Week 13/14 Neuro

Question 1

what is main CNS inhibitory neurotransmitter?

Answer 1

GABA

Question 2

what is main CNS excitatory neurotransmitter?

Answer 2

Glutamate

Question 3

what is a focal (partial) seizure?

Answer 3

localized in one cerebral hemisphere

Question 4

what is generalized seizure?

Answer 4

involves both cerebral hemispheres

Question 5

AE of antiepileptic

Answer 5

• neurotoxicity, sedation, ataxia, confusion, dizziness,

- many DDI

Question 6

therapeutic concerns with epileptic drugs

Answer 6

• sedation, dizziness, ataxia
• skin rashes - massage may exacerbate
• bone marrow depression and Vit K deficiency - check for bruising/bleeding

Question 7

3 subtypes associated with ADHD

Answer 7

inattentive, hyperactivity, and impulsivity

Question 8

stimulant medication MOA

Answer 8

block re-uptake of NE, dopamine, or both

Question 9

atomoxetine (Strattera) MOA

Answer 9

SNRI - selective NE reuptake inhibitor - blocks NE reuptake

Question 10

methylphenidate (Ritalin, Concerta) MOA

Answer 10

stimulant - blocks dopamine and NE reuptake

Question 11

amphetamine (Adderral) MOA

Answer 11

stimulant - blocks dopamine and NE reuptake

Question 12

common AE of stimulants

Answer 12

decreased appetite/weight loss, stomachache, insomnia, HA, rebound symptoms, jitteriness

Question 13

boxed warning of stimulants

Answer 13

safe if no baseline CV disease

report signs of abuse/dependence

Question 14

atomoxetine (Strattera) AE

Answer 14

similar to stimulants (decreased appetite/weight loss, stomachache, insomnia, HA, rebound symptoms, jitteriness) but more fatigue, sedation, and dizziness
- monitor mood changes

Question 15

Parkinson’s is related to a decrease in what?

Answer 15

dopamine

Question 16

what is dyskinesia

Answer 16

uncontrolled, involuntary movements

Question 17

levodopa-carbidopa MOA

Answer 17

Parkinson’s
l-dopa is a precursor to dopamine and can cross BBB and carbidopa stops the breakdown of l-dopa in the periphery so more l-dopa can cross BBB to be converted to dopamine

Question 18

levodopa-carbidopa AE

Answer 18

Parkinson’s

motor disturbances, end dose wearing off, delayed on, freezing

Question 19

MAO-B inhibitor MOA

Answer 19

Parkinson’s

inhibit monoamine oxidase B (MAO B) which breaks down dopamine

Question 20

MAO-B inhibitor AE

Answer 20

Parkinson’s

serotonin syndrome, watch for DDI

Question 21

COMT inhibitor MOA

Answer 21

Parkinson’s

inhibit COMT which breaks down l-dopa

Question 22

COMT inhibitor AE

Answer 22

Parkinson’s

involuntary movements, nausea

Question 23

dopamine agonists MOA

Answer 23

Parkinson’s

bind to and agonize dopamine receptor

Question 24

dopamine agonists AE

Answer 24

Parkinson’s

drowsiness, dizziness, syncope

Question 25

2 options for MS treatment

Answer 25

DMT - disease-modifying therapies and symptom management

Question 26

Interferon B AE and what needs to be monitored

Answer 26

MS - flu-like symptoms, HA, injection site reaction - fatigue, depression, pain, nausea, increase LFT, myalgia - monitor for neuropsychiatric changes, drug-induced hypothyroidism, worsening cardiac function

Question 27

Glatiramer acetate MOA

Answer 27

MS | reduce autoimmune response to myelin by reducing T-cell response against myelin

Question 28

Glatiramer acetate AE

Answer 28

MS | injection site reaction, rash, vasodilation, dyspnea, chest pain

Question 29

Sphingosine 1-Phosphate (S1P) receptor modulator MOA

Answer 29

MS | decrease inflammation

Question 30

Sphingosine 1-Phosphate (S1P) receptor modulator AE and what should you monitor

Answer 30

MS HA, increase LFT (liver function tests), macular edema, infection - monitor bradycardia

Question 31

dimethyl fumarate AE

Answer 31

``` MS GI (N/V/D, abdominal pain) and flushing - usually improve with time ```

Question 32

common ending for monoclonal antibodies

Answer 32

-mab

Question 33

monoclonal antibodies MOA

Answer 33

MS | decrease inflammation in CNS

Question 34

monoclonal antibodies AE and what should you monitor

Answer 34

MS infusion-related reactions, HA, fatigue, arthralgia - monitor for infection

Question 35

serious risk associated with monoclonal antibodies (-mab), dimethyl fumarate, and SP1 receptor modulators

Answer 35

PML - progressive multifocal leukoencephalopathy

Question 36

PML s/sx

Answer 36

altered mental status (AMS), aphasia, ataxia, hemiparesis, hemiplegia, visual disturbance, seizures

Question 37

what is the most common and disabling MS symptom

Answer 37

fatigue

Question 38

what neurotransmitter is depleted with Alzheimer's

Answer 38

ACh

Question 39

cholinesterase inhibitor MOA

Answer 39

Alzheimer's | - inhibits AChesterase which breaks down ACh = increase ACh

Question 40

cholinesterase inhibitor AE

Answer 40

Alzheimer's cholinergic AE - nausea, vomiting - SLUDGE

Question 41

NMDA Antagonists MOA

Answer 41

Alzheimer's | antagonizes NMDA receptor = stops activation by glutamate = decreases excitation and neuronal death

Question 42

NMDA Antagonists AE

Answer 42

Alzheimer's | - usually well tolerated; monitor for falls

Question 43

what should Alzheimer patients not be taking?

Answer 43

anticholinergic drugs

Question 44

tizanidine MOA

Answer 44

a2 agonist for spasticity | - bind to a2 receptors in CNS to decrease the release of excitatory neurotransmitters

Question 45

tizanidine AE

Answer 45

drowsiness, dizziness, asthenia (weakness)

Question 46

Flexeril AE

Answer 46

spasticity - sedation and dizziness - Beer's list

Question 47

Baclofen MOA

Answer 47

spasticity | - inhibit effect on alpha motor neurons through inhibition of excitatory neurons

Question 48

Baclofen AE

Answer 48

spasticity - abruptly stopping med can lead to: high fever, altered mental status, rebound spasticity, rhabdo - CNS depressant (sedation, CV depression), muscle weakness, TBI in older adults

Question 49

therapeutic concerns with antispasticity/muscle relaxant drugs

Answer 49

sedation and weakness