NURS 8024 PHARM EXAM 3 - NEURO QUESTIONS WITH CORRECT ANSWERS LATEST UPDATE 2026

NURS 8024 PHARM EXAM 3 - NEURO QUESTIONS WITH CORRECT ANSWERS LATEST UPDATE 2026 Type of solubility that passes BBB - Answers Lipid soluble Low weight passes BBB easier Parkinson's disease - Answers Neuro degenerative disease Destruction of dopaminergic neurons in the substantia negra (black substance) Causes a progressive reduction in dopamine action in the basal ganglia leading to motor control function Parkinsonian pharmacology goal - Answers To restore dopamine in the basal ganglia & antagonizing the excitatory effect of acetylcholine at the muscarinic receptors Reinstates balance of dopamine/acetylcholine Does not stop or reverse neuronal degeneration Glutamate Antagonist (Amantadine) - Answers Enhances dopaminergic neurotransmission & muscarinic blocking Used for minor symptoms Caution in patients with seizures & CHF Anticholinergic (antimuscarinic) agents - Answers Decreases the excitatory actions of cholinergic neurons on cells in the striatum by blocking muscarinic receptors Improves tremor & rigidity but not bradykinesia Benxtropine (Cogentin) - Answers Antimuscarinic Can cause narrow angle glaucoma Caution in elderly, BPH, urinary retention, liver, renal or GI disease Dopamine Receptor Agonists - Answers Pramipexole (mirapex) & ropinerole (requip) Treatment for mild Parkinson's Used in restless leg syndrome Use in combo with levadopa Monamine Oxidase B Inhibitors (MAO-B) - Answers Selegiline (eldepryl) & rasagiline (azilect) Used in early disease & as adjunct RX with levadopa Do not combine with fluoxetine or meperidine due to additive effects Dopamine Precursors - Answers Levadopa & carbidopa (sinemet) Enhances synthesis of dopamine in surviving neurons of the substantia nigra conversion of levodopa to dopamine Overtime the number of available neurons decreases so drug does not work forever Works to decrease symptoms only while drug is present in the body Levodopa - Answers Attempts to replace dopamine Crosses BBB short half life- "on off phenomenon" due to unstable levels Taken on empty stomach Levodopa ADE - Answers NV and anorexia Tachycardia, PVCs, postural hypotension Mydriasis CNS effects- hallucinations, abnormal involuntary movements, dyskinesias, mood changes C/I in hx of psychosis Levodopa Carbidopa Combination - Answers Potent & effective Carbidopa enhances the effect of levodopa by allowing more availability to cross into the CNS significantly reduces severity of symptoms Typical decline in response in 3rd to 5th year of treatment COMT Inhibitors - Answers Entacapone (comtan) Increases uptake of levadopa resulting in increased concentration of dopamine in CNS Adjunct therapy with Levodopa carbidopa Frequent dosing Don't use MAO & COMT together (both metabolize catecholamines) Alzheimer's Disease - Answers Progressive memory impairment, dementia, & cognitive dysfunction Alzheimer's Disease Pharmacologic Therapy - Answers Goal is to improve cholinergic transmission in the CNS & prevent excitotoxic actions resulting from overstimulation of NMDA glutamate receptors Palliative & modest short term benefit Cholinesterase Inhibitors - Answers Mild to moderate Alzheimer's Can be initiated by PCPs Block enzymes that degrade acetylcholine leaving more acetylCh at the synaptic cleft Only helps slow progression of symptoms, not the disease 1/3 rule NMDA receptor antagonist - Answers Namenda Moderate to severe Often given together with cholinesterase inhibitors 100% bioavailability with or without food Neuroprotective Dose reduction in renal impairment GABA Analog - Answers Gabapentin used for tonic clonic, partial & generalized seizures Pregabalin used for partial seizures Decrease excitatory transmission Not metabolized, elderly well tolerate Fosphenytoin & Phenytoin - Answers first line for generalized convulsant and seizure disorders and status epilepticus zero order pharmacokinetics Fosphenytoin & Phenytoin ADE - Answers gingival hyperplasia, folic acid deficiency multiple drug interactions folic acid deficiency in pregnancy can cause neural tube defects Benzodiazepines - Answers potentiates GABA responses and suppresses spread of seizure activity Diazepam (Valium) & Lorazepam (Ativan) Clonazepam (Klonopin) ADE- don't take with alcohol! Paradoxical effects in children Barbituate (Phenobarbitoal) - Answers used for partial & generalized tonic clonic seizures neonatal seizure drug of choice multiple drug interactions Primidone (Mysoline)- metabolized to phenobarbital Carbamazepine (Tegretol) - Answers acts on sodium channels to limit seizure propagation, blocks postsynaptic transmission Used for tonic clonic & partial seizures, BPD, trigeminal neuralgia, aggressive behaviors in dementia BBW for stevens johnson syndrome, blood dyscrasias Lamotrigine (Lamictal) - Answers used for multiple seizure types BBW: toxic epidermal necrolysis Levetiracetam (Keppra) - Answers used for multiple seizure types minimal drug interactions Topiramate (Topamax) - Answers used for multiple seizure types and for migraine prophylaxis oral contraceptives may be less effective - may need higher estrogen dose Sodium Valproate (Depacon) Valproic Acid (Depakene) - Answers used for multiple seizure types, BPD, and migraine prevention BBW: hepatotoxicity, teratogenicity, pancreatitis Discontinuation of Anti epileptic Drugs - Answers withdrawal should be done gradually Treatment for symptomatic mild to moderate migraine - Answers aspirin, NSAIDs with combo of tylenol, and caffeine Abortive Agents - Answers serotonin receptor agonists- triptans first line for moderate to severe migraine or rescue therapy Imitrex- sumatriptian all triptans have similar MOA- cranial vessel constriction, rapidly & effectively reduces severity of migraines ADE of Triptans - Answers NV, fatigue, chest tightening due to vasoconstriction serotonin syndrome possible with SSRI, avoid in MAOI x2 weeks c/i- ischemia, uncontrolled HTN, stroke Ergotamine Derivative - Answers Ergotamine tartrate moderate to severe migraines constricts peripheral and cranial blood vessels and depresses central vasomotor centers Migraine prophylaxis - Answers first line- beta blockers (-olol) Tricyclic antidepressants (triptyline) second line- anticonvulsants (topiramate FDA approved) calcium channel blockers, SSRIs, magnesium, ACE-I, clonidine abortive agents should not be given for more than 2 days a week Selective Serotonin Reuptake Inhibitors: SSRI - Answers block reuptake of serotonin increasing the concentration takes 2-6 weeks for improvement patient's who don't respond to one may respond to another SSRI - Answers MDD, anxiety, panic, OCD, PTSD, bulimia well absorbed with oral except zoloft Fluoxetine (Prozac) - Answers SSRI long half life 4-5 days can be a once weekly dose safe for pediatric use SSRI ADE - Answers overall well tolerated headache, sweating, anxiety, agitation, SEXUAL DYSFUNCTION, sleep disturbances BBW: suicidality all SSRIs have potential to cause serotonin syndrome when used with MAOI or serotonergic drugs Discontinuation syndrome- abrupt withdrawal causes HA, malaise, flu symptoms, agitation, irritability, nervousness, and sleep changes Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) - Answers venlafaxine (effexor), duloxetine (cymbalta) indicated for MDD, chronic pain, fibromyalgia, PMS nausea, HA, sexual dysfunction, dry mouth, constipation, insomnia, fatigue Norepinephrine/Dopamine Reuptake Inhibitors (NDRIs) - Answers Atypical antidepressants Buproprion (Wellbutrin)- short half life, more doses required during the day decreases the craving and attenuating symptoms of nicotine withdrawal low incidence of sexual dysfunction Serotonin and Alpha 2 adrenergic Antagonist - Answers Mirtazapine (Remeron) enhances serotonin and norepi neurotransmission