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Pharma From Sure Success > CNS Pharmacology > Flashcards

CNS Pharmacology Flashcards

1
Q

Define seizures

A

Focal,periodic ,unpredictable and paroxysmal episodes of rapid firing of neurons in the brain which causes changes in :
Behavioral, sensory and motor changes.

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2
Q

2 types of seizures

A

Generalized seizures:
1. GTCS
2. Absence seizures
3. Atonic seizures
4. Myoclonic seizures
5. Infantile spasm

Partial seizures:
1. Simple seizures
2. Complex seizures
3. Simple and complex seizures.

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3
Q

MOA of antiepileptic drugs with egs (4)

A
  1. Prolongation of Na+ channel inactivation
    Phenytoin, Carbamazepine, Topiramate,
    Valproate, Lamotrigine, Lancosamide, Zonisamide.
  2. Facilitation of GABA mediated chloride channels :
    Barbiturates, BZP, Valproate, Vigabatrin, Gabapentin, Tiagabine.
  3. Decrease in excitatory glutamate channels :
    Felbamate
  4. Inhibition of T type calcium channels:
    Ethosuximide
    Valproate
    Zonisamide.
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4
Q

Seizures are due to …..

A

Decrease in inhibitory GABA channels
Increase in excitatory glutamate channels

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5
Q

How is GABA formed ?

A

Glutaminic acid ————>GABA——metab
GABA decarboxylase. GAT

GAT: GABA trans carboxylase:
GABA———> metabolites
GAT-1: reuptake of GABA to presynaptic neurons.

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6
Q

MOA of Na+ channel inactivation

A

Normally: Na channel resting stage (closed)—> activated stage (open )—-> inactivated stage ( open)—-> resting stage (closed).

Antiepileptics prolong the activity of these channels; keeping them open in inactivated state. Thus decreasing the rate of recovery of sodium channels.

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7
Q

MOA of barbiturates and BZP.

A

Natural GABA: opens the beta subunit of Cl- channels.
Barbiturates: open Ab subunit of cl- channels:
Facilitating GABA to increase duration of cl-channel opening.

GABA mimetic action. Opens the cl-channel by itself.

BZP: acts on ag subunit.
Facilitating the frequency of opening of GABA channels.

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8
Q

MOA of valproate and Vigabatrin

A

They inhibit GABA transaminase responsible for degradation of GABA into matabolites.

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9
Q

MOA of tiagabine

A

They inhibit GAT-1 channels responsible for reuptake of GABA.

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10
Q

MOA of Felbamate

A

Inhibit glutamate NMDA receptors—> decreasing action of glutamate.

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11
Q

MOA of ethosuximide

A

Inhibit the low threshold of T type calcium channels—> decreased calcium entry—> decreased firing—>decreased seizures.

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12
Q

MOA of valproate (3)

A
  1. Prolongation of Na channel inactivation
  2. Facilitate GABA opening of Cl- channels
  3. Reduce the low threshold of T type calcium channels.
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13
Q

MOA of leviracetam

A

Selective binding to synaptic vesicle protein 2A (SV2A).

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14
Q

Therapeutic range of carbamazepine

A

4-12 microgm/ml

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15
Q

Dose related side effects of carbamazepine (5)

A
  1. GIT disturbances
  2. Double/blurred vision
  3. Vertigo
  4. Hematological disturbances
  5. Task performance impairment.
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16
Q

Idiosyncratic side effects of carbamazepine (6)

A
  1. Agranulocytosis
  2. SJS: (a/w HLA B1502)
  3. Aplastic anemia
  4. Hepatic failure
  5. Rash
  6. Pancreatitis.
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17
Q

Phenytoin is also called ….
Therapeutic range

A

Diphenylhydantoin
10-20 microgm/ml

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18
Q

Phenytoin follows ……kinetics

Route of phenytoin administration

………counteracts the action of phenytoin

A

Zero order Kinetics.

IM route.

Folic acid .

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19
Q

Side effects of phenytoin

A

PHENYTOIN
P-cyt P450 inhibition
Hirsuitism
Enlarged gums
Nystagmus
Teratogenic-fetal hydantoin syndrome
Osteomalacia
Interference with B12 metabolism(anemia
Neuropathies: vertigo, rash, headache.

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20
Q

Side effects of lamotrigine (3)

A

SJS
Lymphohistiocytosis
Visual disturbance.

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21
Q

Zonisamide should not be used if you have ……allergy

Side effects of zonisamide (2)

A

Sulfonamide

Renal stones, hypohydrosis

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22
Q

Antiepileptic with PR prolongation

A

Lacosamide

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23
Q

Side effects of ethosuximide (2)

A

SJS
BMS

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24
Q
  1. GABA receptor agonists
  2. GABA reuptake inhibitor
  3. GABA transaminase inhibitor
A
  1. Phenobarbitone, BZP
  2. Tiagabine
  3. Vigabatrin
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25
Q

Therapeutic range of phenobarbital

A

10-40 microgm/ml

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26
Q

Side effects of phenobarbitone (7)

A
  1. Sedation
  2. Tolerance
  3. Dependence
  4. Rebound seizures
  5. Learning difficulty
  6. Hyperactivity
  7. Folic acid supplementation- phenytoin increases the metabolism of folic acid as it’s an enzyme inducer.
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27
Q

2 drugs c/I in sulfonamide allergy

A

Zonisamide
Tiagabine

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28
Q

Side effects of Tiagabine (4)

A

Speech and language problems
Renal calculi
Abdominal pain
Psychosis

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29
Q

Side effects of vigabatrin (2)

A

Peripheral visual field loss
SJS

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30
Q

Antiepileptics causing SJS (4)

A
  1. Carbamazepine -when ass with HLAB1502
  2. Phenytoin
  3. Lamotrigine
  4. Vigabatrin
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31
Q

Speech and language problem is with …..antiepileptic

Word finding difficulty is with ….

A

Tiagabine

Topiramate

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32
Q

Therapeutic range of valproate

A

50-135 microgm/ml

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33
Q

Side effects of valproate (7)

A
  1. Hepatotoxicity
  2. Transient alopecia
  3. Weight gain
  4. Hyperammonemia
  5. PCOD
  6. Thrombocytopenia
  7. Spina bifida
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34
Q

Side effects of topiramate (5)

A
  1. Weight loss
  2. Word finding difficulty
  3. Hypohydrosis
  4. Kidney stones
  5. Acute angle closure glaucoma
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35
Q

Drug reserved for refractory seizures. Importance of the drug

A

Felbamate
Written consent is needed to transfuse the drug as it causes aplastic anemia .

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36
Q

Antiepileptic that causes homicidal ideation.

A

Perampanel- NMDA receptor antagonist

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37
Q

Antiepileptic causing QT prolongation
Other side effects (3)

A

Retigabine
1. Retina abnormalities
2. Skin discoloration
3. Urinary retention

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38
Q

Side effects of leviracetam (3)

A

Anemia
Leukopenia
Neuropsychiatric symptoms

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39
Q

Drug that causes QT interval shortening

A

Rufinamide

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40
Q

MOA of Rufinamide (2)

A

Inhibits voltage dependent sodium channels
Inhibits mGluR5

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41
Q

Lacosamide inhibits ……other than na channels

A

CMRP-2

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42
Q

Side effect of trimethadione

A

Day blindness due to excessive glare and photophobia - hemeralopia

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43
Q

Endogenous anti seizure substance that prevents seizure is ….

A

Adenosine

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44
Q

Rx for partial complex seizures

A

Vagal nerve stimulation (VNS)

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45
Q

DOC for infantile spasm

A

ACTH
But when with tuberous sclerosis - vigabatrin is DOC

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46
Q

DOC for juvenile myoclonic epilepsy

DOC for absence seizures

A

Valproate

Ethosuximide, valproate

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47
Q

DOC for neonatal seizures

A

Phenobarbitone

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48
Q

DOC for post herpetic neuralgia

A

Gabapentin

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49
Q

Antiepileptic Drugs used for migraine prophylaxis (2)

A

Topiramate
Valproate

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50
Q

Drug for lennox gestaut syndrome

A

Topiramate

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51
Q

Seizure of eclampsia DOC

Isoniazid induced seizure

A

MgSO4

Pyridoxine

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52
Q

DOC for partial seizure (3)

A

Carbamazepine
Valproate
Phenytoin

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53
Q

DOC for tonic clonic seizure

A

Carbamazepine
Phenytoin
Valproic acid

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54
Q

Iv for status epileptics

A

Iv BZP: lorazepam + iv AED: phenytoin/valproate/leveracetam

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55
Q

Symptoms of Parkinson’s disease. Why does it occur?

A

Tremor, rigidity,bradykinesia
Occurs due to destruction of dopaminergic neurons in the brain and an unopposed action of Ach.

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56
Q

Why does parkinsons happen only in old age?

A

Coz as we age, the glutathione gets depleted, which was initially responsible for scavenging the free radicals from ferrous oxide metabolism in the basal ganglia.

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57
Q

Drugs given for parkinsons disease (6)

A
  1. Levodopa, carbidopa
  2. Da agonists: Non ergots: ropirinole,pramipexole
  3. Amantadine
  4. COMT inhibitors: tolcapone,entecapone
  5. MAOI : selegilline, rasagilline

Anticholinergics: benztropine,trihexyphenidyl

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58
Q

DOC for restless leg syndrome

A

Ropinirole, pramipexole

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59
Q

Anti parkinsons drug preferred in age <65yrs old?

A

Ropirinole, pramipexole ,piribedil

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60
Q

Adverse effects of da agonists (3)

A
  1. N/v- act on CTZ
  2. Postural hypotension-Da action on bv
  3. CNS:
    a)increased sleepiness,
    b)hallucinations,
    c)impulse control disorder (gambling) ,
    d) confusion.
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61
Q

Eg of ergot da agonist (2)

A

Bromocriptine, pergolide

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62
Q

MOA of amantadine
Indications (3)

A

Dopamine facilitator
Increase synthesis, release and reuptake of dopamine.

  1. Effective against rigidity and bradykinesia
  2. Acute exacerbations
  3. Reduce levodopa induced dyskinesias
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63
Q

Adverse effects of amantadine (3)

A

Ankle edema
Livedo reticularis
Ataxia

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64
Q

Action of levodopa

A

Levodopa—————->dopamine
DDC

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65
Q

Disadvantages of peripheral conversion of dopamine (3)

A
  1. N/v - due to CTZ
  2. Postural hypotension-action on bv
  3. Heart- arrythmias
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66
Q

Late adverse effects of peripheral dopamine (4)

A
  1. Abnormal movements
  2. Nightmares
  3. End of dose deterioration
  4. On-off effect
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67
Q

One thing to keep in mind while giving levodopa is ….

A

Avoid taking multivitamins with it!
Pyridoxine is a cofactor of DDC, enhances conversion of levodopa to dopamine in the bv and reduces the activity of levodopa.

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68
Q

What is given along with levodopa?

A

Carbidopa, benserazide
Peripheral dopa decarboxylase inhibitors
Decrease the peripheral conversion of levodopa to dopamine; so that more levodopa is available in the brain.

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69
Q

MOA of COMT inhibitors
Eg of peripherally acting and central acting
Which is preferred and why?

A

Inhibiting Conversion of levodopa to 3-O Methyldopa by inhibiting COMT.

Peripherally acting: entacapone
Both peripheral and central: tolcapone

Entacapone is preferred as tolcapone is hepatotoxic.

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70
Q

Another drug used as monotherapy early in PD is …..
Use.

A

Selegilline, rasagilline.
Delay the need to start levodopa

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71
Q

S/e of MAOB inhibitors

A

At high doses they inhibit MAOA as well.
Increase in NE/epi- HTN crisis
Increase in 5HT- serotonin syndrome

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72
Q

Drug that can only improve tremor but not bradykinesia is….
They are effective in ……

A

Anticholinergics- trihexylphenydyl, benztropine

Phenothiazine induced PD

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73
Q

S/e of anticholinergic drugs (7)

A
  1. Delirium
  2. Mydriasis
  3. Increased body temp
  4. Increased HR,BP
  5. Constipation
  6. Urinary retention
  7. Dry eyes, dry mouth
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74
Q

2 drugs used in “off” episodes when levodopa stops working

A

Safinamide (MAOB inhibitor)
Istradefylline (adenosine receptor antagonist)

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75
Q

Drug used to rx hallucination and delusions associated with PD

A

Pimavanserin- 5HT2A inverse agonist

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76
Q

What is deep brain stimulation ?

A

High frequency stimulation of subthalamic nuclei -mc site
Or globus pallidus internus.

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77
Q

A 75 yr old with Parkinson’s disease no longer responding to anticholinergic Rx for tremor and bradykinesia. What combination is the appropriate plan?

A

Levodopa
Carbidopa
Entacapone

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78
Q

Peripheral side effects of arrythmias, postural hypotension, nausea and vomiting of levodopa can be reduced by …..drug?

A

Carbidopa

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79
Q

Anti parkinsons drug that causes vasospasm
Other side effects

A

Bromocriptine
Other side effects:
1. Fibrosis of heart,lung
2. Retroperitoneal fibrosis

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80
Q

What are the natural opioids ?

A

Morphine
Codeine
“Morning coffee”

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81
Q

What are the semisynthetic opioids?

A

H2O2 + Buprenorphine + Heroin
Hydroxymorphone
Hydrocodone
Oxycodeine
Oxymorphone

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82
Q

What are the synthetic opioids ?

A

Mirinda
Fanta
Thumbs up
Pepsi
Meperidine
Methadine
Fentanyl
Tapendol
Tramadol
Pentazocine

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83
Q

What is Pethidine?

A

Pethidine =meperidine= synthetic opioid

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84
Q

What are the opioid receptors ?

A

Mu: MUSCAR
Miosis
Euphoria
Sedation
Constipation
Analgesia
Respiratory depression

K:kappa
Dysphoria, hallucinations

Delta

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85
Q

Analgesia,euphoria,constipation are ….receptors while physical dependence is …..

A

M2
M1

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86
Q

Opioid antagonists at all 3 opioid receptors

A

Naloxone
Naltrexone
Mu>k>d

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87
Q

Distribution of mu receptor (4)

A
  1. Periductal grey
  2. Nucleus solitaris
  3. Area postrema
  4. Dorsal horn
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88
Q

Distribution of kappa receptors (6)

A
  1. Cerebral cortex
  2. Striatum
  3. Midbrain
  4. Hippocampus
  5. Dorsal horn
  6. Medulla
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89
Q

Distribution of delta receptors (8)

A
  1. Cerebral cortex
  2. Striatum
  3. Midbrain
  4. Hippocampus
  5. Dorsal horn
  6. Medulla
  7. Trigeminal nucleus
  8. Myenteric plexus
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90
Q

Distribution of NOP receptors (4)

A
  1. Hippocampus
  2. Cerebral cortex
  3. Sensory neuron
  4. Descending pain control circuit
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91
Q

What are the agonist at mu receptor? (3)

A

Methadone
Endorphin
Endomorphine 1&2

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92
Q

What is the agonist at kappa receptor ?

A

Dynorphin A

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93
Q

What is the receptor at delta receptor?

A

Enkephalin

{ K-D : EnKephalin - delta receptor
D-K: Dynorphin- kappa receptor}

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94
Q

Opioid receptor are ……..receptors
Analgesia is by …..

A

G protein coupled
All 3 M>k>d

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95
Q

What are the morphine antagonists ?
Which one is not antagonist ?

A

Naloxone
Naltrexone
Nalmefene

Nalbuphine = partial agonist

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96
Q

Which are the iv and oral morphine antagonist?

A

Naloxone = iv
Nalmefine= iv , long lasting
Naltrexone = oral , long acting

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97
Q

Uses of naltrexone ?

A

Teer —> 1. Decrease Opioid addiction
2. Decrease Alcohol craving
Thus given as maintenance drug after de addiction.

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98
Q

Most potent acting opioid and shortest acting opioid

A

Most potent: sufentanyl
Shortest: (fastest acting): remifentanyl

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99
Q

Opioid agonist drug acting on all 3 receptors

A

Sufentanyl

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100
Q

What are the egs of partial morphine agonists? Which receptors they act?

A

Pentazocine : partial agonist M
Agonist K
Nalbuphine : agonist k , antagonist m
Butorphanol : agonist k , partial agonist m
Buprenorphine: partial agonist at m
Antagonist at k,d

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101
Q

Use of codeine

A

It is low efficacy
So only used as cough suppressant

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102
Q

Codeine is metabolized by ……cytochrome to …….

A

Cyp P2D6
Morphine by demethylation

Thus inducer in CYP p2D6: toxicity
Inhibition in CYP p2d6: efficacy

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103
Q

Peripheral norepinephrine,serotonin reuptake inhibitor:
Causes …..s/e

A

Tapentadol > tramadol
Serotonin syndrome

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104
Q

Respiratory depression ceiling effect is not seen in ….., seen in …..

A

Morphine
Seen in mixed agonist , antagonist

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105
Q

Straub tail reaction seen with ….

A

Peripheral action of morphine
Constipation by increasing GI transit time and decreasing GI motility

After administration of morphine in rats, they present with a stiff tail due to spasm of the muscle at the base of the tail.

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106
Q

Tolerance to morphine is not seen in which effects ?

A

Miosis
Constipation
Convulsion.

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107
Q

C/I of morphine

A
  1. Biliary colic
  2. Head trauma
  3. Asthma
  4. Extreme of age
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108
Q

Drug used for CABG anesthesia
Use of morphine in acute LVF

A

Fentanyl

Decreases preload, afterload , anxiety

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109
Q

Morphine Rx for diarrhea (2)

A

Loperamide
Diphenoxylate

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110
Q

Morphine antitussives (4)

A

Codeine
Dexomethorphan
Noscapine
Levopropoxyphene

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111
Q

Use of Pentazocine
…..is more potent than Pentazocine

A

Post operative pain , oral tablet
Nalbuphine - iv/im , obstetric analgesia

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112
Q

Morphine that can be given as nasal spray

A

Butorphanol

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113
Q

Rx for opioid induced constipation (3)

A

Alvimopan
Methylnaltrexone
Naloxegal

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114
Q

Rx for acute exacerbation of MS

A

Iv methyl prednisolone

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115
Q

Drug given to reduce spasticity

A

Baclofen

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116
Q

Drug to improve speed in MS .MOA

A

Dalfampridine
Potassium channel blocker

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117
Q

Antibodies for relapsing MS

A

Ocrelizumab- anti CD20
Alemtuzumab- anti CD52

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118
Q

What are the drugs given to prevent relapses in MS? MOA (8)

A
  1. Beta interferon
  2. Glatiramer acetate- synthetic polymer amino acid
  3. Fingolimod- sphingosine 1-phosphate receptor
  4. Natalizumab- alpha4 integrin antagonist
  5. Teriflunomide- pyrimidine synthesis inhibitor
  6. Alemtuzumab- anti cd52
  7. Ocrelizumab- anti cd20
  8. Dimethyl fumarate ,diroximel fumarate
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119
Q

Rx for ALS (4)

A
  1. Iv immunoglobulin
  2. Plasmapheresis
  3. Physical therapy
  4. Respiratory support until recovery

Almost all survive ,majority recover completely within weeks to months.

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120
Q

MOA of 1st line drugs for Alzheimer’s disease

A

Donepezil,rivastigmine , galantamine
Inhibit AchE —> increase Ach in brain

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121
Q

MOA of memantine
S/e of tacrine

A

NMDA blocker

Hepatotoxicity

122
Q

Rho kinase inhibitor used for Alzheimer’s disease ,s/e….
Also used for ….

A

Fasudil
Vasodilatation

Subarachnoid hemorrhage

123
Q

PDE-1 inhibitor used for Alzheimer’s disease

A

Vinpocetine

124
Q

Area of brain resistant to neurofibrillary tangles

A

Lateral geniculate body

125
Q

Alcoholic beverage %

A
  1. Malted liquor: beer , stout
    Undistilled, from fermentation of cereals
    %: 3-6%
  2. Wines: undistilled, from fermentation of grapes
    %: 16-22%

Spirit: distilled % 40-55

126
Q

C/I of alcohol (5)

A
  1. Peptic ulcer,hyperacidity,gastritis
  2. Epilepsy
  3. CLD
  4. Unstable patients
  5. Pregnancy
127
Q

Drugs with disulfiram like effects

A

Sorry- sulfonylureas-chlorpropamide
Pluto-procarbazine
Cant -cephalosporin-cefotetan,cefoperazone
Go-griseofulvin
To
Mars-metronidazole

128
Q

Define disulfiram effect (5)

A
  1. Flushing,burning sensation
  2. Throbbing headache,vomiting
  3. Uneasiness,chest tightened
  4. Dizziness,visual disturbance,confusion
  5. Fainting, circulatory collapse
129
Q

Pharmacokinetics of alcohol (3)

A
  1. Follows zero order kinetic-constant amount is only eliminated
  2. Absorption from stomach is slow,from intestine is fast
  3. Peak absorption within 30 mins of alcohol intake
130
Q

What are the local effects of alcohol ? (4)

A
  1. Cooling effect -evaporation
  2. Astringent -dissolve proteins
  3. Counterirritant & rubifactant- redness,burning sensation
  4. Hardening and cleaning the skin-hence used for decubitus ulcers
131
Q

What percentage of alcohol is best? Why? And what does it kill?

A

70% is better than 90/100% due to decreased evaporation with the 70% and prolonged contact with skin.
Degrades bacterial proteins and dissolves lipids hence bactericidal.

No action against : virus,fungi ,spores.

132
Q

Alcohol blood levels and their effects

A

20mg%: pt is relaxed
30mg%: relaxed but increased talkative
50mg%: yet in control
50-100mg%: careless,free
100mg%: uncoordinated, slurred speech
200mg%: intoxicated: but can walk
300mg%: stupor
400mg%: death

133
Q

Statutory limit of alcohol for driving is …..
Under act ….

A

30mg%
185 of Indian motor vehicle act 1988

134
Q

Guidelines for safe drinking

A

1drink =50ml spirit
=150ml wine
=400ml beer

All contain approximately 16g alcohol that becomes blood 30mg/dl in 30 mins of drinking.

135
Q

What is a hangover ? (5)

A

Headache, laziness,dry mouth, disturbed mood,impaired performance next morning

136
Q

CNS effects of alcohol
2 sensitive areas of brain

A

Depressant
Increased talkativeness is due to depression of inhibitory centre.

Cortex, reticular activating system

137
Q

Optic neuropathy seen with alcohol is …..

Brain structure feature of alcohol

A

Retrobulbar optic neuropathy
Centrocecal scotoma

Widened sulci and ventricles

138
Q

Encephalopathy of alcoholism (4)

A

Wernicke’s + korsakoff syndrome
Opthalmoplegia -6nerve mc
Ataxia
Confusion
Retro and anterograde amnesia

139
Q

Atrophy of ……is seen
Gliosis of ……occurs
EEG changes

A

Mammillary bodies
Bergman gliosis
Decrease alpha activity

140
Q

Blood lab changes of alcoholism (4)

A

Increased MCV
Folate deficiency
Sideroblastic anemia
CDT increase - carbohydrate deficient transferrin

141
Q

CVS effect of alcoholism

A

Small doses : no change in bp
Moderate doses: bp increase,HR increase
Large doses: bp decrease —> atrial fibrillation-holiday heart syndrome

142
Q

Cancers that occur due to alcoholism (5)

A

Breast
Oral
Esophageal
Rectal
Liver

143
Q

GIT effects of alcohol (6)

A

Obesity
Diarrhoea
Gastric erosion
Peptic ulcer
Varices
Pancreatitis-Acute and chronic

144
Q

Bx of alcoholics

A

Mallory bodies +_ neutrophilic infiltrate

145
Q

Liver changes that occur due to alcohol

A

Fatty liver : reversible
Hepatitis : fever,jaundice ,vomiting
80% progress to Cirrhosis

146
Q

GGT ,SGOT,SGPT changes of liver

A

GGT: increased >35U
Increased SGOT/ SGPT

147
Q

Psychiatric changes with alcoholism (6)

A

Personality changes
Depression
Suicidal ideation
Erectile dysfunction
Delayed ejaculation
Morbid jealousy with fixed delusion

148
Q

Testing for alcohol

A

Blood alcohol level
Widmark’s formula

149
Q

Alcoholism according to jellineks classification

A

Gamma alcoholism: malignant alcoholism
Epsilon alcoholism: dipsomania-compulsive drinking

150
Q

Max alcohol is in …..organ of body

A

Proximal small intestine

151
Q

Questionarres to identify alcohol addiction

A

CAGE
MAST -Michigan alcohol screening test
AUDIT- alcohol use disorder identification test

152
Q

Stages of alcohol withdrawal

A

Stage 1: within 1-2 days : Acute shakes
Stage 2: after 48hrs: delirium tremens
Visual hallucinations of snakes,bug
Formication: tactile hallucination of insects crawling
Lilliputian hallucination: objects appear small

Stage 3: alcoholic hallucinosis- auditory hallucinations

153
Q

What is Mc Swan’s sign ?

A

Stage of narcosis in acute alcohol intoxication
Deep sleep, miosis,but on pinching the face /neck, they dilate and slowly return to their original size

154
Q

Stages of acute alcohol intoxication

A

Stage of excitement: well being, euphoric
Stage of incordination:
Slurred speech, blackouts, dilated pupils
Stage of narcosis - mc ewan’s sign

155
Q

Most specific breath alcohol test

A

Gas chromatography mass spectrometry

156
Q

Principle of drunkalyzer/ breathalyzer

A

Chemical oxidation
Photometry
Uses the principle that alcohol is easily oxidised to acetic acid by oxidizing agents such as potassium dichromate

157
Q

Rx of acute alcohol intoxication (5)

A
  1. Tracheal suction + PPV
  2. Induce vomiting
  3. Gastric lavage
  4. Iv NaHCO3 + thiamine+ glucose
  5. Hasten recovery with hemodialysis
158
Q

C/f of chronic alcoholism

A

Tolerance
Dependence
Withdrawal sms

159
Q

Rx of chronic alcoholism (5)

A
  1. Social and motivational therapy
  2. Substitutinal therapy - long acting diazepam
  3. Naltrexone: long acting - decrease relapse, decrease craving
  4. Acamprosate: NMDA antagonist
  5. Disulfiram-those who sincerely want to leave the habit
160
Q

…….recovers earliest in wernicke’s encephalopathy

A

Opthalmoparesis

161
Q

Avoid ……in chronic alcoholic why?

A

Phenytoin
As alcohol is a CYP induced and decrease level of phenytoin ppt seizures

162
Q

Rehab of alcohol

A

Alcoholic anonymous AA

163
Q

Level of methanol that causes effects

A

15ml- blindness
30ml- death

164
Q

Rx for methanol poisoning (8)

A
  1. Keep the pt in quiet,dark room
  2. Protect eyes from light
  3. Supportive measures to maintain ventilation
  4. Gastric lavage with NaHCO3
  5. If hypokalemia-KCl
  6. Ethanol
  7. Fomepizole (alcohol dh inhibitor)
  8. HD
165
Q

Difference between first generation and second generation antipsychotics

A

First generation : neuroleptics
D2 blockers

Second generation:
atypical
5HT2A blockers
Less EPS
Benefit in positive and negative sms

166
Q

Antipsychotic that is most potent
DOC for schizophrenia

A

Risperidone

Atypicals like aripripazole

167
Q

Antipsychotic that can be used for Hyperprolactinemia

A

Aripripazole as it’s a partial agonist at D2 receptor

168
Q

DOC for schizophrenia in pregnancy
Why is second generation not given?

A

Haloperidol

Not preferred as there is higher incidence of low birth weight baby and abortion.

169
Q

DOC for resistant schizophrenia
Define resistant schizophrenia

A

Clozapine

Schizophrenia not responding to 2 or more drugs

170
Q

Uses of clozapine (3)

A
  1. Resistant schizophrenia
  2. Tardive dyskinesia
  3. Anti suicidal indication
171
Q

S/e of clozapine (6)

A
  1. Sedation
    2 Sialorrhoea- wet pillow
  2. Weight gain
  3. Agranulocytosis
  4. Seizures
  5. Carditis
172
Q

Labs that must be done when giving clozapine

A

CBC- agranulocytosis
ECG- carditis

173
Q

Psychotic sms that is most beneficial by neuroleptic drugs

A

Hallucination and delusion

174
Q

Sms improved in order while giving antipsychotics (4)

A
  1. Biological sms- sleep, appetite
  2. Auditory hallucinations
  3. Delusion
  4. Negative sms
175
Q

How long should antipsychotics be given if no psychotic sms after rx?

A

1st episode : 2yrs
Subsequent episodes: 5 yrs /indefinitely

176
Q

Max weight gain is for …….why?

A

Clozapine
Due to blockage of H1 receptor

177
Q

Cause and Rx of tardive dyskinesia
Drug c/i?

A

Supersensitivity of D2 receptor to prolonged D2 blackage.
Rx:
1. Stop the drug
2. DA deplete drug -VMAT- valbenazine
3. Shift to clozapine
4. Gingko biloba-herbal drug.

C/i: central anticholinergic can worsen TD, hence not given.

178
Q

Doc for L-dopa induced schizophrenia

A

Pimvanserin

179
Q

DOC for multiple relapses of schizophrenia caused by non compliance

A

IM formulation:
FGA: fluphenazine
Haloperidol
Zuckopenthixol

SGA: Risperidone
Olanzapine
Paliperidone

180
Q

Problem with tardive dyskinesia
Sms

A

Can occur even after offending drug has been withdrawn long time back or with Rx for >6months-1yr.

Sms:
abnormal movements
Constant chewing
Puffing of cheeks
Thrusting of tongue

181
Q

Drug causing paradoxical tachycardia

Drug causing malignant hyperthermia. Rx

A

Quinidine

Succinyl choline
Halothane
——increase calcium from RYR receptor

Rx: dantrolene

182
Q

Define neuroleptic malignant syndrome (3)
Rx? (3)

A

Rigidity
Hyperthermia
Cv collapse secondary to D2 blockage

  1. External cooling
  2. Bromocriptine > dantrolene
  3. Amantadine
183
Q

Antipsychotics not given to elderly with dementia . Why?

A

They can increase mortality- stroke.
Eg: Risperidone
Olanzapine

184
Q

What are the positive and negative sms of schizophrenia? Drug of choice ?

A

Positive : delusion, hallucinations
Negative :
asocial, Alogia, affective blunting

DOC: SGA
Haloperidol- only positive sms rx

185
Q

High potency and low potency typical antipsychotics

A

Low potency: chlorpropazine, thioridazine
Less EPS

High potency: haloperidol, trifluperazine
High EPS

186
Q

What are the EPS? Timing ? Rx

A

4 hrs:
Acute dystonia -earliest
Seen mainly in young men and girls <10yr
Oculogyric crisis- upward movement of eyes

Rx: Central anticholinergics
Benzhexol, trihexylphenydyl, promethazine

4 days: akinesia-Parkinsonian sms

4 weeks: akathesia
Mc s/e- desire to move around ; restless
Rx: propanolol

4 months: tardive dyskinesia
Rx: clozapine

187
Q

Antipsychotic c/I in angle closure glaucoma. Why?

A

Thioridazine- max anticholinergic action
Dry mouth, blurred vision, mydriasis, urine retension.

188
Q

Max sedation is with ……. Antipsychotic
Another side effect is ….

A

Chlorpromazine
Cholestatic jaundice

189
Q

Endocrine side effects of antipsychotics

A

DA blocker- Hyperprolactinemia, amenorrhoea, galactorrhoea

190
Q

DOC for neuroleptic malignant syndrome (3)
Sms of NMS (3)

A
  1. External cooling
  2. Bromocriptine > dantrolene
  3. Amantadine

Sms: rigidity
Hyperthermia
CV collapse

191
Q

DOC for initial hiccups
DOC for intractable hiccups

A

Hiccups: initial: baclofen, gabapentin
Intractable :
chlorpromazine + metoclopramide

192
Q

Uses of antipsychotics

A
  1. Psychosis- schizophrenia
  2. Others :
    Main Anti Psy Cho Tic Hoo
    Maniac
    Antiemetic - procarbazine, olanzapine
    Psychosis L-dopa- pimvanserin
    Chorea: hunting tons , syndenhams
    Tic disorder: Tourette syndrome
    Hiccups
193
Q

Antipsychotic given for chemotherapy induced vomiting

DOC for Tourette syndrome (3)

A

Olanzapine

  1. D2 blocker : pimozide, haloperidol
  2. Atypical : risperdone
  3. Clonidine
194
Q

Doc for restless leg syndrome
Patch used

A

Pramipexole, ropirinole - DA agonist
Rotigotine patch
+
Iron replacement for anemia

195
Q
  1. Max EPS is with ……
  2. Max EPS among atypical antipsychotics
  3. Min EPS among atypical antipsychotics
A
  1. Haloperidol
  2. Risperidone
  3. Clozapine
196
Q
  1. Clozapine blocks ……..receptors
  2. Max weight gain
  3. Least weight gain
  4. Drugs causing Qt prolongation
A
  1. 5HT2A, D1,D4, very less D2
  2. Clozapine
    3 . Ziprasidone, aripripazole
  3. Thioridazine, Ziprasidone
197
Q

Long acting (depot) injections of antipsychotics

A

First generation:
1. Haloperidol
2. Fluphenazine
3. Flupenthixol

Second generation:
1. Risperdone
2. Aripripazole
3. Olanzapine
4. Ziprasidone

198
Q

All antipsychotics cause qt prolongation except ….
Qt prolongation is due to …..

A

Lurasidone

Inward K+ channel block

199
Q

Eye and skin side effects of chlorpromazine (3)

A

Corneal and lens deposits : whorl like
Cataracts
Blue-grey skin pigmentation

200
Q

Specific side effect of eye for thioridazine
Quetiapine causes …..

A

Retinal deposits-salt and pepper
< 800mg/dl

Cataract

201
Q

Haloperidol is DOC for ..(3)

A
  1. Acute schizophrenia
  2. Huntingtons chorea
  3. Gille’s de la Tourette syndrome
202
Q

Uses of chlorpromazine (5)

A
  1. Psychiatric uses
  2. N/V rx
  3. Intractable hiccups
  4. Preanesthetic meds
  5. Skeletal muscle relaxation in tetanus
203
Q

Checking for agranulocytosis in clozapine is ….

A

CBC weekly X 6 months , then biweekly

204
Q

What are the H3 receptors? What are the uses of inverse agonist at H3 receptor ?

A

H3 receptor: presynaptic NE release blocker. It’s an autoreceptor.
H1 receptor is necessary for wakefulness
Therefore H3 receptor —> sedation.

H3 inverse agonist : pitolisant, tiprolisant
Increase H1 release—> increase wakefulness .
Used in narcolepsy

205
Q

Other than antipsychotic action, what else does Ziprasidone and aripripazole have?

A

Antidepressant
Antianxiety actions

206
Q

Antipsychotic with least chances of cognitive dysfunction

A

Aripripazole- partial agonist

207
Q

Hyperprolactinemia is main side effect for ….(3)

A

FGA
Risperidone
Amisulpirid

208
Q

DOC for Huntingtons chorea

A
  1. DA depleter- tetrabenazine (block VMAT
  2. Haloperidol
209
Q

DOC for syndenhams chorea

A

Phenobarbital —-> resistant—> haloperidol

210
Q

Action of antidepressants are …..
First line antidepressant
DOC for severe depressant

A

Slow- 3-4 weeks
SSRI

SNRI > TCA

211
Q

DOC for atypical antidepressant
DOC for Resistant depression

A

MAOI

Esketamine nasal spray

212
Q

DOC for post partum depression

A

Brexanolone

213
Q

Doc for fibromyalgia

A

Fatigue, generalized bodyache, labs normal

Rx: SNRI- Milnacipram
Also used for neuropathic pain

214
Q

Duloxetine s/e

Venlafaxine s/e

A

Hepatotoxicity

Increase bp, increase HR

215
Q

TCA blocks …(2)
Types

A

SERT, NET blocker
Tertiary amines: SERT blocker
Eg: clomipramine- max SERT blocker

Secondary amine: NET blocker

216
Q

Max SERT blocker is ……
Doc for premature ejaculation ….

A

Clomipramine

Dapoxetine

217
Q

S/e of paroxetine (5)

A
  1. Sexual s/e
  2. Weight gain
  3. Teratogenic- pulm HTN, cardiac septal defect
  4. Max sedation
  5. Increased withdrawal
218
Q

Antidepressant that exerts protective effect from suicidality

Antidepressant with Qt prolongation (2)

A

Venlafaxine

TCA, citalopram

219
Q

Antidepressant with dose related CV effect

Antipsychotic with no effect on prolactin (2)

A

Citalopram

Clozapine
Aripripazole

220
Q

AntiHTN that should not be given with TCA is……

A

Clonidine

221
Q

Uses of TCA

A

MiND COP
1. Migraine prophylaxis
2. Neuropathic pain -TCA,SSRI, pregab,gabapentin
3. Depression - effective in severe depression
4. Childhood disease: ADHD,nocturnal enuresis
5. OCD - Clomipramine,SSRI- DOC
6. Pruritus- doxepin

222
Q

DOC for nocturnal enuresis

A
  1. Desmopressin
  2. ADHD+ nocturnal enuresis- imipramine
223
Q

Antidepressant used in children

Drugs used for acute vs chronic anxiety

A

Fluoxetine

Acute: BZP, beta blockers
Chronic : fluovoxamine -SSRI

224
Q

DOC for PTSD (2)

A

Sertaline
Paroxetine

225
Q

DOC for eating disorder
S/e of fluoxetine (3)

A

Fluoxetine

S/e:
1. Increase 5HT3-GIT: nausea>diarrhoea
2. Sexual S/E: 5HT2: ED, delayed orgasm
Anorgasmia
3. CNS: anxiety , insomnia

226
Q

Difference between bupropion and buspirone

A

Bupropion: antidepressants
Smoking cessation
Weight loss

Buspirone: antianxiety-
no anticonvulsant muscle relaxing property

227
Q

What are the transdermal patches we know of? And for what diseases is it used? (4)

A

Transdermal patches :
1. Depression: selegilline
2 Alzheimer’s: rivastigmine
3. Post menopausal sms: clonidine
4. Parkinsons disease: rotigotine

228
Q

S/e of reserpine

A

VMAT blocker- depression.

229
Q

Longest and shortest acting SSRI

A

Longest: fluoxetine
Shortest: fluvoxamine

230
Q

Most teratogenic SSRI
Most specific SSRI

A

Paroxetine

Esitalopram

231
Q

Vilasodone MOA (2)

A

SERT blocker
Partial agonist at 5HT1A

232
Q

DOC for stress incontinence ; mechanism

A

Duloxetine
Constricts bladder sphincter

233
Q

Reason for delayed effect of antidepressants (2)

A
  1. Inhibition of autoreceptors
  2. Synthesis of brain derieved neuroleptic factor.
234
Q

Drugs that can cause anxiety (5)

A
  1. Bupropion
  2. Reserpine
  3. Amphetamines
  4. CCK
  5. SSRI
235
Q

Best DOC for OCD
Resistant OCD

A

SSRI-fluovoxamine

Clomipramine

236
Q

Best drug for PMS
MOA of TCA (3) and s/e

A

Fluoxetine

Mu blocker -dry mouth,mydriasis
Alpha blocker -hypotension
H1 blocker - sedation

237
Q

Long term rx for severe anxiety with intermittent panic attacks

Define panic attack. DOC

A

SSRI

Sudden,severe,spontaneous anxiety attack,feeling of impending doom.
DOC: BZP- alprazolam,clonazepam,lorazepam,diazepam

238
Q

Define panic disorder,DOC

A

4 or more panic attacks /yr
DOC: SSRI, / buspirone /TCA

239
Q

MOA of buspirone

A

Partial agonist at 5HT1A
Slow acting anxiolytic
No physical dependence
No withdrawal

240
Q

MOA of Mirtazepine

A
  1. Block presynaptic receptor ->increase NT release
  2. 5HT2 blocker
  3. 5HT3 blocker
241
Q

S/e of mirtazepine (3)

A
  1. Highly sedative
  2. Max weight gain
  3. Agranulocytosis-rare
242
Q

Best tolerated TCA is …..

A

Nortriptyline

243
Q

TCA + D2 blocker is ……
SNRI egs. (3)

A

Amoxapine

Duloxetine
Venlafaxine
Milnacipran

244
Q

NARI Eg

A

Noradrenaline reuptake inhibitor
Reboxetine

245
Q

5HT2 antagonist (2)

A

Nefazodone
Trazodone

246
Q

MOA of bupropion

A

NDRI- norepinephrine dopamine reuptake inhibitor
Block NET, DAT
No action on 5HT-no sexual s/e

247
Q

MOA of Agomelatine (2)

A

Melatonin receptor agonist
5HT2C antagonist

248
Q

Less sedating TCA
S/e of TCA

A

Desipramine

  1. Metabolic acidosis
  2. Myoclonic seizures-diazepam
  3. Increase HR

TCA not removed by HD as it has higher Vd.
TCA lower seizure threshold.

249
Q

S/e of TCA at high doses (2) Rx for TCA poisoning

A
  1. Seizure
  2. Cardiac arrhythmia

Iv NAHCO3

250
Q

Rx for sexual dysfunction caused by SSRI
Safest SSRI to use with warfarin

A

Cryptoheptadine

Sertaline,citalopram- rest all cause bleeding as they affect platelet serotonin levels.

251
Q

SSRI causing SIADH in elderly
SSRI used in GAD, s/e

A

Fluoxetine

Venlafaxine
Increased Bp

252
Q

……causes seizure in bulimic patients
SSRI safe in acute MI or angina

A

Bupropion

Sertaline

253
Q

SSRI causing priapism (2)

A

Trazodone
Nefazodone

254
Q

Nefazodone should not be given along with…..(3) due to risk of ……&……

A

Terfenadine
Astemizole
Cisapride

Qt prolongation
Hepatic failure

255
Q

………… is a glutamatergic modulator

Eg of NaSSA uses(2)

A

Tianeptin

Mirtazepine
Noradrenergic Selective serotonin antidepressant
Use: antiemetic, appetite stimulant

256
Q

Non selective MAOI (2)

A

Phenelzine
Tranylcypromine

257
Q

Reversible and selective MAO A Inhibitor

A

Moclobemide

258
Q

MOA B selective inhibitor

A

Selegilline

259
Q

MOA of MAO I

A

Inhibit MAO irreversibly, increasing NE and serotonin conc in the synapse and improve mood.

260
Q

DOC for cheese reaction
2 syndromes with MAOI

A

Phentolamine

  1. HTN crisis -
    ingestion of pressor amines,tryramine containing food.
  2. Serotonin syndrome-
    MAOI + SSRI
    MAOI+ venlafaxine
    SSRI alone at high doses .
261
Q

Sms of serotonin syndrome
Rx.

A

HARMS
Hyperthermia
Autonomic instability
Rigidity
Myoclonus
Seizures
Death

  1. Stop the offending drug
  2. Cyproheptadine
  3. Start SSRI only after 14 days of stopping MAOI
262
Q

DOC for psychotic depression
Drug to reduce craving in cocaine withdrawal

A

Amoxapine

Desipramine

263
Q

Antidepressant with hepatotoxicity

A

Nefazodone -withdrawn from market

264
Q

Antidepressant with wakefulness

A

Bupropion-amphetamine like metabolite
Anxiety
Weight loss
Seizure

265
Q

Antidepressant with sedation (2)

A

Mirtazepine
Trazodone

Therefore they are used to rx insomnia

266
Q

DOC for narcolepsy
Therapy for borderline personality disorder

A

Modafinil - mood alert

Dialectical therapy

267
Q

Mood stabilizers eg (4)

A
  1. Lithium
  2. Carbamazepine
  3. Valproate
  4. Lamotrigine
268
Q

Difference between bpd1 and bpd2

A

BPD 1: Single mania

BPD2: major depression + hypomania

269
Q

Doc for acute mania (4)

A
  1. Antipsychotic + lithium
  2. Antipsychotic
  3. Valproate
  4. Lithium
270
Q

C/f of acute mania (4)

A

Increased mood/irritability
Decreased sleep
Increased energy
Goal directed activity

271
Q

Doc for rapid control of mania
What are rapid cyclers ? DOC

A

Olanzapine

> -4 episodes of mania/depression within 1 year.
DOC: valproate

272
Q

Note of lithium toxicity

A

> 80% lithium is reabsorbed in PCT
Lithium is a competitive inhibitor at na-li channel
1. Acute tubular necrosis- increase excretion of lithium-no toxicity
2. Hyponatremia- increase toxicity

273
Q

Causes of hyponatremia for lithium toxicity (3)

A

Dehydration
Diarrhoea
Diuretic - thiazide / furosemide/k+ sparing

274
Q

Lithium therapy was started by …….
It is a ……salt

A

John F cade
Carbonate salt-converted to chloride in stomach

275
Q

MOA of lithium

A

Inhibit hydrolysis of ionositol-1-p04

276
Q

Only mood stabilizer with anti suicidal action
Psychiatric uses of lithium (4)

A

Lithium

  1. Acute BPD
  2. Major depression
  3. OCD
  4. Schizoaffective disorder
277
Q

Non psychiatric uses of lithium (4)

A
  1. Migraine - cluster headache
  2. Neutropenia
  3. SIADH
  4. Ulcerative colitis
    Cyclical vomiting
278
Q

Starting dose of lithium

Care of lithium for a patient undergoing surgery

A

300mg BD/TDS

Stop it 24 hrs before surgery

279
Q

Blood lithium levels decreased by …..(5)

A
  1. Bronchodilators:
    theophylline, aminophylline
  2. Verapamil
  3. Carbonic anhydrase inhibitors
  4. Osmotic diuretics : acetazolamide,mannitol
  5. Sodium bicarbonate
280
Q

Doc for prophylaxis of BPD

Signs of lithium toxicity (4)

A

Lamotrigine

  1. N/V/ profuse diarrhoea
  2. Coarse tremor
  3. Hyperreflexia,
    ataxia,
    confusion,
    convulsion,
  4. Death
281
Q

Rx of choice of antipsychotic in pregnancy
1. Acute mania
2. Prophylaxis

A
  1. Antipsychotic
  2. Lamotrigine
282
Q

Monitoring for lithium toxicity

A

T1/2: 24 hrs
Time to steady state- 4-5 t1/2= 4-5 days
Therefore: blood levels taken after 12 hrs after last dose

283
Q

What are the blood tests to be done for lithium toxicity?

A

Test- tremor fine mc, coarse- overdose
TFT: hypothyroidism, hyperthyroidism
UPT: teratogenic
BC: leucocytosis- increase GCSF
ECG: T wave inversion/ sick sinus/Av block
Weight: gain
Electrolyte- hyperK, hypercalcemia
Edema
KFT- Nephrogenic DI

Others : diarrhea, acne, worsen Psoriasis

284
Q

Therapeutic levels of lithium in
1. Acute mania
2. Prophylaxis of BPD
3. Toxicity
4. Hemodialysis

A
  1. 1-1.0 mEq/L
  2. 0.5-1.0 mEq/L
  3. > 1.5mEq/L
  4. > 3/>4 mEq/L
285
Q

Sleep cycle stages

A

Stage 0: first 1/2 hrs, eyes closed only
Stage 1,2,3
Stage 4: deepest stage of sleep
Stage 5: REM

286
Q

Classification of barbiturates

A

Long acting : phenobarbitone
Short acting: butobarbitone, pentobarbitone
Ultra short acting : thiopentone

287
Q

3 MOA of barbiturates

A
  1. GABA facilitatory action
  2. GABA mimetic action- at high doses
  3. Glutamate inhibitors through AMPA receptor
288
Q

Sensitive area of the brain where sedative, hypnotics act
Dose dependent action :

A

Reticular activating system

Sedation —>sleep—>anesthesia —>coma

289
Q

Sleep pattern of using barbiturates

A

Decrease sleep latency
Increase sleep duration
Sleep architecture disturbed -
REM, stage 3,4 decreased
Stage 0,1,2 increased

290
Q

Uses of barbiturate

A

Phenothiazine- epilepsy
Thiopentone- anesthesia

291
Q

Barbiturates can cause anterograde amnesia, forget earlier dose was taken and keep taking it again and again—> overdose
Features of barbiturate poisoning (4)

A
  1. Unconscious
  2. Respiratory collapses
  3. Circulatory collapse
  4. Shock
292
Q

Management of barbiturate poisoning (4)

A
  1. Gastric lavage
  2. Airway protection
  3. IVF - NaHCO3
  4. Alkaline diuresis
  5. H.D
293
Q

Classification of BZP

A

Based on uses :
1. Hypnotic:
Diazepam, fluzepam,alprazolam,nitrazepam

  1. Antianxiety:
    Diazepam, chlorpromazine, oxazepam, lorazepam
  2. Seizures
    Diazepam,lorazepam,clonazepam
294
Q

Non competitive GABA antagonist

Competitive BZP antagonist

A

Bicuculine -act in b sub unit

Flumazenil

295
Q

GABA inverse agonists

A

DMCM- dimethoxymethylcarbomethylcarboline

296
Q

Drug that blocks Cl- channel directly

A

Picrotoxin

297
Q

Action of BZP (5)

A
  1. Sedation
  2. Hypnosis
  3. Anticonvulsants
  4. Analgesia
  5. Anterograde amnesia
298
Q

Advantages of BZP over barbiturate (6)

A
  1. Flat DRC
  2. No action on respiratory/CVS/ body syst
  3. Minute disturbance in sleep architecture
  4. No CYP induction
  5. Lower abuse potential
  6. Flumazenil- specific antidote
299
Q

DOC for chronic anxiety
DOC for performance anxiety

A

Chlordiazepoxide

Propanolol

300
Q

BZP drugs given for insomnia (2)

A

Zolpidem, zaleplon

301
Q

Egs of azapirones
MOA
Uses

A

Buspirone
Gepirone
Isapirone

Partial agonist of 5HT1A - decrease release of 5HT

No sedation, anticonvulsant or muscle relaxant properties
Ineffective in acute anxiety

302
Q

BZP with active metabolites (5)

A

Alprazolam
Buspirone
Chlordiazepoxide
Diazepam
Flurazepam

ABCDeF

Pharma From Sure Success (10 decks)

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