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Neuro > Exam 4 Pharmacology > Flashcards

Exam 4 Pharmacology Flashcards

1
Q

mild anxiety tx

A

SSRI > Benzo > TCAD, MAOIs

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2
Q

what is difference betwen Phase 1 and phase 2 metabolism

A

phase 1 is slow with long T1/2 that leads to daytime sedation and contraindicated in elderly.
phase 2 are fast with short t1/2 and good for elderly

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3
Q

Volatile anesthetic onset and recovery

A

slow

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4
Q

Phenobarbital action

A

faciltiates GABA-A channel opening, GABA indpendent.

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5
Q

Lamotrigine - class

A

new broad spectrum anti-epileptic that inhibits VSSC and VSCC

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6
Q

PTSD tx

A

SSRI not TCAD, MAOI, mirtazapine

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7
Q

Psuedoparkinsonism and treatment

A

ESP with traiditional antipsychotics
onset 5-90 days
Tx: anticholinergic

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8
Q

when is BZD used in overdoses?

A

CNS stimulant, hallucinogens, dissocitave anesthetics - for agitation support

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9
Q

Eszopiclone use

A

sleep maintence

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10
Q

BDZ - uses

A 
alcohol withdrawal - Chlorodiazopoxide, lorazepam
Anxiolytic for GAD, panic
Short term insomnia
parasomnia in kids
Status epileptics - Lorazepam, diazepam
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11
Q

Phenytoin uses

A

Due to side effects not first choice in partial or tonic clonic
Add on for partial and tonic clonic
IV form - fosphenytoin used for active seizure

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12
Q

Half life of Z drugs

A

longest is Eszopiclone

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13
Q

Citalopram - class

A

SSRI

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14
Q

Trazodone uses

A

Insomnia to decrease REM but increase SWS

Antidepressant

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15
Q

Mirtazapine - class

A

alpha 2 antagonist to increase NE and antagonize 5HT2 and 5TH3

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16
Q

Suvorexant

A

Sleep aid that is antagonist to Orexin R (ynthesized in latera hypothalamus) used to reduce sleep latency, increase REM and NREM sleep
Schedule IV, very expensive!

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17
Q

lamotrigine ADRs

A

similar to pheytoin but much less

Dizzy, diplopia, skin rash, SJS

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18
Q

Halothane

A

volatile anesthetic

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19
Q

DDIs of Valproate

A

inhibits metabolism of CP450

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20
Q

which antidepressants cause sedation?

A

TCADs, Trazodone, mirtazapine

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21
Q

Lithium - class

A

Antimanic - maintenance and prophylaxis

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22
Q

Potency of Haloperidol vs. Chlorpamazine

A

Haloperidol is low potency compared to chlorpromazine

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23
Q

Levitracetam - ADRs

A

somnolence, dizziness, safe in pregnancy

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24
Q

metabolsim of barbiturates

A

cyp450 inducers

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25
Q

Alcohol mechanism

A

Facilitates GABA-a CHannel and antagonizes NMDA-R to cause CNS depression
3

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26
Q

Olanzapine - class

A

Atypical antipsychotic

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27
Q

Lithium mechanism

A

unclear
Enhances 5HT and decreases DA and NE,
interefere with PIP recycling

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28
Q

Isoflurane

A

volatile anesthetic

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29
Q

What BZD are used for sleep?

A

Triazolam, flurazepam, temezapm

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30
Q

Mirtazapine Side Effects

A

NO sexual dysfunction, but weight gain, dry mouth, sedation

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31
Q

antidepresants and weight gain

A

highest with TCADs, mirtazapine, paroxetine

lowest with buproprion

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32
Q

Buprenoprhine

A

partial mu agonist

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33
Q

Ethosuximide – class

A

old broad spectrum antiepileptic that blocks T type Calcium Channel

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34
Q

Quetapine - class

A

Atypical antipsychotic

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35
Q

Benzos used as antiepileptics

A

Clonazepam (absence), diazepam (Status epilepticus)

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36
Q

Opsthontonus

A

part of acute dystonia - backward carching of neck

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37
Q

Phenelzine - class

A

MAOi -A to increase 5HT, NE, and DA by preventing degradation

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38
Q

Pharmokinetics of Phenytoin

A

zero order - small dose changes lead to toxicity

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39
Q

Oxazepam - class

A

BDZ

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40
Q

Side Effects of TCAD

A

Major: high Anticholinergic effects, also risk of overdose/death with convulsions, coma, cardiotoxicity (arrhythmia)
weight agin, sexual dysfunction, ortho hypotension, prolonged QT, sedation

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41
Q

Escitralopram - class

A

SSRI

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42
Q

Buspirone class

A

5HT partical agonst used to treat chornic anxiety - some risk of EPS

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43
Q

BDZ - short half lives

A

alprazolam, triazolam, oxazepam, mirazolam

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44
Q

BDZ - ind half lives

A

Lorazepam, temazepam

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45
Q

DA:5HT ration for atypical antipsychotics

A

low compared to typical,

Aripirazole - slightly higher than others

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46
Q

Sevoflurane

A

volatile anesthetic

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47
Q

Chlorpromazine - Class

A

1st generation antipyschoti, with extremely high DA:5HT ratio

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48
Q

Bupropion - class

A

Atypical Antidepressant by blocking Ne and DA reuptake.

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49
Q

what class of drugs has no weight gain side effects for antidepressants?

A

Bupropion

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50
Q

Fluoxetine - class

A

SSRI

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51
Q

BDZ - long half lives

A

flurazepam, diazepam, chlordiazepoxide

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52
Q

Trazodone - class

A

Mixed serotonin reuptake blocker - blocks 5HT2 R and Alpha1 AR

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53
Q

Ethosuximide uses

A

first line for absence seizures

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54
Q

Treatment of ADHD

A

Amphetamines, myethylphenidates (also TCAD, Alpha agonists, atoxmidine, bupropion)

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55
Q

what decreases alcohol consumption

A

disulfiram (anabuse), naltrexone (opioids antagonist), NMDA receptor blocker, Campral (acamprostate)

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56
Q

LSD - mechanism

A

partial agonist to 5HT 2A Rceptors

1

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57
Q

Carbamezepine - class

A

Old partial antiepileptic that works by inhibition VSSC

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58
Q

Midazolam

A

IV benzodiazpam that is used for endoscopy with other gaseous anesthetics

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59
Q

methadone

A

long acting mu agonist used for opioid disorders

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60
Q

Phase 2 stage 3 metabolism of benzos

A

conjugation, glucouronidation in kidney and intestine

Seen in oxazepam, lorazepam

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61
Q

Akathisia and treatment

A

EPS seen with traditional antipsychotics - onset 6-60 days
Inability to sit still, restlessness
Tx: anticholinergic, BB, benzos

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62
Q

which class of drugs have no sexual side effects for antidepressants?

A

Bupropion and Mirtazapine

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63
Q

Levitracetam

A

Tonic clonic, partical atonic myoclonic

add pn for absnece

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64
Q

Contraindications of Bupropion

A

Panic disorders

Eating disorders due to increase seizure risk

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65
Q

Side effects of Traditional antipsychotics

A 
Hypotension (due to alpha1 affect)
Antimuscarinic
Sedation (h1 antagonist)
Neuroepileptic syndrome
EPS
prolong QT
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66
Q

alpha 1 (GABA)

A

in cortex

sedation, bezos only for anticonvulsant. both have amnesia and CNS depression

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67
Q

Side effects of inhated anesthetcis

A

CV depression, respiratyr depression

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68
Q

Propofol use

A

induction of GA, sedation in ICU, short procedures

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69
Q

Alprazolam - class

A

BDZ

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70
Q

Use of TCAD

A

Resistant MDD or MDD with insomnia
Diabetic peripheral neuropathy
Chronic pain
Migrain Prophylaxis

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71
Q

Phase 1 - stage 1metabolism of Benzos

A

rapid! via CYP450 - oxidation in liver

seen in Chlordiazepoxide, diazepam, clorazapate, alprazolam

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72
Q

Olaxapine-Fluoxetine -class

A

treats bioplar depression

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73
Q

Propofol side effects

A

profound vasodilation - hypotension

less postop nausea than thiopental

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74
Q

Sertraline - class

A

SSRI

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75
Q

Divaloproex-sodium - class

A

anti manic

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76
Q

Bupropion use

A

MDD with hypersomnolence, smoking cessation

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77
Q

Diazepam - - class

A

bdz

78
Q

Naloxone

A

tx for opoid oversode

79
Q

what can treat manic depression?

A

lithium

olaxapine-fluoxetine

80
Q

Phenobarbital DDI

A

CYP450 inducer
contraindicated wither other depressants
schedule II drug

81
Q

Phenelzine - side effects

A

Major: hypertensive crisis with inhibitng digestion of tyramine
also associated with hypotension, anticholinergic, sexual SE, weight gain

82
Q

Treatment of Social Anxiety

A

BB, high potent BZD

83
Q

which benzo has highest anteriorgrade amnesia

A

Temazepam

84
Q

Uses of Venalfaxine

A

Depression, GAD, panic, PTSD

85
Q

Second gas effect in N2O

A

in blanced anesthesia, high volume of N2O uptake drives both gases into lung and increase than predicted for second sunstance

86
Q

Benzodiazepams addiction number

A

3

87
Q

Isoflurane Side effects

A

Less hepatotoxicity, less renal toxicity than halothane

pungent odor that cuases coughing

88
Q

BDZ mechanism

A

facilitates GABA-A by increasing frequency of opening

89
Q

Valproate class

A

old broad spectrum antiepileptic that inhibits VSSC, T type Ca Cannel, GABA activation (inhibits GABA transaminase)

90
Q

Cannabinoids - mechanism

A

agonist of CB1 to lead to disinhibiton

2

91
Q

Side Effects of Atypical Antipsychotics

A

Fewer EPS and Anticholinergic
weight gain
orthostatic hypothension
prolong QT interval

92
Q

trismus

A

part of acute dystonia - jaw spasm

93
Q

Diffusion hypoxia in N2O

A

when terminate, N20 leaves so rapidly that it dilutes O2 in alveoli

94
Q

Zaleplon - class

A

Z drug

95
Q

Vereniceline (chantix)

A

partical agonist of alpha4Beta2 NR

96
Q

Bupropion Side effects

A

NO weight gain or sexual side effects
NE - tachycardia, anxiety, insomnia
Increased seizure risk (contraindicated in eating disorders)

97
Q

Z drugs uses

A

First line for sleep agents

98
Q

naltrexone

A

opioid antagonist - used for alcohol and opioid substance abuse

99
Q

Side Effects of Venalfaxine

A

more than SSRI
Major: increased diastolic BP, increase HR,
Flu like withdrawal
Sexual dysfunction

100
Q

Halperidol ADR

A

high Extrapyramidal with low hypotensive and sedation

high Neuroepileptic Malignant syndrome and Tardive dyskinesia

101
Q

Ethosiximide ADRs

A

GI distress, HA, dissiness

102
Q

what antieleptics are anti-manic

A

Carbamazpine and valproate

103
Q

Toxicity of BZD

A

CNS depression - daytime sedation
ataxia - increased risk in elderly
anterograde amnesia (flunitrazepam - date rape)
Dependence - increase risk with high dose, regular use, abuseive hisotry
Oversode if combined with other CNS depressants - opioids, tCAD, antipsychotic, anti convulsants, anthistamines

104
Q

Risperidone - class

A

Atypical antipsychotic

105
Q

Zaleplon use

A

decrease sleep latency, does not prevent nocturnal wakenings - good for use during night wakenings

106
Q

Propofol

A

IV anesthetic that potentials Cloride current through GABA A channels

107
Q

Midazolam - class

A

BDZ

108
Q

Side effects of SSRIs

A

Sexual dysfunction (major)
weight gain
Anticholinergic
Serotonin Syndrome with MAOIs, Opioids, or St johns wort

109
Q

which benzo has highest risk of daytime sedation

A

flurazepam - especially with liver problems

110
Q

side Effects of Trazodone

A

Oversedation, orthohypotension, sexual side effects, weight gain, priapism

111
Q

alpha 2-5 (gaba)

A

in brainstem and limbic

anxiolytic, myorelaxant, leads to motor incoordiantion, tolerance, decreased REM

112
Q

phase 1 stage 2 metabolism of benzos

A

slow, but still is active

Oxidation in liver

113
Q

Phenobartibal toxicity

A

Respirtaory and CV depression
CNS depression
Tolerance and dependence is high!

114
Q

Eszopiclone -class

A

Z drug

115
Q

Thiopental

A

IV barbiturate used for periopertaive anesthesia, conscious sedation for minor procedures

116
Q

which atypical antipsychotic increased risk of agranulocytosis

A

clozapine

117
Q

N2O potency

A

low

118
Q

Aripiprazole - classification and mechanism

A

Atypical antipsychotic - partial DA agonist.

119
Q

Nicotine Mechanism

A

Agonist of N receptor to lead to excitation of DA neurons

4

120
Q

Chlorpromazine ADR

A

med/low EPS with high sedation and hypotension

Corneal deposits

121
Q

Zolpidem - class

A

Z drug

122
Q

Lamotrgine DDIs

A

valroate increases levels, estrogen decreases levels

123
Q

Neuroepileptic Malignant Syndrome

A

Risk of high dose of antipsychotics - halperidol
fever, encophalopthy, unstable vitals, increased enzyme, rigidity of muscles.
Tx: Dantrolene

124
Q

what can treat Bipolar prevention?

A

lithium

125
Q

Lorazepam - class

A

BDZ

126
Q

Serotonin Syndrome

A

hyperthermia, muscle rigidity, myoclonus, rapid changes in mental status

127
Q

Treatment of GAD

A

SSRI, SNRI over MAOI

128
Q

Valproate ADRs

A

generaly few: GI, weight gain, pancreatitis, hepatotoxiciy in those under 2, Contraindicated in pregnancy to cuse NT defects

129
Q

Concentration affect N2O

A

since most of inspired air is N2O, total pressure of other air in alveoli is less and uptake is more than predicted

130
Q

Opioid mechanism

A

u receptor agonist of GABA interneurons to lead to disinhibition
4

131
Q

Phenobarbital uses

A

sedation, antiepipletic, not antianxiety

132
Q

Venlafaxine - class

A

SNRI - increases NE and 5HT

133
Q

Amphetamines

A

Aderall and Vyvanse used for ADHD treatment

134
Q

Mirtazapine - use

A

Depression with insomnia (no change in REM and increase SWS)

135
Q

Tradive Dyskinesia and treatment

A

ESP with antipsychotics
onset 3-6 months
involuntary movement of orofacial muscles, choreathetoid movements
Tx: prevention - no real treatment.

136
Q

Topiramate

A

new drug that acts everywehre exctep TType CA Channel

137
Q

Phenelzine -use

A

atypical or nonresponstive depression and anxiety

138
Q

OCD tx

A

SSRI > antispyctoci

139
Q

MDMA mechanism

A

SERT (soem DAT, NET) reversal to releaset 5HT

?? - additicion

140
Q

Ketamine

A

IV Anesthetic by antagonism of NDMA receptor to induce anesthesia

141
Q

N20 Solubitliy

A

low (low blood:gas partition)

142
Q

Subozone

A

buprenorphine with naloxone for opioid addiction

143
Q

Phenbarbital as antiepileptic

A

used as adjunctive therapy for partial or tonic clonic

Neonatal status epilepticus

144
Q

Lamotrigine uses

A

first line for Partial, Tonic clonic, atonic myoclonic
add on for absence
Mainentence for biplar, or bipolar depression

145
Q

Topiramate

A

used as anjuct for partial seizures

146
Q

N20 Onset and recovery speed

A

Fast

147
Q

Temazepam - - class

A

BDZ

148
Q

Side effects of Halothane

A

1) repiratory depression with or without CV failure
2) heptatoxicity with repeated exposure
3) malignant hypothermia

149
Q

Torticollis

A

part of acute dystonia - wry neck

150
Q

Ketamine - mechanism

A

antagonist to NMDA receptor

1

151
Q

CLonzapine - class

A

Atypical antipsychotic

152
Q

Mechanism of 1st gen antipsychotid

A

Decrease DA in the mesolimbic pathway, with high DA R antagonist and low 5HT R antagonist.

153
Q

Haloperidol - Class

A

1st generation Antipsychotic

154
Q

Flurazepam - class

A

BDZ

155
Q

Uses of SSRIs

A

Depression, GAD, Panic, PTSD, OCD, Bulemia

156
Q

Meth mechanism

A

DAT (SERT, NET, VMAT) reversal of transporter to cause increase DA release
5

157
Q

Carbamezepine ADRs

A

Diplopia ataxia, hyponatrema, SJS, blood dyscrasias - agranulocytosis, aplastic anemia, hepatotoxic

158
Q

campral (acamprostate)

A

GABA mimic to decrease symptoms post alcohol wtihdrawal

159
Q

what treats acute alcohol withdrawal -

A

Chloradiazepoxide, lorazepam, clondine

160
Q

Lithium DDIs

A

don’t use with diuretics, NSAIDS or drugs that decrease GFR

competes with Na reabsorption (high sodium diet decreases absorption)

161
Q

what can treat acute mania?

A

Lithium
antiepileptics - carbamazapiine, valproate
Antipsychotics
Divalproex-sodium

162
Q

Phenelzine - DDIs

A

do not use with SSRIs, TCADs, st johns work - risk of serotonin syndrome
decongestant - increase risk of hypertensive crisis

163
Q

Levitracetam - class

A

New broad spectrum anti-epileptic that inhibits VSCC and GABA activation

164
Q

Acute Dystonia And treatment

A

EPS seen with traditional antipsychotics- acute onset in 1-5 days
Torticollis, trismus, opstotonus
Anticholinergic

165
Q

Phenytoin class

A

Old partial antiepiletic that inhibits VSSC; also Class 1b antiarrhythmic (zero order)

166
Q

Triazolam - class

A

BDZ

167
Q

Sevoflurorane Side effects

A

toxic to kidney due to fluroide release

Pelaant odor so less coughing than isoflurane

168
Q

Weight gain - atypical antipsychotics

A

highest in olazapine, clozapine, and quetapine

lowest in ariprazole

169
Q

Lithium Side Efects

A

Narrow Therapeutic index
Acute: GI upset
Chornic: hypothyroidism, Diabetes insipidous, oversode - coma, sexisure,
Tremor

170
Q

Divalproex

A

combined with other antieptileptics as broad spectrum antiepileptic.

171
Q

Valrpaote uses

A

First line for Tonic clonic, used for atonic myoclonic of absence
add on for partial seizure
antimanic

172
Q

sedation in atypical antiphyschotics

A

highest in quetapine and olazapine

173
Q

Volatile anesthetic potency

A

high

174
Q

which Z drug has highest rebound insomnia

A

eszopiclone

175
Q

Methylphenidates

A

Ritalin and Cocert - used for ADHD treatment

176
Q

which benzos do not use CYP450 metabolism

A

Oxazepam, lorazepam

177
Q

Cocaine mechanism

A

DAT (SERT, NET) inhibition to block reuptake

secedule 5

178
Q

Side effects of thiopental

A

rapid onset, decrease cerebral blood flow

179
Q

Flumenizil

A

antagonist to benzodiazepines to treat benzo overdose not ethanol or barb

180
Q

Pheytoin ADRs

A

nystagmus, diplopia, sedation, gingival hyperplasia, hirsutism, peripheral neuropathy, SLE-like, SJS, overdose risk

181
Q

Zolpidem use

A

Reduces latency, reduces wakenings, increase sleep time

182
Q

Uses of Carbamezepine

A

Partial, tonic clonic
drug of choice for trigeminal neuralgia
antimanic

183
Q

Gabapentin

A

Binds to VSCC to decrease glutamate release, is GABA analogue
Anti epileptic
few SE or DDIs, safe in pregnancy, treatment of resistant epilpsy.

184
Q

Amitryptiline - class

A

Tricyclic Antidepressant

185
Q

Paroxetine - class

A

SSRI

186
Q

Ramelteon

A

Sleep aid that is a Melatonin Recpetor agonist in Suprachiastmatic nuc of hypothalamus to decrease sleep latency

187
Q

Volatike anesthetic solubility

A

High blood:gas partition

188
Q

antidepressants and sexual dysfunction

A

lowest with bupropion and mirtazapine

189
Q

Acute panic Tx

A

benzo

190
Q

Potency of atypical antipsychotics

A

all high potency except Clozapine - med an quetapine - low

Neuro (5 decks)

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