Mehlman pharm cyclobenz/benz/diphenhydr/dantrolene

Question 1

Cyclobenzaprine. mechanism?

Answer 1

Structurally similar to TCAs; helps modulate pain sensation at brain stem.

Question 2

Cyclobenzaprine. indication?

Answer 2

Muscle relaxant used for spasms

Question 3

Structurally similar to TCAs; helps modulate pain sensation at brain stem?

Answer 3

Cyclobenzaprine

Question 4

Benztropine. mechanism?

Answer 4

Muscarinic (cholinergic) receptor antagonist.

Question 5

Muscarinic (cholinergic) receptor antagonist?

Answer 5

Benztropine.

Question 6

Used to treat acute dystonia due to anti-psychotics?

Answer 6

Benztropine.

Question 7

Benztropine. indication?

Answer 7

Used to treat acute dystonia due to anti-psychotics.

Question 8

what is dystonia?

Answer 8

Dystonia is a brain condition that causes uncontrollable muscle movements.

Question 9

Q:If patient starts antpsychotic and then gets stiff neck, oculogyric crisis (abnormal eye movements), or muscle rigidity WITHOUT fever, the answer = Tx?

Answer 9

benztropine

Question 10

Diphenhydramine /
Chlorpheniramine. group?

Answer 10

First-generation histamine-1 (H1) antagonists.

Question 11

First-generation histamine-1 (H1) antagonists.?

Answer 11

Diphenhydramine /
Chlorpheniramine.

Question 12

Diphenhydramine /
Chlorpheniramine.

Diphenhydramine is quite possibly the highest-yield drug on USMLE.

Answer 12

.

Question 13

Diphenhydramine /
Chlorpheniramine.
used when?2

Answer 13

acute dystonia, similar to benztropine, as well as motion sickness

Question 14

Diphenhydramine /
Chlorpheniramine.

what side effects?

Answer 14

nasty anti-cholinergic
(anti-muscarinic) side-effects.

Question 15

acute dystonia, similar to benztropine, as well as motion sickness?

Answer 15

Diphenhydramine /
Chlorpheniramine.

Question 16

Diphenhydramine /
Chlorpheniramine.

anticholinergic side effects are good when we want to treat what?

Answer 16

acute dystonia

Question 17

Diphenhydramine /
Chlorpheniramine.

Psych Qs will either list benztropine or diphenhydramine (or chlorpheniramine) as the answer, but not both at the same
time.

Answer 17

.

Question 18

Diphenhydramine /
Chlorpheniramine.

For whatever reason, anti-cholinergic effects treat motion sickness.

what very specific drug used for motion sickness?

Answer 18

Scopolamine
is an anti-cholinergic used to treat motion sickness classically.

Question 19

Diphenhydramine /
Chlorpheniramine.

I’ve seen NBME ask diphenhydramine straight-up for this (motion sickness) as well – i.e., the nasty anti-cholinergic side-effects are, once again, a good thing if the aim is Tx of motion sickness.

Answer 19

.

Question 20

Diphenhydramine /
Chlorpheniramine.

1st-gen H1 blockers can cause what dysfunction and what other symptom?

Answer 20

1st-gen H1 blockers can cause cognitive dysfunction (delirium, as well as worsening of dementia) and drowsiness

Question 21

Diphenhydramine /
Chlorpheniramine.

in what patients to avoid and why?

Answer 21

avoid in elderly and
locomotive/machine operators if at all possible.

cause cognitive dysfunction (delirium, as well as worsening of dementia) and drowsiness

Question 22

Diphenhydramine /
Chlorpheniramine.

1st-gen H1 blockers can also ……?

Answer 22

cause anti-a1 adrenergic effects (orthostatic
hypotension)

Question 23

Dantrolene. mechanism?

Answer 23

block ryanodine Ca2+ channel.

Question 24

block ryanodine Ca2+ channel?

Answer 24

Dantrolene.

Question 25

Dantrolene. Tx for what?2

Answer 25

for neuroleptic malignant syndrome (NMS) and malignant hyperthermia (MH).

Question 26

Dantrolene.

NBME will sometimes give vignette of NMS or MH, and then the answer for Tx is mentioned mechanism of drug.

Answer 26

Blocks ryanodine Ca2+ channel/decreases sarcoplasmic calcium release.

Question 27

If patient gets muscle rigidity and fever following commencement of antipsychotic, or following administration of succinylcholine during surgery, Tx?

Answer 27

Dantrolene.

Question 28

In NMS and MH, the ryanodine channel, which allows calcium to move from the sarcoplasmic reticulum into the cytosol, gets stuck open, so high amounts of calcium moves into the cytoplasm. The cell then needs to use a lot of ATP to pump the calcium back into the sarcoplasmic reticulum. This generates heat -> fever.
Dantrolene closes this channel.

Answer 28

.