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ZNeurology > CNS Pharm EC > Flashcards

CNS Pharm EC Flashcards

1
Q

Phenytoin (MOA, Use)

A

Inactivate Na channels

1st line for tonic clonic seizures
1st line for status epilepticus prophylaxis
Simple partial seizures
Complex partial seizures

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2
Q

Phenytoin toxicity

A

Nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hirsutism, megaloblastic anemia, teratogen, SLE-like syndrome, induction of P450s, lymphadenopathy, Steven’s Johnson syndrome, osteopenia

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3
Q

Carbamazepine (MOA, Use)

A

Inactivate Na channels

1st line for simple partial seizures
1st line for complex partial seizures
1st line for tonic clonic seizures
1st line for trigeminal neuralgia

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4
Q

Carbamazepine toxicity

A

Diplopia, ataxia, blood dyscrasias, liver toxicity, induce P450s, teratogen, SIADH, Stevens-Johnson syndrome

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5
Q

Lamotrigine (MOA, Use)

A

Blocks voltage gated Na channels

Simple partial seizures
Complex partial seizures
Tonic clonic seizures

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6
Q

Lamotrigine toxicity

A

Stevens-Johnson syndrome

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7
Q

Gabapentin (MOA, Use)

A

Inhibits voltage activated Ca channels

Simple partial seizures
Complex partial seizures
Tonic clonic seizures
Peripheral neuropathy
Migraine prophylaxis
Bipolar disorder
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8
Q

Gabapentin toxicity

A

Sedation, ataxia

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9
Q

Topiramate (MOA, Use)

A

Blocks Na channels
Potentiates GABA

Simple partial seizures
Complex partial seizures
Tonic clonic seizures
Migraine prevention

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10
Q

Topiramate toxicity

A

Sedation, mental dulling, kidney stones, weight loss

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11
Q

Phenobarbital (MOA, Use)

A

Potentiate GABAa

1st line in children
Simple partial seizures
Complex partial seizures
Tonic clonic seizures

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12
Q

Phenobarbital toxicity

A

Sedation
Tolerance
Dependence
Induction of P450s

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13
Q

Valproic acid (MOA, Use)

A

Inactivate Na channels
Increase GABA concentration

1st line for tonic clonic seizures
Simple partial seizures
Complex partial seizures
Absence seizures
Myoclonic seizures
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14
Q

Valproic acid toxicity

A 
GI distress
Fatal hepatotoxicity
Neural tube defects (contraindicated in pregnancy) 
Tremor
Weight gain
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15
Q

Ethosuximide (MOA, Use)

A

Blocks thalamic T-type Ca channels

1st line for absence seizures

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16
Q

Ethosuximide toxicity

A 
GI distress
Fatigue
Headache
Urticaria
Stevens-Johnson syndrome
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17
Q

Diazepam or Lorazepam (MOA, Use in seizures)

A

Potentiate GABAa

1st line for acute status epilepticus
Seizures of eclampsia

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18
Q

Tiagabine (MOA, Use)

A

Inhibits GABA reuptake

Simple partial seizures
Complex partial seizures

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19
Q

Vigabatrin (MOA, Use)

A

Irreversibly inhibits GABA transaminase (increases [GABA])

Simple partial seizures
Complex partial seizures

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20
Q

Levetiracetam (MOA, Use)

A

Modulate GABA and glutamate release

Simple partial seizures
Complex partial seizures
Tonic clonic seizures

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21
Q

Zolpidem, Zaleplon, Eszopiclone (MOA, Use, Tox)

A

Act on BDZ1 GABA receptor (effects reversed by flumazenil)

Treats insomnia

Can cause ataxia, headaches, confusion.

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22
Q

Halothane, enflurane, isoflurane, sevoflurane, methoxyflurane, nitrous oxide (Use, Effects, Tox)

A

Inhaled anesthetics

Myocardial depression, respiratory depression, N/V, Increase cerebral blood flow

Malignant hyperthermia (all but NO)

23
Q

Halothane toxicity

A

Hepatotoxicity

24
Q

Methoxyflurane toxicity

A

Nephrotoxicity

25
Q

Enflurane toxicity

A

Proconvulsant

26
Q

NO toxicity

A

Expansion of trapped gas in a body cavity

27
Q

Thiopental (Class, Use, Effects)

A

High potency barbiturates used as IV anesthetic

Induction of anesthesia

Rapid redistribution
Decrease cerebral blood flow

28
Q

Midazolam (Class, Use, Effects)

A

Benzodiazepine used as IV anesthetic

Choice for endoscopy
Adjunct with gaseous anesthetics and narcotics

Severe postoperative respiratory depression
Decrease in BP
Amnesia

29
Q

Ketamine (MOA, Use, Effects)

A

Block NMDA receptor (PCP analog) used as IV anesthetic

Cardiovascular stimulant
Disorientation
Hallucination/bad dreams
Increase cerebral blood flow

30
Q

Morphine and Fentanyl as IV anesthetics

A

Adjunct in general anesthesia

31
Q

Propofol (MOA, Use, Effects)

A

Potentiates GABAa

IV anesthetic

Used for sedation in ICU
Rapid anesthesia, induction and short procedures
Little postoperative nausea

32
Q

Procaine, Cocaine, Tetracaine (Class, MOA, Use, Tox)

A

Ester local anesthetic

Block activated Na channels (most effective in rapidly firing neurons)

Minor surgical procedures, spinal anesthesia

Causes CNS excitation, Hypertension/Hypotension

33
Q

Lidocaine, Mepivacaine, Bupivacaine (Class, MOA, Use, Tox)

A

Amide local anesthetic (2 I’s in name)

Block activated Na channels (most effective in rapidly firing neurons)

Minor surgical procedures, spinal anesthesia

Causes CNS excitation, Hypertension/Hypotension
CV toxicity (Bupivacaine)
Arrhythmias (Cocaine)

34
Q

Succinylcholine (MOA, Use, Tox, Reversal of blockade)

A

Depolarizing neuromuscular blocker
ACh receptor agonist (sustained depolarization and prevents muscle contraction)

Muscle paralysis in surgery or mechanical ventilation

Hypercalcemia, Hyperkalemia, malignant hyperthermia

Phase I (prolonged depolarization) - no antidote 
Phase II (repolarization, ACh desensitized) - Cholinesterase inhibitors (Neostigmine)
35
Q

Tubocurarine, Atracurium, Mivacurium, Pancuronium, Vecuronium, Rocuronium (MOA, Use, Reversal of blockade)

A

Competitive antagonists at ACh receptors

Nondepolarizing neuromuscular blocker

Cholinesterase inhibitors (Neostigmine, edrophonium)

36
Q

Dantrolene (MOA, Use)

A

Prevents Ca release from SR of skeletal muscle

Treatment of MALIGNANT HYPERTHERMIA
Treats neuroleptic malignant syndrome (antipsychotic toxicity)

37
Q

Bromocriptine, Pramipexole, Ropinirole (MOA, Use)

A

Dopamine agonists

Used to treat Parkinson’s

38
Q

Amantadine (MOA, Use, Tox)

A

Increases dopamine levels

Used in Parkinson’s
Used as antiviral against Influenza A and Rubella

Can cause ataxia

39
Q

L-DOPA/Carbidopa (MOA, Use, Tox)

A

L-DOPA can cross BBB and is converted to dopamine
*given with Carbidopa which inhibits PERIPHERAL dopa decarboxylase to isolate effect to CNS

Used in Parkinson’s

Arrhythmias
Dyskinesia with long term use

40
Q

Selegiline (MOA, Use)

A

MOA-B blocker (prevent dopamine breakdown)

Adjunct to L-DOPA in Parkinson’s

41
Q

Entacapone, Tolcapone (MOA, Use)

A

COMT inhibitors (prevent L-DOPA breakdown)

Used in parkinson

42
Q

Benztropine (MOA, Use)

A

Antimuscarinic

Improves tremor and rigidity in Parkinson’s

43
Q

Memantine (MOA, Use, Tox)

A

NMDA antagonist (prevents Ca-mediated excitotoxicity)

Used in Alzheimer’s

Dizziness, confusion, hallucinations

44
Q

Donepezil, Galantamine, Rivastigmine (MOA, Use, Tox)

A

Acetylcholinesterase inhibitors

Used in Alzheimer’s

Nausea, dizziness, insomnia

45
Q

Tetrabenazine, Reserpine (MOA, Use)

A

Inhibit VMAT (limiting dopamine vesicle packaging and release)

Used in Huntington’s

46
Q

Haloperidol (MOA, Use in Huntington’s)

A

Dopamine receptor antagonist

47
Q

Sumatriptan (MOA, Use, Tox)

A

5-HT1B/1D agonist
(inhibits trigeminal nerve activation, prevents vasoactive peptide release, induces vasoconstriction)

Used in acute migraines and cluster headache

Coronary vasospasm (contraindicated in CAD or Prinzmetal’s angina)

48
Q

Epinephrine, Brimonidine (MOA, Use, Tox)

A

alpha-agonists -decrease aqueous humor synthesis

Open angle glaucoma

Mydriasis, blurry, vision, ocular hyperemia, foreign body sensation, allergic reaction/pruritus

49
Q

Timolol, Betaxolol, Carteolol (MOA, Use, Tox)

A

Beta-blockers - decrease aqueous humor synthesis

Glaucoma

No pupillary or vision changes

50
Q

Acetazolamide in eye (MOA, Use, Tox)

A

Decrease aqueous humor synthesis via inhibition of carbonic anhydrase

Glaucoma

No pupillary or vision changes

51
Q

Pilocarpine, Carbachol (MOA, Use Tox)

A

Direct Cholinomimetics - Increase aqueous humor outflow via contraction of ciliary muscle and opening of trabecular meshwork

Glaucoma (USE PILOCARPINE FOR EMERGENCIES)

Miosis and cyclospasm (contraction of ciliary muscle)

52
Q

Physostigmine, Echothiophate (MOA, Use, Tox)

A

Indirect Cholinomimetics - Increase aqueous humor outflow via contraction of ciliary muscle and opening of trabecular meshwork

Glaucoma

Miosis and cyclospasm (contraction of ciliary muscle)

53
Q

Latanoprost (MOA, Use, Tox)

A

Prostaglandin - PGF2a (increase aqueous humor outflow)

Glaucoma

Darkens color of iris

ZNeurology (8 decks)

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