Neuro Drugs
Adverse Effects/Teaching of Levodopa-Carbidopa
Adverse effects: orthostatic hypotension, tachycardia, palpitation, N/V
Teaching: administer 30 minutes before food, don't eat with a high protein diet, not given with multivitamins that contain Pyridoxine
Rare but serious side effect of Metformin use
Lactic acidosis
Hemorrhagic Stroke Causes
HTN, certain brain tumors, aneurysms, arteriovenous malformation
S/S of hypoglycemia
Blood glucose <70 mg/dL
Severe <40 mg/dL
Often sudden
Shaky, tachycardiac, sweating, dizzy, anxious, hungry, blurry vision, weakness or fatigue, headache, irritable
"cool and clammy need some candy"
S/S of Hyponatremia
Cardiac: Tachycardia, Hypotension
Neuro: Seizure, confusion, coma
GI: Nausea, vomiting
GU: Increased urination
MSK: General weakness which is worse in extremities
NMDA Receptor Agonist (Name, MOA, Adverse Effects)
Namenda
Prevents NMDA binding to glutamate (glutamate causes excess excitation and cell injury)
falls risk & hypersensitivity (dyspnea & bronchospasms)
Pramlintide (Drug Name, MOA)
Bonus: Type 1 or Type 2?
Pramlintide acetate
decreases gastric emptying, decrease glucagon secretion
Modifiable Risk Factors for Stroke
HTN, Dyslipidemia, Diabetes, Smoking, Obstructive sleep apnea, Excessive alcohol consumption, Migraine, Obesity, Sedentary Lifestyle, Hypercoagulation States (Pregnancy, Cancer, OCP), Atrial Fibrillation, Carotid Stenosis
Diagnosis of Diabetes
symptoms AND lab values
Symptoms: polyuria, polydipsia, polyphagia, unexplained weight loss, fatigue, blurred vision, slower wound healing, recurrent infections (UTIs, fungal, etc.)
Fast Blood Glucose (FBG): >126 mg/dL x 2 occasions
Random Blood Glucose: >200 mg/dL WITH symptoms
Hgb A1c: >6.5% x 2 occasions OR 1 x if BG >200 mg/dL
Carbapenems (Name, Special Aspect)
Imipenem-cilastatin
The kidneys rapidly degrade imipenem so cilastatin acts as a protector to increase half-life and efficacy
Catechol-O-methyltransferase Inhibitor and Decarboxylase Inhibitor/Dopamine Precursor (Name, MOA, Adverse Effects, Teaching)
levodopa-carbidopa-entacapone (Stalevo)
levodopa is a dopamine precursor, carbidopa prevents peripheral metabolism by block AADC, and entacapone prevents metabolization by COMT, increasing the amount of levodopa that makes it through BBB
increases risk of melanoma, diarrhea - drug induced colitis, somnolence
may turn urine orange-brown, falls risk (orthostatic hypotension)
DPP-4 Inhibitor (Name, MOA, dosage)
"gliptins"
Increases insulin activity after food intake by blocking DPP-4, an enzyme that breaks down GLP-1; inhibits glucagon secretion by the pancreas, improves BG control after a meal
once daily dosing
1. destruction of dopaminergic neuronal cells in the substania nigra in the basal ganglia
2. degeneration of the dopaminergic nigrostriatal pathway
3. depletion of dopamine stores
4. imbalance of excitatory (acetylcholine) and inhibitory (dopamine) neurotransmitters
5. impairment of extrapyramidal tracts controlling complex body movements
6. tremors, rigidity, bradykinesia, postural changes
Chronic Diabetes Complications
Microvascular Disease: Retinopathy - glaucoma, cataracts, poor night vision; Diabetic nephropathy - renal failure
Diabetic Neuropathies: Autonomic (type of peripheral, innervate our vessels) or peripheral
Macrovascular Disease: coronary artery disease, stroke, peripheral arterial disease, dementia
Infection: gingivitis/carries, fungal, UTI/cystitis (inflammation of the bladder)
Peripheral Artery Disease (What is it, typically caused by what, S/S)
A form of peripheral vascular disease in which there is partial or total blockage of an artery, usually one leading to a leg or arm
typically caused by atherosclerosis (associated w/ type 2 DM & smoking)
intermittent claudication, weak pedal pulses, cool and pale skin, shiny/discolored skin, dependent rubor, hair loss, slow wound healing
Thrombolytic Therapy (names, MOA, adverse effects, calculation, antidote)
"plase" (tPA)
promotes the conversion of plasminogen into plasmin which lyses unwanted fibrin blood clots
bleeding
0.9mg/kg body weight, 10% of the dose given as IV bolus and remaining given on IV drip
Aminocaproic acid
Name all types of insulin and peak start time
Rapid Acting: Humalog (0.5-1.5)
Short Acting: Regular (2.5-5)
Intermediate Acting: NPH (4-12)
Long Acting: Lantus (No peak)
tPA criteria
-older than 18
-Clinical diagnosis of ischemic stroke
-Systolic blood pressure ≤185 mm Hg; diastolic ≤110 mm Hg
-Glucose >50 mg/dL
-Platelet count ≥100,000/mm
-No hx of seizure, TIAs, head injury, major surgery, or pregnancy within last 3 months
- stroke within last 3 hours
HHNS (stands for? type of diabetes? S/S?)
Hyperglycemic Hyperosmolar Non-ketonic Syndrome
Type 2 DM
BS >600 mg/dL, polyuria, polydipsia, hypotension, tachycardia, normal blood pH, normal bicarbonate level, no ketones present
Aliskiren (type, MOA, adverse effects, important points)
Direct Renin Inhibitor
MOA: binds tightly to renin and inhibits the cleavage of angiotensinogen into angiotensin I
Adverse effects: angioedema, cough, GI effects, hyperkalemia, fetal injury and death
Expensive, hasn't proven to be better or worse than ACE inhibitors or ARBS. More GI effects than ACE and ARBS
Contraindicated in individuals with decreased kidney function
Name all 6 Dopamine Receptor Drugs in SEARS
Sinemet, Eldepryl, Apokyn, Requip, Symmetrel
Name all 9 types of Diabetes medication & their medication/naming convention
Biguanides (Metformin), GLP-1 Inhibitors (tide), SLGT-2 Inhibitors (flozin), DPP-3 Inhibitors (gliptins), Sulfonylureas (ide or starts with G), TZD (Actos), Alpha Glucosidase Inhibitor (Acarbose), Meglitinides (glinides), Pramlintide (Pramlintide acetate)
Neurologic Deficits Stroke (Motor/Verbal, Visual/Sensory, Cognitive, Emotional)
Motor/Verbal: hemiparesis, hemiplegia, dysarthria, dysphagia, expressive aphasia, receptive aphasia
Visual/Sensory: hemianopia, paresthesia, agnosia
Cognitive: short term and long term memory loss, short attention span, altered judgement
Emotional: depression, withdrawal, feeling of isolation
Compare and contrast DM 1 & DM 2 (Patho, Onset, Risk Factors, Complications, Treatment)
Patho: Insulin deficiency, autoimmune beta cell destruction vs. Insulin resistance & liver produces too much glucose
Onset: rapid onset at a younger age vs insidious onset at an older age
Risk Factors: genetic vs obesity & sedentary lifestyle
Complications: DKA vs HHNS
Treatment:
Name all of the MSK drugs + Use
Colchicine (gout treatment & prophylaxis)
Allopurinol (primary and secondary gout)
Cyclobenzaprine hydrochloride (Flexeril) Muscle relaxant - used for muscle spasms
Baclofen (Lioresal) Muscle relaxant - used for muscle spasticity and pain
Calcium/Vitamin D osteoporosis
Bisphosphonates osteoporosis