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CNS FINAL Flashcards

1
Q

What is the class/MOA of Acetylcholine?

A

Direct-Acting Cholinergic Agonist; acts on muscarinic and nicotinic receptors

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2
Q

What are the indications for Acetylcholine?

A

Limited clinical userapidly eliminated; used in eye surgery

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3
Q

What are the side effects of Acetylcholine?

A

Decreases HR, lowers BP, increases gastric acid secretion

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4
Q

What is the class of Bethanechol?

A

Direct-Acting Cholinergic Agonist

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5
Q

What is the mechanism of action of Bethanechol?

A

Stimulates smooth muscle in bladder and GI tract

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6
Q

What are the indications for Bethanechol?

A

Atonic bladder, GI atony

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7
Q

What are the side effects of Bethanechol?

A

Diaphoresis, salivation, nausea, bronchospasm

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8
Q

What are important notes about Bethanechol?

A

Contraindicated in bladder/GI obstruction

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9
Q

What is the class of Pilocarpine?

A

Direct-Acting Cholinergic Agonist

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10
Q

What is the mechanism of action of Pilocarpine?

A

Stimulates secretions (sweat, tears, saliva); used in glaucoma

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11
Q

What are the indications for Pilocarpine?

A

Glaucoma, dry mouth

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12
Q

What are the side effects of Pilocarpine?

A

Sweating, excessive salivation, risk of systemic effects

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13
Q

What are important notes about Pilocarpine?

A

First-line for acute glaucoma attacks

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14
Q

What is the class of Cevimeline?

A

Direct-Acting Cholinergic Agonist

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15
Q

What is the mechanism of action of Cevimeline?

A

Selective for muscarinic receptors; used for dry mouth
Sjorgrens

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16
Q

What are the indications for Cevimeline?

A

Xerostomia due to radiation or Sjogren’s syndrome

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17
Q

What are the side effects of Cevimeline?

A

Fewer systemic effects than pilocarpine (preferred over Pilocarpine)
Sweating, salivating, possible systemic effects

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18
Q

What is the class of Physostigmine?

A

Reversible Acetylcholinesterase Inhibitor

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19
Q

What is the mechanism of action of Physostigmine?

A

Reverses CNS effects of anticholinergic toxicity

Acetylcholinesterase inhibitor

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20
Q

What are the indications for Physostigmine?

A

Reversal of anticholinergic overdose

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21
Q

What are the side effects of Physostigmine?

A

Bradycardia, seizures, salivation, bronchospasm

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22
Q

What are important notes about Physostigmine?

A

Used for atropine overdose

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23
Q

What is the class of Neostigmine?

A

Reversible Acetylcholinesterase Inhibitor

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24
Q

What is the mechanism of action of Neostigmine?

A

Enhances skeletal muscle contraction

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25
Q

What are the indications for Neostigmine?

A

Myasthenia gravis, neuromuscular blockade reversal

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26
Q

What are the side effects of Neostigmine?

A

GI distress, salivation, bronchospasm

myasthenia gravis. It can also reverse the effects of anesthesia

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27
Q

What is the class of Pyridostigmine?

A

Reversible Acetylcholinesterase Inhibitor

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28
Q

What is the mechanism of action of Pyridostigmine?

A

Long-acting acetylcholinesterase inhibitor for myasthenia gravis

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29
Q

What are the indications for Pyridostigmine?

A

Chronic myasthenia gravis management

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30
Q

What are the side effects of Pyridostigmine?

A

Similar to neostigmine, but longer duration

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31
Q

What is the class of Donepezil?

A

Acetylcholinesterase Inhibitor

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32
Q

What is the mechanism of action of Donepezil?

A

Prevents breakdown of acetylcholine to slow Alzheimer’s progression

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33
Q

What are the indications for Donepezil?

A

Mild to moderate Alzheimer’s disease

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34
Q

What are the side effects of Donepezil?

A

Nausea, diarrhea, syncope, bradycardia

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35
Q

What are important notes about Donepezil?

A

Take at bedtime; caution with bradycardia

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36
Q

What is the class of Rivastigmine?

A

Acetylcholinesterase Inhibitor

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37
Q

What is the mechanism of action of Rivastigmine?

A

Prevents breakdown of acetylcholine, available as patch or oral

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38
Q

What are the indications for Rivastigmine?

A

Mild to moderate Alzheimer’s disease

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39
Q

What are the side effects of Rivastigmine?

A

GI distress, weight loss, muscle wasting

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40
Q

What is the class of Galantamine?

A

Acetylcholinesterase Inhibitor

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41
Q

What is the mechanism of action of Galantamine?

A

Prevents breakdown of acetylcholine to slow Alzheimer’s progression

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42
Q

What are the indications for Galantamine?

A

Mild to moderate Alzheimer’s disease

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43
Q

What are the side effects of Galantamine?

A

GI distress, weight loss, dizziness

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44
Q

What are important notes about Galantamine?

A

Derived from plants; marketed as natural

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45
Q

What is the class of Memantine?

A

NMDA Receptor Antagonist
Alzheimer’s

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46
Q

What is the mechanism of action of Memantine?

A

Blocks excitotoxic effects of glutamate to slow cognitive decline

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47
Q

What are the indications for Memantine?

A

Moderate to severe Alzheimer’s disease

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48
Q

What are the side effects of Memantine?

A

Dizziness, headache, rare seizures

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49
Q

What are important notes about Memantine?

A

Often combined with acetylcholinesterase inhibitors

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50
Q

What is the class of Lecanemab?

A

Monoclonal Antibody for Alzheimer’s

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51
Q

What is the mechanism of action of Lecanemab?

A

Monoclonal antibody that reduces amyloid plaque in Alzheimer’s

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52
Q

What are the indications for Lecanemab?

A

Early-stage Alzheimer’s disease with amyloid plaques

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53
Q

What are the side effects of Lecanemab?

A

Brain microhemorrhages, infusion reactions

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54
Q

What is the mechanism of action of Diazepam?

A

Binds to GABA receptors, enhancing inhibitory effects to reduce neuron firing

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55
Q

What are the indications for Diazepam?

A

Seizures, anxiety, muscle spasms, status epilepticus

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56
Q

What are the side effects of Diazepam?

A

Drowsiness, dizziness, respiratory depression, tolerance development

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57
Q

What are important notes about Diazepam?

A

Used mainly for acute seizure management; tolerance can develop

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58
Q

What is the class of Levetiracetam?

A

SV2A Binding Anticonvulsant

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59
Q

What is the mechanism of action of Levetiracetam?

A

Binds synaptic vesicle protein 2A, reducing neurotransmitter release

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60
Q

What are the indications for Levetiracetam?

A

Focal seizures, generalized tonic-clonic seizures, myoclonic seizures

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61
Q

What are the side effects of Levetiracetam?

A

Mood alterations, dizziness, fatigue

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62
Q

What are important notes about Levetiracetam?

A

Well absorbed orally; primarily excreted unchanged in urine

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63
Q

What is the class of Carbamazepine?

A

Sodium Channel Blocker

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64
Q

What is the mechanism of action of Carbamazepine?

A

Blocks Na+ channels, reducing neuronal excitability

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65
Q

What are the indications for Carbamazepine?

A

Partial seizures, generalized tonic-clonic seizures, trigeminal neuralgia, bipolar disorder

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66
Q

What are the side effects of Carbamazepine?

A

Hyponatremia, dizziness, drowsiness, aplastic anemia, Stevens-Johnson Syndrome

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67
Q

What are important notes about Carbamazepine?

A

Induces its own metabolism; avoid in HLA-B1505 positive Asians due to SJS risk

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68
Q

What is the class of Phenytoin?

A

Hydantoin

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69
Q

What is the mechanism of action of Phenytoin?

A

Stabilizes hyper-excitable neurons by selectively inhibiting Na+ channels

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70
Q

What are the indications for Phenytoin?

A

Generalized tonic-clonic seizures, partial seizures, status epilepticus

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71
Q

What are the side effects of Phenytoin?

A

Gingival hyperplasia, sedation, dizziness, ataxia, Stevens-Johnson Syndrome

72
Q

What are important notes about Phenytoin?

A

Highly protein-bound; many drug interactions; nonlinear kinetics require careful dosing

73
Q

What is the class of Ethosuximide?

A

Calcium Channel Blocker

74
Q

What is the mechanism of action of Ethosuximide?

A

Blocks T-type Ca++ channels to suppress nerve transmission in motor cortex

75
Q

What are the indications for Ethosuximide?

A

Generalized absence seizures

76
Q

What are the side effects of Ethosuximide?

A

GI distress, dizziness, rash, weight loss

77
Q

What is the class of Perampanel?

A

AMPA Receptor Antagonist

78
Q

What is the mechanism of action of Perampanel?

A

Selective AMPA receptor antagonist that reduces excitatory neurotransmission

79
Q

What are the indications for Perampanel?

A

Focal seizures, adjunct for generalized tonic-clonic seizures

80
Q

What are the side effects of Perampanel?

A

Aggression, hostility, irritability, homicidal ideation

81
Q

What are important notes about Perampanel?

A

Long half-life allows once-daily dosing; psychiatric side effects require monitoring

82
Q

What is the mechanism of action of Phenobarbital?

A

Increases seizure threshold by enhancing GABA-mediated inhibition

83
Q

What are the indications for Phenobarbital?

A

Seizures, sedation, status epilepticus

84
Q

What are the side effects of Phenobarbital?

A

Sedation, drowsiness, confusion, CNS depression

85
Q

What are important notes about Phenobarbital?

A

Long half-life; tolerance may develop; gradual taper needed when discontinuing

86
Q

What is the class of Cenobamate?

A

Sodium Channel Blocker & GABA Modulator

87
Q

What is the mechanism of action of Cenobamate?

A

Blocks voltage-gated Na+ channels and modulates GABAA receptors

88
Q

What are the indications for Cenobamate?

A

Focal seizures

89
Q

What are the side effects of Cenobamate?

A

Fatigue, headache, dizziness, diplopia

90
Q

What is the class of Valproic Acid (VPA)?

A

Multiple MOA Anticonvulsant

91
Q

What are the indications for Valproic Acid (VPA)?

A

All seizure types, bipolar disorder, migraine prophylaxis

92
Q

What are the side effects of Valproic Acid (VPA)?

A

Tremors, GI distress, weight gain, hepatotoxicity, alopecia, sedation

93
Q

What are important notes about Valproic Acid (VPA)?

A

Avoid in pregnancy due to teratogenicity; interacts with multiple drugs; monitor LFTs

94
Q

What is the class of Lamotrigine?

A

Sodium Channel Blocker

95
Q

What is the mechanism of action of Lamotrigine?

A

Blocks Na+ channels, stabilizes membranes, prevents glutamate & aspartate release

96
Q

What are the indications for Lamotrigine?

A

Partial seizures, generalized tonic-clonic seizures, bipolar disorder maintenance

97
Q

What are the side effects of Lamotrigine?

A

Dizziness, headache, double vision, ataxia

98
Q

What are important notes about Lamotrigine?

A

Risk of Stevens-Johnson Syndrome; titrate dose slowly; avoid rechallenge if rash develops

Anti epileptic

99
Q

What is the class of Topiramate?

A

Multiple MOA Anticonvulsant

100
Q

What is the mechanism of action of Topiramate?

A

Blocks Na+ channels, augments GABA activity, inhibits glutamate

101
Q

What are the indications for Topiramate?

A

Adjunct therapy for seizures, migraine prophylaxis

102
Q

What are the side effects of Topiramate?

A

Fatigue, difficulty concentrating, speech problems, weight loss, kidney stones

103
Q

What are important notes about Topiramate?

A

Increase hydration (kidney stones); interacts with CYP

104
Q

What is the class of Cannabidiol (Epidolex)?

A

Unknown MOA Anticonvulsant

105
Q

What are the indications for Cannabidiol (Epidolex)?

A

Seizures from Lennox-Gastaut, Dravet, or tuberous sclerosis syndromes

106
Q

What are the side effects of Cannabidiol (Epidolex)?

A

Drowsiness, diarrhea, vomiting, decreased appetite, increased LFTs (with VPA)

107
Q

What are important notes about Cannabidiol (Epidolex)?

A

No psychoactive effects; only available as a liquid; interacts with multiple drugs

108
Q

What is the class of Fenfluramine (Fentepla)?

A

5-HT2 Receptor Agonist

Dravet syndrome seizure

109
Q

What is the mechanism of action of Fenfluramine (Fentepla)?

A

Exact MOA unknown for seizures; originally used for obesity

110
Q

What are the indications for Fenfluramine (Fentepla)?

A

Seizures from Dravet syndrome

111
Q

What are the side effects of Fenfluramine (Fentepla)?

A

Drowsiness, lethargy, reduced appetite, weight loss

Possibly valvular heart disease, or pulmonary htn

112
Q

What are important notes about Fenfluramine (Fentepla)?

A

Requires bi-annual echocardiograms due to risk of valvular heart disease

113
Q

What is the class of Gabapentin (Neurontin)?

A

Unknown MOA Anticonvulsant

114
Q

What is the mechanism of action of Gabapentin (Neurontin)?

A

Increases GABA release, inhibits seizure discharges, inhibits pain transmission

115
Q

What are the indications for Gabapentin (Neurontin)?

A

Adjunct for partial seizures, RLS, neurogenic pain

116
Q

What are the side effects of Gabapentin (Neurontin)?

A

Sedation, dizziness, ataxia, fatigue, weight gain

117
Q

What are important notes about Gabapentin (Neurontin)?

A

No major drug interactions; requires slow titration to avoid sedation

118
Q

What is the class of Rufinamide (Banzel)?

A

Sodium Channel Blocker

119
Q

What is the mechanism of action of Rufinamide (Banzel)?

A

Acts on Na+ channels to reduce excitability

120
Q

What are the indications for Rufinamide (Banzel)?

A

Add-on therapy for Lennox-Gastaut syndrome

121
Q

What are the side effects of Rufinamide (Banzel)?

A

Shortened QT intervals, dizziness, fatigue

122
Q

What is the class of Carbidopa/Levodopa (Sinemet)?

A

Dopamine Precursor

123
Q

What is the mechanism of action of Carbidopa/Levodopa (Sinemet)?

A

Levodopa is converted to dopamine in the CNS; Carbidopa prevents peripheral metabolism

124
Q

What are the indications for Carbidopa/Levodopa (Sinemet)?

A

Parkinson’s disease

125
Q

What are the side effects of Carbidopa/Levodopa (Sinemet)?

A

Nausea, vomiting, hypotension, arrhythmias, anxiety, hallucinations

126
Q

What are important notes about Carbidopa/Levodopa (Sinemet)?

A

Gold standard treatment; effects diminish over time; contraindicated in malignant melanoma

127
Q

What is the class of Selegiline (Eldepryl)?

A

MAO-B Inhibitor

128
Q

What is the mechanism of action of Selegiline (Eldepryl)?

A

Prevents dopamine metabolism in the brain

129
Q

What are the indications for Selegiline (Eldepryl)?

A

Adjunct therapy in Parkinson’s disease

130
Q

What are the side effects of Selegiline (Eldepryl)?

A

Hypertension (if over 10 mg/day), insomnia, nausea

131
Q

What is the class of Rasagiline (Azilect)?

A

MAO-B Inhibitor

132
Q

What is the mechanism of action of Rasagiline (Azilect)?

A

Blocks metabolism of dopamine, improving quality of life and slowing disease progression

133
Q

What are the indications for Rasagiline (Azilect)?

A

Parkinson’s disease

134
Q

What are the side effects of Rasagiline (Azilect)?

A

Orthostatic hypotension, headache, dyskinesia

135
Q

What are important notes about Rasagiline (Azilect)?

A

Potentiated by CYP1A2 inhibitors; avoid tyramine-rich foods

136
Q

What is the class of Pramipexole (Mirapex)?

A

Dopamine Agonist

137
Q

What is the mechanism of action of Pramipexole (Mirapex)?

A

Selective D2 receptor agonist

138
Q

What are the indications for Pramipexole (Mirapex)?

A

Parkinson’s disease, restless leg syndrome

139
Q

What are the side effects of Pramipexole (Mirapex)?

A

Nausea, dizziness, hallucinations, somnolence, hypotension

140
Q

What are important notes about Pramipexole (Mirapex)?

A

Used as monotherapy in early disease; combined with levodopa in later stages

141
Q

What is the class of Ropinirole (Requip)?

A

Dopamine Agonist

142
Q

What is the mechanism of action of Ropinirole (Requip)?

A

D2/D3 receptor agonist

143
Q

What are the indications for Ropinirole (Requip)?

A

Parkinson’s disease, restless leg syndrome

144
Q

What are the side effects of Ropinirole (Requip)?

A

Nausea, dizziness, daytime somnolence, hypotension

145
Q

What are important notes about Ropinirole (Requip)?

A

Used as monotherapy in young patients or with Sinemet to reduce levodopa needs

146
Q

What is the class of Apomorphine (Apokyn)?

A

Dopamine Agonist

147
Q

What is the mechanism of action of Apomorphine (Apokyn)?

A

Non-ergot D1/D2 dopamine agonist

148
Q

What are the indications for Apomorphine (Apokyn)?

A

Treatment of ‘off’ episodes in Parkinson’s disease

149
Q

What are the side effects of Apomorphine (Apokyn)?

A

Hypotension, nausea, hallucinations

150
Q

What are important notes about Apomorphine (Apokyn)?

A

Requires antiemetic (Tigan); administered subcutaneously

151
Q

What is the class of Tolcapone (Tasmar)?

A

COMT Inhibitor

152
Q

What is the mechanism of action of Tolcapone (Tasmar)?

A

Blocks peripheral levodopa metabolism, increasing CNS dopamine levels

153
Q

What are the indications for Tolcapone (Tasmar)?

A

Parkinson’s disease (adjunct to levodopa)

154
Q

What are the side effects of Tolcapone (Tasmar)?

A

Liver toxicity, diarrhea, dyskinesia

155
Q

What are important notes about Tolcapone (Tasmar)?

A

Black box warning for hepatotoxicity; requires liver function monitoring

156
Q

What is the class of Entacapone (Comtan)?

A

COMT Inhibitor

157
Q

What is the mechanism of action of Entacapone (Comtan)?

A

Prevents breakdown of levodopa in the periphery

158
Q

What are the indications for Entacapone (Comtan)?

A

Parkinson’s disease (adjunct to levodopa)

159
Q

What are the side effects of Entacapone (Comtan)?

A

Dyskinesia, nausea, diarrhea

160
Q

What are important notes about Entacapone (Comtan)?

A

Often combined with carbidopa/levodopa to extend its duration

161
Q

What is the class of Istradefylline (Nourianz)?

A

Adenosine A2A Receptor Antagonist

162
Q

What is the mechanism of action of Istradefylline (Nourianz)?

A

Reduces frequency of ‘off’ episodes by blocking adenosine receptors

163
Q

What are the indications for Istradefylline (Nourianz)?

A

Adjunct to Sinemet in Parkinson’s disease

164
Q

What are the side effects of Istradefylline (Nourianz)?

A

Dyskinesia, nausea, hallucinations, impulse control issues

165
Q

What is the class of Amantadine (Symmetrel)?

A

Glutamate Agonist

166
Q

What is the mechanism of action of Amantadine (Symmetrel)?

A

Promotes dopamine release and inhibits reuptake

167
Q

What are the indications for Amantadine (Symmetrel)?

A

Parkinson’s disease, rigidity, akinesia

168
Q

What are the side effects of Amantadine (Symmetrel)?

A

Insomnia, dizziness, hallucinations, livedo reticularis

169
Q

What are important notes about Amantadine (Symmetrel)?

A

Used as an add-on therapy for Parkinson’s symptoms (last ditch)

170
Q

Which medication could interfere with the effectiveness of Sinemet in a Parkinson’s patient?

A

Metoclopramide

171
Q

Which combination of drugs is appropriate for a 75-year-old with moderate Parkinson’s disease?

A

Levodopa, Carbidopa, Entacapone

172
Q

What common side effect should you caution about when prescribing Bethanechol?

A

Diaphoresis, bronchospasm, nausea

173
Q

Which agent is a first-line treatment for a 79-year-old patient with Alzheimer’s dementia?

174
Q

Which drug is most appropriate for a child with absence seizures affecting school performance?

A

Ethosuximide (Zarontin)

175
Q

For a 28-year-old woman with generalized seizures planning pregnancy, what should be done?

A

Consider switching to Lamotrigine (Lamictal)

176
Q

Which AED is least likely to have a drug interaction with Carbamazepine in a focal seizure patient?

A

Levetiracetam (Keppra)

177
Q

Which AED increases the risk of hyponatremia in a 62-year-old with HTN on HCTZ?

A

Carbamazepine (Tegretol)

Pharm (34 decks)

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