Neuro Agents

Front 1

What are the S/S of diseases that affect the EPS?

Back 1

Tremors
Rigidity
Postural Instability
Slow Movements

Front 2

What is Parkinson's Disease?

Back 2

Disease resulting in the death of neurons that produce Dopamine

Results in a imbalance between Dopamine and Acetylcholine in the basal ganglia.

Front 3

What are the effects of Antiparkinsonism drugs?

Back 3

Restore the balance of Dopamine and Acetylcholine.

Dopaminergics (Increase Dopamine)
Anticholinergics (Reduce amount of Acetylcholine)

However, these agents do not provide a cure, but simply treat the S/S.

Front 4

What is Levodopa?

Back 4

Is a Dopaminergics and increase Dopamine in the corpus striatum of the brain.
Turns into Dopamine after biosynthesis in the brain.
Can pass through BBB, Dopamine alone cannot.
Long-term use usually causes adverse effects to increase, while therapeutic effects diminish.

Front 5

What are some Adverse Effects of Levodopa?

Back 5

Dyskinesias = A defect in the ability to perform voluntary movements.
Postural Hypotension
Psychosis = In about 20% of clients (Hallucinations, Nightmares, Paranoid Ideation)
Darkened color of sweat and/or urine.
On/Off Phenomonon

Front 6

What is the On/Off Phenomonon?

Back 6

Abrupt loss of effectiveness of the drug.
Occurs when drug levels are high.
"Off" time may only last minutes to hours.
Over the course of treatment, Off hours will occur more frequently.

Front 7

What are some Food Interactions of Levodopa?

Back 7

High protein foods cause a reduction in therapeutic response by reducing the amount of the drug that is actually absorbed and transported to the brain.
Advise patients to spread their protein consumption throughout the day.

Front 8

What might be recommended to patients using Levodopa?

Back 8

"Drug Holidays" which is a brief interruption of treatment for 10 days.
However, must be hospitalized during the Drug Holiday.
May lead to severe psychologic distress, immobility, aspiration, pneumonitis, pressure ulcers.

Front 9

Why use Levodopa/Carbidopa combination drug?

Back 9

Carbidopa enhances the effects of Levodopa, but has no effect by itself.
Allows for the dosage of Levodopa to be reduced by as much as 75%.

Front 10

What are Dopamine Agonists?

Back 10

Stimulate Dopamine receptors directly.
Recommended as the initial drug of choice for patient's with mild to moderate S/S.
Pramipexole (Mirapex) and Ropinirole (Requip)

Front 11

What are some Advantages/Disadvantages of the use of Dopamine Agonists?

Back 11

Advantages - They don't compete with dietary proteins for absorption and transport across BBB. Also, lower incidence of response failure if used long-term.
Disadvantages - Hallucinations and Day-Time Sleepiness.

Front 12

What do Anticholinergics do for the treatment of Parkinson's?

Back 12

Brings Acetylcholine lower so that it is in balance with the lower levels of Dopamine.
Block the effects of Acetylcholine in the brain and thus decreasing S/S.
Ex - Tihexphenidyl (Artane) and Benztropine (Cogentin)

Front 13

What are the Side Effects of Anticholinergics?

Back 13

Tachy, Dry Mouth, Urinary Retention, Blurred Vision, Constipation.

Front 14

What are the MAO-B Inhibitors and why are they used in treatment of Parkinson's?

Back 14

(Mona Amine Oxidase) - Is an enzyme that inactivates Dopamine.
Therefore, we inhibit MAO and thus leads to increase of Dopamine available to the CNS.
May be used as drug of choice for mild S/S.
Can also be given during "Off" times from Levodopa.
Ex - Selegiline and Rasagiline

Front 15

What is Alzheimer's Disease?

Back 15

Degenerative disorder characterized by progressive memory loss, confusion, inability to think or communicate effectively.

Associated with cerebral atrophy.

Front 16

What neurotransmitter is responsible for learning and memory?

Back 16

Acetylcholine - Is known to be reduced in Alzheimer's patients by 90%.

Front 17

What are the most common agents used for the treatment of Alzheimer's?

Back 17

Acetylcholinesterase Inhibitors

Front 18

What is Acetylcholinesterase and why is it relevant to Acetylcholinesterase Inhibitors?

Back 18

Acetylcholinesterase is an enzyme that STOPS the action of Acetylcholine. Thus, when Acetylcholinesterase is inhibited, more Acetylcholine levels can become elevated.

Front 19

What type of agent is Acetylcholinesterase Inhibitors?

Back 19

Parasympathomimetic

Front 20

Should any of the Acetylcholinesterase Inhibitors be used with patients with asthma or COPD?

Back 20

No, because it can cause excessive bronchoconstriction.

Front 21

Should any of the Acetylcholinesterase Inhibitors be used with patients with a history of peptic ulcer disease?

Back 21

No, because of an increase in perstalic activity creating a more acidic (lower pH) environment within the stomach.

Front 22

What is the newest approved drug for the treatment of Alzheimer's?

Back 22

Memantine....Approved in 2003 and is indicated for moderate to severe disease and is thought to slow cognitive decline.
Works by slowing the influx of calcium into the cells.

Front 23

What are the drugs called for Seizures and what do they do?

Back 23

Antiepileptics suppress the abnormal electrical impulses.
Also, they suppress seizures, but do not treat the cause of the seizure and suppress neuronal activity to prevent abnormal misfiring.

Front 24

What are the four mechanisms that Antiepileptics act on?

Back 24

Potentiating GABA (Inhibitory Neurotransmitter)
Blocking the receptors for Glutamate
Delaying influx of Sodium
Delaying influx of Calcium

Front 25

What are the types of seizures?

Back 25

Partial (Focal) - Localized symptoms (arm, leg, or facial twitches).
Generalized (Tonic) - Abnormal conduction throughout both hemispheres of the brain.
Absence - Totally loses focus and looks like they are day dreaming.

Front 26

Is Phenytoin effective with partial and tonic seizures, but not absence seizures?

Back 26

True

Front 27

What seems to be the most effective for all seizure types?

Back 27

Valproic Acid

Front 28

Do Antiepileptic Agents have a narrow or wide therapeutic range?

Back 28

Narrow range, and thus, should establish safe plasma levels.
Also, these agents should be discontinued over a period of 6 weeks to several months.

Front 29

What are the two categories of Antiepileptic Agents?

Back 29

Traditional - Last approved agent in 1978 (still widely used because of well know side effects and results). Cost less, but can have troublesome side effects and complex drug interactions.
Newer Agents - Approved in 1993 or later. They can cost more, we have less experience with them, but have smaller risk of teratogenic and fewer drug interactions.

Front 30

What is the most widely used drug to treat epileptic seizures, except for Absence seizures and how does it work?

Back 30

Phenytoin (Dilantin)....inhibits sodium channels.
Has a narrow therapeutic range and with "small changes in the dosage, can produce large changes in drug levels"
Becomes toxic very quickly.
Therapeutic Range = 10-20 mcg/mL

Front 31

What are some side effects of Phenytoin (Dilantin)?

Back 31

Gingival Hyperplasia - Excessive growth of gum tissues that is common in 20% of clients.
Nurse must teach patient the importance of good oral hygiene including gum massages using a soft tooth brush and flossing.
Teratogenic Effects - Category D drug and can lead to cleft palate, heart malformations, and bleeding tendencies in newborns.

Front 32

What is Carbamazepine (Tegretol) and what does it do?

Back 32

Effective against tonic-clonic and partial seizures, but not absence seizures.
Suppresses sodium influx.
Is a liver enzyme inducer, and decreases its own half-life over time.

Front 33

What are some adverse effects of Carbamazepine (Tegretol)?

Back 33

Hematologic Effects - Bone marrow suppression resulting in Leukopenia, Anemia, and Thrombocytopenia.
Therefore, CBC should be monitored.

Front 34

What is Valproic Acid (Depakene and Depakote) used for and how does it work?

Back 34

Will treat all major seizure types. Works by three mechanisms: Suppresses sodium and calcium influx, along with augmenting GABA.

Front 35

What is Ethosuximide (Zarontin) and what is it used for?

Back 35

Drug of choice for absence seizures.
It does not work for any other types of seizures.
Also, dosage is determined by watching the incidence of the seizure activity.

Front 36

What is Phenobarbital?

Back 36

Oldest antiepileptic agent and is considered a "Barbiturate".
Significant side effects = Learning impairment, lethargy, and depression.
Not commonly used.

Front 37

What is Oxcarbazepine (Trileptal) and what does it do?

Back 37

Newer antiepileptic agent, however doesn't cause bone suppression.
Adverse Effects - Dizziness and Drowsiness, Hyponatremia.

Front 38

What is Status Epilepticus and what is the goal of treatment?

Back 38

Continuous tonic-clonic seizures that last at least 20-30 minutes.
Goal - Maintain airway, coreect hypoglycemia (IV), and stop the seizure.
Lorazepam (Ativan) or Diazepam (Valium) are agents of choice.

Front 39

What are some symptoms of Schizophrenia?

Back 39

Hallucinations, Delusions, Agitation, and Paranoia
Lack of Motivation, Blunt Affect, Social Withdrawal.
Disordered thinking, MEmory and Learning Difficulties.

Front 40

What are thought to be causes of Schizophrenia?

Back 40

Thought to be caused by excess of Dopamine in the brain.
All antipsychotic drugs works by competing with Dopamine receptor sites.
Therefore, Dopamine Antagonists

Front 41

What are the two major categories Antipsychotic Agents?

Back 41

First Generation (Conventional) - Block dopamine with low potency, medium potency, or high potency and are likely to have EPS symptoms.
Second Generation (Atypical) - Moderately block dopamine receptors and have low risk for EPS symptoms.

Front 42

What are two first generation agents for antipsychotic episodes?

Back 42

Phenothiazines - Chlorpromazine (Thorazine) and Thioridazine (Mellaril)

Front 43

What are side effects of conventional antipsychotic medications?

Back 43

Drowsiness, Anticholinergic Effects, Orthostatic Hypotension, and EPS (Acute Dystonias) and (Akathisia).

Front 44

What are Risperidone (Risperdal), Olanzapine (Zyprexa), and Dibenzodiazepine (Clozapine)?

Back 44

Atypical (Second Generation) antipsychotic medications that block dopamine receptors loosely and also block Serotonin and Alpha-Adrenergic receptors.

Front 45

What are some side effects of Atypical Antipsychotic medications?

Back 45

Weight gain, Increase in prolactin levels, Teratogenic effects, and Diabetes.

Front 46

What are the three types of depression?

Back 46

Reactive - Sudden onset with precipitating factors and is normal grief/sadness.
Unipolar - MAjor depression with a loss if interest in work and home
Bipolar - Manic and depressive

Front 47

What is the theory of depression?

Back 47

Insufficient amount of neurotransmitter Norepi and Serotonin.

Front 48

What are the 5 types of Antidepressants?

Back 48

Tricyclic (TCA's)
SSRI's
Serotonin/Norepi Reuptake Inhibitors (S/NRI's)
Monoamine Oxidase Inhibitors (MAOI's)
Atypical Antidepressants

Front 49

What are TCA's used for and what are some important characteristics of using them?

Back 49

Blocks the uptake of norepi.
Therapeutic response in 2-6 weeks and must be gradually withdrawn from.
Used most commonly for major depression, but not reactive depression.

Front 50

What are some examples of TCA's and what are some side effects?

Back 50

Amitriptyline (Elavil) and Imipramine (Tofranil)
Side Effects - Sedation, Anticholinergic effects, Increase risk in suicide early in treatment.

Front 51

What are SSRI's used for?

Back 51

They block reuptake of serotonin
They DO NOT block the uptake of dopamine or norepi.
Used for major depression.

Front 52

What are some examples of SSRI's?

Back 52

Fluoxatine (Prozac)
Fluxovamine (Luvox)
Sertraline (Zoloft)
Paroxetine (Paxil)
Citalopram (Celexa)
Excitalopram (Lexapro)

Front 53

What are common side effects of SSRI's?

Back 53

Sexual Dysfunction
Insomnia
Headache
Slight Weight Gain
SES (Serotonin Syndrome) - Occurs when serotonin levels accumulate in the body.