CNS Flashcards
Treatment for rheumatic chorea
Mild
Severe
Refractory
-Calm environment
-Valproate, haloperidol carbamazepine
-Steroids
Dose of epinephrine for anaphylaxis
1:1000 , 0.5ml IM
Side effects of levo dopa due to action on D1
Hypotension
Side effects of levo dopa due to action on D2
Nausea , vomiting
Side effects of levo dopa due to action on limbic system
Psychosis
DOC- pimavanserin
Side effects of levo dopa due to action on striatum
Dyskinesia
Doc- amantidine, levetiracetam
Contraindications of levodopa
Psychosis
Closed angle glaucoma
Opiod used in non secretory diarrhoea like IBS by reducing motility
Loperamide(do not cross BBB)
Diphenoxylate and difenoxin(can cross bbb so combined with atropine to prevent abuse)
Contraindications of morphine
Head trauma
Bronchial asthma
Activationof codeine is by
CYP2D6 (10%)
DOC for postop or post anaesthesia chills/chills due to monoclonal antibodies/amphotericin B
Pethidine
Normeperidine (derivative of pethidine) is neurotoxic and can cause ___
Seizures
Normeperidine is MAO inhibitor amd causes risk of
Serotonin syndrome
DOC for opoid dependence
Methadone/buprenorphine
During tapering if symptoms of withdrawal occur, give beta blockers or clonidine
QT prolongation is caused due to which opoid drug
Methadone
Drugs contraindicated with MAO inhibitor
Tramadol
Pethidine
Pentazocine is partial agonist at MU receptor and full agonist at kappa. Contraindicated in
Myocardial infarction
Buprenorphine is C/I in labor pain because
Naloxone cannit reverse neonatal depression caused by it
Tolerance develops to all effects of opoid except
Miosis
Constipation
Convulsions
Prevent relapse of opioid dependence
Naltrexone
Most teratogenic anti epileptic
Valproate
Neural tube defects
Doc for liver toxicity due to valproate
Carnitine
Side effects of phenytoin
Hyperplasia of gums
Hirsutism
Hyperglycemia
Lymphadenopathy
Decreased vitamind D
Diplopia ataxia nystagmus- signs of acute toxicity
Teratogenic- cleft lip palate
Induces vitamin K metabolism-2,7,9,10 factor deficiency
Megaloblastic anemia ,neutropenia (folic acid absorption is less)
Purple glove syndrome
Tissue necrosis if extravasation occurs
Precipitates with glucose so use with Normal saline
Valproate is enzyme _
And phenytoin is enzyme _
Inhibitor
Inducer
Side effects of carbamazepine
SIADH causing hyponatremia
Hypersensitivity
SJS
Aplastic anemia
Agranulocytosis
Doc trigeminal neuralgia
Carbamazepine
Doc for partial seizure
Carbamazepine
Lamotrigine bolus dose can cause
SJS
Side effect of topiramate in the eye
Secondary angle closure glaucoma (due to choroidal edema pushes lens forward)
Most preferred anti epileptic for migrane prophylaxis
Topiramate
(Also used for obesity with phentermine)
Lacosamida can increase _ tendency
Suicidal (black box warning)
Also cause PR prolonging
Used for partial seizure
Tiagabine MOA and use
Increase GABA at synapse
Resistant partial seizure
Vigabatrin inhibits
GABA transaminase
Can cause irreversible visual fieled defect
Treatment of infantile spasm
Vigabatrin (tuberous sclerosis +)
Acth/ steroids(no tuberous sclerosis)
Pregabalin and gabapentin MOA
Inhibit a subunit of presynaptic calcium channels to inhibit glutamate release
SV2 A inhibitor
Levetiracetam
Also N type calcium channel blocker
Saftest anti epileptic in pregnancy
Treatment alzheimer disease
Reversible cholinesterase inhibitors
Donepezil
Galantamine
Transdermal rivastigmine
NMDA antagonist- memantine
Disease modifying agent in alzhemiers
Aducanumab
Monoclonal IgG1 abtibody
Reduces amyloid plaques in brain
Doc for acute mania
Atypical antipsychotics
Combined with BZD
Alternatives- valproate , carbamazepine
DOC for prophylaxis of mania and treatment of bipolar disorder is Lithium
Lithium MOA
Inhibits Gq receptor and inositol moniphosphate to decrease BNDF
Also inhibit GSK3 to increase beta catenin pathway to increase BNDF
Hence mood stabilizer
Side effects of lithium
Fine tremors
Hypercalcemia
Acne
Obesity
Ebstein anomaly in fetus, floppy infant(hypotonia)
Worsen psoriasis
Toxicity of lithium
Nausea vomit
Profuse diarrhea
Ataxia
Dysarthria
Coarse tremors
Arrhythmia
Drugs that inhibit serotonin reuptake
Ssri
Snri
TCA
TCA has action on multiple receptors like
H1
M
5HT
ALFA1
Selective norepinephrine reuptake inhibitors
Atomoxetine, viloxazine
Used in ADHD, not used in depression
Typical antidepressants
MOA Inhibitors
TCA
SSRI
SNRI take 2 weeks to act
Increase serotonin and NE
Cheese reaction is seen with
MAO inhibitors
When taken with cheese block tyramine metabolism, increase NE, causing HTN crisis
DOC phentolamine iv
MOA inhibitors can cause _ when consumed with other durgs like
Serotonin syndrome
Ssri, snri, tca, opioids
Drugs for treatment of serotonin syndrome
Cyproheptadine or chlorpromazine
Most lethal TCA on overdosing
Desipramine
Use- cocaine dependence
TCA for nocturnal enuresis
Imipramine
Amoxapine, D2 blocker used in
Psychotic depression
Similar drug is loxapine
DOC For TCA toxicity
Sodium bicarbonate
Cause of death is arrhythmia is tca toxicity due to sodium channel blockade
High risk for suicidal death
Venlafaxine, duolexetine, milnacipran are
SNRIs
Venlafaxine is shortest acting
Duloxetine js used for
PMS, fibromyalgia, neuropathic pain, stress incontinence
Milnacipran also used in fibromyalgia
SSRI are DOC for
Depression
PMS
Neurosis- OCD, phobia, GAD, anorexia, bulemia
Longest acting SSRI
Fluoxetine
Once a week formulation, no withdrawal symptoms
Depression along with insomnia give
Paroxetine as it causes sedation
Side effect- erectile dysfunction ,Teratogenic
Shortest acting SSRI
Vilazodone is SSRI plus
5HT1a agonist
Used in resistant depression
Side effects of SSRI SNRI
Nausea vomiting
Loose stools
Erectile dysfunction, anorgasmia, delayed ejaculation
Anxiety(transiet for 2 to 6 weeks), vibd dreams
akathasia
Increase risk of bleeding
Trazodone acts as _ and used for_
5HT2 blocker
Depression and erectile dysfunction
Side effects- PRIAPISM, sedation
Mirtazapine and mianserin are together called as
NASSA noradrenergic specific serotonergic antidepressant drugs)
5HT3 block- antiemetic
Alfa 2 and 5HT2 block- antidepressant
H1 block- sedation
Hence used in depression with insomnia
Mirtazapine can cause agramulocytosis
Bupropion increases _ and _
NE and dopamine
Used in ADHD, obesity(decreases appetite)
Depression
SMOKING DEPENDENCE
peripheral neuropathy
Side effects- anxiety++
DOC for restless leg syndrome
Gabapentin
DOC for drug induced parkinsonism
Benzhexol aka trihexiphenydil
Ambenonium is used in
Myasthenia gravis(anti cholinestrase)
