Kaplan Flashcards
DA antagonist and agonist causes what in nigrostriatal pathway?
bradykinesia (Parkinson like)/hyperkinesia
Drug that increase DA in mesolimbic and mesocortical tract would?
Increase reinforcement/psychosis (side effect of DA drugs)
DA antagonist in tuberoinfundibular pathway causes?
gynecomastia/amenorrhea and galactorrhea
DA antagonist can be used for ___ during chemo and radio therapy
antiemetic
DA agonist can also causes weight gain or lost?
Weight lost
D1/D2 receptor are __ coupled receptors?
Gs/Gi
Where are D2A and D2C found in the brain?
nigrostriatal and mesolimbic
What is the reason behind cogwheel rigidity and resting tremor in Parkinson’s pts?
Increase ACh on muscarinic receptors
What is the transmitter imbalance in Parkinson’s?
Decrease DA and increase ACh
In nigrostriatal pathway, DA binds to __ receptor on the GABA neuron to inhibit GABA and start movement?
D2A receptor
In nigrostriatal pathway, ___ bind to GABA neuron to promote GABA and inhibit movement?
ACh binds to muscarinic receptor
What are the 4 ways to treat Parkinson’s at the nigrostriatal level?
L-DOPA (increase DA)/D2 agonist/inhibit MAO-B (selegiline)/Muscarinic blocker
Levodopa is converted to DA by?
AAAD
Is carbidopa a competitive or noncompetitive inhibitor of AAAD in periphery?
Non-competitive
Why do we use levodopa with other drugs?
Levodopa causes on and off dyskinesia—>use with other drugs to reduce the fluctuation of DA in CNS
Tolcapone is highly?
Hepatotoxic
COMT metabolizes DA and L-DOPA to partial agonists which ___ during ___? and why tolcapone and entacapone are used?
Blocks DA from binding to receptor when there are high level of DA/these drugs block COMT therefore prevent partial agonists from forming
Selegiline is metabolized into ___ and causes ___?
Amphetamine (stimulant) and causes insomnia
Pramipexole and ropinerole are also ___?
Antioxidant (key in Parkinson’s disease)
What drug causes livedo recticularis (lace like rash)?
Amantidine
What kind of drugs do you use to treat EPS?
Antimuscarinic
What is acute and chronic EPS?
acute: pesudoparkinsonism/dystonia/dyskinesia/akathisia (I like to move it move it, I like to move it move it…)
chronic: tardive dyskinesia
How does tardive dyskinesia happen?
Chronic using of D2 blocking antipsychotic drugs—->upregulation of D2 receptor—>hyperkientic (similar to Hungtinton’s)
DA antagonist would worsen ___ symptoms of schizo pt and also cause increase ___ that cause ___ in male and ___ in female?
worsen - symptoms (decrease DA)/increase prolactin/gynecomastia in male and amenorrhea and galactorrhea in female
Antipsychotic drugs (both 1st and 2nd gen) besides block D2, what else do they block?
Muscarinic and alpha
What cause neuroleptic malignant syndrome? and what do you give pt for that?
Caused by antipsychotic drugs such as haloperidol/give pt bromocriptine
What caused neuroleptic malignant syndrome?
DA antagonist of antipsychotic drugs interrupt temp control in the brain cause fever and muscle rigidity (from antimuscarinic affect)
Clozapine (SGA) blocks D2_ and __ that results in___?
D2C (in mesolimbic system)—>no tardive dyskinesia/5HT—>improve negative symptoms
All antipsychotic drugs causes weight __?
gain
90% of 5HT is in ___ system and block 5HT results in __?
digestion system/increase salivation (side effect of clozapine)
SGA has __ EPS symptoms only ___ gives agranulocytosis?
little EPS symptoms/clozapine
Aripiprazole is a ___ blocker but also a partial ___ agonis results in?
DA blocker and also a partial D2/3 agonist—>not as potent as DA blocker
The goal of antidepressant is to increase ___ and ___?
NE and 5HT
Antidepressant can causes high NE and 5HT which are called?
HTN crisis/serotonin syndrome
Do we still use MAOi and TCA?
Not really due to their side effects, mainly SSRI now
What else do we use amitriptyline for besides depression?
Neuropathic pain
What do we use for enuresis that also treats depression?
Imipramine
What are 2 side effect of TCA?
Antimuscarinic and alpha blockade
What to give with SSRI in the beginning to prevent anxiety and further suicide?
Alprazolam (a benzodiazepine)
SSRI has the side effect of ?
Serotonin syndrome/bruxism and anorgasmia/weight loss
Venlafaxine is like TCA but?
It does not have antimuscarinic and alpha blockade
What is the only antidepressant that causes weight gain and often used for anorexia?
Mirtazapine
Diuretics would ___ Li clearance hence ___ Li level
decrease clearance and increase Li level
What congenital defect can Li cause?
Ebstein’s anomaly (downward displacement of tricuspid valve)
Stimulant drugs like methylphenidate and amphetamine for ADHD should not be stopped abruptly because?
It may produce severe depression—>suicide
Cocaine block reuptake of ? and __ channel blocker as well?
NE/5HT/DA and Ca channel blocker (local anesthetic)
Increase 5HT in cocaine abuser might cause?
Aggressiveness
Difference between benzodiazepine and barbiturate?
Benzo is GABA agonist/barb prolong GABA
benzodiazepine and barbiturate both are CNS ___?
depressant
What does BZ1 and BZ2 of benzodiazepine mediate?
BZ1: sedation/BZ2: cognitive impairment
Benzodiazepine toxicity can be reversed by?
Flumazenil
What are the 3 opioid receptors and which one is the most potent?
mu/kappa/delta—>mu is the most potent one
Which area within the limbic system that is associated with DA and addition?
Nucleus accumbens
Which two drugs are life threatening if withdrawal?
Barbiturate and ethanol
What is MDMA?
Amphetamine like/hallucinogenic/ppl died of dehydration during RAVE parties
Only __ form of inhaled anesthetics (gas inhalation) is active and they go to ___ first rapidly and redistribute to __ that can go back to the blood and ___?
Free form/CNS/fat/CNS
The more ___ the anesthetic, the ___ MAC and the greater the potency
Lipid soluble/lower
MAC is lower in ___ population and with ___ kind of drug?
Elderly/opiate
___ blood gas ratio drugs has fast onset and recovery
Lower
What are the 2 side effects of N2O?
Diffusional hypoxia/spontaneous abortion
Halothane and the newer agents (-flurane) also succinylcholine can cause
Malignant hyperthermia
Sensitivity of nerve fibers to local anesthetics in descending order
(smaller diameter fiber response first) B and C >A delta
What to give with local anesthetics to prevent systemic effect?
Alpha 1 agonist—>prolonged effects
What does tetradotoxin TTX work on?
It blocks Na channel (from puffer fish)
How many molecule of NMB is needed to block Nm?
Just 1
What is the progression for NMB?
Face—>limbs–>respiratory muscles
What is the angle in open and closed angle glaucoma?
Angle between iris and cornea
Is open angle glaucoma chronic or acute?is it painful or painless? and what does it caused by?
Chronic/painless/decrease reabsorption of aqueous humor
Where is the aqueous humor produced and drained?
Ciliary body (beta 1 receptor)/through the tribecular meshwork in the angle
What does closed angle glaucoma lead to?and it is chronic or acute?
It leads to the obstruction of canal of Schlemm/it can be both chronic and acute
What is use dependence of anesthetics?
Use-dependence relates to the fact that more drug binds to the sodium channel protein
when the fiber fires at a faster rate.
All local anesthetics are ___ molecule
Amphipathic
Gabapentin undergoes ___ clearance unlike all the other anti seizure drugs?
Renal
Gabapentin can also treat ___?
Neuropathic pain
Opioid causes broncho__?
Constriction
Which alcohol compound form crystal?
Ethylene glycol
SSRI and TCA takes how long to work?
8 weeks
Benzo has a slow or fast onset?
Fast
Which benzo does not have active metabolites?
Lorazepam
What therapy works the fastest for antidepressant?
ECT
High LI causes what dysfunction?
Renal
Major side effect of SSRI?
Sexual dysfunction?
Only injectable drug for migraine? IV?
Sumotriptan/DHE
What is Baclofen?
GABAb agonist—>antispaticity
What is the Henry’s law equation?
Partial pressure = concentration/solubility
What drug do you give before giving general anesthesia?
Benzo
What brain part does general anesthesia target to cause LOS?
Thalamus
MAC means to prevent ___?
Movement—>immobility
Which anesthesia causes dissociative anesthesia?
Ketamine
What brain part does general anesthesia target to cause immobility?
Spinal cord
ACh comes from what part of the brain?
Nucleus of maynert
What drug to give if the Parkinson’s pt is young and has mild disease? what about mild and older pt?
Anticholinergic/amantidine
What is the concern of L-dopa drug for Parkinson?
Delay it as long as possible, only use it for severe disease under 65
Most important of determining the type of headache is ?
Time course
Jaw pain and visual symptoms with headache indicate?
Temporal arteritis
Concern regarding treating migraine?
Only use NSAIDs first
What is the proprolaxysis guidline for migrain headache?
more than 2 headaches per month and less than 8
