CNS Pharma Flashcards
What is increased in central sensitization?
Calcium
How does NAMDA receptor activation initiate central sensitization?
a. Increased intracellular calcium through activation of adenylate cyclase
b. decrease intracellular calcium through inhibition of adenylate cyclase
c. Increased calcium entry through linked receptors
d. decreased calcium entry through linked receptors
C
How does NMDA receptor activation initiate central sensation?
a. Increase intracellular Ca+ through activation of adenyl cyclase
b. Decrease intracellular Ca+ through inhibition of adenyl cyclase
c. Increase Ca+ entry through linked receptor
d. Decrease Ca+ entry through linked receptor
e. Increase Cl- entry through linked receptor
C
How does the NK-1 receptor participate in inducing central sensitization?
By increasing the release of calcium from intracellular stores by forming IP3
What is responsible for central sensitization of pain?
a. GABA
b. Glycine
c. NMDA and NK1
C
How does the NK-1 receptor participate in inducing central sensitization?
By increasing intracellular CA2+ release from stores by IP3
Which receptor is responsible for serotonin excitatory action?
a. 5-HT1 receptor
b. 5-HT2 receptor
c. 5-HT3 receptor
d. 5-HT4 receptor
C
What is the mechanism of action of neurokinin-1?
a. Increase Ca2+ release from intracellular stores via inositol trisphosphate
b. Increase intracellular Ca2+ through voltage-gated Ca2+ channels
A
What describes the mechanism through which long term depression occurs?
Phosphorylation and internalization of AMPA receptors
How does the NK-1 receptor work?
Increase the release of calcium from intracellular stores by increasing the synthesis of inositol
triphosphate (IP3)
Long Term Potentiation
↑ entry of Ca & insertion of AMPA
What is the consequence of NK-1 activation?
Intracellular Ca will increase by inositol triphosphate
Noxious receptors
Increase Ca influx
What receptor that once activated can also produce PG-I & PG E?
Bradykinin B2 receptor
What type of receptor does the muscle relaxant baclofen work on?
a. GABA-A receptor
b. GABA-B receptor
c. GABA-C receptor
d. NMDA receptor
e. Histamine H1 receptor
B
A patient recently diagnosed with MS has severe anxiety and can’t sleep. What drug can be used for her muscle cramps/ spasms?
a. Diazepam
b. Tiagabine
c. Valproate
A
A young woman with a long history of depression, accompanied by body aches and pain. Which drug is useful for her?
a. Diazepam
b. Tiagabine
c. Valproate
A
Which drug can be given to reduce anxiety and relieve muscle strain?
Diazepam
Which of the following increases dopamine and noradrenaline in the synaptic cleft?
a. Nicotine
b. Amphetamine
c. Cocaine
B
Mr.Ali has been addicted to a drug for a very long time. He ended up having cirrhosis and liver failure. Which of the following drugs of abuse he was addicted to?
a. Heroin
b. LSD
c. Cannabis
d. Ethanol
D
What is the mechanism of action of cannabinoids on CB1 receptor?
Inhibition of adenylate cyclase, decreasing the production of cAMP
Which drug inhibits the reuptake of noradrenaline, serotonin, and dopamine.
a. Caffeine
b. Nicotine
c. Cannabinoids
d. Cocaine
D
Which drug inhibits Phosphodiesterase?
a. Caffeine
b. Nicotine
c. Cannabinoids
d. Cocaine
A
What is the mechanism of action of Cannabis on the CB1 receptor?
Block AC, close Ca, open K
Which of the following drugs causes fatty liver upon chronic administration?
Ethanol
Which of the following inhibits phosphodiesterases?
Caffeine
What is the mechanism of action of cocaine?
Inhibits reuptake of monoamines
What is the mechanism of action of cocaine?
Blockage of presynaptic reuptake of monoamines
What is the mechanism of action of fluoxetine?
a. selective NE reuptake inhibitor
b. Monoamine oxidase inhibitors
c. Selectively inhibits serotonin reuptake
d. Serotonin and norepinephrine reuptake inhibitor
C
Which drug is used limitedly due to its complicated dietary restrictions?
a. Citalopram
b. Duloxetine
c. Phenelzine or tranylcypromine
d. Venlafaxine
C
What is the mechanism of action of imipramine?
a. Inhibits serotonin and NA reuptake
b. Inhibits serotonin and DA reuptake
A
What is the mechanism of action of the antidepressant citalopram?
Selective Serotonin Reuptake Inhibition
What drug causes blurred vision, dry mouth, and urinary retention?
a. Imipramine
b. Phenelzine
A
Which drug acts on A2 and 5-HT receptors?
a. Mirtazapine
b. Imipramine
c. Phenytoin
A
Typical cyclic antidepressant that is used in the case of severe depression
a. Fluoxetine
b. Citalopram
c. Venlafaxine
d. Duloxetine
e. Mirtazapine
f. Imipramine
g. Phenelzine
h. Clozapine
F
Which of the following drugs predisposes to serotonin syndrome when taken with SSRI?
a. Imipramine
b. Phenelzine
c. Clozapine
B
A patient should avoid tyramine containing food in which drug?
Phenelzine
What is the mechanism of action of amitriptyline?
Inhibit neuronal reuptake of noradrenaline and 5-hydroxytryptamine
What is the mechanism of action of fluoxetine
a. Inhibit serotonin uptake
b. Increase monoamine A
c. Decrease monoamine A
d. Increase monoamine B
A
What are the indications for Istradefylline?
a. Used to treat dyskinesias in late disease
b. Used to treat ‘off’ episodes
B
Parkinson symptomes treated with a drug and get better in one year
Levodopa
Which drug decreases the side effects of levodopa peripherally?
a. Domperidone
b. Carbidopa
A
Istradefylline is used in the treatment of the “off” symptoms of Parkinson’s disease. What is the mechanism by which it works?
Act on A2A adenosine receptors
What drug causes purple mottling of skin?
Amantadine
What drug causes insomnia if administered after mid afternoon
Selegiline
Which of the following drugs blocks nicotinic receptors and stimulates dopamine release for the treatment of Parkinson?
a. Valproate
b. Benztropine
c. Amantadine
C
What is the best treatment plan for a patient diagnosed with Parkinson’s disease?
a. Carbidopa-selegiline-amantadine
b. Levodopa-carbidopa-entacapone
c. Carbidopa-domperidone-benztropine
d. Domperidone-ropinirole-amantadine
B
What drug needs to cross the blood brain barrier?
a. Domperidone
b. Selegiline
c. Benserazide
B
What is the mechanism of action of ropinirole?
a. Dopamine agonist
b. Increases dopamine release
A
What drug decreases the peripheral side effects of levodopa?
a. Benztropine
b. Carbidopa
B
What is the mechanism of action of ropinirole?
Agonist of dopamine D2 receptor in the CNS
Which drug is a peripheral DOPA decarboxylase inhibitor
a. Benserazide
b. Ropinirole
c. Tolcapone
d. Selegiline
e. Benztropine
A
Which drug is a muscarinic antagonist
a. Benserazide
b. Ropinirole
c. Tolcapone
d. Selegiline
e. Benztropine
E
Which of the following is a drug that prevents the metabolism of levodopa to 3-o-methyldopa?
a. Selegiline
b. Benserazide
c. Entacapone
C
What drug is a precursor of dopamine that crosses the blood brain barrier?
a. Levodopa
b. Domperidone
c. Carbidopa
A
Which drug causes gambling with excessive shopping as side effects?
Ropinirole
Which of the following is an antagonist to peripheral dopaminergic receptors used to treat the side effects of L-dopa such as anorexia and nausea?
Domperidone
Entacapone is a Levodopa optimizer given with it to enhance its CNS concentration. What is its mechanism of action?
Inhibition of catechol-o-methyl-transferase
Which drug has an on-off effect?
Levodopa
What drug is a Muscarinic acetylcholine antagonist?
Benztropine
MOA-B inhibitor?
Selegiline
Which drug blocks levodopa effect in the periphery by binding to the receptors?
Domperidone
Patient receiving antipsychotic drugs & she’s diagnosed with parkinson’s disease, what is the best drug to treat her?
Benztropine
L-dopa 3- methyl transferase?
Tolcapone
Which drug inhibits dopamine metabolism in the brain?
Selegiline
Which drug is a dopa decarboxylase inhibitor?
Carbidopa
Which drug is an inducer of an enzyme leading to many drug-drug interactions?
a. Phenytoin
b. Ethosuximide
c. Vigabatrin
d. Cannabinoids
A
Which of the following antiepileptic drugs at more than 50 mg/min in an adult can evoke cardiac arrhythmia?
a. Carbamazepine
b. Diazepam
c. Phenobarbital
d. Clonazepam
e. Phenytoin
A
What is the drug of choice for absence seizures?
a. Ethosuximide
b. Vigabatrin
c. Carbamazepine
A
Which drug causes irreversible visual field defects in some patients?
a. Ethosuximide
b. Tiagabine
c. Phenytoin
d. Lamotrigine
e. Vigabatrin
E
Which drug induce metabolism of other antiepileptics, anticoagulants, and oral contraceptives?
a. Ethosuximide
b. Tiagabine
c. Phenytoin
d. Lamotrigine
e. Vigabatrin
C
Which drug inhibits the reuptake of GABA?
Tiagabine
What is the drug of choice for status epilepticus?
Phenytoin
Which anti-epileptic drug is relegated for refractory cases because of its side effects?
Vigabatrin
What is the mechanism of action of vigabatrin?
Inhibits degradation of GABA by GABA transaminase
What is the mechanism of action of carbamazepine?
a. Block Ca channel
b. Block Na channel
B
Which drug irreversibly inhibits the enzyme GABA transaminase?
Vigabatrin
What is the mechanism of action of phenytoin?
Blocks Na+ channels
How would benzodiazepines mediate their anti-epileptic activity?
Enhance GABA-A transmission through increased chloride ion influx
Carbamazepine is prescribed to a patient. At first it has a half-life of 10-20 hours. After chronic administration the half-life decreased to 4 hours. What is the cause?
It induces CYP enzymes and accelerates its own destruction
Which drug has a narrow spectrum of activity and blocks T calcium channels?
Ethosuximide
Which drug acts by inhibiting GABA transaminase and increasing the activity of glutamate decarboxylase
Valproic acid
Which drug will increase the plasma concentration of drugs taken with it?
Valproic acid (it inhibits metabolism so the drug will be active longer)
What is the mechanism of action of benzodiazepine?
Potentiation of GABA Chloride Pore
What drug is used for partial seizures and induces liver enzymes?
Carbamazepine
What drug is used to treat Lennox Gastant syndrome?
Felbamate
What is the mechanism of Midazolam?
GABA-A modulators → enhance GABA-mediated synaptic inhibition
Which anxiolytic-hypnotic drug causes endocrine changes like increasing prolactin and decreasing testosterone levels?
a. Ramelteon
b. Zolpidem
c. Zaleplon
A
What is the mechanism of action of benzodiazepines?
a. Enhance GABA-A mediated inhibition through binding to the receptor active site
b. Enhance GABA-A mediated inhibition through binding to the modulatory site of the receptor
B
Which drug can be used as an anxiolytic and reduce muscle tone?
Diazepam
What drug is used to treat muscle spasms in patients with multiple sclerosis and cerebral palsy
Diazepam
Which drug blocks 5HT1A-receptor?
Buspirone
Which drug causes a hangover when used for a long period of time?
Nordazepam
What activates melatonin 1 and 2 receptors in the suprachiasmatic nucleus?
Ramelteon
Which drug activates the inhibitory 5HT1A-receptor?
Buspirone
A baby is brought by his mother because he has problems sleeping. The physician prescribes drug X, which resolves the problem but the mother then reports that it produces a bad odor from his mouth. What was the drug prescribed?
Chloral hydrate
Which of the following drugs has anxiolytic but no sedative or hypnotic effects?
Buspirone
A patient complained to his doctor that he suffers from insomnia. However, once he falls asleep, he can sleep for 6 hours. Which drug can be given to this patient?
Zolpidem
Tolerance to which of the following effects doesn’t develop with the repeated use of benzodiazepines
Anxiolytic effect
What is the mechanism of action of Benzodiazepines?
a. GABA-A receptor, enhancing GABA- receptor mediated inhibition
b. GABA-A modulators, enhancing GABA- Mediated synaptic inhibition
B
What is the antidote for midazolam?
Flumazenil
Which drug is used to treat sleep-onset insomnia?
Zolpidem
What is the mechanism by which tramadol works?
a. M receptor agonist and serotonin norepinephrine reuptake inhibitor
b. GABA
c. Increase intracellular calcium
A
Which of the following is NOT associated with opioid
A. Bronchoconstriction
B. Diarrhea
C. Nausea
D. Pupil constriction
B
What opioid has less GI and respiratory effects?
A. Cocaine
B. Morphine
C. Pethidine
D. Tramadol
D
What is the mechanism of action of morphine?
a. Activates AC, Opens K+ channels, Opens Ca2+ channels
b. Activates AC, Closes K+ channels, Closes Ca2+ channels
c. Inhibits AC, Opens K+ channels, Closes Ca2+ channels
d. Inhibits AC, Closes K+ channels, Closes Ca2+ channels
C
What is used as a cough suppressor at a sub-analgesic dose?
Codeine
Which opioid is prescribed to asthamtic patients?
Pethidine
Tolerance does not develop to which of the following effects of opioids?
Pupillary constriction [also constipation]
Which of the following is not an effect of opioids?
Constipation
What antipsychotic causes the strongest EPS?
Haloperidol
What is true regarding haloperidol?
Increased extrapyramidal tract symptoms due to high potency
What is a contraindication for treatment with all antipsychotics?
a. Sickle cell anemia
b. Alzheimer’s disease
c. Epilepsy
d. MS
e. Arthritis
C
Why does the majority of antipsychotic drugs cause extra pyramidal symptoms?
a. Low affinity binding to D2R
b. Binding to nAch receptors
c. Blocking D2R in the nigrostriatal pathway
C
A young man who was recently diagnosed with schizophrenia. What will help treat his apathy and bluntness?
a. Olanzapine
b. Thioridazine
c. Haloperidol
d. Chlorpromazine
e. Carbidopa
A
What drug causes serious side effects such as bone marrow suppression and orthostatic hypertension?
a. Valproate
b. Clozapine
c. Amantadine
d. Chloramphenicol
e. Tiagabine
B
Which antipsychotic drug doesn’t have an antiemetic effect?
a. Aripiprazole
b. Thioridazine
c. Fluphenazine
d. Haloperidol
A
Why are second generation antipsychotics preferred over 1st generation?
Less likely to cause extrapyramidal symptoms
What is used to treat the negative symptoms associated with schizophrenia?
a. Fluoxetine
b. Citalopram
c. Venlafaxine
d. Duloxetine
e. Mirtazapine
f. Imipramine
g. Phenelzine
h. Clozapine
H
What drug can cause QT prolongation?
a. Phenelzine
b. Fluoxetine
c. Thioridazine
d. Mirtazapine
e. Haloperidol
f. Chlorpromazine
g. Aripiprazole
C
What can lead to Extrapyramidal motor effects (EPS) due to its strong affinity (tight binding) to dopaminergic receptors?
a. Phenelzine
b. Fluoxetine
c. Thioridazine
d. Mirtazapine
e. Haloperidol
f. Chlorpromazine
g. Aripiprazole
E
A young man who was recently diagnosed with schizophrenia. What will help treat his apathy and bluntness affect?
a. Olanzapine
b. Thioridazine
c. Haloperidol
d. Chlorpromazine
e. Carbidopa
A
What is the difference between antipsychotics that preferentially block the D2Rs and those that have strong anticholinergic activity such as thioridazine?
Thioridazine has lower incidence of extrapyramidal signs
Which drug inhibits DNA synthesis and is used to treat Cytomegalovirus- induced cephalitis?
a. Ganciclovir
b. Ampicillin
c. Acyclovir
A
What are the characteristics of a drug that crosses the blood brain barrier?
a. A
b. B
c. C
d. D
C
A 15 year old boy presented to the ER with fever, headache, and seizures. HSV1 was identified by the PCR in the CSF. What is the appropriate treatment for this patient?
a. Acyclovir
b. Ampicillin
c. Cefotaxime and vancomycin
d. Gentamycin
A
What is a prodrug?
drug that gets into its active form after being metabolized
Which drug crosses the blood brain barrier and is effective in treating herpes-simplex induced encephalitis?
Acyclovir
A drug that has side effects like neuromuscular paralysis and nephrotoxicity?
Gentamicin
Which of the following best represents the properties of a drug that passes the blood-brain barrier?
High lipid solubility, low molecular weight, low amount of hydrogen bonds with water
What does amoxicillin inhibit?
A. Cell wall
B. DNA
C. Protein
A
What is the mechanism of action of ampicillin?
Inhibition of bacterial cell wall synthesis
What is the drug of choice to treat HSV?
Acyclovir
Which of the following drugs causes nephrotoxicity, neuromuscular paralysis?
Gentamicin
What is the mechanism of action of amphotericin B?
Binds to ergosterol and causes leakiness
Which of the following drugs has the longest duration of action in the treatment of Alzheimer’s disease?
a. Rivastigmine
b. Galantamine
c. Tacrine
d. Donepezil
D
What is the main side effect for Tacrine?
A. Ototoxicity
B. Hepatotoxicity
C. Nephrotoxicity
D. Cardiovascular toxicity
B
What is the mechanism of action of donepezil?
a. Inhibition of GABA A
b. Inhibition of GABA B
c. Inhibition of Butyrylcholinesterase
d. Inhibition of Acetylcholinesterases
D
What is the side effect of tacrine that makes it not used in Alzheimer’s patients?
a. Nephrotoxicity
b. Hepatotoxicity
c. Cardiotoxicity
B
What is true about Alzheimer’s?
ApoE4 increases the risk
What is the mechanism of action of Memantine?
NMDA antagonist
What is the mechanism by which Rivastigmine treats dementia?
Anticholinesterase
Which drug combination produces neurolept analgesia?
a. Droperidol-fentanyl
b. Ketamine
c. Propofol
d. Morphine
A
What drug causes malignant hyperthermia?
Halothane
Dr. Bushra wants to perform a minor surgical procedure on her patient but she wants him to remain responsive to simple commands yet in a deep state of sedation and analgesia. Which combination of drugs will she use?
A. Propofol and fentanyl
B. INNOVAR Preparation Droperidol and fentanyl
B
Which drug is an NMDA-receptor antagonist?
Ketamine
Which drug is given before a procedure to reduce anxiety and ease amnesia?
Midazolam
What would you use to maintain anesthesia in someone with heart disease and has vitamin B12 deficiency anemia who is undergoing a three-hour-long knee procedure?
Isoflurane
[You can’t use Nitric oxide since it causes bone marrow depression neither can you use halothane since it sensitizes the heart to catecholamines]
Which drug is redistributed in fat and thus has a very short half life?
Thiopental
What anxiolytic drug is used to induce sedation and amnesia before procedure?
Midazolam
What type of receptor does the muscle relaxant baclofen work on?
a. GABA-A receptor
b. GABA-B receptor
c. GABA-C receptor
d. NMDA receptor
e. Histamine H1 receptor
B
A patient recently diagnosed with MS has severe anxiety and can’t sleep. What drug can be used for her muscle cramps/ spasms?
a. Diazepam
b. Tiagabine
c. Valproate
A
A young woman with a long history of depression, accompanied by body aches and pain. Which drug is useful for her?
a. Diazepam
b. Tiagabine
c. Valproate
A
Which drug can be given to reduce anxiety and relieve muscle strain?
Diazepam
What channel does lidocaine (local anesthetic) work on?
a. Na+
b. K+
c. Cl-
d. Ca2+
A
What is the mechanism of procaine, a local anesthetic?
A. Block Na channels
B. Block K channels
C. Block Ca channels
A
What is a characteristic of local anesthetics?
a. Adrenaline is used as an adjunct to prolong duration of action
b. Weak acids
c. Amides have short duration of action
d. Esters have long duration of action
A
What is the mechanism of action of local anesthetics?
Block Na channel
What is a property of local anesthetics?
They are weak bases
What is the mechanism of action of lidocaine at normal doses?
It blocks voltage-gated sodium channels
Which type of nerve fibers is first blocked by local anesthesia?
A delta
Which of the following drugs has the longest duration of action in the treatment of Alzheimer’s disease?
a. Rivastigmine
b. Galantamine
c. Tacrine
d. Donepezil
D
What is the main side effect for Tacrine?
A. Ototoxicity
B. Hepatotoxicity
C. Nephrotoxicity
D. Cardiovascular toxicity
B
What is the mechanism of action of donepezil?
a. Inhibition of GABA A
b. Inhibition of GABA B
c. Inhibition of Butyrylcholinesterase
d. Inhibition of Acetylcholinesterases
D
What is the side effect of tacrine that makes it not used in Alzheimer’s patients?
a. nephrotoxicity
b. Hepatotoxicity
c. Cardiotoxicity
B
What is true about Alzheimer’s?
ApoE4 increases the risk
What is the mechanism of action of Memantine?
NMDA antagonist
What is the mechanism by which Rivastigmine treats dementia?
Anticholinesterase
