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Neurology

Neurology. NAPLEX. PG 89. Drugs used for Convulsive Disorders. NAPLEX. PG 89. The medication lorazepam (Ativan) has which of the following pharmacological activities? a. sedative/hypnotic b. anticonvulsant c. muscle relaxant d. anxiolytic e. all of the above.

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Neurology

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  1. Neurology NAPLEX PG 89

  2. Drugs used for Convulsive Disorders NAPLEX PG 89

  3. The medication lorazepam (Ativan) has which of the following pharmacological activities? a. sedative/hypnotic b. anticonvulsant c. muscle relaxant d. anxiolytic e. all of the above

  4. The medication lorazepam (Ativan) has which of the following pharmacological activities? a. sedative/hypnotic b. anticonvulsant c. muscle relaxant d. anxiolytic e. all of the above

  5. Major Types of Convulsive Disorders • Partial – generally involves only one hemisphere of the brain (initially) and asymmetrical: • Simple-no loss of consciousness • Complex-loss of consciousness Phenytoin, carbamazepine, barbiturates, valproate • Generalized – generally involves both hemispheres of the brain; bilateral/symmetrical: • absence, myoclonic, clonic, tonic, tonic-clonic, Valproate, lamotrigine, carbamazepine, ethosuximide • Status epilepticus—30 minutes of continuous seizures or five minutes of convulsive seizures. Lorazepam is drug of choice; midazolam or propofol PG 89

  6. Anticonvulsant Drugs • AED monotherapy is preferred, but some patients do require combination therapy. • First-line AEDs for partial seizures include carbamazepine, phenytoin, lamotrigine, valproic acid, and oxcarbazepine. • First-line AEDs for generalized absence seizures include valproic acid and ethosuximide. • First-line AEDs for tonic-clonic seizures include phenytoin, carbamazepine, and valproic acid. • Alternative AEDs include gabapentin, topiramate, levetiracetam, zonisamide, tiagabine, primidone, felbamate, lamotrigine, and phenobarbital. PG 89-91

  7. PG 89-91

  8. PG 89-91

  9. Which of the following medications is NOT an inducer of the liver CYP450 system? a. carbamazepine b. phenytoin c. valproate d. olanzapine e. phenobarbital

  10. Which of the following medications is NOT an inducer of the liver CYP450 system? a. carbamazepine b. phenytoin c. valproate d. olanzapine e. phenobarbital

  11. Valproic acid is available in which of the following dosage forms? I. Capsules II. Liquid III. Tablets a. I only b. III only c. I and II only d. II and III only e. I, II, and III

  12. Valproic acid is available in which of the following dosage forms? I. Capsules II. Liquid III. Tablets a. I only b. III only c. I and II only d. II and III only e. I, II, and III

  13. A drug specific for petit mal is: a. clonazepam b. diazepam c. flurazepam d. lorazepam e. oxazepam

  14. A drug specific for petit mal is: a. clonazepam b. diazepam c. flurazepam d. lorazepam e. oxazepam

  15. Drugs to Treat Parkinson’s Disease NAPLEX PG 92

  16. Drugs to Treat Parkinson Disease Causes of Parkinson disease Disruption of dopaminergic / cholinergic balance Characteristics of patients (TRAP) Slow onset; Tremor, Rigidity, Akinesia, Postural instability Drug therapy Goals – Mainly palliative; attempt to inhibit cholinergic and attenuate dopaminergic action PG 92

  17. Drugs to Treat Parkinson Disease (cont’d) Anticholinergic Drugs. Watch for dry mouth, constipation, urinary retention, intraoccular pressure • Trihexyphenidyl (Artane) • Benztropine (Cogentin) • Biperiden (Akineton) • Diphenhydramine (Benadryl) PG 92

  18. Bradykinesia is best defined as: a. slow movements b. rapid heart rate c. narrowing of the pupil d. excessive sweating e. loss of desire for pleasurable activities

  19. Bradykinesia is best defined as: a. slow movements b. rapid heart rate (tachycardia) c. narrowing of the pupil (miosis) d. excessive sweating (diaphoresis) e. loss of desire for pleasurable activities (anhedonia)

  20. Drugs to Treat Parkinson Disease (cont’d) • Dopaminergic Agents • Levodopa (Larodopa, Dopar) - watch for on-off effect and vitamin B6 decreases efficacy, iron increases absorption, nausea • Levodopa/carbidopa (Sinemet) - wait 8 hours if converting from levodopa. Cut levodopa dose to 25% of original. • Amantadine (Symmetrel) - increases release of dopamine stores (hypersensitivity); antiviral properties - antiviral for flu • Ergot-derived dopamine receptor agonists - stimulate dopamine receptors; (a) bromocriptine mesylate (Parlodel), and (b) pergolide mesylate (Permax)—withdrawn from market PG 92-93

  21. Drugs to Treat Parkinson Disease (cont’d) • • Nonergot dopamine receptor agonists - stimulate dopamine • receptors; (a) pramipexole (Mirapex), (b) ropinirole (Requip), and • (c) rotigotine (Neupro Transdermal) --- ropinirole approved for Restless Leg Syndrome • COMT inhibitors - adjunct that extends the action of levodopa/carbidopa; (a) Tolcapone (Tasmar), monitor hepatic function, and (b) entacapone (Comtan), combo with Sinemet (Stalevo) ---no monotherapy • MAO-B inhibitor-adjunct that decreases breakdown of dopamine; (a) selegiline (Eldepryl, Emsam, Zelapar), (b) rasagiline (Azilect) ---watch for MAO-inhibitor drug interactions •Dopamine agonist for rescue; apomorphine (Apokyn) PG 93

  22. What information should the doctor know prior to initiating Mirapex in a patient with Parkinson’s Disease? I. Decrease the levodopa dose by 20-30% when initiating Mirapex II. Patient must wear patch for 24 hours for efficacy III. Monitor for serious cardiac side effects a. I only b. III only c. I and II only d. II and III only e. I, II, III

  23. What information should the doctor know prior to initiating Mirapex in a patient with Parkinson’s Disease? I. Decrease the levodopa dose by 20-30% when initiating Mirapex II. Patient must wear patch for 24 hours for efficacy III. Monitor for serious cardiac side effects a. I only b. III only c. I and II only d. II and III only e. I, II, III

  24. Alzheimer's Drugs NAPLEX p. 121

  25. Drugs for Alzheimer’s Disease • Cholinesterase inhibitors: all enhance cholinergic activity • • Donepezil (Aricept) • • Galantamine (Razadyne) (Reminyl – D/C)) • • Rivastigmine (Exelon) • Glutamate antagonists • • Memantine (Namenda) • Miscellaneous agents • • Vitamin E • • Selegiline (Eldepryl) p. 121

  26. Cholinesterase Inhibitors Dosing • Dose dependent side effects require titration • Start low and take steps to avoid side effects p. 121

  27. Drugs for Alzheimer’s Disease Adverse Effects • Cholinesterase inhibitors: • • Hepatotoxicity • • Cholinergic effects (N/D, anorexia, salivation) • • Bradycardia • • Headache • Glutamate antagonists • • Hypertension • • Tachycardia • • Insomnia p. 121

  28. Reference Sources for Pharmacists NAPLEX PG 413 PG

  29. Literature Review • Primary literature  Original journal articles (research reports, case reports, editorials); serves as information for development of secondary and tertiary literature resources • Secondary literature  Indexing and abstracting services (e.g. MEDLINE, IPA, EMBASE, Cochrane) • Tertiary literature  Textbooks and review articles; summarize and interpret primary literature PG 413

  30. References • USP-NF • Official monographs for drug structure, solubilities, assays and therapeutic category • Limited info on dosage, dosage forms • USP DI (Micromedex) • Three volume set • I---DI for healthcare professionals (“package insert”) 11,000 drug products • II---Advice for patients – easy to understand • III---Approved Drug products, legal requirements, Orange book • FDA Orange Book (electronic - 2004) • Bioequivalence information PG 413

  31. References • Remington’s • “Pharmacy encyclopedia” – pharmacology, theoretical science, sterilization, practical pharmacy practice • Facts and Comparisons • Rx and OTC by therapeutic category – monthly updates • AHFS • Good info on drug pharmacology – intended for institutional • Blue Book / Red Book • Drugs / OTC / Cosmetics • Prices, NDC numbers, manufacturer address PG 414

  32. References • Physician’s Desk Reference (PDR) • White pages—manufacturer index of products • Pink pages—product names by trade name • Blue pages—products by therapeutic category • Yellow pages—generic and trade names with colored product ID • Martindale’s • Comprehensive drug lists (think foreign products) • Merck Manual • Describes diseases by symptoms • Merck Index • Listing of chemicals • Drugs in Pregnancy and Lactation (Briggs) • Gold standard PG 414

  33. A comparison of the relative daily cost of six brands of HCTZ can most easily be obtained by using the: a. Martindale’s Extra Pharmacopeia b. Facts and Comparisons c. Red Book/Blue Book d. Merck Index e. Remington’s

  34. A comparison of the relative daily cost of six brands of HCTZ can most easily be obtained by using the: a. Martindale’s Extra Pharmacopeia (drug lists foreign) b. Facts and Comparisons (therapuetics) c. Red Book/Blue Book (prices & NDCs) d. Merck Index (list of chemicals) e. Remington’s (pharmacology)

  35. Which of the following items is NOT presented in USP DI Volume III: a. Description of therapeutic uses for drugs b. List of orphan drugs c. Description of good pharmacy compounding practices d. Definition of official storage conditions e. The Federal Controlled Substances Act

  36. Which of the following items is NOT presented in USP DI Volume III: a. Description of therapeutic uses for drugs b. List of orphan drugs (Martidale) c. Description of good pharmacy compounding practices (“a handbook on compounding”) d. Definition of official storage conditions (Remington's or AHFS) e. The Federal Controlled Substances Act (Guide to Federal Pharmacy Law)

  37. Compilation of information concerning parenteral drug solutions are found in: a. Goodman and Gilman b. Martindale’s c. Merck Index d. Remington’s e. Trissel’s

  38. Compilation of information concerning parenteral drug solutions are found in: a. Goodman and Gilman b. Martindale’s c. Merck Index d. Remington’s e. Trissel’s

  39. Solubility data for potassium gluconate will be found in: I. Merck Index II. USP-NF III. Remington’s a. I only b. III only c. I and II only d. II and III only e. I, II, and III

  40. Solubility data for potassium gluconate will be found in: I. Merck Index II. USP-NF III. Remington’s a. I only b. III only c. I and II only d. II and III only e. I, II, and III

  41. Contraindications for a commercial prescription drug may be located in: I. PDR II. Merck Manual III. USP-NF a. I only b. III only c. I and II only d. II and III only e. I, II, and III

  42. Contraindications for a commercial prescription drug may be located in: I. PDR II. Merck Manual III. USP-NF a. I only b. III only c. I and II only d. II and III only e. I, II, and III

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