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My Pharm II > Quiz 8 > Flashcards

Quiz 8 Flashcards

1
Q

Treatment for first phase (5-20 min) of status epilepticus? Second phase (20-40 min)?

A
  • Benzo

- No true first choice for 2nd phase - fosphenytoin, valproic acid, keppra

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2
Q

3rd phase (40-60 min) of status epilepticus treatment

A
  • repeat second line

- anesthetic doses of thiopental, midazolam, pentobarbital, propofol

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3
Q

look at slide 6-7

A

.

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4
Q

GABA enhancers: Increased _________ movement through the GABA-A receptor, blocking pre-synaptic GABA uptake, inhibiting GABA metabolism by GABA transaminase, increasing GABA ______ (modulate glutamic acid decarboxylase)

A

chloride

synthesis

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5
Q

Glutamate blockers block what? (3)

A

NMDA
AMPA
kainate receptors- reduces the Na in/K out

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6
Q

Carbonic Anhydrase Inhibitors- blocks the normal function of increasing __ ions/reducing __ leading to K+ shifts to buffer acid base status and _________ seizure threshold.

A

H+

pH

increasing

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7
Q

Na channel blockers

A
  • ‘zepines
  • Dilantin
  • lotragine
  • ‘samides
  • Carbamazepine (Tegretol, Carbatrol)
  • Oxcarbazepine (Trileptal)
  • Eslicarbazepine (Aptiom)
  • Phenytoin/Fosphenytoin (Dilantin)
  • Lamotrigine (Lamictal)
  • Zonisamide (Zonegran)
  • Lacosamide (Vimpat)
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8
Q

Carbamezapime speed up or slow down other med metabolism?

A

speeds up, CYP inducer

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9
Q

Carbamazepine ADRs (3)

A
  • Stevens- Johnson syndrome
  • Increased LFTs
  • Hyponatremia
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10
Q

important for Eslicarbazepine

A

Adjust dose in renal impairment

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11
Q

Important for Phenytoin/Fosphenytoin

A
  • 70-95% protein bound

- Fosphenytoin = prodrug for parenteral administration

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12
Q

Phenytoin/Fosphenytoin ADRs

A 
Ginginval hyperplasia
Arrhythmias, cardiovascular depression, hypotension
Ataxia
Nystagmus
Osteoporosis
Blood dyscrasias
N/V
Rash
Vitamin K and folate deficiencies
Bone marrow hypoplasia
If given during pregnancy: cleft palate, cleft lip, congenital heart disease, slowed growth rate, mental deficiency
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13
Q

Lamotrigine ADR’s (5)

A
  • interaction with Valproic Acid
  • Blood dyscrasias
  • Ataxia, Tremor
  • Diplopia
  • Psychosis, insomnia
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14
Q

Zonisamide ADRs

A
  • Oligohidrosis in children

- confusion, speech abnormalities, mental slowing

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15
Q

important for lacosamide

A

Pregnancy Category C

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16
Q

GABA Agonists

GABA Reuptake Inhibitors

GABA Transaminase Inhibitors

GABA Other

A

GABA Agonists

  • Benzodiazepines
  • Phenobarbital
  • Primidone (Mysoline)

GABA Reuptake Inhibitors
-Tiagabine (Gabitril)

GABA Transaminase Inhibitors
-Vigabatrin (Sabril)

GABA Other

  • Gabapentin (Neurontin)
  • Pregabalin (Lyrica)
  • Valproate (Depakote
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17
Q

withdrawal risk greatest in which benzo

A

Clobazam (Onfi)

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18
Q

Highest safety risk of gabapentin in the operative setting

A

Post-op sedation

given 30 mins preoperatively

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19
Q

GABA analogue, binds alpha2 and delta receptor sites- reduced release of excitatory NTs via Calcium currents.

A

Pregabalin

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20
Q

Pregabalin ADRs

A

Rare - Angioedema

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21
Q

valproic acid (Depakote) concerns?

A
  • 85-95% protein bound - watch out for low protein/burn victims
  • In utero exposure- lower IQ in children compared to other anti-epileptics
  • Hepatotoxicity (highest risk in children), rare but fatal pancreatitis
  • Hyperammonemia

metabolized by liver

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22
Q

Glutamate Blockers names?

A

The -amates and parampanel

23
Q

High risk aplastic anemia and fatal hepatic failure?

24
Q

Topiramate MOAs (4)

A
  • Inhibitory sodium effects
  • GABA enhancement via unknown mech
  • AMPA inhibition
  • Weak carbonic anhydrase inhibitor
25
Perampanel common side effect concern?
Dizziness, irritability
26
Look at slide 43
.
27
look ast slide 47
.
28
Tizanidine action (2) and S/E (1)
- Centrally acting alpha 2 agonist - May potentiate glycine - Withdrawal also possible with abrupt discontinuation
29
Blocks ryanodine channel > reduced Ca ++ release from SR
Dantrolene
30
Dantrolene ADR and BB warning
-Dose dependent diarrhea and hepatotoxicity | BB warning > 800 mg/day with long term use
31
Can withdraw from sedative hypnotics like Ambien, True or false?
True
32
tricyclic antidepressants potential for?
Cardiotoxicity - QT prolongation, Arrhythmias
33
tricyclic antidepressants MOA (3)
- Serotonin and Norepinephrine reuptake inhibitition - Anticholinergic - 1A antiarrhythmic
34
Serotonin inhibitory receptors
1, 5
35
Serotonin receptor that is a Na/K ion channel?
3
36
look at slide 57
.
37
SSRI's ADRs (2)
platelets and sodium
38
SNRIs ADRs (2)
- Serotonin syndrome | - HTN
39
DNRIs inhibitory or excitatory?
excitatory
40
look at slide 63
.
41
Lithium MOA (1)
Alters neuronal sodium transport
42
Lithium ADRs (2 categories)
- Diabetes insipidus, polyuria, polydipsia | - Coma, Seizures, Tremors
43
More dopamine, more agitated you are and vice versa
.
44
Clozaril BB warning (2)
- dementia related death | - agranulocytosis
45
dopamine precurser
levadopa
46
false dopamine
carbadopa
47
COMT inhibitor
entacopone
48
MAOB Inhibitors MOA (1), examples?
Increase DA availability via enzyme inhibition Rasaligine (Azilect) Selegiline (Eldepryl)
49
for parkinsons with dementia? Concern?
- Amantadine (Symmetrel) - Nuplazid (Pimavanserin) QT prolongation
50
look at slide 76-77
.
51
Benzos have ________ withdrawal
FATAL
52
Post op delirium
Non-pharmacologic for prevention/treatment - Educate healthcare professionals - delirium vs dementia - Cognitive re-orientation, sleep hygiene, early mobility, nutrition/fluids, pain mgmt
53
Post op delirium, avoid which meds?
BDZs, anticholinergics, benadryl, H2 receptor antagonists, sedative/hypnotics, demerol, polypharmacy

My Pharm II (8 decks)

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