Neurology

1
Neurology
NAPLEX
2
Drugs used for Convulsive Disorders
NAPLEX
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 epilepticus30 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 Parkinsons Disease
NAPLEX
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 (contd)
• 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 (contd)
• 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 (contd)
• 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 Parkinsons
  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 Parkinsons
  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
Alzheimer's Drugs
NAPLEX
p. 118
27

• Drugs for Alzheimers 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 Alzheimers 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
PG 399
PG
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
• 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 - 2004)
• Bioequivalence information

PG 399
33
References

• Remingtons
• 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

• Physicians Desk Reference (PDR)
• White pagesmanufacturer index of products
• Pink pagesproduct names by trade name
• Blue pagesproducts by therapeutic category
• Yellow pagesgeneric and trade names with colored
  product ID
• Martindales
• 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. Martindales Extra Pharmacopeia b. Facts
  and Comparisons
• c. Red Book/Blue Book
• d. Merck Index
• e. Remingtons

36

• A comparison of the relative daily cost of
  six brands of HCTZ can most easily be obtained by
  using the
• a. Martindales Extra Pharmacopeia (drug lists
  foreign)
• b. Facts and Comparisons (therapuetics)
• c. Red Book/Blue Book (prices NDCs)
• d. Merck Index (list of chemicals)
• e. Remingtons (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. Martindales
• c. Merck Index
• d. Remingtons
• e. Trissels

40

• Compilation of information concerning parenteral
  drug solutions are found in
• a. Goodman and Gilman
• b. Martindales
• c. Merck Index
• d. Remingtons
• e. Trissels

41

• Solubility data for potassium gluconate will be
  found in
• I. Merck Index
• II. USP-NF
• III. Remingtons
• 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. Remingtons
• 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 Doolittles 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 Doolittles 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.
  Doolittles 3-year-old boy?
• a. Anacin
• b. Ascriptin
• c. Bayer PM
• d. Panadol
• e. Bayer Childrens Aspirin

52

• Which one of the following analgesics is most
  suitable to relieve the fever and headache of Ms.
  Doolittles 3-year-old boy?
• a. Anacin
• b. Ascriptin
• c. Bayer PM
• d. Panadol (acetaminophen)
• e. Bayer Childrens 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

55
(No Transcript)
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. 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. 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. 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. 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!!!!!