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63 Cards in this Set
- Front
- Back
What is Parkinson's Disease?
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a degenerative disease of the neurons
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What are s/s of parkinson's disease?
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tremor, rigidity, postural instability, slowed movement, autonomic disturbances, depression, psychosis and dementia - symptoms appear middle age and keep progressing
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What is the cause of parkinson's disease (PD)?
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degeneration of neurons that supply dopamine - neurol degernation begins long before symptoms appear can take 5-20 years, can be caused from genetics or enviromental toxins
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How do drugs help someone with PD?
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improving bradykinesia, gait disturbancess and postural instability - then provide symptoms support. There is no cure for PD
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Name mech of action for Levodopa
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promotes sysnthesis of dopamine first line drug
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How long does it take for Levodopa to work in PD?
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full therapeutice effects several months - rise steadily over first few months - drug becomes less effective with time
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Adverse effects of levodopa
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N/V, dyskinesais, posturnal hypotension, dysrhythmias, psychosis, darken sweat and urine & activate malignant melanoma
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Teaching with how to take levodopa
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taken with food delays absorption & high protien foods will decrease effects of drug
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drug interactions with Levodopa
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first generation antipsychotics block receptors for dopamine, and can cause a hypertensive crisis if given with MAO inhibitors, avoid B6 as can decrease levels of levodopa
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Is levodopa/carbidopa more effective thatn levodopa alone and why?
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carbidopa used to enhance effects of levodopa and ineffective on its own
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Why is adding carbiodopa superior to levodopa alone?
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1) increases availability of levodopa for levodopa dose can be lowered 2) reduces CV and N/V side effects 3) Vitamine B6 can still be taken w/o decreasing effects of drug
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What 2 drugs are a levodopa/carbiodopa mix
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Sinemet & paracopa
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How do dopamine agonists work?
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directly acitivate dopamine receptors - less effective than levadopa, but used first with mild to mod PD
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Side effects of dopamine agonists?
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greater hallcinations, day time sleepiness and postunal hypotension reserved for younger patients
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Name 2 types of dopamine agonists?
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ergot and nonergot preparations - nonergot less side effects
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Name the nonergot dopamine agonists that can be used alone in early stage PD or in addition to levodopa in late stage PD
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Pramipexole, ropinirole, apomorphine
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What are side effects of Nonergot dopamine agonists?
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N/B, dizziness, daytime sleepi8ness or sleep attacks, weakness and hallicnations, complusive, self rewarding behaviors after about 9 months of med
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Drug to avoid if on nonergot dopamine agonists?
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cimetidine - inhibits renal excretion and thereby increases blood level
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COMT Inhibitors use and indication
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Entacapone - inhibits metabolism of levodopa in periphery so increases time levodopa can be used in teh brain - no good if used alone. use with levodopa
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MOA - B Inhibitors
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2nd or 3rd line drugs - combine with levodopa and can reduce wearing off effect. effects are modest
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What is Alzeheimers Disease
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progressive illness - memory loss, impaired thinking, neuropsychiatric s/s, (hallucinations and delusions) & inabililty to perform routine tasks - 4th leading cause of death
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What is pathology of alzehiemers?
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degeneration of cholinergic neurons and presence of neuritis places and neurofibrillary tangles. Damage irreversible
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What happens with coritcal degernation with alzeheimers?
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loss of speach, loss of bladder and bowel control, complete inability for sefl-care. Eventually destroys enough brain fx to cause death.
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Risk factors for AD?
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advancing age onset usually over 65, and family history
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What is the progression of AD?
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can take 20 years, from onset to death but usualy 4-8 years
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Mild s/s of AD
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confusion & memory loss, disorientation, problesm with routine tasks, changes in personality,
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Moderate s/s of AD
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Difficulty with ADL's, Anxiety, agitation, sleep disturbances, wandering, diff recognizing family and friends
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Severe s/s of AD
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loss of speach, loss of appetite, weight loss, loss of bladder and bowels, compelte dependence
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Have AD meds shown to be effective?
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No
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What AD meds are available?
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Cholinesterase inhibitors and memantine
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How do cholinesterase inhibitors help with AD
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provide modest improvement cognition & quality of life - improvment usualy short acting - only 25-30% people respond
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How does memantine help with AD
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works in moderate to severe
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What is epilepsy?
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excitabiltiy of neurons in the CNS, can produce unconsciencness and convulsions
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How are seizures initiated?
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by synchronous, high frequency discharge from group of yperexcitabel neurons called a focus
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What 2 types of seizures are there?
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partial or focal and generalized seizures
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Name types of partial seizures
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simple partial seizure - no loss of conscienceness persist for 20-60 seconds, complex partial: impaired consciencesness & lack of responsiveness - fixed stare w/ reptitive movements like lip smacking or hand writhing. Secondary generalized: start as simple or complex and move into tonic-clonic last 1-2 min
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Name generalized seizures
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tonic-clonic (grand mal), absence (petit mal), atonic seizure, myoclonic , status epilepticus and febrile
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What is a tonic-clonic seizure
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neuronal dischage across both hemispheres of brain, major convulsions, muscle rigidty, adn muscle jerks
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What is an absence seizure?
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loss of conscienceness for a brief time 10-30 seconds. usually involved mild eye blinking or staring - no motor activity
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What is an atonic seizure?
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sudden loss of muscle tone - can be a head drop or complete collapse
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What is a myoclonic seizure?
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sudden muslce contriactions that last for just 1 sec
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What is status epilepticus
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A seizure that lasts for more than 30 mintues
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what are some non-drug therapies used for epilepsy?
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Neurosurgery, vagus nerve stimulation and ketogenic diet
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How do drugs work with seizures?
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Drugs are seizure selective must first diagnosis type of seizure before know which med will work
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What is best way to adjust drug levels for anti-seizure drugs?
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draw drug plasma levels
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What is a big risk with those taking antiepileptic drugs (AED)?
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increaes risk of suicide
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What 2 categories are there for AED?
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traditional AEDa nd newer AED
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Name the most commonly used traditional AEDs?
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phenytion, carbamazepine, valproic acid, ethosuximide, phenobarbital, primidone
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What are drawbacks of traditional AEDs?
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less tolerated than new AEDs, pose greater risk to developing fetus, & greater interaction with other meds
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What is most widley used AED
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phenytion - dilantin
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What is danger of phenytoin?
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small therapuetic range - between effective dose and lethal dose - tetragenic in pregnancy
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What kind of epilepsy can phenytoin not help?
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absense seizures
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How is phenytoin with other drugs?
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decreases effectiveness of oral contraceptives, glucocorticoids and warfarin, need to avoid CNS depressants as decreases levels of phenytoin in bld
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What is carbamazepine or Tegretol used for?
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partial seizures and tonic-clonic seizures, bipolar disorder, and certain neuralgias
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Adverse effects of Carbamazepine?
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bone marrow suppression, birth defects, rash - do not drink grapefruit juice as it may inhibit metabolism of carbamazepine
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How is valproic Acid (depakote) used for seizures?
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all major seizure types, bipolar disorder, migraines
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What is the drug of choice for absense seizures?
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Ethosuximide (Zarontin)
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How are the newer AED's better or worse
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They are more expensive, they are less fetal toxic, less interaction with other medications, better tolerated that traditional AEDs
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Name most used newer AEDs
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oxcarbazepine (Trileptal) & Lamotrigine (Lamictal)
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What type of seizures is oxcarbazepine used for?
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partial seizures in adult and children
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What is lamotrigine or lamictal used for?
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adjuncitive therapy for seizures if over 2 yr old and for monotherapy ofor partial seizures if at least 16 and converting from another AED
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What is a serious side effect with oxcarazepine and lamotrigine AED medication?
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life-threatning skin rashes
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How to treat AED in pregnancy?
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give lowest dose possible to keep seizures under control and only use monotherapy - take folic acid at dose of 2mg/day to prevent neural tube defects, increase Vit K last weeks of pregnancy
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