Parkinson's
Name the first line treatment for Parkinson's (give the drug combo) and describe the MoA
Levodopa/Carbidopa (only ever given together)
Carbidopa inhibits breakdown of levodopa, Levodopa increases availability of L-Dopa
Which are the two cholinesterase inhibitor drugs and what is the antidote to both of them?
Neostigmine and Donepezil
Atropine - a cholinergic antagonist (sits on cholinergic receptors blocking action of ACh)
What are the two MoA's for antiepileptics?
Slows Na and Ca channels to slow frequency of neuronal firing
Enhances inhibitory effects of GABA
Which drug is a centrally acting muscle relaxant, and what is our main concern when giving this drug?
Diazepam - reduces contraction signals from the brain
AE: CNS depression, physical dependence
What is the purpose of IV anesthetics and what are some adverse effects?
loss of consciousness; eliminates response to painful stimuli
respiratory and cardiovascular complications (decreased rr and hr)
Describe the effects of Amantadine and what is its MoA
CNS- dizziness, confusion, restlessness
Anticholinergic Effects
Skin discoloration (reverses after med is stopped)
MoA - increases dopamine release and blocks reuptake of dopamine into presynaptic neurons
Describe Myasthenia Gravis and what are the symptoms?
autoimmune disease results in gradual destruction of ACh receptors so ACh has reduced effects
weakness/easily fatigued, begins proximally and moves distally, often eye movements are effected first, ptosis is also common, eventually diaphragm is involved = myasthenia crisis (respiration is compromised)
What are the CNS effects of all AEDs?
nystagmus/double vision
lightheadedness
sedation/cognitive impairment
ataxia
avoid other CNS drugs
What is Dantrolene used for and what are some adverse effects?
peripheral muscle relaxants; suppresses release of Ca from skeletal muscles directly inhibiting muscle contraction. Relieves spasticity associated with cerebral palsy, spinal cord, injury, multiple sclerosis, malignant hyperthermia.
AE: muscle weakness, hepatotoxicity, nausea, abdominal pain
What two opioids are used for IV anesthetic? (opioid receptor agonist)
fentanyl and morphine sulfate
Which three drugs are rescue drugs for freeze attacks? What are their MoA and adverse effects?
Pramipexole, Ropinirole, and Apomorphine
directly stimulate postsynaptic dopamine receptors
CNS - sleep attacks and dyskinesias
Cardiac - ortho hypo, tachycardia (beta 1 stimulation)
Psychiatric - visual hallucinations, nightmares, and impulsivity
What drug is given to patient's with MG and what is it's MoA
Acetylcholinesterase is an enzyme that breaks down AcH. Symptoms may be improved with drugs that inhibit acetylcholinesterase, leaving more ACh available.
What patient education would you give more Carbamazepine?
Report any skin rash!
This drug may cause blood dyscrasias (look for s/s of bleeding)
If taking two doses, take largest dose at HS
What is the difference between succinylcholine and pancuronium?
They are both neuromuscular blocking agents. They both provide muscle relaxation that is used for surgery, ECT, and mechanical ventilation. Succinylcholine works rapidly and is good for tracheal intubation. It's main adverse effects are malignant hyperthermia, muscle pain, and hyperkalemia. Succinylcholine is a depolarizing nicotinic agonist and pancuronium is a nondepolarizing nicotonic antagonist.
Which IV anesthetic is a glutamate blocker?
ketamine (street drug)
hypnotic effect
hallucination, so avoid in clients with mental illness
Which are the COMT Inhibitors, what is the MoA, and what are the adverse effects
Entacapone and Tolcapone
decrease the breakdown of dopamine by COMT
CNS - sleepiness
GU - turns urine yellow-orange
Hepatotoxicity - Tolcapone takes a toll on the liver (not Entacapone)
Describe Alzheimer's disease
Abnormal neurotic plaques and neurofibrillary tangles. Drugs that increase availability of acetylcholine can help brain cells communicate with each other.
What is considered traditional treatment for seizures?
Barbiturates (phenobarbital, primidone)
CNS depression (paradoxical response in elderly or kids), avoid other CNS depressants
Toxicity - nystagmus, ataxia, respiratory depression, coma, pinpoint pupils
What drug is used for nonobstructive urinary retention? What are the adverse effects?
Bethanechol - muscarinic agonist; relaxes sphincter muscles and contracts detrusor
AE: (think over activation of the PNS) increased gastric acid, abd pain, diarrhea, sweting, tearing, urinary urgency, bradycardia, hypotension, bronchoconstriction
Which IV anesthetic activates GABA receptor?
Propofol (milk of amnesia)
very rapid onset
infection risk (6 hr hang time)
Which drugs decrease the breakdown of dopamine by MAO-B and what are the adverse effects of these drugs?
CNS - insomnia
Cardiac - risk of hypertensive crisis (avoid tyramine)
Interactions - similar to MAOI drugs
What is the drug given to treat Alzheimer's, what is the MoA and adverse effects?
Donepezil (indicated for Alzheimer's and Parkinson's)
Adverse Effects - excessive muscarinic stimulation, increased GI motility and secretions including saliva, diaphoresis, bradycardia, urinary urgency, cholinergic crisis (respiratory depression/possible paralysis of respiratory muscles)
What are the adverse effects for the two drugs with the MoA of enhancing the inhibitory effects of GABA?
Valproic Acid - thrombocytopenia, N/V, indigestion (take w/food), hepatotoxicity, pancreatitis
Topiramate - psychiatric events, metabolic acidosis, angle closure glaucoma
Which muscarinic antagonist decreases the urge to void and name the adverse effects?
Oxybutynin
AE: anticholinergic effects (confusion, dilated pupils, urinary retention, constipation, no spit) prolonged QT intervals
Which IV anesthetic enhances inhibitory effects of GABA
Pentobarbital Sodium (barbiturate)
it is like a benzo with a longer half life