Exam 3 Review

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1
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cyclobenzaprine brand

Amrix, Fexmid

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cyclobenzaprine class

muscle relaxant

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cyclobenzaprine use

muscle spasm, fibromyalgia

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cyclobenzaprine moa

Potentiates norepinephrine and binds to serotonin receptors, reducing spasticity (centrally acting muscle relaxant)

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cyclobenzaprine dose

5-10 mg PO TID or 15 mg ER qD

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cyclobenzaprine contraindications

elderly pts, MI pts, hepatic pts, arrhythmias, heart block, CHF, avoid abrupt withdrawal

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cyclobenzaprine bbw

none

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tramadol brand

ConZip, Qdolo

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tramadol class

opioid agonist

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tramadol use

moderate to moderate-severe pain

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tramadol moa

binds to mu receptors and weakly inhibits norepinephrine and serotonin reuptake producing analgesia (central opioid agonist

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tamadol dose

50-100 mg PO q4-6h

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tramadol contraindications

MAOI use, respiratory depression, asthma, GI obstruction, seizure disorder, head injury, alcohol use

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tramadol bbw

high addiction/misuse risk, opioid analgesic REMS, life threatening respiratory depression can occur, concomitant use with benzodiazepines

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nortriptyline brand

Pamelor

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nortriptyline class

tricyclic antidepressant

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nortriptyline use

depression

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nortriptyline moa

inhibits norepinephrine and serotonin reuptake

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nortriptyline dose

50-150 mg PO qHS

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nortriptyline contraindications

Brugada syndrome, acute MI, avoid abrupt withdrawal

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nortriptyline bbw

may cause suicidal thoughts in children and young adults, not approved for pediatric use

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amitriptyline brand

amitriptyline

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amitriptyline class

tricyclic antidepressant

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amitriptyline use

depression, neuropathic pain, migraine, fibromyalgia

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amitriptyline moa

inihibits norepinephrine and serotonin reuptake

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amitriptyline dose

50-150 mg PO qHS

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amitriptyline contraindications

MI recovery, avoid abrupt withdrawal

28
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amitriptyline bbw

may cause suicidal thoughts in children and young adults

29
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pregabalin brand

Lyrica

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pregabalin class

anticonvulsant

31
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pregabalin use

neuropathic pain, partial seizures, fibromyalgia

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pregabalin moa

binds to alpha 2 delta subunit of calcium channels, reducing neurotransmitter

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pregabalin dose

IR: 50-100 mg PO TID, ER: 165-330 mg PO qD

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pregabalin contraindications

renal disease

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pregabalin bbw

none

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hydrocodone & acetaminophen brand

Lortab, Norco

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hydrocodone & acetaminophen class

opioid combination, narcotic and non-narcotic

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hydrocodone & acetaminophen use

moderate to severe pain

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hydrocodone & acetaminophen moa

binds to various opioid receptors and centrally acting non opioid analgesic

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hydrocodone & acetaminophen dose

2.5-10 mg hydrocodone PO q4-6h PRN

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hydrocodone & acetaminophen contraindications

respiratory depression, asthma, GI obstruction

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hydrocodone & acetaminophen bbw

avoid doses of APAP >4000 mg qD

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oxycodone brand

Oxycontin, Roxicodone, Xtampza ER

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oxycodone class

opioid agonist

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oxycodone use

moderate to severe pain

46
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oxycodone moa

binds to various opioid receptors, producing analgesia and sedation

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oxycodone dose

individualized dosing

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oxycodone contraindicatons

MAOI use, respiratory depression, asthma, GI obstruction, seizure disorder, head injury, alcohol use

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oxycodone bbw

high addiction/misuse risk, opioid analgesic REMS, life threatening respiratory depression can occur, concomitant use with benzodiazepines

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morphine sulfate brand

Kadian, Morphabond ER, MS Contin

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morphine sulfate class

opioid agonist

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morphine sulfate use

moderate to severe pain

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morphine sulfate moa

binds to various opioid receptors, producing analgesia and sedation

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morphine sulfate dose

varies

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morphine sulfate contraindications

MAOI use, respiratory depression, asthma, GI obstruction, seizure disorder, head injury, alcohol use

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morphine sulfate bbw

high abuse potential, may lead to dependency and respiratory depression may occur even at accepted dosing, adverse CV events and death reported on misuse

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gabapentin brand

Neurontin, Horizant

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gabapentin class

anticonvulsant

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gabapentin use

partial seizures, neuralgia

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gabapentin moa

blocks voltage dependent calcium channels, modulating excitatory neurotransmitter release

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gabapentin dose

300-1200 mg PO TID

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gabapentin contraindications

none

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gabapentin bbw

none

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lamotrigine brand

Lamictal, Lamical XR

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lamotrigine class

anti mania anticonvulsant

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lamotrigine use

bipolar disorder, partial seizures

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lamotrigine moa

inhibits voltage dependent sodium channels, decreasing presynaptic glutamate and aspartate release

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lamotrigine dose

varies by disease state

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lamotrigine contraindications

avoid abrupt withdrawal

70
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lamotrigine bbw

serious rashes requiring hospitalization may develop

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topiramate brand

Topamax, Trokendi, Qudexy

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topiramate class

anticonvulsant

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topiramate use

partial seizures, tonic/clonic seizures, migraine prophylaxis

74
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topiramate moa

blocks voltage dependent sodium channels, augments GABA activity, antagonizes glutamate receptors, inhibits carbonic anhydrase

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topiramate dose

IR: 200 mg PO BID, ER: 400 mg PO qD

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topiramate contraindications

avoid abrupt withdrawal

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topiramate bbw

none

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DSM-5 Criteria for Dementia

Evidence of significant cognitive decline from 1+ of the domains of:

  • learning and memory

  • language

  • executive function

  • complex attention

  • perceptual-motor

  • social cognition

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Signs of cognitive decline

interference with indepence of everyday activities (including paying bills or taking medications), cannot be other mental disorders or delirium

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Diagnosing Alzheimer’s

memory impairment along with one of the following: apraxia, aphasia, agnosia, disturbance of executive function

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Define Alzheimer’s disease

chronic irreversible neurodegenerative disorder with slow, progressive loss of cognitive function

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Clinical presentation of Alzheimer’s

Cognitive and non-cognitive symptoms (BPSD)

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Examples of reversible cognitive impairment

normal pressure hydrocephalus, medication conditions (depression, thyroid/B12 deficiency, metabolic imbalances)

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Examples of irreversible cognitive impairment

Alzheimer’s, Vascular dementia, Lewy body dementia, Parkinson’s, Frontotemporal dementia, Creutzfeldt-Jakob disease

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*Medication-Induced Cognitive Impairment

  • anticholinergics

  • antihypertensives

  • hypoglycemics

  • opioids

  • sedatives/hypnotics

  • steroids

  • NSAIDs

  • anticonvulsants (B12 & folic acid deficiency)

  • methotrexate (folic acid deficiency)

  • metformin (B12 deficiency)

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Signs of B12 deficiency

confusion, fatigue (these are reversible if it’s caught soon enough

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What is the mini mental status exam used for?

Assess cognitive impairment

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What does the MMSE measure?

orientation, attention, recall, language

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What does the MMSE NOT measure?

mood and disordered forms of thinking

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True or False. The MMSE is used as a diagnostic tool

False. Only used for screening

91
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What stages of AD are present with mild cognitive impairment (24-20)?

decrease in memory of recent events, decline in ability to manage finances, withdrawal from hobbies and challenging tasks, mood swings, personality changes

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What stages of AD are present with a moderate MMSE (19-10)?

Need assistance in activities of daily living, disorientation, short and long term memory impairment, aphasia, ataxia, agnosia, BPSD (depression, suspicion, agitation, paranoia, delusions)

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What stages of AD are present with a severe MMSE (9-0)?

loss of speech, loss of ambulation, loss of ability to self feed, incontinence, 24/7 care, bed or chair bound, may need long term care

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Early Stage treatment goals

improve and preserve cognitive function, slow disease progression

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Mid-Stage treatment goals

Preserve function of ADLs, maintain safety/dignity, support within the home, delay institutionalization

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Advanced Stage treatment goals

treating psychiatric and behavioral issues, provide family and caregiver support

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Palliative stages of treatment goals

symptom management

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Acetylcholinesterase inhibitors used to treat Alzheimer’s

donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne)

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NMDA antagonist used to treat Alzheimer’s

memantine (Namenda)

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IgG1 used to treat Alzheimer’s

lecanemab (Leqembi)