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BECOM 4 > Exam #2 > Flashcards

Exam #2 Flashcards

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
Typical antipsychotics names
Chlorpromazine | Haloperidol
26
Atypical antipsychotics names
Chlorpromazine | Haloperidol
27
Typical antipsychotics MOA
D2 antagonist
28
Atypical antipsychotics MOA
Preferential antagonism of 5-HT2A receptors; some D2 antagonist action
29
Aripiprazole MOA
partial agonist at D2
30
5-HT2A Transducer: Effect:
Transducer: Gq Effect: PKC mediated reduction of Ca2+ and Na+ conductance
31
5-HT2C Transducer: Effect:
Transducer: Gq Effect: PKC mediated reduction of Ca2+ and Na+ conductance
32
Dopamine Inhibition α-adrenergic Inhibition Muscarinic Inhibition Histamine (H1) Inhibition
``` Dopamine Inhibition: -extrapyramidal reaction -hyperprolactinemia α-adrenergic Inhibition: -orthostatic hypotension Muscarinic Inhibition -urinary retention -constipation -blurred vision -dry mouth Histamine (H1) Inhibition: -sedation ```
33
antipsychotics w highest Dopamine Inhibition
haldol
34
Neuroleptic Malignant Syndrome
``` Life threatening disorder most commonly associated w/ typical antipsychotics with high affinity for D2 receptors Symptoms: -Hyperthermia -extreme muscle rigidity -tachycardia ```
35
typical psychotics adverse effects
Weight gain QT prolongation Sedation
36
Diazepam MOA
GABAa agonist that hyperpolarizes the cell via opening of Cl- channels
37
Baclofen MOA
GABAb agonist which hyperpolarizes via: - Closure of pre-synaptic Ca+2 channels - Increased post-synaptic K+ channels - Inhibits dendritic Ca+2 influx channels
38
Tizanidine MOA
alpha2 adrenergic agonist in spinal cord (pre and post synaptic inhibitor in spinal cord, inhibits nociceptive transmission in dorsal horn)
39
Tizanidine contraindication
Potent CYP1A2 inhibitor (don’t take w fluvoxamine/ciprofloxacin)
40
Cyclobenzaprine adverse effects
Concomitant MAO Acute recovery phase of MI Patients w heart block or congestive heart failure
41
Cyclobenzaprine adverse effects
Hallucinations
42
Dantrolene MOA
blocks RYR1 channels in SR of SKM
43
Botulinum Toxin MOA
inhibits synaptic exocytosis of vesicles via cleaning SNAP-25 or synaptobrevin-2
44
Malignant hyperthermia treatment
Dantrolene
45
Dantrolene adverse effects
Hepatotoxicity
46
Contraindication concomitant use of meperidine
Selegiline | Rasagiline
47
Amantadine MOA
increase dopamine release and decrease dopamine uptake (exact MOA unknown)
48
Amantadine adverse Effects
Orthostatic hypotension Urinary retention Peripheral edema
49
Benztropine MOA
muscarinic and histamine antagonist
50
Benztropine contraindication
Children <3 yo
51
Trihexyphenidyl MOA
muscarinic and histamine antagonist
52
Adjunctive PD therapy w on-off phenomena
Selegiline
53
Trihexyphenidyl adverse effect
Glaucoma
54
Pramipexole MOA
D3 agonist
55
Cylclobenzaprine contraindication
Concomitant MAO Acute recovery phase of MI Patients w heart block or congestive heart failure
56
Vigabatrin MOA
Irreversibly inhibits GABA-T
57
Vigabatrin adverse effects
Permanent Visual field loss (Black Box)
58
Tiagabine MOA
selective inhibitor of the GAT-1 GABA transporter
59
Tiagabine adverse effects
Dizziness, drowsiness, nervousness, lack of concentration
60
Perampanel MOA
non-competitive antagonist of the AMPA receptor on post-synaptic neurons, a main mediator of synaptic excitation in the central nervous system
61
Perampanel adverse effects
aggression, hostility, irritability, and anger | **Alcohol use may exacerbate the level of anger
62
Selegiline | Rasagiline adverse effects
anxiety and insomnia
63
what special about Oxcarbazepine
no cyp interactions
64
Phenytoin adverse effects
diplopia ataxia gingival hyperplasia hirsutism
65
Lamotrigine indication
Conversion to monotherapy in adults with partial-onset seizures
66
Topiramate adverse effects
Decreased serum bicarbonate | impaired expressive language function
67
Topiramate contraindication
alcohol use | patients with metabolic acidosis
68
Valproic Acid/Valproate/Divalproex contraindication
pregnancy | liver failure
69
Lacosamide MOA
Selectively binds fast-inactivated state of sodium channels
70
Ethosuximide MOA
inhibition of low-voltage activated T-type calcium channels in thalamocortical neurons
71
Lamotrigine adverse effect
insomnia
72
Gabapentin MOA
avidly binds to alpha-2-delta-1 (α2δ) subunit of voltage-gated calcium channels
73
Gabapentin adverse effects
somnolence | ataxia
74
Phenobarbital MOA
- positive allosteric modulators of GABAa receptors at low concentrations - directly activate GABAA receptors at higher concentrations
75
Levetiracetam MOA
binds selectively to SV2A, a ubiquitous synaptic vesicle integral membrane protein, reducing the release of glutamate during trains of high-frequency activity
76
Perampanel MOA
non-competitive antagonist of the AMPA receptor on post-synaptic neurons, a main mediator of synaptic excitation in the central nervous system
77
Perampanel adverse effect
aggression, hostility, irritability, and anger
78
Ezogabine MOA
binds the KCNQ voltage-gated potassium channels
79
Inhibitors of Brain Carbonic Anhydrase
Topiramate | Zonisamide
80
Known teratogens or associated with congenital malformations
Valproate phenobarbital topiramate
81
Ethosuximide adverse effects
``` Fatigue GI distress Headache Itching (and urticaria) SJS ```
82
ezogabine adverse effect
pigment discoloration
83
Levetiracetam adverse effect
personality changes
84
Tabes dorsalis effects
Dorsal columns: proprioception, vibration, ataxia | Doral roots: reflex
85
Troheryma whipplei association
endocarditis
86
Leptospira uniterrogans symptoms
meningitis hepatitis conjuntivitis acute renal failure w hematuria
87
Leptospira uniterrogans treatment
doxycycline
88
Borrelia burgdorferi serology
ELISA IgM/IgG antibody | followed by western blot
89
Nocardia can causes
parenchymal brain abscesses
90
basilar meningitis
Tb
91
cavernous sinus cranial nerves
3,4,V1,V2,6 | internal carotid artery
92
prosthetic devices meningitis
Staph epi | Staph aureus
93
cochlear implants
strep pneum
94
CSF leaks
strep pneum
95
mycotic aneurysm
staph aureus | salmonella
96
paraspinous abscess
staph aureus
97
bacterial meningitis treatment neonate normal >60
neonate: Ampicillin + Gentamicin + Cefotaxime normal: ceftriaxone + vancomycin >60: ceftriaxone + vancomycin + ampicillin
98
skin popping
clostridium
99
HSV-1 on EEG
slow, sharp spikes
100
"Ghost" or Mollaret's cells
HSV
101
CMV associations
myelitis | polyradiculopathy
102
CMV treatment
gancyclovir
103
Primary CNS lymphoma in HIV patient
solitary, ring enhancing lesion in white matter usually next to ventricle
104
HHV-6 roseola symptoms
child w high fevers, seizures, and macular-papular rash beginning at torso and spreading to the extremities
105
colorado tick fever virus (dengue fever) symptoms
saddleback/biphasic fever
106
Chikungunya virus symptoms
rash inflammatory arthritis **severe arthralgias and arthritis that can last for weeks-years
107
zika virus symptoms
conjunctivitis rash (including palms) arthralgia in pacific florida or texas
108
Measles/Rubeola causes
subacute sclerosing panencephalitis
109
Naegleria fowleri work up
check both centrifuged and non uncentrifuged CSF
110
Rhabdovirus histo
bullet shaped | negri bodies
111
Rhabdovirus encephalitic symptoms
hyperpyrexia alternating to hypothermia hydrophobia aerophobia hypersalvation
112
Rhabdovirus paralytic symptoms
mimicking guillian barre leadings to ascending paralysis
113
crypto treatment
flucytosine + amp B
114
coccidiodes treatment
fluconazole
115
aspergillus
elevated beta-D-glucan
116
mucomycosis
negative beta-D-glucan
117
eosinophilic meningits
angiostrongylus cantonensis
118
acanthomeoba
spikey
119
hippocampus controls
episodic memory and spatial maps
120
entorhinal cortex
declarative memory and memory consolidation
121
hyperphosphorylate tau
CDK5 GSK3B CRMP2
122
frontotemporal lobe dementia
aka pick disease | TDP-43
123
Neisseria meningitidis agars
Blood agar Chocolate agar Mueller-Hinton agar Thayer-Martin
124
Neisseria meningitidis associations
DIC | Waterhouse-Friderichson syndrome
125
CSF adenosine deaminase means
TB
126
Familial fatal insomnia location mutation diagnosis
location: thalamus mutation: PRNP diagnosis: thalamic hypometabolism on PET scan
127
Huntington mutation
CAG repeat in HTT gene on chromosome 4
128
Lewy body dementia location
midbrain
129
Chronic encephalopathy histo
tau protein chains that start in gray matter
130
Glutamate channels | GABA channels
Glutamate: Na+ open, K+ channels close GABA: Cl- into cell, K+ channels open
131
GABA is made how
Glucose -> alpha ketoglut -> glutamate -(GAD-B6)> GABA
132
glutamate recycle patoway
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
tyrosine pathway
diet/phenylalanine -> tyrosine -> DOPA -> dopamine -> NE -> epi
134
glutmate receptors and type
NMDA AMPA KA ionotropic (ligand gated channel)
135
NDMA
requires glycine and glutamate for activation
136
GABAa | GABAb
GABAa: inotropic (inc Cl- influx) GABAb: metabotropic (G protein, dec Ca2+ and activated K+ channels)
137
alpha1, beta | alpha 2
alpha1, beta: excititory | alpha 2: inhibitory
138
5HT3
inotropic
139
H1 | H2
H1: Gq H2: Gs
140
multiple system sclerosis def and hist
autonomic nervous system and movement dysfunction | histo: accumulation of alpha-synuclein
141
MS primary progressive
no history of attack, slow insidious progressive worsening
142
RR w secaondyr progression
slow progressing worsening after initial history of "relapsing remitting" form
143
progressive muscular atrophy
ALS with w mainly LMN involvement
144
primary lateral sclerosis
ALS w mainly UMN involvement
145
kugelberg-welnader disease
childhood/adolescents w LMN
146
bind GABAa
``` benzos barb alc etomidate propofol ```
147
subdural chronic and acute treatment
acute: 2 incision chronic: burr hole
148
encephalitis CSF
RBC present
149
concussion
rotational/angular force
150
decorticate | decerebrate
decorticate: arms flexed to chest decerebrate: arms ext to side
151
vasogenic edem
disruption of BBB
152
cervicaly myelopathy effect
arms>legs
153
nueromyelitis optica
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
Acute disseminated encephalomyelitis
one attack that leaves (not reemitting like MS)
155
Acute transverse myelitis
one attack that leaves deficits
156
rubrospinal tract
forelimbs
157
SPECT
dopamine transporter
158
Parkinson's induced by Basal gang Latrogenic
Basal gang: dec dopamine, inc Ach -abnorma SPECT Latrogenic: drug induces -normal SPECT
159
ALS prognosis
bulbar (CN) has worse prognosis than manual (extremities)
160
diffuse axonal injury
global brain injury due to high velocity deceleration | -micro/macro transaction of neurons
161
rate limiting step for tyrosine pathway
tyrosine hydroxylase | tyrosine -> DOPA
162
NE location
LC
163
watershed infarcts manifestation
paraplegia to legs
164
penumbra | ischemic core
penumbra: enough blood to keep tissue alive but electrically silent ischemic core: permanent tissue damage
165
brain infarcts acute chronic
acute: -edema -no gliosis -RBCs chronic: -no edema -hemosiderin -gliosis -liquification necrosis
166
inc subdural hematoma mortality
inc age anticoagulants unhelmeted
167
best montage for seizures
referential
168
alpha waves
8-13 hz
169
alpha rhythm
post prominent alpha waves | surpassed w eye opening
170
delta waves
<3 hz
171
absent seizure is a
generalized seizure
172
clonus
rhythmic fast flexion and slow extension
173
myoclonus
sudden movente w no rhythm
174
Kidling
focal simulation leads to continued intermittent seizures after simulation is removed
175
mirror focus def | most common location
secondary epileptic foci develop in the contralateral hemisphere homotopic area -temporal/frontal love epilepsy (occipital not likely)
176
post titanic potentiation
inc frequency of miniature excitatory post synaptic potential w no affect on amplitude
177
long term potentiation
persisting strengthening of synaptic signaling based on recent patterns of activity -long lasting gin in signaling transmission between two neurons
178
tuberous sclerosing complex
cortical tubers seizures subependymal nodules giant cel astrocytomas
179
Down syndrome most common seizure
tonic clonic
180
PKU EEG
slowing, epileptiform discharge, or hyper arrhythmic patterns
181
dravets syndrome
100s of seizures
182
epilepsy mutations commonly include
K+, Na+, Ca2+ channels
183
myoclonus epilepsy
ragged red fibers | mitochondrial dna mutation

BECOM 4 (4 decks)

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