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Exam #2 Flashcards

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1
Q

Treatment for Bipolar disorder
Normal
Anti seizure drugs
Antipsychotics

A 
Normal: lithium
Anti seizure drugs:
- valproic acid
- carbazepime
- Lamatrigine
Antipsychotics:
- Quetiapine
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2
Q

Lithium MOA

A
  • activates GABA release
  • inhibits glutamate and dopamine
  • inhibits phosphoinositol cascade (IP3 and DAG pathway)
  • Inhibition of glycogen synthase kinase-3 (GSK-3) leading to neuroprotection
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3
Q

Lithium therapeutic range

A

0.6-1.5 mEq/L

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4
Q

Lithium Pharmokinetics

A

Competes w Na+ for tubular reabsorption in the kidneys (Lithium can be in by Na+ loss often seen in diuretic use)
-diuretics can inc lithium concentration

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5
Q

Lithium Adverse Effects

A

Hypothryroidism (weight gain, dry skin, hair loss, and constipation)
Tremors
Ataxia (ESP WHEN PAIRED W ATYPICAL PSYCHOTICS)
Nephrogenic diabetes insipidus (dec response to ADH leading to polyuria)
Nausea, vomiting, diarrhea
PREGNANCY = Ebstein anomaly

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6
Q

Carbamazepine CYP

A

inducer

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7
Q

Monoamine Hypothesis

A

Depression resulting from pathological dec in serotonin, NE, and/or dopamine neurotransmission

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8
Q

Neurotropic Hypothesis

A

Loss of neurotrophic support leading to depression (Brain derived neurotrophic factor)

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9
Q

Hypothalamic-Pituitary-Adrenal Axis Dysregulation

A

Elevated levels of cortisol and CRH

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10
Q

Thyroid Dysregulation

A

Depression associated w hypothyroidism or hyperthyroidism

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11
Q

SSRIs names

A 
Fluoxetine
Paroxetine
Sertraline
Citalopram
Escitalopram
Vilazadone
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12
Q

SNRIs names

A

Duloxetine
Venlafaxine
Milnacipran
Levomilnacipran

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13
Q

initial inhibition of SERT induces

A

activation of 5-HT1A and 5-HT1D autoreceptors

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14
Q

TCS names

A

Imipramine

Amitriptyline

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15
Q

TCA nonselective effects

A

Antimuscarinic
Antihistaminic
Alpha-blockade

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16
Q

5-HT2 Antagonists

A

Trazodone

Nefazodone

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17
Q

5-HT2 Antagonists Nonselective effects

A

Antimuscarinic, antihistamine, alpha-blockade

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18
Q

MOA-A and MOA-B irreversible inhibitors

A

Phenelzine

Tranylcypromine

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19
Q

MOA-B irreversible inhibitor only

A

Selegiline

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20
Q

bupropion MOA

A

inhibits the norepinephrine transporter (NET) and the dopamine transporter (DAT)

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21
Q

Mirtazapine moa

A

alpha-2 inhibition increases presynaptic release of serotonin and norepinephrine

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22
Q

Trazodone moa

A

serotonin modulator (antagonizes 5-HT receptors and inhibits 5-HT reuptake)

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23
Q 
increased risk of suicide between children, adolescents and young adults.
SSRI
SNRI
TCA
MOA inhibitor
Atypical
A 
SSRIs:
-Escitalopram
-Fluoxetine
SNRIs:
-Duloxetine
TCAs:
-Imipramine
MOA inhibitor:
-Phenelzine
Atypical:
-Bupropion
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24
Q

Schizophrenia pathology

A
  • Inc dopaminergic activity (D2 receptor)
  • Inc serotonergic activity (5-HT2A and 5-HT2C)
  • Diminished GABA activity leading to hyperstimulation
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25
Q

Typical antipsychotics names

A

Chlorpromazine

Haloperidol

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26
Q

Atypical antipsychotics names

A

Chlorpromazine

Haloperidol

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27
Q

Typical antipsychotics MOA

A

D2 antagonist

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28
Q

Atypical antipsychotics MOA

A

Preferential antagonism of 5-HT2A receptors; some D2 antagonist action

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29
Q

Aripiprazole MOA

A

partial agonist at D2

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30
Q

5-HT2A
Transducer:
Effect:

A

Transducer: Gq
Effect: PKC mediated reduction of Ca2+ and Na+ conductance

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31
Q

5-HT2C
Transducer:
Effect:

A

Transducer: Gq
Effect: PKC mediated reduction of Ca2+ and Na+ conductance

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32
Q

Dopamine Inhibition
α-adrenergic Inhibition
Muscarinic Inhibition
Histamine (H1) Inhibition

A 
Dopamine Inhibition:
-extrapyramidal reaction
-hyperprolactinemia
α-adrenergic Inhibition:
-orthostatic hypotension
Muscarinic Inhibition
-urinary retention
-constipation
-blurred vision
-dry mouth
Histamine (H1) Inhibition:
-sedation
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33
Q

antipsychotics w highest Dopamine Inhibition

A

haldol

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34
Q

Neuroleptic Malignant Syndrome

A 
Life threatening disorder most commonly associated w/ typical antipsychotics with high affinity for D2 receptors
Symptoms:
-Hyperthermia
-extreme muscle rigidity
-tachycardia
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35
Q

typical psychotics adverse effects

A

Weight gain
QT prolongation
Sedation

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36
Q

Diazepam MOA

A

GABAa agonist that hyperpolarizes the cell via opening of Cl- channels

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37
Q

Baclofen MOA

A

GABAb agonist which hyperpolarizes via:

  • Closure of pre-synaptic Ca+2 channels
  • Increased post-synaptic K+ channels
  • Inhibits dendritic Ca+2 influx channels
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38
Q

Tizanidine MOA

A

alpha2 adrenergic agonist in spinal cord (pre and post synaptic inhibitor in spinal cord, inhibits nociceptive transmission in dorsal horn)

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39
Q

Tizanidine contraindication

A

Potent CYP1A2 inhibitor (don’t take w fluvoxamine/ciprofloxacin)

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40
Q

Cyclobenzaprine adverse effects

A

Concomitant MAO
Acute recovery phase of MI
Patients w heart block or congestive heart failure

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41
Q

Cyclobenzaprine adverse effects

A

Hallucinations

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42
Q

Dantrolene MOA

A

blocks RYR1 channels in SR of SKM

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43
Q

Botulinum Toxin MOA

A

inhibits synaptic exocytosis of vesicles via cleaning SNAP-25 or synaptobrevin-2

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44
Q

Malignant hyperthermia treatment

A

Dantrolene

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45
Q

Dantrolene adverse effects

A

Hepatotoxicity

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46
Q

Contraindication concomitant use of meperidine

A

Selegiline

Rasagiline

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47
Q

Amantadine MOA

A

increase dopamine release and decrease dopamine uptake (exact MOA unknown)

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48
Q

Amantadine adverse Effects

A

Orthostatic hypotension
Urinary retention
Peripheral edema

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49
Q

Benztropine MOA

A

muscarinic and histamine antagonist

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50
Q

Benztropine contraindication

A

Children <3 yo

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51
Q

Trihexyphenidyl MOA

A

muscarinic and histamine antagonist

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52
Q

Adjunctive PD therapy w on-off phenomena

A

Selegiline

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53
Q

Trihexyphenidyl adverse effect

A

Glaucoma

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54
Q

Pramipexole MOA

A

D3 agonist

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55
Q

Cylclobenzaprine contraindication

A

Concomitant MAO
Acute recovery phase of MI
Patients w heart block or congestive heart failure

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56
Q

Vigabatrin MOA

A

Irreversibly inhibits GABA-T

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57
Q

Vigabatrin adverse effects

A

Permanent Visual field loss (Black Box)

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58
Q

Tiagabine MOA

A

selective inhibitor of the GAT-1 GABA transporter

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59
Q

Tiagabine adverse effects

A

Dizziness, drowsiness, nervousness, lack of concentration

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60
Q

Perampanel MOA

A

non-competitive antagonist of the AMPA receptor on post-synaptic neurons, a main mediator of synaptic excitation in the central nervous system

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61
Q

Perampanel adverse effects

A

aggression, hostility, irritability, and anger

**Alcohol use may exacerbate the level of anger

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62
Q

Selegiline

Rasagiline adverse effects

A

anxiety and insomnia

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63
Q

what special about Oxcarbazepine

A

no cyp interactions

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64
Q

Phenytoin adverse effects

A

diplopia
ataxia
gingival hyperplasia
hirsutism

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65
Q

Lamotrigine indication

A

Conversion to monotherapy in adults with partial-onset seizures

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66
Q

Topiramate adverse effects

A

Decreased serum bicarbonate

impaired expressive language function

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67
Q

Topiramate contraindication

A

alcohol use

patients with metabolic acidosis

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68
Q

Valproic Acid/Valproate/Divalproex contraindication

A

pregnancy

liver failure

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69
Q

Lacosamide MOA

A

Selectively binds fast-inactivated state of sodium channels

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70
Q

Ethosuximide MOA

A

inhibition of low-voltage activated T-type calcium channels in thalamocortical neurons

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71
Q

Lamotrigine adverse effect

A

insomnia

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72
Q

Gabapentin MOA

A

avidly binds to alpha-2-delta-1 (α2δ) subunit of voltage-gated calcium channels

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73
Q

Gabapentin adverse effects

A

somnolence

ataxia

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74
Q

Phenobarbital MOA

A
  • positive allosteric modulators of GABAa receptors at low concentrations
  • directly activate GABAA receptors at higher concentrations
75
Q

Levetiracetam MOA

A

binds selectively to SV2A, a ubiquitous synaptic vesicle integral membrane protein, reducing the release of glutamate during trains of high-frequency activity

76
Q

Perampanel MOA

A

non-competitive antagonist of the AMPA receptor on post-synaptic neurons, a main mediator of synaptic excitation in the central nervous system

77
Q

Perampanel adverse effect

A

aggression, hostility, irritability, and anger

78
Q

Ezogabine MOA

A

binds the KCNQ voltage-gated potassium channels

79
Q

Inhibitors of Brain Carbonic Anhydrase

A

Topiramate

Zonisamide

80
Q

Known teratogens or associated with congenital malformations

A

Valproate
phenobarbital
topiramate

81
Q

Ethosuximide adverse effects

A 
Fatigue
GI distress
Headache
Itching (and urticaria)
SJS
82
Q

ezogabine adverse effect

A

pigment discoloration

83
Q

Levetiracetam adverse effect

A

personality changes

84
Q

Tabes dorsalis effects

A

Dorsal columns: proprioception, vibration, ataxia

Doral roots: reflex

85
Q

Troheryma whipplei association

A

endocarditis

86
Q

Leptospira uniterrogans symptoms

A

meningitis
hepatitis
conjuntivitis
acute renal failure w hematuria

87
Q

Leptospira uniterrogans treatment

A

doxycycline

88
Q

Borrelia burgdorferi serology

A

ELISA IgM/IgG antibody

followed by western blot

89
Q

Nocardia can causes

A

parenchymal brain abscesses

90
Q

basilar meningitis

A

Tb

91
Q

cavernous sinus cranial nerves

A

3,4,V1,V2,6

internal carotid artery

92
Q

prosthetic devices meningitis

A

Staph epi

Staph aureus

93
Q

cochlear implants

A

strep pneum

94
Q

CSF leaks

A

strep pneum

95
Q

mycotic aneurysm

A

staph aureus

salmonella

96
Q

paraspinous abscess

A

staph aureus

97
Q

bacterial meningitis treatment
neonate
normal
>60

A

neonate: Ampicillin + Gentamicin + Cefotaxime
normal: ceftriaxone + vancomycin
>60: ceftriaxone + vancomycin + ampicillin

98
Q

skin popping

A

clostridium

99
Q

HSV-1 on EEG

A

slow, sharp spikes

100
Q

“Ghost” or Mollaret’s cells

A

HSV

101
Q

CMV associations

A

myelitis

polyradiculopathy

102
Q

CMV treatment

A

gancyclovir

103
Q

Primary CNS lymphoma in HIV patient

A

solitary, ring enhancing lesion in white matter usually next to ventricle

104
Q

HHV-6 roseola symptoms

A

child w high fevers, seizures, and macular-papular rash beginning at torso and spreading to the extremities

105
Q

colorado tick fever virus (dengue fever) symptoms

A

saddleback/biphasic fever

106
Q

Chikungunya virus symptoms

A

rash
inflammatory arthritis
**severe arthralgias and arthritis that can last for weeks-years

107
Q

zika virus symptoms

A

conjunctivitis
rash (including palms)
arthralgia
in pacific florida or texas

108
Q

Measles/Rubeola causes

A

subacute sclerosing panencephalitis

109
Q

Naegleria fowleri work up

A

check both centrifuged and non uncentrifuged CSF

110
Q

Rhabdovirus histo

A

bullet shaped

negri bodies

111
Q

Rhabdovirus encephalitic symptoms

A

hyperpyrexia alternating to hypothermia
hydrophobia
aerophobia
hypersalvation

112
Q

Rhabdovirus paralytic symptoms

A

mimicking guillian barre leadings to ascending paralysis

113
Q

crypto treatment

A

flucytosine + amp B

114
Q

coccidiodes treatment

A

fluconazole

115
Q

aspergillus

A

elevated beta-D-glucan

116
Q

mucomycosis

A

negative beta-D-glucan

117
Q

eosinophilic meningits

A

angiostrongylus cantonensis

118
Q

acanthomeoba

A

spikey

119
Q

hippocampus controls

A

episodic memory and spatial maps

120
Q

entorhinal cortex

A

declarative memory and memory consolidation

121
Q

hyperphosphorylate tau

A

CDK5
GSK3B
CRMP2

122
Q

frontotemporal lobe dementia

A

aka pick disease

TDP-43

123
Q

Neisseria meningitidis agars

A

Blood agar
Chocolate agar
Mueller-Hinton agar
Thayer-Martin

124
Q

Neisseria meningitidis associations

A

DIC

Waterhouse-Friderichson syndrome

125
Q

CSF adenosine deaminase means

A

TB

126
Q

Familial fatal insomnia
location
mutation
diagnosis

A

location: thalamus
mutation: PRNP
diagnosis: thalamic hypometabolism on PET scan

127
Q

Huntington mutation

A

CAG repeat in HTT gene on chromosome 4

128
Q

Lewy body dementia location

A

midbrain

129
Q

Chronic encephalopathy histo

A

tau protein chains that start in gray matter

130
Q

Glutamate channels

GABA channels

A

Glutamate: Na+ open, K+ channels close
GABA: Cl- into cell, K+ channels open

131
Q

GABA is made how

A

Glucose -> alpha ketoglut -> glutamate -(GAD-B6)> GABA

132
Q

glutamate recycle patoway

A

glutamate that is not used is broken down to glutamine via glutamine synthase in astrocytes it is then transferred to neuron where it is converted back to glutamate

133
Q

tyrosine pathway

A

diet/phenylalanine -> tyrosine -> DOPA -> dopamine -> NE -> epi

134
Q

glutmate receptors and type

A

NMDA
AMPA
KA
ionotropic (ligand gated channel)

135
Q

NDMA

A

requires glycine and glutamate for activation

136
Q

GABAa

GABAb

A

GABAa: inotropic (inc Cl- influx)
GABAb: metabotropic (G protein, dec Ca2+ and activated K+ channels)

137
Q

alpha1, beta

alpha 2

A

alpha1, beta: excititory

alpha 2: inhibitory

138
Q

5HT3

A

inotropic

139
Q

H1

H2

A

H1: Gq
H2: Gs

140
Q

multiple system sclerosis def and hist

A

autonomic nervous system and movement dysfunction

histo: accumulation of alpha-synuclein

141
Q

MS primary progressive

A

no history of attack, slow insidious progressive worsening

142
Q

RR w secaondyr progression

A

slow progressing worsening after initial history of “relapsing remitting” form

143
Q

progressive muscular atrophy

A

ALS with w mainly LMN involvement

144
Q

primary lateral sclerosis

A

ALS w mainly UMN involvement

145
Q

kugelberg-welnader disease

A

childhood/adolescents w LMN

146
Q

bind GABAa

A 
benzos
barb
alc
etomidate
propofol
147
Q

subdural chronic and acute treatment

A

acute: 2 incision
chronic: burr hole

148
Q

encephalitis CSF

A

RBC present

149
Q

concussion

A

rotational/angular force

150
Q

decorticate

decerebrate

A

decorticate: arms flexed to chest
decerebrate: arms ext to side

151
Q

vasogenic edem

A

disruption of BBB

152
Q

cervicaly myelopathy effect

A

arms>legs

153
Q

nueromyelitis optica

A

long lesion of demyelination in spinal cord involving optic nerve

  • anti aquaporin 4 antibody
  • more segment involved than MS (>3)
  • more aggro than MS
154
Q

Acute disseminated encephalomyelitis

A

one attack that leaves (not reemitting like MS)

155
Q

Acute transverse myelitis

A

one attack that leaves deficits

156
Q

rubrospinal tract

A

forelimbs

157
Q

SPECT

A

dopamine transporter

158
Q

Parkinson’s induced by
Basal gang
Latrogenic

A

Basal gang: dec dopamine, inc Ach
-abnorma SPECT
Latrogenic: drug induces
-normal SPECT

159
Q

ALS prognosis

A

bulbar (CN) has worse prognosis than manual (extremities)

160
Q

diffuse axonal injury

A

global brain injury due to high velocity deceleration

-micro/macro transaction of neurons

161
Q

rate limiting step for tyrosine pathway

A

tyrosine hydroxylase

tyrosine -> DOPA

162
Q

NE location

A

LC

163
Q

watershed infarcts manifestation

A

paraplegia to legs

164
Q

penumbra

ischemic core

A

penumbra: enough blood to keep tissue alive but electrically silent
ischemic core: permanent tissue damage

165
Q

brain infarcts
acute
chronic

A

acute:
-edema
-no gliosis
-RBCs
chronic:
-no edema
-hemosiderin
-gliosis
-liquification necrosis

166
Q

inc subdural hematoma mortality

A

inc age
anticoagulants
unhelmeted

167
Q

best montage for seizures

A

referential

168
Q

alpha waves

A

8-13 hz

169
Q

alpha rhythm

A

post prominent alpha waves

surpassed w eye opening

170
Q

delta waves

A

<3 hz

171
Q

absent seizure is a

A

generalized seizure

172
Q

clonus

A

rhythmic fast flexion and slow extension

173
Q

myoclonus

A

sudden movente w no rhythm

174
Q

Kidling

A

focal simulation leads to continued intermittent seizures after simulation is removed

175
Q

mirror focus def

most common location

A

secondary epileptic foci develop in the contralateral hemisphere homotopic area
-temporal/frontal love epilepsy (occipital not likely)

176
Q

post titanic potentiation

A

inc frequency of miniature excitatory post synaptic potential w no affect on amplitude

177
Q

long term potentiation

A

persisting strengthening of synaptic signaling based on recent patterns of activity
-long lasting gin in signaling transmission between two neurons

178
Q

tuberous sclerosing complex

A

cortical tubers
seizures
subependymal nodules
giant cel astrocytomas

179
Q

Down syndrome most common seizure

A

tonic clonic

180
Q

PKU EEG

A

slowing, epileptiform discharge, or hyper arrhythmic patterns

181
Q

dravets syndrome

A

100s of seizures

182
Q

epilepsy mutations commonly include

A

K+, Na+, Ca2+ channels

183
Q

myoclonus epilepsy

A

ragged red fibers

mitochondrial dna mutation

BECOM 4 (4 decks)

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