Pharm Exam 3 - Fill in the Blank

The blood-brain barrier _____ drug entry into the brain; _____-soluble drugs pass more easily.

1) restricts; 2) lipid

Newborns are more sensitive to many CNS drugs because their _____ is not fully developed.

blood-brain barrier

GABA _____ neuronal firing; glutamate is _____.

1) inhibits; 2) excitatory

Drug _____ is a reduced response after prolonged exposure, so higher doses may be needed.

tolerance

Physical _____ means abrupt discontinuation produces withdrawal; it is not the same as addiction.

dependence

With sedating medications, a major nursing priority is assessing _____, alertness, fall risk, and other CNS depressants.

respiratory rate

Parkinson motor symptoms come from loss of _____ neurons in the substantia nigra, leaving _____ effects relatively unopposed.

1) dopamine; 2) acetylcholine

The 4 main motor symptoms of Parkinson disease are _____.

resting tremor, rigidity, bradykinesia, postural instability

The 2 main Parkinson drug strategies are to _____ dopamine activity or _____ central cholinergic effects.

1) enhance; 2) decrease

Levodopa/carbidopa is a dopamine _____ plus a peripheral _____ inhibitor; it treats Parkinson motor symptoms.

1) precursor; 2) decarboxylase

Levodopa is given instead of dopamine because levodopa crosses the _____ and dopamine does not effectively cross.

blood-brain barrier

Carbidopa prevents _____ conversion of levodopa, increasing CNS delivery and reducing nausea.

peripheral

The 3 common side effects of levodopa/carbidopa are _____.

nausea, dizziness, orthostatic hypotension

The 3 serious long-term effects of levodopa/carbidopa are _____.

dyskinesias, hallucinations/psychosis, motor fluctuations

The levodopa _____ effect is when motor symptoms return before the next dose as the drug effect declines.

wearing-off

Wearing-off can be managed by shortening dosing intervals or adding a _____ inhibitor, an _____ inhibitor, or a dopamine agonist.

1) COMT; 2) MAO-B

Large high-_____ meals can compete with levodopa absorption, so keep timing consistent.

protein

Levodopa/carbidopa teaching: take on schedule, monitor mobility and falls, and do not _____.

stop abruptly

Common dopamine agonists are _____; _____ treats acute "off" episodes.

1) pramipexole, ropinirole, rotigotine; 2) apomorphine

Dopamine agonists _____ stimulate dopamine receptors and are used alone or with levodopa.

directly

Unusual dopamine agonist adverse effects to report are sleep attacks, hallucinations, and _____ behaviors such as gambling.

impulse-control

The COMT inhibitors _____ and _____ prolong levodopa availability and are given with levodopa.

1) entacapone; 2) tolcapone

Entacapone can cause dyskinesia, nausea, diarrhea, orthostatic hypotension, and _____ urine.

orange-brown

Tolcapone use is limited by a severe toxicity, potential fatal _____; monitor the matching labs.

liver injury (monitor liver function)

The MAO-B inhibitors _____ and _____ reduce dopamine breakdown in the CNS.

1) selegiline; 2) rasagiline

MAO-B inhibitors can cause dangerous reactions with _____ drugs and certain opioids.

serotonergic

Benztropine is a central _____; it is best for tremor and rigidity, not _____.

1) anticholinergic; 2) bradykinesia

Benztropine causes dry mouth, constipation, urinary retention, and confusion; use caution with _____.

glaucoma

Amantadine gives modest Parkinson benefit and may reduce levodopa-induced _____.

dyskinesia

Amantadine's distinctive adverse effect is _____ (mottled skin); it also causes confusion and anticholinergic effects.

livedo reticularis

The guide names hypersensitivity and _____ as major levodopa/carbidopa contraindications; verify the prescription and patient history.

narrow-angle glaucoma

Additional levodopa/carbidopa monitoring: track symptom control and assess _____ and _____ function if ordered.

1) renal; 2) hepatic

Nondrug and advanced Parkinson options: exercise, physical/occupational therapy, fall prevention, and _____ in carefully selected patients.

DBS (deep brain stimulation)

Alzheimer disease is progressive neuronal loss, especially in the hippocampus/cortex, with _____ and _____.

1) plaques; 2) neurofibrillary tangles

In Alzheimer disease, _____ commonly declines first; later speech, judgment, and self-care decline.

short-term memory

_____ is worsening confusion or agitation later in the day.

Sundowning

Donepezil, rivastigmine, and galantamine are _____ inhibitors for cognitive symptoms.

acetylcholinesterase

Donepezil reversibly inhibits acetylcholinesterase to increase _____; it is used for Alzheimer dementia.

acetylcholine

The 3 common donepezil adverse effects are _____.

nausea, diarrhea, reduced appetite or weight loss

Serious donepezil effects that need monitoring are _____, syncope, and falls; assess pulse and safety.

bradycardia

_____ drugs oppose cholinesterase inhibitors and reduce their effectiveness.

Anticholinergic

Rivastigmine/galantamine class risks are GI effects, weight loss, and bradycardia/syncope; monitor _____ and _____.

1) weight; 2) pulse

Memantine is an _____ receptor antagonist used for _____ Alzheimer disease.

1) NMDA; 2) moderate-to-severe

The 4 common memantine adverse effects are _____.

dizziness, headache, confusion, constipation

Alzheimer medications do not _____ the disease; they may modestly relieve or slow symptom progression, not reverse it.

cure

Donepezil teaching: take it _____; assess for hypersensitivity, fainting, bradycardia, and weight loss.

consistently

Nonmedication Alzheimer care includes structured _____, caregiver support, cognitive engagement, and home safety measures.

routines

MS neurologic deficits come from immune-mediated CNS _____, which disrupts nerve conduction.

demyelination

The 6 MS symptoms listed are _____.

fatigue, weakness, spasticity, sensory changes, bladder dysfunction, visual problems

Disease-modifying MS agents reduce _____ and lesions; symptom drugs treat issues like spasticity or pain.

relapses

An acute MS exacerbation is commonly treated with a short course of high-dose _____, often IV _____.

1) corticosteroids; 2) methylprednisolone

Interferon beta is an _____ that reduces inflammatory activity in relapsing MS.

immunomodulator

Interferon beta benefits: fewer _____, fewer MRI lesions, and slower accumulation of disability.

relapses

Common interferon beta side effects are _____ symptoms and _____ reactions.

1) flu-like; 2) injection-site

Serious interferon beta effects are _____, depression/suicidal thoughts, and blood count abnormalities.

hepatotoxicity

For interferon beta, monitor _____ and _____; rotate injection sites and teach self-injection.

1) CBC; 2) LFTs

The 6 other MS disease-modifying drugs on the slides are _____.

glatiramer, fumarates, fingolimod, teriflunomide, natalizumab, alemtuzumab

_____, a CNS muscle relaxant from the muscle-relaxant lecture, can help MS spasticity.

Baclofen

Disease-modifying drugs do not _____ MS; they reduce inflammatory relapses and progression risk, particularly in relapsing disease.

cure

The specifically listed interferon beta contraindication is severe _____ to interferon beta or formulation ingredients.

hypersensitivity

Mitoxantrone is an _____ for MS; it causes myelosuppression, cardiotoxicity, and a _____ tint to urine, skin and sclera.

1) immunosuppressant; 2) blue-green

Dalfampridine improves _____ in MS; it is a _____ channel blocker that can cause seizures.

1) walking; 2) potassium

The goal of antiseizure treatment is to prevent seizures with minimal _____ and maintain safety/adherence.

adverse effects

_____ seizures begin in one brain region; _____ seizures involve both hemispheres from onset.

1) focal; 2) generalized

The two antiseizure generations on the slides are _____ agents (e.g., phenytoin/valproate) and newer agents (e.g., _____).

1) traditional; 2) levetiracetam

Universal antiseizure teaching: never _____; seizures may recur or worsen.

discontinue abruptly

A blistering, painful rash with mucosal lesions on an antiseizure drug suggests _____; report it immediately.

Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN)

Phenytoin is a traditional antiseizure drug that blocks voltage-gated _____ channels for focal/tonic-clonic seizures.

sodium

The usual total phenytoin therapeutic level is _____ mcg/mL; interpret with albumin/free level and clinical status.

10–20

The 5 dose-related phenytoin toxicity signs are _____.

nystagmus, ataxia, diplopia, sedation, confusion

The chronic phenytoin side effect that needs teaching is _____; emphasize brushing, flossing, and dental care.

gingival hyperplasia

Phenytoin enzyme induction may reduce the effectiveness of _____.

hormonal contraceptives

Phenytoin monitoring: drug level when indicated, neurologic status, _____, and skin reactions.

CBC/LFTs

_____ is the injectable prodrug of phenytoin, used when parenteral loading is needed.

Fosphenytoin

Carbamazepine blocks _____ channels, reducing repetitive neuronal firing.

sodium

Serious carbamazepine toxicities are _____, liver injury, and severe rash; monitor CBC/LFTs.

aplastic anemia/agranulocytosis

Carbamazepine can cause _____ from SIADH.

hyponatremia

Valproate treats multiple seizure types and also acute _____/bipolar mood stabilization.

mania

The 4 serious valproate adverse effects are _____.

hepatotoxicity, pancreatitis, thrombocytopenia, fetal harm

Valproate labs: liver function, _____, and drug level as ordered.

CBC/platelets

Ethosuximide is used especially for _____ seizures; it reduces thalamic _____ calcium currents.

1) absence; 2) T-type

Phenobarbital is a _____ antiseizure drug; it causes sedation and respiratory depression.

barbiturate

Oxcarbazepine's important electrolyte adverse effect is _____; check the matching serum level when indicated.

hyponatremia (check serum sodium)

Lamotrigine is associated with the serious skin reaction _____; slow titration helps reduce the risk.

Stevens-Johnson syndrome

Gabapentin is used as adjunct focal-seizure therapy and for _____ pain; adverse effects are dizziness, sedation, and edema.

neuropathic

Pregabalin treats neuropathic pain, _____, and is a focal-seizure adjunct; watch for sedation, edema, and weight gain.

fibromyalgia

On levetiracetam, monitor for _____, agitation, and mood or behavior changes.

irritability

The 5 distinctive topiramate adverse effects are _____.

cognitive slowing, paresthesias, weight loss, kidney stones, metabolic acidosis

The immediate nursing priority in status epilepticus is to protect _____, check _____, and get emergency assistance.

1) airway and breathing; 2) glucose

The first-line status epilepticus drug on the slide is IV _____; _____ is an alternative when needed.

1) lorazepam; 2) diazepam

After the initial benzodiazepine in status epilepticus, give a longer-acting antiseizure load such as _____, per protocol.

fosphenytoin/phenytoin

Seizure precautions: protect from injury, keep suction/oxygen available as appropriate, and time seizures; never _____ or _____.

1) restrain; 2) place objects in the mouth

The 3 common antiseizure class side effects that need fall precautions are _____; assess safety.

dizziness, drowsiness, impaired coordination

For carbamazepine, follow the serum drug concentration as ordered, CBC, liver tests, and _____.

sodium

Avoid valproate in significant _____ disease; pregnancy exposure can cause serious fetal harm.

liver

The whole antiseizure class increases the risk of _____; monitor mood and behavior.

suicidal thoughts and behavior

Non-drug seizure treatments on her slide: _____ (best success rate), vagal nerve stimulation, and the ketogenic diet.

neurosurgery

Her slide defines status epilepticus as a continuous series of tonic-clonic seizures lasting _____ minutes. The 3 treatment goals are _____.

1) 20 to 30; 2) maintain ventilation, correct hypoglycemia, stop the seizures

She said lorazepam is preferred over diazepam because it acts _____ with fewer CNS effects at lower doses; give IV, keep the airway open, and keep the patient on the side.

faster

The carbamazepine target trough level is _____.

4 to 12 mcg/mL