Week 1 antiepileptic 4 of 4 (6/3) Flashcards by Amanda D

these three side effects are more commonly associated with bromocriptine than those treated with levodopa.

hypotension

auditory and visual hallucinations

dyskinesia

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what med classification can occasionally cause pleuropulmonary fibrosis sometimes with pleural effusions?

synthetic dopamine agonists.

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what med classification can cause erythromelalgia (red, edematous, tender extremities)
uncommon complication

synthetic dopamine agonist

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synthetic dopamine agonists can cause an asymptomatic increases in what laboratory finding

serum transaminase (ALT)

alkaline phosphate (ALP)

liver enzymes

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what side effects are occasionally associated with bromocriptine

vertigo and nausea

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with respect to CNS side effects is there an advantage of non ergot alkaloids over ergot derivatives?

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with respect to nausea and orthostatic hypotension, is it important that non ergot alkaloids cause less nausea and orthostatic hypotension than ergot derivatives

this is clinically INsignificant.

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what are the effects of anticholinergic drugs such as trihexyphenidyl and benztropine on parkinson’s disease

blunt the effects of ACH- correcting the balance between dopamine and ACH

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what do anticholinergic drugs specifically help control in patients with parkinson’s disease

tremors and decrease the excess salivation.

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do anticholinergic drugs help parkinsons patients with their skeletal muscle rigidity and bradykinesia

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what are the side effects of treating parkinson patients with synthetic anticholinergic drugs?

anticholinergic drugs to treat patients with parkinson’s disease has diminished.

memory disturbances
hallucinations
confusion
sedation
mydriasis
cycloplegia
adynamic ileus
urinary retention

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name the antiviral drug used for prophylaxis against infection with influenza A

amantadine

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discovered by chance, this drug also produces symptomatic improvement in patients with parkinson’s disease

amantadine

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amantadine is speculated to aid parkinson’s patients by these three mechanisms

facilitating the release of dopamine from dopaminergic terminals

delay uptake of dopamine back into nerve endings

antagonist effects at NMDA receptors.

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amantadine is different from anticholinergics drugs for in its ability to improve what two symptoms

muscle rigidity

bradykinesia

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side effects of amantadine are similar to anticholinergics but in addition can induce

ankle edema

livedo reticular of the legs with or without cardiac failure

Livedo reticularis is a rare skin condition caused by stagnation of blood within dilated capillaries causing a lacy, nonraised pink/purple net-like blotchy skin discoloration -google_

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non pharmacologic treatments of parkinson’s disease include

deep brain stimulation

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deep brain stimulation mechanism of action?

what specific benefit to the patient does it provide

unknown MOA

benefits controls symptoms resistant to medications, allows reduced reliance of drugs.

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what type of drugs are selegiline and rasagiline

monoamine oxidase type B enzyme inhibitors (MAO-B)

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MAO-B antiparkinson effect when used alone?

MAO-B antiparkinson effect when combined with carbidopa-levodopa

alone- weak

adjunt- moderate effect

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name the significant side effect of selegiline

insomnia

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other side effects of selegiline

confusion, hallucinations, mental depression paranoid ideation

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avoidance of tyramine is ideally recommended if patient is on what class of medication

MAO-B

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what two ways do analeptics increase excitability

blocking inhibition or by enhancing excitation

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this class of medication was used in CNS depressions after a person deliberately overdosed on drugs- No longer used for this purpose

CNS stimulants

CNS stimulants margin of safety is___

low

This centrally acting analeptic also acts peripherally on chemoreceptors augmenting breathing efforts

doxapram

doxapram 1mg/kg IV dose is similar to that produced by a pa02 of _____ acting on the carotid bodies

are doxapram positive effects seen because of increasing in breathing frequency or increase in tidal volume?

increase in tidal volume is response for the induce increase in minute ventilation

doxapram increase minute ventilation- what happens to o2 consumption

o2 consumption increases

doxapram margin of safety?

large margin of safety

how many fold difference in the dose that stimulates ventilation and the dose that produces seizures for doxapram

20-40 fold difference

how long dose a single dose of doxapram last? due to this what must we do?

single dose 5-10min continuous infusion may be required

a continuous infusion of doxapram often results in what clinical manifestations?

``` sub convulsive CNS stimulatiion HPTN tachy cardiac dysrhythmias vomiting increased body temp ```

how extensive is doxapram metabolized? what percent is excreted unchanged in the urine

extensively metabolized <5%

doxapram iv infusion dose

2-3mg/min

this drug can be used to maintain ventilation during administration of supplemental 02 to patients with COPD who would otherwise rely on hypoxic drive to maintain

doxapram

post operatively doxapram has been used to prevent { this } produced by opioids without altering analgesia

ventilatory depression

other than helping patients breath- why else would we want to give doxapram to our post op patients

shown to be useful in stopping post op shivering

what can we administer to neonates in the ICU in lieu of placing an advanced airway

doxapram used for apneic babies to delay or prevent intubation and ventilation

what 4 conditions can we give dantrolene for

Thyroid storm NMS-neuroleptic malignant syndrome spastic disorders- associated with hepatic dysfunction MH

compare dantrolene to ryanodex | sterile water to reconstitute

dantrolene-60ml ryanodex- 5ml

compare dantrolene to ryanodex | shelf life

dantrolene 3 years ryanodex 2 years

compare dantrolene to ryanodex | mannitol

dantrolene 3000mg ryanodex 125mg

why do we not used ryanodex?

its more expensive (2,581) vial

revonto vial contains how many mg | ryanodex vial contains how many mg

revonto- 20mg ryanodex -250mg

ryanodex has enough dantrolene in a single vial for a loading dose in what kg patient

100kg

most serious complication of dantrolene use?

generalized muscle weakness that may result in respiratory insufficiency or aspiration PNA

why do we use a CVL with dantrolene

can cause phlebitis in small peripheral veins

dantrolene dose

2.5mg/kg- 10mg/kg q5min until episode has stopped follow up with 1mg/kg q6hrs for 24-48 hrs

dantrolene vs ryanodex time to reconstitute

86sec vs 20sec

mechanism of action for dantrolene

DIRECTLY INTERFERES WITH MUSCLE CONTRACTION BY BINDING THE Ryr1 RECEPTOR CHANNEL AND INHIBITING CALCIUM ION RELEASE FROM THE SARCOPLASMIC RETICULUM

per flood- half life of dantrolene

9 hrs

dantrolene exerts antispasmodic effect by decrease what release from SR

calcium

PO absorption of dantrolene?

slow and incomplete

starting oral dose of dantrolene

25mg BID

max oral dose of dantrolene

200mg/day

what do we have to check prior to starting dantrolene?

lab investigation for liver dysfunction should be explore prior to use d/t potential hepatotoxicity

primary indication for centrally acting muscle relaxants

spasticity with accompany pathologic conditions such as stroke, cerebral palsy, multi sclerosis, amyotrophic lateral sclerosis and CNS injuries.

centrally acting muscle relaxants act where

on CNS or on skeletal muscles to relieve spasticity

this medication is a chlorophenol derivative of GABA

baclofen

does baclofen have any effect on the NMJ

where does baclofen act as an agonist

at GABA (B) receptors in the dorsal horn of the spinal cord

what is baclofen often administered for treatment of

spastic hypertonia of cerebral and spinal cord origin

MOA- baclofen

activating G protein linked presynaptic gaba b receptors that hyper polarize muscles spindle afferent neurons. there by decreasing the number and amplitude of excitatory postsynaptic potentials along the dendrites of motor neurons

baclofen is particularly effective in treatment of

Flexor spams | Skeletal muscle rigidity associated with spinal cord injury or MS

which administration route may be an effective treatment of spinal spasticity that has not responded to oral adminstration

intrathecal

how is baclofen absorbed in the gi tract

rapidly and almost completely

elimination half time for baclofen

3-6hrs

what percent of baclofen is excreted by the kidneys

80% dose may need to be adjusted with renal dysfunction

side effects of baclofen

sedation skeletal muscle weakness confusion

if you suddenly d/c chronic use of baclofen what may occur

withdrawal

therapeutic plasma concentrations of baclofen

80-400mg/ml

accidental intrathecal overdose of baclofen

hemodynamic instability and delayed awakening following general anesthesia

overdose of baclofen | seizure concerns

Threshold for initiation of seizures may be lowered in pts with epilepsy

sudden d/c of baclofen vocal cord concerns

Vocal cord spasm following abrupt d/c of intrathecal infusion

what may occur with an overdose of baclofen

Coma, depression of ventilation and seizures with overdose

Sudden d/c of chronic baclofen use may result in severe withdrawal reactions:

Tachy Auditory and visual hallucinations A known case of cardiac arrest has been reported

this CNS stimulant is a methylxanthine derived phosphodiesterase inhibitor that is present in a variety of drinks

CAFFEINE!!

(3) pharmacologic uses of caffeine include

administration to neonates experiencing apnea of prematurity treatment for postural puncture headache common cold remedies to offset the sedating effects of certain antihistamines

this medication is used for patients with excessive day time sleepiness associated with narcolepsy, OSA, shift work sleep disorder

modafinil

this drugs acts on the carotid body chemoreceptors to increase minute ventilation

almitrine

this drug is used to prevent one lung ventilation hypoxia

almitrine

caffeine, theophylline and theobromine are called

methylxanthines

methylxanthines can do what 4 things

stimulate CNS produce diruesis increase myocardial contractility relax smooth muscle

this drug treats ADHD

methylphenidate

side effects seen with methylphenidate

``` HTN tachycardia priapism seizures serious cardiovascular events stroke MI ```

carbamazepine and rifampin interaction with theophylline produce

enhancement of theophylline

cimetidine, erythromycin interact with theophylline produce

inhibition of theophylline

how must benzo's be administered in the presence of theophylline

you must increase the dose of benzo

what may occur in patients being treated with oral baclofen

mild hypotension in awake patients

patients treated with oral baclofen given general anesthesia may experience

bradycardia and hypotension and delayed awakening.

Week 1 antiepileptic 4 of 4 (6/3) Flashcards

slide 72-94 (92 cards)