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76 Cards in this Set
- Front
- Back
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Tx for febrile seizures
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antipyretics (APAP) sponge bath
if >10 min, phenobarbital or diazepam |
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nonRx Tx for seizures
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temporal lobectomy- need definite diagnosis, inadequate drug response, seizure not near speech or motor control
-vagal nerve stimulation (not as effective) -ketogenic diet- worry about growth retardation or hypercholesterolemia |
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Tx for simple partial seizures
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caramazepine
lamotrigine oxcarbazepine phenobarbital phenytoin topiramate |
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Tx for complex partial seizures
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carbamazepine
lamotrigine oxcarbazepine phenobarbital phenytoin topiramate |
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Tx adjuncts for simple and complex partial seizures
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acetazolamide
levetiracetam pregabalin tiagabine zonisamide |
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Tx for absence seizures
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children: lamotrigine
adults: ethosuximide, valproic acid |
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Tx for generalized tonic-clonic seizures
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carbamazepine
phenobarbital phenytoin topiramate valproic acid |
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Tx for atonic seizures
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clonazepam or valproic acid
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Tx for myoclonic seizures
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clonazepam or valproic acid
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Tx for infantile spasms
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corticotropin or valproic acid
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Tx for status epilepticus
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diazepam, lorazepam, prednisone
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carbamazepine
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DOC for partial seizure
-therapeutic 8-12mcg/ml (get serum conc. levels) -induces other drugs and itself -ADEs: CNS and GI, rash, SIADH, aplastic anemia, thrombocytopenia, leukopenia |
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oxcarbazepine
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used for partial seizures
-adjust dose in renal dysfxn -no serum conc. monitoring -ADEs: hyponatremia (worse than carbam), blood dyscrasias (less than carbam), hypersensitivity, rash |
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phenytoin
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used for all seizures- mostly partial and generalized tonic-clonic (except absence and febrile)
-range 10-20mcg/ml- get blood levels -correct for low albumin and renal dysfxn -IV, oral suspension, cap/tab -dose-ADE: nystagmus, ataxia, drowsiness, cognitive impair. -nondoseADE: rash, hepatotoxicity, hirsutism, acne, gingival hyperplasia |
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fosphenytoin
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used for status epilepticus
-less phlebitis -ADEs: hypotension, perianal itching, phenytoin ADEs (nystagmus, drowsiness, cognitive imp) |
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phenobarbital
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used in generalized seizures and febrile (not absence)
-3-4 weeks to steady state -15-40 range- get blood levels -ADEs: CNS, cognit imp, confusion, agitation or depression in elderly, hyperactivity in chidren |
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primidone
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used for essential tremor more commonly
-range 5-12- monitor levels -ADEs: CNS, ataxia, nystagmus, rash, leukopenia |
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valproic acid (epilepsy)
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used in absence, partial, generalized seizures (and sometimes status epilept)
-also used for mania and migraines -range 50-100mcg/ml- get levels -ADEs: hepatotoxicity, N/V, weight gain, alopecia, pancreatitis, platelet agg. -monitor LFTs |
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ethosuximide
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DOC for absence seizures in adults
-range 40-100mcg- get levels -minor ADEs: sedation, N, V, ataxia, HA, dizziness |
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benzodiazepines for epilepsy
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clonazepam- atonic and myoclonic
loraz, diaz. for status epil. -no serum conc. monitoring -ADEs: CNS, ataxia |
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gabapentin
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adjunct for partial seizures and gener. tonic-clonic
-no serum conc. monitoring -multiple daily dosing -adjust dose in renal dysfxn -ADEs: fatigue, dizzy, N, HA, nystagmus |
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lamotrigine
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adjunct in partial seizures
-DOC in children for absence -t1/2 inc. with valproic acid -t1/2 dec. w/ phenyt, carbam -no serum conc. monitoring -ADEs: rash, CNS, need to titrate slowly |
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pregabalin
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adjunct in partial seizures
-adjust dose in renal imp -no serum conc. monitoring -ADEs: drowsiness, blurred vision, edema, weight gain -used for diabetic neuropathy, postherpetic neuralgia, fibromyalgia |
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tiagabine
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adjunct in partial, atonic, and myoclonic
-no serum conc. monitoring -t1/2 shorter when given with phenobarb, carbam, phenytoin -ADEs: confusion, speech problems, impaired conc. |
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topiramate (epilepsy)
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used in partial and generalized tonic-clonic
-no serum conc monit. -monitor bicarb -lower dose if CrCl<70 -ADEs: drowsiness, psychomotor slowing, weight loss, kidney stones, metabolic acidosis -used for migraine prophylaxis |
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zonisamide
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used as adjunct in partial
-sulfa drug -no serum conc. monitoring -ADEs: CNS, depression, rash, psychomotor slowing |
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levetiracetam
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used as adjunct in partial
-no serum conc. monitoring -ADEs: CNS, coordination difficulties -no drug interactions |
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epilepsy Tx discontinuation candidates
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-no seizure 2-5 yrs
-normal neurological exam -normal intelligence -normal EEG -single type of seizures -withdraw drug slowly over 6 months |
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Tx STEPS for status epilepticus
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ABC
-med to stop seizure -long acting med (fosphenytoin, phenytoin, phenobarb, valproic acid, levetiracetam) |
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nonRx Tx for parkinsons
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exercise
physical therapy nutrition psychological support -deep brain stimulation (expensive) -surgical treatment: pallidotomy or thalamotomy |
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general Tx for parkinsons- predominant tremor
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amantadine (dopamine agonist) or anticholinergics (benztropine, biperiden, procyclidine, trihexyphenidyl)
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general Tx for parkinsons- rigidity or motor complic.
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carbidopa/levodopa or dopamine agonists
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general Tx for parkinsons- fluctuations or advancing symptoms
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adding MAOI (rasagiline or selegiline) or COMTi (entacapone or tolcapone) to levodopa-carbidopa
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levodopa-carbidopa
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can cause motor complications long term (neurotoxicity)
-also used for RLS -contra in narrow angle glaucoma, melanoma -ADEs depression, orthostatic hypotension, dyskinesia- bad if sudden withdrawal! -causes dizziness, anxiety, confusion, HA, hallucinations -On-off phenomenon -high protein diets decrease efficacy -get hypertensive crisis with MAOIs |
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bromocriptine
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ergot derivative, dopamine agonist
-ADEs sedation, N, hypotension, dyskinesia, psychosis (hallucionations, delusions) -potential for vasoconstriction (avoid in Raynauds or unstable CAD) |
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cabergoline
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ergot derivative
-used for hyperprolactinemia -ADEs sedation, N, hypotension, dyskinesia, psychosis (hallucionations, delusions) -potential for vasoconstriction (avoid in Raynauds or unstable CAD) |
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pramipexole
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nonergot dopamine agonist
-ADEs sedation, psychosis, orthostatic hypotension, dyskinesias, N -sleep attacks |
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ropinirole
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nonergot dopamine agonist
-also used for RLS -ADEs sedation, psychosis, orthostatic hypotension, dyskinesias, N -sleep attacks |
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rotigotine
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dopamine agonist- non ergot
-transdermal for difficulty swallowing/GI problems -ADEs skin reactions at site, dizzy, NA, V, drowsiness, insomnia |
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monitoring parameters for parkinsons
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-improvement in symptoms
-blood pressure and heart rate -weight changes -LFT, renal function -psychiatric changes -drug interactions |
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tolcapone
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-COMT inhibitor
-adjunct to levodopa-carb -hepatic toxicity- most monitor LFTs baseline and q2weeks x yr -ADEs: dyskinesia, N, urine discoloration, D, dizziness, ab pain, hallucinations |
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entacapone
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-COMT inhibitor
-adjunct to levodopa-carb -no hepatotoxicity -ADEs: dyskinesia, N, urine discoloration, D, dizziness, ab pain, hallucinations |
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selegiline
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MAO-B inhibitor
-B selective < 10mg/d -adjunct to levodopa-carb -ADEs: dyskinesia, psychiatric -metabolized to amphetamine and methamphetamine |
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rasagiline
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MAO-B inhibitor
-B selective < 10mg/d -adjunct to levodopa-carb -ADEs: dyskinesia, psychiatric, increased risk of melanoma -no amphetamine byproducts -avoid tyramine (HTN crisis) |
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anticholinergics used for parkinsons
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trihexyphenidyl
benztropine procyclidine biperiden ADEs: blurred vision, dry mouth, C, urinary retention, memory impairment |
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tx for peak-dose dyskinesias in parkinsons patients
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amantadine
-NMDA antag. propranolol -for choreiform dyskinesias -monitor for orthostatic hypo. mirtazapine |
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tx for psychosis/ hallucinations in parkinsons patients
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d/c any unncessary meds
-use atypical neuroleptic drugs quetiapine- DOC clozapine- monitor WBCs olanzapine- weight gain |
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tx for confusion/dementia in parkinson's patients
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acetylcholinesterase inhibitors
-donepezil -rivastigmine -galantamine NMDA antag (memantine) |
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tx for dizziness in parkinsons patients
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salt tablets
fludrocortisone compression stockings elevation of head of bed |
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tx for GI symptoms in parkinsons patients
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avoid metoclopramide or prochlorperazine (DA antag)
-start DA agonists at low doses and administer with meals |
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Tx for medication overuse HA
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-withdraw overused med
-manage acute sxs with NSAIDs, corticosteroids, or TCAs (amitriptyline or nort.) -initiate prophylactic therapy: B blocker, CCB, TCA, NSAIDs, anticonvulsants, tizanidine -recovery can take 6-12 mo |
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tx for acute cluster HA
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-oxygen
-ergotamine derivatives (DHE IV or IM, or ergotamine tartrate SL or rectal) -triptans (sumatriptan SQ) -intranasal lidocaine or capsaisin |
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tx for cluster HA- prophylaxis
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verapamil, lithium, ergotamine, prednisone, anticonvulsants (divalproex, gabapentin, topiramate)
-vitamin B2 or magnesium |
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tx for acute tension HA
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otc analgesics (APAP)
triptans |
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tx for prophylaxis tension HA
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TCAs
tizanidine clonidine -biofeedback, stress managemnt, massage, acupuncture |
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eletriptan
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1b,1d serotonin agonist
-for acute migraine -ADEs paresthesia, flushing, N, dry mouth, dizzy, drowsy, chest tightness -contra with uncontr. HTN, within 24 hrs of 5-HT agonist or ergot med, within 2 weeks of MAOI, risk of serotonin syndrome if used with SSRIs |
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frovatriptan
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1b,1d serotonin agonist
-for acute migraine -very long half life (slower onset) -ADEs paresthesia, flushing, N, dry mouth, dizzy, drowsy, chest tightness -contra with uncontr. HTN, within 24 hrs of 5-HT agonist or ergot med, within 2 weeks of MAOI, risk of serotonin syndrome if used with SSRIs |
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almotriptan
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1d serotonin agonist
-for acute migraine -triptans are first line therapy after NSAIDs -ADEs paresthesia, flushing, N, dry mouth, dizzy, drowsy, chest tightness -contra with uncontr. HTN, within 24 hrs of 5-HT agonist or ergot med, within 2 weeks of MAOI, risk of serotonin syndrome if used with SSRIs |
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rizatriptan
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1d serotonin agonist
-for acute migraine -oral disintegrating tablet -ADEs paresthesia, flushing, N, dry mouth, dizzy, drowsy, chest tightness -contra with uncontr. HTN, within 24 hrs of 5-HT agonist or ergot med, within 2 weeks of MAOI, risk of serotonin syndrome if used with SSRIs |
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sumatriptan
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1d serotonin agonist
-for acute migraine -nasal spray, injection, oral -ADEs paresthesia, flushing, N, dry mouth, dizzy, drowsy, chest tightness -contra with uncontr. HTN, within 24 hrs of 5-HT agonist or ergot med, within 2 weeks of MAOI, risk of serotonin syndrome if used with SSRIs |
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zolmitriptan
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1d serotonin agonist
-for acute migraine -oral disintegrating tablet, nasal spray -ADEs paresthesia, flushing, N, dry mouth, dizzy, drowsy, chest tightness -contra with uncontr. HTN, within 24 hrs of 5-HT agonist or ergot med, within 2 weeks of MAOI, risk of serotonin syndrome if used with SSRIs |
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naratriptan
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1d serotonin agonist
-for acute migraine high bioavailability, short 1/2 life -ADEs paresthesia, flushing, N, dry mouth, dizzy, drowsy, chest tightness -contra with uncontr. HTN, within 24 hrs of 5-HT agonist or ergot med, within 2 weeks of MAOI, risk of serotonin syndrome if used with SSRIs |
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ergotamine tartrate
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-oral with caffeine, sublingual, rectal
-for moderate to severe migraine attack, or cluster HA -contra in angina, CAD patients, uncontrl HTN, renal or liver disease, narrow angle glaucoma, pregnancy ADEs: GI, weakness, chest tightness, muscle pain, severe peripheral ischemia, rebound HA |
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dihydroergotamine
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-nasal spray or injection
-for moderate to severe migraine attack, or cluster HA -contra in angina, CAD patients, uncontrl HTN, renal or liver disease, narrow angle glaucoma, pregnancy ADEs: GI, weakness, chest tightness, muscle pain, severe peripheral ischemia (less than ergotamine), rebound HA (less than ergotamine) |
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NSAIDs
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-used for acute migraines
-better efficacy than APAP -monitor for GI disturbances -rebound HAs with continued use |
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opiates
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butorphanol nasal spray or opioid combination analgesics for acute migraines
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corticosteroids
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dexamethasone, prednisone, hydrocortisone
-used for acute migraines |
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propofol
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general anesthetic and sedative used for acute migraines
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antiemetics for migraines
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phenothiazines (decrease dopamine) (chlorpromazine, metoclopramide, prochlorperazine) can cause EPS
-given before abortive med |
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TCAs
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migraine prophylaxis
-amitriptyline 1st choice -nortriptyline -doxepin -imipramine |
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5HT2a antag. antidepressants
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migraine prophylaxis
-mirtazapine, nefazodone, trazodone |
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beta blockers
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migraine prophylaxis
-atenolol -metoprolol -nadolol -propranolol -timolol |
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calcium channel blockers
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migraine prophylaxis
nimodipine verapamil |
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divalproex sodium
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migraine prophylaxis
-ADEs N, V, tremor, weight gain, hair loss, hepatotoxicity, bleeding, polycystic ovarian disease |
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topiramate (HAs)
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migraine prophylaxis
-ADEs dizzy, ataxia, sedation, psychomotor slowing, weight loss |
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NSAIDs for migraine prophylaxis
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used premenstrually 1-2 days prior to headache for a week
-aspirin, ibuprofen, ketoprofen, naproxen sodium |
