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*Boards* > CNS Pharm > Flashcards

CNS Pharm Flashcards

1
Q

Are BZs or Barbs safer?

A

BZs

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2
Q

What can Barbs or alcohol lead to that BZs can’t?

A

Coma

BZs can reach medullary depression and level out, Barbs and alcohol can pass that and lead to coma

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3
Q

Describe the GABA-A binding complex.

A

5 subunits – a, B, y, p, d

Alpha = GABA binding site
Gamma = BZ binding site
Beta = Barb binding site
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4
Q

GABA-A activation leads to the movement of what ion?

A

Increased Cl- influx

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5
Q

GABA-B activation leads to the movement of what ion?

A

Increased K+ efflux

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6
Q

This drug class potentiates GABA and increases the FREQUENCY of Cl- channel opening.

A

BZs

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7
Q

This drug class prolongs GABA activity by increasing DURATION of Cl- channel opening.

A

Barbs

“BarbiDURate”

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8
Q

This nonspecific BZ receptor antagonist is used for BZ overdose or anesthesia reversal.

A

Flumazenil

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9
Q

Which BZ receptor mediates sedation and is largely used for sleep disorders?

A

BZ-1

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10
Q

What are the suffixes used for BZs?

A
  • lam

- pam

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11
Q

This BZ is best for acute anxiety attacks, panic, or phobias.

A

Alprazolam

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12
Q

This BZ is long-acting and best for anxiety, preop sedation, muscle relaxation, and withdrawal states.

A

Diazepam

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13
Q

Which BZs are used for sleep disorders?

A

Temazepam

Oxazepam

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14
Q

This BZ is short-acting and used for preop sedation and anesthesia.

A

Midazolam

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15
Q

List the BZs (6).

A 
Alprazolam 
Diazepam
Lorazepam
Midazolam
Temazepam
Oxazepam
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16
Q

Which BZs are safe for use in pts with liver dysfunctions? Why?

A

Oxazepam
Temazepam
Lorazepam

They are conjugated extrahepatically, making use safer for pts with liver dysfunctions

“OTL” = “Outside The Liver”

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17
Q

Which Barb is used for seizures?

A

Phenobarbital

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18
Q

What are the withdrawal signs of Barbs and ethanol?

A

Anxiety
Agitation
Life-threatening seizures (Delirium tremens w/ alcohol)

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19
Q

What is the best way to treat withdrawal from Barbs and ethanol?

A

Long-acting BZs

Supportive care

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20
Q

What are the non-BZ drugs and their MOA?

A

Zolpidem - BZ-1 receptor agonist
Zaleplon - BZ-1 receptor agonist
Buspirone - 5HT1a partial agonist

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21
Q

What is the main use for Zolpidem and Zaleplon?

A

Sleep disorders

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22
Q

This drug is better for chronic anxiety because it takes 1-2 weeks to fully work.

A

Buspirone

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23
Q

Due to the end-product of alcohol metabolism being acids, what severe electrolyte disorder can occur?

A

Metabolic acidosis

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24
Q

Ethylene glycol (antifreeze) metabolizes into what acids?

A

Glycolic acid –> Oxalic acid

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25
Q

What is the most worrisome side effect from ethylene glycol metabolism?

A

Nephrotoxicity

26
Q

Methanol metabolizes into what?

A

Formaldehyde –> Formic acid

27
Q

What is the most worrisome side effect from methanol metabolism?

A

Ocular damage

28
Q

Ethanol metabolizes into what?

A

Acetaldehyde –> Acetic acid

29
Q

What enzyme is inhibited by Disulfiram in ethanol metabolism?

A

Acetaldehyde dehydrogenase

30
Q

What are the drugs that cause a Disulfiram-like effect when taken with alcohol?

A

Metronidazole
Griseofulvin
Cefoperazone

31
Q

What is the best treatment for OD of ethylene glycol or methanol?

A

Ethanol – b/c it’s the best substrate for alcohol dehydrogenase (gonna have a hella hangover tho)

32
Q

This is another antidote that can be used for methanol OD, it is a long-acting inhibitor of alcohol dehydrogenase.

A

Fomepizole

33
Q

What are the characteristics of a child with fetal alcohol syndrome?

A 
Growth restriction
Midfacial hypoplasia
Microcephaly 
CNS dysfunction
Mental retardation
34
Q

What are the main SSRIs used? (5)

A 
Fluoxetine
Paroxetine
Sertraline
Citalopram
Fluvoxamine
35
Q

What is the MOA of SSRIs?

A

Selective blockade of 5HT reuptake

36
Q

What are the major uses for SSRIs?

A 
Major depression
OCD
Bulimia
PMDD
PTSD
37
Q

What is a major side effect of SSRIs that results in many pts discontinuing their use?

A

Sexual dysfunction (can’t orgasm or have decreased libido)

38
Q

If SSRIs are used in conjunction with other drugs that cause increased 5HT, what can result?

A

Serotonin syndrome

39
Q

What are the characteristics of serotonin syndrome?

A 
Sweating
Rigidity
Myoclonus
Hyperthermia
ANS instability
Seizures
40
Q

What are the main Tricyclic Antidepressants (TCAs)?

A

Amitriptyline
Imipramine
Clomipramine

41
Q

What is the suffix most often used for TCAs?

A

-ipramine

42
Q

What are major uses of TCAs?

Besides depression b/c mostly SSRIs are used now

A 
Neuropathic pain (diabetics or postherpetic neuralgia) 
Enuresis (bed-wetting)
43
Q

What is the MOA of TCAs?

A

Nonspecific blockade of 5HT and NE reuptake

44
Q

What the “3 C’s” of toxicity that can occur with TCAs?

A

Coma
Convulsions
Cardiotoxicity (Torsades de pointe)

45
Q

This class of drugs are like TCAs but without the ANS effects, and its use is for depression.

A

SNRIs

46
Q

What are the main SNRIs?

A

Venlafaxine
Desvenlafaxine
Duloxetine

47
Q

What is the MOA of SNRIs?

A

Inhibit reuptake of both serotonin and NE

48
Q

Which drugs, if combined, can result in serotonin syndrome?

A

SSRIs
TCAs
MAOIs
Meperidine

49
Q

What are the MAOIs?

A

Phenelzine

Tranylcypromine

50
Q

MAOIs are (IRREVERSIBLE/REVERSIBLE) inhibitors of MAO-A and MAO-B.

A

Irreversible

51
Q

This antidepressant is associated with cardiac arrhythmias and priapism.

A

Trazodone

52
Q

This antidepressant is a dopamine and NE reuptake blocker that has fewer sexual side effects, so pts often switch to this.

A

Bupropion

53
Q

This drug is a dopamine and NE reuptake blocker used in smoking cessation.

A

Bupropion

54
Q

This drug is a partial agonist of nicotinic receptors used in smoking cessation.

A

Varenicline

55
Q

This is the DOC for bipolar disorders.

A

Lithium

56
Q

What is the MOA of lithium?

A

Prevents recycling of inositol by blocking inositol monophosphatase (results in decreased cAMP)

57
Q

What are the most worrisome side effects of lithium?

A

Tremor
Hypothyroidism with goiter
Nephrogenic diabetes insipidus

58
Q

Lithium can be teratogenic. What abnormalities can it lead to in the fetus?

A

Ebstein anomaly (malformed tricuspid valve)

59
Q

What other drugs can be used in bipolar disorders?

A

Valproic acid

Carbamazepine

60
Q

What drugs are often used in ADHD?

A

Methylphenidate
Amphetamine
Atomoxetine (backup to methylphenidate)

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