Pharmacology Iii: Neurology Part 2

Front 1

What are some non-drug options for treating seizures?

Back 1

surgery, diet, avoidance of precipitators (sleep deprivation, stress, etoh, caffeine)

Front 2

What is the most important factor when choosing an anti-epileptic drug?

Back 2

clinical response

Front 3

T or F? All patients can be seizure free.

Back 3

FALSE

Front 4

What is the goal of anti-epileptic drug therapy?

Back 4

enough med to completely prevent seizures without producing side effects

Front 5

What are some AED's indicated for monotherapy?

Back 5

lamictal, trileptal, felbatol(when other AED's have failed)

Front 6

When can you withdraw AED therapy?

Back 6

seizure free for 2-5 years

Front 7

Can you use a regular dilantin level in a pt with renal failure?

Back 7

no. you must get free drug levels

Front 8

What medical emergency are pts at risk for after rapid discontinuation of AED's? How do you prevent this?

Back 8

status epilepticus - taper 1st

Front 9

T or F? When you are substituting one AED for another, you should achieve a therapeutic dose of the new med before dicontinuing the old one?

Back 9

TRUE

Front 10

What are first line drugs of choice for complex partial seizure with secondary generalization (aura)?

Back 10

tegretol, dilantin

Front 11

T or F? Tegretol is good for absence seizures?

Back 11

FALSE

Front 12

What are monitoring parameters for tegretol?

Back 12

CBC and LFT - baseline, monthly x 2-3 months, then yearly

Front 13

SSx of hyponatremia - SIADH?

Back 13

HA, N/V, dizziness, confusion, increased seizures

Front 14

SSx of tegretol intoxication syndrome?

Back 14

nausea, double vision, dizziness, inability to concentrate, unsteady gait

Front 15

Explain saturation kinetics.

Back 15

enzymes that break down certain drugs become saturated and levels of that particular drug increase rapidly

Front 16

Adverse events with Dilantin?

Back 16

sedation, blurred or double vision, dysarthria, dizziness, gingival hyperplasia, hypertrichosis, mental dullness, intoxication,

Front 17

Drug interactions with dilantin?

Back 17

Valproate --> increase in free dilantin

Front 18

How often should you dose dilantin suspension?

Back 18

every 8 hrs

Front 19

How long before you can assume a steady state of dilantin?

Back 19

30 days or 2 levels within 10% of one another

Front 20

Can you give a tube feeding at the same time as dilantin?

Back 20

No it can decrease the absorption of the dilantin. Hold the tube feeding until the dilantin is absorbed

Front 21

T or F? With dilantin extend caps, the half life equals the duration of the drug.

Back 21

FALSE

Front 22

What is the major adverse drug reaction with depakene?

Back 22

GI distress

Front 23

What is the advantage of depakote over depakene?

Back 23

slow release with fewer GI side effects

Front 24

In whom are side effects of AED's more serious?

Back 24

children

Front 25

What is valproate used for? (types of seizures)

Back 25

absence and primary generalized tonic-clonic seizures

Front 26

Adverse events of valproate?

Back 26

GI distress, intention tremor, weight gain, thrombocytopenia, difficulty concentrating, hepatotoxicity, increased liver enzymes without hepatotoxicity

Front 27

Drug interactions with valproate?

Back 27

enzyme inducing drugs (dilantin, tegretol) cause increased clearance of valproate. If stopping these drugs, valproate dose may need to be lowered.

Front 28

Disadvantages of phenobarbital?

Back 28

sedation, behavoiral disturbances, risk of learning impairment, hyperactivity (in children), may aggravate coexisting absence seizures

Front 29

What drug is structurally related to phenobarbital and is used primarily for intention tremor?

Back 29

Primidone (Mysoline)

Front 30

What are some newer (less sedating) AED's?

Back 30

felbatol, neurontin, lamictal, topamax, gabitril, keppra, trileptal, zonegran

Front 31

Adverse events of Felbatol?

Back 31

insomnia, irritability, HA, wt loss, N/V, anorexia, aplastic anemia, hepatic failure

Front 32

Adverse events of lamictal?

Back 32

Erythema multiforme, TEN, nausea, diplopia, ataxia, dizziness

Front 33

Adverse events of topamax?

Back 33

cognitive disturbances, lethargy, impaired concentration, kidney stones, wt loss, increased IOP

Front 34

T or F? Gabitril is a psych drug that can be used to treat seizures.

Back 34

False. This is discouraged by the manufacturer

Front 35

Adverse events of Trileptal?

Back 35

ataxia, dizziness, fatigue, nausea, somnolence, diplopia, hyponatremia (more than with tegretol)

Front 36

Contraindication to Zonegran?

Back 36

sulfa allergy

Front 37

Adverse events of zonegran?

Back 37

ataxia, somnolence, agitation, anorexia, kidney stones

Front 38

What are some drugs besides zarontin that can be used for absence seizures?

Back 38

valproate, klonopin (3rd line),

Front 39

adverse events of klonopin?

Back 39

sedation, ataxia, mood changes, tolerance

Front 40

Treatment of febrile seizures?

Back 40

if prolonged or repeated, phenobarbital or diazepam

Front 41

What causes drug induced parkinsonism?

Back 41

antidopaminergic activity of neuroleptics, compazine, reglan

Front 42

What is the goal of drug therapy for parkinsons?

Back 42

begin treatment when pt begins to experience functional impairment. Treatment is symptomatic. Adjust dosage frequently due to chronic and progressive nature of the disease

Front 43

What are the stages of parkinsons?

Back 43

I - unilateral involvement, min. to no functional impairment,
II - bilateral involvement, no impairment of balance,
III - postural imbalance, restriction in activity, still has independent life, mild to mod. disability,
IV - severly disabled, can't walk or stand unassisted,
V - wheelchair/bed bound,

Front 44

T or F? Dopamine crosses the blood, brain barrier.

Back 44

FALSE

Front 45

How does Sinemet work?

Back 45

carbidopa protects levodopa from being decarboxylated

Front 46

What is the minimum dose of carbidopa needed for it to work?

Back 46

60 mg

Front 47

What vitamin can decrease the absorption of levodopa?

Back 47

B6

Front 48

What are some limitations of parkinson's meds?

Back 48

response fluctuations, end of dose deterioration

Front 49

What drugs can you give with sinemet to prolong it's effects?

Back 49

COMT inhibitors, MAOI, type B, anticholinergics

Front 50

What can happen when attempting to adjust the dose of parkinson's meds?

Back 50

overstimulation of dopamine receptors-->dyskinesias and other choreiform movements

Front 51

What are some complications of parkinson's requiring drug therapy?

Back 51

neuropsychiatric, autonomic dysfunction, falls, sleep disorders

Front 52

What is monotherapy for young parkinson's patients early in the disease?

Back 52

dopamine agonists

Front 53

What do you add to dopamine agonists with the progression of parkinson's?

Back 53

levodopa

Front 54

Adverse effects of dopamine agonists?

Back 54

mental disturbances (confusion, hallucinations, insomnia, nightmares, daytime somnolence), orthostatic hypotension, greater risk of adverse effects if >65yo

Front 55

If a patients CrCl is <60 mL/min, should you dose Mirapex more or less frequently?

Back 55

less

Front 56

Adverse effects of Mirapex in early stage Parkinson's?

Back 56

nausea, dizziness, somnolence, insomnia, constipation, asthenia, hallucinations

Front 57

Adverse effects of Mirapex in advanced stage parkinson's?

Back 57

orthostatic hypotension, dyskinesias, insomnia, confusion, hallucination

Front 58

What drug would be considered a "last ditch effort" in the treatment of Parkinson's?

Back 58

Pergolide

Front 59

What is an advantage of pergolide over other dopamine agonists?

Back 59

ability to improve response fluctuations in levodopa treated patients

Front 60

What is the mainstay of treatment in advanced parkinson's?

Back 60

levodopa

Front 61

side effects of levodopa?

Back 61

confusion, depression, restlessness, overactivity, psychosis, hypomania, vivid dreams, dyskinesia

Front 62

What is the most common mental side effect of levodopa?

Back 62

organic confusional state with disorientation, toxic delirium

Front 63

What are drug interactions of levodopa?

Back 63

TCA's, anticholinergics, benzos, reglan, neuroleptics

Front 64

What lab tests can levodopa interfere with?

Back 64

asymptomatic elevations in serum uric acid, mild increase in BUN, elevated LFT's, increased FBG

Front 65

What can happen after abrupt discontinuation of dopaminergic agonists and/or levodopa?

Back 65

NMS, acute confusional state, severe worsening of parkinson's (with rigidity)

Front 66

T or F? Dyskinesias can be seen upon withdrawal of DA's and/or levodopa.

Back 66

False. Dyskinesias are seen with therapy not withdrawal

Front 67

What are the adverse effects of COMT inhibitors? What are they caused by?

Back 67

dyskinesias, nausea, dizziness, hallucinations - caused by increased levodopa exposure

Front 68

Adverse effects specifically related to entacapone (comtan)?

Back 68

urine discoloration, abdominal pain, diarrhea

Front 69

Adverse effects specifically related to tolcapone?

Back 69

liver toxicity

Front 70

What is an example of an MOAI - type B used to treat Parkinson's?

Back 70

Selegeline (Eldepryl)

Front 71

Contraindications of Eldepryl?

Back 71

meperidine and other opioids, SSRI's, TCA's, tyramine containing foods, sympathomimetics

Front 72

What class of drugs is reserved for the treatment of resting tremor in early stage parkinson's?

Back 72

anticholinergics

Front 73

What drug can be used for mild forms of parkinson's, as an adjunct to other meds, and may help reduce dyskinesias?

Back 73

amantadine

Front 74

What adverse effect develops in 80% of patients taking amantadine?

Back 74

livedo reticularis

Front 75

Can you use traditional antipsychotics to treat the psychiatric sx of parkinson's?

Back 75

NO

Front 76

What is the drug of choice for treating drug induced hallucinations in parkinson's?

Back 76

seroquel

Front 77

What antipsychotic CAN be used with parkinson's patients? Monitoring parameters for this drug?

Back 77

clozaril - weekly CBC

Front 78

In addition to clozaril and seroquel, what other class of drugs can be used to treat psychiatric sx in parkinson's?

Back 78

cholinesterase inhibitors