When treating seizures, we want to decrease the activity of these types of channels?
Voltage-gated
Phenytoin, Carbamazepine, Lamotrigine all decrease activity of ______ gated channels.
sodium
Ethosuximide and Lamotrigine decrease activity of ______ gated channels.
calcium
When it comes to treating seizures we want to decrease ________ activity and increase _______ activity.
Decrease glutamate activity
Increase GABA inhibitory activity
What drugs do we use for tonic-clonic seizures?
Carbamazepine, Lamotrigine, Phenytoin, Gabapentin, Valproate
Structural CNS lesion, abnormal EEG, partial seizure type, positive family history, postictal motor paralysis are all risk factors for?
Seizures!
If someone has no risk factors, what are the chances that they will have another seizure?
10-15%
If someone has 2 or more risk factors, what are the chances that they will have another seizure?
100%
What two seizure drugs increase the concentration of P450 enzymes?
Carbamazepine and Phenytoin
But mainly Carbamazepine
If you start someone on a new seizure drug, do you abruptly stop the other?
No.
Down titrate the original and up titrate the new.
What is our tri-cyclic anti-seizure drug?
Carbamazepine
What drug is our cyclic ureides anti-seizure drug?
Phenytoin
What drug is our anticonvulsant?
Valproic acid
What drug is our succinimide anti-seizure medication that is used for absence seizures in children?
Ethosuximide
What seizure medication is a benzodiazepine?
Lorazepam (Ativan)
Alzheimer’s disease is caused by a ______ deficit in the ______.
acetylcholine, hippocampus
Therapeutic approach to treating Alzheimer’s:
Inhibit _______ metabolism by inhibiting __________.
acetylcholine, acetylcholinesterase
Excess glutamate signaling produces increased _____ receptor Ca2+ channel activity
NMDA
This then induces secondary cascade leading to neuronal cell death.
What drug is our CNS acetylcholinesterase inhibitor?
Donepezil (Aricept)
What drug is our NMDA Receptor Antagonist?
NMDA Receptor anatagonist
What 2 seizure medications do you have to supplement folate?
Lamotrigine and Phenytoin
Parkinson’s disease is caused by loss of _______ cells in the _______ _______.
Dopamine, substantia nigra
4 main symptoms of Parkinson’s?
Tremor, rigidity, bradykinesia, and gait abnormalities.
What drug is our anticholinergic for Parkinson’s, and how does it work?
Benztropine (Cogentin)
MoA: acetylcholine receptor inhibitor – decreases the imbalance between dopamine and acetylcholine, increasing the amount of dopamine
What drug is our NMDA Receptor Inhibitor and how does it work?
Amantadine (Symmetrel)
MoA: decreases levodopa injury to NMDA receptor – modulates levodopa impact on NMDA receptors which leads to bradykinesia, rigidity, and tremor
What drug is our MAO-B inhibitor and how does it work?
Selegiline (Eldepryl)
MoA: inhibits MAO-B enzyme with resulting rise in available dopamine in CNS
What really sucks about MAO-B inhibitors?
They have a bajillion dx-dx interactions
What drug is our dopamine agonist?
Ropinrole (Requip)
What drug functions as our dopamine replacement?
Levodopa/Carbidopa
What drug is our COMT inhibitor?
Entacapone (Comtan)
How does Entacapone work?
Decreases levodopa metabolism to 3-OMD allowing more to be metabolized to dopamine
MS is an autoimmune disorder that causes CNS __________ and axonal ________
demyelination, transection
Demyelination leads to the ________ of MS.
Axonal Transection leads to the _______ of MS.
Symptoms
Relapses/Progression
Most common type of MS is?
Relapsing remitting – 85%
How do we treat an acute relapse of MS?
Steroids
What drug is a synthetic myelin basic protein?
Glatiramer acetate (Copaxone)
By what percent does Glatiramer reduce relapse?
28%
What sucks about Interferon B-1a
Neutralizing antibodies develop to interferon after 18-24 months use; 27% reduction in relapses in year 1
What drug is a Monoclonal IgG4 antibody?
Natalizumab (Tysabri)
What was the first oral medication?
Fingolimod (Gilenya)
What drug is a sphingosine 1-PO4 receptor inhibitor?
Gilenya
What drug do we use when all other treatments have failed?
Natalizumab (Tysabri)
What drug is a Nrf2 Pathway Systemic Immunomodulator?
Dimethyl Fumarate (Tecfidera)
By what percent does Tecfidera reduce relapse?
75%
What drug is our peripheral muscle relaxant?
Dantrolene
What drug is our CNS GABA agonist CNS antispasmodic?
Baclofen
Trauma and chemical inflammation are what types of pain?
Nociceptive
B12 deficiency, MS, CVA are examples of what type of pain?
Neuropathic
If you have a patient complaining of 2/10 pain, what would their treatment look like?
Non-opioid analgesic, regular scheduled dosing
If you have a patient complaining of 5/10 pain, what would their treatment look like?
Add an opioid to the non-opioid, still with regular scheduled dosing.
For example, tylenol with codeine
If you have a patient complaining of 8/10 pain, what would their treatment look like?
High potency opioid, regular scheduled dosing.
For example: morphine or hydromorphone
Acute pain is usually what type of pain?
Nociceptive
Chronic pain is usually what type of pain?
Most commonly a combo of nociceptive and neuropathic
Who do we need to avoid using aspirin in?
People with asthma + nasal polyps or chronic uritcaria
Is aspirin reversible?
Nah dog.
What is our COX-2 selective drug?
Celebrex
What are the three CNS opioid receptors?
Mu, kappa, delta
What is serotonin syndrome?
Excess stimulation of peripheral and CNS serotonin receptors
What pain medication has the side effects of increased seizure risk and serotonin syndrome?
Tramadol (ultram)
Codeine is metabolized to?
Morphine
Hydrocodone + tylenol is?
Vicodin
Vicodin is metabolized to?
Hydromorphone
The long-acting monoproduct of oxycodone is?
Oxycontin
What is the “standard high potency opioid analgesic”?
Morphine
What are our two drugs for acute treatment of migraines?
Eletriptan (Relpax) and Sumatriptan (Imitrex)
What drug do we give PPx for migraines?
Propranolol