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Migraine, Alzheimer's, PD

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toejammer's version from 2013-06-20 17:33

Migraines

Question Answer
use these for menstrual migrainesNSAIDs, topiramate
headaches with musculoskeletal componenttension headaches
do not use these drugs in migraine patientsnarcotic analgesics
common side effects of triptanstingling, warmth, flushing, chest discomfort
triptans where somnolence is more commonshorter acting
CAD, or many CAD risk factors--avoid theseavoid triptans
uncontrolled HTN, use of an MAOI--avoid theseavoid triptans
pregnancy category of triptansC
avoid within 24 hours of ergottriptans
no more than 2 doses of these per migrainetriptans
all of these drugs have DI warning with SSRIs for serotonin syndrometriptans
treximet =sumatriptan and naproxen
sumavelsq injection of sumatriptan
inadequate initial treatment of migraine results inmedication overuse headache
most important component of treating ARHD/C the offending agent
this is an option other than Frovatriptan to treat ARHMedrol Dose Pack
options for ARHNSAID, DHE, steroids, triptan
if migraine trigger is known, do thisgive naproxen before activity
put a heavier person on this drug for migraine prophylaxistopiramate
if a person is going to be on topiramate counsel on this possibilityrenal calculi
herbals with lit for migraineriboflavin, feverfew, magnesium
MOA of Triptansagonist at serotonin 5-HT1B/1D receptors-->vasoconstriction of the cranial blood vessels
Don't use these in migraines with auraOCs with estrogen
This can benefit patients with menstrual migrainesOCs
How is sumatriptan supplied?SC, PO, nasal spray
reason to use injectable or nasal sumatriptanfaster onset or presence of nausea
triptan contraindicationsCV disease, cerebrovascular disease, uncontrolled HTN
triptan with longest duration of actionFrova
triptans that come as ODTsRizatriptan and Zolmitriptan
triptans contraindicated with MAOIsImitrex (Sumatriptan), Maxalt (Rizatriptan), & Zomig (Zolmitriptan)
important counseling point with triptan nasal spraysdo not prime or you will lose a dose
pregnancy category of ergot productsX
BBW with ergot productsavoid with 3A4 inhibitors
safer migraine agent in patient with liver problemstopiramate
best beta blockers for migraine prophypropranolol, timolol, metoprolol
does Zomig come in nasal spray?yes
this triptan is metabolized by 3A4Eletriptan
this is AKA stadol nasal sprayButorphanol
this migraine med is a mixed opioid agonist/antagonistButorphanol
this NSAID has a longer duration of action than ibuprofennaproxen
this is the most common triptansumatriptan
dosage range of sumatriptan (po)25, 50, 100
max doses of triptan per headache2
2 important contraindications to triptan therapycerebrovascular disease and uncontrolled HTN
are triptans serotonin agonists or antagonists?agonists
this is the triptan with the longest duration of action, useful for patients with recurrent migrainefrovatriptan
2 triptans that come as nasal sprayszolmitriptan and sumatriptan
what is in fiorinal?aspirin, butalbital, caffeine
what is in fioricet?acetaminophen, butalbital, caffeine
this formulation of butalbital comes with codeine as wellfiorinal
schedule of butalbital drugsCIII
where do you inject Imitrex injection?SC, upper outside arm
the three triptans that are contraindicated with MAOIssumatriptan, rizatriptan, and zolmitriptan
what is the risk with higher levels of ergot products?cerebral ischemia
AKA migranaldihydroergotamine mesylate
this drug is for refractory migraine cases only--liver toxfelbamate
type of pill that should be used in patient with migraine/auraprogestin only
Nor-QDprogestin only
Nora-Beprogestin only
Lybrelestrogen birth control
Camilaprogestin only
this migraine drug is CIVbutophanol
this drug can cause PCOS in young women d/t increased testosterone levelsVPA
this is a second-line migraine agent (only lasts 15 days/month)botox
SNRI that is a second-line migraine agentvenlafaxine
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Lecture 9 (Alzheimer's)

Question Answer
tell-tale signs of Alzheimer's upon autopsyplaques and tangles
this is AKA multi-infarct dementia --it is due to multiple strokesvascular dementia
component in tylenol PM that has anti-cholinergic effectsbenadryl
this bladder drug has been documented to cause cognitive impairment due to lipophilicityDitropan
examples are Aricept, Exelon, Razadyneacetylcholinesterase inhibitors
AKA AriceptDonepezil
enzyme that metabolizes Donepezil3A4 and 2D6
AKA ExelonRivastigmine
preferred dosage form of Rivastigminepatch
AD drug with more common GI issuesRivastigmine
other AD drug metabolized by 3A4 and 2D6Galantamine
this AD drug regulates NDMA receptorNamenda (memantine)
abnormal levels of this lead to excessive neuroexcitabilityglutamate
this AD drug has an extremely long half-lifeNamenda (memantine)
can you use Namenda and AChEIs together?yes
all of these drugs have a BBW for increased risk of stroke and death in elderlyantipsychotics
be aware of these side effects of antipsychoticsEPS
good antipsychotic as far as EPS, but worry about sedation and orthostasisQuetiapine
donezepilAricept
memantineNamenda
galantamineRazadyne
rivastigmineExelon
tacrineCognex
Alzheimer's drug not used much d/t heptatoxCognex
this cholinesterase inhibitor is given with foodrivastigmine (Exelon)
take XR Namenda with or without foodwith food
Alzheimer's drug that requires renal dosingNamenda
use caution with cholinesterase inhibitors and these types of drugsdrugs that lower HR, drugs that cause dizziness
Alzheimer's drug that comes in oral liquidNamenda
options for patients with Alzheimer's that experience nauseaODT, patch formulation
when to take Ariceptat night--sleep through the nausea
dosing for Namenda IRbid
how often are Exelon patches applieddaily
MOA of NamendaNMDA receptor antagonist
MOA of Aricept, Exelon, Razadyne, CognexAchE inhibitors
steroid that is anticholinergicprednisone
asthma drug that is anticholinergictheophylline
HF drug that is anticholinergicdigoxin
score of MMSE that indicates impairment<24
drawback to higher dose of Aricept (23mg)Brand name only, may not work
this Vitamin is sometimes used for dementia but doses > 150 IU have riskVitamin E
this supplement is also used for memory, but can increase bleeding riskGinkgo biloba
these drugs oppose cholinesterase inhbitors, but are commonly used in older patientsanti-muscarinics for overactive bladder
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Lecture 10 (PD)

Question Answer
in PD, there is a loss of DA and excess of thisacetylcholine
why do antimimetics, antipsychotics, metoclopramide cause PD?they are DA antagonists
L-DOPA is transported by this type of transporteramino acid
if you take L-DOPA with this food you interfere with transporthigh protein meal
the purpose of carbidopa is to do thisinhibit decarboxylase
carbidopa blocks decarboxylase where?in the periphery
peripheral side effects of L-DOPAGI and cardiac
blood pressure issue of L-DOPAorthostatic hypotension
avoid these drugs with L-DOPAmetoclopramide and antipsychotics
this metal interacts with L-DOPAiron
starting dose of L-DOPA200-300mg/day
doses of carbidopa70-100 mg/day
Sinemet =L-DOPA and carbidopa
optimal mix of carbidopa and L-DOPA1 to 4 (25/100)
examples are Entacapone, TolcaponeCOMT inhibitors
these inhibit breakdown of L-DOPACOMT inhibitors
can COMT inhibitors be given without L-DOPA?no
these drugs don't delay peak of L-DOPACOMT inhibitors
avoid these drugs with MAOIsCOMT inhibitors
COMT inhibitor with no food effect, urinary excretion, short half-lifeEntacapone
reason that Tolcapone is not used oftencan cause liver injury and GI disease
COMT inhibitor that causes delayed onset diarrheaTolcapone
this drug has amphetamine-like metabolitesSelegiline
stimulating MAO-B drugSelegiline
less stimulating MAO-B drugRasagiline
DIs are nonspecific MAO-Is, TCAs, prozac, tyramineMAO-B drugs
MAO-B drug with less issues with Prozac and tyramineRasagiline
CI with meperidine, SJWRasagiline
this drug increases DA and NE release and inhibits uptakeAmantadine
DA agonists approved for monotherapyPramipexole, Ropinirole
examples are benztropine, trihexyphenidyl, diphenhydramineanti-cholinergics
these drugs help more with tremors than rigidityanti-cholinergics
drug used more often in older patientsL-DOPA
drug used more often in younger patientsDA agonists
way to prolong life of L-DOPACOMT inhibitor
withdrawal of this drug can cause deliriumAmantadine
two antipsychotics that can be used in PD psychosisquetiapine, clozapine
part of brain that is damaged in PDsubstantia nigra
deficiency of this NT causes PDdopamine
two most effective classes of PD drugsSinemet and DA agonists
second generation antipsychotics that may cause movement disordersRisperidone and Paliperidone (Invega)
GI drug that causes movement disordersReglan
why is metoclopramide sometimes overdosed?it should be dose-reduced in renal impairment
CNS drugs that can worsen movement disorderscholinesterase inhibitors
DOC for PD in elderlySinemet
useful drugs for tremor in younger patientsanticholinergic
this PD drug is often used for tremor in younger patientsAmantadine
rare side effect of Sinemetunusual sexual urges
common side effect of SinemetN/V, dizziness, dyskinesias
AKA SinemetL-DOPA and Carbidopa
drugs that can buy time before dopaminergic therapyMAO-B drugs
contraindication to Sinemetwithin 2 weeks of non-selective MAO-I
avoid placing Neupro patch in same place for how many days14
how is Apokyn given?SC
MAO-B inhibitor with more drug interactionsSelegiline
MAO-B inhibitor with drug and food interactionsRasagiline
avoid these meals with L-DOPAhigh protein meals
CI closed angle glaucoma, cardiac issuesL-DOPA
GI side effects, vivid dreams, psychiatric disturbances are associated withL-DOPA
abruptly D/C = neurleptic malignant syndromeL-DOPA
avoid with metoclopramide, antipsychoticsL-DOPA
these block breakdown of DAMAO-B inhibitors
need carbidopa doses of this70-100 mg/day
block breakdown of L-DOPA (not DA)COMT inhibitors
PD drugs associated with discolored urineCOMT inhibitors and Sinemet
AKA EntacaponeComtan
Staleveo is AKACarbidopa, L-DOPA, Comtan together
these drugs increase peak of L-DOPAMAO-B drugs
this is AKA Eldepryl, ZelaparSelegiline
fatal drug interaction with MAO-B drugmeperidine
what methadone, DXM, SJW, mirtazepeine, cyclobenzaprine have in commoninteract with MAO-B drugs
this is AKA RasagilineAzilect
this drug is thought to facilitate DA and NE release and inhibit reuptakeAmantadine
this drug is AKA AmantadineSymmetrel
Pramipexole (Mirapex) and Ropinerole (Requip)DA agonists
give this if patient can't tolerate increase in L-DOPADA agonists
PD drug given for hyperprolactinemiaBromocriptine (Parlodel)
this DA agonist is an ergotBromocriptine (Parlodel)
DA agonists that carry warning about daytime sedationPramipexole and Ropinerole (Requip)
PD drug if main symptom is tremoranticholinergics
better PD drug in older patientsL-DOPA
better PD drug in younger patientsDA agonists
this GI agent causes Parkinson-like symptomsmetoclopramide
this class of antipsychotics causes movement disordersphenothiazines
AmantadineSymmetrel
this drug is approved for PD and the fluamantadine
usefulness of Amantadine in PDearly symptoms (mainly tremor)
ComtanEntacapone
this COMT drug isn't used much because of liver toxTolcapone (Tasmar)
StalevoCarbidopa, levodopa, and Entacapone
you must reduce the dose of Amantadine with poor [] functionrenal
this is a rare side effect of Amantadine --causes purplish discoloration of lower extremitieslivedo reticularis
usual dose of the carbidopa component70-100mg daily
function of carbidopa in SinemetThe carbidopa prevents the peripheral (outside of the CNS) breakdown of levodopa by the enzyme decarboxylase
what is unique about controlled release Sinemet?it can be cut and remain CR
Is Selegiline used alone?no
when is Selegiline given?morning--it is activating
this MAO-B drug can be used aloneRasagiline
watch these PD drugs with drugs with serotoninergic activityMAO-Bs
lower dose of this drug when starting carbidopa/levodopaSelegiline
isocarboxazidmarplan
phenelzineNardil
tranylcypromineParnate
Two indications for Benztropinetremor in PD, painful dystonic reactions with antipsychotics
separate Sinemet from these supplementsiron
hallucinations are caused by which PD drugsSinemet and the DA agonists
Roprinrole =Requip
Mirapex =Pramipexole
dose of Entacapone200mg with each dose of L-DOPA
main side effects of Sinemeturine discoloration, dizziness, abnormal movements
why do DA agonists have to be titrated slowly?because of risk of daytime sleepiness
what formulation do DA agonists come in when used for RLS?immediate-release taken 1-3 hours before sleep
TolcaponeTasmar
Apomorphine causes thissevere nausea and vomiting
Apokyn =Apomorphine
type of disease that Apomorphine treatsAdvanced PD
can you use 5HT agonists with apomorphine?no
besides N/V, what is a severe side effect of apomorphine?QT prolongation
agent that can help with apomorphine N/Vtrimethobenzamide (Tigan)
Zelapar ODT =Selegiline
how often are the DA agonists dosed?three times daily
rare side effect of levodopapriapism
Parcopa RapiTabcarbidopa-levodopa
Rotigotine =Neupro
MOA of NeuproDA agonist
can you get an MRI with Neupro?must remove patch first
how often is Neupro applied?daily
indications for NeuproPD and RLS
2 drugs to avoid in patients with sensitivity to sulfitesComtan and Lovenox
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