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67 Cards in this Set
- Front
- Back
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carbamazine |
Treat generalize & partial tonic-clonic seizure MOA: Na+ channel blocker ADR: ataxia, aplastic anemia, GI distress, cognitive impairment DI: erythromycin, fluoxetine, chloramphenicol, isoniazid, verapamil, propoxyphene, valproate, phenytoin, felbamate |
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phenytoin |
Treat generalize & partial tonic-clonic seizure MOA: Na+ channel blocker ADR: anemia secondary to folate deficiency, coarsening of facial features, hirsutism, peripheral neuropathy, gingival hyperplasia, dipoplia, ataxia, nystagmus, dec. bone density DI: CYP3A4 inhibitors increase levels CYP3A4 inducers decrease levels Pregnancy category D |
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valproic acid |
Treat generalize & partial tonic-clonic seizure Treats generalized absence seizures MOA: Blocks Na+ Channels, blocks T-type Ca++ channels, increases GABA, decreases glutamate ADR: tremor, weight gain, thrombocytopenia, hepatotoxicity (esp in children) DI: ASA, isoniazide and felbamate inc levels carbamazine and phenytoin dec levels Pregnancy category D |
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phenobarbital & primidone |
Treat generalize & partial tonic-clonic seizure MOA: Increases GABA, primidone blocks Na+ channels ADR: ataxia, dizziness, cognitive impairment, folate, vit D & K deficiencies, hyperactivity in young children, DI: valproate, phenytoin and isoniazid increase levels |
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ethosuxamide |
Treats Generalized Absence seizures in children MOA: inhibit T-type Ca++ channels in the thalamus ADR: N/V, somnolence, dizziness, neutropenia DI: valproate increases levels, haldol |
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felbamate |
MOA: blocks glycine coactivation of NMDA recepters ADR: FATAL APLASTIC ANEMIA (monitor weekly) hepatic failure, weight loss 2nd line -- only used in refractory seizures |
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gabapentin |
2nd line for seizures MOA: increases GABA ADR: ataxia, tremor, dizziness, drowsiness, nystagmus, hyperactivity in kids DI: none |
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lamotrigine |
MOA: blocks Na+ channels ADR: rash, Stevens-Johnson syndrome, cerebellar dysfunction, headache, CI: partial seizures in adults and children. DI: Valproic acid inc levels |
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topiramate |
MOA: Na+ channel blocker, inc GABA, dec glutamate ADR: cerebellar dysfunction, drowsiness, weight loss, renal stones, glaucoma CI: adjunct treatment for partial and generalized seizures |
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levitiracetam |
MOA: increases GABA ADR: brings out underlying psychiatric disorders, hallucinations, somnolence CI: partial seizures in children
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zonisamide |
MOA: dec Na & Ca channel activity ADR: Somnolens, kidney stones, dec sweating CI: partial and generalized seizures (sulfa drug) |
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What is the treatment for status epilecticus? |
1st: diazepam or lorazepam (IV) Q10-15 minutes 2nd: phenytoin |
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Non drug therapies for seizure disorders |
ketogenic diet - 3:1 or 4:1 fat to protein/carb 1/3 of patients are seizure free, another 1/3 have 50% reduction vagus nerve stimulator Surgery: focal resection, hemispherectomy, corpus callostomy |
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Level A evidence migraine prevention |
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Antiepileptic drugs (AEDs): divalproex sodium, sodium valproate, topiramate * β-Blockers: metoprolol, propranolol, timolol Triptans: frovatriptan for short-term MAMs prevention * INEFFECTIVE: LAMOTROGINE |
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Level B evidence migraine prevention |
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Antidepressants: amitriptyline, venlafaxine * β-Blockers: atenolol, nadolol * Triptans: naratriptan, zolmitriptan for short-term MAMs prevention * INEFFECTIVE: clomiperamine |
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Dementia treatment |
cholinesterase inhibitors (donepezil, tacrine, galantamine) neuropeptide modifying agent (memantine) |
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MOA of benzodiazepines |
stimulate GABA
allosteric binding to GABA receptor-Cl channel, increase channel opening
inhibit reuptake of adenosine |
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Indications for benzodiazepines |
acute anxiety panic disorder (will cause sedation, SSRIs better) phobic disorders (SSRIs better) generalized anxiety disorder PTSD (usually SSRI first) |
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Migraine headaches - prevalence - presentation |
20% of population prodrome -- 60% of patients -- mental changes, neurological changes, sluggishness, thirst anorexia, diarrhea or constipation aura -- 20% of patients, minutes to 1 hour before headache -- visual disturbances, vertigo, aphasia, photofphobia |
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Migraine headaches - headache phase |
severe, throbbing n/v in 90% of patients photophobia vertigo diarrhea tremor, chills, diaphoresis
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Migraine headaches - pathophysiology |
Nerve fibers in CNS release vasoactive substances and trigger an inflammatory reaction around cerebral blood vessels 5-HT1 is serotonin receptor subtype that dec this inflammatory response and causes vasoconstriction 5-HT2 is excitatory and will worsen migraine symptoms when activated |
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What analgesic medication can result in toxicity with a relatively small dose and causes irreversible liver damage? |
acetaminophen |
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Drugs used to abort a migraine headache are |
ergot agents (ergotamine) triptans (first - sumatriptan, additional -- naratriptan, rizatriptan, zolmitriptan, newest -- frovatriptan, almotriptan, eletriptan) |
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What migraine drug is contraindicated for patients with CAD |
Ergot agents and triptans |
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Dose limitations for
-- ergotamines
-- triptans |
ergotamine -- 8 treatment days/month
triptans -- 6 treatment days per months, 2 treatment days per week |
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Generalized seizures |
originates in both hemispheres and involves loss of consciousness includes absence & tonic-clonic |
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Partial (focal) seizures |
originates in one hemisphere, no loss of consciousness includes complex partial and simple partial |
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absence seizure |
* Brief staring
* Eye blinking sometimes * Can have several hundred per day * Psychomotor slowing
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Generalized tonic-clonic |
* Stiffening, followed by rhythmic jerks of entire body * Can begin with complex partial seizure and evolve into generalized, tonic clonic seizure
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Complex partial seizure |
* Variable presentationhand or mouth automatisms * staring * spinning around
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Simple partial seizure |
* Consciousness retainedRepetitive simple movement or sensation * Can happen continuously (epilepsia partialis continua)
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What are the cardinal signs of parkinsons? |
Bradykinesia, resting tremor (pill rolling), rigidity, postural instability |
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What is the first agent used in the treatment of parkinsons? |
levodopa-carbidopa |
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benzodiazepine pregnancy category |
Pregnancy category D
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Benzodiazepine antagonist |
flumazenil |
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alprazolam drug interactions |
fluoxetine and fluvoxamine inc levels |
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chlordiasepoxide and diazepam drug interactions |
cimetidine and rifampin increase levels |
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lorazepam, oxazepam and temazepam drug interaction |
cimetidine and rifampin increase levels |
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estazolam, flurazepam, triozalam |
CI: Insomnia triazolam banned in UK due to delirium -- short-acting flurazepam -- long acting DI: hypersensitivity, anaphylaxis, complex sleep behaviors
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clonazepam clinical indications |
panic disorder, seizure disorder |
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midazolam |
IV only, anaesthetic |
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hypnotics for insomnia |
zolpidem, zaleplon (Sonata), eszopiclone (lunesta)
Work at GABA receptor |
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ramelteon CI & MOA |
insomnia works at melatonin receptor, non sedating |
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list long-acting benzodiazepines (3) |
chlordiazepoxide diazepam flurazepam
these have long lived metabolites |
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list short-acting benzodiazepines (4) |
alprazolam estazolam midazolam triazolam |
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benzodiazepins that bypass P1 oxidation and use only P2
short acting & safer (3) |
oxazepam temazepam lorazepam |
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ceiling effect definition |
benzodiazepines work only in the presence of GABA released by neurons, and therefore have a limited effect on sedation. They inc frequency that the channel opens. barbituates work regardless of presence of GABA and keep channel open and can increase sedation without limit based on dose. |
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insomnia drugs w/MOA |
zolpidem, zaleplon, escoplicone - selectively target GABA-A receptors. Shorter 1/2 life than benzos. Zaleplon has shortest 1/2 life of 1 hour.
benzodiazepines - bind to Cl channel and keep it open, increase GABA
ramelteon - melatonin receptors |
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benzodiazepine dependence |
patient will experience withdrawal characterized by anxiety, insomnia, headache, irritability and muscle twitches.
Dosage should be gradually tapered over several weeks. |
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role of GABA and glutamate in seizure disorders |
excessive activation by glutamate of N-methyl-D-aspartate (NMDA) displaces Mg++ ions and facilitates C++ entry into neurons
GABA (gamma-aminobutyric acid) neurotransmission is suppressed |
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Anti-epileptic drugs MOA |
1) Block Na+ channels 2) Block T-type calcium channels 3) increase GABA activation or activate receptor or increase GABA release, or inhibit degradation 4) inhibit glutamate neurotransmission |
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First line agents for generalized tonic/clonic seizures (5) |
* carbamazine -- Na+ channel blocker * phenytoin -- Na+ channel blocker * phenobarbital -- enhances GABA * primidone -- degrades to phenobarbital & phenylethylmalonamide * valproate - Na+ channel blocker, T-type calcium channel blocker, inc GABA, dec glutamate |
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first line agents for absence seizures (1 for kids, 1 for adults) |
ethosuzamide - kids - inhibits T-type Ca++ channels valproate -- adults |
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adjuvant agents for partial seizures (6) |
felbamate gabapentin lamotrigine topiramate levetiracetam zonisamide |
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First line agents for partial seizure |
------- |
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etiology of parkinsons |
degeneration of the dopaminergic neurons in the substantia nigra and development of Lewy bodies in the residual dopaminergic neurons |
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levodopa-carbidopa MOA & ADR |
MOA - levodopa ^ dopamine levels & carbidopa ^ amount of levodopa that enters the brain ADR - levodopa - N/V, which is reduced my co-administration with carbidopa; dyskinesias, psychosis |
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amantadine MOA & ADR |
MOA - increases release of dopamine ADR - sedation, restlessness, dreams, nausea, dry mouth, hypotension |
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selegiline MOA & ADR |
MOA: inhibits MAO-B & thereby prevents the oxidation of dopamine ADR: potential for food interactions, interactions with SSRIs and meperidine |
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tolcapone MOA & ADR |
MOA: inhibits COMT, the enzyme that metabolizes levodopa ADR: nausea, diarrhea which reduces over time; hepatotoxicity |
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Alzheimers Disease etiology & presentation |
etiology: destruction of cholinergic and other neurons in the cortex and limbic structures of the brain, especially the amygdala, basal forebrain, and hippocampus Presentation: dementia |
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donepezil |
CI: Alzheimers MOA: cholinesterase inhibitor ADR: diarrhea, nausea, vomiting |
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rivastigmine |
CI: Alzheimers MOA: cholinesterase inhibitor ADR: |
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galantamine |
CI: Alzheimers MOA: cholinesterase inhibitor |
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memantine |
CI: Alzheimers MOA: noncompetitive antagonist at NMDA receptor (attenuates the excitotoxic effects of glutamate) |
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ergot ADR |
nausea, vomiting, diarrhea, muscle cramps, cold skin, paresthesias, vertigo peripheral vasoconstriction -- contraindicated in persons with CAD or peripheral vascular disease rebound headache |
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triptan ADR |
chest tightness, weakness, somnolence, dizziness, paresthesias, coronary vasospasm
risk of serotonin syndrome with SSRIs |
