Neurology Pharm Ii

eesohbel's version from 2015-09-24 21:49


Question Answer
who should triptans not be used inshould not be used in patient with a history or risk of coronary artery disease
What drugs are used for migraine abortive therapy?triptans, ergots, IV antiemetics
what drugs are used for prophylaxis if migraines? B-blockers, TCAs, and anticonvulsants
when should patients be given migraine prophylaxisif headaches occur more frequently than once per month
what is the treatment for cluster headachestriptans and 100 percent oxygen
what agents over long term prophlaxysis for cluster headachesverapamil and lithium
treatment for paroxysmal hemicraniaindomethacin
treatment for IIH pseudotumor cerebricarbonic anhydrase inhibitors such as acetazolamide and topiramate, which reduce production of CSF. BP shunting is second line. for severe papilledema slit, optic nerve
can you give triptan and ergots togetherno can cause serotonin syndrome

Seizure medication

Question Answer
Phenytoin (dilantin) MOAinhibition of voltage-dependent sodium and calcium channels along with inhibitng release of glutamate from presynaptic neurons
Phenytoin seizure types treatedpartial and generalized tonic clonic
Phenytoin characteristic side effectsgingival hyperplasia, coarsening of facial features, ataxia, hirsutism, teratogenic ex. limb and nail defects. cerebellar tox if overdose
Carbamazepine (Tegretol) MOANa channel inactivation
Carbamazepine indicationsfocal seizures, tonic clonic generalized seizures, acute mania in the setting of bipolar disorder and trigeminal neuralgia
Carbamazepine a/ehyponatremia, agranulocytosis, diplopia
Valproic Acid (Depakote) MOAinhibit Na channel, increase GABA receptor
Valproic acid seizure type treatedpartial, generalized
Valproate a/eGI symtpoms, tremor, weight gain, hair loss, hepatotox, thrombocytopenia, NTD
Phenobarbital MOAGABA receptor
Seizure types treated by phenobarbpartial, generalized, first line drug in pregnant women
phenobarbital a/esedation, angioedema, erythema multiforme
MOA ethosuximide (zarontin)t-type calcium channel.
A/E ethosuximideGI symptoms
MOA gabapentin (zarontin)T-typerenal stones, calcium channel
type of seizure gabapentinpartial, postherpetic neuralgia
a/e gabapentinsedation, ataxia
topiramate (topamax) moaNa channel/GABA activity
seizures types topiramatepartial, generalized, lennox-gastaut syndrome, headaches
a/e topiramateword finding difficulty, renal stones, weight loss
MOA tiagabine (gabatril)GABA reuptake
type of seizure tigabinepartial
a/e tigabinesedation
MOA levetiracetam (keppra)unknown
indications for levetiracetampartial, tonic clonic, juvenile myoclonic epilepsy
a/e kepprainsomnia, anxiety, irritabiliity
MOA oxcarbazepine (trileptal)Na channel
type of seizure oxcarbazepinepartial
A/E oxcarbazepinesedation, hyponatremia
MOA zonisamide (zonegran)unkown
type of seizures zonisamidepartial, generalized
a/e zonisamidesedation, renal stones, weight loss
what drug should be given to prevent seizures in women with hypertension or eclampsiamagnesium sulfate
moa lamotrigine (lamictal)inhibition of voltage gated sodium channels
indications for lamotriginefocal seizures and tonic seizures.
a/e lamotriginerash, SJS
primidoneanticonvulsant agent can ttreat benign essential tremor besides propanolol
a/e primidoneAIP
which AED is a potent enzyme inducerphenytoin, phenobarbital and oxycarbazepine
steroids can causepsychosis
statinscan cause rhabdo
AED inhibitorvalproate
what long term vitamin deficiency can result from phenytoin usefolate

Status epilepticus

Question Answer
step 1 treatmentABCS, fingerstick glucose establish IV access
step 2 treatmentgive 100mg IV thiamine, followed by 50% dextrose infusion
step 3lorazepam .1mg/kg IV
step 4 if continuesphenytoin 20mg/kg IV
step 5 if continutesintubate if not already done. phenobarbital 20mg/kg IV
step 6 if continuesinduce coma with barbituates, midazolam or propofol
if cannot access IV line giveIM midazolam

Alzheimer Disease therapy

Question Answer
MOA donepezil (aricept)cholinesterase inhibitor
A/E donepezildiarrhea, abdominal cramps and hepatotox
MOA rivastigmine (exelon)cholinesterase inhibitor
A/E rivastigmineGI disturbances during dose adjustment
MOA memantine (namenda)NMDA receptor antagonist
A/E memantine dizziness, headache, confusion
MOA galantamine (razadyne)cholinesterase inhibtor
A/E galantamineGI side effects, weight loss

Antipsychotic extrapyramidal effects

Question Answer
which antipsychotics have higher risktypical
acute dystonic reactionsudden, sustained contraction of the neck, mouth, tongue, eye muscles
treatment for acute dystonic reactionbenzotropine or diphenydramine
akasthisiasubjective restlessness, inability to sit still
treatment for akathsisialorazepam
tardive dyskinesiagradual onset after greater than 1-6 months of therapy. dyskinesia of the mouth, face, extremities
treatment for NMSstop offending agent, supportive treatment, can start dopamine agonist
neuromalignant syndromeuncommon disorder caused muscle rigidity, fever, elevated creatinine kinase

Antiplatelet/Antithrombotic Therapy for Stroke

Question Answer
presentation within 3.5-4 hours of symptoms onset and no contraindicationsIV altepase
stroke with no prior antiplatelet therapyaspirin
stroke on aspirin therapyaspirin + dipyridamole or clopidogrel
stroke on aspirin therapy and patient with intracranial large artery atherosclerosisaspirin and clopidogrel
stroke with evidence of afiblong term anticoagulation

Parkinson Drug side effects

Question Answer
A/E levodopa plus carbidopasomnolence, confusion, hallucinations, dyskinesia, orthostatic hypotension
A/E trihexyphenidyl or benzotropinedry mouth, blurred vision, constipation, nausea and urinary retention
A/E amantadineankle edema and livedo reticularis
A/E ropinirolesomnolence, hypotension and confusion. hallucinations
A/E entacaponedyskinesia, hallucinations, confusion, nausea and orthostatic hypotension
A/E selegilineinsomnia and confusion (elderly patients)
L-Dopa plus carbidopa MOAdopamine precursor plus dopa decarboxylase inhibitor
trihexyphenidyl plus benzotropineanticholinergic
amantidineNMDA antagonist
selegiline/rasagilineMAO-B antagonist
entacapone or tolcaponeCOMT inhibtor

therapeutic strategies in parkinson disease

Question Answer
initial treatmentlevodopa/decarboxylase inhibtor
poor or no response to initial treatmentincrease dose and consider alternative diagnoses
tremor-predominant diseaseantcholinergic or amantadine
early morning stiffnessconsider overnight controlled release preparation of L-DOPA
L-dopa induced hallucinationsdiscontinue concurrent therapy , decrease dose of levo-dopa, low dose atypical antipsychotic
"wearing off"combine levodopa and dopamine agonist, switch dopamine agonist, add anticholinergic, add COMT inhibitor
dyskinesiareduce dose of levodopa, add or increase dose of dopamine agonist, change dopamine agonist, add amantidine, consider surgery

Movement disorder

Question Answer
treatment for myoclonusclonazepam and valproate
idiopathic torsion dystonia treatmentbotulinum toxin
chorea treatmenthaloperidol
ballism treatmentdopamine depleting and blocking agents

MS treatment

Question Answer
treatment for acute MS relapsesIV steroids
disease modifying agentsglatiramer and interferon B
bladder dysfunctionanticholinergic
natalizumab (tysabri) a/ePML. hepatotox, hypersensitvity reaction
what is PMLJC virus is the causative agent and leads to demyelination by infecting oligodendrocytes
Natalizumab and immunosuppresantsshould not be combined with immunosuppressants


Question Answer
Methamphetamine antidoteAmmonium chloride
Methamphetamine - Rx for SxBenzodiazepines, Antipsychotics, Antihypertensives
Acetaminophen antidoteN-acetylcysteine (replenishes glutathione, which works on elimination + provides sulfhydryl groups to enhance the non-toxic sulfating elimination of the drug)
Salicylates antidote Sodium bicarbonate, dialysis
Organophosphate antidotePralidoxime
Organophosphate - Rx for SxAtropine
Antimuscarinic agent antidotePhysostigmine
ß-blocker antidoteGlucagon, Atropine, Calcium
Non-dihydropyridine Ca2+ channel blocker antidoteGlucagon, Atropine, Calcium
Digitalis antidoteAnti-dig Fab fragments
Digitalis antidoteK+ and Mg++ optimization
Digitalis antidoteAtropine
Iron overload antidoteDeferoxamine
Lead poisoning antidote in childrenDimercaprol, Calcium EDTA, Succimer, Penicillamine
Lead poisoning antidote in adultsCalcium EDTA, Succimer
Mercury, arsenic, gold antidoteDimercaprol, Succimer
Copper, arsenic, gold antidotePencillamine
CO poisoning antidote 100% O2, Hyperbaric O2
Methylhemoglobin antidoteMethylene blue, Vit. C
Cyanide antidoteHydroxocobalamin, Thiosulfate, Nitrates
Methanol antidoteFomepizole, Ethanol, dialysis
Ethylene glycol antidoteFomepizole, Ethanol, dialysis
Opiod antidoteNaloxone (short t1/2), Naltrexone
Benzodiazepine antidoteFlumazenil
TCAs antidoteSodium bicarbonate
Heparin antidoteProtamine
Warfarin antidoteVitamin K (slow), fresh frozen plasma
tPA, streptokinase, urokinase antidoteAminocaproic acid
Theophylline antidoteß-blocker
Tumor Lysis Syndrome "antidote"Allopurinol or Rasburicase

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