1. Ch 8 Drugs for Central Nervous System Disorders Epilepsy Parkinson Disease Other Central Nervous System Disorders Other Central Nervous System Disorders

2. Words to Define Epilepsy Seizure Convulsion Anticonvulsant Adjunct Ataxia Attention-Deficit Hyperactivity Disorder (ADHD)

3. Epilepsy Common neurologic disorder with sudden and recurring seizures Caused by abnormal electrical impulses in the brain All epilepsy patients have seizures; not all with seizures have epilepsy 1% to 2% have chronic epilepsy

4. Seizures Disturbances of neuronal electrical Behavior change patient not aware of Conscious periods may or may not lose control over movement Loss of body control may affect one area or entire body

5. Convulsions Excessive firing of neurons can result in a convulsion – Involuntary contraction or series of contractions of the voluntary muscles

6. Causes of Seizures Imbalance of excitatory and inhibitory neurotransmitters – GABA: excitatory – Glutamate: inhibitory Enzymes control neurotransmitter levels Disruption in enzymes = disruption of neurotransmitters

7. Causes of Seizures Alcohol or drug withdrawal Epilepsy High fever Hypoglycemia, hyperglycemia Infection (meningitis) Neoplasm (brain tumor) Trauma or injury (head, hematoma)

8. Two Goals of Antiepileptic Therapy Seizure control or lessen the frequency Prevent emotional and behavioral changes that may result from seizures

9. Dispensing Issues of Anticonvulsants Warning! Prescribers often do not allow generic drugs Pharmacy technicians watch for DAW If computer changes drug to generic, technicians often change drug to brand

10. clonazepam (Klonopin) Anticonvulsant Prophylaxis of seizures & panic Depresses nerve transmission in the motor cortex C-IV controlled substance (benzodiazepine) Do not drink Alcohol Pregnancy Cat. D

11. Gabapentin (Neurontin) Anticonvulsant Used as adjunct No significant drug interactions, well-tolerated, easy to use Used for many other disorders, particularly neuropathic pain Pregnancy Cat. C

12. Dispensing Issues of Neurontin Warning! Sound-alike drugs, but different strengths – Neurontin, usually 100 mg – Noroxin (antibiotic), usually 400 mg

13. pregabalin (Lyrica) Anticonvulsant Reduces release of neurotransmitters glutamate, norepinephrine, substance P Similar to gabapentin, more potent. Fewer side effects than other anticonvulsants Controlled substance, Schedule V Also approved to treat diabetic neuropathy Pregnancy Cat. C

14. Attention-Deficit Disorders Attention-Deficit Hyperactivity Disorder (ADHD) Attention-Deficit Disorder (ADD)

15. Attention-Deficit Hyperactivity Disorder (ADHD) Neurologic disorder characterized by hyperactivity, impulsivity, and distractibility Symptoms can persist into adult life Most drugs used are amphetamines and amphetamine derivatives, C-II

16. Dispensing Issues of Attention-Deficit Disorders Agents Warning! ADHD drugs used for treatment as a group must provide a medication guide to patient or caretaker Technicians—check for mediation guide when drug is handed to patient or caretaker, even if drug is not C-II

17. Drug of choice to treat attention-deficit disorders CNS stimulant, C-II controlled substance Improved dosage allows the drug to be taken only in the morning One form comes in a patch, improving compliance methylphenidate (Concerta, Daytrana Metadate, Metadate ER, Methylin, Ritalin, Ritalin-SR)

18. methylphenidate (Concerta) CNS Stimulant Dosed once a day, in morning Outer layer dissolves to release part of drug immediately Rest of drug is OROS (Osmotic- controlled release delivery system) tablet – Slowly releases through pores in tablet, leaving a ghost Pregnancy Cat. C