuptake inhibition
66
SNRIs ADRs
Hypertension (not related to SS) Norepi adds excitatory side effects
67
Example of DNRI
Bupropion (Wellbutrin)
68
Meds used for people who have failed 4-5 SS/SNRIs ZERO motivation
DNRIs MOA: Dopamine and NE reuptake inhibitor
69
5HT2A antagonists drug names
Mirtazapine (Remeron) depressed, cant sleep no appetite Nefazodone (Serzone) Trazodone (Desyrel) Vilazodone (Viibryd) Think SLEEP
70
5HT2A antagonist ADRs
ADRs: Highly sedating, increased appetite, hepatoxicity
71
Nuedexta ADRs (Dextromethorphan/Quinidine)
QT prolongation
72
Lithium action and MOA
Mood stabilizer (bipolar use) MOA: Alters neuronal sodium transport
73
Lithium has ______ of ADRs!
LOTS! (CNS and CV toxicity) Diabetes insipidus, polyuria, polydipsia Long term renal damage Toxicity Weight gain
74
Nigrostriatal side effects
EPS, TD, parkinsons like mvmt
75
Mesocortical symptoms
Negative symptoms, cognitive and affective sx (depressive, hidden)
76
Most serious Antipsychotic ADRs
EPS, TD
77
BB warning for Antipsychotics
Dementia related death, agranulocytosis
78
What is Carbidopa used for ?
false dopamine (similar to beta-lactamase inhibitor use)
79
MAOB inhibitor MOA ("giline")
Increase Dopamine availability via enzyme inhibition Rasagiline (Azilect) Selegiline (Eldepryl)
80
Acetylcholinesterase Inhibitors ADRs
Rest/digest side effects: Bradycardia Loose stools OAB
81
Withdrawal of Meds warning
Never d/c a psych medication without reviewing risk of withdrawal
82
Only meds that can be started and stopped?
Dementia meds
83
Post-Op Delirium for older adults
-May be fatal, preventable in up to 40% of cases -May be hypo or hyperactive or mixed presentation -Almost 50% not reported (particularly hypoactive)
84
Post-op delirium prevention
Cognitive re-orientation, sleep hygiene, early mobility, nutrition/fluids, pain mgmt
85
Never use ______ for post-op delirium unless in the case of _______.
Benzos ETOH withdrawal
86

Pharm 2 (5 decks)

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