PT Ch 8 Drugs for Central Nervous System Disorders – Flashcards
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epilepsy
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a neurologic disorder involving sudden and recurring seizures
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seizure
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abnormal electrical discharges in the cerebral cortex caused by sudden, excessive firing of neurons; result in a change in behavior of which the patient is not aware
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enzymes
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biological molecule the catalyzes chemical reactions in the body
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partial seizure
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and abnormal electrical discharge centered in a specific area of the brain; usually caused by trauma
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generalized seizure
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a seizure that involves both hemispheres of the brain simultaneously and has no local origin; can be a tonic-clonic (grand mal), absence (petit mal), myoclonic, or atonic seizure
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tonic-clonic seizure
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a type of generalized seizure characterized by body rigidity followed by muscle jerks; formerly called a grand mal seizure
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absence seizure
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a type of generalized seizure characterized by a sudden, momentary break in consciousness; formerly called a petit mal seizure
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myoclonic seizure
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a type of generalized seizure characterized by sudden muscle contractions with no loss of consciousness
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atonic seizure
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a type of generalized seizure characterized by sudden loss of both muscle tone and consciousness
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status epilepticus
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a serious disorder involving tonic-clonic convulsions that last at least 30 minutes
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anticonvulsant
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a drug to control seizures
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diazepam (Valium)
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-drug of choice for status epilepticus
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gabapentin (Neurontin)
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-used as an adjunct for drug-refractory partial and generalized seizures, not effective for absence seizures -it was designed to mimic GABA, but studies show it has another mechanism of action -renal function should be monitored
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adjunct
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a drug used with another drug
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ataxia
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irregular muscle movements
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lamotrigine (Lamictal)
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-blocks sodium channels, thereby reducing neuron excitation -has a black box warning about fatal rashes in the FDA-approved product information -should NOT be used in patients younger than 16
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levetiracetam (Keppra)
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-adjunctive therapy for partial seizures -no evidence that doses greater than 300mg are effective
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oxcarbazepine (Treleptal)
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-decreases the effectiveness of birth control pills
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dysphagia
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difficulty in swallowing
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phenytoin (Dilantin)
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-useful for all types of seizures except absence -patients should have routine hepatic and hematologic tests while taking this drug -must be discontinue if a mild rash appears -IV dosage form should NEVER be shaken before administration
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area under the curve (AUC)
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a measure of drug concentration in the blood
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substance P
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a potent neurotransmitter mediating sensations of pain, touch, and temperature
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Parkinson's disease
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a neurologic disorder characterized by akinesia, resting tremor, and mucsular rigidity
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basal nuclei
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symmetric, subcortia masses of gray matter embedded in the lower portions of the cerebral hemisphere; part of the extrapyramidal system
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substantia nigra
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a layer of gray substance separating the parts of the brain
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armantadine (Symmetrel)
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-an antiviral used as a prophylaxis and treatment for influenza -also treats parkinson's disease
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levodopa-carbidopa (Sinemat)
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-most commonly used drug for patients with parkinson's -on-off syndrome occurs in as many as 2/3s of parkinson's patients after about 5 years of therapy
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on-off phenomenon
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a wide fluctuation between abnormally increased and abnormally diminished motor function, present in many parkinson's patients after about five years of levodopa therapy
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dyskinesia
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impairment of the power of voluntary movement
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pramipexole (Mirapex)
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-used for Parkinson's -dopamine agonist -fewer side effects than other anti-Parkinson's drugs -should be taken with food -approved for RLS -it may help with fibromyalgia but is not yet approved for the disease
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myasthenia gravis
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an autoimmune disorder of the neuromuscular junction in which the ACh receptors are destroyed at the motor end plate, preventing muscles from responding to nerve signals to move them
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motor end plate
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the neuromuscular junction where the nervous system and muscular system meet to produce or stope movement
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ptosis
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paralytic drooping of the upper eyelid
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diplopia
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the perception of two images of a single object
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dysarthria
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imperfect articulation of speech
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azathrioprine (Imuran)
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-used for MS -suppress cell-mediated hypersensitivity -alters antibody production and reverses neuromuscular blockade -taken with food to avoid nausea -side effects: leukopenia, pancytopenia, infection, GI irritation, and abnormal liver functions
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amyotrophic lateral sclerosis (ALS)
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a degenerative disease of the motor nerves; also called Lou Gehrig's disease
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multiple sclerosis (MS)
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an autoimmune disease in which the myelin sheaths around nerves degenerate
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baclofen (Lioresal)
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-skeletal muscle relaxant to treat MS -should be taken with milk or food -onset requires 3-4 days
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tizanidine (Zanaflex)
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-indicated to reduce muscle spasticity in MS -inhibits presynaptic motor neurons -first oral drug approved for spasticity since baclofen (Lioresal)
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huntington's disease
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a neurodegenerative disorder characterized by brief, repetitive, involuntary movement; also known as Huntington's chorea
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restless leg syndrome (RLS)
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an overpowering urge to move legs, especially while at rest
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fibromyalgia
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a condition characterized by long-term pain throughout the entire body
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alzheimer's disease
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a degenerative disorder of the brain that leads to progressive dementia and changes in personality and behavior
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memantine (Namenda)
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-slows the advancement of Alzheimer's -blocks glutamate receptors -physician will provide starter doses to titrate the patient to the optimal dose
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attention-deficit hyperactivity disorder (ADHD)
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a neurologic disorder characterized by hyperactivity, impulsivity, and distractibility
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atomoxetine (Strattera)
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-used for ADHD -not controlled -can cause weight loss and slow growth -lower risk for abuse -should be used as a first-line agent
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isomer
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one of two or more compounds that contain the same number and type of atoms but have different molecular structures
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dextroamphetamine-amphetamine (Adderall)
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-used for ADHD -CII -effects can last about 6 hours -primary side effect is depression as the drug wears off
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lisdexamfetamine (Vyvanse)
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-used for ADHD -is dextroamphetamine chemically bonded to the amino acid lysine -CII -medication guide must be dispensed
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Seizures can be caused by epilepsy alcohol withdrawal infection all of these
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all of these
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The two major classifications of seizures are
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generalized and partial
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Goals of epilepsy therapy are -to control seizures or reduce their frequency to the extent that the patient can live essentially a normal life -to prevent emotional and behavioral changes -A & B -none of these
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A & B
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Which is the only indication for Klonopin? MS prophylaxis ADHD Alzheimer's Disease seizure prophylaxis
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seizure prophylaxis
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Which drug has a boxed warning about fatal rashes?
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Lamictal
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Which oral liquid drug should be well shaken before administering?
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phenytoin
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Which anticonvulsant is a schedule drug? phenytoin primidone carbamazepine phenobarbital
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phenobarbital
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Which drug is metabolized to phenobarbital?
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primidone
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Which anticonvulsants are used to treat bipolar disorders?
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carbamazepine and valproic acid
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The three non controlled substances to treat ADHD are
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clonidine, guanfacine, atomoxetine
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T/F The drug of choice for convulsive status epilepticus is Klonopin.
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FALSE
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T/F Dopamine crosses the blood-brain barrier.
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FALSE
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T/F Sinemet is an anti-Parkinson's drug that has an "on-off" phenomenon.
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TRUE
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T/F The most commonly used drug in Parkinson's disease is levodopa.
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TRUE
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T/F Amantadine can be used for prophylaxis and treatment of flu
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TRUE
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T/F Parodel can be used to dry up milk in a nursing mother
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TRUE
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T/F Alzheimer's drugs cannot reserve or cure the disease but can slow its progression.
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TRUE
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T/F Copaxone must be kept frozen
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FALSE
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T/F Lyrica is a controlled substance.
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TRUE
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T/F Vyvanse is the least addictive of the ADHD drugs
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FALSE
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What two neurotransmitters in the brain appear to play the greatest role in seizures?
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GABA and glutamate
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What term is used to describe continuous tonic-clonic seizures, lasting over 30 minutes, during which consciousness may not return?
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status epilepticus
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What is the potential way in which antiepileptic medications can interact with each other and with other drugs? They can affect the absorption of other drugs. They can alter the metabolism of other drugs. They can alter the renal and hepatic distribution of other drugs. They can compete for transporters that affect drug access to the central nervous system (i.e., brain). all of the above
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all of the above
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Which of the following anticonvulsants is a DEA scheduled controlled substance? carbamazepine (Tegretol) gabapentin (Neurontin) fosphenytoin (Cerebyx) phenytoin (Dilantin) diazepam (Valium)
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diazepam (Valium)
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The use of what anticonvulsant may result in physical or psychological dependence?
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clonazepam (Klonopin)
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Which anticonvulsant does not appear to act via GABA receptors and is frequently used to treat neuropathic pain?
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gabapentin (Neurontin)
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The prevalance of Parkinson disease (parkinsonism) is highest in what age group?
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above age 60
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Which drug listed below is used to treat patients with multiple sclerosis? interferon beta-1a (Avonex, Rebif) interferon beta-1b (Betaseron) mitoxantrone (Novantrone) baclofen (Lioresal) All of the above
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All of the above
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Which condition listed below is a chronic aching and stiffness with a lack of stamina?
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Fibromyalgia
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Involuntary contractions or series of contractions of the voluntary muscles are called
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convulsions
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A generalized seizure
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involves both hemispheres of the brain simultaneously.
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Newer drugs for antiepileptic drug therapy
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are seizure-specific.
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What drug is both a prophylaxis and treatment for influenza, and is used to treat Parkinson disease?
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amantadine (Symmetrel)
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Which is a new class of anti-Parkinson agents that increase patient "on-time"?
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catechol-o-methyl transferase inhibitors
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What is a primary side effect of dextroamphetamine-amphetamine (Adderall)?
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depression as the drug wears off
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Which blood pressure medication is also used to treat ADD?
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clonidine (Catapres)
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Which of the following is part of the profile for Alzheimer disease?
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depression
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Why might a prescribing physician prefer donepezil (Aricept) over tacrine (Cognex) for Alzheimer disease? Donepezil is given once a day. Donepezil does not result in nausea, vomiting, and diarrhea. Donepezil improves memory and alertness. a and b a, b, and c
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a, b, and c
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What drug blocks NMDA (N-methyl¬D-aspartate) in patients with Alzheimer disease?
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memantine (Namenda)
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What drug that is used to treat Alzheimer disease is derived from daffodil bulbs?
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galamtamine (Razadyne)
