Kaplan-Lecture 3 Flashcards by Jonathan Casazola

Pathological denervation of the eye will lead to?

Horner’s syndrome: oculo-sympathetic paralysis. Loss of sympathetic innervation.

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Drug that generates NO (arterial and venodilator) can cause CN toxicity?

Nitroprusside

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Sidenafil is contraindicated with?

Nitroglycerin

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What enzyme does disfulfiram inhibits?

Aldehyde dehydrogenase (it is an irreversible inhibition)

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What condition causes vertical nystagmus?

PCP and Wernickes encephalopathy , due to B1 (thiamine) deficiency.

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What do we use in order to treat methanol intoxication ?

Ethanol and Fomepizole

Fomepizole deactivates alcohol dehydrogenase while ethanol has a higher activity to the enzyme and displaces methanol.

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What are 4 major SSRIs

Fluoxetine
Paroxetine
Sertraline
Citalopram

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What is one of the MAJOR SE of SSRIs?

Sexual dysfunction: affects libido, orgasm

other SE include anxiety, agitation, bruxism (grinding of teeth), weight loss.

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What are the drugs that causes Drug-drug interaction with SSRIs?

MAOIs, TCAs, and Meperidine. It leads to serotonin syndrome which present with sweating, rigidity, myoclonus, hyperthermia, ANS instability, seizures.

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What are the TCAs drugs and MOA?

Amitriptyline / Imipramine / Clomipramine

MOA: block reuptake of NE and 5HT

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What are the uses of TCAs?

Uses: treats MD, phobic and panic anxiety states, OCD, and neuropathic pain, tx childhood nocturnal enuresis (but desmopressin is DOC).

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What are the drugs that interfere with alpha-2 agonists?

TCAs, they prevent the antihypertensive action of alpha-2 agonists.

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What are the SE of TCAs?

Coma, convulsions, and cardiotoxicity.

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What are the names of MAOIs?

What kind of diet modifications pts on this need?

Phenelzine and Tranylcypromine

Tyramine free diet, because it can cause a HTN crisis.

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what is the MOA of Mirtazapine:

Alpha-2 antagonist, weight gain. It has a drug interaction with MAOIs.

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Ebstein’s anomaly (malformed tricuspid valve) is due to a SE from?

Lithium an antidepressant / antipsychotic

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What is the action of Prochlorperazine?

It’s a DA antagonists and it is used as an antiemetic

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What drugs inhibits aromatic amino acid decarboxylase in the periphery?

Carbidopa. Hence it is given with Levodopa to increase its reabsorption into CNS and inhibit its conversion to DA in the periphery.

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What drug inhibits central and periphery COMT? why is the benefit?

Tolcapone inhibits COMT, which decreases the conversion of Levodopa to its inactive form.

What is the MAO-B inhibitor? what SE is not associated with this drug but it is with MAO-A?

Selegiline is an MAO-B inhibitor and it is not associated with HTN crisis. But it does cause insomnia and it recommended to be taken in the morning.

This drug increases DA levels in CNS.

What are some DA agonists?

Bromocriptine / Pramipexole and ropinirole.

What is the DOC for hyperprolactinemia and acromegaly?

Bromocriptine

SE: Dyskinesias and psychosis, identical to L-Dopa.

What are three extrapyramidal SE will antipsychotics cause?

How do we treat this symptoms?

Pseudo-Parkinsonism
Dystonias : torticollis , eye gyrate
Akathisia : excessive movement “pt. walk up and down the hallways, sit down (rock their bodies)

TX: antimuscarinic (Benztropine), antihistamine (Diphenhydramine).

What drug causes agranulocytosis?

Clozapine. It blocks 5-HT receptors. No tardive diskenisia. Sialorrhea (hypersalivation)

What drugs are good for complex and tonic-clonic seizures?

Valproic Acid Phenytoin Carbamazepine Lamotrigine

What drugs are good for complex , absence, and tonic-clonic seizures?

Valproic Acid, only drug that is good for all 3 types of seizures

What is the MOA of phenytoin?

Blocks axonal Na channels in inactivates state, preventing seizure propagation.

What is the anticonvulsant causes Gingival hyperplasia? What's the other Ca channel blocker that does this too?

Phenytoin and Nifedipine

A 29 year woman comes to the physician because she has recently become pregnant even though she is taking an anti-contraceptive pill. What anticonvulsant drug is she taking?

Carbamazepine: it has an identical MOA as phenytoin, it blocks axonal Na channel in inactivated state. SE: Induces, P450

What is carbamazepine used for?

Seizures, trigeminal neuralgia and bipolar disorder.

What is the preferred antiepilieptic drug for treating bipolar disorder?

Valproic acid , as it is more effective as treating the different presentation of bilpolar disorder, more than Li. It is a broad-spectrum AED, it is also used for migraine prophylaxis.

A 30year just gave birth to an infant with spina bifida, what kind of AED was she taking?

Valproic Acid, it is teratogenic Other SE: hepatoxicity and pancretitis.

What is Topiramate used for?

Migraine prophylaxis, It blocks Na channels and glutamate receptor and enhances GABA activity. Used in people > 2 years old.

What's going to happen to MAC if the lipid solubility of a drug increases?

MAC value lowers, indicating it is a very potent drug. = Greater potency.

What is pure opiod, mu-agonist?

Fentanyl used as a patch for indunction and maintenance of anesthesia. SE: decreases respiration.

What is the NMDA antagonist that can cause emergent delirium (vivid dreams, hallucinations) as SE during recovery.

Ketamine, used for induction of anesthetics. Typically used on pediatric patients rather than adults as they don't experience emergent delirium.

What drug do we co-administer with local anesthetics and why?

Coadministration of alpha-1 agonist. Decrease local anesthetic absorption into the systemic circulation, prolong effects and decrease toxicity.

Pt. presents with post-op myalgia, what was the pt. administered?

Succinylcholine. Phase I: Depolarization --- fasciculations---prolong depolarization---flaccid paralysis. Phase II: desensitization

What drug works through GABA-B receptor and what channels does it open?

Baclofen is a GABA-B agonist and open K+ channels.

Do opiods raise pain tolerance or pain threshold?

They raise pain tolerance, and decrease perception and reaction to pain.

Pinpoint pupils (non-reactive) and depressed respiration, most likely signifies abuse of what type of drugs?

Opioid abuse

What's the only opioid that possesses M blocking activity?

Meperidine, no change in pupil size.

How does morphine gets excreted?

Glucuronidation , Used with caution in pts. with renal dysfunction.

What drug will lead to serotonin syndrome and seizures

Meperidine. Metabolized by CYP-450 to normeperidine, a serotonin reuptake inhibitor; normeperidine may cause serotonin syndrome and seizures

What drug blocks the reinforcement effects of alcohol?

Naltrexone: PO, decrease craving for alcohol and used in opiate addiction.