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Neurology- First Aid > Neural pharmacology > Flashcards

Neural pharmacology Flashcards

1
Q

how does epinephrine treat glaucoma

A

decreases aqueous humor production via vasoconstriction

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2
Q

name an alpha 2 agonist that treats glaucoma

A

brimonidine

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3
Q

what are the side effects of using epinephrine to treat glaucoma

A

mydriasis (so do not use in close-angle glaucoma)

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4
Q

what are the side effects of brimonidine

A

ocular allergic reactions and blurry vision

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5
Q

what beta blockers are used to treat glaucoma

A

timolol, betaxolol, and carteolol

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6
Q

how does acetazolamide treat glaucoma

A

decreases aqueous humor by inhibiting carbonic anhydrase

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7
Q

which direct cholinomimetics treat glaucoma and what are their side effects

A

pilocarpine and carbachol;

side effects= miosis and cyclospasm (from contraction of the ciliary muscle)

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8
Q

how do direct cholinomimetics treat glaucoma

A

increase aqueous humor outflow by contracting ciliary muscle and opening of trabecular meshwork

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9
Q

name two indirect cholinomimetics that treat glaucoma

A

physostigmine and echotiophate

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10
Q

how do indirect cholinomimetics treat glaucoma

A

open trabecular meshwork to absorb aqueous humor

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11
Q

what prostaglandin is used to treat glaucoma and how does it work

A

latanoprost (PGF-2alpha); works by increasing outflow of aqueous humor

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12
Q

what is the side effect of latanoprost

A

darkening of the iris

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13
Q

list as many opioid analgesics as you can

A

morphine, fetanyl, codeine, loperamide, methadone, meperidine, dextromethorphan, diphenoxylate

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14
Q

by what mechanism do opioid analgesics work

A

they bind and stimulate opioid receptors (mu, delta and kappa) in order to open K+ channels and close Ca2+ channels —> decreased synaptic transmission —> inhibits release of ACh, serotonin, NE, glutamate and substance P (a neuromodulator)

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15
Q

what are opioid analgesics used for

A

pain, cough suppression (dextromethorphan), diarrhea (loperamide and diphenoxylate), acute pulmonary edema, maintenance programs for heroin addicts (methadone)

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16
Q

what are the side effects of opioid analgesics

A

addiction, respiratory depression, constipation, miosis, additive CNS depression with other drugs;

Note: tolerance does not develop to miosis and constipation

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17
Q

what is the antidote for opioid analgesics

A

naloxone or naltrexone (opioid receptor antagonists)

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18
Q

name the three opioid receptors and what they respond to

A 
mu-opioid = morphine
delta= enkephalin (regulates nociception by inhibiting pain)
kappa= dynorphin (another pain modulator)
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19
Q

what two receptors does butorphanol act on and with what relative efficacy

A

butorphanol is a kappa full agonist and mu partial agonist

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20
Q

what is butorphanol used for and what makes it better than the alternative choices

A 
severe pain (headaches, labor)
less respiratory depression
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21
Q

what are the toxicities of butorphanol

A

withdrawl if taken with a full opioid agonist; not easily reversed with naloxone

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22
Q

what does tramadol treat and how does it work

A

tramadol treats chronic pain;

works as a weak opioid agonist and also as a reuptake inhibitor for 5-HT and NE.

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23
Q

what are the toxicities of tramadol

A

decreases seizure threshold and can cause serotonin syndrome

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24
Q

list all the epilepsy drugs

A

“ECG TTVV LLPP Benzos”:
ethosuximide, carbamazepine, gabapentin, topiramate, tiagabine, valproic acid, vigabatrin, lamotrigine, levetiracetam, phenytoin, phenobarbitol, benzodiazepines (diazepam and lorazepam)

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25
what kind of seizure is ethosuximide used for and how does it work
absence; ethosuximide blocks thalamic T-type Calcium channels
26
what are the side effects of ethosuximide
EFGHIJ: Ethosuximide causes Fatigue, Gastrointestinal upset, Headache, Itching (urticaria), and steven-Johnson syndrome
27
what kind of seizure are benzodiazepines used for and how do they work
status epilepticus; they work by increasing GABA-A action
28
what are the side effects of benzodiazepines
sedation, dependence, tolerance, respiratory depression
29
what is first line treatment for ecclampsia seizure? second line treatment?
1st line= MgSO4 | 2nd line= benzodiazepines
30
what kinds of seizure does phenytoin treat
simple and complex 1st line for tonic-clonic prophylaxis for status epilepticus
31
how does phenytoin work
sodium channel inactivation
32
what ind of kinetics does phenytoin exhibit
zero-order
33
what are the side effects of phenytoin
face: nystagmus, ataxia, diplopia, hirsutism, gingival hyperplasia systemic: megaloblastic anemia, teratogenesis (fetal hydantoin syndrome), SLE-like syndrome, induction of CYP-450, LAD skin/bone: osteopenia, Steven-Johnson syndrome
34
how is phenytoin given parenterally
fosphenytoin
35
for what 3 kinds of seizures is carbamazepine 1st line therapy
simple partial, complex partial, and tonic-clonic
36
how does carbamazepine work
sodium channel inactivation
37
what are the side effects of carbamazepine
diplopia, ataxia, blood dyscrasias (such as agranulocytosis and aplastic anemia), hepatotoxicity, teratogenesis, induction of CYP-450, SIADH, Stevens-Johnson syndrome
38
what is valproic acid used for
1st line for simple partial, complex partial and absence | 1st line acute treatment for: tonic-clonic seizures
39
what 3 drugs are used as 1st line acute therapy for tonic-clonic seizures
phenytoin, carbamazepine and valproic acid
40
what drug is 1st line treatment for trigeminal neuralgia
carbamazepine
41
how does valproic acid work
sodium channel inactivation; | inhibiting GABA transaminase in order to increase GABA concentration
42
what are the toxicities of valproic acid
GI upset, hepatotoxicity, spina bifida in fetus (contraindicated in pregnancy), tremor, weight gain
43
what are the other uses of valproic acid
myoclonic seizures and bipolar disorder
44
what kinds of seizures does gabapentin treat
simple, complex and tonic-clonic
45
how does gabapentin work
inhibits high-voltage Ca2+ channels; GABA analog
46
what are the non-epileptic conditions that gabapentin is used for
peripheral neuropathy, postherpetic neuralgia, migraine prophylaxis, bipolar disorder
47
what kind of seizure does phenobarbitol treat
simple, complex and tonic-clonic
48
how do barbituates work
facilitate GABA-A action by increasing duration that Cl- channel is open, thereby decreasing neuron firing
49
how do lamotrigine and topiramate work
block Na+ channels
50
what drugs treat simple, complex and tonic-clonic seizures
``` phenytoin (1st line tonic-clonic) carbamazepine (1st line for all three) gabapentin phenobarbital topiramate levetiracetam lamotrigine (plus absence) ```
51
what drugs treat only simple and complex seizures and how do they work
tiagabine and vigabatrin; | they work by increasing GABA levels
52
what is Steven Johnson syndrome
prodrome of malaise and fever followed by erythematous, purpuric macules (oral, ocular and genital) that become necrotic and slough off
53
for what condition are barbituates contraindicated
porphyria
54
what are barbituates used for
sedative for anxiety, seizures, insomnia, induction of anesthesia (thiopental)
55
what are the side effects of barbituates
cardiac and respiratory depression, CNS depression, dependence, drug interactions (induces CYP-450)
56
name as many benzodiazepines as possible
lorazepam, diazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, alprazolam
57
how do benzodiazepines work
they increase the frequency of Cl- channel opening
58
what are benzodiazepines used for
anxiety, spasticity, status epilepticus, alcohol detox, night terrors, sleepwalking, general anesthesia, insomnia
59
which is safer for your airway: barbituates or benzodiazepines
benzodiazepines
60
what are the side effects of benzodiazepine
dependence, additive CNS depression with alcohol
61
what drug is used to treat benzo overdose
flumazenil (competitive antagonist at GABA benzodiazepine receptor)
62
name three nonbenzodiazepine hypnotics
zolpidem (ambien), zaleplon, eszopiclone
63
how do nonbenzodiazepine hypnotics work and how are they reversed
act on the BZ1 subtype GABA receptor; | reversed by flumazenil
64
what is minimal alveolar concentration
concentration at which 50% of patients will move in response to noxious stimuli
65
name as many inhales anesthetics as you can
halothane, isoflurane, enflurane, sevoflurane, methoxyflurane, nitrous oxide
66
what are the effects of inhaled anesthetics
myocardial and respiratory depression, N/V, decreased cerebral metabolic demand
67
list all of the intravenous anesthetics
barbituates, benzodiazepines, arylcyclohexamines (ketamine), opioids, propofol, etomidate
68
what's the mechanism of action of ketamine
NMDA receptor blocker
69
what are the side effects of ketamine
cardiovascular stimulant, causes disorientation, hallucination and bad dreams as well as increased cerebral blood flow
70
name the ester and amine local anesthetics
ester- procaine, cocaine, tetracaine | amines- lidocane, mepivacane, bupivacane
71
how do local anesthetics work
bind and inhibit activated Na+ channels
72
what's the order of sensory loss with local anesthetics
(1) pain, (2) temperature, (3) touch, (4) pressure
73
how does dantrolene work and what is it used for
blocks Ca2+ release from sarcoplasmic reticulum; | used for malignant hyperthermia
74
name the depolarizing and non-depolarizing neuromuscular blockers
depolarizing (strong AChR agonist)= succinylcholine non-depolarizing (AChR antagonist)= tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, rocuronium
75
name the five kinds of drugs that treat Parkinson's
``` BALSA: bromocriptine (not really used in practice anymore) amantadine l-dopa with carbidopa selegiline antimuscarinic (benztropine) ```
76
how does selegiline work
inhibits MAO-B
77
what drugs are used to treat Alzheimer's disease
memantine (NMDA receptor antagonist) donepezil, rivastigmine, galantamine (AChE inhibitors)
78
what drugs are used to treat Huntington's disease
tetrabenazine and reserpine (VMAT inhibitors) haloperidol (dopamine receptor antagonist)
79
how does sumatriptan work and what is it used for
5HT agonist; blocks vasoactive peptide release in order to vasoconstrict used for cluster headaches and acute migranes
80
what toxicity is associated with sumatriptan
coronary vasospasm, mild tingling

Neurology- First Aid (7 decks)

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