Pharm Animals

Question 1

When treating seizures, we want to decrease the activity of these types of channels?

Answer 1

Voltage-gated

Question 2

Phenytoin, Carbamazepine, Lamotrigine all decrease activity of ______ gated channels.

Answer 2

sodium

Question 3

Ethosuximide and Lamotrigine decrease activity of ______ gated channels.

Answer 3

calcium

Question 4

When it comes to treating seizures we want to decrease ________ activity and increase _______ activity.

Answer 4

Decrease glutamate activity

Increase GABA inhibitory activity

Question 5

What drugs do we use for tonic-clonic seizures?

Answer 5

Carbamazepine, Lamotrigine, Phenytoin, Gabapentin, Valproate

Question 6

Structural CNS lesion, abnormal EEG, partial seizure type, positive family history, postictal motor paralysis are all risk factors for?

Answer 6

Seizures!

Question 7

If someone has no risk factors, what are the chances that they will have another seizure?

Answer 7

10-15%

Question 8

If someone has 2 or more risk factors, what are the chances that they will have another seizure?

Answer 8

100%

Question 9

What two seizure drugs increase the concentration of P450 enzymes?

Answer 9

Carbamazepine and Phenytoin

But mainly Carbamazepine

Question 10

If you start someone on a new seizure drug, do you abruptly stop the other?

Answer 10

No.

Down titrate the original and up titrate the new.

Question 11

What is our tri-cyclic anti-seizure drug?

Answer 11

Carbamazepine

Question 12

What drug is our cyclic ureides anti-seizure drug?

Answer 12

Phenytoin

Question 13

What drug is our anticonvulsant?

Answer 13

Valproic acid

Question 14

What drug is our succinimide anti-seizure medication that is used for absence seizures in children?

Answer 14

Ethosuximide

Question 15

What seizure medication is a benzodiazepine?

Answer 15

Lorazepam (Ativan)

Question 16

Alzheimer’s disease is caused by a ______ deficit in the ______.

Answer 16

acetylcholine, hippocampus

Question 17

Therapeutic approach to treating Alzheimer’s:

Inhibit _______ metabolism by inhibiting __________.

Answer 17

acetylcholine, acetylcholinesterase

Question 18

Excess glutamate signaling produces increased _____ receptor Ca2+ channel activity

Answer 18

NMDA

This then induces secondary cascade leading to neuronal cell death.

Question 19

What drug is our CNS acetylcholinesterase inhibitor?

Answer 19

Donepezil (Aricept)

Question 20

What drug is our NMDA Receptor Antagonist?

Answer 20

NMDA Receptor anatagonist

Question 21

What 2 seizure medications do you have to supplement folate?

Answer 21

Lamotrigine and Phenytoin

Question 22

Parkinson’s disease is caused by loss of _______ cells in the _______ _______.

Answer 22

Dopamine, substantia nigra

Question 23

4 main symptoms of Parkinson’s?

Answer 23

Tremor, rigidity, bradykinesia, and gait abnormalities.

Question 24

What drug is our anticholinergic for Parkinson’s, and how does it work?

Answer 24

Benztropine (Cogentin)

MoA: acetylcholine receptor inhibitor – decreases the imbalance between dopamine and acetylcholine, increasing the amount of dopamine

Question 25

What drug is our NMDA Receptor Inhibitor and how does it work?

Answer 25

Amantadine (Symmetrel) MoA: decreases levodopa injury to NMDA receptor -- modulates levodopa impact on NMDA receptors which leads to bradykinesia, rigidity, and tremor

Question 26

What drug is our MAO-B inhibitor and how does it work?

Answer 26

Selegiline (Eldepryl) MoA: inhibits MAO-B enzyme with resulting rise in available dopamine in CNS

Question 27

What really sucks about MAO-B inhibitors?

Answer 27

They have a bajillion dx-dx interactions

Question 28

What drug is our dopamine agonist?

Answer 28

Ropinrole (Requip)

Question 29

What drug functions as our dopamine replacement?

Answer 29

Levodopa/Carbidopa

Question 30

What drug is our COMT inhibitor?

Answer 30

Entacapone (Comtan)

Question 31

How does Entacapone work?

Answer 31

Decreases levodopa metabolism to 3-OMD allowing more to be metabolized to dopamine

Question 32

MS is an autoimmune disorder that causes CNS __________ and axonal ________

Answer 32

demyelination, transection

Question 33

Demyelination leads to the ________ of MS. Axonal Transection leads to the _______ of MS.

Answer 33

Symptoms Relapses/Progression

Question 34

Most common type of MS is?

Answer 34

Relapsing remitting -- 85%

Question 35

How do we treat an acute relapse of MS?

Answer 35

Steroids

Question 36

What drug is a synthetic myelin basic protein?

Answer 36

Glatiramer acetate (Copaxone)

Question 37

By what percent does Glatiramer reduce relapse?

Answer 37

28%

Question 38

What sucks about Interferon B-1a

Answer 38

Neutralizing antibodies develop to interferon after 18-24 months use; 27% reduction in relapses in year 1

Question 39

What drug is a Monoclonal IgG4 antibody?

Answer 39

Natalizumab (Tysabri)

Question 40

What was the first oral medication?

Answer 40

Fingolimod (Gilenya)

Question 41

What drug is a sphingosine 1-PO4 receptor inhibitor?

Answer 41

Gilenya

Question 42

What drug do we use when all other treatments have failed?

Answer 42

Natalizumab (Tysabri)

Question 43

What drug is a Nrf2 Pathway Systemic Immunomodulator?

Answer 43

Dimethyl Fumarate (Tecfidera)

Question 44

By what percent does Tecfidera reduce relapse?

Answer 44

75%

Question 45

What drug is our peripheral muscle relaxant?

Answer 45

Dantrolene

Question 46

What drug is our CNS GABA agonist CNS antispasmodic?

Answer 46

Baclofen

Question 47

Trauma and chemical inflammation are what types of pain?

Answer 47

Nociceptive

Question 48

B12 deficiency, MS, CVA are examples of what type of pain?

Answer 48

Neuropathic

Question 49

If you have a patient complaining of 2/10 pain, what would their treatment look like?

Answer 49

Non-opioid analgesic, regular scheduled dosing

Question 50

If you have a patient complaining of 5/10 pain, what would their treatment look like?

Answer 50

Add an opioid to the non-opioid, still with regular scheduled dosing. For example, tylenol with codeine

Question 51

If you have a patient complaining of 8/10 pain, what would their treatment look like?

Answer 51

High potency opioid, regular scheduled dosing. For example: morphine or hydromorphone

Question 52

Acute pain is usually what type of pain?

Answer 52

Nociceptive

Question 53

Chronic pain is usually what type of pain?

Answer 53

Most commonly a combo of nociceptive and neuropathic

Question 54

Who do we need to avoid using aspirin in?

Answer 54

People with asthma + nasal polyps or chronic uritcaria

Question 55

Is aspirin reversible?

Answer 55

Nah dog.

Question 56

What is our COX-2 selective drug?

Answer 56

Celebrex

Question 57

What are the three CNS opioid receptors?

Answer 57

Mu, kappa, delta

Question 58

What is serotonin syndrome?

Answer 58

Excess stimulation of peripheral and CNS serotonin receptors

Question 59

What pain medication has the side effects of increased seizure risk and serotonin syndrome?

Answer 59

Tramadol (ultram)

Question 60

Codeine is metabolized to?

Answer 60

Morphine

Question 61

Hydrocodone + tylenol is?

Answer 61

Vicodin

Question 62

Vicodin is metabolized to?

Answer 62

Hydromorphone

Question 63

The long-acting monoproduct of oxycodone is?

Answer 63

Oxycontin

Question 64

What is the "standard high potency opioid analgesic"?

Answer 64

Morphine

Question 65

What are our two drugs for acute treatment of migraines?

Answer 65

Eletriptan (Relpax) and Sumatriptan (Imitrex)

Question 66

What drug do we give PPx for migraines?

Answer 66

Propranolol