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 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

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 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

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 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

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. 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

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

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

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 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

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 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

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

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

Drugs to Treat Parkinson’s Disease NAPLEX PG 92

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 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)

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 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

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) 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)

PG 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 93 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)

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 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

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 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

Alzheimer's Drugs NAPLEX p. 121

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

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

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

Reference Sources for Pharmacists NAPLEX PG 413PG

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 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

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 ) Bioequivalence information 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 ) Bioequivalence information PG 413

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 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

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 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

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 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

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) 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)

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 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

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) 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)

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 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

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 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

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 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

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 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

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 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

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 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