1. NAPLEX
Neurology

2. Drugs used for Convulsive Disorders
NAPLEX
Drugs used for Convulsive Disorders
PG 88

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 88

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 89-90

7. PG 89-90

8. PG 89-90

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. Which of the following has no known drug interaction with oral contraceptives?
a. Neurontin
b. Carbamazepine
c. Valproic Acid
d. Phenytoin
e. Topiramate

16. Which of the following has no known drug interaction with oral contraceptives?
a. Neurontin
b. Carbamazepine
c. Valproic Acid
d. Phenytoin
e. Topiramate

17. Drugs to Treat Parkinson’s Disease
NAPLEX
Drugs to Treat Parkinson’s Disease

18. 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 91

19. Drugs to Treat Parkinson Disease (cont’d)
Anticholinergic Drugs. Watch for dry mouth, constipation, urinary retention, intraoccular pressure
• Procyclidine (Kemadrin)
• Trihexyphenidyl (Artane)
• Benztropine (Cogentin)
• Biperiden (Akineton)
• Diphenhydramine (Benadryl)
PG 91

20. 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

21. 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 (apathy)

22. Drugs to Treat Parkinson Disease (cont’d)
Dopaminergic Agents
• Levodopa (Larodopa, Dopar) - watch for on-off effect and B6 decreases efficacy, iron increases absorption
• 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)
PG 91

23. 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 to Restless Leg Syndrome
• COMT inhibitors - adjunct that extends the action of
levodopa/carbidopa; (a) Tolcapone (Tasmar), monitor hepatic
function, and (b) entacapone (Comtan)
---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
PG 92

24. 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

25. 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

26. NAPLEX
Alzheimer's Drugs
p. 118

27. 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. 118

28. Cholinesterase Inhibitors Dosing
Dose dependent side effects require titration
Start low and take in steps to avoid side effects
p. 118

29. Drugs for Alzheimer’s Disease
Adverse Effects
Cholinesterase inhibitors:
• Hepatotoxicity
• Cholinergic effects (N/D, anorexia, salivation)
• Bradycardia
• Headache
Glutamate antagonists
• Hypertension
• Tachycardia
• Insomnia
p. 118

30. Reference Sources for Pharmacists
NAPLEX
Reference Sources for Pharmacists PG
PG 399

31. 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 399

32. References USP-NF USP DI (Micromedex) Three volume set
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 399

33. 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 399

34. 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 - EUP)
Merck Manual
Describes diseases by symptoms
Merck Index
Listing of chemicals
Drugs in Pregnancy and Lactation (Briggs)
Gold standard
PG 399

35. 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

36. 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)

37. 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

38. 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)

39. 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

40. 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

41. 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

42. 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

43. 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

44. 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

45. PG.40

46. What is the generic name for Actos?
a. Indinavir
b. Glyburide
c. Pioglitazone
d. Rosiglitazone
e. Zafirlukast

47. The pharmacist should inform the patient that the Actos:
a. must be taken first thing in the morning before breakfast
b. must be taken with the evening meal
c. must be taken approximately 1 h before bedtime
d. requires consumption of at least 1 glass of water
e. may be taken any time during the day

48. The pharmacist should inform the patient that the Actos:
a. must be taken first thing in the morning before breakfast
b. must be taken with the evening meal
c. must be taken approximately 1 h before bedtime
d. requires consumption of at least 1 glass of water
e. may be taken any time during the day

49. Which of the following cold remedies would be suitable for Ms Doolittle’s cough?
I. Robitussin DM
II. Robitussin AC
III. Robitussin PE
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, and III

50. Which of the following cold remedies would be suitable for Ms Doolittle’s cough?
I. Robitussin DM
II. Robitussin AC
III. Robitussin PE
a. I only
b. III only
c. I and II only
d. II and III only
e. I, II, and III

51. Which one of the following analgesics is most suitable to relieve the fever and headache of Ms. Doolittle’s 3-year-old boy?
a. Anacin
b. Ascriptin
c. Bayer PM
d. Panadol
e. Bayer Children’s Aspirin

52. Which one of the following analgesics is most suitable to relieve the fever and headache of Ms. Doolittle’s 3-year-old boy?
a. Anacin
b. Ascriptin
c. Bayer PM
d. Panadol (acetaminophen)
e. Bayer Children’s Aspirin
Reye Syndrome – 1970s – caused by inborn error of metabolism or toxin – peak onset age 6,

53. Which one of the following drug products has the same active ingredient as Calan?
a. Dyazide
b. Effexor
c. Isordil
d. Plendil
e. Verelan

54. Which one of the following drug products has the same active ingredient as Calan?
a. Dyazide
b. Effexor
c. Isordil
d. Plendil
e. Verelan

56. Bactrim DS is probably being used to treat which of the following microorganisms?
Chlamydia pneumoniae
Clostridium difficile
Enterococcus faecalis
Escherichia coli
Pseudomonas aeruginosa

57. Bactrim DS is probably being used to treat which of the following microorganisms?
Chlamydia pneumoniae
Clostridium difficile
Enterococcus faecalis
Escherichia coli
Pseudomonas aeruginosa

58. Which of the following lab alterations would you expect to see in Ms
Which of the following lab alterations would you expect to see in Ms. Brown as a result of starting the Bactrim DS?
Increased INR
Decreased INR
Increased potassium
Decreased potassium
Increased sodium

59. Which of the following lab alterations would you expect to see in Ms
Which of the following lab alterations would you expect to see in Ms. Brown as a result of starting the Bactrim DS?
Increased INR
Decreased INR
Increased potassium
Decreased potassium
Increased sodium

60. A patient recently moved to the United States from England
A patient recently moved to the United States from England. She brings in her prescription bottle and asks the pharmacist if they carry the antibiotic that she has been taking for a UTI. Which of the following references could be used by the pharmacist to determine if there is an equivalent antibiotic available in the United States?
Facts and Comparisons
Martindale
Merck Index
PDR
Red Book

61. A patient recently moved to the United States from England
A patient recently moved to the United States from England. She brings in her prescription bottle and asks the pharmacist if they carry the antibiotic that she has been taking for a UTI. Which of the following references could be used by the pharmacist to determine if there is an equivalent antibiotic available in the United States?
Facts and Comparisons
Martindale
Merck Index
PDR
Red Book

62. THANKS!!!!!