Pharmacology: Valproic Acid & Mircera
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Questions and Answers

What is the mechanism of action of Mircera in treating anemia associated with chronic kidney disease?

  • Stimulates production of RBCs and hemoglobin by blocking iron absorption
  • Interacts with the erythropoietin receptor to stimulate RBC production (correct)
  • Directly increases iron levels in the bloodstream
  • Inhibits the breakdown of erythropoietin to increase RBC production

    • What is a significant pharmacokinetic property of warfarin?

  • Long duration of action lasting several days (correct)
  • Administered only via intravenous routes
  • Not affected by dietary factors
  • Rapid onset of action within hours

    • Which of the following is NOT a common adverse effect of valproic acid?

  • Tremor
  • Hemeralopia (correct)
  • Nausea
  • Diarrhea

    • When is selegiline indicated in treatment protocols?

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

    What effect does dietary vitamin K have on warfarin therapy?

    <p>Decreases the effectiveness of warfarin</p> Signup and view all the answers

    What is a common characteristic of benzodiazepines when used in the context of seizures?

    <p>Provide rapid anticonvulsant effects with minimal sedation</p> Signup and view all the answers

    Which of the following is NOT a documented adverse effect of Mircera?

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

    What mechanism does trimethadione, an oxazolidinedione drug, use to control absence seizures?

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

    Which type of seizure involves limited areas of the brain and does not cause loss of consciousness?

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

    What is the main effect of antiplatelet drugs?

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

    Which neurotransmitter is released from the corpus striatum and has an excitatory effect?

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

    What is a common adverse effect of antiplatelet medications?

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

    Which drug interaction is recommended when taking aspirin and ibuprofen?

    <p>Take aspirin first, then ibuprofen</p> Signup and view all the answers

    What do anticonvulsant drugs primarily aim to do?

    <p>Terminate convulsive seizures</p> Signup and view all the answers

    Which of the following is an example of an anticonvulsant medication?

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

    What is the role of dopamine as a neurotransmitter?

    <p>Inhibitory from the corpus striatum</p> Signup and view all the answers

    Which characteristic is typical of complex partial seizures?

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

    How do antiepileptic drugs primarily function?

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

    What is the primary function of hemoglobin in the body?

    <p>Transport oxygen to all tissues</p> Signup and view all the answers

    What is the mechanism of action of erythropoietin?

    <p>Stimulates production of RBCs in the bone marrow</p> Signup and view all the answers

    What is the primary role of vitamin K in the coagulation pathway?

    <p>It is required for synthesizing many factors, especially prothrombin</p> Signup and view all the answers

    How is vitamin K administered?

    <p>Intramuscularly or subcutaneously</p> Signup and view all the answers

    What characterizes a tonic-clonic seizure?

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

    Which of the following is a common adverse effect of phenytoin?

    <p>Gingival hyperplasia</p> Signup and view all the answers

    What happens during the clot resolution stage of coagulation?

    <p>Conversion of plasminogen to plasmin</p> Signup and view all the answers

    What is a key consideration when administering levodopa?

    <p>It should be taken on an empty stomach to avoid amino acid interference</p> Signup and view all the answers

    What type of anemia is indicated by the term 'hypochromic'?

    <p>Anemia with paler than normal RBCs</p> Signup and view all the answers

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

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

    What is a common characteristic of absence seizures?

    <p>Causes loss of consciousness</p> Signup and view all the answers

    Which type of plaque is considered unstable and can be dangerous?

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

    What is indicated by hematuria?

    <p>Blood in urine</p> Signup and view all the answers

    What describes the term 'status epilepticus'?

    <p>Continuous series of generalized seizures without interruption</p> Signup and view all the answers

    Which stage of coagulation involves thromboplastin converting prothrombin to thrombin?

    <p>Stage 2</p> Signup and view all the answers

    Which of the following medications is the drug of choice for absence seizures?

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

    What is the mechanism of action for barbiturates in treating seizures?

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

    Which medication is often used as an alternative for both generalized and partial seizures?

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

    How are triglycerides transported in the bloodstream after being absorbed from the diet?

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

    What should you do to safely withdraw a patient from phenobarbital treatment?

    <p>Gradually decrease the dose</p> Signup and view all the answers

    Which factor is necessary for the formation of blood clots and is released by platelets?

    <p>Thromboxane A2</p> Signup and view all the answers

    When measuring triglycerides, which condition must be adhered to for accurate results?

    <p>Patient must be fasting for 24 hours</p> Signup and view all the answers

    What type of heparin is preferred for use during pregnancy?

    <p>Low molecular weight heparin</p> Signup and view all the answers

    Which of the following is primarily transported by VLDL after being produced in the liver?

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

    What task do platelets perform when an injury occurs?

    <p>Migrate to the injury site and adhere</p> Signup and view all the answers

    What serious adverse effect is specifically associated with valproic acid?

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

    Which drug is indicated for treating absence seizures?

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

    How does Mircera function to treat anemia in chronic kidney disease?

    <p>Stimulates RBC and hemoglobin production</p> Signup and view all the answers

    What is the main action of selegiline in the treatment of Parkinson's disease?

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

    What potential side effect is associated with the use of oxazolidinediones like trimethadione?

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

    What is a characteristic of unstable plaque?

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

    Which stage comes directly after thromboplastin production in the coagulation process?

    <p>Conversion of prothrombin to thrombin</p> Signup and view all the answers

    What occurs during generalized tonic-clonic seizures?

    <p>Increased heart rate and loss of consciousness</p> Signup and view all the answers

    What is the primary component of a blood clot?

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

    What does hematuria indicate?

    <p>Blood in the urine</p> Signup and view all the answers

    Which type of seizure is characterized by brief impairments of consciousness without motor convulsions?

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

    What does the term 'hypochromic' refer to in relation to red blood cells?

    <p>Loss of color in red blood cells</p> Signup and view all the answers

    What is the role of vitamin K in the coagulation pathway?

    <p>Synthesizes many clotting factors</p> Signup and view all the answers

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

    <p>Both A and C</p> Signup and view all the answers

    Which of the following is an adverse effect of anticholinergic drugs?

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

    Which blood test is primarily used to monitor the effect of heparin?

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

    What condition is monitored using the INR test for patients on warfarin?

    <p>Coagulation status</p> Signup and view all the answers

    Which class of heparin contains the full complement of saccharides of endogenous heparin?

    <p>Unfractionated heparin</p> Signup and view all the answers

    What is a common method of administration for heparin?

    <p>Intravenous line</p> Signup and view all the answers

    What is a potential effect of heparin on platelets?

    <p>Decrease in platelet aggregation</p> Signup and view all the answers

    What is the therapeutic goal of administering benztropine?

    <p>Restore balance between acetylcholine and dopamine</p> Signup and view all the answers

    Which factor is the target of the anticoagulant action of standard heparin?

    <p>Factor II (thrombin)</p> Signup and view all the answers

    What is the recommended INR range for patients being treated with warfarin?

    <p>2-3</p> Signup and view all the answers

    What characterizes a simple partial seizure?

    <p>Can be sensory or motor in nature</p> Signup and view all the answers

    What is the primary clinical use of antiplatelet drugs?

    <p>To prevent formation of thrombi</p> Signup and view all the answers

    Which neurotransmitter is classified as inhibitory and originates from the substantia nigra?

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

    Which characteristic is typically associated with complex partial seizures?

    <p>No memory of the event</p> Signup and view all the answers

    What effect do antiepileptic drugs primarily have on brain activity?

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

    What action is taken when co-administering aspirin and ibuprofen?

    <p>Aspirin first, then ibuprofen</p> Signup and view all the answers

    Which of the following adverse effects is commonly associated with antiplatelet medications?

    <p>Headache and dizziness</p> Signup and view all the answers

    Which statement regarding anticonvulsant medications is TRUE?

    <p>They must be administered IM or IV to terminate seizures</p> Signup and view all the answers

    What effect do chelator drugs have on coagulation?

    <p>Prevent coagulation by binding calcium</p> Signup and view all the answers

    Which action is NOT a function of antiplatelet drugs?

    <p>Blocking calcium in coagulation</p> Signup and view all the answers

    What is the primary benefit of adding carbidopa to levodopa treatment?

    <p>It inhibits DOPA carboxylase, increasing levodopa's availability in the brain.</p> Signup and view all the answers

    What condition is entacapone primarily used to treat?

    <p>Parkinson's disease.</p> Signup and view all the answers

    Which of the following describes a common adverse effect of trimethadione?

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

    What era of Parkinson’s treatment primarily utilized anticholinergic drugs?

    <p>Prior to the development of levodopa therapies.</p> Signup and view all the answers

    Which component primarily makes up Sinemet?

    <p>Levodopa and carbidopa.</p> Signup and view all the answers

    What mechanism is employed by benztropine in the treatment of Parkinson's?

    <p>It reduces cholinergic activity to restore balance.</p> Signup and view all the answers

    Which statement about levodopa treatment for younger patients is accurate?

    <p>Levodopa is often avoided until symptoms are severe.</p> Signup and view all the answers

    Which of the following adverse effects can be caused by COMT inhibitors like entacapone?

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

    Why is trimethadione considered less popular in modern prescriptions?

    <p>High risk of adverse effects and toxicities.</p> Signup and view all the answers

    Which effect can high doses of anticholinergic drugs result in?

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

    What is a significant adverse effect associated with valproic acid?

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

    What is the primary indication for the use of Mircera?

    <p>Treatment of anemia in chronic kidney disease</p> Signup and view all the answers

    Which mechanism is primarily responsible for the action of selegiline in Parkinson's disease?

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

    What is a common adverse effect of the oxazolidinediones, specifically trimethadione?

    <p>Snow blindness</p> Signup and view all the answers

    Which of the following pharmacokinetic properties is true of warfarin?

    <p>Highly bound to plasma proteins</p> Signup and view all the answers

    What is a primary clinical indication for administering heparin?

    <p>Deep vein thrombosis prevention</p> Signup and view all the answers

    Which of the following properties of heparin contributes to its antihyperlipidemic effect?

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

    What is the typical duration of action for intravenous heparin?

    <p>2-5 hours</p> Signup and view all the answers

    Which factor does heparin primarily increase the activity of?

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

    What is one of the major adverse effects associated with heparin use?

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

    Which type of heparin is preferred for use during pregnancy?

    <p>Low molecular weight heparin</p> Signup and view all the answers

    Transient ischemic attack is characterized by which of the following?

    <p>Interruption of blood flow for a short duration</p> Signup and view all the answers

    Which of the following statements about heparin is NOT true?

    <p>Heparin is a synthetic anticoagulant</p> Signup and view all the answers

    What characterizes complex partial seizures?

    <p>Involves purposeless movements and the patient has no memory of the event</p> Signup and view all the answers

    What is the primary function of antiplatelet drugs?

    <p>To inhibit clot formation by blocking platelet adhesion</p> Signup and view all the answers

    How do antiepileptic drugs primarily function?

    <p>By decreasing brain cell excitability to prevent seizures</p> Signup and view all the answers

    Which neurotransmitter is primarily inhibitory and is sourced from the substantia nigra?

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

    What common adverse effect can be associated with antiplatelet medications?

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

    Which combination is recommended regarding the administration of aspirin and ibuprofen?

    <p>Take aspirin first, then ibuprofen</p> Signup and view all the answers

    What is a notable characteristic of anticonvulsant medications?

    <p>They can terminate convulsive seizures when administered intravenously</p> Signup and view all the answers

    Which drug is known to inhibit enzymes and increase the effects of other drugs requiring microsomal metabolism?

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

    What is the main role of chelator drugs in the context of coagulation?

    <p>To bind calcium and interrupt the coagulation process</p> Signup and view all the answers

    What type of seizure might progress from a complex partial seizure to become tonic-clonic?

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

    What is the main difference between stable and unstable plaque?

    <p>Stable plaque may contain calcium, while unstable plaque has a thin cap.</p> Signup and view all the answers

    Which factor is essential for synthesizing prothrombin in the coagulation pathway?

    <p>Vitamin K</p> Signup and view all the answers

    What characterizes a tonic-clonic seizure?

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

    What is the primary role of thromboplastin in the coagulation process?

    <p>To convert prothrombin to thrombin.</p> Signup and view all the answers

    What describes the term 'hematuria'?

    <p>Presence of blood in urine.</p> Signup and view all the answers

    Which statement about generalized seizures is true?

    <p>They encompass both tonic-clonic and absence seizures.</p> Signup and view all the answers

    What is a possible effect following a tonic-clonic seizure?

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

    What is the primary effect of plasmin in clot resolution?

    <p>It acts on fibrin elements to produce a soluble product.</p> Signup and view all the answers

    What distinguishes absence seizures from other types of generalized seizures?

    <p>They primarily manifest as a loss of consciousness.</p> Signup and view all the answers

    What defines 'hypochromic' anemia?

    <p>Red blood cells that are paler than normal.</p> Signup and view all the answers

    What triggers the need for erythropoietin administration?

    <p>Chronic renal failure</p> Signup and view all the answers

    What is a primary mechanism of phenytoin in seizure management?

    <p>Prolong inactivation of Na+ channels</p> Signup and view all the answers

    Which adverse effect is commonly associated with levodopa?

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

    For which condition is lorazepam recommended as the drug of choice?

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

    Which pharmacokinetic property is essential to note when administering erythropoietin?

    <p>Intravenous or subcutaneous, not mixed with other solutions</p> Signup and view all the answers

    What is a significant adverse effect of using diazepam?

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

    How does vitamin K function as an antidote to Warfarin?

    <p>Stimulates prothrombin synthesis</p> Signup and view all the answers

    What serious condition is linked to the prolonged use of phenytoin?

    <p>Birth defects</p> Signup and view all the answers

    What is a key consideration when taking levodopa?

    <p>Never mix with antipsychotics or MAO inhibitors</p> Signup and view all the answers

    What is the primary role of GABA in relation to benzodiazepines?

    <p>Increase inhibitory effects</p> Signup and view all the answers

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

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

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

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

    Which group of patients is typically started on other drugs instead of levodopa?

    <p>Patients younger than 65</p> Signup and view all the answers

    What condition is primarily treated with trimethadione?

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

    What symptom does benztropine primarily aim to reduce in Parkinson's patients?

    <p>Muscular rigidity</p> Signup and view all the answers

    Which medication is the drug of choice for treating absence seizures?

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

    What is the primary function of triglycerides in the body?

    <p>Provide energy</p> Signup and view all the answers

    Which of the following medications is indicated for use during status epilepticus?

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

    What happens to triglycerides when lipids are not available in the diet?

    <p>The liver produces triglycerides</p> Signup and view all the answers

    Which of the following is NOT a common indication for the use of phenobarbital?

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

    Which component of platelets is responsible for constricting blood vessels during injury?

    <p>Thromboxane A2</p> Signup and view all the answers

    What is the significance of measuring triglycerides from fasting blood samples?

    <p>Eliminates interference from alcohol consumption</p> Signup and view all the answers

    What is the appropriate method for withdrawing a patient from barbiturate treatment?

    <p>Gradually decrease the dose</p> Signup and view all the answers

    What is the primary role of prostacyclin in the bloodstream?

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

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

    <p>Dry mouth</p> Signup and view all the answers

    What blood test is most frequently used to assess the effect of heparin?

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

    Which of the following statements about low molecular weight (LMW) drugs is true?

    <p>Routine total blood and platelet counts are used for monitoring.</p> Signup and view all the answers

    What is the mechanism by which unfractionated heparin affects blood coagulation?

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

    Which of the following interventions is recommended for taking blood samples for APTT?

    <p>Take the sample one hour after heparin administration.</p> Signup and view all the answers

    For patients taking warfarin, what is the standard therapeutic range for INR?

    <p>2-3</p> Signup and view all the answers

    What is an indication of using prothrombin time (PT) testing?

    <p>Monitoring patients on warfarin therapy</p> Signup and view all the answers

    What effect do anticholinergic drugs generally have on the body?

    <p>Decrease parasympathetic activity</p> Signup and view all the answers

    What is a major advantage of using low molecular weight heparin (LMWH) over standard heparin?

    <p>Higher bioavailability and no coagulation monitoring needed</p> Signup and view all the answers

    Which of the following is a risk associated with the administration of LMWH?

    <p>Epidural or spinal hematomas with concomitant anesthesia</p> Signup and view all the answers

    What is a defining characteristic of Mircera as an erythropoietin stimulating agent?

    <p>It has the longest half-life of all ESAs</p> Signup and view all the answers

    What describes a tonic-clonic seizure?

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

    Which symptom is NOT typically associated with absence seizures?

    <p>Muscle rigidity</p> Signup and view all the answers

    What is the main characteristic of complex partial seizures?

    <p>They may include purposeless repetitive movements.</p> Signup and view all the answers

    Which feature distinguishes myoclonic seizures from other types?

    <p>Muscle contractions confined to a specific part of the body</p> Signup and view all the answers

    Which of the following is a clinical indication for antiplatelet drugs?

    <p>To prevent heart attack or stroke.</p> Signup and view all the answers

    What is a common complication associated with the later stages of Parkinson’s disease?

    <p>Wheelchair dependence due to postural instability</p> Signup and view all the answers

    How does low molecular weight heparin (LMWH) differ from standard heparin in its mechanism?

    <p>Only contains the active anticoagulant fraction of heparin</p> Signup and view all the answers

    What is a common side effect associated with antiplatelet medications?

    <p>Nausea or vomiting.</p> Signup and view all the answers

    Which of the following describes bradykinesia in the context of Parkinson's disease?

    <p>Extreme slowness of movement</p> Signup and view all the answers

    How do anticonvulsant drugs primarily function?

    <p>By reducing excitability of brain cells.</p> Signup and view all the answers

    What is a common effect of a generalized seizure?

    <p>Loss of bladder control during the event</p> Signup and view all the answers

    Which neurotransmitter is classified as inhibitory and originates from the substantia nigra?

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

    What is the primary purpose of chelator drugs in the context of coagulation?

    <p>To bind calcium and interrupt coagulation.</p> Signup and view all the answers

    Which class of drugs is administered to terminate convulsive seizures?

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

    What is a common interaction to consider when taking aspirin and ibuprofen?

    <p>Take aspirin first, then ibuprofen.</p> Signup and view all the answers

    Which antiepileptic drug interaction can lead to reduced drug effectiveness?

    <p>Carbamazepine with phenobarbital.</p> Signup and view all the answers

    What characterizes simple partial seizures?

    <p>They are brief and involve a limited brain area.</p> Signup and view all the answers

    Study Notes

    Pupillary Dilation (Mydriasis)

    • Dilated pupils are associated with various conditions, including drug use, neurological disorders, and eye trauma.

    Valproic Acid (Depakote)

    • Treats all types of epilepsy, especially absence seizures, generalized tonic-clonic seizures, and partial seizures.
    • Also used for bipolar disorder (BPD).
    • Mechanism of action:
      • Decreases sodium (Na+) ion influx, inhibiting high-frequency neuronal firing.
      • Blocks excitatory glutamate (NMDA) receptors.
      • Increases inhibitory effects of GABA.
    • Pharmacokinetics: Produces little sedation.
    • Adverse effects:
      • Nausea, vomiting, diarrhea, tremor.
      • Serious risk: Fatal liver toxicity.
      • Pregnancy Category D drug due to birth defect risks.

    Mircera (Methoxy polyethylene glycol-epoetin beta)

    • Treats anemia associated with chronic kidney disease.
    • Mechanism of action: Interacts with the erythropoietin receptor on bone marrow cells, stimulating red blood cell (RBC) and hemoglobin production.
    • Pharmacokinetics: Administered intravenously (IV) or subcutaneously (SC).
    • Adverse effects:
      • Hypertension (HTN), allergic reactions, myocardial infarction (MI), stroke, embolism, and seizures.

    Oxazolidinediones

    • The main drug in this class is Trimethadione.
    • Treats absence seizures (petit mal).
    • Mechanism of action: Reduces type-T calcium currents.
    • Pharmacokinetics: More toxic than succinimides.
    • Adverse effects:
      • Hemeralopia ("snow blindness").
      • Hypersensitivity reactions, including rashes and blood disorders.

    Selegiline (Deprenyl)

    • An MAO-B inhibitor used in early Parkinson's disease to slow progression.
    • Mechanism of action: Inhibits the metabolism of dopamine in the brain, increasing its concentration and duration of action.
      • Dopamine is metabolized by the enzyme MAO-B.
    • Pharmacokinetics:
      • Administered orally with meals.
      • Often used in combination with levodopa.
    • Adverse effects:
      • Dizziness, hallucinations, and abdominal pain.

    Warfarin (Coumadin)

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

    Hemoglobin

    • Function: Transports oxygen to all tissues in the body.
    • A protein found in red blood cells (RBCs) responsible for their red color.

    Plaque Types

    • Stable plaque:
      • Cholesterol core with a fibrous cap that may contain calcium.
      • Less prone to rupture.
    • Unstable plaque:
      • Cholesterol core with a thin cap.
      • Dangerous because the cap can erode, break away, and form a clot.

    Thromboplastins

    • Stage 1 of the coagulation cascade.
    • Produced by both intrinsic and extrinsic factors.
    • Intrinsic pathway requires multiple clotting factors and platelets, while the extrinsic pathway only needs factor 12 and tissue extract.
    • Once thromboplastins are produced, the clotting process continues automatically.
    • Stage 2: Thromboplastin converts prothrombin to thrombin.
    • Stage 3: Thrombin converts fibrinogen to fibrin, the primary component of a blood clot, and activates clotting factors, forming a fibrin mesh that holds platelets together.
    • Stage 4: Clot resolution: Plasmin, formed from the conversion of plasminogen by tissue plasminogen activator (tPA), acts on fibrin elements to produce a more soluble product.
    • Vitamin K is essential for synthesizing many coagulation factors, especially prothrombin (factor II).
    • Hemostasis: The balance between clot formation and clot breakdown that occurs throughout the day.

    Hematuria

    • Blood in the urine.

    Hypochromic

    • Anemia characterized by RBCs that are paler than normal.

    Hemanitic

    • Medications containing iron compounds used to increase hemoglobin production.

    Generalized Seizures

    • Involve both hemispheres of the brain.
    • Tonic-clonic seizures (grand mal):
      • Alternating muscle contractions and relaxations.
      • Loss of consciousness, often accompanied by:
        • Jerking movements, increased heart rate and blood pressure, urination, defecation, and tongue biting.
      • Typically last several minutes followed by confusion, fatigue, and muscle soreness.
    • Status epilepticus:
      • Continuous series of generalized tonic-clonic seizures without interruption, considered a medical emergency requiring immediate treatment.
    • Absence seizures (petit mal):
      • Generalized seizures that do not involve motor convulsions.
      • Effect on consciousness: Brief impairment of consciousness, often characterized by staring into space or rapid eye blinking for seconds to a minute.
      • Effect on motor activity: None; the individual continues as if nothing happened.

    Partial Seizures

    • Localized to a specific area of the brain.
    • Simple partial seizures:
      • Involve a limited area of the brain.
      • Sensory or motor in nature.
      • Brief; no loss of consciousness.
    • Complex partial seizures:
      • Impairment of consciousness.
      • May involve the entire body.
      • Purposeless, non-goal-directed movements, such as lip smacking or repetitive movements.
      • The patient does not remember the event.
      • Can spread to other brain areas and become tonic-clonic.

    Dopamine

    • An inhibitory neurotransmitter produced by the substantia nigra.

    Acetylcholine (ACh)

    • An excitatory neurotransmitter produced by the corpus striatum.

    Antiplatelet Drugs

    • Examples: Aspirin, dipyridamole, clopidogrel, ticlopidine.
    • Inhibit platelet aggregation, preventing the formation of a platelet plug or blocking platelet adhesion to the blood vessel wall, ensuring blood flow is not blocked.
    • Make platelets less sticky by inhibiting adenosine diphosphate (ADP).
    • Clinical indications:
      • Help prevent heart attacks, stroke, and angina.
      • Reduce clots and prevent thrombi.
      • Prevent reinfarction following a myocardial infarction (MI).
      • Treat intermittent claudication.
    • Adverse effects: Headache, vomiting, rash, dizziness, and diarrhea.

    Chelators

    • Inhibit coagulation by binding calcium (Ca+), interrupting the clotting process.

    Anticonvulsant/Antiepileptic Drugs

    • Anticonvulsants:
      • Administered intramuscularly (IM) or intravenously (IV).
      • Terminate convulsive seizures.
      • Some barbiturates (anticonvulsant) are also antiepileptic, such as phenobarbital and mephobarbital, but their sedative and hypnotic effects are not desirable for epilepsy treatment. Tolerance to these effects develops with chronic use.
    • Antiepileptic drugs:
      • Administered orally.
      • Prevent epileptic seizures.
      • Decrease the excitability of brain cells, reducing epilepsy.
      • Drug interactions:
        • Carbamazepine and phenytoin cause microsomal enzyme induction, increasing the rate of metabolism and reducing drug effects.
        • Valproic acid inhibits these enzymes, increasing the effects of drugs that require microsomal metabolism.
        • Phenytoin and valproic acid are highly protein-bound, increasing the free drug concentration and leading to greater pharmacological effects.
    • Commonly used antiepileptic drugs for different seizure types:
      • Tonic-clonic: phenobarbital, phenytoin, valproic acid, carbamazepine.
      • Partial seizures: phenytoin, carbamazepine, valproic acid.
      • Absence seizures: Ethosuximide (drug of choice, especially for children), trimethadione, valproic acid.
      • Status epilepticus: Clonazepam, diazepam, phenytoin.

    Barbiturates

    • Mechanism of action: Increase the excitatory effects of GABA, suppressing the excitability of epileptogenic neurons and making them less likely to trigger a seizure.
      • Also decreases glutamate release.
    • Indication: Phenobarbital is used as an alternative to other preferred drugs for treating both generalized and partial seizures.
      • Phenobarbital is considered one of the safest anti-seizure drugs and is often used in infants.
    • When withdrawing from barbiturates, gradually decrease the dose.

    Triglycerides

    • The main form of fat from the diet.
    • Provide energy to the body.
    • The body converts calories into triglycerides, which are then stored in adipose tissue (fat cells).
    • Chylomicrons transport dietary (exogenous) cholesterol and triglycerides.
    • Triglycerides are hydrolyzed by lipoprotein lipase, releasing free fatty acids that are used by muscles or stored as fat.
    • When lipids are not available, the liver produces triglycerides, packaging them into VLDL.
    • Triglycerides transported by VLDL are hydrolyzed by lipoprotein lipase to provide energy to target tissues.
    • Triglyceride levels are measured from fasting blood samples, meaning the patient has not had alcohol for 24 hours. Serum samples are preferred because they have the greatest concentration of cholesterol and triglycerides for measurement. Serum is the fluid remaining after blood clots.

    Low Molecular Weight (LMW) Heparin

    • Preferred anticoagulant drug during pregnancy because it does not cross the placenta.

    Platelets/Thrombocytes

    • Thrombocytes are blood cells (platelets) essential for coagulation.
    • When injury occurs, platelets migrate to the site, sticking to each other and the vessel wall.
    • When platelets release Thromboxane A2, it constricts blood vessels, slowing blood flow and giving the platelets time to aggregate and adhere to the vessel wall, forming a platelet plug.

    Erythropoietin (EPO)

    • Indication: Chronic renal failure, cancer chemotherapy, and dialysis patients with confirmed anemia based on hematocrit and hemoglobin levels.
    • Mechanism of action: Stimulates RBC production in the bone marrow, providing more vehicles to transport oxygen to tissues, improving oxygenation.
    • Pharmacokinetics: Administered IV or SC; should not be added to another drug solution.
    • Adverse effects: Headache, arthralgia (joint pain), nausea, HTN, diarrhea.

    Vitamin K (Phytonadione) or Mephyton (oral formulation)

    • Indication: Antidote for Warfarin (Coumadin).
    • Mechanism of action: Replenishes vitamin K, which is essential for the synthesis of clotting factors that warfarin blocks.
    • Pharmacokinetics: Administered IM or SC.
    • Adverse effects: Rare, generally mild, and may include allergic reactions.

    Phenytoin (Dilantin)

    • The most important drug from the Hydantoins class.
    • Indication:
      • All types of partial seizures and tonic-clonic generalized seizures (drug of choice for tonic-clonic).
      • Used for various epilepsy types and produces little sedation.
    • Mechanism of action:
      • Affects the activity of neuron ion channels (Na+, K+, Ca+) and neurotransmitter functions.
        • Primary effect: Prolongs the inactivation of Na+ channels in the nerve membrane, reducing the generation of high-frequency repetitive action potential firing by neurons involved in initiating seizures.
      • Increases GABA release and decreases glutamate release.
    • Pharmacokinetics: Administered IV.
    • Adverse effects:
      • Dizziness, ataxia (impaired coordination), visual disturbances, postural imbalance, hirsutism (excessive hair growth), skin rashes, and gingival hyperplasia (enlarged gums).
      • Associated with birth defects.

    Diazepam (Valium)

    • A benzodiazepine.
    • Indication: Tonic-clonic seizures and status epilepticus.
      • Equally as effective as lorazepam but has a shorter duration of action when administered IV, possibly requiring additional administration.
    • Mechanism of action: Increases the inhibitory effects of GABA.
    • Pharmacokinetics: Administered IV.
    • Adverse effects: Drowsiness, confusion, ataxia (impaired coordination), minor GI disturbances, and rashes.

    Lorazepam (Ativan)

    • A benzodiazepine.
    • Indication: Tonic-clonic seizures and status epilepticus (drug of choice for status epilepticus).
    • Mechanism of action: Increases the inhibitory effects of GABA.
    • Pharmacokinetics: Administered IV.
      • If necessary, can be followed with IV phenytoin.
    • Adverse effects: Drowsiness, confusion, ataxia (impaired coordination), minor GI disturbances, and rashes.

    Levodopa

    • The most effective drug available for Parkinson's disease, used for mild to moderate and advanced disease.
    • Mechanism of action:
      • Precursor of dopamine; it crosses the blood-brain barrier and is converted to dopamine.
        • Dopamine typically does not cross the blood-brain barrier.
    • Pharmacokinetics:
      • Administered orally on an empty stomach since amino acids (protein) can interfere with the absorption of levodopa across the blood-brain barrier.
      • Administered with carbidopa, which inhibits DOPA decarboxylase.
        • DOPA decarboxylase converts levodopa to dopamine peripherally, minimizing dopamine conversion before it can reach the brain and maximizing the amount that crosses the blood-brain barrier.
        • Carbidopa does not cross the blood-brain barrier, preventing the conversion of levodopa to dopamine in the basal ganglia.
        • Co-administration of carbidopa with levodopa allows for lower doses of levodopa, reducing adverse effects.
    • Adverse effects:
      • Nausea, vomiting, loss of appetite (anorexia).
      • Orthostatic hypotension or fainting (low blood pressure upon standing).
      • Behavioral disturbances.
      • Dyskinesias and dystonias (involuntary movements).
      • On-off phenomenon (periods of immobility and mobility).
      • Rapid/irregular heartbeat (beta-receptor stimulation).

    Important Notes Regarding Levodopa Use

    • Levodopa should not be taken with antipsychotic or antidepressant medications (MAO inhibitors) because they block dopamine receptors and can lead to high levels of norepinephrine (NE), causing hypertensive crises and other adverse effects.
    • Vitamin B6 should not be taken with levodopa since it increases peripheral conversion of levodopa to dopamine, diminishing the amount reaching the brain.

    Bile Salts

    • Component of bile salts

    Hemoglobin

    • Transports oxygen to all tissues of the body
    • Protein found in red blood cells (RBCs)
    • Gives RBCs their red color

    Types of Plaque

    • Stable: Cholesterol core with fibrous cap. May contain calcium.
    • Unstable: Cholesterol core with thin cap. The cap can erode and break away, forming a clot.

    Thromboplastins

    • Produced by intrinsic and extrinsic factors:
      • Intrinsic - Requires many clotting factors and platelets
      • Extrinsic - Requires only factor 12 and tissue extract
    • Once produced, clotting proceeds automatically.
    • Stage 2: Thromboplastin converts prothrombin to thrombin.
    • Stage 3: Thrombin converts fibrinogen to fibrin, the primary element of a blood clot. Activated clotting factors build a fibrin mesh to hold platelets together.
    • Stage 4: Clot resolution. Plasmin, formed from the conversion of plasminogen by tPA, acts on fibrin elements to produce a more soluble product.
    • Vitamin K is required to synthesize many coagulation factors, particularly prothrombin (factor 2).

    Hemostasis

    • The balance between clot formation and clot breakdown.

    Hematuria

    • Blood in the urine

    Hypochromic

    • Any anemia where RBCs are paler than normal

    Hemanitic

    • Medications containing iron compounds. Used to increase hemoglobin production.

    Generalized Seizures

    • Involve both hemispheres of the brain
    • Tonic-Clonic (Grand Mal): Alternating muscle contractions and relaxations. Involves loss of consciousness.
      • Jerking movements caused by muscle contractions and relaxations
      • Increased heart rate, blood pressure, urination, defecation, and tongue biting
      • Seizure lasts several minutes. After the seizure, the individual experiences confusion, fatigue, and muscle soreness.
    • Status Epilepticus: Continuous series of generalized tonic and clonic seizures without interruption. A medical emergency requiring immediate treatment.
    • Absence Seizures (Petit Mal): Generalized seizure that does not involve motor convulsions.
      • Effect on consciousness: Brief impairment of consciousness. Staring into blank space or rapid eye blinking, lasting seconds to a minute.
      • Effect on motor activity: None. The individual proceeds as if nothing happened.

    Partial Seizures

    • Localized to a specific area of the brain
    • Types:
      • Simple Partial: Involves a limited area of the brain.
        • Can be sensory or motor in nature.
        • Brief. No loss of consciousness.
      • Complex Partial: Impairment of consciousness.
        • May involve the entire body.
        • Purposeless, not goal-directed.
        • Lip smacking, repetitive movements.
        • The patient does not remember the seizure.
        • Can spread to other areas of the body and become tonic-clonic.

    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. They can also block platelet adhesion, preventing the plug from attaching to the wall of a blood vessel and blocking blood flow.

    • Make platelets less sticky by inhibiting ADP.

    • Clinical Indications:

      • Help prevent heart attack, stroke, or angina.
      • Reduce clots and prevent thrombi.
      • Avoid reinfarction following a myocardial infarction (MI).
      • Intermittent claudication.

    • Adverse effects: Headache, vomiting, rash, dizziness, and diarrhea.

    Chelators

    • Inhibit coagulation by binding calcium ions (Ca+) and interrupting the coagulation process.

    Anticonvulsant / Antiepileptic Drugs

    • Anticonvulsant:
      • Administered intramuscularly (IM) or intravenously (IV).
      • Terminates convulsive seizures.
      • Includes barbiturate drugs (anticonvulsants). Some barbiturates (phenobarbital and mephobarbital) are also antiepileptic but have sedation and hypnotic effects. Tolerance to these effects develops with chronic use.
    • Antiepileptic Drugs:
      • Administered orally.
      • Prevent epileptic seizures.
      • Decrease the excitability of brain cells, reducing epilepsies.
      • Antiepileptic drug interactions:
        • Carbamazepine and phenytoin cause microsomal enzyme induction, increasing the rate of metabolism 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 producing greater pharmacologic effects.

    Prostacyclin

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

    Anticholinergic Drugs

    • Benztropine: An anticholinergic drug used to treat Parkinson's disease by restoring acetylcholine/dopamine balance.
    • Adverse effects: Decrease parasympathetic activity. 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 frequently used. Calibrates commercial rabbit thromboplastins against an international human reference standard.
    • APTT (Activated Partial Thromboplastin Time): Used to assess the effect of heparin. Performed 1 hour before the next dose of heparin. Should be taken on the arm without an IV line to avoid false results.
    • LMW drug assessment: Routine total blood and platelet counts.
    • Warfarin monitoring: PT or INR. The target INR for warfarin therapy is 2-3.

    Heparin Classes

    • Standard (Unfractionated Heparin): Contains the full complement of saccharides of endogenous heparin.
      • Advantage due to the additional chain of saccharides, which depresses platelet aggregation.
      • Inactivates factor 13 (fibrin-stabilizing factor) and binds thrombin (factor 2).
      • Indications:

    Levodopa (L-dopa)

    • Mechanism: Precursor to dopamine, crosses the blood-brain barrier, and is converted to dopamine within the brain.
    • Indication: Parkinson's disease.
    • Adverse effects:
      • Nausea, vomiting, orthostatic hypotension.
      • Development of dyskinesias (involuntary movements) with long-term use.
      • B6 (vitamin B6): May increase the metabolism rate of levodopa if the patient is not taking carbidopa with levodopa.
    • Levodopa therapy is often delayed in favor of other drugs until symptoms require more effective medications.
    • Levodopa is typically used for patients 65 years and older. Patients younger than 65 are usually started on other medications.

    Carbidopa

    • Mechanism: Inhibits DOPA decarboxylase, an enzyme that metabolizes levodopa before it can cross the blood-brain barrier. This increases the amount of levodopa that enters the brain.
    • Indication: Added to levodopa to enhance its effectiveness.
    • Pharmacokinetics: Administered with levodopa.

    Entacapone

    • Mechanism: Inhibits COMT (catechol-O-methyltransferase), an enzyme involved in the metabolism of dopamine both peripherally and in the brain, increasing the levels of levodopa that reach the brain.
    • Indication: Parkinson's disease.
    • Pharmacokinetics:
      • Administered with levodopa to increase drug levels and prolong the duration of action of dopamine.
    • Adverse effects:
      • Nausea, orthostatic hypotension, mental disturbances, dyskinesias.

    Trimethadione

    • Mechanism: Reduces type-T calcium currents in the thalamus.
    • Indication: Absence seizures.
    • Pharmacokinetics: More toxic than succinimides.
    • Adverse effects:
      • Hemeralopia ("snow blindness").
      • Hypersensitivity reactions, including rashes and blood disorders.
      • Liver and kidney damage.
    • Trimethadione is rarely prescribed today due to its higher incidence of adverse effects and toxicities.

    Sinemet

    • Combination of levodopa and carbidopa.
    • Most widely used drug preparation for Parkinson's disease.

    Benztropine

    • Anticholinergic drug.
    • Mechanism: Decreases the level of cholinergic activity. When there is a deficiency of dopamine in the basal ganglia, there is excess acetylcholine activity. Anticholinergic drugs act by blocking acetylcholine actions, restoring acetylcholine/dopamine balance.
    • Indication: Parkinson's disease. Used to reduce the symptoms of tremor and muscular rigidity. Before the development of levodopa, anticholinergic drugs were the primary treatment for Parkinson's disease. They are less effective than levodopa but produce a lower incidence of peripheral side and adverse effects.
    • Adverse effects: Decreased parasympathetic activity. Dry mouth, constipation, urinary retention, rapid heartbeat, and pupillary dilation (mydriasis).

    Valproic Acid

    • Mechanism: Decreases the influx of sodium ions, inhibiting high-frequency firing of neurons. It also blocks excitatory glutamate (NMDA) and increases the inhibitory effects of GABA.
    • Indication: All types of epilepsy, particularly absence seizures, generalized tonic-clonic seizures, partial seizures, and bipolar disorder.
    • Pharmacokinetics: Produces little sedation.
    • Adverse effects: Nausea, vomiting, diarrhea, tremor. Valproic acid can cause serious and even fatal liver toxicity. It is a Pregnancy Category D drug, suggesting a risk of birth defects.

    Mircera

    • Mechanism: Interacts with the erythropoietin receptor on cells in the bone marrow, simulating production of RBCs and hemoglobin. Sustains a therapeutic response.
    • Indication: Treatment of anemia associated with chronic kidney disease.
    • Pharmacokinetics: Intravenous (IV) or subcutaneous (SC) administration.
    • Adverse effects: Hypertension (HTN), allergic reactions, myocardial infarction (MI), stroke, embolism (blood clots), and seizures.

    Oxazolidinediones

    • The primary drug in this class is trimethadione.
    • Mechanism: Reduce type-T calcium currents.
    • Indication: Absence seizures.
    • Pharmacokinetics: More toxic than succinimides.
    • Adverse effects: Hemeralopia ("snow blindness"), hypersensitivity reactions, including rashes and blood disorders.

    Selegiline

    • MAO-B inhibitor.
    • Mechanism: Inhibits the metabolism of dopamine in the brain. This increases the concentration and prolongs the duration of action of the dopamine formed in the brain. Dopamine is metabolized by the enzyme MAO-B.
    • Indication: Early-stage Parkinson's disease to slow disease progression.
    • Pharmacokinetics: Administered orally with meals. Used in combination with levodopa.
    • Adverse effects: Dizziness, hallucinations, abdominal pain.

    Warfarin

    • Vitamin K antagonist.
    • Mechanism: Inhibits the synthesis of vitamin K-dependent clotting factors, including prothrombin.
    • Onset of action: Slow onset (12-72 hours).
    • Duration of action: Long duration of action (2-10 days).
    • Dietary vitamin K: Effects warfarin activity.
    • Administration: Oral.
    • Pharmacokinetics: Highly bound to plasma proteins. Metabolized by the liver.
    • Contraindications: Vitamin K-deficient patients.

    Transient Ischemic Attack

    • Brief interruption of blood flow to the brain, causing stroke-like symptoms without lasting damage.
    • Also known as a "mini stroke."

    Heparin

    • Naturally occurring mucopolysaccharide that inhibits plasma clotting factors.
    • Extracted from cattle and pig lungs and intestines.
    • Binds to antithrombin to accelerate inactivation of factor X.
    • Available as standard (unfractionated) or low molecular weight heparin.
    • Administered intravenously or subcutaneously depending on desired effect.
    • Used for deep vein thrombosis, pulmonary embolism, and to prevent clotting in various situations.

    Hemoglobin

    • Protein found in red blood cells responsible for oxygen transport.
    • Gives red blood cells their characteristic color.

    Types of Plaque

    • Stable plaque has a cholesterol core with a fibrous cap and may contain calcium.
    • Unstable plaque has a cholesterol core with a thin cap, which can easily erode and form a clot.

    Thromboplastins

    • Produced by intrinsic and extrinsic pathways of coagulation.
    • Convert prothrombin to thrombin in stage 2 of coagulation.
    • Thrombin converts fibrinogen to fibrin in stage 3, forming a blood clot.
    • Vitamin K is essential for synthesizing clotting factors, particularly prothrombin (factor 2).

    Hemostasis

    • Balance between clot formation and clot breakdown.

    Hypochromic Anemia

    • Anemia characterized by paler than normal red blood cells.

    Hemanitic Medications

    • Contain iron compounds to increase hemoglobin production.

    Generalized Seizures

    • Affect both hemispheres of the brain.
    • Tonic-clonic seizures (grand mal) involve alternating muscle contractions and relaxations with loss of consciousness.
    • Status epilepticus is a medical emergency characterized by continuous tonic-clonic seizures without interruption.
    • Absence seizures (petit mal) do not involve motor convulsions, but cause brief impairment of consciousness.

    Partial Seizures

    • Localized to a specific area of the brain.
    • Simple partial seizures involve a limited brain region and do not cause loss of consciousness.
    • Complex partial seizures involve impairment of consciousness and may spread to other parts of the brain, potentially becoming tonic-clonic.

    Dopamine

    • Inhibitory neurotransmitter produced in the substantia nigra.

    Acetylcholine (ACh)

    • Excitatory neurotransmitter produced in the corpus striatum.

    Antiplatelet Drugs

    • Aspirin, dipyridamole, clopidogrel, and ticlopidine are commonly used antiplatelet drugs.
    • Inhibit platelet aggregation and adhesion to prevent clot formation.
    • Used to prevent heart attack, stroke, angina, and thrombi formation.

    Chelators

    • Inhibit coagulation by binding calcium, disrupting the coagulation cascade.

    Anticonvulsants/Antiepileptic Drugs

    • Anticonvulsants are administered intravenously or intramuscularly to terminate convulsive seizures.
    • Antiepileptic drugs are administered orally to prevent epileptic seizures.
    • They reduce brain cell excitability and decrease the frequency of epileptic seizures.

    Erythropoietin

    • Used to treat anemia associated with chronic renal failure, cancer chemotherapy, and dialysis.
    • Stimulates red blood cell production in the bone marrow, improving oxygenation.

    Vitamin K (Phytonadione)

    • Antidote for warfarin (coumadin).
    • Used to reverse the anticoagulant effects of warfarin.

    Phenytoin

    • Hydantoin drug used for all types of partial seizures and tonic-clonic generalized seizures.
    • Prolongs the inactivation of sodium channels in nerve membranes, reducing neuronal firing.

    Diazepam and Lorazepam

    • Both are benzodiazepines used to treat tonic-clonic seizures and status epilepticus.
    • Increase the inhibitory effects of GABA in the brain.

    Levodopa

    • Used to treat Parkinson's disease, particularly in mild to moderate stages.
    • Precursor to dopamine that crosses the blood brain barrier and converts to dopamine.
    • Administered with carbidopa to inhibit the peripheral conversion of levodopa to dopamine, enhancing its brain penetration.

    Valproic Acid

    • Effective for all types of epilepsy, particularly absence seizures, generalized tonic-clonic seizures, and partial seizures.
    • Decreases sodium ion influx and inhibits neuronal firing.
    • Blocks excitatory glutamate and increases GABAergic effects.

    Mircera

    • Used to treat anemia associated with chronic kidney disease.
    • Stimulates red blood cell production by interacting with the erythropoietin receptor on bone marrow cells.

    Oxazolidinediones

    • Trimethadione is a commonly used oxazolidinedione drug for absence seizures.
    • Reduce type-T calcium currents in neurons, leading to reduced neuronal excitability.

    Selegiline

    • Selegiline is a MAO-B inhibitor used in the early stages of Parkinson's disease.
    • Inhibits the metabolism of dopamine in the brain, increasing its concentration and duration of action.

    Warfarin

    • Vitamin K antagonist used as an anticoagulant.
    • Slow onset of action (12-72 hours) and long duration (2-10 days).
    • Dietary vitamin K intake can affect its effectiveness.

    Drug Interactions

    • Aspirin should be taken before ibuprofen.
    • Valproic acid can increase the effects of drugs metabolized by microsomal enzymes.
    • Phenytoin and valproic acid are highly protein bound, potentially increasing free drug concentrations and effects.

    Adverse Effects

    • Heparin: Hemorrhage, bleeding from mucous membranes and open wounds.
    • Antiplatelet Drugs: Headache, vomiting, rash, dizziness, diarrhea.
    • Phenytoin: Dizziness, ataxia, visual disturbances, postural imbalance, hirsutism, skin rashes, gingival hyperplasia.
    • Diazepam and Lorazepam: Drowsiness, confusion, ataxia, minor GI disturbances, rashes.
    • Levodopa: Nausea, vomiting, anorexia, orthostatic hypotension, behavioral disturbances, dyskinesias, dystonias, "on-off" phenomenon, rapid/irregular heartbeat.
    • Valproic Acid: Nausea, vomiting, diarrhea, tremor, fatal liver toxicity, birth defects.
    • Mircera: Hypertension, allergic reactions, myocardial infarction, stroke, embolism, seizures.
    • Oxazolidinediones: Hemeralopia, hypersensitivity reactions (rashes, blood disorders).
    • Selegiline: Dizziness, hallucinations, abdominal pain.

    Additional Notes

    • Levodopa should not be taken with antipsychotic or antidepressant medications (MAO inhibitors), as they can block dopamine receptors and potentially cause hypertensive crisis.
    • Vitamin K deficiency can interfere with warfarin's effectiveness.
    • Vitamins can affect various drugs, such as those used to treat Parkinson's disease.
    • Pupillary dilation (mydriasis) can result from certain drugs, such as those interacting with dopamine pathways.

    Anticonvulsant/Antiepileptic Drugs

    • Anticonvulsant drugs are given via IM or IV to terminate convulsive seizures.
    • Antiepileptic drugs are given orally to prevent epileptic seizures.
    • Phenobarbital and mephobarbital are both anticonvulsant and antiepileptic drugs, but have sedative and hypnotic effects.
    • Valproic acid inhibits microsomal enzymes, increasing the effects of drugs that require microsomal metabolism.
    • Phenytoin and valproic acid are highly protein bound, which increases free drug concentration and produces greater pharmacologic effects.

    Generalized Seizures

    • Tonic-clonic seizures involve alternating muscle contractions and relaxations, increased HR and BP, urination, defecation, tongue biting.
    • Myoclonic seizures are muscle contractions in one part of the body.
    • Atonic seizures cause severe muscle tone loss and falling.
    • Absence seizures are characterized by brief impairment of consciousness and staring and blinking.

    Parkinson's Disease

    • Abnormal muscular movements include tremors, rigidity, bradykinesia, and postural instability.
    • Levodopa therapy is a common treatment for Parkinson's disease, but not recommended for patients under 65 years old.
    • Vitamin B6 increases levodopa metabolism, so it is contraindicated in patients not taking carbidopa.

    Carbidopa

    • Carbidopa is given with levodopa to increase the amount of levodopa that enters the brain by inhibiting DOPA carboxylase.

    Entacapone

    • Entacapone is a COMT inhibitor that increases the amount of levodopa reaching the brain.
    • COMT is an enzyme that metabolizes dopamine in the periphery and brain.
    • Entacapone is administered with levodopa to prolong its duration of action.

    Trimethadione

    • Trimethadione is used for absence seizures but is rarely prescribed due to its toxicity.
    • Adverse effects of trimethadione include hemeralopia, hypersensitivity reactions, and liver and kidney damage.

    Sinemet

    • Sinemet is a common treatment for Parkinson's disease, containing a combination of levodopa and carbidopa.

    Benztropine

    • Benztropine is an anticholinergic drug used to treat Parkinson's.
    • Anticholinergic drugs were used to treat Parkinson's before levodopa.
    • Benztropine reduces cholinergic activity, which can help restore balance between acetylcholine and dopamine in the basal ganglia.
    • Adverse effects of Benztropine include dry mouth, constipation, urinary retention, rapid heartbeat, and pupillary dilation.

    Heparin Classes

    • Unfractionated heparin is a standard heparin that contains a full complement of saccharides.
    • Low molecular weight (LMW) heparin is derived from porcine heparin and contains only an active anticoagulant fraction.
    • LMW heparin has 90% bioavailability and is dosed based on body size, without coagulation test monitoring.
    • LMW heparin can increase the risk of epidural/spinal hematomas when administered with epidural or spinal anesthesia.

    Erythropoietin Stimulating Agents (ESA)

    • Mircera is a 3rd generation ESA that is a continuous erythropoietin receptor activator.
    • Mircera interacts with the erythropoietin receptor in the bone marrow to stimulate production of RBCs and hemoglobin.
    • Mircera has a long half-life of 22 hours, allowing for extended dosing intervals.

    Blood Tests for Anticoagulant Monitoring

    • Activated Partial Thromboplastin Time (APTT) is used to assess the effect of heparin.
    • Prothrombin Time (PT) and International Normalized Ratio (INR) are used to monitor warfarin.
    • INR is a standardized measurement of PT.

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    Pharmacology Quiz 3 Study Guide PDF

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    Test your knowledge of pharmacology focusing on Valproic Acid and Mircera in this quiz. Explore their mechanisms of action, uses, and potential side effects. Perfect for students studying medication management and pharmacotherapy.

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