Term
|
Definition
Immediate Release LD is metab to DA
CD blocks peripheral conversion of LD to DA and increased LD CNS penetration
Dose: 300-2000 mg QD (broken up q2h if necessary) |
|
|
Term
| MOA, MD of Paracopa with phenylalanine |
|
Definition
Rapid dissolving LD
Dose: 300-2000 mg QD (broken up q2h if necessary) |
|
|
Term
|
Definition
SR LD
Dose: 200-2200 daily |
|
|
Term
|
Definition
Stable gel suspension of LD
Portable pump that continuously delivers LD of 20 mg/mL and carbidopa 5 mg/mL via duodenal pump |
|
|
Term
|
Definition
Activate postsynaptic D1 and D2 DA receptors
2-6 mg 3-5 times daily for off periods |
|
|
Term
|
Definition
Activate postsynaptic D2; Block D1
Dose: 1.25 mg at bedtime, then 1.25 BID
Week 2: 2.5 BID
Increase by 2.5 mg daily every 2-4 weeks up to 15-45 mg daily divided 2-3 times daily |
|
|
Term
|
Definition
Activate postsynaptic D2
Start with 0.125 mg TID
Increase 0.375-0.75 mg/day
MD: 0.5-1.5 mg TID
Dose reduction if CrCl < 60 |
|
|
Term
MOA, MD of Ropinerole
IR/XL dosing |
|
Definition
Activate postsynaptic D2DA receptors
IR 3-8 mg daily
CL: max dose 24 mg/day |
|
|
Term
|
Definition
Blocks MAO-B metabolism and presynaptic reuptake of DA in the brain
Dose: 5 mg QD effective as 10 mg with fewer AE |
|
|
Term
| MOA, MD of Zelapar with phenylalinine |
|
Definition
Rapid dissolving selegiline
Dose: Start 1.25 mg QAM before beakfast
If no better after 6 weeks, increase to 2.5 AM
Avoid food/liquid 5 minutes before ad after dose |
|
|
Term
|
Definition
MOA: Blocks MAO-B metabolism
Start with 0.5 mg and increase to 1 mg daily
Dose: 0.5 mg up to 1 mg daily |
|
|
Term
|
Definition
MOA: peripherally blocks COMT metabolism of DA; some central activity
Dose: 100-200 mg TID |
|
|
Term
| MOA, MD of CD/LD/Entacapone |
|
Definition
CD/LD: Blocks peripheral conversion of DA, allowing LD into CNS
Entacapone: Blocks COMT metab of DA peripherally
Dose: 300-1600 mg LD daily |
|
|
Term
|
Definition
MOA: NMDA- receptor antagonist that blocks glugamate transmission, promotes DA release, and blocks Ach
Dose: 200-300 mg daily (last dose in faternoon)
Decrease if CrCl <80 |
|
|
Term
| MOA, MD of anticholinergics |
|
Definition
| Block Ach, decrease Ach: DA ratio |
|
|
Term
| What would you do if you had motor flux bc of suboptimal peak response |
|
Definition
-Take LD/CD on empty stomach
-Decrease dietary protein/fat around dose
-Use raid dissolving tablet, crush LD/CD or liquid
-Substiute std Ld/CD instead of CR
-Minimize constipation
-Withdraw drugz that have anticholinergic properties
-Add intermittent ssubq apomorphine |
|
|
Term
| What would you do if you had motor flux w/ optimal peak but early wearing off? |
|
Definition
-Decrease dose and increase frequency of std Ld/Cd
-Subsitute CR for std LD/CD
-Add other meidcations |
|
|
Term
| What would you do if motor flux with optimal peak but unpredictable offs? |
|
Definition
-Adjust time of medications with meals and avoid high protein meals or redistribute the amount of protein in the diet
-Substitute or add rapid-dissolving tablet form or liquid form of LD/CD
-Add COMT-inhibitor
-Add or try a different DA agonist
-Consider CI of LD/CD
-Deep brain stimulation procedure |
|
|
Term
| What would you do for motor flux of freezing? |
|
Definition
Gait modifications
Difficult to treat--adjust current med up or down based on sx
On freezing: reduce DA meds (inject botulinum)
Off freezing: increase LD/CD dose or add DA agonists
Treat anxiety if present |
|
|
Term
| How do you treat a peak dose chorea dyskinesia? |
|
Definition
Evaluate value of adj PD medications
Decrease risk by lowering LD/CD dose when adding other PD medication
Adjust LD/CD formulation, dose, frequency
Add amatadine
Add propranolol, fluoxetine, buspirone, clozapine
Deep brain stimulation. |
|
|
Term
| What would you do for an dyskinesia off period dystonia in the early morning (foot cramping) |
|
Definition
Add LD/CD CR or DA at betime if having night offs
Morning LD/CD dose IR not CR
Add lithium or baclofen |
|
|
Term
| How would you treat a diphasic dyskinesia? |
|
Definition
Avoid CR preps; consider liquid LD/CD
Add DA agonist, amantadine, COMT inhibitor
Increase LD/CD dose and frequncy
Deep brain stimulation. |
|
|
Term
| How would you treat akathesia? |
|
Definition
-Benzo
-Propranolol
-DA agonists
-Gabapentin |
|
|
Term
| What must you add with apomorphine? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Pharmacologic txy for fatigue in MS? |
|
Definition
1st line: amantadine 100 mg PO qAM q afternoon (renally dose)
2nd line: methylphenidate 10-20 mg every morning and noon |
|
|
Term
|
Definition
Pre/Post synaptic GABA blocker
Dose: 5 mg TID (increase 5 mg every 3 days, max 80 mg)
Renal ddosing |
|
|
Term
|
Definition
Centrally acting alpha 2 agonist
Dose: 4 mg daily. Increase by 2-4 mg TID, QID
max 36 mg daily
Hepatic/renal dosing |
|
|
Term
|
Definition
Direct inhibitor of muscle contraction by decreasing release of calcium from skeletal muscle sarcoplasmic reticulum
Dose: 25 mg daily, 25 mg TID, QID.
25 mg every 4-7 days for max 400 mg |
|
|
Term
|
Definition
GABA agonis
2-10 mg TID, QID |
|
|
Term
|
Definition
Episodic: 3 days/month
Chronic: 15+ attacks in a one month period |
|
|
Term
| Which HA disorder has a genetic predisposition apparent? |
|
Definition
|
|
Term
| What type of HA are debilitating unilateral pains that occur in series lasting months at a time? |
|
Definition
|
|
Term
|
Definition
Moderate-severe
Throbbing
Unilateral
Retro-orbital
Accompanied by n/sensitivity to light, sound/difficulty concntrating |
|
|
Term
Almotriptan
Dosage Form
Usual Dose
Repeat dose
DDI |
|
Definition
|
|
Term
Eletriptan
Dosage Form
Usual Dose
Repeat dose
DDI |
|
Definition
Oral
20-40
DDI: Substrate @ 3A4, 2D6, ergot |
|
|
Term
Frovatriptan
Dosage Form
Usual Dose
Repeat dose
DDI |
|
Definition
PO
2.5 mg
repeat 2 hours
Sub 1A2, ergot |
|
|
Term
Naratriptan
Dosage Form
Usual Dose
Repeat dose
DDI |
|
Definition
PO
2.5 mg
4 hours
Various cyps, ergot |
|
|
Term
Rizatriptan
Dosage Form
Usual Dose
Repeat dose
DDI |
|
Definition
PO, ODT
5-10 mg
Repeat 2 hours
Ergot, MAO-B |
|
|
Term
Sumatriptan
Dosage Form
Usual Dose
Repeat dose
DDI |
|
Definition
SQ injection
6 mg--1 hour
50 mg--2 hours
Mao-B, ergot |
|
|
Term
Sumatriptan/Naproxen
Dosage Form
Usual Dose
Repeat dose
DDI |
|
Definition
PO, IN
5-10(2 hours); 85/100 (12 hours) |
|
|
Term
Zolmitriptan
Dosage Form
Usual Dose
Repeat dose
DDI |
|
Definition
IN, PO, ODT
2.5 PO
5 ODT
2 hours
Substrate at 1A2, ergot, maob |
|
|
Term
| AED used for migraine prophylaxis? |
|
Definition
Gabapentin (U)
VPA
Topirimate
Divalproex |
|
|
Term
| BB for migraine prophylaxis? |
|
Definition
Timolol
Metoprolol
Atenolol (B)
Propranolol |
|
|
Term
| CCB for migraine prophylaxis? |
|
Definition
|
|
Term
| Ergot for migraine prophylaxis? |
|
Definition
|
|
Term
| TCA for migraine prophylaxis? |
|
Definition
| Amitryptiline (B, 2nd line) |
|
|
Term
| Ergot drugs for migraine prophylaxis? |
|
Definition
Ergotamine tartrate
Methysergice |
|
|
Term
| Other drugs for migraine prophylaxis? |
|
Definition
Various hormones
Various muscle relaxants |
|
|
Term
| Use of how many NSAIDS for TTH weekly suggests need for prophylactic txy? |
|
Definition
|
|
Term
| Which two BB are approved by FDA for migraine prophylaxis? |
|
Definition
|
|
Term
| Which triptan interacts with propranolol? |
|
Definition
|
|
Term
Estazolam:
Duration, Half Life, Renal/Hepatic Dosing, Comments |
|
Definition
Duration: 12-15 hours
T 1/2: 2 hours
Dose reduction in hepatic
Moderate duration |
|
|
Term
Eszopiclone
Duration, Half Life, Renal/Hepatic Dosing, Comments |
|
Definition
8 hour duration
6 hour half life
Reduce in hepatic impairment
Can be used for 6 months in chronic |
|
|
Term
Flurazepam
Duration, Half Life, Renal/Hepatic Dosing, Comments |
|
Definition
Duration: 10-30 hours
Half life: 8 hours
No change necessary
High risk of hangover/residual effects |
|
|
Term
Quazepam
Duration, Half Life, Renal/Hepatic Dosing, Comments |
|
Definition
25-41 hours
2 hour half life
Dose reduction may be necessary in hepatic
High risk of hangover/residual effects |
|
|
Term
Ramelton
Duration, Half Life, Renal/Hepatic Dosing, Comments |
|
Definition
Unpublished DOA
1-2.6 hour half life
Don't use in hepatic impairment
Noncontrolled substance, may use if hx of abuse |
|
|
Term
emazepam
Duration, Half Life, Renal/Hepatic Dosing, Comments |
|
Definition
DOA: 7 hours
T 1/2: 10-15 hours
No change necessary
Moderate duration
Well tolerated
Inexpensive |
|
|
Term
Triazolam
Duration, Half Life, Renal/Hepatic Dosing, Comments |
|
Definition
6-7 hours
T 1/2 2 hours
Use lower dose in hepatic impairment
Shorter acting; little residual effect |
|
|
Term
Zaleplon
Duration, Half Life, Renal/Hepatic Dosing, Comments |
|
Definition
6 hour duration
1 hour half life
Use lower dosing range
Short acting
Only for difficulty falling asleep |
|
|
Term
|
Definition
6-8 hours
2-2.6 hour half life
Use lower dosing range
Short-moderate duration
No effects on sleep architecture |
|
|
Term
|
Definition
7-8 hour duration
2.8 hour T 1/2
Use lower dosing range in hepatic impairment |
|
|
Term
| Sleep: Pharmacologic Class, T 1/2, AE/disadvantages of LD |
|
Definition
Dopaminergic Agent
T 1/2: 1.5-2 hours
AE: N/V
High incidence of symptom augmentation |
|
|
Term
| Sleep: Pharmacologic Class, T 1/2, AE/disadvantages of pramipezole |
|
Definition
DA agent
8-12 hours
AE: N/V
Risk of compulsive behaviors |
|
|
Term
| Sleep: Pharmacologic Class, T 1/2, AE/disadvantages of ropinerole |
|
Definition
DA agent
6 hours
AE: N/V
Risk of compulsive behaviors |
|
|
Term
| Sleep: Pharmacologic Class, T 1/2, AE/disadvantages of gabapentin |
|
Definition
anticonvulsant
5-7 hour half life
AE: dizziness, ataxia |
|
|
Term
| Sleep: Pharmacologic Class, T 1/2, AE/disadvantages clonazepam |
|
Definition
Hypotonic agent
30-40 hours
Tolerance, carryover sedation |
|
|
Term
| Sleep: Pharmacologic Class, T 1/2, AE/disadvantages of temazepam |
|
Definition
Hypnotic agent
10-15 hours
Tolerance
Carryover sedation |
|
|
Term
| Sleep: Pharmacologic Class, T 1/2, AE/disadvantages of Zolpidem |
|
Definition
Hypnotic agent
2-2.6 hour half life
Tolerance |
|
|
Term
| Sleep: Pharmacologic Class, T 1/2, AE/disadvantages of Zaleplon |
|
Definition
Hypnotic agent
2 hour half life (may be longer if hepatic)
Tolerance
May not last entire night |
|
|
Term
| Sleep: Pharmacologic Class, T 1/2, AE/disadvantages of Hydrocodone |
|
Definition
Opioid
2.8-4.5 hours
constipation, Nausea, sedation |
|
|
Term
|
Definition
Opioid
2.5-3.5
Constipation, nausea, sedation |
|
|
Term
|
Definition
Opioid
6-12
Consitpation, nausea, sedation |
|
|
Term
|
Definition
Opioid
3.2-12
Constipation, Nausea, Sedation |
|
|
Term
| Drugs for tonic-clonic seizures |
|
Definition
Phenytoin
Phenobarbital
Oxcarbazepine
Carbamazepine
VPA
Levatiracetam
Lamotrigine
Zonisimide
Topirimate |
|
|
Term
| Drugs for myoclonic seizures? |
|
Definition
Zonisimide
VPA
Lamotrigine
Keppra
Topirimate |
|
|
Term
| Drugs for atonic seizures? |
|
Definition
|
|
Term
| Drugs for absence seizures? |
|
Definition
VPA
Zonisimide
Lamotrigine
Ethosuximide |
|
|
Term
| Drugs for partial seizures? |
|
Definition
Gabapentin
Topirimate
Phenytoin
Phenobarbital
Oxcarbamazepine
Carbamazepine
Lamotrigne
Levitiracetam
VPA |
|
|
Term
| AAN Drugs for Tonic-Clonic Seizures? |
|
Definition
Carbamazepine
Oxcarbazepine
Phenytoin
Phenobarb
VPA
Lamotrigine
Toirimate |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| ILAE tonic-clonic (adults and children) |
|
Definition
Adults:
-Phenytoin
-Phenobarb
-Carbamazepine
-Oxcarbazepine
-Lamotrigine
-VPA
-Topirimate
Children: Phenobarbital, Carbamazepine, Topirimate, VPA |
|
|
Term
|
Definition
Ethosuximide
Lamotrigine
VPA |
|
|
Term
|
Definition
-Clonazepam
-Lamotrigine
-Levitiracetam
-VPA
-Zonisimide
-Topirimate |
|
|
Term
| Drugs that may cause seizures? |
|
Definition
Tramadol
Bupropion
Thophylline
Some antidepressants
Some antipsychotics
Amphetamines
Cocaine
Imipenem
Lithium
Excess PCN doses/cephalosporins
Sympathomimetics
Stimulants |
|
|
Term
| AE of vagal nerve stimulation |
|
Definition
Hoarseness
Swallowing diffiuculties
Tinging or vibration of theneck
Infection or bleeding due to surgery
Rarely laryngeal spasms |
|
|
Term
How should you titrate phenytoin in the following:
<7
7-12
>12? |
|
Definition
<7: increase 100 mg/day
7-12: increase 50 mg/day
>12: increase no more than 30 mg/day |
|
|
Term
| Reasons protein binding is messed up? |
|
Definition
Kidney failure
Hypoalbuminemia
Neonates
Pregnant women
Highly protein bound drugs
Patients in critical care |
|
|
Term
| Refractory seizure: tonic clonic |
|
Definition
Topirimate
(insufficient evidence for gabapentin, lamotrigine, oxcarbazeine, keppra, zonisamide)
combo not addresed, could be useful |
|
|
Term
| Refractory seizures: Partial epilepsy |
|
Definition
Lamotrigine noted to be effective (high dropout rate)
Use oxcarbazpine or topiramate |
|
|
Term
| What seizure meds can be used in combination? |
|
Definition
|
|
Term
| Drugs with idiosyncratic rxn? |
|
Definition
Carbamazepine
Oxcarbazepine
Pheytoin
Phenobarb
VPA
Lamotrigine
Felbamate |
|
|
Term
| What AED is osteoporosis a concern in? |
|
Definition
Carbamazepine
Oxcarbazepine
Phenytoin
Phenobarb
VPA |
|
|
Term
| What AED should be used if HA? (which should not be used?) |
|
Definition
USE: Topirimate, VPA
Don't use: Lamotrigine, felbamate |
|
|
Term
| What AED should you use in depression, which exacerbate depression? |
|
Definition
Use: Lamotrigine, Carbamazepine, Oxcarbazepine
Worsen: Keppra, Phenytoin |
|
|
Term
| 5 criteria before stopping AED: |
|
Definition
2-5 years w/o seizure
Normal EEG
Normal Neuro exam
No mental problems
Single seizure disorder |
|
|
Term
| What can decrease absorption of carbamazepine? |
|
Definition
|
|
Term
| Which AED have neural tube defects? |
|
Definition
|
|
Term
| which AED associated with cognitive developemnt impairments in fetus? |
|
Definition
|
|
Term
| Interaction between AED and OC? |
|
Definition
Decrease OC efficacy
OC glucoronide some AED (lamotrigine, VPA)
Some drugs may cause infertility |
|
|
Term
Carbamazepine
MOA, Loading Dose, Elimination, Protein Binding, Serum concentration, idiosyncratic AE |
|
Definition
MOA: Fast Na Channel Activation
Loading dose: Not necessary
Elimination: Hepatic
Protein binding: 67-81%
Serum conc: 2-4
AE: Aplastic anemia, hyponatremia, leucopenia, osteoporosis |
|
|
Term
Clonazepam (AED)
MOA, Loading Dose, Elimination, Protein Binding, Serum concentration, idiosyncratic AE |
|
Definition
Enhance GABA pathway
No load--increased AE
Hepatic
47-80% protein bound
No serum monitoring or idiosyncratic AE |
|
|
Term
Ethosuximide
MOA, Loading Dose, Elimination, Protein Binding, Serum concentration, idiosyncratic AE |
|
Definition
Modulate Ca Channels
No loading dose--increase AE
Hepatic
No protein binding
Serum-40-100
AE: hepatotoxicity, neutropenia, rash |
|
|
Term
Felbamate
MOA, Loading Dose, Elimination, Protein Binding, Serum concentration, idiosyncratic AE |
|
Definition
MOA: Inhibit glucamate
No loading dose: increased AE
Elimination: Hepatic
Protein binding: 25-35%
Serum concentration--N/A
AE: Anorexia, aplastic anemia, HA, hepatotoxicity, wt loss. |
|
|
Term
Gabapentin
MOA, Loading Dose, Elimination, Protein Binding, Serum concentration, idiosyncratic AE |
|
Definition
MOA: Modulate Ca channels
No load
Renal
<10% PROTEIN BINDING
No serum monitoring
AE: Peripheral edema, weight gain |
|
|
Term
Lacosamide
MOA, Loading Dose, Elimination, Protein Binding, Serum concentration, idiosyncratic AE |
|
Definition
MOA: Slow Na channel inactivation; modulate collapsing response protein modulator II
No loading dose
40% renal; 60% hepatic
<15% protein bound
No monitoring
PR interval prolongation |
|
|
Term
Lamotrigine
MOA, Loading Dose, Elimination, Protein Binding, Serum concentration, idiosyncratic AE |
|
Definition
Fast Na channel inactivation
No load (increased rash)
Hepatic
55% protein bound
No monitoring
AE: rash |
|
|
Term
Levetiracetam
MOA, Loading Dose, Elimination, Protein Binding, Serum concentration, idiosyncratic AE |
|
Definition
MOA: Modulate synaptic vesicle protein
No load
No monitoring
70% renal; 30% hepatic
AE: Depression |
|
|
Term
Oxcarbazepine
MOA, Loading Dose, Elimination, Protein Binding, Serum concentration, idiosyncratic AE |
|
Definition
MOA: Fast Na channel inactivation
No load--excess AE
Hepatic
40%
No monitoring
AE: Hyponatremia; 25-35% cross sensitivity in pts w/ hypersensitivity to carbamazepine |
|
|
Term
Phenobarbital
MOA, Loading Dose, Elimination, Protein Binding, Serum concentration, idiosyncratic AE |
|
Definition
MOA: GABA agonist
Loading: Yes
Hepatic
~50%
Level: 15-40
AE: Attention deficit, cognitive impairment, hyperactiivty, osteoporosis, passive-aggressive behavior |
|
|
Term
Phenytoin
MOA, Loading Dose, Elimination, Protein Binding, Serum concentration, idiosyncratic AE |
|
Definition
MOA: Fast Na channel inactivation
Yes load
Hpatic
88-92%
Level 10-20 mcg/mL (1-2 mcg/mL unbound)
AE: anemia, gingival hyperplasia, hirsutism, lymphadnopathy, osteoprososi, rsh |
|
|
Term
pregabalin
MOA, Loading Dose, Elimination, Protein Binding, Serum concentration, idiosyncratic AE |
|
Definition
MOA: Modulate Ca channels
No load--increased AE
Renal
Meh protein
No monitoring
AE: Edema, weight gain |
|
|
Term
Rufinamide
MOA, Loading Dose, Elimination, Protein Binding, Serum concentration, idiosyncratic AE |
|
Definition
MOA: Unknown, may inactivate Na channels
No load
Hepatic
34% protein bound
No monitoring
AE: Dizziness, fatigue, HA, N/V, somnolence |
|
|
Term
Tiagabine
MOA, Loading Dose, Elimination, Protein Binding, Serum concentration, idiosyncratic AE |
|
Definition
MOA: enhance GABA activity
No load
No monitoring
Hepatic
No AE
96% protein bound |
|
|
Term
Topiramate
MOA, Loading Dose, Elimination, Protein Binding, Serum concentration, idiosyncratic AE |
|
Definition
MOA: Fast Na channel inactivation, inhibit glutamate activity, enhance GABA
No load, no monitoring
60% renal; 40% hepatic
13-17% protein bound
AE: actue glaucoma, metabolic acidosis, oligohidrosis, paresthesia, renal calculi, weight loss |
|
|
Term
VPA/Divalproex Sodium
MOA, Loading Dose, Elimination, Protein Binding, Serum concentration, idiosyncratic AE |
|
Definition
MOA: Fast Na channel inactivation
Yes load
Hepatic
90% protein bound (but decreased with increased serum [])
Level: 50-100 (children may need 150)
AE: hepatotoxicity, osteoporosis, pancreatitis, weight gain |
|
|
Term
Vigabatrin
MOA, Loading Dose, Elimination, Protein Binding, Serum concentration, idiosyncratic AE |
|
Definition
MOA: Inhibits GABA transaminase
Yes load
Renal
Meh protein
No monitooring
AE: Vision loss, blindness |
|
|
Term
Zonisamide
MOA, Loading Dose, Elimination, Protein Binding, Serum concentration, idiosyncratic AE |
|
Definition
MOA: Modulate Na and Ca channels
No Load
No monitoring
Hepatic
AE: metabolic acidosis, oligohidrosis, paresthesia, renal calculi |
|
|
Term
|
Definition
Carbamazepine
Phenytoin
Phenobarbital
Rifampin |
|
|
Term
|
Definition
Carbamazepine
Phenytoin
Phenobarbital
Rifampin |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
Carbamazepine
Phenytoin
Phenobarb
Rifampiin |
|
|
Term
|
Definition
Lamotrigine
Phenytoin
Phenobarb
OCs |
|
|
Term
|
Definition
Cimetidine
Cipro
Erythromycin
Clarithromycin |
|
|
Term
|
Definition
amiodarone
Cimetidine
Fluconazole
VPA |
|
|
Term
|
Definition
Felbamate
Ticlodipine
Topiramate
Zonisamide |
|
|
Term
|
Definition
|
|
Term
|
Definition
Amiodaraone
Erythromycine
Propoxyphene
Ketoconazole |
|
|
Term
|
Definition
|
|
Term
| Which AED get a loading dose? |
|
Definition
Phenytoin
Phenobarbital
VPA
Vigabatrin |
|
|
Term
| Which AED require monitoring? |
|
Definition
Carbamazepine (4-12)
Ethosuximab (40-100)
Phenobarbital(15-40)
Phenytoin (10-20; 1-2 free)
VPA (50-100; 150 in children) |
|
|
Term
Clobazam
MOA, Use, Cyps, Half Life, AE, efficacy |
|
Definition
MOA: Enhances GABA
Add on in lennox gasteux syndrome
Matab by cyp2c19
36-42 hour T 1/2
AE: somnolence, fever, lethargy, URT infection |
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Term
Ezogabine
MOA, indication, protein bound, metabolism, AE |
|
Definition
MOA: Binds to KCNQ voltage gated K channels (always open)
Used in adj txy of partial seizures
85% protein bound
UGT metabolism
Half life 7-11 hours
Controlled substance
AE: QT prolongation |
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Term
Perampanel
MOA, use, protein bound, metabolism, T1/2, AE |
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Definition
MOA: binds to AMPA--glutamate antag
Only for partial seizures
Highly protein bound
cyps on cyps on cyps
Dizziness, somnolence, fatigue
BBW: Paranoid, depression, irritability, suicide. |
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Term
|
Definition
Paranoia
Depression
Irritability
Suicide |
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Term
| What is the most effective AED in the elderly? |
|
Definition
Lamotrigine
Followed by keppra |
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Term
| SE of lamotrigine discussed in class---not in book? |
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Definition
|
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Term
| what antiepileptics have the highest risk of fractures in the elderly? |
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Definition
|
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Term
| What happens in purpble glove syndrome? |
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Definition
IV phenytoin infiltrates hand
Leads to necrosis |
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Term
| Characteristics of Phase I SE: |
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Definition
Tachycardia
HTN
Hyperglycemia
hyperthermia
sweating
salivation |
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Term
| Characteristics of phase II SE: |
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Definition
Decreased cerebral blood flow
Increased ICP
Systemic HOTN
Hypoglycemia
Hyperthermia
Respiratory failure
Hypoxis
Respiratory and metabolic acidosis
Hyperkalemia
Hyponatremia
Uremia |
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Term
|
Definition
History of repeated seizures and impaired consciousness has been witnessed by HCP
EEG |
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Term
| When do muscle contractions go away in SE? |
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Definition
|
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Term
| Serum chemistry abnormalities that cause seizures? |
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Definition
Hyponatremia
Hypernatremia
Hypoglycemia
Hypomagnesium
Hypocalcemia
Renal/liver failure |
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Term
Which SE benzo has rapid redictribution to foxy fat and muscle, but penetrates CNS quickly?
-Which one is less lipophilic, but has a longer half life redistribution? |
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Definition
-Diazepam for first
-Lorazepam |
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Term
| Dosage forms of Diazepam? |
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Definition
|
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Term
| Max cumulative ativan dose? |
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Definition
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Term
|
Definition
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Term
|
Definition
|
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Term
| Which DF of versed can be hindered? How? |
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Definition
| IN hindered by increased breathing and increased nasal secretions |
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Term
| What SE medication shouldn't be infused with other medication bc of stability concerns? |
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Definition
| Phenytoin--soluble in propylene glycol |
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Term
| What is purple glove syndrome? |
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Definition
| Local discoloration, edema, pain, necrosis caused by phenytoin |
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Term
| Advantages of fosphenytoin over phenytoin? |
|
Definition
More compatable with IV solutions
IM tolerated
Infused 3x faster
Fewer CV AE (still monitor BP, ECG, HR) |
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Term
|
Definition
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Term
| Efficacy of phenobarbital after benzo+phenytoin? |
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Definition
| Progressive resistance of GABA-A receptor |
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Term
| Which medications in SE require hemodynamic monitoring and mechanical ventilation? |
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Definition
Phenobarbital
Pentobarbital
Propofol |
|
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Term
|
Definition
Not FDA approved
various types of SE: gneralized tonic clonic, myoclonic, nonconvulsive SE
Similar efficacy to phenytoin shown |
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Term
| T/F D/C all other AED when starting Txy for RSE? |
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Definition
| No. Continued, monitor serum levels in order to minimize breakthrough or withdrawal seizures |
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Term
|
Definition
| Prolonged infusions especially with renal failure |
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Term
| Which benzo has an active metabolite that can accumulate in renal failure (SE) |
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Definition
|
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Term
| RSE disadvantages of versed? |
|
Definition
Breakthrough seizures (increase rate 20%)
Tachyphylaxis |
|
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Term
| Monitoring of pentobarbital while in barbitruate coma? |
|
Definition
Mechanical vent
IV vasopressor
Invasive hemodynamic monitoring
TPN |
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Term
| Which RSE txy is beneficial if there is an elevated ICP? |
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Definition
|
|
Term
Use of levetiracetam in SE
-Dose
-AE
-Seizure indications
-Elimination
-Protein binding
-DDI |
|
Definition
Synaptic vesicle protein 2A
1000-3000 mg/day
AE: somnolence, dizziness, depression, coordincation, agitation in children, rash, thrombocytopenia
tonic clonic; myoclonic; atonic; partial seizures
Renal and hepatic (not cyp)
Not highly protein
No significant DDI |
|
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Term
| Ketamine and Topiramate in SE |
|
Definition
Ketamine: NMDA agonist (IV, PO in children)
Topiramate: already learned everything it said in epilepsy |
|
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Term
| Use of inhaled anesthetics for SE? |
|
Definition
Desflurane isolurane
Typically delivered in the OR (special equipment for administration in the ICU) |
|
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Term
| Phenytoin/Fosphenytoin in the elderly? |
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Definition
| May need to lower dosing weight |
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|
Term
Diazepam in SE:
-Loading dose
-Txp Level
-SE
-Comments |
|
Definition
-0.15 mg/kg (5-10 PR)
-No monitoring
-HOTN, Respiratory depression
-Rapid redistribution rate; PR available |
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Term
Lorazepam in SE:
-Loading dose
-Txp Level
-SE
-Comments |
|
Definition
0.1 mg/kg (max 4 mg/kg single dose; max cumulative dose 8 mg)
no monitoring
HOTN, respiratory depression
May be longer acting than diazepam |
|
|
Term
Midazolam in SE:
-Loading dose
-Txp Level
-SE
-Comments |
|
Definition
0.2 mg/kg (RSE 0.05-2 mg/kg/h)
No moitoring
AE: Sedation, Respiratory depression
Other routes: IM, bucally, IN
$$$$ |
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Term
Phenytoin in SE:
-Loading dose
-Txp Level
-SE
-Comments |
|
Definition
15-20 mg/kg
Level: 10-20
AE: arrhythmias, HOTN (elderly) |
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Term
Fosphenytoin in SE:
-Loading dose
-Txp Level
-SE
-Comments |
|
Definition
15-20 PE/kg
Level 10-20 mcg/mL
AE: parathesias, HOTN
Can give IM, less CV than phenytoin |
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|
Term
Phenobarbital in SE:
-Loading dose
-Txp Level
-SE
-Comments |
|
Definition
30 mg/kg
Level: 15-40
AE: HOTN, Sedation, Resp depression
Long acting |
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|
Term
VPA in SE:
-Loading dose
-Txp Level
-SE
-Comments |
|
Definition
15-20 mg/kg (40 mg/kg)
Level: 50-150 mcg/mL
No AE listed
Less CV than phenytoin |
|
|
Term
Propofol in SE:
-Loading dose
-Txp Level
-SE
-Comments |
|
Definition
1-2 mg/kg (RSE 2-15 mg/kg/h)
No txp level (titrated to EEG)
AE: HOTN, respiratory depression
Requires mechanical intubation, increased lipid load, propofol infusion syndrome |
|
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Term
| What is propofol infusion syndrome? |
|
Definition
| Rhabdomyolysis, acidosis, cardiac arrhythmias |
|
|
Term
Pentobarbital in SE:
-Loading dose
-Txp Level
-SE
-Comments |
|
Definition
10-15 mg/kg (RSE: 0.5-4 mg/kg/h)
Txp level: 10-30 mcg/mL
Typically titrated to EEG
AE: HOTN, resp depression, cardiac depression, infection, ileus
Mechanical intubation, pressors, hemodynamic monitoring |
|
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Term
| What do you do minute 0 when SE presents? |
|
Definition
Stabalize airway
Gain IV access
Administer O2
Thiamine+Glucose |
|
|
Term
| what do you do minutes 0-10 in SE? |
|
Definition
Lorazepam 0.1 mg/kg (max 4) max 2 mg/min--repeat 10-15 min if no response
Diazepam 10 mg PR (repeat in 10)
Versed 0.2 mg/kg IM (repeat in 10) |
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Term
| what do you do in minutes 10-20 in SE? |
|
Definition
Phenytoin 15-20 mg/kg IV max rate 50 mg/min
Fosphenytoin same dose rax rate 150
Fosphenytoin IM
VPA 20 mg/kg IV (max 6 mg/kg/min)
Treat possible infection |
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Term
| What do you do minutes 30-60 in SE? |
|
Definition
Phenytoin bolus 5-10 mg/kg (additional)
Phenobarbial 20 mg/kg IV infusion
VPA 20 mg/kg IV infusion |
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Term
|
Definition
Versed 2 mg/kg bolus (0.05-2 mg/kg/h)
Propofol 1 mg/kg bolus: 2-15 mg/kg/h
Pentobarbital 10-15 mg/kg bolus over 1-2 hours |
|
|
Term
| Max dose of diazpam in children <5 YO; >5 YO? |
|
Definition
|
|
Term
| Which drug is not reocmmended in children SE? Why? |
|
Definition
|
|
Term
| Outcome of studies regarding VPA and Phenytoin in SE? |
|
Definition
One study showed similar efficacy, less CV AE in VPA.
One showed better control in phenytoin as 2* txy, but less AE in VPA.
Another showed similar effeicay and less AE with VPA |
|
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Term
| Outcome of study relating to diazepam/lorazepam? |
|
Definition
|
|
Term
| Studies comparing phenybarb vs phenytoin |
|
Definition
| Phenobarb looked better with less AE. |
|
|
Term
| What if you have 2 attacks/2 lesions? |
|
Definition
|
|
Term
| What if you have 2 attacks+1 lesion? |
|
Definition
-Space (9 brain; 2 spine; 4-8 brain + 1 spine
-CSF + 2 lesions on MRI
-Another attack |
|
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Term
| What if you have 1 attack+ 2 lesions |
|
Definition
Look at time by MRI (gadolinium lesion 3+ months after a clinical attack; Gadolium or new T2 lesion after 6+ months)
Another attack |
|
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Term
| What if you have 1 attack+1 lesion? |
|
Definition
Look at time (gadolium 3 months; T2 or gadolium 6 months)
(+) CSF +2 MRI lesions
Space (9 brain; 2 spine; 4-8 brain+1 spine) |
|
|
Term
| What if you have 0 attacks+1 lesion? |
|
Definition
|
|
Term
| Dose of methylpred and pred in MS exacerbation? |
|
Definition
Methylpred 1 g IV QD 3-5 days
Pred 1250 QOD x 5 doses |
|
|
Term
Interferon Beta 1A IM
Route, Frequency, AE |
|
Definition
Route IM
Given Weekly
AE: Flu like syymptoms, anemia |
|
|
Term
| Hepatic or renal for beta interferons? |
|
Definition
| Renal excretion is minimal |
|
|
Term
| Pregnancy category of beta interferons, natalizumab, glatiramer |
|
Definition
|
|
Term
| MOA of Beta interferons, glatiramer, natalizumab? |
|
Definition
Beta-antiviral, antiprolif, antitumor, immunomodulatory
Glatiramer: T cell activation interfere, Induction of myelin specific protein for MHC binding site responsible for antigen presentation
Natalizumab: Partial block of immune cell adhesion to vasc endothelium and migration of lymphocytes into CNS |
|
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Term
| Who is mitoxantrone reserved for? |
|
Definition
| Patients who failed other txy |
|
|
Term
Interferon Beta-1A SQ
Frequency, AE |
|
Definition
SQ q 2-3 days
AE: leucopenia, injection rxn, flu like symptoms, increased AST/ALT |
|
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Term
Interferon beta 1B
Route, Frequency, AE |
|
Definition
SQ QOD
AE: menstrual disorders, leucopenia, injection rxn, increased AST/ALT, flu like rxn, weakness |
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Term
Glatiramer
Route, Frequency, AE |
|
Definition
SQ QD
AE: injection site, systemic |
|
|
Term
Mitoxantrone
Route, Frequncy, AE |
|
Definition
IV q 3 months
AE: nausea, cardiac toxicity, arrhythmias, alopecia, increased glutamyl transpeptidase, menstrual disorders, amenorrhea, UTI |
|
|
Term
Natalizumab
Route
Frequncy
AE |
|
Definition
IV q 4 weeks
AE: UTI, HA, fatigue, arthralgia, hypersensitivity in less than 1% |
|
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Term
| Ways to reduce flu like symptoms? |
|
Definition
Take at night
1/4-1/2 dose for two weeks, titrate up
200 mg IBU before, 6, 12 hours
Aleternatives: APAP, pred taper, pentoxyphylline |
|
|
Term
| Ways to minimize injection site rxn? |
|
Definition
Bring med to room temp
Ice injection before taking it
HC 1% cream
If severe or necrotic, D/C and see dermatologist |
|
|
Term
| What lab values would recommend temporary D/C of interferons? |
|
Definition
Hb <9
WBC < 3
ANC <150
Plts < 75
Bilirubin >2.5x baseline
AST/ALT > 5x baseline
Alkaline phosphate >5x baseline |
|
|
Term
| Lab abnormalities that require D/C of beta interferon? |
|
Definition
Hb <9.4
WBC < 3
ANC <150
Plts < 75
Bilirubin >2.5x baseline
AST/ALT >5x baseline
alkaline phose >5x baseline |
|
|
Term
| What drugs treat UI in MS patients? |
|
Definition
Oxybutynin
Tolteridine
Flavoxate
Antimuscarinic TCA |
|
|
Term
| What drugs treat depression in MS patients? |
|
Definition
|
|
Term
| First and second line therapies for fatigue in MS? Dosing adjustments? |
|
Definition
Amantadine 100 mg QAM, Q afternoon
-Crcl 30-50 QAM
-Crcl 15-30 QOD
-Crcl <15 200 mg QQ
Methylphenidate 10-20 mg QA, noon |
|
|
Term
| Baclofen: MOA, Dosing in spasticity |
|
Definition
Pre/Post GABA inhibitor
5 mg TID (titrate 5 q 3 days)
Max 80 mg |
|
|
Term
| Tizantinine: MOA, Dosing in spasticity |
|
Definition
Central alpha blocker
4 mg initial (increase 2-4 mg q 3-4 days)
Max 36 mg |
|
|
Term
| Dantrolene: MOA, dosing in MS |
|
Definition
Blocks muscles from moving by inhibiting calcium from sarcoplasmic reticulum
25 mg TID-QID (titrate 25 mg q 4-7 days)
Max 400 mg |
|
|
Term
| Diazapam MOA and Dose for MS? |
|
Definition
2-10 mg TID-QID
GABA agonist |
|
|
Term
Dalfampridine
AE, Metabolism |
|
Definition
Faster walking speeds in MS patients
May increase seizures
Renally eliminated |
|
|
Term
| Dextromethorphan/Quinidine |
|
Definition
|
|
Term
|
Definition
Sphingosine 1 phosphate receptor modulator
AE: eye disorders, heart, lung, cancer (EKG prior to use) |
|
|
Term
| When should you not use fingolomod? |
|
Definition
Cardiovascular or cerebrovascular disease w/in last 6 months
Need EKG before use |
|
|
Term
|
Definition
Inhibits dihydroorotate dehydrogenase (de novo hyprmidine synthesis; reduces T and T cell prolif/fxn)
BBW: hepatotoxicity and teratogen |
|
|
Term
| What drugs worsen PD symptoms? |
|
Definition
-Antipsychotics
-Amoxapine
-Anti emetics (proclorperazine, metoclopramide) |
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