Pharmacology- Neuro

Question 1

What are some first generation AEDs??

Answer 1

Phenobarbital
phenytoin
primidone
ethosuximide
diazepam
lorazepam
carbamazepine
Valproic acid, divalproex

Question 2

What are considered broad spectrum, second generation AEDs?

Answer 2

Lamotrigine
levetiracetam
oxcarbazepine
Zonisamide

Question 3

broad spectrum AED medications means?

Answer 3

They can be used for generalized and focal seizures

Question 4

Benefits of 2nd generation AEDs?

Answer 4

they are equally as effective as first generation AEDs
they are considered clean drugs- less drug interactions, less symptoms

Question 5

what are some very important second generation AED medications?

Answer 5

Gabapentin
lamotrigine
levetiracetam
oxcabazepine
zonasimide

Question 6

What are some things to think about when choosing an AED?

Answer 6

seizure type(most important)
mechanism of action
pharmacokinetics
concomitant medical/psychiatric conditions
adverse side effects
cost

Question 7

Why is it important to know the seizure type?

Answer 7

picking the wrong drug can cause seizure to get worse

Question 8

What are some first line medications for focal seizures, either impaired aware, with or without secondary generalization)

Answer 8

Carbamazepine- MOST common
lamotragine
levetiracetam
oxcarbazepine
perampanel

Question 9

what are some medications that are first line for ELDERLY patients w/ focal aware or impaired awareness (partial seizures)

Answer 9

Lamotrigine
gabapentin

Question 10

what is first line treatment for non-motor (Absence)

Answer 10

Ethosuximide
Divalproex

Question 11

what are alternative or add-on therapies that should be considered for Absence seizures

Answer 11

Clonazepam
lamotrigine
levetiracetam
zonisamide

Question 12

What is first line treatment for Tonic Clonic seizures?

Answer 12

Divalproex
lamotrigine
levetiracetam
* broad spectrum medication*

Question 13

what is first line treatment for generalized onset motor (atonic or myoclonic)

Answer 13

Divalproex
lamotrigine
levetriacetam

Question 14

First line treatment for status epilepticus (*medical emergerncy)

Answer 14

1st. IV/IM/BZD
(diazempam, lorazepam, or midazolam)
OR rectal diazepam (very fast onset)
2nd. IV Fosphenytoin

Question 15

Alternative line treatment for status epilepticus (*medical emergerncy)

Answer 15

IV phernobarbital

Question 16

first line medication for Infantile spasms (may be focalized or generalized onset epileptic spasms)

Answer 16

vigabatrin

Question 17

What is the mechanism of seizures

Answer 17

seizures are a mismatch of excitation and inhibition

Question 18

what is the culprit of excitation in seizures?

Answer 18

glutamate

Question 19

AEDs for seizures often target?

Answer 19

glutamate or GABA

Question 20

what helps to provide inhibition

Answer 20

Gaba

Question 21

A majority of AEDs block what?

Answer 21

Sodium

Question 22

What are possible mechanisms of actions for AEDs to decrease excitation

Answer 22

-inhibit voltage gated Na+ channels to prevent release of neurotransmitters
-inhibit voltage-gated Ca2+ channels to prevent release of neurotransmitters
-inhiber neurotransmitter release by binding to SV2A
-antagonize glutamate activity at receptor sites

Question 23

what are the possible mechanisms of actions for AEDS to increase inhibtion

Answer 23

-enhance GABA action by increasing concentration (block reuptake, block metabolism)
-enhance GABA action by modulating GABA receptor mediated Cl- current
-activation of K+ channels by ezogabine

Question 24

what AEDs are sodium channel blockers

Answer 24

phenytoin
carbamazepine
oxcarbazepine
lamotrigine
lacosamide
rufinamide

Question 25

what AEDs are glutamate receptor blockers

Answer 25

topiramate zonisamide

Question 26

what AEDs are GABA enhancers?

Answer 26

Benzodiazepines barbituates valproic acid vigabatrin tiagabine

Question 27

Something to know about Lamotrigine

Answer 27

Must start with low dose and titrate slowly to avoid steven johnsons syndrome

Question 28

which AEDs are CYP enzyme inducers? What does that mean?

Answer 28

carbamazepine oxcarbazepine phenobarbital pheytoin topiramate * lower concentration of other drugs- causing failure

Question 29

Which AEDs are CYP inhibitors? what does that mean?

Answer 29

Oxcabazepine topiramate valproic acid * may inhibit enzyme causing toxicity.

Question 30

which medications put you at risk for stevens-johnson syndrome?

Answer 30

Carbamazepine, lamotrigine (TOP TWO) Levetiracetam, phenytoin, zonisamide

Question 31

what is the first line treatment for tension-type headache? what should you keep in mind?

Answer 31

Over the counter NSAIDs and Acetaminophen as needed * medication overuse headache may superimpose if treatment is used too often

Question 32

what are non-specific treatments of migraines- specific treatments? who is this medication for?

Answer 32

Triptans ergotamines

Question 33

which medications are triptans?

Answer 33

sumatriptan rizatriptan zomiitriptan

Question 34

how do you pick which triptan to prescribe?

Answer 34

consider migraine attack duration? Longer lasting attack may be treated better with a longer half life if patient is vomiting- choose non-oral formulation may be better rapid onset attacks may benefit from nasal/subcutaneous route

Question 35

which medication is an ergotamine?

Answer 35

dihydroergotamine

Question 36

MOA: selective 5-hydroxtryptamine, serotonin (5-HT) agonists

Answer 36

triptans

Question 37

5-HT receptor agonist. Non-oral treatment that is available in intra-nasal, injectable and IV forumulations

Answer 37

Dihydroergotamine

Question 38

which medications are anti-emetic medications?

Answer 38

ondansetron metoclopramide, prochlorperazine, promethazine

Question 39

antiemetics such as metoclopramide, procholorperazine and promethazine need to be used with benadryl... why?

Answer 39

to reduce the risk of extrapyramidal side effects

Question 40

what is the MOA of metoclopramide and procholoperazine?

Answer 40

dopamine receptor blocker

Question 41

promethazine has what mechanism of action?

Answer 41

H1 receptor blocker and weak dopamine antagonist

Question 42

what treatments are used for cluster headache?

Answer 42

-inhaled oxygen -subcutaneous imitrex

Question 43

what classes of medications can be used for headache prevention?

Answer 43

Antiepileptic drugs antidepressant drugs beta-blockers calcium-channel blockers

Question 44

what is widely used as a first line preventative (mostly for migraine)

Answer 44

topiramate

Question 45

which medication is highly terotogenic, so it is not give to reproductive age females?

Answer 45

valproate

Question 46

what antidepressants can be used as preventative treatments for headache?

Answer 46

amitriptyline and other tricyclic antidepressants (star at lower dose) venlafaxine ( very good for migraine prevention; start at lower dose)

Question 47

Beta-blockers are often a great option for long-term prevention of migraines. What medication is a beta-blocker?

Answer 47

propranolol

Question 48

what is considered the treatment of choice for cluster headaches

Answer 48

verapamil

Question 49

what are preventative treatments for tension type headache?

Answer 49

amitriptyline venlafaxine

Question 50

what is a good alternative to verapamil used for cluster headaches when the patient has shorter active cluster periods?

Answer 50

glucocorticoids (prednisone, etc)

Question 51

What is the preferred treatment Guillain-Barre syndrome?

Answer 51

plasma exchange (removes antibodies from the blood) IVIG (intravenouse immuge globulin)

Question 52

what medication could you prescribe for bell's palsy patients?

Answer 52

steroids (prednisone) to reduce inflammation are associated with good facial functional recovery *antiviral medications

Question 53

what are treatment options for myasthenia gravis?

Answer 53

Treatment is acetylcholinesterase inhibitors, immunosuppressants or thymectomy

Question 54

what is the preferred treatment option for acute attacks in a patient with MS?

Answer 54

glucocorticoids (for functionally disabling symptoms associated with relapse)

Question 55

How is methylprednisolone used for MS care

Answer 55

it is used as IV short course to shorten the recovery time from moderate to severe relapses

Question 56

what are some adverse reactions seen from the use of methylprednisolone?

Answer 56

mental status changes increased infection fracture risk

Question 57

what is a form of platform injection therapy

Answer 57

interferon beta

Question 58

which drug decreases inflammation in the CNS by preventing inflammatory leukocytes from entering the CNS? It also decreases the number of lesions found on MRI

Answer 58

Interferon Beta

Question 59

what are are some adverse reactions the treatment with interferon beta?

Answer 59

injection site necrosis flue like sxs liver dysfunction development of neutralizing antibodies

Question 60

what is a platform injection therapy?

Answer 60

Glatiramer acetate

Question 61

which drug is a synthetic protein that mimics the structure of myelin, blocking the damaging T cell. it also decreases inflammation, working primarily inside the CNS to promote anti-inflammatory activity

Answer 61

glatiramer acetate

Question 62

what drugs are considered monoclonal antibodies?

Answer 62

natalizumab & mixoantrone

Question 63

which drug blocks the molecular pathway involving cell adhesion that draws the lymphocytes into the CNS

Answer 63

natalizulamab

Question 64

which drug is antineoplastic agent that supresses the activity of T cells, B cells and macrophages that lead the attack on myelin

Answer 64

mitoxantrone

Question 65

What should you know about monoclonal antibodies as therapy of MS?

Answer 65

- both of these have high side effect profiles and serious safety issues -also the highest efficacy therapy

Question 66

what is the first line treatment of essential tremor? What class of drug is it?

Answer 66

Propranolol beta blocker

Question 67

What is another medication treatment alternative for essential tremor?

Answer 67

Primidone(2nd line) topiramate (3rd line) gabapentin (4th line) anticonvulsants * clonazepam and alprazolam- benzodiazepam (4th line)

Question 68

what are other treatment options for essential tremor?

Answer 68

occupational therapy assistive devices deep brain stimulation MRI guided focused ultrasound

Question 69

what are the treatment options for restless leg syndrome

Answer 69

Iron supplementation eliminate/replace offending medications dopamine agonists (pramipexole, ropinirole) carbidopa-levodopa gabapentin

Question 70

what is the gold standard for treating Parkinson's disorder?

Answer 70

carbidopa/levodopa

Question 71

what are positives and negatives of carbidopa/levodopa

Answer 71

positives: effectively controls motor symptoms negatives: short half life- eventually the effectiveness decreases, so timing between doses shortens

Question 72

what side effects standout with Carbidopa/levodopa?

Answer 72

dyskinesia- (often times due to overmedication) motor fluctuations

Question 73

What drug can you give with carbidopa/levodopa to help with dyskinesia?

Answer 73

amantadine

Question 74

when would you use amantadine as a monotherapy for parkinson's?

Answer 74

In early disease course and when tremor is the predominant symptom

Question 75

what drug can you give with carbidopa/levodopa to help with motor fluctuations?

Answer 75

COMT inhibitors (Entacapone, Tolcapone)

Question 76

What option can you give a patient who needs a COMT inhibitor and carbidopa/levodopa?

Answer 76

stalevo (combined pill of Carbidopa/levodopa and Entacapone)

Question 77

what is the benefit of COMT inhibitors

Answer 77

Extends the life of levodopa by stopping the breakdown of levodopa before it reaches the brain

Question 78

why can't you use a COMT inhibitor by itself?

Answer 78

it has no no benefit as a monotherapy

Question 79

which medications are dopamine agonists?

Answer 79

pramipexole ropinirole rotigitine bromocriptine

Question 80

what is a side effect that is very concerning with dopamine agonists?

Answer 80

Impulse control issues * pathological gambling, compulsive eating, compulsive shopping, hypersexuality

Question 81

what is often a first line treatment for mild symptoms of parkinson's?

Answer 81

MAO-B inhibitors

Question 82

which drug class breaksdown dopamine by monoamine oxidase B

Answer 82

MAO-B inhibitors

Question 83

what drugs are MAO-B inhibitors

Answer 83

Rasagiline selegiline

Question 84

what is the benefit of using MOA-B inhibitors with carbidopa/ levodopa?

Answer 84

prolongs the effectiveness of dopamine, so improves motor fluctuations

Question 85

what drugs are anticholinergics?

Answer 85

trihexyphenidyl benzotropine

Question 86

when is the use of anticholinergics beneficial? when should you not use it?

Answer 86

can be useful in younger patients with tremor predominant disease OR in more advanced cases where tremor is still present despite other treatments Avoid- in the elderly-confusion, hallucinations

Question 87

what are nonmedical treatments for parkinson's

Answer 87

physical therapy and occupational therapy exercise like rock steady therapy surgical treatments like ablative surgery, deep brain stimulation

Question 88

what medication should always be given to treat gram positive bacterial meningitis ?

Answer 88

ceftriaxone

Question 89

what else can be given to treat gram-positive infections?

Answer 89

vancomycin