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Pharmacology > CNS > Flashcards

CNS Flashcards

1
Q

Fluoxetine mechanism of action

A

SSRI

Selective blockade of 5HT reuptake

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2
Q

Amitriptyline mechanism of action

A

TCA

Nonspecific blockade of 5HT and NE reuptake

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3
Q

Phenelzine mechanism of action

A

Inhibits MAOA and MAOB

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4
Q

Carbamazapine adverse affects

A
  1. CNS depression
  2. Osteomalacia
  3. Megaloblastic anemia
  4. Aplastic anemia
  5. Exfoliative dermatitis
  6. Increase ADH secretion causing dilutional hyponatremia
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5
Q

Gabapentin mechanism of action and use

A
  • Increase GABA effect
  • Used in seizure states, neuopathic pain (postherpetic neuralgia)
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6
Q

Nigrostriatal tract

A
  • Cell bodies in the substantia Nigra project to the stritum where they release DA which inhiits GABA-ergic neurons
  • In Parkinsons, loss of DA neurons leads to excessive ACh activity
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7
Q

Amides and esters (local anesthetics) co-adminstered with? And why?

A

Alpha 1 agonist

  1. Decreas local anesthetic absorption into the system circulation
  2. Prolong effect and decrease toxicity
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8
Q

D2 second messenger

A

Gi

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9
Q

SSRI’s are used for

A
  1. Major depression
  2. OCD
  3. Bulimia
  4. Anxiety disorders
  5. Premenstrual dysphoric disorder (PMDD)
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10
Q

Phenytoin pharmacokinetics

A
  1. Variable absorption
  2. Nonlinear kinetics
  3. Induction of Cytochrome P450
  4. Zero-order kinetic of elimination
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11
Q

Lithium teratogenicity

A

Causes Ebstein’s anomaly (Malformed tricuspid valve)

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12
Q

Withdrawl signs of BZ

A
  1. Anxiety
  2. Rebound insomnia
  3. Seizure when BZ are used as antiepileptic or in High doses
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13
Q

Meperidine chx:

A
  • Full opiod agonist
  • Also antimuscarinic so causes no miosis, tachycardia and no GI/GU/GB spasms
  • Metabolized by P450 to normeperidine, a serotonin reuptake inhibitor. May cause serotonin syndrome and seizures
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14
Q

Selegiline mechanism of action

A

MAOB Selective inhibitor preventing DA breakdown to metabolites

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15
Q

Lithium adverse affects

A
  • Tremor, flu-like symptoms, seizures
  • Hypothyroidism with goiter (due to inhibition of 5’-deiodinase)
  • Nephrogenic DI (Decrease ADH) [manage with AMILORIDE]
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16
Q

Withdrawl signs of Barbs

A
  1. Anxiety
  2. Agitation
  3. Life-threatening seizures
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17
Q

Buprenorphine CHX:

A
  • Partial opiod agonist
  • Used for precipation of withdrawl
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18
Q

Lithium mechanism of action

A
  • Prevents recycling of Inositol (Decrease in PIP2) by blocking Inositol monophosphatase
  • Decrease cAMP
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19
Q

Alcohol in pregnancy causes

A
  1. Growth restriction
  2. Midfacial hypoplasia
  3. microcephaly
  4. CNS dysfunction
  5. frequent occurrence of mental retardation
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20
Q

Methadone CHX:

A
  • Full opiod agonist
  • Used in maintenance of opiate addiction
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21
Q

Amides and esters (Local anesthetics) mechanism of action

A
  • Ionized form blocks internal inactivated Na channel in axon
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22
Q

Clozapine CHX:

A

Atypical antipsycotic

Blocks D2c and 5HT2 receptors

NO TD

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23
Q

Benzodiazepine mechanism of action

A

Potentiates GABA causing increased frequency of Cl channel opening

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24
Q

Alprazolam indication

A

BZ

  1. Anxiety
  2. Panic
  3. Phobias
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25
Q

Barbiturate mechanism of action

A

Prolong GABA activity by increaing duration of Cl channel opening

Also inhibits Complex 1 of ETC

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26
Q

TCA toxicity

A

3 C’s

  1. Coma
  2. Convulsions
  3. Cardiotoxicity
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27
Q

Nalbuphine CHX:

A
  • Mixed opiod agonist - antagnoist
  • Kapa Agonist: Spinal analgesia and dysphoria
  • Mu antagonist: Precipitation of withdrawl
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28
Q

D2A found in

A

Nicrostriatal

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29
Q

Mirtazapine CHX:

A

Antidepressant that is an ALPHA 2 antagonist associated with weight gain

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30
Q

SSRI adver affects

A
  1. Anxiety
  2. Agitation
  3. Bruxism
  4. Sexual dysfuntion
  5. Weight loss
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31
Q

Olanzapine EPS, M Block, Sedation and Alpha Block:

A

Atypical Antipsycotic

EPS: -/+

M Block: +

Sedatoin: +

Alpha Block: ++

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32
Q

Risperidone EPS, M Block, Sedation and Alpha Block:

A

Atypical Antipsycotic

EPS: +

M Block: +/-

Sedation: ++

Alpha Block: ++

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33
Q

Acute adverse affects of opiods

A
  1. Pinpoint pupils
  2. Respiratory depression
  3. Coma
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34
Q

When to caution with Morphine

A
  1. Head trauma due to vasodilation
  2. Renal dysfuntion due to morphine metabolite is active
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35
Q

Disulfiram-like drugs

A
  1. Metronidazole
  2. Chlorpropamide
  3. Griseofulvin
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36
Q

Carbamazepine mechanism of action

A

Blocks axonal Na channels in their inactivated state decreasing axonal conduction preventing seizure propagation

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37
Q

Phenelzine and Tranylcypromine used for

A

MOA inhibitors used for atypical depression

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38
Q

Pharmocologic goal in Parkinsons

A

Increase DA and decrease ACh

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39
Q

Buspirone mechanism of action

A

5-HT1A Partial agonist that has no effect on GABA therefore it is NON sedative but takes 1 to 2 wks for effect

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40
Q

Nondepolarizing skeletal mucle blockers Mechanism and CHX

A
  • Nicotinic antagonists
  • Reversible with AChEI
  • No effects on cardiac and smooth muscle
  • No CNS effects
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41
Q

Diazepam indicaiton

A

BZ

  1. Anxiety
  2. Peop sedation
  3. Muscle relaxation
  4. Withdrawal state
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42
Q

Oxazepam indication

A

BZ

  1. Sleep disorder
  2. Anxiety
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43
Q

Tolcapone Mechanism of action

A

Inhibits COMT from converting L-Dopa to 3-O-methyldopa (a partial agonist at DA receptor)

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44
Q

Felbamate is

A

Same as lamotrigine by blocking Na channels and glutamate receptors

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45
Q

In partial seizures (simple or complex) give

A
  1. Valproic acid
  2. Phenytoin
  3. Carbamazepine
  4. Lamotrigine
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46
Q

Aripiprazole CHX:

A

Atypical Antipsycotic

Partial agonist of D2 receptors

Blocks 5HT2 receptors

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47
Q

Lamotrigine adverse affects

A

Steven-Johnson syndrome (skin rash)

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48
Q

Levodopa adverse affects

A
  1. Dyskinesias
  2. “on-off” effect
  3. Psychosis
  4. Hypotension
  5. Vomiting
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49
Q

Antipsycotics adverse affects from DA block

A
  1. Dyskinesias (extrapyramidal symptoms)
  2. Dysphoria
  3. Endocrine dysfunction: Tem regulation problems, Increase Prolactin, Increase eating
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50
Q

Ethosuximide mechanism of action

A

Blocks T-type Ca channels in thalamic neurons

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51
Q

Lorazepam indication

A

BZ

  1. Anxiety
  2. Preop sedation
  3. Status epilepticus (IV)
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52
Q

Ketamine adverse affects

A
  1. Cardiovascular stimulation
  2. Increase intracranial pressure
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53
Q

Zolpidem and Zaleplon overdose reversed by

A

Flumazenil

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54
Q

Valproic acid adverse affects

A
  1. Hepatotoxicity from metabolites
  2. Thrombocytopenia
  3. Pancreatitis
  4. Alopecia
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55
Q

Phenytoin adverse affects

A
  1. CNS depression
  2. Gingival hyperplasia
  3. Hirsutism
  4. Osteomalacia (decreas Vit D)
  5. Megaloblastic anemia (decrease Folate)
  6. Aplastic Anemia (check hematology)
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56
Q

Atracurium mechanism of action

A
  • Nondepolarizing (competative) skeletal muscle relaxant
  • Nicotinic antagonist
  • Rapid in recovery
  • Safe in hepatic or renal impairment
  • Spontaneous inactivation to Laudanosine (can cause Seizures)
57
Q

Fluvoxamine mechanism of action

A

SSRI

Selective blockade of 5HT reuptake

58
Q

Olanzapine and Risperidone CHX:

A

Atypical antipsycotic

Blocks 5HT2 receptors improves negative symptoms

59
Q

Venlafaxine CHX:

A

Antidepressant that is a nonselective reuptake blocker devoid of ANS side effects

60
Q

Ketamine as anesthetics mechanism of action

A

Glutamate antagonist

NMDA receptor antagonist

61
Q

Temazepam indication

A

BZ

  1. Sleep disorder
62
Q

Lamotrigine mechanism of action

A

Blocks Na channels and Glutamate receptors

63
Q

Midazolam indication

A

BZ

  1. Preop sedation
  2. Anesthesia via IV
64
Q

Thioridazine EPS, M Block, Sedation and Alpha Block:

A

Typical Antipsycotic

EPS: +

M Block: +++

Sedation: +++

Alpha block: +++

65
Q

Entacapone

A

Same as Tolcapone without hepatotoxicity

66
Q

Sedating drug list

A
  1. BZ (-zolam or -zepam)
  2. Barb (Phenobarbital or Thiopental)
  3. Z drugs (Zolpidem and Zaleplon)
  4. Buspirone
67
Q

DA receptor agonists

A
  1. Bromocriptine
  2. Pramipexole
  3. Ropinirole
68
Q

MOLTAD of BZ

A

Duration of action for Short to long

  • M: Midazolam
  • O: Oxazepam (No active metabolite)
  • L: Lorazepam (No active metabolite)
  • T: Temazepam (No active metabolite)
  • A: Alprazolam
  • D: Diazepam
69
Q

In status epilepticus give

A
  1. Lorazepam
  2. Diazepam
  3. Phenytoin
  4. Fosphenytoin
70
Q

Full opiod agonists

A
  1. Meperidine
  2. Methadone
  3. Codeine
71
Q

Haloperidol EPS, M Block, Sedation and Alpha Block:

A

Typical antipsycotic

EPS: +++

M Block: +

Sedation: +

Alpha block: +

72
Q

Inhaled anesthetics have barying potency in proportion to:

A

Their lipid soluability

73
Q

Atomoxetine CHX:

A

Durg used in ADHD

Selective NE reuptke inhibitor

74
Q

Phenytoin mechanism of action

A

Blocks axonal Na channels in their inactvated states decreasing axonal conduction and preventing seizure propagation

75
Q

Levodopa converted to DA by

A

Aromatic amino acid decarboxylas (AAAD)

76
Q

Codeine CHX

A
  • Full opiod agonist
  • Cough suppressant
  • Analgesia
  • Used in combination with NSAIDS
77
Q

Methylphenidate adverse affects

A
  1. Agitation
  2. Restlessness
  3. Insomnia
  4. Cardiovascular toxicity
78
Q

Two phase system of Depolarizing Skeletal Muscle relaxants

A

Phase 1

  • Depolarization, fasciculation, prlong depolarization, flaccid paralysis

Phase 2

  • Desensitization
79
Q

Valproic acid teratogenicity

A

Spina bifida

80
Q

Naltrexone CHX:

A
  • Opiod antagonist
  • Oral, decrease craving for alcohol and used in opiate addiction
81
Q

D1 second messenger

A

Gs

82
Q

Phenytoin teratogenicity

A

Causes Cleft lip and palate

83
Q

Carbamazepine DOC

A

Trigeminal neuralgia

84
Q

Pentazocine chx:

A
  • Mixed opiod agonist - antagnoist
  • Kapa Agonist: Spinal analgesia and dysphoria
  • Mu antagonist: Precipitation of withdrawl
85
Q

Selegiline adverse affects

A

Dyskinesias, psychosis, insomnia (because it is metabolized to AMPHETAMINE)

86
Q

Midazolam as anesthetic uses

A
  1. Pre op sedation
  2. Anterograde amnesia
  3. Induction
  4. Outpatient surgery
87
Q

Carbamazepine teratogenicity

A
  1. Cleft lip and palate
  2. Spina bifida
88
Q

Paroxetine mechanism of action

A

SSRI

Selective blockade of 5HT reuptake

89
Q

Carbidopa given with Levodopa for

A

Carbidopa inhibits conversion of LDopa to DA in periphery allowing MORE LDopa to enter CNS

90
Q

Trazadone CHX:

A

Antidepressent associated with Cardiac arrhythmias and PRIAPISM

91
Q

Methylnaltrexone chx:

A
  • Opiod antagonist
  • Treatment of opiod-induced consitbation because it doesn’t not cross BBB and wont precipitate withdrawal
92
Q

TCA used for

A
  1. Major depression
  2. Phobic and panic anziety states
  3. OCD
  4. Neuropathic pain
  5. Enuresis
93
Q

Lamotrigine and Felbamate used for

A

Seizure states as an adjunct therapy

94
Q

Imipramine mechanism of action

A

TCA

Nonspecific blockade of 5HT and NE reuptake

95
Q

Morphone in CVS

A

Causes Vasoldilation (avoid in head trauma)

96
Q

Tranylcypromine mechanism of action

A

Inhibits MAOA and MAOB

97
Q

Drugs the decrease ACh activity in Parkinsons

A
  1. Benztropine
  2. Trihexyphenidyl
  3. Diphenhydramine
98
Q

Amantadine mechanism of action in parkisons

A

Antiviral that block M receptora dn increase DA release

99
Q

Amantadine adverse affects

A

Livedo reticularis

100
Q

Signs of opiod withdrawl

A
  1. Yawning
  2. Lacrimation, rhinorrhea, salivation
  3. Anxiety, sweating, goose bumps
  4. Muscle cramps, spasm, CNS-originating pain
101
Q

Valproic acid mechanism of action

A
  • Blocks axonal Na channels in their inactivated state decreasing axonal conduction and preventing seizure propagation
  • Inhibition of GABA transaminase
  • Blocks T-type Ca channels
102
Q

Antipsycotics used for

A
  1. Schizophrenia
  2. Schizoaffective states
  3. Bipolar
  4. Tourette syndrome
  5. Huntington
  6. Drug or radiation emesis
103
Q

Zolpidem and Zaleplon mechanism of action

A

BZ1 Receptor agonist and have a less effect on cognitive function

104
Q

Fluphenazine EPS, M Block, Sedation and Alpha Block:

A

Typical antipsycotic

EPS: +++

M Block: +

Sedation: +

Alpha Block: +

105
Q

Thioridazine adverse affects

A
  • Cardiotoxic causing quinidine like Torsades
  • Retinal deposits
106
Q

Valproic acid used for

A
  1. Seizures
  2. Mania of bipolar disorders
  3. Migraine prophylaxis
107
Q

BZ receptors

A

BZ1: sedation

BZ2: Antianxiety and impairment of cognitive funtion

108
Q

Felbamate adverse affects

A

Hepatotoxicity and Aplastic anemia

109
Q

Thipopental (Barb) use as anethetic

A

IV for induction

Highly lipid soluable: Rapid onset

Short acting due to redistribution

110
Q

Citalopram mechanism of action

A

SSRI

Selective blockade of 5HT reuptake

111
Q

Clozapine EPS, M Block, Sedation and Alpha Block:

A

Atypical Antipsycotic

EPS: -/+

M Block: ++

Sedation: +

Alpha Block: +++

112
Q

Endogenous opiate peptides:

A
  1. Endorphins
  2. Enkephalins
  3. Dynorphins
113
Q

Amides and esters (local anesthetics) adverse affects

A
  1. Neurotoxicity
  2. Cardio toxicity
  3. Allergies (Esters via PABA formation)
114
Q

Antipsycotic adverse affects from M blockade

A

Tachycardia and decrease seizure threshold

115
Q

Clomipramine mechanism of action

A

TCA

Nonspecific blockade of 5HT and NE reuptake

116
Q

Midazolam as anesthetics adverse affects

A

Depresses respiratory functions

117
Q

MAC and potency

A

The more lipd soluble the anethetic, the lower the MAC and the greater the potency

118
Q

Morphine receptor

A

Mu agonist

119
Q

D2C found in

A

Mesolimbic

120
Q

Depolarizing (noncompetative) skeletal muscle relaxants Mechanism and CHX

A
  • Nicotinc antagonist
  • Two phase system
  • AChEI increase phase 1 and may reverse phase 2
  • Rapidly hydrolyzed by pseudocholinesterase
121
Q

Clozapine adverse affects

A

Agranulocytosis (requires weakly WBC count)

Increased salivation (“wet pillow”

Seizures

122
Q

Haloperidol adverse affects

A

Most likely cause of Neuoleptic malignant syndrome (NMS) and TD

123
Q

Morphine on Respiratory

A

Respiratory depression: Decrease response to increase pCO2 (do not give O2 in crisis, give Naloxone)

124
Q

In general (absence) seizures give

A
  1. Ethoxuzimide
  2. Valproic acid
125
Q

Sertraline mechanism of action

A

SSRI

Selective blockade of 5HT reuptake

126
Q

Morphine on Smooth muscle

A
  • Relaxes Longitudinal muscles
  • Constics Circular muscles
127
Q

Mesolimbic-mesocortical tract

A

Cell bodies in midbrain project to cerebrocortical and limbic structures

128
Q

Chlorpromazine EPS, M Block, Sedation and Alpha Block:

A

Typical Antipsycotic

EPS: ++

M Block: ++

Sedation: +++

Alpha block: +++

129
Q

Methylphenidate CHX:

A

Used in ADHD

Amphetamine lik

130
Q

Tolcapone adverse affects

A

Hepatotoxic

131
Q

Buspirone used for

A

Generalized anxiety disorder

132
Q

In general (tonic clonic) seziures give

A
  1. Valproic acid
  2. Phenytoin
  3. Carbamazepine
  4. Lamotrigine
133
Q

IV anesthetic drugs

A
  1. Thiopental (barb)
  2. Midazolam (BZ)
  3. Propofol
  4. Fentanyl (opiate)
  5. Ketamine (Glutamate antagonist)
134
Q

Morphine in Analgesia

A
  • Increase pian tolerance and decrease perception and reacto to pain
  • Sedation
135
Q

Aripiprazole EPS, M Block, Sedation and Alpha Block:

A

Atypical Antiypsycotic

EPS: +

M Block: +/-

Sedation: +/-

Alpha Block: +/-a

136
Q

Mivacurium mechanism of action

A
  • Nondepolarizing (competative) Skeletal muscle relaxant
  • Very short duration
  • Metabolized by Plasma cholinesterases
137
Q

Naloxone chx:

A
  • Opiod antagonist
  • IV reversal for respiratory depression
138
Q

TCA adverse affects

A

Muscarinic and alpha blockade

Pharmacology (12 decks)

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