(406 E2) drugs

Question 1

what class is sumatriptan

Answer 1

serotonin receptor agonists

(Migraine)

Question 2

sumatriptan MOA

Answer 2

-constrict intracranial blood vessels
-suppress release of inflam. neuropeptides
-block brain pathways for pain

(Migraine)

Question 3

sumatriptan routes

Answer 3

subq, PO, intranasal

(Migraine)

Question 4

sumatriptan SE

Answer 4

injection site rx
chest pressure
flushing
weakness
headache
bad taste (nasal)

(Migraine)

Question 5

sumatriptan nursing considerations

Answer 5

avoid w/ ischemic stroke, heart disease & angina

(Migraine)

Question 6

what class is rimegepant

Answer 6

CGRP antagonists

(Migraine)

Question 7

rimegepant MOA

Answer 7

mediates pain transmission

(Migraine)

Question 8

rimegepant SE

Answer 8

GI upset

(Migraine)

Question 9

rimegepant considerations

Answer 9

CYP substrate

(Migraine)

Question 10

dopaminergic drugs

Answer 10

enhance dopamine

Question 11

anticholinergic drugs

Answer 11

block the effects of ACH

Question 12

levodopa/carbidopa MOA

Answer 12

-levodopa: converts to dopamine in the brain and activates dopamine receptors
-carbidopa: blocks destruction of levodopa

Question 13

levodopa/carbidopa advantages

Answer 13

most effective drug for PD

Question 14

levodopa/carbidopa disadvantages

Answer 14

-several months to see improvement
-does not work long term
-adverse effects

Parkinson’s disease

Question 15

levodopa/carbidopa key teaching points

Answer 15

-“on-off” phenomenon
-avoid high proteins meals

Parkinson’s disease

Question 16

levodopa/carbidopa SE

Answer 16

-N/v
-dyskinesias
-postural hypotension
-dysrhythmias
-psychosis/hallucinations/nightmares
-paranoia
-darken sweat & urine
-activate malignant melanoma

Parkinson’s disease

Question 17

what decreases the effects of levodopa

Answer 17

vitamin B6
antipsychotics
protein

Parkinson’s disease

Question 18

what increases the effects of levodopa

Answer 18

carbidopa
anticholinergics
MAOIs (can lead to toxicity)

Parkinson’s disease

Question 19

duopa

Answer 19

-G or J tube infusion levodopa/carbidopa
-gel form
-infuse up to 16hr/d

Question 20

duopa teaching points

Answer 20

-do not take within 2 weeks of nonselective MAOI
-avoid high protein foods

Question 21

duopa SE

Answer 21

-falling asleep w/o warning
-orthostatic hypotension
-hallucinations
-unusual urges
-depression
-dyskinesia

Question 22

what class is pramipexole

Answer 22

dopamine receptor agonist

Parkinson’s disease

Question 23

pramipexole MOA

Answer 23

binds w/ D2 receptors

Parkinson’s disease

Question 24

pramipexole indications

Answer 24

-monotherapy in early PD
-combo w/ sinemet w/ advanced PD
-restless leg syndrome

Question 25

pramipexole SE

Answer 25

-nausea -sleep attacks -pathologic gambling & compulsive behaviors Parkinson’s disease

Question 26

pramipexole + levodopa SE

Answer 26

-orhtostatic hypotension -dyskinesias -hallucination risk doubles Parkinson’s disease

Question 27

what class is ropinirole

Answer 27

dopamine receptor agonist Parkinson’s disease

Question 28

ropinirole MOA

Answer 28

increase in nerve impulses within the substantia nigra Parkinson’s disease

Question 29

ropinirole SE

Answer 29

long term use cause increased risk for DM and acromegaly Parkinson’s disease

Question 30

rotigotine

Answer 30

-dopamine agonist -once daily patch Parkinson’s disease

Question 31

apomorphine

Answer 31

-dopamine agonist -short acting subq for fast relief of PD sx during "off phase"

Question 32

how do cholinesterase inhibitors work

Answer 32

prevent inactivation of ACH by cholinesterase and intensifies the effect of ACH released from motor neurons which increases muscle strength

Question 33

what class is neostigmine

Answer 33

cholinesterase inhibitors

Question 34

neostigmine indication

Answer 34

MG

Question 35

neostigmine MOA

Answer 35

enhances cholinergic action by facilitating transmission of impulses across neuromuscular junctions MG

Question 36

neostigmine SE

Answer 36

-cholinergic effects -toxic doses reduce muscle contraction and can lead to cholinergic crisis MG

Question 37

neostigmine / cholinergic crisis antidote

Answer 37

atropine (MG)

Question 38

what med can test between MG or Chol crisis

Answer 38

edrophonium, a short acting cholinesterase inhibitor

Question 39

another name for interferon beta

Answer 39

avonex (MS)

Question 40

another name for glatiramer acetate

Answer 40

copaxone (MS)

Question 41

interferon beta MOA

Answer 41

inhibit pro inflammatory WBCs from cross BBB **decrease relapse rate by up to 30%** (MS)

Question 42

interferon beta SE

Answer 42

-flu like rx -liver toxicity -bone marrow suppression -depression -drug interactions (MS)

Question 43

glatiramer acetate MOA

Answer 43

increased production of anti inflammatory T cells which cross the BBB and suppress inflammation (MS)

Question 44

glatiramer acetate SE

Answer 44

-injection site rx -flushing, palpitaitons, chest pain, rash, laryngeal constriction **do not need to treat, resolves in 15-20 mins** (MS)

Question 45

glatiramer acetate & interferon beta indication

Answer 45

MS

Question 46

fingolimod (oral MS agent)

Answer 46

retain lymphocytes in the lymph nodes, preventing them from crossing the BBB which decreases inflammation **good for RRMS**

Question 47

dimethyl fumarate (oral MS agent)

Answer 47

thought to inhibit immune cells and may have anti oxidant properties

Question 48

natalizumab MOA

Answer 48

Prevents circulating T cells from leaving the vasculature and crossing blood-brain barrier (ALS)

Question 49

natalizumab indications

Answer 49

MS Crohn's

Question 50

natalizumab nursing considerations

Answer 50

monotherapy only available through TOUCH program (MS)

Question 51

natalizumab SE

Answer 51

**headache & fatigue** -hepatotoxicity -hypersensitivity -progressive multifocal leukoencephalopathy (PML) (MS)

Question 52

what med do you give for fatigue related to MS

Answer 52

amantadine

Question 53

what med do you give for cognitive dysfunction related to MS

Answer 53

donepezil

Question 54

what class is riluzole

Answer 54

glutamate inhibitor (ALS)

Question 55

riluzole indication

Answer 55

ALS

Question 56

riluzole MOA

Answer 56

glutamate antagonist reduces damage to motor neurons (ALS)

Question 57

riluzole SE

Answer 57

dizziness, GI upset, hepatotoxicity ALS

Question 58

pharm for GBS

Answer 58

steroids high dose immunoglobulin therapy

Question 59

pharm for bacterial meningitis

Answer 59

IV ceftriaxone or vancomycin acyclovir steroids prophylaxis vaccine

Question 60

encephalitis pharm

Answer 60

acyclovir anti-seizure meds treat sx w/ Tylenol & antiemetics

Question 61

TIA pharm

Answer 61

ASA clopidogrel heparin and warfarin in cardiac related

Question 62

alteplase class

Answer 62

thrombolytics / fibrinolytics

Question 63

alteplase MOA

Answer 63

promotes conversion of plasminogen to plasmin **remove thrombi after they have formed**

Question 64

alteplase indications

Answer 64

acute MI PE ischemic stroke

Question 65

alteplase SE

Answer 65

increased risk of intracranial bleeding

Question 66

alteplase antidote

Answer 66

aminocaproic acid