472 unit 3

What 2 drugs are used to treat Parkinson's Disease?

Levodopa/Carbidopa and Benzotropine

What is the purpose of Levadopa in Levadopa/Carbidopa?

cross BBB and converted to dopamine in brain

What is the purpose of Carbidopa in Levadopa/Carbidopa?

prevents peripheral absorption of levadopa so it can go to the brain

What is something to consider for Levadopa/Carbidopa?

No high-pro meals bc competes for absorption and can transport across BBB

For Levadopa/Carbidopa, monitor patients for potential activation of __.

Malignant melanima

What is the MOA of Banzotropine?

BLOCK muscarinic receptor in striatum to improve ACh and Dop balance

What 2 drugs are used to treat Alzheimer's Disease?

Donepezil and Memantine

What class is Donepezil?

Cholinesterase Inhibitor

What class is Memantine?

Neuronal receptor blocker

What is the MOA of Donepezil?

Prevent ACh breakdown by AChE, increasing ACh availability at cholinergic synapse

What are severe ADE of Donepezil?

Withdrawl syndrome, prolonger QT interval, Heart block

What is the MOA of Memantine?

BLOCK Ca2+ influx in NMDA when glutamate is low, vise versa.

What are severe ADE of Memantine?

none, usually well tolerated but report ANGINA

What 2 drugs are used to treat muscle spacities?

Baclofen and Dantrolene

What is Baclofen specifically used for?

is a centrally acting muscle relaxer for spacity; related to MS or spinal cord injuries

MOA of Baclofen

Suppress hyperactive reflex, structual analog of GABA

MOA of Dantrolene

act DIRECTLY on skeletal muscle by suppressing CA2+ release from SR

Serious ADE of Baclofen?

Withdrawl symptoms (esp w intrathecal)

Serious ADE of Dantrolene?

Hepatic toxicity

For seizure meds, __ is highly individualized

pharmacologic management

Seizure meds: withdrawl should be slow and sequential to prevent __.

status epilepticus

Seizure meds: advise __ supplementation during pregnancy.

folic acid

What are the 4 blocking mechanisms of all ASD? (anti-seizure)

Na+, Ca2+, Glutamante receptor, GABA receptor

what is the prototype of the ASD where it blocks Na+ channel?

Phenytoin

MOA of Phenytoin

DELAY Na+ influx, slowing spread of abnormal electrical discharges

ADE of Phenytoin

Gingival hyperplasia, Morbiliform rash-> SJS, Purple glove syndrome

What drug is used to treate Bipolar Disorder?

Lithium

What drugs should be used for short term therapy of bipolar disorder?

Lithium, Valproate

What drugs should be used for long term therapy of bipolar disorder?'

Antipsychotics

When taking Lithium PO, take with __ to avoid GI upset.

meals/milk

What is the therapeutic level of Lithium?

0.4-1mEq/L, ideally 0.6-0.8

What are some s/s of lithium toxicity?

lithium induced polyuria, tremor, hypothydroidism

What is the most important sign of lithium toxocity?

Na+ depletion

What are the 4 classes of antidepressants?

SSRI, SNRI, MAOI, TCA

what is the MOA of SSRI/SNRI?

BLOCK serotonin (+NE) in the synaptic space, increasing availability

What is the prototype of SSRI

Fluoxetine

What is the prototype of SNRI

Venlafaxine

What is the prototype of MAOI

Phenelzine

What is the prototype of TCA

Imipramine

2 ADEs of SSRI/SNRI

Seretonin Syndrome and Withdrawl Syndrome

What is the onset of Seretonin Syndrome after dose?

2-72hr

__ is essential to prevent withdrawl syndrome

gradual tapering

what are additional ADE of SSRI/SNRI?

bruxism (teeth grinding), GI bleed, sexual dysfunc, dizziness, fatigue

ADE of Imipramine

Anticholinergic effects, sweating, seizure, sedation, hypomania

what is the most serious ADE of Imipramine?

Orthostatic hypotension

what is the most dangerous ADE of Imipramine?

Cardiac toxicity

Which class of antidepressant has the most drug interactions?

MAOI

Foods rich in __ should not be combined with MAOI

Tyramine (avocado, figs, banana, fermented meat, cheese, soysauce)

MAOI are not recommended for patients age __

older than 60

ADE of Phenelzine

Hypertensive crisis, orthostatic hypotension

The first generation antipsychotic is also known as __

conventional

The second generation antipsychotic is also known as __

atypical

Prototype of 1st gen antipsychotic

Haloperidol

Prototype of 2nd gen antipsychotic

Clozapine

What is the difference of MOA between 1st gen adn 2nd gen antipsychotics?

1st gen: block D2 (dopamine) receptor, 2nd gen: block mainly serotonin receptor

What is the difference of ADE between 1st gen adn 2nd gen antipsychotics?

1st gen: Tardive Dyskinesia (mvmt), 2nd gen: metabolic effects (weight gain, diabetes, dyslipidemia)

What 2 drugs are used to manage ADHD?

Methylphenidate and Atomoxetine

what class is Methylphenidate (Ritalin)?

Amphetamine-like drug

what class is Atomoxetine?

NE reuptake inhibitor

MOA of Methylphenidate

STIMULATE NE and Dop release, partially prevent reuptake

ADE of Methylphenidate

increase in CNS, overstimulation

Unline Methylphenidate, Atomoxetine __ ADHD in children/adults

treats

MOA of Atomoxetine

selective NE reuptake INHIBITOR

ADE of Atomoxetine

generally well tolerated, maybe some suicidal thinking in children

What 2 drugs are used to manage Anxiety Disorders?

Busiprone and Diazepam

Unlike Diazepam, Busiprone is NOT __

a CNS depressant and has an abuse potential

ADE for Busiprone

none

Avoid __ in busiprone as it can increase its levels.

grapefruit juice

What is a major disadvantage of Busiprone?

it takes weeks to take effect

Class of Busiprone

Nonbenzodiazepine, nonbarbituate

Class of Diazepam

Benzodiazepine

MOA of Diazepam

potentiate GABA action

Besides Diazepam, what is the most prescribed benzos?

Lorazepam

What is the difference between Lorazepam and Diazepam?

Diazepam is long acting, Lorazepam is short acting

DM: T1DM is autoimmune leading to __ production

no insulin

DM: T2DM is insulin __.

resistance

DM: What is the med management for T1DM?

insulin replacement

DM: What is the med management for T2DM?

Oral antidiabetics, followed by insulin if it gets worse

DM: for T1DM Tx, it requires a combination of _ and _ insulin

basal and prandial (mealtime)

DM: for T2DM Tx, it focuses on increasing _ and reducing _.

insulin sensitivity, hepatic gluc production

DM: What is the prototype of Rapid Acting Insulin?

Insulin Lispro (Humalog)

DM: What is the prototype of Short Acting Insulin?

Regular Insulin

DM: What is the prototype of Intermed Acting Insulin?

NPH Insulin

DM: What is the prototype of Long Acting Insulin?

Insulin Glargine

DM: What is the onset, peak, and duration Rapid Insulin?

onset 15-30 min, peak .5-2.5 hours, duration 3-6 hours

DM: What is the onset, peak, and duration Short Insulin?

onset .5-1 hr, peak .1-5 hours, duration 6-10 hours

DM: What is the onset, peak, and duration Intermed Insulin?

onset 1-2hr, peak 6-14hr hours, duration 14-24 hours

DM: What is the onset, peak, and duration Long Insulin?

onset 1.5-2, peak NONE, duration 18-24 hours

DM: When should you administer Insulin Lispro?

immediately before/after meal

DM: When should you administer Regular Insulin?

before meal

DM: When should you administer NPH Insulin?

2-3x/day

DM: When should you administer Insulin Glargine?

once a day

When administering NPH and regular insulin, what is one key thing to consider?

draw short acting FIRST (clear), then draw NPH (cloudy)

In the same syringe, you should NEVER mix any type of insulin with __

insulin glargine

What are 3 things that cause a pt to have DECREASED need for insulin?

missed meal, physical activity, first trim of pregnancy

What are some things that cause a pt to have INCREASED need for insulin?

infection, illness, stress, obesity, adolesc growth spurt, preg AFTER 1st trim

What are 5 key insulin therapy complications that can occur?

Hypoglycemia, Hypokalemia, Lipohypertrophy, Allergix rxn, drug interxn

Someone is said to have hypoglycemia when their blood levels are __mg/dl

UNDER 70

if patient is unconsious, then what is necessary for RAPID tx?

glucagon or IV dextrose

how can you prevent lipohypertrophy?

by rotating injection sittes