CNS FINAL Flashcards
1
Q
What is the class/MOA of Acetylcholine?
A
Direct-Acting Cholinergic Agonist; acts on muscarinic and nicotinic receptors
2
Q
What are the indications for Acetylcholine?
A
Limited clinical userapidly eliminated; used in eye surgery
3
Q
What are the side effects of Acetylcholine?
A
Decreases HR, lowers BP, increases gastric acid secretion
4
Q
What is the class of Bethanechol?
A
Direct-Acting Cholinergic Agonist
5
Q
What is the mechanism of action of Bethanechol?
A
Stimulates smooth muscle in bladder and GI tract
6
Q
What are the indications for Bethanechol?
A
Atonic bladder, GI atony
7
Q
What are the side effects of Bethanechol?
A
Diaphoresis, salivation, nausea, bronchospasm
8
Q
What are important notes about Bethanechol?
A
Contraindicated in bladder/GI obstruction
9
Q
What is the class of Pilocarpine?
A
Direct-Acting Cholinergic Agonist
10
Q
What is the mechanism of action of Pilocarpine?
A
Stimulates secretions (sweat, tears, saliva); used in glaucoma
11
Q
What are the indications for Pilocarpine?
A
Glaucoma, dry mouth
12
Q
What are the side effects of Pilocarpine?
A
Sweating, excessive salivation, risk of systemic effects
13
Q
What are important notes about Pilocarpine?
A
First-line for acute glaucoma attacks
14
Q
What is the class of Cevimeline?
A
Direct-Acting Cholinergic Agonist
15
Q
What is the mechanism of action of Cevimeline?
A
Selective for muscarinic receptors; used for dry mouth
Sjorgrens
16
Q
What are the indications for Cevimeline?
A
Xerostomia due to radiation or Sjogren’s syndrome
17
Q
What are the side effects of Cevimeline?
A
Fewer systemic effects than pilocarpine (preferred over Pilocarpine)
Sweating, salivating, possible systemic effects
18
Q
What is the class of Physostigmine?
A
Reversible Acetylcholinesterase Inhibitor
19
Q
What is the mechanism of action of Physostigmine?
A
Reverses CNS effects of anticholinergic toxicity
Acetylcholinesterase inhibitor
20
Q
What are the indications for Physostigmine?
A
Reversal of anticholinergic overdose
21
Q
What are the side effects of Physostigmine?
A
Bradycardia, seizures, salivation, bronchospasm
22
Q
What are important notes about Physostigmine?
A
Used for atropine overdose
23
Q
What is the class of Neostigmine?
A
Reversible Acetylcholinesterase Inhibitor
24
Q
What is the mechanism of action of Neostigmine?
A
Enhances skeletal muscle contraction
25
What are the indications for Neostigmine?
Myasthenia gravis, neuromuscular blockade reversal
26
What are the side effects of Neostigmine?
GI distress, salivation, bronchospasm
myasthenia gravis. It can also reverse the effects of anesthesia
27
What is the class of Pyridostigmine?
Reversible Acetylcholinesterase Inhibitor
28
What is the mechanism of action of Pyridostigmine?
Long-acting acetylcholinesterase inhibitor for myasthenia gravis
29
What are the indications for Pyridostigmine?
Chronic myasthenia gravis management
30
What are the side effects of Pyridostigmine?
Similar to neostigmine, but longer duration
31
What is the class of Donepezil?
Acetylcholinesterase Inhibitor
32
What is the mechanism of action of Donepezil?
Prevents breakdown of acetylcholine to slow Alzheimer’s progression
33
What are the indications for Donepezil?
Mild to moderate Alzheimer’s disease
34
What are the side effects of Donepezil?
Nausea, diarrhea, syncope, bradycardia
35
What are important notes about Donepezil?
Take at bedtime; caution with bradycardia
36
What is the class of Rivastigmine?
Acetylcholinesterase Inhibitor
37
What is the mechanism of action of Rivastigmine?
Prevents breakdown of acetylcholine, available as patch or oral
38
What are the indications for Rivastigmine?
Mild to moderate Alzheimer’s disease
39
What are the side effects of Rivastigmine?
GI distress, weight loss, muscle wasting
40
What is the class of Galantamine?
Acetylcholinesterase Inhibitor
41
What is the mechanism of action of Galantamine?
Prevents breakdown of acetylcholine to slow Alzheimer’s progression
42
What are the indications for Galantamine?
Mild to moderate Alzheimer’s disease
43
What are the side effects of Galantamine?
GI distress, weight loss, dizziness
44
What are important notes about Galantamine?
Derived from plants; marketed as natural
45
What is the class of Memantine?
NMDA Receptor Antagonist
Alzheimer's
46
What is the mechanism of action of Memantine?
Blocks excitotoxic effects of glutamate to slow cognitive decline
47
What are the indications for Memantine?
Moderate to severe Alzheimer’s disease
48
What are the side effects of Memantine?
Dizziness, headache, rare seizures
49
What are important notes about Memantine?
Often combined with acetylcholinesterase inhibitors
50
What is the class of Lecanemab?
Monoclonal Antibody for Alzheimer’s
51
What is the mechanism of action of Lecanemab?
Monoclonal antibody that reduces amyloid plaque in Alzheimer's
52
What are the indications for Lecanemab?
Early-stage Alzheimer’s disease with amyloid plaques
53
What are the side effects of Lecanemab?
Brain microhemorrhages, infusion reactions
54
What is the mechanism of action of Diazepam?
Binds to GABA receptors, enhancing inhibitory effects to reduce neuron firing
55
What are the indications for Diazepam?
Seizures, anxiety, muscle spasms, status epilepticus
56
What are the side effects of Diazepam?
Drowsiness, dizziness, respiratory depression, tolerance development
57
What are important notes about Diazepam?
Used mainly for acute seizure management; tolerance can develop
58
What is the class of Levetiracetam?
SV2A Binding Anticonvulsant
59
What is the mechanism of action of Levetiracetam?
Binds synaptic vesicle protein 2A, reducing neurotransmitter release
60
What are the indications for Levetiracetam?
Focal seizures, generalized tonic-clonic seizures, myoclonic seizures
61
What are the side effects of Levetiracetam?
Mood alterations, dizziness, fatigue
62
What are important notes about Levetiracetam?
Well absorbed orally; primarily excreted unchanged in urine
63
What is the class of Carbamazepine?
Sodium Channel Blocker
64
What is the mechanism of action of Carbamazepine?
Blocks Na+ channels, reducing neuronal excitability
65
What are the indications for Carbamazepine?
Partial seizures, generalized tonic-clonic seizures, trigeminal neuralgia, bipolar disorder
66
What are the side effects of Carbamazepine?
Hyponatremia, dizziness, drowsiness, aplastic anemia, Stevens-Johnson Syndrome
67
What are important notes about Carbamazepine?
Induces its own metabolism; avoid in HLA-B1505 positive Asians due to SJS risk
68
What is the class of Phenytoin?
Hydantoin
69
What is the mechanism of action of Phenytoin?
Stabilizes hyper-excitable neurons by selectively inhibiting Na+ channels
70
What are the indications for Phenytoin?
Generalized tonic-clonic seizures, partial seizures, status epilepticus
71
What are the side effects of Phenytoin?
Gingival hyperplasia, sedation, dizziness, ataxia, Stevens-Johnson Syndrome
72
What are important notes about Phenytoin?
Highly protein-bound; many drug interactions; nonlinear kinetics require careful dosing
73
What is the class of Ethosuximide?
Calcium Channel Blocker
74
What is the mechanism of action of Ethosuximide?
Blocks T-type Ca++ channels to suppress nerve transmission in motor cortex
75
What are the indications for Ethosuximide?
Generalized absence seizures
76
What are the side effects of Ethosuximide?
GI distress, dizziness, rash, weight loss
77
What is the class of Perampanel?
AMPA Receptor Antagonist
78
What is the mechanism of action of Perampanel?
Selective AMPA receptor antagonist that reduces excitatory neurotransmission
79
What are the indications for Perampanel?
Focal seizures, adjunct for generalized tonic-clonic seizures
80
What are the side effects of Perampanel?
Aggression, hostility, irritability, homicidal ideation
81
What are important notes about Perampanel?
Long half-life allows once-daily dosing; psychiatric side effects require monitoring
82
What is the mechanism of action of Phenobarbital?
Increases seizure threshold by enhancing GABA-mediated inhibition
83
What are the indications for Phenobarbital?
Seizures, sedation, status epilepticus
84
What are the side effects of Phenobarbital?
Sedation, drowsiness, confusion, CNS depression
85
What are important notes about Phenobarbital?
Long half-life; tolerance may develop; gradual taper needed when discontinuing
86
What is the class of Cenobamate?
Sodium Channel Blocker & GABA Modulator
87
What is the mechanism of action of Cenobamate?
Blocks voltage-gated Na+ channels and modulates GABAA receptors
88
What are the indications for Cenobamate?
Focal seizures
89
What are the side effects of Cenobamate?
Fatigue, headache, dizziness, diplopia
90
What is the class of Valproic Acid (VPA)?
Multiple MOA Anticonvulsant
91
What are the indications for Valproic Acid (VPA)?
All seizure types, bipolar disorder, migraine prophylaxis
92
What are the side effects of Valproic Acid (VPA)?
Tremors, GI distress, weight gain, hepatotoxicity, alopecia, sedation
93
What are important notes about Valproic Acid (VPA)?
Avoid in pregnancy due to teratogenicity; interacts with multiple drugs; monitor LFTs
94
What is the class of Lamotrigine?
Sodium Channel Blocker
95
What is the mechanism of action of Lamotrigine?
Blocks Na+ channels, stabilizes membranes, prevents glutamate & aspartate release
96
What are the indications for Lamotrigine?
Partial seizures, generalized tonic-clonic seizures, bipolar disorder maintenance
97
What are the side effects of Lamotrigine?
Dizziness, headache, double vision, ataxia
98
What are important notes about Lamotrigine?
Risk of Stevens-Johnson Syndrome; titrate dose slowly; avoid rechallenge if rash develops
Anti epileptic
99
What is the class of Topiramate?
Multiple MOA Anticonvulsant
100
What is the mechanism of action of Topiramate?
Blocks Na+ channels, augments GABA activity, inhibits glutamate
101
What are the indications for Topiramate?
Adjunct therapy for seizures, migraine prophylaxis
102
What are the side effects of Topiramate?
Fatigue, difficulty concentrating, speech problems, weight loss, kidney stones
103
What are important notes about Topiramate?
Increase hydration (kidney stones); interacts with CYP
104
What is the class of Cannabidiol (Epidolex)?
Unknown MOA Anticonvulsant
105
What are the indications for Cannabidiol (Epidolex)?
Seizures from Lennox-Gastaut, Dravet, or tuberous sclerosis syndromes
106
What are the side effects of Cannabidiol (Epidolex)?
Drowsiness, diarrhea, vomiting, decreased appetite, increased LFTs (with VPA)
107
What are important notes about Cannabidiol (Epidolex)?
No psychoactive effects; only available as a liquid; interacts with multiple drugs
108
What is the class of Fenfluramine (Fentepla)?
5-HT2 Receptor Agonist
Dravet syndrome seizure
109
What is the mechanism of action of Fenfluramine (Fentepla)?
Exact MOA unknown for seizures; originally used for obesity
110
What are the indications for Fenfluramine (Fentepla)?
Seizures from Dravet syndrome
111
What are the side effects of Fenfluramine (Fentepla)?
Drowsiness, lethargy, reduced appetite, weight loss
Possibly valvular heart disease, or pulmonary htn
112
What are important notes about Fenfluramine (Fentepla)?
Requires bi-annual echocardiograms due to risk of valvular heart disease
113
What is the class of Gabapentin (Neurontin)?
Unknown MOA Anticonvulsant
114
What is the mechanism of action of Gabapentin (Neurontin)?
Increases GABA release, inhibits seizure discharges, inhibits pain transmission
115
What are the indications for Gabapentin (Neurontin)?
Adjunct for partial seizures, RLS, neurogenic pain
116
What are the side effects of Gabapentin (Neurontin)?
Sedation, dizziness, ataxia, fatigue, weight gain
117
What are important notes about Gabapentin (Neurontin)?
No major drug interactions; requires slow titration to avoid sedation
118
What is the class of Rufinamide (Banzel)?
Sodium Channel Blocker
119
What is the mechanism of action of Rufinamide (Banzel)?
Acts on Na+ channels to reduce excitability
120
What are the indications for Rufinamide (Banzel)?
Add-on therapy for Lennox-Gastaut syndrome
121
What are the side effects of Rufinamide (Banzel)?
Shortened QT intervals, dizziness, fatigue
122
What is the class of Carbidopa/Levodopa (Sinemet)?
Dopamine Precursor
123
What is the mechanism of action of Carbidopa/Levodopa (Sinemet)?
Levodopa is converted to dopamine in the CNS; Carbidopa prevents peripheral metabolism
124
What are the indications for Carbidopa/Levodopa (Sinemet)?
Parkinson's disease
125
What are the side effects of Carbidopa/Levodopa (Sinemet)?
Nausea, vomiting, hypotension, arrhythmias, anxiety, hallucinations
126
What are important notes about Carbidopa/Levodopa (Sinemet)?
Gold standard treatment; effects diminish over time; contraindicated in malignant melanoma
127
What is the class of Selegiline (Eldepryl)?
MAO-B Inhibitor
128
What is the mechanism of action of Selegiline (Eldepryl)?
Prevents dopamine metabolism in the brain
129
What are the indications for Selegiline (Eldepryl)?
Adjunct therapy in Parkinson’s disease
130
What are the side effects of Selegiline (Eldepryl)?
Hypertension (if over 10 mg/day), insomnia, nausea
131
What is the class of Rasagiline (Azilect)?
MAO-B Inhibitor
132
What is the mechanism of action of Rasagiline (Azilect)?
Blocks metabolism of dopamine, improving quality of life and slowing disease progression
133
What are the indications for Rasagiline (Azilect)?
Parkinson’s disease
134
What are the side effects of Rasagiline (Azilect)?
Orthostatic hypotension, headache, dyskinesia
135
What are important notes about Rasagiline (Azilect)?
Potentiated by CYP1A2 inhibitors; avoid tyramine-rich foods
136
What is the class of Pramipexole (Mirapex)?
Dopamine Agonist
137
What is the mechanism of action of Pramipexole (Mirapex)?
Selective D2 receptor agonist
138
What are the indications for Pramipexole (Mirapex)?
Parkinson’s disease, restless leg syndrome
139
What are the side effects of Pramipexole (Mirapex)?
Nausea, dizziness, hallucinations, somnolence, hypotension
140
What are important notes about Pramipexole (Mirapex)?
Used as monotherapy in early disease; combined with levodopa in later stages
141
What is the class of Ropinirole (Requip)?
Dopamine Agonist
142
What is the mechanism of action of Ropinirole (Requip)?
D2/D3 receptor agonist
143
What are the indications for Ropinirole (Requip)?
Parkinson’s disease, restless leg syndrome
144
What are the side effects of Ropinirole (Requip)?
Nausea, dizziness, daytime somnolence, hypotension
145
What are important notes about Ropinirole (Requip)?
Used as monotherapy in young patients or with Sinemet to reduce levodopa needs
146
What is the class of Apomorphine (Apokyn)?
Dopamine Agonist
147
What is the mechanism of action of Apomorphine (Apokyn)?
Non-ergot D1/D2 dopamine agonist
148
What are the indications for Apomorphine (Apokyn)?
Treatment of 'off' episodes in Parkinson’s disease
149
What are the side effects of Apomorphine (Apokyn)?
Hypotension, nausea, hallucinations
150
What are important notes about Apomorphine (Apokyn)?
Requires antiemetic (Tigan); administered subcutaneously
151
What is the class of Tolcapone (Tasmar)?
COMT Inhibitor
152
What is the mechanism of action of Tolcapone (Tasmar)?
Blocks peripheral levodopa metabolism, increasing CNS dopamine levels
153
What are the indications for Tolcapone (Tasmar)?
Parkinson’s disease (adjunct to levodopa)
154
What are the side effects of Tolcapone (Tasmar)?
Liver toxicity, diarrhea, dyskinesia
155
What are important notes about Tolcapone (Tasmar)?
Black box warning for hepatotoxicity; requires liver function monitoring
156
What is the class of Entacapone (Comtan)?
COMT Inhibitor
157
What is the mechanism of action of Entacapone (Comtan)?
Prevents breakdown of levodopa in the periphery
158
What are the indications for Entacapone (Comtan)?
Parkinson’s disease (adjunct to levodopa)
159
What are the side effects of Entacapone (Comtan)?
Dyskinesia, nausea, diarrhea
160
What are important notes about Entacapone (Comtan)?
Often combined with carbidopa/levodopa to extend its duration
161
What is the class of Istradefylline (Nourianz)?
Adenosine A2A Receptor Antagonist
162
What is the mechanism of action of Istradefylline (Nourianz)?
Reduces frequency of 'off' episodes by blocking adenosine receptors
163
What are the indications for Istradefylline (Nourianz)?
Adjunct to Sinemet in Parkinson’s disease
164
What are the side effects of Istradefylline (Nourianz)?
Dyskinesia, nausea, hallucinations, impulse control issues
165
What is the class of Amantadine (Symmetrel)?
Glutamate Agonist
166
What is the mechanism of action of Amantadine (Symmetrel)?
Promotes dopamine release and inhibits reuptake
167
What are the indications for Amantadine (Symmetrel)?
Parkinson’s disease, rigidity, akinesia
168
What are the side effects of Amantadine (Symmetrel)?
Insomnia, dizziness, hallucinations, livedo reticularis
169
What are important notes about Amantadine (Symmetrel)?
Used as an add-on therapy for Parkinson’s symptoms (last ditch)
170
Which medication could interfere with the effectiveness of Sinemet in a Parkinson's patient?
Metoclopramide
171
Which combination of drugs is appropriate for a 75-year-old with moderate Parkinson's disease?
Levodopa, Carbidopa, Entacapone
172
What common side effect should you caution about when prescribing Bethanechol?
Diaphoresis, bronchospasm, nausea
173
Which agent is a first-line treatment for a 79-year-old patient with Alzheimer’s dementia?
Donepezil
174
Which drug is most appropriate for a child with absence seizures affecting school performance?
Ethosuximide (Zarontin)
175
For a 28-year-old woman with generalized seizures planning pregnancy, what should be done?
Consider switching to Lamotrigine (Lamictal)
176
Which AED is least likely to have a drug interaction with Carbamazepine in a focal seizure patient?
Levetiracetam (Keppra)
177
Which AED increases the risk of hyponatremia in a 62-year-old with HTN on HCTZ?
Carbamazepine (Tegretol)
