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Undeleted > "High Yield" Stuff that I think is important but Hoppe and Esper probably think otherwise > Flashcards

"High Yield" Stuff that I think is important but Hoppe and Esper probably think otherwise Flashcards

1
Q

Focal seizures with altered mental status sx

A

Usually frontal or temporal lobe involvement with automatism and impaired memory

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2
Q

Phenytoin MOA and use

A

Na+ channel blocker, for tonic-clonic seizures, high drug-drug interaction (oral contraceptives)

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3
Q

Side effects of phenytoin

A

gingival hyperplasia, hirsutism and others

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4
Q

Carbamazepine MOA and use

A

Na+ channel blocker, for focal seizure tx, induces own metabolism (increase dose over time to compensate

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5
Q

Lamotrigine MOA and use

A

Na+ channel blocker, 3rd choice for absence seizures, can cause Steven Johnsons syndrome, rash and other side effects

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6
Q

Lacosamide MOA and use

A

Na+ channel blocker, modulates NMDA receptor, adjunct for focal seizures

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7
Q

Ethosuximid MOA and use

A

decreases threshold for Ca2+ T-type currents (closer to depolarized state), used for 1st line absence seizures

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8
Q

Valproic acid MOA and use

A

Na+ and Ca+2 T-type channel blockers, increases GABA an d for both absence and focal seizures

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9
Q

Gabapentin MOA and use

A

increases GABA in synaptic cleft, not as potent/not 1st line

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10
Q

Pregabalin MOA and use

A

decreases excitatory NT’s, affects calcitonin, more potent than gabapentin, METABOLIZED by KIDNEYS (not liver)

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11
Q

Benzodiazepine use

A

chronic inhibition of seizures

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12
Q

Clonazepam MOA and use

A

is a BZ, indirectly inhibits Ca2+ T-type so used for tx of absence seizuires, lots of side effects=4th choice for tx

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13
Q

Phenobarbital use

A

focal, tonic-clonic, and resistant seizures. CAN MAKE ABSENCE SEIZURES WORSE

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14
Q

Vigabatrin MOA and use

A

increases GABA by GABA transaminase inhibition, for infantile seizures and focal epilepsy. Side effect=VISION LOSS

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15
Q

Tiagabine MOA

A

GABA inhibitor for reuptake (increases synaptic GABA)

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16
Q

Felbamate MOA and use

A

Inhibits NMDA receptors, tx for refractory epilepsy, CAN CAUSE APLASTIC ANEMIA AND LIVER FAILURE

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17
Q

Rufinamide MOA and use

A

inhibits mGluR5 in high doses/prolongs Na+ channels, tx for focal seizures, Lennox-Gastaut, and refractory seizures

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18
Q

Drug hierarchy for tx of status epilepticus

A

lorazepam/diazepam, fosphenytoin, phenobarbital, general anesthesia (propofol/midazolam)

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19
Q

Sign of absence seizure on EEG

A

3Hz spike and wave

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20
Q

Atonic vs myoclonic seizure

A

Atonic has brief impaired consciousness, myoclonic does not

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21
Q

Simple vs complex partial seizure

A

comples has LOC, simple does not, complex also has aura and amnesia

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22
Q

Sign of partial seizure with 2nd generalization

A

eye deviation

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23
Q

Benign febrile convulsions sx/age

A

4mo to 4 years, from rapid increase in temp

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24
Q

Tx for absence seizure (1st and 2nd line)

A

ethosuxamide and valproic acid

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25
Q

Tx for juvenile myoclonic epilepsy

A

depakote

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26
Q

West syndrome sx

A

infantile spasms, severe developmental delay

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27
Q

Lennox-Gastout syndrome sx

A

multiple seizure types (intractable), developmental delay

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28
Q

Diet for tx of seizures

A

ketogenic diet

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29
Q

Cause of cerebral palsy generally

A

nonprogressive injury to the brain

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30
Q

Specific causes of cerebral palsy (3)

A

intraparenchymal hemorrhages (thalamus/caudate), periventricular leukomalacia (infarcts), multicystic encephalopathy

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31
Q

Sx of Chiari Malformation type I

A

loss of pain/temp/m. strength of upper extremities

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32
Q

Assc with Chiari malformation

A

meningomyelocele anchoring spinal cord, increased intracranial pressure

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33
Q

Pachygyria

A

broad gyri with decreased number

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34
Q

Lissencephaly

A

smooth gyri surface, failure of cell migration

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35
Q

Assc with Down’s syndrome

A

Alzheimer’s by 4th decade

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36
Q

Trisomy of chromosomes 13-15 sx

A

midline defects/holoproencephaly

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37
Q

Developmental Reflexes/disappearance (8 of them)

A

stepping at 1-2m, galant at 1-2m, grasp at 3m, moro at 3-6m, tonic neck at 3-6m, root/suck at 4-7m, babinski at 1-2 yr, parachute starts at 8-9m and stays

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38
Q

Developmental milestones/appearance (7)

A

smile/recognize parents at 2m, roll back to front at 4m, roll front to back 5m, sit/recognize stranges at 6m, walk alone/use 2 words at 12 m

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39
Q

Only neuroprotective tx for neonates

A

hypothermia

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40
Q

Tx to prevent neonatal hemorrhages

A

antenatal corticosteroids

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41
Q

Assc of cerebral palsy (common cause)

A

periventricular leukomalacia

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42
Q

Aicardi syndrome causes/sx

A

absence of corpus callosum, more in females (X chromosome defect), seen infantile spasms

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43
Q

Possible cause of ADHD

A

prenatal tobacco exposure

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44
Q

Dx of ADHD

A

in more than 1 setting, longer than 6 months, before 7 yrs, some type of impaired function

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45
Q

Tx for ADHD

A

methylphenidate/dextroamphetamine (stimulants), atomoxetine (NE reuptake inhibitor)

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46
Q

Autism sx

A

enlarged head, regression/no attainment of language

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47
Q

Rett syndrome cause (genetically) and sx

A

MECP 2 gene mutation on Xq28. See smaller head, stereotypic hand movements and dementia. More in females

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48
Q

Sx of Neurofibromatosis-1 and cause

A

scoliosis, epilepsy, eye problems. From chromosome 17

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49
Q

Cause of NF-2

A

merlin/NF2 proteins on chromosome 22

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50
Q

Sx of NF

A

cafe au lait spots, axillary freckling, neurofribromas in 2nd/3rd decade

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51
Q

Sturge Weber sx

A

port wine stain on face, cerebral calcification, seizures. Can see trolley track lines in occipital lobe

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52
Q

Tuberous sclerosis triad

A

mental retardation, adenoma sebaceum, and epilepsy

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53
Q

Cause of tuberous sclerosis

A

hamartin and tuberin genes on chromosomes 9 and 16

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54
Q

Sx of maple syrup urine disease

A

seizures, hypoglycemia, hypertonia, delicious urine

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55
Q

Sx of homocystinuria

A

multiple thromboembolic events, ectopia lentis, seizures

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56
Q

Dx of Niemann Pick Disease

A

bone marrow x with decreased sphingomyelinase in leukocytes

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57
Q

Wilson disease sx

A

degeneration of basal nuclei, cirrohosis of liver, Kaysier Fleischer rings, onset 11-25 yrs

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58
Q

Aminoesters and their metabolism

A

Cocaine, procaine, tetracaine. Via pseudocholinesterase in plasma/tissues

59
Q

Aminoamides and their metabolism

A

lidocaine, bupivacaine, prilocaine, articaine, ropivacaine, levobupivacaine. Via CYP450 in liver, excreted via urine

60
Q

When to use mepivacaine

A

with kids, causes little vasodilation so no epi needed

61
Q

When to use bupivacaine

A

long procedures

62
Q

What can epi cause with local anesthetics?

A

epi-indued hypoxia from vasoconstriction

63
Q

Serious side effect of bupivacaine

A

cardiotoxicity

64
Q

Risk of procaine (and aminoesters)

A

allergic rxn from PABA (metabolite)

65
Q

Extra effect of lidocaine

A

1b anti-arrhythmi drug for atrial fibrillation

66
Q

Use of prilocaine

A

for pts who cannot use epi (cardio pts), because it causes vasoconstriction

67
Q

Atricaine metabolism uniqueness

A

metabolized in liver and plasma

68
Q

Major toxicity of local anesthetics

A

decreased cardio conduction velocity and contractility

69
Q

Propofol use and side effects

A

For inducing anesthesia, but causes cardio/respiratory depression

70
Q

Contraindication for barbiturates and metabolism

A

porphyria. metabolized in liver

71
Q

Antidote for benzodiazepines

A

flumazenil

72
Q

Ketamine MOA, use and perk

A

NMDA inhibitor used for profound analgesia (only) with sympathetic stimulation. Causes minimal respiratory depression

73
Q

Etomidate use and perk

A

for anesthesia (no analgesia), alternate to propofol cause it causes not cardio contraction problems

74
Q

Dexmedetomidate MOA, use and side effects

A

alpha2 agonist, for short term sedation (intubation), and causes heart block/bradycardia

75
Q

N2O use and side effects

A

For analgesia/sedation, causes pneumothorax and B12 deficiency sx

76
Q

Halothane use and side effects (has lots)

A

For induction of children and maintenance of adult anesthesia. Causes malignant hyperthermia, hepatotoxicity, sensitization of catecholamines (arrhythmias)

77
Q

Enflurane use and side effects

A

for anesthesia maintenance and causes increased isoniazid metabolism, m. relaxation, seizures

78
Q

Isoflurane perk, side effects, and contraindication

A

Has no proconvulsive properties, causes airway irritation, cannot use with coronary artery disease

79
Q

Desflurane use and side effects

A

for maintenace of anesthesia, caueses airway irritation and bronchospasm

80
Q

Sevoflurane use and perk

A

For outpt anesthesia, causes no airway irritation

81
Q

Thiopental + inhaled anesthetics perk

A

skip stage 1 and 2 of anesthesia

82
Q

Use of trimethaphan

A

dissecting aortic aneurysm/HTN emergency

83
Q

Use of mecamylamine

A

adjunct to nicotine patch or electroconvulsive therapy

84
Q

Drugs interacting with NMJ nondepolarizing blockers

A

inhaled anesthetics, aminoglycosides, tetracyclins, Ca2+ channel blockers

85
Q

Metabolism of NMJ nondepolarizing blockers (+2 special cases)

A

Excreted via urine/bile. Atracurium via plasma esterase, and cisatracurium via Hoffmann degradation

86
Q

Nondepolarizing NMJ blocker to use with liver/renal failure

A

cisatracurium

87
Q

Atracurium side effect/cause

A

cardio/respiratory involvement from histamine release

88
Q

Long acting NMJ nondepolarizing blockers

A

doxacurium and pancuronium

89
Q

Contraindication of succinylcholine

A

Muscle injury

90
Q

Anticholinesterase effects on NMJ blockers

A

nondepolarizing effects are reversed, depolarizing effects are enhanced

91
Q

Drug addiction pathway

A

Mesolimbic (ventral tegmental area to nucleus accumbens)

92
Q

MOA of reward system for opioids

A

disinhibition (resulting in excitation at nucleus accumbens with DA release)

93
Q

Tx for alcohol addiction

A

Benzodiazepine taper for withdrawal

94
Q

Areas involved in cocaine/amhpetamine addiction

A

Nucleus accumbens and locus ceruleus

95
Q

Marijuana addiction MOA

A

feed forward enhances VTA stimulation

96
Q

Phencyclidine MOA

A

blocks NMDA Glut receptors

97
Q

MDMA MOA

A

increases 5HT release and blocks reuptake and synthesis

98
Q

Tx for opioid withdrawal

A

methadone/buprenorphine taper

99
Q

Tx for barbiturate withdrawal

A

phenobarbital

100
Q

What is common among all drug withdrawals?

A

Sympathetic hyperactivity

101
Q

MOA of disulfiram

A

accumulates acetylaldehyde (from EtOH), causes aversion

102
Q

Naltroxane MOA

A

opioid antagonist, only prevents “high”

103
Q

Methadone MOA

A

long acting opioid agonist, no “high” spike when taken orally

104
Q

Buprenorphine MOA

A

u-opioid partial agonist, decreases withdrawal sx and cravings

105
Q

Suboxane characteristic

A

buprenorphine and naloxone, if injected naloxone prevents high, but if taken orally get buprenorphine effect

106
Q

Varenicline MOA

A

nicotine partial agonist, contraindicated with psych pts

107
Q

Acamprosate use

A

Modulation of Glu hyperactivity in EtOH dependence

108
Q

Bupropion use and side effect

A

tx for smoking cessation but lowers seizure threshold (is an antidepressant)

109
Q

Tx for cocaine/amphetamine addiction

A

antidepressants (desipramine/fluoxetine)

110
Q

Triad of spasmus nutans

A

ocular oscillations, head nodding and torticollis

111
Q

Signs of central vertigo

A

no habituation, nystagmus may change direction, immediate or delayed nystagmus

112
Q

Signs of peripheral vertigo

A

habituation, no vertical nystagmus, delayed nystagmus

113
Q

Dix-Hillpike with peripheral disorder

A

onset 2-20s, lasts less than 1 min, fatiguability, one direction

114
Q

Dix-Hillpike with central disorder

A

no latent onset, lasts over 1 min, nonfatiguing, may change direction

115
Q

Sx of benign paroxysmal positional vertigo

A

rotatory, fatigable, transient nystagmus. from otoliths being displaced

116
Q

Vertigo sx with Meniere’s disease

A

severe and spontaneous lasting min to hrs, nausea and vomiting seen

117
Q

Vestibular neuritis vertigo sx

A

sudden and severe, lasts days to months

118
Q

Meds causing vertigo

A

antihistamines (meclizine, promethazine, dimenhydrinate), anticholinergics (scopolamine), benzo’s (diazepam)

119
Q

Sx of cardiac syncope

A

rapid onset, little posture relation, exertion causes it

120
Q

What causes convulsive syncope?

A

seizure triggered by decrease in BP

121
Q

DM mononeuropathy cause

A

occlusion of vasa nervorum or compressive injury from lack of sensation

122
Q

EEG seen with Creutzfeldt Jacob

A

bi or triphasic spike wave complexes

123
Q

Most common roots affected in DM radiculopathy

A

Thoracic roots due to sheer number. Resembles herpes zosters without the vesicles

124
Q

Sx of poylmyositis

A

elevated serium creatinine and creatine kinase, inflammation of muscles on MRI/ultrasound, ANA + in 1/3

125
Q

Sx of Lambert-Eaton syndrome

A

is paraneoplastic. proximal m. weakness that improves with use, no improvement with anticholinesterase, autonomic findings

126
Q

Sx of pseudotumor cerebri

A

elevated intracranial pressure (CSF tap over 250 mmH20)

127
Q

EtOH abuse disorders (4)

A

subacute combined degeneration (B12 deficiency), Alcoholic polyneuropathy (symmetric and distal), Marchiafava Bignami (demyelination of cc with seizures, dementia), Wernicke Korsakoff (thiamine deficiency impacting memory)

128
Q

Tx for Wernicke Encephalitis

A

thiamine before glucose

129
Q

Stages of Lyme disease

A

Bull’s eye rash (local), meningitis/carditis/neuropathy (early disseminated), persistent arthritis (late disseminated)

130
Q

Sx of Myasthenia Gravis

A

fluctuating m. weakness that is better in the morning, assc with thymoma. Pyridostigmine used to tx

131
Q

Location of cluster headaches

A

Supraorbital/temporal region. often occurs at night. Tx with sumatriptan, verapamil, Li+, methylsergide

132
Q

Tx for MS

A

solumedrol (steroid) or interferon drugs

133
Q

Side effect of all drug withdrawals (and tx)

A

all will cause hyperactivity of sympathetics. use clonidine which is an alpha2 agonist

134
Q

Contraindication of varenicline

A

It is for nicotine craving reduction, but cannot be used with psychiatric pts

135
Q

Side effect of buproprion

A

It is for smoking cessation but can cause seizures by lowering threshold

136
Q

Weak side of Lipid Theory

A

enantiomers of barbiturates, etomidate and steroids do not almost membranes/do not cause anesthesia (stereochemistry is involved somehow)

137
Q

Preoperative drugs to control emesis

A

droperidol/ dexamethasone and metoclopramide

138
Q

Adverse effect of barbiturates (thiopental/methohexital)

A

extreme vasoconstriction -> gangrene

139
Q

Use of ketamine

A

analgesia w/ sympathetic stimulation

140
Q

Side effect of etomidate

A

adrenocortical depression

141
Q

EEG of West syndrome

A

high amplitude abnormal spikes (hypsarrhythmia)

142
Q

EEG of Lennox Gastaut Syndrome

A

slow spike and wave, paroxysmal fast activity

143
Q

EEG of atonic seizure

A

low voltage, polyspike wave, electrodecrement

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