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58 Cards in this Set
- Front
- Back
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What decreases the efficacy of L-dopa in Parkinson's disease
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Vit B6 (increases the peripheral breakdown of L-dopa)
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Why do you not take MAOIs with L-dopa
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Can cause HTN crisis
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MOA Carbidopa
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Inhibits the peripheral decarboxylase but does not penetrate BBB
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SE L-dopa
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Increases intraocular pressure (don't use in glaucoma pt)
Arrhythmias (don't use in heart pt) |
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SE Carbidopa
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N/V
Blood dyscrasia Dyskinesia Mydriasis Brown urine & saliva Psychic disturbances Tachycardia & hypotension |
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MOA Pramipexole
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Dopamine R agonist (greatest affinity for D3 R)
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MOA Ropinirole
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Dopamine R agonist (D2 & D3)
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MOA Rotigotine
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Dopamine R agonist (D1, D2, D3)
Not used much in US CI - sulfite allergy |
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MOA & SE Bromocriptine
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Direct DA agonist
N, hallucinations, confusion, delirium, orthostatic hypotension, serious CV problems, confusion Worsening of pre-existent ulcers |
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MOA Amantadine
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Enhance synthesis, release, reuptake DA from surviving neurons
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SE Amantadine
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Restlessness, hallucinations, confusion
Acute toxic psychosis |
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MOA Selegiline & Rasagiline
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Inhibits MAO-B
SE - HTN |
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What are these: Benztropine, Procyclidine, Trihexyphenidyl, Biperiden
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Anticholinergics
(specifically antimuscarinics) |
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Who are anticholinergics contraindicated in
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Glaucoma
BPH Pyloric stenosis |
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SE anticholinergic medications used to tx Parkinson's
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Visual problems
Mood changes Hallucinations |
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COMT inhibitors used for parkinson's disease
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Entacapone
Tolcapone |
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Why do you have to slowly taper WD of COMT inhibitors
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Can precipitate neuroleptic malignant syndrome
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Typical antipsychotics
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Chlorpromazine
Fluphenazine Haloperidol Droperidol Loxapine Malindone Perphenazine Thioridazine Thiothixene Trifluoperazine |
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SE Chlorpromazine
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Extrapyramidal SE
Significant anticholinergic effects Significant sedation Freq. hypotension, wt gain |
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SE Fluphenazine
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Higher risk of EPS
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SE Haloperidol
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Higher for EPS
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Who is thioridazine contraindicated for use in
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Hx cardiac arrhythmias
Risk QT prolongation |
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SE Thioridazine
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QT prolongation --> torsades
Anticholinergic effects Significant wt gain, hypotension |
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Second generation neuroleptics (atypical antipsychotics)
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Aripiprazole
Clozapine Olanzapine Paliperidone Quetiapine Risperidone Ziprasidone |
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SE Aripiprazole
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Anticholinergic effects
Sedation Some wt gain |
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SE Clozapine
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BM suppression --> agranulocytosis
(Check WBW freq) Sign. anticholinergic, sedation, hypotension, wt gain Cause diabetes |
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SE quetiapine
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Increased risk cataracts
(eye exam q6 mos) Sedating Sign. wt gain, hypotension |
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What are EPS (extrapyramidal SE)
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Dystonias
Parkinsonian symptoms Tardive dyskinesia (irreversible) |
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What is Neuroleptic malignant syndrome
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Fever
Encephalopathy Vitals - unstable Elevated m. enzymes (CPK) Rigidity of m. |
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Cause of neuroleptic malignant syndrome
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Large or rapid increase in dose of antipsychotic drug
(typically occurs in 1st 2 wks of starting drug) |
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Tx neuroleptic malignant syndrome
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Dantrolene
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Tx tonic-clonic seizure
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Phenytoin
Carbamazepine Phenobarbital |
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Tx absence seizure
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Ethosuximide
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Tx myoclonic seizure
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Valproic acid
Clonazepam (used to limit spread of seizure) |
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Tx febrile seizure
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Tx the cause - antipyretics
ongoing & recurrent - Phenobarbital |
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Tx status epilepticus
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Diazepam - DOC
Phenytoin |
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MOA phenytoin
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Decrease Na influx
Decrease Ca influx (highly bound to albumin) |
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SE Phenytoin
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Depress CNS - nystagmus, ataxia
N/V Gingival hyperplasia Megaloblastic anemia Inhibition ADH release Hyperglycemia Hirsutism Glucosuria P450 inducer TERATOGENIC |
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MOA phenobarbital
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Increases GABA effect
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MOA Carbamazepine
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Blocks Na channels
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SE Carbamazepine
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Stupor, coma
Resp. depression Drowsiness Vertigo Ataxia Blurred vision N/V Aplastic anemia --> agranulocytosis Thrombocytopenia Liver tox |
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SE Ethosuximide
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Blood dyscrasias (regular CBC monitoring)
Increases risk of grand mal seizure Use w/ caution in liver or renal dz |
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MOA Valproic acid
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Increases GABA concentration in brain
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SE Valproic acid
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Hepatotoxic
Multiple d-d interactions Life-threatening hepatitis, pancreatitis GI irritation Thrombocytopenia |
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SE Pregabalin
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Myopathy
Rhabdomyolysis Changes in vision |
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MOA Metoclopramide
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Dopaminergic antagonist
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Use metoclopramide
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N a/w chemo
(effective against extremely emetic cisplatin drugs) Post-op N |
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SE Metoclopramide
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EPS
(irreversible tardive dyskinesia) Parkinsonian effects Seizures |
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MOA Prochloperazine
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Dopamine R blocker
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SE Prochlorperazine
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EPS
Arrhythmias Sedation Seizures Leukopenia Thrombocytopenia Anticholinergic GI & urinary effects Neuroleptic malignant syndrome |
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MOA Promethazine
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Weak dopaminergic antagonist
Powerful H1 R antagonist |
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SE Dronabinol
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Cardiac
Cause or exacerbate psychiatric conditions (do not use if pt has seizure d/o) |
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Use dronabinol
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N a/w chemo
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5-HT3 inhibitors used as antiemetic
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Ondansetron
Dolasetron Granisetron Palonosetron |
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Use dimenhydrinated
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Mild to moderate N
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Use meclizine
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Vertigo
(H1 blocker) |
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Use Scopolamine
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Motion sickness
(Potent muscarinic blocker) |
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SE Scopolamine
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Promotes hallucinations & flying sensations
Sudden increase in libido |
