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Neuro: CNS meds
Neuro: CNS meds
83
Anatomy
Graduate
11/20/2011

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Term
If whatever drugs you're giving for seizures are not working, ___ or __ are good to switch to.
Definition
- Valproate
- Lamotrigene

(after these 2- second choice would be Phenytoin)
Term
DOC for status epilepticus:
Definition
Lorazepam
Term
Why is Lorazepam not used long term for seizure control:
Definition
tolerance develops in 2-3 days
Term
Why is Lorazepam doc for status epilepticus over Diazepam:
Definition
Lorazepam is more water soluble so it lasts longer
Term
When can you take a pt off of seizure meds?
Definition
seizure free for 4 years, taper off slowly
Term
Kids with absense seizures are already ADD in school, the antiseizure meds you give them tend to make this __.
Definition
worse
Term
Valproate side effects:
Definition
- really hard on GI tract
- liver toxicity
- doubles risk of spina bifida
Term
Depacote side effect:
Definition
spina bifida
Term
Patient doesn't like side effects of Valproate and Lamotrigene is not controlling her seizures. What drug would you switch her to?
Definition
Phenytoin
Term
Main advantage of Phenytoin:
Definition
clear consciousness (awake)
Term
Side effects of phenytoin:
Definition
- gingival hyperplasia
- acne
- hirsutism
Term
Precaution to give with Carbamazepine:
Definition
have pt contact you immediately if they get a RASH
Term
Anti-seizure drug that may cause Stephen-Johnsons syndrome:
Definition
Lamotrigene
Term
Population most susceptible to Stephen Johnsons Syndrome:
Definition
kids
Term
2 antiseizure drugs that are effective against all seizure types:
Definition
- Valproate
- Lamotrigene
Term
Drug that is good for absense (petit mal) seizures:
Definition
Ethosuximide
Term
MONOTHERAPY IS ALWAYS WHAT YOU WANT WITH SEIZURE MEDICATIONS.
Definition
Term
Antiseizure drug that is good for tonic clonic seizures (grand mal) but will make absense seizures (petit mal) worse:
Definition
Phenytoin
Term
Fever of __ catches pediatricians attention. Below this take 2 __ and observe.
Definition
104
tylenol
Term
Kids with high fever alternate __ with __ every 3 hours.
Definition
acetaminophen
ibuprofen
Term
Pts who have had benign febrile seizures are/are not at increased risk for more seizures later in life?
Definition
are not
Term
Carbamazepine is good for what type of seizures?
Definition
Grand mal (tonic clonic)- but watch for rash
Term
Benign febrile seizures occur in kids when their fever gets over __.
Definition
104
Term
CNS disorder with delusions and hallucinations (mostly auditory);
Definition
Schizophrenia

(delusions tend to be more of a problem than the hallucinations)
Term
22 y/o female brought to er by friends. Been hearing voices telling her to repnt. Thin disheeveld, anxious. Garbled, flights of ideas and mistaken ideas. She thinks you’re a federal agent. What drug do you give to calm agitated behavior?
Definition
D2 blocker

(schizophrenia)
Term
Determinants of prognosis with Schizophrenia:
Definition
- age of onset
- abruptness of onset
Term
The __ the age of onset of schizophrenia and the more __ the onset, the worse the prognosis.
Definition
- younger
- insidious

Better to be older and abrupt onset.
Term
With Schizophrenia drugs, __ comes under control first, but thinking remains strange longer.
Definition
agitation
Term
Common ages of onset for schizophrenia in females and males:
Definition
- under 20s for women
- early 20s for men
Term
With Parkinson's and Huntington's the problem is with the __ __ in the __ __.
Definition
substantia nigra in the basal ganglia
Term
With Schizophrenia there is __ dopamine in the __ __.
Definition
- excess dopamine in the basal ganglia
Term
Atyical antipsychotics block the ___ receptor.
Definition
5-HT2. These receptors are thought to be more associated with bizarre thinking aspect of Schizophrenia
Term
Aripiprazole is an __ antipsychotic that is a weak __ __ and __ __. How long does it take to control delusional thinking?
Definition
- atypical antipsychotic
- D2 agonist and 5HT2 blocker
- 1-3 weeks (older agents took 5-6 weeks)

So with the atypicals it still takes longer to get delusions under control, but not as long as they typicals took.
Term
Pt started Haloperidol and it made his hands shaky,rigid muscles, and shuffling gait. This is called __ __.
Definition
iatrogenic Parkinsonism
Term
Akathisia;
Definition
can't stop walking, even when sitting feet are still moving, striated issue
Term
Dystonia:
Definition
twisting hands, striated issue
Term
D2 blocking drugs result in excess __ which causes __ __ and __ __.
Definition
- acetylcholine
- iatrogenic Parkinsonism
- tardive dyskinesia
Term
Now we have tardive thing going on, what happens if remove haloperidol (d2 blocker?)?
Definition
- Tardive will initially get much worse b/c all of the sudden the dopamine can access the receptors
- Psychosis returns in full force over 3-6 weeks
- Tardive will eventually settle down, but will never be completely gone
Term
Patient has tardive dyskinesia. What happens if we increase his Haloperidol (D2 blocker)?
Definition
- tardive will initially improve b/c more D2 receptors get covered, but then receptors will upregulate> tardive gets worse
Term
What are the therapeutic options for tardive dyskinesia?
Definition
switch to an atypical antipsychotic
Term
Haloperidol is __ antipsychotic __ blocker.
Definition
typical
D2 blocker
Term
Atypical antipsychotics blocker more __ receptors and some __ receptors. Main advantage of these is:
Definition
- 5HT2
- D2
- Much less likely to cause tardive dyskinesia
Term
39 y/o on haloperidol for many years, more withdrawn over past several year. Doesn’t talk much, nothing gives him pleasure. What would you do for w/drawn aspect?
Definition
Clozapine
Term
Main side effect of Clozapine;
Definition
- bone marrow suppression (fatal blood diascrasis)> as soon as count begins to drop stop Clozapine
Term
All antipsychotics lower the __ __.
Definition
seizure threshold
Term
Olanzapine is an __ antipsychotic.
Definition
atypical
Term
Atypical antipsychotics are known for causing __ and __ __ __ __.
Definition
hyperosmolarity
Type II Diabetes Mellitus
Term
Atypical antipsychotic that is less likely to cause TIIDM:
Definition
Aripiprazole
Term
Atypical that is still pure D2 blocker:
Definition
Risperidone
Term
strange side effect of D2 blockers:
Definition
- females: galactorrhea
- males: gynecomastia
Term
How do D2 blockers cause galactorrhea/gynecomastia:
Definition
Normally dopamine drops down from the hypothalamus to the pituitary and inhibits the production of prolactin.

So with all the D2 receptors being blocked in the pituitary, there is no inhibition of prolactin anymore> milk/boobs
Term
There is no approved tmt for violence, but at high doses __ make a chemical straight jacket.
Definition
antipsychotics

So you can give haloperidol to calm agitation
Term
Advantage of giving Haloperidol to calm agitation/violence:
Definition
- minimal sedating and cardiovascular effects
Term
dosage of haloperidol to calm agitated person:
Definition
5-10 mg PO/IV/IM every 10-30 minutes as needed

peak level after 20-40 minutes of dose
Term
There is no recognized __ __ with haloperidol.
Definition
ceiling dose
Term
Don't use benzos to calm an agitated person b/c then you just have a violent drunk.
Definition
Term
After getting multiple doses of haloperidol to calm down, a pt becomes febrile and rigid. Whats going on?
Definition
Drug Induced Neuroleptic Malignancy Syndrome

(fever is life threatening> ice bath)
Term
High dose D2 blockers can cause;
Definition
Drug Induced Neuroleptic Malignancy Syndrome (fever and rigid)
Term
ATYPICALS ARE BETTER AGAINST NEGATIVE SYMPTOMS, BUT EVIDENCE FOR THAT HAS BEEN DSENEGRATING. ATYPICALS LESS LIKELY TO PRODUCE TARDIVE, BUT ATYPICALS CAN CAUSE DIABETES.
Definition
Term
Hydrocodone is schedule _.
Definition
3
Term
Hydrocodone works on the __ receptors.
Definition
mu receptors in brain and spinal cord (not joints)
Term
Effects of hydrocodone:
Definition
- analgesia
- cough suppression
- constipation
- miosis
Term
Opioid pain relief: pain is still there but the patient doesn't care anymore
Definition
Term
The runners high is linked to stimulation of __ receptors causing release of beta endorphins.
Definition
mu
Term
What drug would block the "runner's high"?
Definition
Naltrexone- mu antagonist (blocker)
Term
Are opioids better for brilliant pain (knife) or dull pain (tooth ache)?
Definition
dull pain
Term
Are opioids better for brilliant pain (knife) or dull pain (tooth ache)?
Definition
dull pain
Term
24 y/o females has nonproductive cough with seasonal rhinitis and coughing disrupts sleep. What can use for cough without danger of opiod dependence?
Definition
Dextromethorphan
Term
4 y/o signif nonproductive cough aggravated by viral URI. Coughing disrupts sleep. Child now has pain in abdomen b/c coughing so hard. Which is best choice for cough suppression if dextromethorphan is not effective?
Definition
Codeine
Term
2 opioids good for cough suppression:
Definition
1. Dextromethorphan
2. Codeine
Term
A pt is involved in MVA has head and rib truam. Significant pain. The head injury may increase which of the following effects of meperidine?
Definition
- RESPIRATORY DEPRESSION
-OPIODS CONTRAINDICATED WITH HEAD INJURY
Term
Opioids are CI with __ _.
Definition
head injury
Term
Cornerstone drug for pain management:
Definition
antidepressants: TCAs- reduce emotional component

avoid opioids if at all possible
Term
The addition of an NSAID will increase pain relieving efficacy of which of the following the most?
Definition
- Hydrocodone much more effective with NSAID, hydrocodone + nsaid almost as effective as morphine
Term
Respriatory depression caused by opiod overdose can be reversed most effectively by administering what?
Definition
NALOXONE- IV
NALTREXONE- ORAL
Term
What do you NOT want to do immediately if a pt has respiratory depression b/c overdosed on opioids?
Definition
oxygen- this would put them into respiratory distress- kill pt
Term
In a pt that has a one time overdose on opioids, but is not dependent, what will the side effect of Naloxone be?
Definition
grogginess
Term
Dependence requires a sufficient dose for a sufficient period of time. Once dependence has developed, if you give an antagonist, __ will develop.
Definition
withdrawal
Term
Opioid poisoning triad:
Definition
- COMA
- REPSIRATORY DEPRESSION
- MIOIS- pin point pupils
Term
What do you do if you see the Opioid poisoning triad?
Definition
Naloxone IV
Term
39 yo scheduled for surgery for internal hemorrhoids. Hx of drug and alcohol abuse. Oxycontin for 6 days after surgery to control pain. What would you after the oxycontin for 6 days that has little dependence risk?
Definition
Tramadol- SNE reuptake inhibitor
Term
Pt treated for back pain with hydrocodone and other pain meds. Having bad constipation, what do you tell them?
Definition
stool softener
Term
The longer and greater the dose with opioids, the worse the tolerance. But what are two effects of opioids in which tolerance does not occur?
Definition
- constipation
- miosis
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