Neuro

Question 1

what are seizures

Answer 1

• abnormal discharges of brain neurons

Question 2

where in the brain can seizures occur

Answer 2

• may occur in part (focal) or all (general) of the brain
• partial—one side
• general—both sides

Question 3

what is the difference between a simple and complex seizure

Answer 3

• level of consciousness
• simple: no loss of consciousness
• complex: loss of consciousness

Question 4

what is the objective of drug therapy with seizures and how do they work

Answer 4

• suppress seizures by maintaining an effective concentration of the drug in the blood and brain cells at all times
• effect ions used in impulses: Cl, Na, Ca
• choose a first-line antiepileptic agent specific to the seizure type
• cannot cure

Question 5

what are phenobarital and benzodiazepines and how do they work

Answer 5

• sedative/hypnotic drugs
• imitates the neurotransmitter GABA
• binds to GABA receptor
• opens chloride channel
• chloride rushes into the cell
• impulse stops
• more adverse effects with barbiturates than benzos
• lorazepam (or diazepam) intravenously (IV) = drug of choice in status epilepticus and in alcoholic-related seizures

Question 6

what are hydantoins and how do they work

Answer 6

• blocks sodium channels
• prevent sodium from entering brain cells
• message not started
• first-line therapy for partial (both simple and complex) seizures and generalized tonic-clonic seizures.
• teratogenic
• narrow therapeutic index (monitor blood levels).
• metabolized by P450 liver enzymes (CYP2C9)
• drug interactions with - metronidazole (increase phenytoin levels)

Question 7

what are some clinical guideline for patients taking hydantoins

Answer 7

• monitor for gingival enlargement
• monitor and emphasize oral hygiene; difficult for patient to adequately maintain oral hygiene because of tissue overgrowth
• place patient on frequent recall appointments to monitor gingival condition

Question 8

what is carbamezipine

Answer 8

• controls partial and generalized tonic-clonic seizures

- originally developed for the treatment of trigeminal neuralgia

Question 9

what are adverse effects of carbamazepine

Answer 9

• agranulocytosis (decreased white blood cells), platelet decrease, aplastic anemia.
• need medical consult for dental treatment.
• metabolized by CYP3A4 enzymes
• many drug interactions; erythromycin, clarithromycin, ciprofloxicin

Question 10

what are some guidelines for patients taking carbamazepine

Answer 10

• avoid erythromycin, clarithromycin (Biaxin), and doxycycline
• monitor for dry mouth
• monitor for blood disorders: infections, spontaneous bleeding (not provoked with an instrument), and poor healing
• look for oral ulcerations, dry mouth, and glossitis
• stress good oral hygiene

Question 11

what are other hydantoins

Answer 11

• valproic Acid (Depakene)/ - valproate (Depakote)
• metabolized by CYP2C9
• many adverse side effects.
• lamotrigine (Lamictal)
• used in children
• gabapentin (Neurontin)
• also used in chronic orofacial pain management
• not metabolized in the liver, so no drug interactions
• far safer than other drugs

Question 12

what are succinmides

Answer 12

• i.e. ethosuximide
• slow the entry of Ca into the nerve cell
• increases the threshold (cannot re-fire if busy firing)
• side effects: hiccups

Question 13

what is Parkinson’s disease

Answer 13

• age-related
• chronic, progressive, degenerative disorder of the CNS
• reduction in the neurotransmitter dopamine
• need balance of ACh and dopamine for control of normal muscle movement

Question 14

what are classic symptoms of Parkinson’s disease

Answer 14

• classic symptoms of Parkinsonism
• resting tremor
• muscle rigidity
• poker face
• bradykinesia (muscular movement becomes slow and rigid)
• masked facial expression
• “short step” walk
• postural instability

Question 15

what is the objective for treating Parkinson’s with drugs

Answer 15

• increasing the activity of DA (dopaminergic drugs) or decreasing the activity of ACh (anticholinergics)
• dopamine cannot get through the blood-brain barrier and get into the brain,
• give levodopa which then converts to dopamine in the brain
• combine levodopa with carbidopa (Sinemet) to reduce dose & SE of levodopa

Question 16

what is a dopamine replacement

Answer 16

• most effective during the first year of the disease; marked decrease in effectiveness by 3 years; by 5 years, signs and symptoms are back to the predrug level
• “on-off effect”
• fluctuations in response to levodopa
• increase involuntary orofacial muscle movements
• undergoes first-pass metabolism in the liver
• no dental drug-drug interactions

Question 17

what are dopamine agonists

Answer 17

• treating the “on-off effect” of levodopa

- prototype drug: bromocriptine (Parlodel), orthostatic hypotension

Question 18

what are anticholinergic agents

Answer 18

• early or mild stages of the disease or later on in combination with levodopa/carbidopa
• primarily effective for tremors
• prototype drug: benzotropine (Cogentin)
• adverse side effects: xerostomia

Question 19

what are monoamine oxidase B inhibitors

Answer 19

• selegiline (Eldepryl)
• rasagiline (Azilect)
• blocks the enzyme MAO-B, which metabolizes dopamine
• do not use Cipro when taking rasagiline

Question 20

what catechol-o-methyltransferase inhibitors

Answer 20

• newest class of drugs

- an adjunct to carbidopa-levodopa to help with motor complications due to levodopa

Question 21

what is the international classification of headache disorders

Answer 21

• primary headache disorders: migraine, tension-type, cluster headaches
• secondary headache disorders: identifiable cause i.e. sinus headache

Question 22

what is a rebound headache

Answer 22

• too much headache medication actually contributes to the headaches rather than easing them
• caffeine present in coffee and sodas and pain relievers may all contribute to rebound headaches
• don’t take pain relievers long-term

Question 23

what is a migraine

Answer 23

• 24 million people (18% of women, 6% of men)
• recurring, episodic and often severe headache disorder with attacks lasting 4 to 72 hours
• phonophobia (fear of sounds including your own voice), nausea, and vomiting, and cutaneous allodynia, aura
• one sided pain
• lights and sounds may aggravate

Question 24

what are the 2 phases of migraine attacks

Answer 24

• vasoconstriction: release of serotonin (5-HT), aura

- vasodilation: pain, substance P released

Question 25

what are the 2 goals of drug therapy for migraines

Answer 25

- two goals: abort current migraine or prevent migraine from occurring 1. abort (acute therapy): symptomatic therapy, either prescription or OTC. should not be used more than twice a week. more than twice a week or 4 times a month = preventative medications (chronic therapy) - therapy should start by eliminating all products containing caffeine, which causes vasoconstriction - ID and eliminate triggers

Question 26

what are migraine drugs for relief

Answer 26

- serotonin agonists = triptans stimulate 5-HT1 receptors (e.g., sumatriptan) - cause vasoconstriction - analgesics (e.g., Excedrin, Tylenol Ultra) and nonsteroidal anti-inflammatory drugs (e.g., NSAIDs such as naproxen, ibuprofen) - narcotics (Tylenol # 1, Tylenol # 3) - ergot derivatives (dihydroergotamine = Migranal) - cause vasoconstriction

Question 27

what are analgesics

Answer 27

- mild migraine attacks, analgesics alone or in combination with caffeine have been used - NSAIDs - naproxen - overuse of analgesics and caffeine can aggravate the migraine (rebound headaches) - use NSAID alone or in combo with triptan - narcotic analgesics - contain codeine - preclude long-term use

Question 28

what are triptans

Answer 28

- orally administered triptans provide pain relief within 30 minutes - injected sumatriptan has an onset of action in less than 15 minutes - caution: blood pressure elevation - caution should be used when using local anesthetics containing epinephrine - patient’s blood pressure should be monitored - caution when taken with SSRIs

Question 29

what are migraine drugs used in prevention

Answer 29

- beta-blockers (e.g., propanolol) - limit EPI use to 2 cartridges of 1:100,000 - drugs that inhibit sodium channels--antiepileptics or anticonvulsants (e.g., valproic acid) - xerostomia - drugs that inhibit 5-HT reuptake into the nerve (e.g., tricyclic antidepressants such as amitriptyline) - lower dose than in depression; dry mouth; limit EPI to 2 cartridges of 1:100,000 - drugs that inhibit calcium channels and stabilize the blood vessels to prevent over dilating -- CCB (e.g. verapamil)