chapter 10 new

Central nervous system (CNS)

Brain and spinal cord

Neurotransmitter

Chemical that transmits signals between nerves

Excitatory neurotransmitters

Acetylcholine, epinephrine, norepinephrine

Inhibitory neurotransmitters

Dopamine, serotonin, GABA

Balance of ACh and dopamine

Needed for smooth movement

Parkinson’s disease cause

Low dopamine

Parkinson’s key symptoms

Tremor, rigidity, bradykinesia, shuffling gait

3 drug classes for Parkinson’s

Dopamine agonists, COMT inhibitors, MAO-B inhibitors

Most important Parkinson drug

Carbidopa/levodopa

Levodopa action

Converts to dopamine in brain

Carbidopa purpose

Increases levodopa effectiveness and reduces side effects

When to take dopamine drugs

30–60 minutes before meals

What decreases levodopa absorption

High-protein foods

“On/off effect”

Drug suddenly stops working

Common side effects

Hypotension, nausea, insomnia, confusion

Dyskinesia

Uncontrolled dance-like movements

Serious mental effects

Hallucinations, delusions

Safety teaching

Rise slowly to prevent falls

Examples of COMT inhibitors

Entacapone, tolcapone

Action of COMT inhibitors

Prolong dopamine effects

Common harmless side effect of COMT inhibitors

Orange-brown urine

Serious adverse effect of tolcapone

Liver failure

Examples of MAO-B inhibitors

Selegiline, rasagiline, safinamide

Action of MAO-B inhibitors

Prevent dopamine breakdown

Major risk of MAO-B inhibitors

Hypertensive crisis

Cause of hypertensive crisis

Tyramine foods

Examples of Tyramine foods

Aged cheese, wine, beer, smoked meats

Cause of Alzheimer’s disease

Decreased acetylcholine

Main symptom of Alzheimer’s disease

Memory loss

Brain changes in Alzheimer’s disease

Plaques, tangles, neuron damage

Examples of cholinesterase inhibitors

Donepezil, rivastigmine, galantamine

Action of cholinesterase inhibitors

Increase acetylcholine

When to take donepezil

At bedtime

Common side effects of cholinesterase inhibitors

Diarrhea, nausea, headache

Parasympathetic effects of cholinesterase inhibitors

Bradycardia, hypotension, bronchospasm

Drug type NMDA blocker

Memantine

Action of NMDA blocker

Blocks calcium entry into neurons

Side effects of NMDA blocker

Headache, dizziness, constipation

Epilepsy

Chronic seizure disorder

Seizure

Abnormal electrical activity in brain

Convulsion

Visible muscle contractions

Purpose of antiepileptic drugs (AEDs)

Prevent seizures

Traditional AEDs

Phenytoin, carbamazepine, ethosuximide, phenobarbital, valproic acid

MOST IMPORTANT RULE for AEDs

Never stop AEDs suddenly

Mental health risk of AEDs

Depression, suicidal thoughts

Phenytoin side effect

Gum hyperplasia

Phenytoin serious reaction

Stevens-Johnson syndrome

Carbamazepine risk

Bone marrow suppression

Phenobarbital risk

CNS depression and dependency

Valproic acid risk

Liver toxicity

Monotherapy drugs (newer AEDs)

Oxcarbazepine, lamotrigine, lacosamide, topiramate

Lamotrigine danger

Rash = STOP immediately

Topiramate danger

High ammonia = encephalopathy

Oxcarbazepine risk

Hyponatremia

Lacosamide risk

Orthostatic hypotension

MS (Multiple sclerosis)

Autoimmune destruction of myelin

Symptoms of MS

Weakness, vision problems, numbness

3 categories of MS drugs

BRMs, monoclonal antibodies, neurologic drugs

BRMs action

Modify immune response

Monoclonal antibodies risk

Infection and allergic reactions

Drug that improves walking in MS

Dalfampridine

Cause of Parkinson’s disease

Low dopamine

Cause of Alzheimer’s disease

Low acetylcholine

MAO inhibitors + tyramine

Hypertensive crisis

Lamotrigine rash indication

Stop immediately

AED rule on stopping medications

Never stop suddenly