Unit 4 exam


1. Headaches

●      Types of headaches- Clinical characteristics, causes

  • Tension headaches: Often caused by stress, characterized by a dull, aching sensation and tightness in the forehead or back of the head.

  • Migraines: Typically triggered by specific factors, presenting with severe, throbbing pain often accompanied by nausea, vomiting, or sensitivity to light and sound.

  • Cluster headaches: Intense, recurrent pain that occurs in cyclical patterns or clusters, often described as piercing and located around one eye.

●      First-line treatments for each headache type - mechanism of action, key side effects, contraindications.

  • Tension headaches: First-line treatment typically involves analgesics such as acetaminophen or NSAIDs, which work by inhibiting cyclooxygenase (COX) enzymes, thus reducing prostaglandin synthesis. Key side effects may include gastrointestinal discomfort and liver toxicity with excessive use. Contraindications include known hypersensitivity or severe liver disease.

  • Migraines: First-line treatment usually consists of triptans (e.g., sumatriptan), which selectively agonize serotonin receptors (5-HT1B/1D), leading to vasoconstriction of intracranial blood vessels. Main side effects can include dizziness, side effects related to injection sites, and potential cardiovascular effects. Contraindications include coronary artery disease, uncontrolled hypertension, and pregnancy.

  • Cluster headaches: First-line pharmacological intervention often involves high-flow oxygen therapy or the use of triptans, utilizing their vasoconstrictive properties. Typical side effects may include chest tightness and potential for rebound headaches. Contraindications include history of cardiovascular diseases.

●      Prophylactic (preventative) management - when to prescribe, classes of medications, mechanism of action, key side effects, and contraindications.

  • When to prescribe: Consider initiating prophylactic therapy for patients with frequent and disabling episodes, typically defined as having more than one attack per week.

  • Classes of medications:

    • Beta-blockers (e.g., propranolol): Mechanism of action involves reducing catecholamine release and stabilizing vascular tone.

    • Antidepressants (e.g., amitriptyline): Work primarily through serotonin reuptake inhibition, affecting neurotransmitter balance.

    • Anticonvulsants (e.g., topiramate): Modulate neurotransmitter release and enhance GABA activity for stabilization.

  • Key side effects: Vary by medication class but may include fatigue, weight changes, and cognitive effects.

  • Contraindications: Specific to the medication class, including previous adverse reactions and patient-specific health conditions.

●      Medication overuse headache

• Can occur with frequent use of analgesics, characterized by increased headache frequency and severity.

 

2. Seizures

●      Types of seizures - presentation, clinical features

  • Focal seizures: Start in one area of the brain and may cause changes in sensation, perception, or consciousness.

  • Generalized seizures: Involve the whole brain and can lead to loss of consciousness, convulsions, or muscle rigidity.

  • Absence seizures: Characterized by brief lapses in awareness, often mistaken for daydreaming.

●      First line treatments - mechanism of action, key side effects, boxed warnings, important drug-drug interactions, and contraindications

  • First line treatments: Various medications are used to manage seizures, each with specific mechanisms of action and side effects.

  • Common first-line medications include:

    • Phenytoin: Stabilizes neuronal membranes and decreases seizure activity.

    • Key side effects: Gum hyperplasia, hirsutism, and ataxia.

    • Boxed warnings: Cardiac arrhythmias with rapid infusion.

    • Contraindications: Hypersensitivity.

    • Carbamazepine: Stabilizes inactivated state of sodium channels, reducing neuronal excitability.

    • Key side effects: Dizziness, sedation, and hyponatremia.

    • Drug-drug interactions: Induces CYP450, affecting metabolism of other drugs.

    • Contraindications: History of bone marrow suppression.

    • Valproate (Valproic Acid): Increases GABA levels and reduces neurotransmitter release.

    • Key side effects: Weight gain, tremors, and hepatic toxicity.

    • Boxed warnings: Liver failure and pancreatitis.

    • Contraindications: Severe hepatic dysfunction and urea cycle disorders.

    • Lamotrigine: Inhibits glutamate release and stabilizes neuronal membranes.

    • Key side effects: Rash (risk of Stevens-Johnson syndrome), dizziness, and headache.

    • Drug-drug interactions: May require dose adjustment with other medications.

    • Contraindications: Hypersensitivity.

    • Levetiracetam: Modulates synaptic neurotransmitter release and reduces neuronal excitability.

    • Key side effects: Drowsiness, dizziness, and behavioral changes.

    • Contraindications: Hypersensitivity.

  • Choosing appropriate treatment depends on seizure type, patient-specific factors, and prior treatment responses.

●      Dose titration principles - monotherapy before polytherapy, slow titration, adherence, and when to adjust

 

3. Alzheimer’s Disease

●      Disease overview

●      First-line treatment – Cholinesterase inhibitors. Understand general mechanism, key side effects, and contraindications

●      Memantine - When to use, general mechanism of action, and key side effects.

●      Noncognitive behavioral symptoms – may require antipsychotics or SSRIs

●      Caregiver + safety considerations

 

4. Parkinson’s Disease

●      Disease overview, onset, clinical features

●      When to start medication therapy and goals

●      Medications for motor symptoms - different potencies, mechanism of action, key side effects, major interactions, and contraindications. Titration basics. Managing “wear off”

●      Medications for nonmotor symptoms - what classes to use for each nonmotor symptom, mechanism of action, key side effects.

●      Advanced therapies

●      Patient education and safety

5. Major Depressive Disorder

●      Diagnosis

●      First line pharmacotherapy - SSRIs and SNRIs. Mechanism of action, evaluating response timeframe, key side effects, treatment duration, and contraindications.

●      Alternative medication options- mechanism of action,  key side effects, treatment duration, and contraindications.

 

6. Bipolar Disorder

●      Bipolar I vs Bipolar II

●      First line pharmacotherapy - Mechanism of action, evaluating response timeframe, key side effects, treatment duration, and contraindications.

 

7. Anxiety Disorders

●      Diagnosis, types of anxiety disorders

●      First line pharmacotherapy for the different disorders- mechanisms of action, response timeframe, duration of treatment, key side effects, and contraindications.

●      Responsible benzodiazepine prescribing and contraindications

●      Second line pharmacotherapy agents

●      Tapering of medications

 

8. Sleep Disorders

●      Insomnia

○      Identifying the sleep defect (difficulty falling asleep, staying asleep, or non-restorative sleep) and what medications may be best for each.

○      Key medication categories for insomnia - mechanism of action, key side effects, and contraindications.

●      Restless Leg Syndrome: First line therapy - mechanism of action, side effects, and contraindications

●      Narcolepsy: First line therapy - mechanism of action, side effects, and contraindications

 

9. ADHD

●      Drug categories used to manage condition, their mechanism of action, key side effects or adverse effects, contraindications/cautions, and significant interactions.

 

10. Substance Use Disorders

●      Alcohol use disorder: First line medications- mechanism of action, side effects, and contraindications.

●      Opioid use disorder: First line medication- mechanism of action, side effects, and contraindications.

 

11. Nausea, Vomiting, Constipation, and Diarrhea

●      Nausea and Vomiting

○      Selecting therapy for types of nausea such as motion sickness, pregnancy, etc.

○      First and second line therapies - mechanism of action, key side effects, and contraindications

○      Red flags

●      Constipation

○      Lifestyle modifications

○      Chronic idiopathic constipation and opioid induced constipation

○      First, second, and third line therapies- mechanism of action, key side effects, and contraindications.

●      Diarrhea

○      Identifying cause and dehydration prevention

○      First line and second line agents - mechanism of action, key side effects, and contraindications.

 

12. GERD and PUD

●      Lifestyle modifications

●      First and second line therapies - mechanism of action, key side effects, contraindications, and major interactions.

●      Other GI agents- Sucralfate

●      H-pylori treatment

 

13. Liver Disease

●      Variceal hemorrhage

○      Prophylactic agents and their side effects, contraindications, and mechanism of action.

○      Acute variceal hemorrhage - first line agent, mechanism of action

●      Ascites management - first line therapy- mechanism of action, side effects, and contraindications

●      Spontaneous bacterial peritonitis (community acquired)

○      Empiric first-line treatment

●      Hepatic encephalopathy

○      First line and second line therapies- mechanism of action, key side effects, and contraindications

Chronic hepatitis B in pregnancy - preferred antiviral