Unit 5 CNS Agents ppt. slides

Question 0

phenelzine (Nardil)
tranylcypromine (Parnate)
isocarboxazid (Marpan)
are all examples of :

Answer 0

MAOIs

Question 1

fluoxetine (Prozac)
citalopram (Celexa)
fluvoxamine (Lyvox)
paroxetine (Paxil)
Sertraline (Zoloft) are all examples of :

Answer 1

SSRIs

Selective serotonin reuptake inhibitors

Question 2

Avoid use of MAOIs and Opiods with what class of medication?

Answer 2

SSRIs

Question 3

Anti depression meds belong to which enzyme family?

Answer 3

CYP2D6

Question 4

Codeine, Fentanyl, Hydrocodone, Meperidine and Oxycodone belong to which enzyme family?

Answer 4

CYP2D6

Question 5

Codeine, Hydrocodone, and Oxycodone are all prodrugs. If a prodrug is poorly metabolized it will result in

Answer 5

Little effect.

Question 6

clonazepam (Klonopin), cocaine, diazepam (Valium), and zolpidem (Ambien) are all metabolized by which enzyme?

Answer 6

CYP3A4

Question 7

The focus of therapy for pain should start with

Answer 7

Non-narcotic treatment first

Question 8

Depression first line pharmacological treatment

Answer 8

SSRIs: fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro)

Question 9

Anxiety first line treatment :

Answer 9

SSRIs and SNRIs

Question 10

Treatment for panic disorder :

Answer 10

Acute: Benzodiazepine

Long term: SSRI (Prozac most common)

Question 11

Patients with Alzheimer’s Disease have a reduced cerebral production of

Answer 11

choline acetyl transferase

Question 12

Treatment for Dementia

Answer 12

Cholinesterase inhibitors :
donepezil (Aricept) first line !
rivastigmine (Exelon)
galantamine (Razadyne)
NMDA receptor agonist : memantine hydrochloride (Namenda)

Question 13

Non pharmacological treatment for dementia:

Answer 13

Symptomatic treatment: environmental manipulation, support function, safety precautions, treatment of behavioral disturbances

Question 14

ADHD first line treatment:

Answer 14

methylphenidate (Ritalin, Methylin,Concentra)

Watch for decrease in seizure threshold !!!

Question 15

Bell’s palsy is caused by

Answer 15

Viral etiology. Trauma to peripheral branches of facial nerve.

Question 16

Bell’s palsy treatment:

Answer 16

Prednisone (60-80mg/day) and
Valacyclovir (1000mg TID)

X 1 week

Question 17

Insomnia treatment:

Answer 17

Benzodiazepines: triazolam, lorazepam (Ativan), temazepam (Restoril)

Nonbenzodiazepine sedatives: zolpidem (Ambien) :Melatonin agonist
Nonbenzos in elderly: prevent falls

Question 18

Headache drug treatment:

Answer 18

Aspirin, acetaminophen, ibuprofen, ketoprofun, naproxen

Question 19

Migraine treatment

Answer 19

NSAIDs first

If responding poorly : triptans, DHE,ergotamine

Question 20

Trigeminal Neuralgia treatment :

Answer 20

Carbamazpine (Tegretol)

100-200 mg BiD

Question 21

Febrile seizures (pedi) treatment

Answer 21

fosphenytoin (15 to 20 mg/kg IV) for persistent seizures

Question 22

Drug of choice for Parkinson’s disease:

Answer 22

Levodopa

Question 23

First choice for mild osteoarthritis pain

Answer 23

Acetaminophen

Question 24

Maximum Tylenol dosage for adult is

Answer 24

4 G/day

Question 25

Aspirin mechanism of action:

Answer 25

Inhibit production of prostaglandins, prostacyclin, and thromboxanes in the CNS and peripheral tissue. Pain is relieved when inflammation is decreased and prostaglandins are reduced.

Question 26

Steps in treating pain:

Answer 26

1. Non pharmacological treatment first ! 2. Acetaminophen 3. NSAIDs

Question 27

Treatment steps in ADHD

Answer 27

1. Counseling for parent or guardian 2. methylphenidate 3. long acting methylphenidate if kid has problem with multiple doses 4. Amphetamine salt 5. TCA antidepressant ( for patients with substance abuse) 6. Bupropion for pts with cardiac disease

Question 28

Cholinesterase inhibitors mechanism of action

Answer 28

Blocks enzyme that degrades acetylcholine in brain therefore increasing acetylcholine at synaptic cleft and enhances cholinergic transmission. Improves function and slows progression of dementia.

Question 29

Emphasize to dementia patients families that medication treatment

Answer 29

Is not a cure

Question 30

``` Hydantoin: Phenytoin Succinimide: Ethosuximide GABA analogs: valproic acid, gabapentin, pregabalin, topiramate Barbiturates: Phenobarbital, primidone Benzodiazepines: Diazepam, clonazepam Are all examples of : ```

Answer 30

Antiepileptics

Question 31

Mechanism of action antiepileptics

Answer 31

All meds increase the threshold of the CNS to convulsive stimuli or inhibit the spread of seizure activity.

Question 32

Discontinuation of antiepileptic therapy may be considered in patients who have been seizure free for ___ years.

Answer 32

2

Question 33

T/F All antiepileptics have been associated with an increase in birth defects

Answer 33

True ! Cleft lip and palate, cardiac and septal defects, neural tube defects

Question 34

Parkinson's disease patient has a lack of :

Answer 34

Dopamine Tx. Levadopa converts to dopamine

Question 35

Treatment principles of antidepressants:

Answer 35

1. Establish diagnosis 2. Assess suicide risk 3. Initiate counseling 4. Offer no pharmacological tx. 5. Drug therapy 6. Continue treatment 4-9 months.

Question 36

Nonpharmacologic treatment for depression:

Answer 36

``` Psychotherapy Relaxation techniques Nutrition Exercise Sleep Hygiene ```