Pharm Quiz 3 pt.1
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Questions and Answers

Which characteristic is associated with complex partial seizures?

  • Patient remains fully conscious
  • Involves a limited area of the brain
  • Always results in tonic-clonic activity
  • Involves purposeless repetitive movements (correct)

    • What is the primary role of dopamine in the brain?

  • Acts as an excitatory neurotransmitter
  • Directly increases muscle contraction
  • Facilitates platelet aggregation
  • Functions as an inhibitory neurotransmitter (correct)

    • Which of the following is a common adverse effect of antiplatelet drugs?

  • Severe allergic reactions
  • Euphoria
  • Muscle spasms
  • Dizziness (correct)

    • What distinguishes antiepileptic drugs from anticonvulsants?

    <p>Antiepileptic drugs prevent future seizures</p> Signup and view all the answers

    Which medication is known to increase the effects of antiepileptic drugs due to enzyme inhibition?

    <p>Valproic acid</p> Signup and view all the answers

    Which antiplatelet drug is commonly used to prevent heart attacks?

    <p>Aspirin</p> Signup and view all the answers

    What is a key feature of a simple partial seizure?

    <p>Only affects a limited area of the brain</p> Signup and view all the answers

    Intermittent claudication is a clinical indication for which group of drugs?

    <p>Antiplatelet drugs</p> Signup and view all the answers

    Which of the following drugs should be taken first to avoid drug interactions?

    <p>Aspirin</p> Signup and view all the answers

    What mechanism of action do chelator drugs utilize in relation to coagulation?

    <p>Bind to Ca+ and interrupt coagulation</p> Signup and view all the answers

    Which types of seizures is valproic acid specifically indicated for?

    <p>Absence seizures, generalized tonic-clonic seizures, and partial seizures</p> Signup and view all the answers

    What is a common adverse effect of valproic acid?

    <p>Fatal liver toxicity</p> Signup and view all the answers

    How does trimethadione work to manage seizures?

    <p>By reducing type-T calcium currents</p> Signup and view all the answers

    What is a notable pharmacokinetic feature of warfarin?

    <p>Long duration of action lasting 2-10 days</p> Signup and view all the answers

    What is the mechanism of action of selegiline?

    <p>Inhibits the metabolism of dopamine</p> Signup and view all the answers

    What adverse effects are associated with trimethadione?

    <p>Hemeralopia and hypersensitivity reactions</p> Signup and view all the answers

    What is the primary indication for trimethadione?

    <p>Absence seizures</p> Signup and view all the answers

    What is the mechanism of action for carbidopa when used with levodopa?

    <p>Inhibits DOPA carboxylase</p> Signup and view all the answers

    What characterizes tonic-clonic seizures?

    <p>Alternating muscle contractions and relaxations lasting several minutes.</p> Signup and view all the answers

    Which of the following is a common adverse effect associated with entacapone?

    <p>Dyskinesias</p> Signup and view all the answers

    What is the primary benefit of administering anticholinergic drugs like benztropine in Parkinson's treatment?

    <p>Reduce symptoms of tremor and muscular rigidity</p> Signup and view all the answers

    Which seizure type involves a brief impairment of consciousness?

    <p>Absence</p> Signup and view all the answers

    Why is trimethadione rarely prescribed today?

    <p>It is more toxic than other available medications</p> Signup and view all the answers

    What is a common adverse effect associated with phenytoin?

    <p>Dizziness</p> Signup and view all the answers

    Which drug is considered the drug of choice for status epilepticus?

    <p>Lorazepam</p> Signup and view all the answers

    What mechanism of action does levodopa have?

    <p>Crosses the blood-brain barrier and converts to dopamine.</p> Signup and view all the answers

    Which of the following is NOT typically associated with Parkinson’s disease?

    <p>Hyperactivity</p> Signup and view all the answers

    What is one adverse effect of levodopa?

    <p>Anorexia</p> Signup and view all the answers

    What pharmacokinetic property of Vitamin K involves its administration?

    <p>Intramuscular or subcutaneous</p> Signup and view all the answers

    Which type of seizures is characterized by jerking movements and stiffening?

    <p>Tonic-clonic</p> Signup and view all the answers

    What is the main reason carbidopa is administered with levodopa?

    <p>To inhibit peripheral conversion of levodopa to dopamine.</p> Signup and view all the answers

    Which of the following seizure types is characterized by sudden loss of muscle tone?

    <p>Atonic seizure</p> Signup and view all the answers

    What is the primary adverse effect of anticholinergic drugs like benztropine?

    <p>Urinary retention</p> Signup and view all the answers

    What therapeutic effect does prostacyclin have in the vascular system?

    <p>Dilates blood vessels</p> Signup and view all the answers

    Which blood test is most commonly used to monitor the effect of warfarin?

    <p>International normalized ratio (INR)</p> Signup and view all the answers

    What is a significant risk when using low molecular weight heparin (LMWH) during spinal anesthesia?

    <p>Risk of epidural/spinal hematomas</p> Signup and view all the answers

    Which type of seizure involves rhythmic jerking movements of the body?

    <p>Clonic seizure</p> Signup and view all the answers

    What is an advantage of low molecular weight heparin over standard heparin?

    <p>Higher bioavailability and less frequent dosing</p> Signup and view all the answers

    What symptom is NOT a common adverse effect of anticholinergic drugs?

    <p>Increased salivation</p> Signup and view all the answers

    In terms of anticoagulant monitoring, which test is specifically useful for assessing the effect of heparin?

    <p>Activated partial thromboplastin time (APTT)</p> Signup and view all the answers

    Which medication is an erythropoietin stimulating agent?

    <p>Mircera</p> Signup and view all the answers

    What is a characteristic of transient ischemic attack (TIA)?

    <p>It is a transient interruption of blood flow to the brain.</p> Signup and view all the answers

    What is the primary mechanism through which heparin functions?

    <p>Increasing the activity of antithrombin.</p> Signup and view all the answers

    What is a common clinical use for heparin?

    <p>Prevention and treatment of deep vein thrombosis.</p> Signup and view all the answers

    Which of the following is an adverse effect associated with heparin therapy?

    <p>Hemorrhage.</p> Signup and view all the answers

    What is a hallmark sign of Alzheimer's disease?

    <p>Progressive memory loss.</p> Signup and view all the answers

    In the context of Parkinson's disease, what is the relationship between dopamine and acetylcholine?

    <p>Dopamine is low and acetylcholine is high.</p> Signup and view all the answers

    Which of the following is NOT a type of anemia?

    <p>Hypochromic anemia.</p> Signup and view all the answers

    Which type of cholesterol is considered 'bad' due to its role in plaque formation?

    <p>LDL.</p> Signup and view all the answers

    What is the mechanism of action of carbidopa when combined with levodopa?

    <p>Inhibits DOPA carboxylase and increases levodopa availability to the brain</p> Signup and view all the answers

    What is a significant adverse effect associated with entacapone?

    <p>Dyskinesias</p> Signup and view all the answers

    Which of the following adverse effects is commonly associated with the use of anticholinergic drugs like benztropine?

    <p>Urinary retention</p> Signup and view all the answers

    For which condition is trimethadione primarily indicated?

    <p>Absence seizures</p> Signup and view all the answers

    Why is levodopa therapy typically delayed in favor of other medications for younger patients?

    <p>To minimize long-term side effects associated with levodopa</p> Signup and view all the answers

    What type of seizure is characterized by purposeless movements and impairment of consciousness?

    <p>Complex partial seizure</p> Signup and view all the answers

    What is the primary function of antiplatelet drugs?

    <p>Decrease clot formation</p> Signup and view all the answers

    Which neurotransmitter is primarily excitatory and produced in the corpus striatum?

    <p>Acetylcholine</p> Signup and view all the answers

    Which of the following best describes anticonvulsant drugs?

    <p>Terminate convulsive seizures via IV or IM administration</p> Signup and view all the answers

    What is a primary characteristic of atonic seizures?

    <p>Severe loss of muscle tone causing falls</p> Signup and view all the answers

    Which adverse effect is typical for antiplatelet medications?

    <p>Rash</p> Signup and view all the answers

    Which statement correctly describes how chelator drugs impact coagulation?

    <p>They bind to calcium to interrupt coagulation</p> Signup and view all the answers

    Which of the following processes is affected by phenytoin's mechanism of action?

    <p>Prolongation of Na+ channel inactivation</p> Signup and view all the answers

    What happens to the metabolism of other drugs when carbamazepine and phenytoin are used?

    <p>They induce enzyme activity, increasing metabolism</p> Signup and view all the answers

    What adverse effect is most associated with the use of levodopa?

    <p>Dyskinesias and dystonias</p> Signup and view all the answers

    Lorazepam is primarily indicated for which condition?

    <p>Tonic-clonic seizures and status epilepticus</p> Signup and view all the answers

    In the context of antiepileptic drugs, what is the significance of valproic acid?

    <p>It inhibits enzymes, increasing the effects of certain drugs</p> Signup and view all the answers

    What is a primary reason for combining carbidopa with levodopa in treatment?

    <p>Prevent conversion of levodopa to dopamine in the periphery</p> Signup and view all the answers

    What is a common clinical indication for the use of antiplatelet agents?

    <p>Prevention of heart attack</p> Signup and view all the answers

    Which of the following is NOT a general characteristic of tonic-clonic seizures?

    <p>Prolonged muscle relaxation</p> Signup and view all the answers

    Which type of drug typically has sedative effects and may not be desired for epilepsy treatment?

    <p>Anticonvulsants</p> Signup and view all the answers

    Which adverse effect is commonly associated with the use of diazepam?

    <p>Drowsiness and confusion</p> Signup and view all the answers

    What is a significant concern when using levodopa with MAO inhibitors?

    <p>Hypertensive crisis</p> Signup and view all the answers

    Which of the following is true regarding myoclonic seizures?

    <p>They are characterized by brief but repetitive muscle contractions confined to a specific area.</p> Signup and view all the answers

    What is the primary action of prostacyclin in the vascular system?

    <p>It inhibits platelet aggregation and dilates vessels.</p> Signup and view all the answers

    Which blood test is primarily used to monitor patients taking warfarin?

    <p>INR</p> Signup and view all the answers

    What is a significant advantage of low molecular weight heparin (LMWH) over unfractionated heparin?

    <p>LMWH has 90% bioavailability and is dosed based on body size.</p> Signup and view all the answers

    What adverse effect is associated with the use of anticholinergic drugs like benztropine?

    <p>Urinary retention</p> Signup and view all the answers

    Which drug is indicated for preventing DVT in abdominal surgery?

    <p>Dalteparin</p> Signup and view all the answers

    What is the mechanism of action of heparin in the coagulation cascade?

    <p>It inactivates thrombin and factor 13.</p> Signup and view all the answers

    When is the activated partial thromboplastin time (APTT) test most frequently performed?

    <p>1 hour prior to the next dose of heparin</p> Signup and view all the answers

    What common adverse effect may be experienced from the use of benztropine?

    <p>Rapid heartbeat</p> Signup and view all the answers

    Which of the following is a black box warning associated with the use of low molecular weight heparin?

    <p>Risk of epidural or spinal hematomas</p> Signup and view all the answers

    Which seizure type is associated with rhythmic jerking movements of the body?

    <p>Myoclonic seizure</p> Signup and view all the answers

    What is the primary use of heparin in clinical settings?

    <p>To prevent clotting in patients</p> Signup and view all the answers

    Which of the following best describes a transient ischemic attack (TIA)?

    <p>A temporary interruption of blood flow to the brain</p> Signup and view all the answers

    What is a significant adverse effect of heparin therapy?

    <p>Thrombocytopenia</p> Signup and view all the answers

    Which mechanism describes the action of heparin in the coagulation process?

    <p>It increases the inactivation of factor X</p> Signup and view all the answers

    What is a hallmark symptom of Alzheimer's disease?

    <p>Progressive memory loss</p> Signup and view all the answers

    Which type of cholesterol is known for its contribution to atherogenic processes?

    <p>LDL</p> Signup and view all the answers

    What type of anemia is characterized by the destruction or absence of bone marrow?

    <p>Aplastic anemia</p> Signup and view all the answers

    Which of the following agents is commonly used to counteract the action of heparin?

    <p>Protamine sulfate</p> Signup and view all the answers

    What is the primary action of prostacyclin in the blood vessels?

    <p>Dilation of blood vessels and inhibition of platelet aggregation</p> Signup and view all the answers

    What is a key indication for administering low molecular weight heparin (LMWH)?

    <p>Preventing DVT in abdominal surgery</p> Signup and view all the answers

    Which blood test is specifically useful for monitoring the effect of heparin?

    <p>Activated partial thromboplastin time (APTT)</p> Signup and view all the answers

    What is a common adverse effect of anticholinergic drugs like benztropine?

    <p>Rapid heartbeat</p> Signup and view all the answers

    What is the primary monitoring test used for patients taking warfarin?

    <p>International normalized ratio (INR)</p> Signup and view all the answers

    What is the primary function of HDL in the body?

    <p>Retrieves cholesterol for disposal via the liver</p> Signup and view all the answers

    Which type of plaque is characterized by a cholesterol core with a thin cap?

    <p>Unstable plaque</p> Signup and view all the answers

    What initiates the coagulation process in the body?

    <p>The production of thromboplastins</p> Signup and view all the answers

    What is the role of plasmin in the coagulation process?

    <p>Acts on fibrin to facilitate clot resolution</p> Signup and view all the answers

    Which of the following is a characteristic of tonic-clonic seizures?

    <p>Includes alternating muscle spasms and loss of consciousness</p> Signup and view all the answers

    What defines status epilepticus?

    <p>A series of seizures without recovery in between</p> Signup and view all the answers

    How does vitamin K contribute to the coagulation process?

    <p>By synthesizing many coagulation factors</p> Signup and view all the answers

    What is a common effect observed after a tonic-clonic seizure?

    <p>Confusion and muscle soreness</p> Signup and view all the answers

    What condition is characterized by the presence of blood in urine?

    <p>Hematuria</p> Signup and view all the answers

    What characterizes the absence seizure?

    <p>Brief impairment of consciousness without motor convulsions</p> Signup and view all the answers

    What is a characteristic feature of complex partial seizures?

    <p>Includes purposeless and non-goal-directed movements</p> Signup and view all the answers

    What is the main purpose of antiplatelet drugs?

    <p>Prevent platelet aggregation and reduce thrombi formation</p> Signup and view all the answers

    Which of the following accurately describes the action of acetylcholine (ACh) as a neurotransmitter?

    <p>Excitatory neurotransmitter that stimulates muscle contraction</p> Signup and view all the answers

    Which adverse effect is NOT commonly associated with antiplatelet drugs?

    <p>Hemorrhaging</p> Signup and view all the answers

    How do anticonvulsant drugs differentiate from antiepileptic drugs in terms of administration?

    <p>Anticonvulsants are primarily injectable, while antiepileptics are oral</p> Signup and view all the answers

    Which statement best describes the role of dopamine in the nervous system?

    <p>Acts as a neurotransmitter that inhibits neuronal activity</p> Signup and view all the answers

    What is a significant interaction between carbamazepine and phenytoin?

    <p>Carbamazepine induces microsomal enzymes and reduces the effects of phenytoin</p> Signup and view all the answers

    What potential elevation in drug levels might occur with phenytoin and valproic acid when co-administered?

    <p>Increased levels due to enhanced protein binding</p> Signup and view all the answers

    Which of the following neurological conditions can be treated with anticonvulsants?

    <p>Status epilepticus</p> Signup and view all the answers

    Which antiepileptic drug is primarily indicated for treating absence seizures?

    <p>Ethosuximide</p> Signup and view all the answers

    What mechanism do barbiturates utilize to manage seizures?

    <p>Increasing excitatory effects of GABA</p> Signup and view all the answers

    When treating status epilepticus, which of the following medications is NOT recommended?

    <p>Valproic acid</p> Signup and view all the answers

    Which statement about triglycerides is accurate?

    <p>They provide energy by being hydrolyzed into free fatty acids.</p> Signup and view all the answers

    What is the primary role of platelets in the blood?

    <p>Aiding in coagulation.</p> Signup and view all the answers

    Which drug is commonly used as a substitute for other antiseizure medications in young patients?

    <p>Phenobarbital</p> Signup and view all the answers

    What happens to triglycerides when dietary lipids are unavailable?

    <p>The liver starts producing triglycerides.</p> Signup and view all the answers

    Which of the following best describes the action of thromboxane A2 released by platelets?

    <p>It constricts blood vessels and slows blood flow.</p> Signup and view all the answers

    Why is low molecular weight heparin (LMWH) preferred for use during pregnancy?

    <p>It does not cross the placenta.</p> Signup and view all the answers

    Which of the following medications reduces the excitatory neurotransmitter glutamate?

    <p>Phenobarbital</p> Signup and view all the answers

    What is a serious adverse effect associated with valproic acid?

    <p>Fatal liver toxicity</p> Signup and view all the answers

    What is the primary mechanism of action for trimethadione?

    <p>Reduction of type-T calcium currents</p> Signup and view all the answers

    Selegiline is indicated for which condition?

    <p>Early stage of Parkinson's disease</p> Signup and view all the answers

    What effect does valproic acid have on glutamate?

    <p>Blocks its activity</p> Signup and view all the answers

    Which statement is true regarding the pharmacokinetics of warfarin?

    <p>It has a long duration of action</p> Signup and view all the answers

    What is the primary reason heparin is administered?

    <p>To inhibit plasma clotting factors</p> Signup and view all the answers

    Which type of anemia is characterized by the absence of sufficient red blood cell production?

    <p>Aplastic anemia</p> Signup and view all the answers

    What is a common adverse effect of heparin therapy?

    <p>Hypersensitivity reactions</p> Signup and view all the answers

    In the context of Parkinson's disease, what is the level of dopamine compared to acetylcholine?

    <p>Dopamine is low, acetylcholine is elevated</p> Signup and view all the answers

    Which of the following options best describes the clinical indication for administering erythropoietin?

    <p>To stimulate red blood cell production</p> Signup and view all the answers

    What are the primary effects of heparin on lipids in the blood?

    <p>Stimulates lipoprotein lipase</p> Signup and view all the answers

    What is a hallmark sign of Alzheimer's disease?

    <p>Progressive memory loss</p> Signup and view all the answers

    Which type of cholesterol is known to be atherogenic and is considered 'bad'?

    <p>LDL</p> Signup and view all the answers

    What characterizes simple partial seizures?

    <p>Involves a limited area of the brain with no loss of consciousness</p> Signup and view all the answers

    Which of these adverse effects is NOT commonly associated with antiplatelet drugs?

    <p>High blood pressure</p> Signup and view all the answers

    What effect do antiepileptic drugs primarily exert in the brain?

    <p>Decrease excitability of brain cells</p> Signup and view all the answers

    What type of medication is specifically designed to stop convulsive seizures?

    <p>Anticonvulsant drugs</p> Signup and view all the answers

    What is the role of HDL in the body?

    <p>Retrieves cholesterol for disposal</p> Signup and view all the answers

    What characterizes unstable plaque?

    <p>Thin cap with a cholesterol core</p> Signup and view all the answers

    What is one of the main mechanisms by which antiplatelet drugs function?

    <p>Inhibit platelet aggregation or adhesion</p> Signup and view all the answers

    Which neurotransmitter is excitatory and derived from the corpus striatum?

    <p>Acetylcholine</p> Signup and view all the answers

    What is the primary function of thrombin in the coagulation pathway?

    <p>Converts fibrinogen to fibrin</p> Signup and view all the answers

    What does hemostasis refer to?

    <p>Balance between clot formation and breakdown</p> Signup and view all the answers

    What is a distinguishing characteristic of complex partial seizures?

    <p>Involves purposeless repetitive movements</p> Signup and view all the answers

    What should be avoided when taking aspirin for antiplatelet therapy?

    <p>Concurrent use of ibuprofen</p> Signup and view all the answers

    Which characteristic is associated with generalized tonic-clonic seizures?

    <p>Continuous muscle contractions and relaxations</p> Signup and view all the answers

    What common adverse effect is associated with anticonvulsant drugs?

    <p>Sedation</p> Signup and view all the answers

    What is a potential risk of status epilepticus?

    <p>Increased risk of brain damage</p> Signup and view all the answers

    Which medication is used to enhance the effect of other drugs requiring microsomal metabolism?

    <p>Valproic acid</p> Signup and view all the answers

    What occurs during the absence seizure?

    <p>Brief impairment of consciousness</p> Signup and view all the answers

    What is one characteristic of hypochromic anemia?

    <p>Decreased hemoglobin concentration</p> Signup and view all the answers

    What does thromboplastin trigger in the coagulation process?

    <p>Conversion of fibrinogen to fibrin</p> Signup and view all the answers

    What type of seizures involve specific areas of the brain?

    <p>Partial seizures</p> Signup and view all the answers

    What is the primary action of prostacyclin in the vascular system?

    <p>Inhibits platelet aggregation and dilates blood vessels</p> Signup and view all the answers

    Which of the following blood tests is most frequently used to monitor the effects of heparin?

    <p>Activated Partial Thromboplastin Time (APTT)</p> Signup and view all the answers

    What is a significant risk associated with low molecular weight heparin (LMWH) when administered with epidural anesthesia?

    <p>Spinal or epidural hematomas</p> Signup and view all the answers

    Which adverse effect is associated with anticholinergic drugs like benztropine?

    <p>Constipation</p> Signup and view all the answers

    How do low molecular weight heparins (LMWH) primarily differ from standard heparin?

    <p>LMWH has better bioavailability and less spectrum of action</p> Signup and view all the answers

    What is the mechanism of action of heparin?

    <p>Inactivates factor XIII and binds thrombin</p> Signup and view all the answers

    Which laboratory test is primarily used to monitor patients on warfarin therapy?

    <p>Prothrombin Time (PT) or International Normalized Ratio (INR)</p> Signup and view all the answers

    What is the primary therapeutic use of erythropoietin stimulating agents (ESA) like Mircera?

    <p>To stimulate red blood cell production</p> Signup and view all the answers

    What common problem do patients experience as an adverse effect of anticholinergic drugs?

    <p>Urinary retention</p> Signup and view all the answers

    During which type of surgery is dalteparin commonly used to prevent DVT?

    <p>Abdominal surgery</p> Signup and view all the answers

    Study Notes

    Pupillary Dilation (Mydriasis)

    • A symptom that can be caused by anticholinergic drugs like Benztropine.

    Valproic Acid

    • Treats all types of epilepsy, including absence, generalized tonic-clonic, and partial seizures.
    • Also treats Bipolar Disorder (BPD).
    • Decreases the influx of sodium ions, inhibiting the high-frequency firing of neurons.
    • Blocks excitatory glutamate (NMDA) and increases the inhibitory effects of GABA.
    • Produces little sedation.
    • Common side effects include nausea, vomiting, diarrhea, and tremor.
    • A serious concern is fatal liver toxicity.
    • Classified as a pregnancy category D drug, meaning it can cause birth defects.

    Mircera

    • An erythropoietin stimulating agent (ESA).

    Oxazolidinediones

    • Trimethadione is the main drug in this class.
    • Treats absence seizures.
    • Reductions of type-T calcium currents are the mechanism of action.
    • More toxic than succinimides.
    • Side effects include hemeralopia ("snow blindness") and hypersensitivity reactions leading to rashes and blood disorders.

    Selegiline

    • An MAO-B inhibitor that can be used in conjunction with levodopa.
    • Treats early stages of Parkinson's disease to slow the progression.
    • Inhibits the metabolism of dopamine in the brain, increasing its concentration and prolonging its effects.
    • Administered orally with meals and in combination with levodopa.
    • Common side effects include dizziness, hallucinations, and abdominal pain.

    Warfarin

    • A vitamin K antagonist.
    • Slow onset (12-72 hours) and long duration of action (2-10 days).
    • Dietary vitamin K can affect warfarin's activity.
    • Administered orally.
    • Highly bound to plasma proteins and metabolized by the liver.
    • Contraindicated in patients with vitamin K deficiency.

    Simple Partial Seizure

    • Involves a limited area of the brain.
    • Can be sensory or motor in nature.
    • Brief and does not cause a loss of consciousness.

    Complex Partial Seizure

    • Impairs consciousness.
    • May involve the entire body.
    • Characterized by purposeless and non-goal-directed behavior, lip smacking, and repetitive movements.
    • Patients often don't remember the seizure.
    • Can spread to other areas of the body and evolve into a tonic-clonic seizure.

    Dopamine

    • An inhibitory neurotransmitter released from the substantia nigra.

    Acetylcholine (ACh)

    • An excitatory neurotransmitter released from the corpus striatum.

    Antiplatelet Drugs

    • Include aspirin, dipyridamole, clopidogrel, and ticlopidine.
    • Inhibit platelet aggregation, preventing the formation of platelet plugs or blocking platelet adhesion to blood vessel walls.
    • Reduce platelet stickiness by inhibiting ADP.
    • Clinical applications include:
      • Preventing heart attacks, strokes, and angina.
      • Reducing blood clots and preventing thrombi.
      • Preventing reinfarction following myocardial infarction (MI).
      • Managing intermittent claudication (burning/cramping in the leg).
    • Common side effects include headache, vomiting, rash, dizziness, and diarrhea.

    Chelators Drugs

    • Interfere with coagulation by binding to calcium ions, disrupting the coagulation process.

    Anticonvulsant/Antiepileptic Drugs

    • Anticonvulsants:
      • Administered intramuscularly or intravenously.
      • Terminate convulsive seizures.
      • Include barbiturates, some of which (phenobarbital and mephobarbital) have antiepileptic effects, but also cause sedation and hypnotic effects not desired for epilepsy treatment.
      • Tolerance to these effects develops with chronic use.
    • Antiepileptic drugs:
      • Administered orally.
      • Prevent epileptic seizures.
      • Reduce the excitability of brain cells to prevent epilepsy.
      • Drug interactions:
        • Carbamazepine and phenytoin induce microsomal enzymes, which increases the rate of metabolism and reduces drug effects.
        • Valproic acid inhibits these enzymes, increasing the effects of drugs requiring microsomal metabolism.
        • Phenytoin and valproic acid are highly protein-bound, increasing the free drug concentration and enhancing their pharmacological effects.

    Types of Seizures

    • Tonic-clonic: Characterized by jerking movements with alternating muscle contractions and relaxations, increased heart rate and blood pressure, urination, defecation, tongue biting, and lasting several minutes.
    • Myoclonic: Muscle contractions confined to a single body part.
    • Atonic: Severe loss of muscle tone, resulting in falling. Helmet use is recommended for patients with this type of seizure.
    • Absence: Brief impairment of consciousness.

    General Seizure Symptoms

    • Staring and blinking, jerking movements, stiffening, loss of consciousness, breathing problems, loss of bladder control, and falling.

    Parkinson's Disease

    • Characterized by abnormal and weak muscular movements.
      • Tremors: Rhythmic shaking.
      • Muscle rigidity: Stiffness and resistance to movement.
      • Bradykinesia: Slowness of movement.
      • Postural instability: Difficulty maintaining balance, leading to falls.
      • In late stages, patients often become wheelchair-bound.

    Erythropoietin

    • An erythropoietin stimulating agent (ESA).

    Vitamin K (Phytonadione) or Mephyton (oral formulation)

    • The antidote for Warfarin (Coumadin).
    • Administered intramuscularly or subcutaneously.

    Phenytoin (Hydantoin)

    • The most important drug from the hydantoin class.
    • Treats all types of partial seizures and tonic-clonic generalized seizures, being the drug of choice for tonic-clonic seizures.
    • Affects the activity of neuron ion channels (sodium, potassium, calcium) and neurotransmitter functions.
    • The primary effect is prolonging the inactivation of sodium channels in the nerve membrane, reducing the generation of high-frequency repetitive firing of action potentials from neurons involved in initiating seizures.
    • Increases GABA release and decreases glutamate release.
    • Administered intravenously.
    • Side effects include dizziness, ataxia, visual disturbances, postural imbalance, hirsutism, skin rashes, and gingival hyperplasia.
    • Associated with birth defects.

    Diazepam (Benzodiazepine)

    • Treats tonic-clonic seizures and status epilepticus.
    • Comparable effectiveness to lorazepam, but shorter duration of action when administered intravenously, potentially requiring additional doses.
    • Increases the inhibitory effects of GABA.
    • Administered intravenously.
    • Side effects include drowsiness, confusion, ataxia, minor gastrointestinal disturbances, and rashes.

    Lorazepam (Benzodiazepine)

    • Treat tonic-clonic seizures and status epilepticus, being the drug of choice for status epilepticus.
    • Increases the inhibitory effects of GABA..
    • Administered intravenously.
    • Can be followed with intravenous phenytoin if needed.
    • Side effects include drowsiness, confusion, ataxia, minor gastrointestinal disturbances, and rashes.

    Levodopa

    • The most effective drug available for Parkinson's disease, commonly used for mild to moderate and even advanced disease.
    • A precursor to dopamine that crosses the blood-brain barrier and converts to dopamine.
    • Dopamine itself does not typically cross the blood-brain barrier.
    • Administered orally, ideally on an empty stomach to avoid interference from amino acids (protein) in transporting levodopa across the blood-brain barrier.
    • Administered with carbidopa, which inhibits DOPA decarboxylase.
    • DOPA decarboxylase converts levodopa to dopamine peripherally, reducing the amount of levodopa that reaches the brain before conversion.
    • Carbidopa does not cross the blood-brain barrier, so it does not prevent the conversion of levodopa to dopamine in the basal ganglia.
    • Administering carbidopa with levodopa allows for lower levodopa dosages, decreasing adverse effects.
    • Common side effects include nausea, vomiting, loss of appetite, orthostatic hypotension (fainting), behavioral disturbances, dyskinesias and dystonias, an "on-off" phenomenon (periods of immobility and mobility), and rapid/irregular heartbeat (beta-1).

    Levodopa Notes

    • Should not be combined with antipsychotic or antidepressant medications (MAO inhibitors), as they can block dopamine receptors and cause hypertensive crises and other severe side effects due to increased norepinephrine levels.
    • Vitamin B6 should be avoided if patients are not taking carbidopa with levodopa, as vitamin B6 increases the metabolism rate of levodopa.
    • Levodopa therapy is typically delayed in favor of other drugs until symptoms require more effective medications.
    • Individuals under 65 years old are typically treated with other drugs initially, while levodopa is reserved for patients aged 65 years and older.

    Carbidopa

    • Administered with levodopa.
    • Inhibits DOPA decarboxylase, increasing the amount of levodopa reaching the brain.

    Entacapone (COMT inhibitor)

    • COMT (catechol-O-methyltransferase) is an enzyme involved in the metabolism of dopamine both peripherally and in the brain.
    • Can be added to levodopa treatment.
    • Treats Parkinson's disease.
    • Inhibits COMT in the periphery, improving the levels of levodopa reaching the brain.
    • Administered with levodopa to increase drug levels and prolong the duration of action of dopamine.
    • Common side effects include nausea, orthostatic hypotension, mental disturbances, and dyskinesias.

    Trimethadione

    • Treats absence seizures.
    • Reduces type-T calcium currents in the thalamus.
    • More toxic than succinimides.
    • Side effects include hemeralopia ("snow blindness"), hypersensitivity (rashes and blood disorders), liver and kidney damage.
    • Rarely prescribed today due to its high incidence of adverse effects and toxicities.

    Sinemet

    • The most widely used drug preparation for Parkinson's disease, consisting of a combination of levodopa and carbidopa.

    Benztropine (Anticholinergic Drug)

    • Treats Parkinson's disease, reducing tremor and muscle rigidity.
    • Before the introduction of levodopa, anticholinergic drugs were the primary treatment for Parkinson's disease.
    • Less effective than levodopa.
    • Decreases cholinergic activity, leading to a lower incidence of peripheral side effects and adverse effects.
    • Restores acetylcholine/dopamine balance.
    • Common side effects include a decrease in parasympathetic activity, resulting in dry mouth, constipation, urinary retention, rapid heartbeat, and pupillary dilation.

    Acetylcholine and Parkinson's Disease

    • A deficiency of dopamine in the basal ganglia leads to excess acetylcholine activity.
    • Anticholinergic drugs block acetylcholine actions, decreasing cholinergic activity.

    Blood Tests for Anticoagulant Monitoring

    • PPT (Partial Thromboplastin Time) -measures the time it takes for blood to clot following the addition of a reagent called partial thromboplastin
    • PT (Prothrombin Time) - measures the time it takes for blood to clot following the addition of tissue thromboplastin (a substance that causes clotting)
    • INR (International Normalized Ratio) -most commonly used, calibrates the commercial rabbit thromboplastins against an international human reference standard
    • APTT (Activated Partial Thromboplastin Time)- The effect of heparin is most frequently assessed with activated partial thromboplastin time (APTT), performed 1 hour prior to the next dose of heparin. It should be taken on a non-IV line arm to avoid false APTT results
    • LMW Drugs assessed by routine total blood and platelet counts
    • People taking warfarin are monitored with PT or INR (2-3 INR for warfarin)

    Heparin Classes

    • Standard: Unfractionated heparin, consisting of the full complement of saccharides of endogenous heparin.
      • Advantage: Additional saccharide chain depresses platelet aggregation.
      • Inactivates factor 13 (fibrin-stabilizing factor) and binds thrombin (factor 2).
      • Indications: Preventing clotting during cardiovascular surgery, transfusions, and dialysis.
    • LMW: Derived from porcine heparin, containing only an active anticoagulant fraction of heparin.
      • Interferes with the coagulation cascade but cannot produce the same spectrum of interference as standard heparin.
      • Administered only subcutaneously.
      • Advantage: 90% bioavailability, dosed based on body size without coagulation test monitoring.
      • Black box warning: Risk of epidural/spinal hematomas when administered with epidural or spinal anesthesia.
      • Indications: Preventing DVT in abdominal surgery (dalteparin) and knee and hip replacement surgery (enoxaparin).

    Erythropoietin Stimulating Agents (ESA)

    • Mircera

    Signs and Symptoms of Seizures

    • Generalized seizures:
      • Tonic: Stiffening of muscles.
      • Clonic: Rhythmic jerking movements.
      • Tonic-clonic: Alternating stiffening and jerking movements.
      • Myoclonic: Brief muscle spasms (jerks).
      • Atonic: Loss of muscle tone.
      • Absence: Brief loss of consciousness.

    Levodopa Therapy and Vitamin B6

    • Vitamin B6 increases the metabolism rate of levodopa. If patients are not taking carbidopa with levodopa, vitamin B6 should be avoided.

    Levodopa Therapy

    • Delay: Levodopa therapy is typically delayed in favor of other drugs until symptoms require more effective medications.
    • Age: Patients under 65 years old are typically treated with other drugs initially, while levodopa is reserved for patients aged 65 years and older.

    Entacapone Notes

    • Entacapone inhibits the enzyme COMT, which is involved in the metabolism of dopamine both peripherally and in the brain.

    Benztropine Notes

    • Before the introduction of levodopa, anticholinergic drugs like benztropine were used for Parkinson's disease.
    • While less effective than levodopa, benztropine can help reduce tremor and muscle rigidity.

    Transient Ischemic Attack

    • A brief interruption of blood flow to the brain, causing stroke-like symptoms without lasting damage.

    Heparin

    • Inhibits plasma clotting factors, increasing the activity of antithrombin.
    • A naturally occurring mucopolysaccharide.
    • Extracted from cattle and pig lungs and intestines.
    • All heparins bind to antithrombin and accelerate the inactivation of factor X.
    • Standard heparin (unfractionated) contains the full complement of saccharides of endogenous heparin.
    • Properties:
      • Anticoagulant
      • Lipolysis: Clears fatty molecules from plasma, stimulating lipoprotein lipase to hydrolyze triglycerides in the blood, reducing large fat molecules in the plasma.
    • Administration:
      • IV (fast acting; lasts 2-5 hours) or subcutaneous (slow acting; lasts 12 hours).
    • Onset and Duration of Action:
      • Quick onset due to anticoagulant effect occurring as soon as the thromboplastin-drug complex is formed.
    • Clinical Indications:
      • DVT
      • Pulmonary embolism
      • Prevention of clotting
      • Disseminated intravascular coagulation
      • Preferred anticoagulant for pregnant women.
    • Adverse Effects:
      • Hemorrhage
      • Bleeding in mucous membranes and open wounds
      • Hypersensitivity, fever, alopecia, osteoporosis, and thrombocytopenia.
    • Antidote: Protamine sulfate
    • Counteracting Effects:
      • Digitalis, tetracycline, and NSAIDs counteract anticoagulant action.

    Erythropoietin

    • A hormone produced primarily by the kidneys that stimulates red blood cell production.

    Types of Anemia

    • Aplastic Anemia: Deficiency of red blood cells, white blood cells, and platelets.
    • Pernicious Anemia: Deficiency in vitamin B12 due to lack of intrinsic factor.
    • Megaloblastic Anemia: Impaired DNA synthesis leading to large, abnormal red blood cells.
    • Normochromic Anemia: Red blood cells have normal color but reduced number.
    • Macrocytic Anemia: Large red blood cells.
    • Microcytic Anemia: Small red blood cells.

    Parkinson’s Disease

    • Caused by deficiency or destruction of dopamine neurons in the substantia nigra.
    • Dopamine levels decrease with age.
    • Characterized by an imbalance of neurotransmitters: high acetylcholine (ACh) and low dopamine (DA).

    Alzheimer’s Disease

    • The most common cause of dementia.
    • Not a normal part of aging, but the risk increases with age (over 65).
    • Primary symptom: Progressive memory loss.
    • Hallmark Features:
      • Plaques and tangles, which kill nerve cells.
    • Treatment: Donepezil

    Types of Cholesterol

    • LDL (Low-Density Lipoprotein): “Bad” cholesterol. Transports cholesterol to damaged areas in the arteries, forming plaque. Atherogenic.

    Simple Partial Seizure

    • Involves a limited area of the brain.
    • Can be sensory or motor in nature.
    • Brief duration, without loss of consciousness.

    Complex Partial Seizure

    • Impairment of consciousness.
    • May involve the entire body.
    • Purposeless, not goal-directed movements.
    • Lip smacking, repetitive movements.
    • Patient does not remember the seizure.
    • Can spread to other areas of the brain and become tonic-clonic.

    Dopamine (DA)

    • Inhibitory neurotransmitter released from the substantia nigra.

    Acetylcholine (ACh)

    • Excitatory neurotransmitter released from the corpus striatum.

    Antiplatelet Drugs

    • Aspirin, dipyridamole, clopidogrel, ticlopidine.
    • Inhibit platelet aggregation, preventing platelet plug formation or blocking platelet adhesion.
    • Make platelets less sticky by inhibiting ADP.
    • Clinical Indications:
      • Prevention of heart attack, stroke, or angina.
      • Reduction of clots and prevention of thrombi.
      • Prevention of reinfarction following MI.
      • Intermittent claudication (burning/cramping in the leg).
    • Adverse Effects: Headache, vomiting, rash, dizziness, and diarrhea.

    Chelator Drugs

    • Inhibit coagulation by binding calcium ions, interrupting the coagulation process.

    Anticonvulsant/Antiepileptic Drugs

    • Anticonvulsant:
      • Administered intramuscularly or intravenously.
      • Terminates convulsive seizures.
      • Includes barbiturate drugs (some have antiepileptic properties), but have sedative and hypnotic effects, leading to tolerance with chronic use.
    • Antiepileptic Drugs:
      • Administered orally.
      • Prevent epileptic seizures.
      • Decrease the excitability of brain cells, reducing epilepsy activity.
      • Drug Interactions:
        • Carbamazepine and phenytoin induce microsomal enzymes, increasing metabolism rate and reducing drug effects.
        • Valproic acid inhibits enzymes, increasing the effects of drugs requiring microsomal metabolism.
        • Phenytoin and valproic acid are highly protein bound, increasing free drug concentration and pharmacologic effects.

    Most Used Antiepileptic Drugs

    • Phenytoin: Used for all types of partial seizures and tonic-clonic generalized seizures (drug of choice for tonic-clonic).
    • Carbamazepine: Effective against partial seizures, tonic-clonic seizures, and trigeminal neuralgia.
    • Valproic Acid: Used for generalized seizures, including absence seizures, and in some cases, partial seizures.
    • Lamotrigine: Used for partial seizures and generalized seizures, including absence seizures.
    • Topiramate: Used for partial seizures, generalized seizures, and migraine headaches.
    • Levetiracetam: Used for partial seizures and generalized seizures.

    Prostacyclin

    • A product of the cyclooxygenase pathway released from blood vessel membranes.
    • Counteracts the action of thromboxane by dilating vessels and inhibiting platelet aggregation.

    Anticholinergic Drugs

    • Benztropine: An anticholinergic drug used to treat Parkinson’s by restoring acetylcholine/dopamine balance.
    • Adverse Effects: Decrease parasympathetic activity: dry mouth, constipation, urinary retention, rapid heartbeat, pupillary dilation.

    Blood Tests for Anticoagulant Monitoring

    • PPT (Partial Thromboplastin Time): Measures the time it takes for blood plasma to clot.
    • PT (Prothrombin Time): Measures the time it takes for blood plasma to clot in the presence of tissue thromboplastin.
    • INR (International Normalized Ratio): Calibrates commercial rabbit thromboplastins against an international human reference standard.
    • APTT (Activated Partial Thromboplastin Time): Most commonly used to assess heparin effects; performed 1 hour prior to the next dose of heparin on the non-IV line arm to avoid false results.
    • LMWH (Low Molecular Weight Heparin): Assessed by routine total blood and platelet counts.
    • Warfarin: Monitored with PT or INR (2-3 INR for warfarin).

    Heparin Classes

    • Standard (Unfractionated Heparin): Contains the full complement of saccharides of endogenous heparin; has additional advantages, such as depressing platelet aggregation; inactivates factor 13 (fibrin-stabilizing factor) and binding thrombin (factor 2).
      • Indications: Prevention of clotting during cardiovascular surgery, transfusions, and dialysis.
    • LMW (Low Molecular Weight Heparin): Derived from porcine heparin but contains only an active anticoagulant fraction of heparin; does not provide the same spectrum of interference as standard heparin; administered subcutaneously.
      • Advantages: 90% bioavailability; dosed based on body size without coagulation monitoring.
      • Black Box Warning: Risk of epidural/spinal hematomas when administered with epidural or spinal anesthesia.
      • Indications: Prevention of DVT in abdominal surgery (dalteparin) and knee and hip replacement surgery (enoxaparin).

    ESA (Erythropoietin Stimulating Agent)

    • Mircera: A long-acting ESA that stimulates red blood cell production.

    Signs and Symptoms

    • Generalized Seizures (Tonic, Clonic, Tonic-Clonic, Myoclonic, Atonic, Absence Seizures):
      • Tonic-Clonic: Jerking movements, alternating muscle contractions and relaxations, increased heart rate, blood pressure, urination, defecation, tongue biting; lasts several minutes.
      • Myoclonic: Muscle contractions confined to one part of the body.
      • Atonic: Severe loss of muscle tone; patient falls; helmet required.
      • Absence: Brief impairment of consciousness.
    • General: Staring, blinking, jerking movements, stiffening, loss of consciousness, breathing problems, loss of bladder control, falling.
    • Parkinson’s Disease:
      • Abnormal and Weak Muscular Movements:
        • Tremors
        • Muscle rigidity
        • Bradykinesia (slowness of movement).
        • Postural instability (patient falls); late stage, wheelchair bound.
    • Tonic-Clonic Seizures: Jerking movements, alternating muscle contractions and relaxations, increased heart rate, blood pressure, urination, defecation, tongue biting; lasts several minutes.

    Drugs: Adverse Effects, Indication, Mechanism of Action, Pharmacokinetics

    Erythropoietin

    • Indication: Treatment of anemia, specifically in chronic kidney disease.
    • Mechanism: Stimulates red blood cell production in the bone marrow.
    • Pharmacokinetics: Administered intravenously or subcutaneously.
    • Adverse Effects: Hypertension, headaches, thromboembolic events, and increased risk of death in patients with certain types of cancers.

    Vitamin K (Phytonadione or Mephyton)

    • Indication: Antidote for Warfarin (Coumadin) overdose.
    • Mechanism: Necessary for the synthesis of clotting factors in the liver.
    • Pharmacokinetics: Administered intramuscularly or subcutaneously.
    • Adverse Effects: Pain at the injection site, hypersensitivity reactions, and jaundice.

    Phenytoin (Dilantin)

    • Indication: All types of partial seizures and tonic-clonic generalized seizures (drug of choice for tonic-clonic).
    • Mechanism:
      • Prolongs the inactivation of sodium channels in the nerve membrane, reducing high-frequency repetitive firing of action potentials from neurons.
      • Increases GABA release and decreases glutamate release.
    • Pharmacokinetics: Administered intravenously.
    • Adverse Effects: Dizziness, ataxia, visual disturbances, postural imbalance, hirsutism, skin rashes, and gingival hyperplasia.
    • Pregnancy Risk: Associated with birth defects.

    Diazepam (Valium)

    • Indication: Tonic-clonic seizures and status epilepticus.
    • Mechanism: Increases the inhibitory effects of GABA.
    • Pharmacokinetics: Administered intravenously.
    • Adverse Effects: Drowsiness, confusion, ataxia, minor gastrointestinal disturbances, and rashes.

    Lorazepam (Ativan)

    • Indication: Tonic-clonic seizures and status epilepticus (drug of choice for status epilepticus).
    • Mechanism: Increases the inhibitory effects of GABA.
    • Pharmacokinetics: Administered intravenously; can be followed with IV phenytoin if needed.
    • Adverse Effects: Drowsiness, confusion, ataxia, minor gastrointestinal disturbances, and rashes.

    Levodopa

    • Indication: Most effective drug available for Parkinson’s disease; used for mild to moderate and advanced disease.
    • Mechanism:
      • Precursor of dopamine; crosses the blood-brain barrier and converts to dopamine.
      • Dopamine itself does not typically cross the blood-brain barrier.
    • Pharmacokinetics:
      • Administered orally on an empty stomach to avoid interference with amino acids (protein) in transporting levodopa across the blood-brain barrier.
      • Co-administered with carbidopa (inhibits DOPA decarboxylase).
        • DOPA decarboxylase converts levodopa to dopamine peripherally, decreasing the amount of levodopa reaching the brain.
        • Carbidopa does not cross the blood-brain barrier, preventing the conversion of levodopa to dopamine in the basal ganglia.
        • Co-administration with carbidopa allows for lower levodopa dosages, reducing adverse effects.
    • Adverse Effects: Nausea, vomiting, loss of appetite (anorexia), orthostatic hypotension/fainting, behavioral disturbances, dyskinesias and dystonias, on-and-off phenomenon, rapid/irregular heartbeat (beta-1).

    Levodopa Notes:

    • Contraindications:
      • Antipsychotic and antidepressant medications (MAO inhibitors; high levels of norepinephrine, leading to hypertensive crisis and other adverse effects).
    • Interactions:
      • Vitamin B6: Increases the metabolism rate of levodopa; should not be taken if carbidopa is not co-administered.
    • Therapy Recommendations:
      • Delayed use of levodopa until symptoms require more effective medications.
      • Use of levodopa for older individuals (65+); younger patients start with other medications.

    Carbidopa

    • Indication: Co-administered with levodopa in Parkinson’s disease.
    • Mechanism: Inhibits DOPA decarboxylase, increasing the amount of levodopa entering the brain.
    • Pharmacokinetics: Administered with levodopa.

    Entacapone (COMT Inhibitor)

    • COMT (Catechol-O-Methyltransferase): Enzyme involved in dopamine metabolism (peripherally and in the brain).
    • Indication: Parkinson’s disease; co-administered with levodopa.
    • Mechanism: Inhibits COMT in the periphery, increasing the amount of levodopa reaching the brain.
    • Pharmacokinetics: Co-administered with levodopa to increase drug levels and prolong dopamine action.
    • Adverse Effects: Nausea, orthostatic hypotension, mental disturbances, dyskinesias.

    Trimethadione

    • Indication: Absence seizures.
    • Mechanism: Reduces type-T calcium currents in the thalamus.
    • Pharmacokinetics: More toxic than succinimides (another type of antiepileptic).
    • Adverse Effects:
      • Hemeralopia (“snow blindness”).
      • Hypersensitivity: Rashes and blood disorders.
      • Liver and kidney damage.
    • Current Use: Rarely prescribed due to higher incidence of adverse effects and toxicities.

    Sinemet

    • Indication: Most widely used drug preparation for Parkinson’s disease; combination of levodopa and carbidopa.

    Benztropine (Cogentin)

    • Indication: Parkinson’s disease; reduces tremor and muscular rigidity symptoms.
      • Used prior to levodopa; less effective than levodopa.
    • Mechanism:
      • Decreases cholinergic activity.
      • Excess acetylcholine activity occurs in the basal ganglia when there is dopamine deficiency; blocking acetylcholine actions reduces this excess activity.
    • Adverse Effects: Decreased parasympathetic activity: dry mouth, constipation, urinary retention, rapid heartbeat, pupillary dilation.

    Transient Ischemic Attack

    • Temporary blood flow interruption to the brain, causing stroke-like symptoms without lasting damage.

    Heparin

    • Anticoagulant that inhibits plasma clotting factors by increasing antithrombin activity.
    • Naturally occurring mucopolysaccharide, historically extracted from animal sources.
    • Heparins bind antithrombin, accelerating factor X inactivation.
    • Standard heparin (unfractionated) contains the full complement of saccharides found in endogenous heparin.
    • Administered via IV (fast acting, 2-5 hour duration) or subcutaneously (slow acting, 12 hour duration).
    • Rapid onset and duration due to anticoagulant effect upon thromboplastin-drug complex formation.
    • Clinical Indications: DVT, pulmonary embolism, clotting prevention, disseminated intravascular coagulation, preferred anticoagulant in pregnancy.
    • Adverse Effects: Hemorrhage, bleeding in mucous membranes and wounds, hypersensitivity, fever, alopecia, osteoporosis, and thrombocytopenia.
    • Protamine sulfate is the antidote.
    • Digitalis, tetracycline, and NSAIDs can counteract anticoagulant action.

    Erythropoietin

    • Production: Kidney (primarily) and liver.

    Types of Anemia

    • Aplastic
    • Pernicious
    • Megaloblastic
    • Normochromic
    • Macrocytic
    • Microcytic

    Parkinson's Disease

    • Cause: Deficiency or destruction of dopamine (DA) neurons in the substantia nigra.
    • Worsens with age.
    • Acetylcholine (ACh) levels are high, while DA levels are low.

    Alzheimer's Disease

    • Most common cause of dementia.
    • Not a normal part of aging, but age (65+) is a risk factor.
    • Hallmark sign: Progressive memory loss.
    • Treated with donepezil.
    • Plaques and tangles kill nerve cells.

    Cholesterol

    • LDL: "Bad" - Transports cholesterol to damaged arterial areas, forming plaque. Atherogenic.
    • HDL: "Good" - Protective lipoprotein. Retrieves cholesterol for liver disposal, inhibits LDL oxidation, and platelet aggregation at plaque sites.

    Hemoglobin

    • Function: Transports oxygen from lungs to tissues and carbon dioxide from tissues to lungs.

    Types of Plaque

    • Stable: Cholesterol core with fibrous cap, may contain calcium.
    • Unstable: Cholesterol core with a thin cap.

    Thromboplastins

    • Stage 1 of coagulation.
    • Produced by intrinsic (requires multiple clotting factors and platelets) and extrinsic factors (requires factor 12 and tissue extract).
    • Triggers automatic coagulation once produced.
    • Stage 2: Thromboplastin converts prothrombins to thrombin.
    • Stage 3: Thrombin converts fibrinogen to fibrin (primary blood clot element) and activates clotting factors.
    • Stage 4: Clot resolution. Plasmin (derived from plasminogen by tPA) acts on fibrin for soluble product formation.
    • Vitamin K is essential for synthesizing coagulation pathway factors, especially prothrombin (factor 2).

    Hemostasis

    • Balance between clot formation and breakdown throughout the day.

    Hematuria

    • Blood in urine.

    Hypochromic

    Generalized Seizures

    • Involve both hemispheres of the brain.

    Tonic-Clonic Seizures (Grand Mal)

    • Alternating muscle contractions and relaxations with loss of consciousness.
    • Jerky movements due to alternating muscle contractions.
    • Increased heart rate, blood pressure, urination, defecation, and tongue biting.
    • Seizures last several minutes, leaving confusion, fatigue, and muscle soreness.

    Status Epilepticus

    • Continuous, uninterrupted series of generalized tonic and clonic seizures.
    • Medical emergency demanding immediate treatment.

    Absence Seizures (Petit Mal)

    • Generalized seizure lacking motor convulsions, affecting consciousness.
    • Brief impairment of consciousness, characterized by staring or rapid eye blinking lasting seconds to a minute.
    • No motor activity, individual appears normal.

    Partial Seizures

    • Localized to a specific area of the brain.

    Simple Partial Seizures

    • Involve a limited area of the brain.
    • Can be sensory or motor in nature.
    • Brief, no loss of consciousness.

    Complex Partial Seizures

    • Impairment of consciousness.
    • May involve the entire body.
    • Purposeless movements.
    • Lip smacking, repetitive movements.
    • No memory of seizure.
    • Can spread and become a tonic-clonic seizure.

    Dopamine

    • Inhibitory neurotransmitter from the substantia nigra.

    Acetylcholine

    • Excitatory neurotransmitter from the corpus striatum.

    Antiplatelet Drugs

    • Aspirin, dipyridamole, clopidogrel, ticlopidine.
    • Inhibit platelet aggregation, preventing the formation of a platelet plug or blocking its attachment to the blood vessel wall.
    • Reduce platelet stickiness by inhibiting ADP.
    • Clinical Indications: Prevention of heart attack, stroke, or angina. Reduction of clots and thrombi. Reinfarction prevention after myocardial infarction. Intermittent claudication.
    • Adverse Effects: Headache, vomiting, rash, dizziness, and diarrhea.
    • Chelators (drugs) inhibit coagulation by binding calcium ions, interrupting coagulation.

    Anticonvulsant/Antiepileptic Drugs

    • Anticonvulsant: Administered intramuscularly (IM) or intravenously (IV). Terminates convulsive seizures. Includes barbiturates (phenobarbital and mephobarbital), but they exhibit sedation and hypnotic effects. Tolerance develops with chronic use.
    • Antiepileptic: Administered orally. Prevents epileptic seizures. Reduces brain cell excitability, reducing epilepsies.
    • Drug Interactions: Carbamazepine and phenytoin induce microsomal enzymes, increasing metabolism and reducing drug effect. Valproic acid inhibits enzymes, increasing the effects of microsomal metabolism-dependent drugs. Phenytoin and valproic acid are highly protein-bound, increasing free drug concentration and pharmacological effects.
    • Commonly used antiepileptic drugs:
    • Tonic-clonic: Phenobarbital, phenytoin, valproic acid, carbamazepine.
    • Partial seizures: Phenytoin, carbamazepine, valproic acid.
    • Absence seizures: Ethosuximide (drug of choice), trimethadione, valproic acid.
    • Status epilepticus: Clonazepam, diazepam, phenytoin.

    Barbiturates

    • Mechanism: Enhance GABA's excitatory effects, suppressing epileptogenic neuron activity. Reduce glutamate levels.
    • Indications: Phenobarbital is used as an alternative for generalized and partial seizures. Phenobarbital is the safest antiseizure drug, particularly in infants.
    • Withdrawal: Gradually decrease the dose to prevent withdrawal symptoms.

    Triglycerides

    • Main dietary fat form.
    • Provide energy to the body.
    • Excess calories are converted to triglycerides and stored in adipose tissue (fat cells).
    • Chylomicrons transport exogenous cholesterol and triglycerides.
    • Triglycerides are hydrolyzed by lipoprotein lipase, releasing free fatty acids for muscle use or storage as fat.
    • When lipids are unavailable, the liver produces triglycerides.
    • Triglycerides are packaged into VLDL by the liver.
    • VLDL-transported triglycerides are hydrolyzed by lipoprotein lipase to provide energy to target tissues.

    Low Molecular Weight (LMW) Heparin Use in Pregnancy

    • Heparins are preferred for pregnant women requiring anticoagulation because they do not cross the placenta.

    Platelets/Thrombocytes

    • Thrombocytes are blood cells required for coagulation.
    • When injury occurs, platelets migrate to the site, adhering to each other and the vessel wall.
    • Thromboxane A2 released by platelets constricts blood vessels, slowing blood flow to facilitate platelet aggregation.
    • Prostacyclin, another cyclooxygenase pathway product released from the blood vessel membrane, counteracts thromboxane by dilating vessels and inhibiting platelet aggregation.

    Anticholinergic Drugs

    • Benztropine: Anticholinergic drug, treats Parkinson's, restores ACh/DA balance.
    • Adverse Effects: Reduced parasympathetic activity, including dry mouth, constipation, urinary retention, rapid heartbeat, and pupillary dilation.

    Blood Tests for Anticoagulant Monitoring

    • PPT (partial thromboplastin time)
    • PT (prothrombin time)
    • INR (international normalized ratio): Most common, calibrates commercial rabbit thromboplastins against a human reference standard.
    • APTT (activated partial thromboplastin time): Best reflects heparin's effect. Performed 1 hour prior to heparin administration, avoiding IV lines to prevent false results.
    • LMW drugs assessed by routine total blood and platelet counts.
    • Warfarin users are monitored with PT or INR (target range 2-3 for warfarin).

    Heparin Classes

    • Standard (Unfractionated Heparin): Contains the full complement of endogenous heparin's saccharides.
    • Advantage: Additional saccharide chain and platelet aggregation depression.
    • Inactivates factor 13 (fibrin-stabilizing factor) and binds thrombin (factor 2).
    • Indications: Prevention of clotting during cardiovascular surgery, transfusions, dialysis.
    • LMW (Low Molecular Weight Heparin): Derived from porcine heparin but contains only an active anticoagulant fraction.
    • Interfere with the coagulation cascade but cannot produce the same spectrum of
      interference as standard heparin.
    • Administered subcutaneously.
    • Advantage: 90% bioavailability, dosed based on body size without coagulation test monitoring.
    • Black Box Warning: Risk of epidural/spinal hematomas when administered with epidural or spinal anesthesia.
    • Indications: DVT prevention in abdominal surgery (dalteparin) and for knee and hip replacement surgery (enoxaparin).

    ESA (Erythropoietin Stimulating Agent)

    • Mircera

    Signs/Symptoms Of Generalized Seizures (Tonic, Clonic, Tonic-Clonic, Myoclonic, Atonic,

    Absence Seizures)

    • Include a variety of symptoms depending on seizure type, ranging from brief staring episodes to convulsions and loss of consciousness.

    Transient Ischemic Attack

    • Interruption of blood flow to the brain for a short period of time.
    • Symptoms mimic a stroke but cause no lasting damage.

    Heparin

    • Naturally occurring mucopolysaccharide.
    • Inhibits plasma clotting factors, acting as a blood anticoagulant.
    • Increases the activity of antithrombin.
    • Standard (unfractionated) heparin contains all saccharides of endogenous heparin.
    • Properties:
      • Anticoagulant
      • Lipolysis (clears fatty molecules from plasma)
    • Administration:
      • IV (fast-acting, duration 2-5 hours)
      • Subcut (slow-acting, duration 12 hours)
    • Clinical Indications:
      • DVT
      • Pulmonary embolism
      • Prevention of clotting
      • Disseminated intravascular coagulation
      • Preferred anticoagulant for pregnant women
    • Adverse Effects:
      • Hemorrhage
      • Bleeding in mucous membranes and open wounds
      • Hypersensitivity, fever, alopecia, osteoporosis, thrombocytopenia.
    • Antidote: Protamine sulfate
    • Interactions: Digitalis, tetracycline, NSAIDs counteract anticoagulant action.

    Erythropoietin

    • Produced in the kidneys.
    • Stimulates red blood cell production in bone marrow.

    Types of Anemia

    • Aplastic: Bone marrow fails to produce enough blood cells.
    • Pernicious: Lack of intrinsic factor, which is needed to absorb vitamin B12.
    • Megaloblastic: Abnormal DNA synthesis due to vitamin B12 or folate deficiency.
    • Normochromic: Red blood cells have a normal amount of hemoglobin.
    • Macrocytic: Large red blood cells.
    • Microcytic: Small red blood cells.

    Parkinson's Disease

    • Caused by a deficiency/destruction of dopamine neurons in the substantia nigra.
    • Dopamine levels decrease with age.
    • Acetylcholine (ACh) levels are high, dopamine levels are low.

    Alzheimer's Disease

    • Most common cause of dementia.
    • Risk factor is increasing age (65+).
    • Hallmark sign: Progressive memory loss.
    • Treatment: Donepezil
    • Pathology: Plaques and tangles kill nerve cells.

    Types of Cholesterol

    • LDL (Low-density lipoprotein) - "Bad Cholesterol":
      • Transports cholesterol to damaged areas in arteries, forming plaque.
      • Atherogenic - contributes to plaque formation.
      • Signals macrophages to engulf LDL, transforming them into foam cells.
      • Foam cells accumulate, leading to fat streaks and plaque buildup.
    • HDL (High-density lipoprotein) - "Good Cholesterol":
      • Protective lipoprotein.
      • Retrieves cholesterol for removal via the liver.
      • Inhibits LDL oxidation, preventing plaque growth.
      • Inhibits platelet aggregation at plaque sites.

    Hemoglobin

    • Function: Binds and transports oxygen in the blood.

    Types of Plaque

    • Stable:
      • Cholesterol core covered by a fibrous cap.
      • May contain calcium.
    • Unstable:
      • Cholesterol core covered by a thin cap.
      • More prone to rupture, leading to blood clots.

    Thromboplastins

    • Produced by intrinsic (requires multiple clotting factors and platelets) and extrinsic factors (requires factor XII and tissue extract).
    • Stimulate the coagulation cascade once produced.
    • Coagulation Stages:
      • Stage 1: Thromboplastin production.
      • Stage 2: Thromboplastin converts prothrombin to thrombin.
      • Stage 3: Thrombin converts fibrinogen to fibrin, activating clotting factors, forming a fibrin mesh to bind platelets.
      • Stage 4: Clot resolution; plasmin breaks down fibrin elements into more soluble products.
    • Vitamin K: Required for the synthesis of coagulation factors, particularly prothrombin.

    Hemostasis

    • Balance between clot formation and clot breakdown.

    Hematuria

    • Blood in the urine.

    Hypochromic

    • Red blood cells have less than the normal amount of hemoglobin (pale in color).

    Generalized Seizures

    • Involve both hemispheres of the brain.
    • Tonic-clonic/Grand Mal: Alternating muscle contractions and relaxations, with loss of consciousness.
      • Jerking movements.
      • Increased heart rate, blood pressure, urination, defecation, tongue biting.
      • Seizures last several minutes, followed by confusion, fatigue, and muscle soreness.
    • Status epilepticus: Continuous series of generalized tonic-clonic seizures without interruption - medical emergency requiring immediate treatment.
    • Absence seizures (Petit Mal): Generalized seizure involving brief impairment of consciousness without motor convulsions.
      • Staring into space, rapid eye blinking (seconds to minutes).
      • No motor activity, the individual appears normal.

    Partial Seizures

    • Localized to a specific area of the brain.
    • Types:
      • Simple Partial:
        • Involves a limited area of the brain.
        • Sensory or motor in nature.
        • Brief, no loss of consciousness.
      • Complex Partial:
        • Impairment of consciousness.
        • Can involve the entire body.
        • Purposeless movements.
        • Lip smacking, repetitive movements.
        • Patient does not remember the seizure.
        • Can spread to other areas, evolving into tonic-clonic seizures.

    Dopamine

    • Inhibitory neurotransmitter from the substantia nigra.

    Acetylcholine (ACh)

    • Excitatory neurotransmitter from the corpus striatum.

    Antiplatelet Drugs

    • Aspirin, dipyridamole, clopidogrel, ticlopidine.
    • Inhibit platelet aggregation, preventing platelet plug formation.
    • Block platelet adhesion, preventing the plug from attaching to blood vessel walls.
    • Mechanism: Inhibit ADP-induced platelet activation.
    • Clinical Indications:
      • Prevention of heart attack, stroke, angina.
      • Reduce clots and prevent thrombi.
      • Avoid reinfarction after myocardial infarction.
      • Intermittent claudication (leg pain).
    • Adverse Effects: Headache, vomiting, rash, dizziness, diarrhea.
    • Chelators: These drugs bind to calcium, inhibiting coagulation and preventing clot formation.

    Anticonvulsant/Antiepileptic Drugs

    • Anticonvulsants:
      • Administered IM or IV.
      • Terminate convulsive seizures.
    • Antiepileptic Drugs:
      • Administered orally.
      • Prevent epileptic seizures.
      • Decrease brain cell excitability.
      • Interactions:
        • Carbamazepine and phenytoin induce microsomal enzymes, increasing drug metabolism and reducing drug effects.
        • Valproic acid inhibits enzymes, increasing effects of drugs requiring microsomal metabolism.
        • Phenytoin and valproic acid are highly protein-bound, increasing free drug concentrations and pharmacological effects.
    • Most used antiepileptic drugs for:
      • Absence seizures
      • Generalized tonic-clonic seizures
      • Partial seizures
      • Bipolar disorder

    Prostacyclin

    • A product of the cyclooxygenase pathway released from blood vessel membranes.
    • Counteracts thromboxane by dilating vessels and inhibiting platelet aggregation.

    Anticholinergic Drugs

    • Benztropine: Used to treat Parkinson's disease by restoring balance between ACh and dopamine.
    • Adverse Effects: Decrease parasympathetic activity: dry mouth, constipation, urinary retention, rapid heartbeat, pupillary dilation.

    Blood Tests for Anticoagulant Monitoring

    • PPT (Partial Thromboplastin Time): Measures the time it takes for blood plasma to clot.
    • PT (Prothrombin Time): Measures the time it takes for prothrombin to convert to thrombin.
    • INR (International Normalized Ratio): Calibrates commercial rabbit thromboplastins against a human reference standard.
    • APTT (Activated Partial Thromboplastin Time): Used most frequently to assess heparin's effect. Performed 1 hour before the next heparin dose, on a non-IV line arm.
    • LMW Drugs Assessment: Routine total blood and platelet counts.
    • Warfarin Monitoring: PT or INR (target INR 2-3 for those taking warfarin).

    Heparin Classes

    • Standard (unfractionated): Contains the full complement of saccharides of endogenous heparin.
      • Advantage: Depresses platelet aggregation, inactivates factor 13 (fibrin-stabilizing factor) and binds thrombin (factor 2).
      • Indications: Prevent clotting during cardiovascular surgery, transfusions, and dialysis.
    • LMW (Low-molecular-weight): Derived from porcine heparin, containing only an active anticoagulant fraction of heparin.
      • Interfere with the coagulation cascade, but to a lesser extent than standard heparin.
      • Administered subcutaneously.
      • Advantage: 90% bioavailability, dosed based on body size without routine coagulation monitoring.
      • Black Box Warning: Risk of epidural/spinal hematomas when used with epidural/spinal anesthesia.
      • Indications: Prevent DVT in abdominal surgery (dalteparin), knee and hip replacement surgery (enoxaparin).

    ESA (Erythropoietin Stimulating Agent)

    • Mircera:
      • Mechanism: Stimulates red blood cell production.
      • Clinical Indication: Treat anemia.

    Signs/Symptoms of Generalized Seizures

    • Pupillary dilation (mydriasis).

    Valproic Acid

    • Indication: All types of epilepsy, particularly:
      • Absence seizures
      • Generalized tonic-clonic seizures
      • Partial seizures
      • Bipolar disorder
    • Mechanism:
      • Decreases sodium ion influx, inhibiting high-frequency neuronal firing.
      • Blocks excitatory glutamate (NMDA).
      • Increases inhibitory effects of GABA.
    • Pharmacokinetics: Produces little sedation.
    • Adverse Effects:
      • Nausea, vomiting, diarrhea, tremor.
      • Serious: Fatal liver toxicity.
      • Pregnancy: Category D drug (potential risk to fetus).

    Mircera

    • Indication:
    • Mechanism:
    • Pharmacokinetics:
    • Adverse Effects:

    Oxazolidinediones

    • Trimethadione is the main drug in this class.
    • Indication: Absence seizures.
    • Mechanism: Reduction of type-T calcium currents.
    • Pharmacokinetics: More toxic than succinimides.
    • Adverse Effects:
      • Hemeralopia ("snow blindness").
      • Hypersensitivity (rashes, blood disorders).

    Selegiline

    • MAO-B inhibitor (can be added to levodopa treatment).
    • Indication: Early stages of Parkinson's disease to slow progression.
    • Mechanism: Inhibits dopamine metabolism in the brain, increasing the concentration and duration of action of dopamine.
      • Dopamine metabolism is mediated by the enzyme MAO-B.
    • Administration: Oral, with meals.
      • Used in combination with levodopa.
    • Adverse Effects: Dizziness, hallucinations, abdominal pain.

    Warfarin

    • Vitamin K antagonist.
    • Slow Onset: 12-72 hours.
    • Long Duration of Action: 2-10 days.
    • Dietary Vitamin K: Affects warfarin activity.
    • Administration: Oral.
    • Metabolism: Highly bound to plasma proteins, metabolized by the liver.
    • Contraindication: Vitamin K deficient patients.

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    Description

    This quiz covers various medications used in the treatment of epilepsy and related conditions, including Valproic Acid and Oxazolidinediones. It explores mechanisms of action, side effects, and clinical considerations. Test your knowledge of these pharmacological agents and their implications in patient care.

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