CNS + Psych

Question 1

Opioid OD reversal

Answer 1

Methadone

Question 2

Mood stabilizers

Answer 2

Lithium (m+d)
- hypothyroidism + ebstein

Valproate (m>d)
- hepatotoxic + NTDs

Lamotrigine d
- rash + SJS

Carbamazepine m
- aplastic anemia + SIADH + NTDs

Mania Sx
Depressive Sx

Question 3

NE + DA reuptake inhin

Answer 3

Bupropion

Antidepressants

Question 4

Tx for trigeminal neuralgia

Answer 4

Carbamazepine

Also, bipolar + seizures

Question 5

Antidepressant which no sexual dys(f) or weight gain

Answer 5

Bupropion

Question 6

SE bupropion

Answer 6

Seizures

Inc risk in pre-existing seizure disorder or eating / electrolyte disorders

Question 7

SNRI w inc BP SE

Answer 7

Venlafaxine

Question 8

SJS SE seen w?

Answer 8

Lamotrigine

Anticonvulsant + Bipolar Tx

Question 9

Which drugs are +ve allosteric modulators of GABA A receptors?

Answer 9

BDZ

• inc FREQUENCY of Cl- ch opening IN PRESENCE OF GABA

Question 10

Alcohol withdrawal Tx

Answer 10

1. BDZ

Question 11

Anti seizure drugs

Answer 11

1. Block Na ch : Phenytoin (recurrence). Carbamazepine.
2. Block Na ch + Inc GABA levels : VALPROIC acid, Topiramate
3. Inc GABA action : BDZ (initial Tx). Phenobarbital.
4. Modulates GABA + glutamate release : Levetiracetam
5. Blocks Ca ch, thalamus : Ethosuximide (T), Gabapentin
6. Irrev GABA transaminase inhib : Vigabatrin (Tx-resistant epilepsy), Valproic acid
7. GABA reuptake inhib :
   Tiagabine

Question 12

Li tox manifested by which other drugs?

Answer 12

1. Thiazides
2. Diuretics
3. NSAIDs
4. ACE inhib
5. Dec glomerular filtration (vol depletion, CHF, cirrhosis)

Tx: Hydration. Hemodialysis.

Question 13

Which opioid can ppt opioid-withdrawal Sx?

Answer 13

Buprenorphine (partial ag acts as antag in presence of full ag)

Question 14

Opioid long term SE?

Answer 14

Central sensitization: inc pain sensitivity

1. Receptor down regulation
2. Unreg of NMDA receptors

» tolerance + opioid-induced hyperalgesia

Question 15

Opioid intox

RF:

CF:

Tx:

Answer 15

RF: Subs abuse. Post-op. Hepatic/ renal insuff.

CF: somnolence. AMS. dec RR, dec HR, dec bowel sounds. Resp acidosis. Hypothermia. MIOSIS.

Tx: Naloxone (t1/2=<1hr : repeat dosing)

Question 16

Rapid recovery from Propofol d/t?

Answer 16

Redistribution from organs w high blood from (brain, heart, kidney, liver) to organs w low blood flow (bone, adipose, CT)

Question 17

Prolonged paralysis after Succinylcholine d/t ?

Answer 17

Pseudocholinesterase def

Succinylcholine rapidly hydrolyzed by plasma pseudocholinesterase : only 10% reached NMJ
Def : large amt reached NMJ » inc paralysis

🌟 polymorphism in BCHE gene

Question 18

NET blockers

Answer 18

1. Cocaine
2. SSRIs, SNRIs
3. TCA

Question 19

What inhibits DA to NE conversion?

Answer 19

Reserpine

Question 20

Lithium tox

Answer 20

» LiTHIUM «

1. Low Thyroid
2. Heart - ebstein anomaly
3. diabetes Insipidus
4. Unwanted Movements - tremors (#MC)

Question 21

Synth of NTs - DA, NE etc

Answer 21

Tyrosine - L dopa - Dopamine - NE - Epi - Melanin

Question 22

Theophylline tox + Tx

Answer 22

~ caffeine : mild cortical arousal + insomnia
-N/V/D, abd pain, cardiac arrhythmia, SEIZURES

Tx:
activated charcoal.
Beta blockers (arrhythmia)
BDZ + phenobarbital (seizures)

Question 23

blood-gas partition coefficient

Answer 23

Low B-G partition coefficient = low solubility : meaning more free to produce effect in blood : quickly saturated : inc partial pressure :: rapid onset of action
Eg. N2O

High B-G partition coefficient = high solubility, less free in blood to produce an effect : partial pressure rises slowly :: slow onset of action
Eg. Halothane

Question 24

How is potency of inhaled anesthetics measured?

Answer 24

MAC : Min alveolar conc

• conc of anesthetic in alveoli that renders 50% pts unresponsive to painful stimuli (ED50)

❗️Potency inv proportional to MAC ❗️

Question 25

What is added to local lidocaine?

Answer 25

1. Lidocaine + Epi : vasoconstriction - dec local bleeding - prolonged duration of action of lidocaine since more remains at site of injection - dec systemic absorption: dec SE 2. Lidocaine + Na bicarbonate: - dec pH : inc potency : dec pain at injection site

Question 26

NTs of pain in PNS

Answer 26

Glutamate + Subs P

Question 27

Tx of GAD in pts w Hx of OD

Answer 27

Buspirone (NOT BDZ) + SSRI

Question 28

2nd gen antipsychotics MOA

Answer 28

1. D2 receptor antag PLUS 2. 5HT2A receptor antag 1st gen - only D2 r antag

Question 29

Tx of FGA SE

Answer 29

Acute dystonia rxn 1. Diphenhydramine Or Benztropine + switching to SGAs

Question 30

SNRI SE HTN seen w?

Answer 30

Venlaxafine

Question 31

Full opioid Ag used for Tx of opioid use disorder?

Answer 31

Methadone - withdrawal + maintenance SE: - resp depression + QT prolongation - dependence

Question 32

Partial opioid Ag used for Tx of opioid use disorder?

Answer 32

Buprenorphine Used alone or w Naloxone, opioid antagonist

Question 33

Tx DI acute dystonia

Answer 33

Diphenhydramine | Benztropine

Question 34

Tx cluster headaches

Answer 34

Sumatriptan 100% O2 Prophylaxis: Verapamil

Question 35

Tx Migraines

Answer 35

NSAIDs Triptans Dihydroergotamine Prophylaxis: b-blockers, valproate. Botulinum. Anti-CGRP MAB.

Question 36

Tx tension headache

Answer 36

NSAIDs | Acetaminophen

Question 37

Tx trigeminal neuralgia

Answer 37

Carbamazepine

Question 38

Tx essential tremors

Answer 38

``` Propranolol Primidone (barbiturate) ```

Question 39

Tx restless leg syndrome

Answer 39

DA Ag: | Pramipexole, Ropinirole

Question 40

Na ch inactivating Antiepileptics

Answer 40

1. Valproate 2. Topiramate 3. Lamotrigine 4. Levitiracetam — seize the land —