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Pharmacy Drugs > 416 Exam 4 PD, MS, Epilepsy > Flashcards

416 Exam 4 PD, MS, Epilepsy Flashcards

1
Q

MOA carbidopa/levodopa (PD)

A

Dopamine replacement

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2
Q

Carbidopa/Levodopa AE

A 
Dyskinesia 
N/V 
Insomnia 
Hallucinations
Confusion 
Hypotension
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3
Q

Carbidopa/Levodopa

A 
Sinemet (25/100)
Sinemet CR (50/200)
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4
Q

Dopamine agonists (PD)

A 
Bromocriptine (rare) 
Pramipexole 
Ropinirole
Rotigotine 
Apomorphine
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5
Q

Dopamine agonists AE

A 
Hallucinations 
Fatigue/somnolence
Edema 
Nausea
Hypotension 
Pleuropulmonary fibrosis 
Impulsivity
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6
Q

MOA of MAOI (PD)

A

Inhibition of DA metabolism- specific for MAO-B receptors

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7
Q

Irreversible MAO-I agents (PD)

A

Selegiline

Rasagiline (monotherapy)

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8
Q

Reversible MAO-I agents (PD)

A

Safinamide

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9
Q

MOA of COMT-I (PD)

A

Inhibition of DA and levodopa metabolism

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10
Q

COMT-I agents (PD)

A

Entacapone (peripherally only)

Tolcapone (BBB)

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11
Q

MOA anticholinergics (PD)

A

Decreases excessive cholinergic activity

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12
Q

Anticholinergic agents for PD

A

Trihexyphenidyl
Benztropine (Cogentin)
Diphenhydramine

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13
Q

MOA of Amantadine for PD

A

Mild increase in DA concentrations

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14
Q

Amantadine SE

A 
Anticholinergic 
Nightmares
Insomnia 
Confusion 
Levido reticularis (discoloration) 
Withdrawal encephalopathy
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15
Q

Amantadine (Symmetrel) immediate release approved for

A

PD motor symptoms but NOT dyskinesia

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16
Q

Amantadine (Gocovri) extended release approved for

A

Levodopa-induced dyskinesia but NOT motor symptoms

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17
Q

Trt depression in PD

A

Pramipexole (D3 receptors)

SSRIs, SNRIs, TCAs

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18
Q

Trt psychosis in PD

A

Quetiapine

Primavanserin

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19
Q

Trt dementia in PD

A

Rivastigmine (approved)

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20
Q

Trt restless leg syndrome in PD

A

Ropinirole
Pramipexole
Levodopa

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21
Q

Trt REM behavior disorder in PD

A

Clonazepam (Klonopin)

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22
Q

Injectable agents for MS

A

IFN B-1a (Betaseron, Extavia)
IFN B-1b (Avonex, Rebif, Plegridy)
Glatiramer acetate (Copaxone)
Daclizumab (Zinbryta)

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23
Q

Oral agents for MS

A

Fingolimod (Gilenya)
Teriflunomide (Aubagio)
Dimethyl Fumarate (Tecfidera)

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24
Q

Infusion agents for MS

A

Natalizumab (Tysabri)
Alemtuxumab (Lemtrada)
Mitoxantrone (Novantrone)
Ocrelizumab (Ocrevus)

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25
Q

IFN approved for

A 
RRMS 
CIS (except Plegridy)
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26
Q

IFN SE

A
  • flu like symptoms
  • injection site pain
  • leukopenia
  • hepatic injury
  • worsening of CHF
  • hyperthyroidism/thyrotoxicosis
  • depression
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27
Q

Glatiramer acetate approved for

A

RRMS

CIS

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28
Q

MOA of Glatiramer acetate (MS)

A

Glatiramer cells secrete anti-inflammatory IL-10 cytokines in CNS

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29
Q

Glatiramer acetate SE

A

Flushing, chest pain, palpitations, anxiety, dyspnea, throat constriction, urticaria
Lipoatrophy (permanent)

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30
Q

Natalizuman approved for

A

RRMS

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31
Q

MOA of Natalizumab (MS)

A

Block alpha-4 integrin preventing linkage to VCAM-1 ultimately preventing the lymphocyte from stopping to be recruited across the BBB

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32
Q

Natalizumab AE

A

Progressive multifocal leukoencephalopathy (PML)

>2yrs of Natalizumab exposure

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33
Q

Fingolimod approved for

A

RRMS

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34
Q

MOA of Fingolimod (MS)

A

Binds to S1P1 receptors on lymphocytes blocking their capacity to egret from lymph nodes and reducing number of lymphocytes in peripheral blood

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35
Q

Fingolimod SE

A 
Bradyarrythmia 
AV block 
-risk of injection 
-macular edema 
-hepatic injury 
-PML
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36
Q

Terifluonomide approved for

A

RRMS

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37
Q

MOA of Teriflunomide (MS)

A

Blocks DHODH

-ultimately exhibits a cytostatic effect on activated lymphocytes in periphery decreasing overreactive immune response

38
Q

Teriflunomide SE

A

Teratogenic (rapid elimination if pregnant)

-hepatotoxicity

39
Q

Dimethyl fumarate approved for

A

RRMS

40
Q

MOA of Dimethyl fumarate (MS)

A

Activates Nrf2 which is unregulated in response to oxidative stress but perhaps not sufficiently

41
Q

Dimethyl fumarate SE

A
  • decreased lymphocyte counts by 30%
  • PML
  • flushing
  • diarrhea and stomach upset
  • hepatic injury
42
Q

Alemutuzumab approved for

A

RRMS

43
Q

MOA of Alemutuzumab (MS)

A

Targets CD52 and targets cells for lysis

-decreases number of new lesions

44
Q

Alemutuzumab SE

A

Infusion causes cytokine release

  • fever, shaking chills
  • flushing and itching
  • alterations of HR and BP
  • dyspnea or chest discomfort

Premeditated with 1GM of methylprednisolone for 3 days prior to infusion

45
Q

Alemtuzumab AE

A
  • autoimmune thyroid disorder
  • immune thrombocytopenia
  • antiglomerular basement membrane disease
  • thyroid cancer
  • melanoma
  • lymphoma
46
Q

Ocrelizumab approved for

A

RRMS

PPMS

47
Q

MOA of Ocrelizumab (MS)

A

Directed against CD20 expressing pre-B and mature B lymphocytes
-cell surface binding results in antibody dependent cellular cytolysis and complement mediated lysis

48
Q

Ocrelizumab SE

A
  • pruritus
  • rash or erythema
  • bronchospasm or dyspnea
  • throat irritation or oropharyngeal pain
  • flushing or hypotension
  • pyrexia
  • nausea
  • tachycardia

Premeditate with 100mg methylprednisolone and antihistamine

49
Q

Ocrelizumab CI

A

Active hep B infection

50
Q

Daclizumab approved for

A

RRMS

51
Q

MOA of Daclizumab (MS)

A

Specific for CD25

Selectivity inhibits signaling through the high-affinity receptor inhibiting lymphocyte activation

52
Q

Daclizumab SE

A
  • skin reaction
  • swollen lymph nodes
  • non-infectious colitis
53
Q

Mitoxantrone approved for

A

RRMS (refractory only)
SPMS
PRMS

54
Q

Mitoxantrone MOA (MS)

A

Suppresses proliferation of T and B cells and macrophages

  • enhances T cell suppressor function
  • decrease secretion or pro-inflammatory cytokines
55
Q

Mitoxantrone CI

A

Liver dysfunction

Pregnancy

56
Q

Mitoxantrone SE

A
  • cardiotoxicity
  • secondary acute myelogenous leukemia (AML)
  • nausea
  • alopecia
  • amenorrhea
57
Q

First generation trt of epilepsy

A 
Carbamazepine 
Ethosuximide 
Phenobarbital 
Phenytoin 
Primidone 
Valproic acid
58
Q

Second generation trt for epilepsy

A 
Eslicarbazepine acetate
Felbamate 
Lacosamide
Levetiracetam
Pregabalin 
Tiagabine 
Vigabatrin 
Gabapentin 
Lamotrigine 
Oxycarbazepine 
Perampanel 
Topiramate 
Zonisamide
59
Q

Drugs with MOA of sodium channel inhibition

A 
Carbamazepine 
Eslicarbazepine 
Lacosamide 
Lamotrigine 
Oxcarbazepine 
Phenytoin/Fosphenytoin 
Rufinamide
60
Q

Carbamazepine approved for

A

Partial seizures
Primarily generalized tonic-clonic seizures

  • may make absence seizures worse
  • may make myoclonic seizure worse
61
Q

Genetic sequence that identifies SJS with carbamazepine

A

HLA-B 1502

62
Q

Eslicarbazepine approved for

A

Partial seizures (monotherapy)

63
Q

Lacosamide approved for

A

Partial seizures (monotherapy)

64
Q

AE of Lacosamide

A
  • dizziness
  • ataxia
  • somnolence
  • nausea
  • PR interval prolongation
  • atrial fibrillation
65
Q

Lamotrigine approved for

A
  • partial seizures
  • primary generalized tonic-clonic (adjunct)
  • Lennox-gastaut syndrome (adjunct)
66
Q

AE of Lamotrigine

A
  • dizziness
  • HA
  • diplopia
  • nausea
  • rash
  • hypersensitivity (SJS/TEN)
  • aseptic meningitis
67
Q

Oxcarbazepine approved for

A

Partial seizures

  • may make absence seizures worse
  • may make myoclonic seizures worse
68
Q

AE of oxcarbazepine

A
  • hyponatremia (<125)
  • dizziness
  • HA
  • somnolence
  • diplopia
  • nausea
  • hypersensitivity (SJS/TEN)
  • HLA-B 1502 positive status
69
Q

Phenytoin/Fosphenytoin approved for

A

Partial seizures

  • primarily generalized tonic-clonic seizures
  • may make absence and myoclonic seizures worse
70
Q

AE of phenytoin

A
  • CNS dose related (dizziness, confusion, ataxia)
  • long term use (coarsening of facial features, neuropathy, vit D and folic acid deficiency)
  • CV with IV preps
  • SJS/TEN
  • lupus
  • bone marrow suppression
  • injection site necrosis
71
Q

Rufinamide approved for

A

Lennox-Gastaut syndrome (adjunct)

72
Q

AE of Rufinamide

A
  • dizziness
  • HA
  • fatigue
  • somnolence
  • nausea
  • QT interval shortening
73
Q

Calcium channel inhibition MOA

A

Ethosuximide
Gabapentin
Pregabalin

74
Q

Ethosuximide approved for

A

Absence seizures only (DOC)

75
Q

AE of Ethosuximide

A
  • nausea
  • HA
  • dizziness
  • bone marrow suppression
  • SJS/TEN
  • psychiatric manifestations
76
Q

Gabapentin approved for

A

Partial seizures (adjunct)

-may make myoclonic seizures worse

77
Q

AE of Gabapentin

A
  • dizziness
  • somnolence
  • ataxia
  • weight gain
  • emotional liability
  • hyperkinesis
  • angioedema
78
Q

Pregabalin approved for

A

Partial seizures (adjunct)

-may make myoclonic seizures worse

79
Q

AE of Pregabalin

A
  • dizziness
  • somnolence
  • ataxia
  • weight gain
  • angioedema
80
Q

Potentiation of GABA activity MOA

A

Clobazam
Phenobarbital
Tiagabine
Vigabatrin

81
Q

Clobazam approved for

A

Lennox-Gastaut syndrome (adjunct)

82
Q

AE of Clobazam

A
  • somnolence
  • drooling
  • aggression (high dose)
  • SJS/TEN
83
Q

Phenobarbital/Primidone approved for

A
  • partial seizures
  • primarily generalized tonic-clinic
  • not generally considered primary therapy for any seizure disorder
  • may make absence seizures worse
84
Q

AE of phenobarbital/primidone

A
  • dependence
  • paradoxical hyperactivity in children
  • dizziness
  • sedation
  • respiratory depression
  • SJS/TEN
  • necrosis
85
Q

Tiagabine approved for

A

Partial seizures (adjunct)

  • may make absence seizures worse
  • may make myoclonic seizures worse
86
Q

AE of Tiagabine

A
  • dizziness
  • asthenia
  • tremor
  • somnolence
  • new onset seizures in pts w/o epilepsy
87
Q

Vigabatrin approved for

A

Complex partial seizure (adjunct)

-very refractor seizures ONLY

88
Q

AE for Vigabatrin

A
  • somnolence
  • dizziness
  • fatigue
  • weight gain
  • permanent loss of peripheral visual field
  • anemia
89
Q

Glutamate inhibition MOA

A

Perampanel

90
Q

Perampanel approved for

A
  • partial seizures in pts >12ys

- primarily generalized tonic-clonic seizures (adjunct)

91
Q

AE of perampanel

A
  • somnolence
  • dizziness
  • fatigue
  • gait disturbances
  • hostility/aggression

Pharmacy Drugs (37 decks)

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