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Pharmacology > CNS > Flashcards

CNS Flashcards

1
Q

side effects of ethosuximide (4)

A 
Ethosuximide causes
Fatigue
GI distress
Headache
Itchiness
Stevens-Johnson syndrome
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2
Q

side effects of benzodiazepines (3)

A
  1. sedation
  2. dependence/tolerance
  3. respiratory depression (less than barbituates)
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3
Q

side effects of phenytoin (10)

A
  1. nystagmus, diplopia
  2. ataxia
  3. gingival hyperplasia
  4. hirsuitism
  5. megaloblastic anemia, peripheral neuropathy
  6. teratogen (fetal hydantoin syndrome)
  7. SLE-like syndrome
  8. cytochrome P-450 induction
  9. Stevens-Johnson syndrome
  10. osteopenia
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4
Q

side effects of carbamezapine (8)

A
  1. diplopia
  2. ataxia
  3. blood dyscrasia (agranulocytosis, aplastic anemia)
  4. liver toxicity
  5. teratogen
  6. cytochrome P-450 induction
  7. SIADH
  8. Stevens-Johnson syndrome
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5
Q

side effects of valproic acid (5)

A
  1. GI distress
  2. hepatotoxicity (measure LFTs)
  3. neural tube defects in fetus (DO NOT USE IN PREGNANCY)
  4. tremor
  5. weight gain
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6
Q

side effects of gabapentin (2)

A
  1. sedation

2. ataxia

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7
Q

side effects of phenobarbitol (4)

A
  1. sedation
  2. dependence/tolerance
  3. cytochrome P-450 induction
  4. cardiorespiratory depression
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8
Q

side effects of topiramate (4)

A
  1. sedation
  2. mental dulling
  3. kidney stones
  4. weight loss
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9
Q

side effects of lamotrigine (1)

A
  1. Stevens-Johnson syndrome
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10
Q

epilepsy drugs that cause Stevens-Johnson syndrome (4)

A
  1. ethosuximide
  2. phenytoin
  3. carbamezapine
  4. lamotrigine
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11
Q

epilepsy drugs that cause SIADH (1)

A
  1. carbamezapine
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12
Q

epilepsy drugs that cause kidney stones (1)

A
  1. topiramate
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13
Q

epilepsy drugs that cause SLE-like syndrome (1)

A
  1. phenytoin
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14
Q

first line tx absence seizures

A

ethosuximide

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15
Q

first line tx tonic-clonic seizures (3)

A
  1. phenytoin
  2. carbamezapine
  3. valproic acid
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16
Q

first line tx simple and complex seizures

A

carbamezapine

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17
Q

acute tx status epilepticus

A

benzodiazepines

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18
Q

prophylaxis of status epilepticus

A

phenytoin

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19
Q

first line tx seizure in neonate

A

phenobarbital

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20
Q

eclampsia seizures treatment

A

1st line: MgSO4

2nd line: benzodiazepines

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21
Q

treatment trigeminal neuralgia

A

carbamezapine

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22
Q

ethosuximide mechanism

A

blocks thalamic T-type Ca channels

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23
Q

benzodiazepines mechanism

A

increase GABA-A action

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24
Q

phenytoin mechanism

A

increase Na channel inactivation (zero-order kinetics)

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25
Q

carbamezapine mechanism

A

increase Na channel inactivation

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26
Q

valproic acid mechanism

A

increase Na channel inactivation

increase GABA concentration by inhibiting GABA transaminase

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27
Q

gabapentin mechanism

A

inhibits high-voltage-activated Ca channels

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28
Q

phenobarbital mechanism

A

increase GABA-A action

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29
Q

topiramate mechanism

A

blocks Na channels

increase GABA action

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30
Q

lamotrigine mechanism

A

blocks voltage-gated Na channels

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31
Q

what is levetiracetam used for?

A

epilepsy

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32
Q

tigabine mechanism

A

increase GABA by inhibiting reuptake

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33
Q

vigabatrin mechanism

A

increase GABA by inhibiting GABA transaminase

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34
Q

what epilepsy drugs cause megaloblastic anemia (1)

A
  1. phenytoin
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35
Q

what epilepsy drugs cause agranulocytosis and aplastic anemia (1)

A
  1. carbamezapine
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36
Q

what epilepsy drugs cause hepatotoxicity (2)

A
  1. carbamezapine

2. valproic acid

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37
Q

drug class phenobarbital

A

barbituate

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38
Q

drug class pentobarbital

A

barbituate

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39
Q

drug class thiopental

A

barbituate

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40
Q

drug class secobarbital

A

barbituate

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41
Q

barbituate mechanism

A

facilitate GABA-A action by increase duration of Cl channel opening

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42
Q

can you use barbituates in porphyria?

A

NO!

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43
Q

side effects of barbituates (4)

A
  1. respiratory/cardiovascular depression
  2. CNS depression (worse with EtOH)
  3. dependence
  4. induces cytochrome P-450
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44
Q

overdose tx for barbituates

A

supportive (maintain breathing and BP)

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45
Q

drug class diazepam

A

benzodiazepine

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46
Q

drug class lorazepam

A

benzodiazepine

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47
Q

drug class triazolam

A

benzodiazepine

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48
Q

drug class temazepam

A

benzodiazepine

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49
Q

drug class oxazepam

A

benzodiazepine

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50
Q

drug class midazolam

A

benzodiazepine

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51
Q

drug class chlordiazepoxide

A

benzodiazepine

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52
Q

drug class alprazolam

A

benzodiazepine

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53
Q

mechanism benzodiazepine

A

facilitate GABA-A action by increase frequency of Cl channel opening

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54
Q

short-acting (more addictive) benzodiazepines

A

TOM (triazolam, oxazepam, midazolam)

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55
Q

effect of benzodiazepines on sleep

A

decrease REM sleep

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56
Q

drugs that bind the GABA-A receptor (3)

A
  1. barbituates
  2. benzodiazepines
  3. EtOH
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57
Q

overdose tx of benzodiazepines

A

flumazenil (competitive antagonist GABA receptor)

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58
Q

drug class zolpidem

A

nonbenzodiazepine hypnotic

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59
Q

drug class zaleplon

A

nonbenzodiazepine hypnotic

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60
Q

drug class esopiclone

A

nonbenzodiazepine hypnotic

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61
Q

mechanism nonbenzodiazepine hypnotic

A

BZI subtype of GABA receptor

62
Q

clinic use of nonbenzodiazepine hypnotic

A

insomnia

63
Q

side effects of nonbenzodiazepine hypnotic (3)

A
  1. ataxia
  2. short duration b/c of liver metabolism
  3. lower risk dependence
64
Q

anesthetics with less solubility in blood

A

rapid induction, rapid recovery

65
Q

anesthetics with greater solubility in lipids

A

higher potency (1/MAC)

66
Q

MAC (minimal alveolar concentration)

A

amount of inhaled anesthetic required to prevent 50% from moving

67
Q

drug class halothane

A

inhaled anesthetic

68
Q

drug class enflurane

A

inhaled anesthetic

69
Q

drug class isoflurane

A

inhaled anesthetic

70
Q

drug class sevoflurane

A

inhaled anesthetic

71
Q

drug class methoxyflurane

A

inhaled anesthetic

72
Q

drug class nitrous oxide

A

inhaled anesthetic

73
Q

effects of inhaled anesthetics (4)

A
  1. myocardial depression
  2. respiratory depression
  3. nausea/vomiting
  4. increased cerebral blood flow
74
Q

side effect of halothane (1)

A
  1. hepatotoxicity
75
Q

side effect of methoxyflurane (1)

A
  1. nephrotoxicity
76
Q

side effect of enflurane (1)

A
  1. seizures
77
Q

what is malignant hyperthermia?

A

rare, hereditary. inhaled anesthetics and succinylcholine induce fever and muscle contractions

78
Q

tx for malignant hyperthermia

A

dantrolene

79
Q

what barbituate is used as IV anesthetic

A

thiopental (high potency, rapid entry and redistribution)

80
Q

what benzodiazepine is used as an IV anesthetic

A

midazolam (for endoscopy)

81
Q

side effects of midazolam anesthetic (3)

A
  1. postoperative respiratory depression
  2. decreased BP
  3. anterograde amnesia
82
Q

mechanism of arylcyclohexylamines

A

PCP analogs, block NMDA receptors

83
Q

what are arylcyclohexylamines

A

IV anesthetic

84
Q

what is ketamine another name for?

A

arylcyclohexylamines

85
Q

what opiates are used as IV anesthetic

A

morphine, fentanyl

86
Q

what is propofol’s used in anesthesia

A

sedation in ICU, rapid induction

less postoperative nausea

87
Q

propofol mechanism

A

potentiates GABA-A

88
Q

what are the two groups of local anesthetics

A
  1. esters (procaine, cocaine, tetracaine)

2. amides (lidocaine, mepivacaine, bupivacaine)

89
Q

mechanism local anesthetics

A

block Na channels (bind activated)

90
Q

what happens to local anesthetics in infected tissue?

A

infected tissue = acidic –> alkaline anesthetics are charged, cannot penetrate –> need more

91
Q

order of nerve blockade

A

small myelinated > small unmyelinated > large myelinated > large unmyelinated

92
Q

order of loss of sensation

A
  1. pain, 2. temperature, 3. touch, 4. pressure
93
Q

side effect of bupivacaine

A

cardiovascular toxicity

94
Q

side effects of local anesthetics (3)

A
  1. CNS excitation
  2. hypertension
  3. hypotension
95
Q

mechanism succinylcholine

A

ACh-receptor agonist –> prevents contraction

96
Q

reversing succinylcholine blockade

A 
Phase I (prolonged depolarization): none
Phase II (repolarization but blocked): cholinesterase inhibitors
97
Q

side effects of succinylcholine

A
  1. hypercalcemia
  2. hyperkalemia
  3. malignant hyperthermia
98
Q

what neuromuscular blocking drug is depolarizing?

A

succinylcholine

99
Q

what neuromuscular blocking drugs are non-depolarizing?

A
  1. tubocurarine
  2. atracurium
  3. mivacurium
  4. pancuronium
  5. vecuronium
  6. rocuronium
100
Q

mechanism of non-depolarizing neuromuscular blocking drugs

A

competitive ACh antagonist

101
Q

drug class tubocurarine

A

non-depolarizing neuromuscular blocking drugs

102
Q

drug class atracurium

A

non-depolarizing neuromuscular blocking drugs

103
Q

drug class mivacurium

A

non-depolarizing neuromuscular blocking drugs

104
Q

drug class pancuronium

A

non-depolarizing neuromuscular blocking drugs

105
Q

drug class vecuronium

A

non-depolarizing neuromuscular blocking drugs

106
Q

drug class rocuronium

A

non-depolarizing neuromuscular blocking drugs

107
Q

reversal of blockade from non-depolarizing neuromuscular blocking drugs (3)

A
  1. neostigmine (with atropine to prevent muscarinic effects like bradycardia)
  2. edrophonium
  3. other cholinesterase inhibitors
108
Q

mechanism dantrolene

A

prevents release of Ca from sarcoplasmic reticulum

109
Q

clinical use dantrolene

A

malignant hyperthermia and neuroleptic malignant syndrome

110
Q

Parkinson’s drugs

A

Bromocriptine (or pramipexole or ropinirole)
Amantadine
L-dopa/carbidopa
Selegiline (or COMT inhibitors entacapone or tolcapone)
Antimuscarinic (benztropine)

111
Q

tx essential tremor

A

beta-blocker

112
Q

carbidopa mechanism

A

blocks peripheral decarboxylase –> increases L-dopa to brain and decreases peripheral side effects

113
Q

side effects of L-dopa (2)

A
  1. arrhythmias

2. on-off phenomenon

114
Q

selegiline mechanism

A

inhibits MAO-B –> increases dopamine

115
Q

what is donepezil

A

AChE inhibitor used in Alzheimer’s

116
Q

what is galantamine

A

AChE inhibitor used in Alzheimer’s

117
Q

what is rivastigmine

A

AChE inhibitor used in Alzheimer’s

118
Q

side effects of AChE inhibitors used in Alzheimer’s (3)

A
  1. nausea
  2. dizziness
  3. insomnia
119
Q

what is memantine

A

NMDA receptor antagonist used in Alzheimer’s (prevents excitotoxicity)

120
Q

memantine side effects (3)

A
  1. dizziness
  2. confusion
  3. hallucinations
121
Q

what neurotransmitter changes are seen in Huntington’s (GABA, ACh, and dopamine)

A

decreased GABA, decreased ACh, increased dopamine

122
Q

what is tetrabenazine

A

inhibits vesicular monoamine transporter (VMAT), used in Huntington’s

123
Q

what is reserpine

A

inhibits vesicular monoamine transporter (VMAT), used in Huntington’s

124
Q

sumatriptan mechanism

A

serotonin agonist, inhibits trigeminal nerve activation, induces vasoconstriction

125
Q

clinical use of sumatriptan

A

migraine, cluster headache

126
Q

side effect of sumatriptan

A

coronary vasospasm

127
Q

what is butorphanol

A

mu partial agonist, kappa agonist

128
Q

clinical use butorphanol

A

opioid, less respiratory depression

129
Q

tramadol mechanism

A

weak opioid agonist, inhibits serotonin and NE reuptake

130
Q

clinical use tramadol

A

chronic pain

131
Q

side effects tramadol

A
  1. seizures

2. serotonin syndrome

132
Q

drug class morphine

A

opioid (mu)

133
Q

drug class fentanyl

A

opioid

134
Q

drug class codeine

A

opioid

135
Q

drug class loperamide

A

opioid (and diarrhea)

136
Q

drug class methadone

A

opioid

137
Q

drug class meperidine

A

opioid

138
Q

drug class dextromethorphan

A

opioid (and cough suppression)

139
Q

drug class diphenoxylate

A

opioid (and diarrhea)

140
Q

side effects opioids

A
  1. respiratory depression
  2. addiction
  3. constipation
  4. miosis
141
Q

opioid overdose tx

A

naloxone or naltrexone (opioid receptor antagonists)

142
Q

alpha agonists used for glaucoma (2)

A
  1. epinephrine

2. brimonidine (alpha-2)

143
Q

beta blockers used for glaucoma (3)

A
  1. timolol
  2. betaxolol
  3. carteolol
144
Q

direct cholinomimetics used for glaucoma (2)

A
  1. pilocarpine

2. carbachol

145
Q

indirect cholinomimetics used for glaucoma (2)

A
  1. physostigmine

2. echothiophate

146
Q

cholinomimetics for glaucoma mechanism

A

constraction ciliary muscle –> increase outflow

147
Q

which drugs should you not use in closed-angle glaucoma

A

alpha-agonists (epinephrine and brimonidine) –> cause mydriasis

148
Q

prostaglandin used for glaucoma

A

latanoprost (PGF-2alpha)

149
Q

latanoprost mechanism

A

increases outflow aqueous humor

150
Q

which glaucoma treatment darkens the iris

A

latanoprost

151
Q

what drug increases survival in ALS?

A

riluzole (decreases presynaptic glutamate release)

Pharmacology (8 decks)

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