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Pharm 3 Exam CNS tutor notes
Terms in this set (50)
What is the primary drug used in management for Parkinson's?
What are the limitations/disadvantages of Levadopa?
-Full therapeutic effect can take months
-Benefits diminish over time (only works 2-5 years)
-Need large doses to achieve adequate levels in CNS
What are dietary issues with Levadopa?
Proteins/Vitamin B6 compete for absorption, food delays absorption
What is the MOA of levadopa/carbidopa(sinemet)?
-Helps prevent breakdown of levodopa
-Reduces dose by 75%
-Reduces concern of food/vitamins
What are the Adverse Effects of Levodopa/carbidopa(sinemet)?
-Dyskinesias (80% in the first year)
What are the limitations of drug therapy for Levodopa?
-Only works 2-5 years
-Loss of response overtime
-Abrupt loss of effect can happen at any time
Levodopa drug holidays
-Must be taken place in a hospital
Why must the drug holiday take place in the hospital?
-Because drug withdrawal immobilizes the patient
-The patient is at risk for all of the physical and psychological effects of this stress
Adverse Effects of Pramipexole(Mirapex) & Ropinirole (Requip)
Gambling & alcoholism
What is the therapeutic use of Interferon?
-Reduces the frequency and severity of attacks
-Reduces the number/size of MRI-detectable lesions
-delays progression of disability
Adverse effects of Interferons
What is the MOA of Glatiramer (Copaxone)?
Protects myelin sheath by inhibiting response to myelin basic protein
What is the adverse effect of Glatiramer (copaxone)?
Brief but severe chest pain after injection, some injection-site reactions
How is Glatiramer (Copaxone) administered?
What is Benzodiazepine--Clonazepam (Klonopin) used for?
Long term-seizure control
What is the therapeutic range for Phenytoin (dilantin)?
What are the side effects of Phenytoin (DIlantin)?
-Toxic epidermal necrolysis (TEN)
-Dysrhythmias;IV push can cause discoloration
-CAT D PREGNANCY!!!
What is Fosphenytoin indicated for?
-Indicated for short-term IM or IV
What is Fosphenytoin used for?
What is the side effect of Carbamazepine (Tegretol) ?
-Depression bone marrow
What are the side effects of Valproic acid (Depakote, Depakane) ?
-Impaired PT & PTT
-CATEGORY X PREGNANCY!!!
What is Gabapentin (Neurontin) used for?
-Used for neuropathic pain
-Adjuvant for partial seizures
Adverse Effects of Gabapentin (neurotin)
What is lamotrigine (Lamictal) used for?
-Used as adjuvant therapy for partial seizures
-Children <2 with generalized seizures
What are the adverse effects of Lamotrigine (Lamictal)?
What is Topiramate (Topamax) used for?
-Partial/primary generalized seizures
-Prevention of migraines
What are the adverse effects of Topiramate?
what is Levetiracetam (Keppra) used for?
-Adjuvant for general, partial, myoclonic seizures; similar to Lamictal, generally well-tolerated
What is the drug of choice for absence seizures?
Ethosuximide (Zarontin) 30-100 mcg/mL
What are the adverse effects of Ethosuximide (Zarontin)?
-Contraindication in renal and liver disease
What is the DOC for spasticity?
What is Malignant hyperthermia caused by?
Potentially fatal condition also caused by succinylcholine and general anesthetics
What are the side effects of Malignant hyperthermia?
-DRAMATIC RISE IN TEMP 113 F
-Abnormally rapid/irregular heartbeat
-Rapid uncomfortable breathing
-Brown urine "coca cola urine"
What is the DOC for manic episodes & long term prophylaxis & preventing suicide?
What are the side effects of Lithium?
-Fatigue, headache, memory loss, poor concentration, N/V, weight gain, hair loss, acne, fine tremors
What are Lithium toxicities?
What are preventions to take with Lithium?
-Check renal function before starting and every year
-Teach patient to drink 8-12 glasses of fluids daily (polyuria/thirst)
What is the therapeutic range for Lithium?
-Chronic: 0.6-1.2 mEq/L
-Acute: 1-1.5 mEq/L
What are patient teachings when taking Lithium?
-Sudden decrease in sodium may result in higher serum lithium levels
-Sudden increase in sodium intake might prompt lithium levels to fall
Several anticonvulsants are used to manage what disorder?
What are anticonvulsants that can be used for bipolar disorder?
What is Morphine's sudden Adverse Effects?
What are Morphine's Adverse Effects prolonged use?
What are toxicities with Morphine?
-Triad of symptoms:
-Pinpoint pupils initially
-Treat with Naloxone (Narcan)
What are concerns for opiod-naive patients?
Respiratory depression can become more tolerant within 72 hours
Risk for tolerance (Morphine)
-Physical dependence (can occur within 2 weeks of taking opiod
What is abstinence syndrome?
10 hours after last dose; yawning, rhinorrhea, sweating, anorexia, irritability, tremors, violent sneezing, weakness, N/V/D, abdominal cramps, bone/muscle spasms, kicking movement
ATC vs PRN
Patients do better/require less pain med if scheduled ATC, no peaks/valley
Naloxone (narcan) is DOC
Why should patients be observed closely when they are on Antidepressants?
Should be observed closely for a few weeks/months for suicidality, worsening moods, changes in behavior
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