Take first thing tomorrow

if >1 day, skip dose for week

Continue on original schedule

if >7 days to next dose, take next morning

go back to original schedule

Don't take >1 per 7 days.

Counseling for Bisphosphonates

(Alendronate & Risedronate)

• 30 minutes before food/drinks
• with 8oz water
• Sit/stand for 30 minutes
• No other drugs for 60 mins.

Bisphosphonate (PO)

10mg QD

CRCL <35

(Actonel) Bisphosphonate (PO)

5mg QD

(Boniva) Bisphosphonate (PO/IV)

2.5mg QD

60 minutes

(Reclast) Bisphosphonate (IV)

QY

(Evista) Estrogen agonist/antagonist (PO)

Risk: Blood clot

(Fortical) Nasal

5 year post menopause

Binds to RANKL (SC)

Osteoclast apoptosis

Recombinant PTH Builds bone (SC)

Post menopause + highest risk

2 years max, osteosarcoma

BMD

• Who?

• women ≥65 & Men ≥70
• Postmenopausal/Risk/Fracture  ≥50
• Bone degenerative med

T scores

• Normal
• Osteopenic
• Osteoperotic
• Severe:

• Normal: -1 or above
• Osteopenic: -2 to -2.5
• Osteoperotic: < -2.5
• Severe: -2.5 + fracture history

25(OH) D

• Deficient
• Insufficient
• Normal

• Deficient: ≤20
• Insufficient: 21-29
• Normal: ≥30

Daily amount for adults over 50

Calcium

Daily amount for adults over 50

Vitamin D

• C
• D
• E
• F
• G

• Ca
• D vitamin
• Exercise
• Fall prevention
• Good habbits

1000 = 400

WF BID

1000 = 210

Citrical

(Food not important)

Delayed On

No On

• Characteristics
• Solution

Delayed response or minimal response to previously adequit

• Give on an empty stomach
• Switch to IR/crush
• Increase dose
• Reduced dietary protein
• Add DA agonist (Apomorphine)

Wearing off

• Characteristics
• Solution

Decreased duration

• Change to CR
• Add MAO/COMT inhibitor
• Add IR at the end
• Oral liquid formulations
• LA at PM to prevent awakening

On/Off

• Characteristics
• Solution

Fluctuates good - poor movement

(Brain adapting to varying blood levels)

• Add DA agonist
• Change to CR
• Add MAO/COMT inhib
• NO drug holiday

Dyskinesias

• Characteristics
• Solution

Abnormal jerking (Too much DA)

• ↓DA, ↑ frequency or CR
• Add amantadine

Freezing

• Characteristics
• Solution

Unable to move lower extremities

• ↑ Dose, agonist, MAOb
• Gait modification (Walker)

Dystonias

• Characteristics
• Solution

sustained muscle contractions AM (low DA)

• Add DA agonist
• CR HS
• Baclofen

Myoclonus

• Characteristics
• Solution

Repetative jerking PM

• ↓ PM dose
• Clonazepam (Benzodiazepine)

restless feeling, restless leg

(wearing off of levodopa)

• Add PM DA med
• Clonazepam

Pramipexole

(Difficulty to P)

Apomorphine

pretreatment with Trimethobenzamide (Tigan)

(Antes de la Tigra)

Bromocriptine

(Kryptonite)

Apomorphine

(Antes de muerto)

Anticholinergics

Amantadine

Anticholinergics

Amantadine

(Cogentin)

Anticholinergic

(Artane)

Anticholinergic

(Eldepryl, Zelapar)

MAO-B inhibitor

(Tasmar)

COMT Inhibitor

• CNS & Periphery
• Liver damage

Loss of normal muscle responsiveness

(Akon can pop lock)

Sense of inner restlessness, constant movement

(Although I am sedated, I feel restless since they put a catheter in me)

Difficulty initiating movement

Unclear pronunciation

(What are you saying Arthyr?)

"masked face"

expressionless

(I met my girlfriend Mimi at a mascarade party)

Sustained muscle contractions usually in the AM

(He sure has good muscle tone)

Tremors or tics

(Kinetics)

Focal Seizures

(First Line)

• Carbamazepine
• Lamotrigine
• Levetiracetam
• Oxcarbazepine
• Phenobarbital
• Phenytoin
• Topiramate

(L2 P2 COT)

focal Seizures

(Second Line)

• Gabapentin
• Primidone
• Valproic Acid

(Secon'd time around I should Go put my P in her V while she is unconscious)

Focal Seizures

(Adjunct)

• Lacosamide
• Pregabalin
• Tiagabine
• Rufinamide
• Zonisamide

(Due to my Lack of protection, she is now Pregnant.  We have a wild child like Rufio which plays with the tigers and Zebras

Generalized Tonic Clonic Seizures

(First Line)

• Carbamazepine
• Lamotrigine
• Levetiracetam
• Phenobarbital
• Topiramate
• Valproic Acid

(He's having a seizure, what should we do?

Look 2 Captain V)

the Barbarian

Generalized Tonic Clonic Seizures

(Second Line)

• Oxcarbazepine
• Phenytoin
• Primidone

(If all else fails, ask my POP)

Absence Seizure

(First Line)

• Ethosuximide
• Phenobarbital
• Valproic Acid

(Every time I watch Alice in wonderland I want to put my P in her V)

Absence Seizure

(Second Line)

• Lamotrigine
• Primidone

(And she would say Please no)

Absence Seizure

(Adjunct)

• Kepra 

(the only thing that can save her is the 1 magician with his spell levetiracetam)

Atonic Seizure

(First Line)

• Valproic Acid

(Loss of muscle tone, only solution is to wear the new Vespar set)

Atonic Seizure

(Adjunct)

• Carbamazepine
• Tiagabine

(CT scans are necesary, especially if the patient trys to fight a tiger)

Myoclonic Seizure

(First Line)

• Valproic Acid

(First choice for protection from a jerk is the Vespar Armor set)

Myoclonic Seizure

(Adjunct)

• Carbamazepine
• Ethosuximide
• Kepra
• Tiagabine
• Zonisamide

(We are at the zoo with Tigers and Zebras, give me a seck, I want to join in on the jitter bug dance)

Which drugs have an Idiosyncratic SE of Acute Hepatic Failure?

• Felbamate
• Valproic Acid

• Carbamazepine
• Oxcarbazepine
• Phenytoin
• Rufinamide
• Topiramate
• Zonisamide
• Lacosamine

• Ethosuximide
• Zonisamide

Drugs that work by blocking GABA

• Felbamate
• Phenobarbitol
• Tiagabine
• Topiramate
• Vigabatin

When I saw Gabriella, I Fap to the photos of her tits & Vag

Rufinamide

Carbamazepine

• A
• U
• S
• T
• I
• N

• Aggravated by activities
• Unilateral
• Sensitivity to light/sound
• Throbbing
• Intensity
• Nausea

Status Epilepticus

0-10 minutes

• Lorazepam
• Diazepam

Status Epilepticus

10-30 minutes

• Phenytoin (IV)
• fosphenytoin (IM)

Status Epilepticus

30-60 minutes

• Phenytoin (IV)
• fosphenytoin (IM)

Status Epilepticus

> 60 minutes

• Phenobarbitol
• Valproate