Q2 Flashcards
1
Q
What is Parkinson’s Disease?
A
Chronic, progressive, degenerative disorder of the CNS
2
Q
Symptoms of Parkinson’s Disease
A
Resting tremor
Bradykinesia
Rigidity
Postural instability
3
Q
Risk Factors of Parkinson’s
A
Age
Genetics
Sex
Exposure to Toxins
4
Q
Is there a reciprocal relationship between Dopamine and Acetylcholine?
A
Yes
5
Q
Vasodilator
A
Widening of the blood vessels in the cardiovascular system, allowing blood to flow more easily
6
Q
T/F - increasing acetylcholine activity by reducing dopamine increases the risk of EPS
A
True
7
Q
Bromocriptine (Parlodel)
A
Effective in the urgent treatment of NMS
8
Q
Dosage of Bromocriptine
A
1.25-40 mg
9
Q
What do Dopamine Receptor Agonists do?
A
Increase dopamine activity in the brain
10
Q
What do MAO-B Inhibitors do?
A
Prevent breakdown of brain dopamine by inhibiting the brain enzyme monoamine oxidase B
11
Q
Benztropine is used for?
A
Dystonia, Parkinsonism, Akinesia, Akathisia
12
Q
Benztropine dosage?
A
1-2 mg BID
13
Q
B blockers are?
A
Competes to bind at adrenergic receptors and has an antagonist effect on certain serotonin receptors
Used to reduce symptoms of Tardive Dyskinesia
Reduce blood pressure
14
Q
Example of a beta blocker
A
Propranolol
15
Q
Dosage of Propranolol
A
60-120 mg
16
Q
Antiparkinsonian Medications are absorbed where?
A
GI Tract
17
Q
Antiparkinsonian - Distribution
A
Throughout the body
18
Q
Antiparkinsonian - Metabolism
A
Liver
19
Q
Antiparkinsonian - Excretion
A
Urine and bile
Cross the placenta and enter breast milk
20
Q
What should be used to monitor side effects while on antipsychotic medication?
A
AIMS
21
Q
EMERGENCY - Antiparkinsonian
A
Dystonic Reactions (benztropine - oculogyric crisis, torticollis, opisthotonos)
NMS (bromocriptine - discontinue)
22
Q
DiphenhyDRAMINE
A
Benadryl
23
Q
DimenhyDRINATE
A
Gravol
24
Q
Common Side Effects of Antiparkinsonian Drugs - Autonomic
A
Dry mouth
Blurred vision
Constipation
Stomach irritation
Tachycardia
Urinary retention
Paralytic ileus
25
Common Side Effects - Antiparkinsonian - Behavioural
Confusion
Giddiness
Listlessness
Depression
Visual Hallucinations
26
Side effects of Propranolol
Congestive Heart Failure, Decreased Libido, Raynaud's syndrome
27
Side effect of Benadryl
Sedation
28
Amantadine
Orthostatic hypotension, livido reticularis (purple mottling to the skin), abnormal dreams
29
Biperiden
Fewer Ach effects, but can cause euphoria and increased tremor
30
Anticholinergic Withdrawal Symptoms
Nausea
Vomiting
Dyskinesia
Restlessness
Sweating
Anxiety
Depression
31
Anticholinergic Crisis
Dilated pupils
Increased thirst
Urinary retention
Paralytic ileus
Tachycardia
"hot as a hare, blind as a bat, mad as a hatter, dry as a bone"
32
Drug Interactions - Dopamine Receptor Agonists
Cholinesterase inhibitors
- used to slow the symptom progression of Alzheimer's - combination will produce an antagonistic action
33
Specifications of Benadryl
Drug of choice for children over the age of 6 and more than 9 kg
34
Monoamine Neurotransmitter Dysfunction
Deficiency of norepinephrine and/or serotonin
35
What are three biogenic amines?
Norepinephrine
Dopamine
Serotonin
36
What is monoamine oxidase?
Enzymes that catalyzes the breakdown of monoamines such as serotonin, dopamine and norepinephrine
37
Treatment of Depressive Disorders
First Generation - tricyclic antidepressants, monoamine oxidase inhibitors
Second Generation - selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors, atypical antidepressants
38
What do tricyclic antidepressants do?
Reduce the reuptake of 5HT and NE into nerves
Blocks dopamine and acetylcholine and histamine receptors
39
Tricyclic Antidepressants - Medications
Amitriptyline (50-300 mg)
Clomipramine (75-300 mg)
Nortiriptyline
Imipramine
40
Monoamine Oxidase Inhibitors
Inhibit Monoamine oxidase (MAO)
Allows accumulation of NE, 5HT, and dopamine in the synaptic cleft
41
Selective Serotonin Reuptake Inhibitors
Blocks 5HT with little effect on NE
Less adverse effects
42
Selective Serotonin Norepinephrine Reuptake Inhibitors
Prevent the reuptake if 5HT and NE
Weakly inhibit dopamine reuptake
43
Atypical Antidepressants
Bupropion (150-300mg)
Mirtazapine (15-60 mg)
Trazadone (150-600mg)
44
Antidepressants - Pharmacokinetics
A - GI Tract
D - Throughout body
M - Liver
E - Kidneys, cross placenta and enter breast milk
45
Considerations in Dosing for Antidepressants - Switching meds
- Usually switch to an antidepressant in a different chemical category
MAOIs are not trialed until two other chemical classes have failed
First drug is tapered off while second is started
MAOI and RIMA need a 2 week WASH OUT PERIOD
46
Adverse Effects - TCA & MAOI
Toxic effects if OD
47
Adverse Effect - SSRI and SSNRI
Sexual side effects (both)
SSNRI - Palpitations
48
Adverse Effect - ALL Anti-depressants
Serotonin syndrome
Antidepressant discontinuation syndrome (except fluoxetine)
49
ADS
If stopped suddenly
- flu like symptoms
- emotional lability
- anxiety and agitation
- dysesthesia (electric shock sensations)
- vivid dreams/nightmares
50
EMERGENCY - Serotonin Syndrome
Excessive serotonin in the synaptic cleft, caused by; combining medications that increase CNS serotonin levels
Cause: hyperthermia, seizures, rhabdomyolysis
51
Risk Factors of Serotonin Syndrome
Recent start or increase of medication
Polypharmacy that increases serotonin
Prevention
- provide person-centered education
- assess all medications, supplements, foods and recreational drugs
52
TCAS and Suicidal Ideation (EMERGENCY)
Lethal doses of TCAs are close to accepted dose range
Overdose is high
Death - hypotension, uncontrollable seizures, cardiac arrhythmia
SHOULD NOT BE PRESCRIBED FOR CLIENTS WITH RISK OF SUICIDE, OR HISTORY
53
MAOI and Risk of Hypertension
Sometimes termed irreversible MAOI
NE is a potent vasoconstrictor
- if there is a sudden release of NE, it can significantly increase blood pressure
- first symptom is occipital headache (severe), stiff neck, dizziness, incoordination
54
MAOI and Tyramine
Dried sausages - salami, pepperoni, pastrami
Alcoholic beverages - beer, unpasteurized beer
55
Antidepressant - Precautions
Suicidal ideation - high risk TCAs, MAOIs, SSRIs
Hypotension
Cerebral vascular disorder
Seizure disorder
56
Antidepressant Contraindications
Known hypersensitivity
Alcohol misuse
Mania
TCA - myocardial infarction or congestive heart failure
57
Theories of Mood Disorders
Biogenic Amine Hypothesis
Chronobiologic Theories
Sensitization and Kindling Theory
Genetic Factors
58
Treatment of Bipolar Disorders
Anti-Mania Medications
Anticonvulsant medications
Antipsychotic medication
59
Anti-Mania Medication
Lithium
60
Anticonvulsants
Carbamazepine
Lamotrigine
Valproic Acid/divalproex sodium
61
Antidepressants need to be administered with mood stabilizer because?
It will prevent rapid cycling from depression to mania
62
Pharmacokinetics - Mood Stabilizers - Lithium Carbonate
A - GI Tract
D - Same as water, crosses the blood brain barrier slowly
M - Liver
E - Kidneys, usually 80% of filtered lithium is re-absorbed
63
Lithium Carbonate - Dosage
Acute: 900-2400 mg
Maintenance: 400-1200 mg
64
Mood Stabilizers - Medication Dosage
Carbamazepine - 300-1600 mg
Iamotrigine - 100 - 500 mg
Valproic avid - 750 - 3000 mg
Divalproex sodium - 750 - 3000 mg
65
Lithium Carbonate
Serum Drug levels are required with lithium carbonate
Baseline bloodwork
- renal
- cardiac
- thyroid
- electrolytes
66
Therapeutic Range of Lithium Carbonate
0.6 - 1.0 mEq/L (mmol/L)
67
Maintenance Range for LiCO3
0.6-1.0 mEq/L
68
Lithium Carbonate and Sodium Intake
Sodium levels need to be maintained to avoid overhydration and dehydration
69
Overhydration
Decreases lithium level
70
Dehydration
Increases lithium level
71
Lithium Toxicity
Includes: GI discomfort, tremor, confusion, fatigue
Treatment: notify prescriber, withhold lithium, obtain a blood sample to measure lithium, emergency medical treatment, IV hydration
72
Lithium Contraindications
Renal impairment
Brain damage
Cardiac impairment
73
Lithium Precautions
NSAIDS
Thyroid conditions
Psoriasis
Hypercalcemia
74
Lithium Carbonate Interactions
Alcohol/diuretics - increase dehydration/fluctuating sodium levels
Haldol - increase encephalopathy syndrome
75
Lithium Carbonate - Older Adult Considerations
Caution with clients that have critical illness, renal, hepatic impairment
Lithium levels are 0.4-0.6 in older adults
76
Epilepsy
Prevalent of neurological disorders
Recurrent seizures that are not caused by secondary sources
77
Sx of Epilepsy
Loss of consciousness
Sensory disturbances
Chorea
Fainting
Partial - involves one hemisphere
Generalized - bilateral
78
Secondary cause of Seizures
Infectious disease
Trauma
Metabolic disorders
Vascular diseases
Neoplastic disease
OD
Withdrawal
79
Idiopathic Seizures
Alteration in cell membrane permeability
Altered distribution of ions
Imbalances in neurotransmitters
- GABA
- Acetylcholine
80
Anti-Seizure Medication
Drugs that potentiate GABA action
Drugs that suppress sodium influx
Drugs that suppress calcium influx
81
GABA is used for?
Calming effect
Helps control anxiety
82
Diazepam Use & Dosage
2-40 mg
Regularly used for treatment of alcohol withdrawal
83
Lorazepam Use and Dosage
0.5-4mg (max 6mg/day)
Alcohol withdrawal
84
Drugs that Suppress Sodium Influx
Delaying sodium ions from crossing the neuronal membranes
NA+ channels are temporarily inactivated
85
Drugs that Suppress Sodium Influx
Carbamazepine - 300-1600mg
Iamotrigine - 100-700 mg
Valproic Acid - 750-3000 mg
- toxic (150+)
86
Drugs that Suppress Calcium Influx
Delaying the entry of calcium into the neurons by blocking low-threshold Ca^2+ channels
Reduces the likelihood of an AP occurring
87
Anti-Seizure Medications - Pharmacokinetics
A - GI Tract
D - Widely & cross the placenta and enter breast milk
M - Liver
E - Kidneys
88
Status Epilepticus - EMERGENCY
Withdrawal of barbiturates, benzodiazepine, alcohol, infections, drug overdoses
Treatment:
Phenytoin - first line drug in treatment of status epilepticus
Phenobarbital - 20 mg/kg in single or divided doses
Diazepam - 5mg/min IV Push
Lorazepam - 2 mg/min IM or IV push
89
Seizure - Timing
5+ = status epilepticus
10+ = brain damage
90
Anticonvulsant Medications
Common Adverse Effects
CNS - Drowsiness, dizziness, diplopia
GI - Nausea, vomiting, indigestion
Other - vitamin deficiencies, hair loss
91
Serious Adverse Effects - AC Medications
Agranulocytosis
CNS Depression
Laryngospasm
Angioedema
92
AC Medication - Contraindications and Cautions
HS
CNS Depression
Phenobarbital - severe uncontrolled pain
Caution
Hepatic dysfunction
History of myocardial infarction
Pregnancy and breast feeding
93
Drug Interactions - AC medications - Hormonal contraceptives
Decrease effectiveness
94
DI - AC Med - Herbal - Gingko and Oil or Primrose
Increase severity and likelihood of seizures
