Transcript Kaplan Medical Template Design

NAPLEX
Neurology
PG 89
NAPLEX
Drugs used for
Convulsive Disorders
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
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 89
Anticonvulsant Drugs

AED monotherapy is preferred, but some
patients do require combination therapy.
PG 89-91

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
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
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
NAPLEX
Drugs to Treat
Parkinson’s Disease
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)
PG 92
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)
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 92-93
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)
PG 93
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
NAPLEX
Alzheimer's Drugs
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
Drug
Starting
dose
Time before
Increasing
dose
6 weeks
Increase
dose by
Max dose
Donepezil
(Aricept)
5mg QHS
5mg QHS
10mg QHS
Rivastigmine 1.5mg BID
(Exelon)
2 weeks
1.5mg BID
6mg BID
Galantamine 4mg BID
(Razadyne)
4 weeks
4mg BID
Recommended range of
16-24 mg a
day.
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
NAPLEX
Reference Sources for
Pharmacists
PG 413
Literature Review



PG 413
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
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

PG 413
FDA Orange Book (electronic - 2004)
 Bioequivalence information
References

Remington’s
 “Pharmacy encyclopedia” – pharmacology, theoretical
science, sterilization, practical pharmacy practice

Facts and Comparisons


AHFS


PG 414
Rx and OTC by therapeutic category – monthly updates
Good info on drug pharmacology – intended for institutional
Blue Book / Red Book
 Drugs / OTC / Cosmetics
 Prices, NDC numbers, manufacturer address
References





PG 414
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
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)
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)
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
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