Neuro 2 USMLE Flashcards by Mani Yavi

In a LMN lesion of CN XII the tongue will deviate _____ (away or towards) the side of the lesion?

towards

mneu: lick your wounds

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In a CN V motor lesion the jaw deviates ______ (towards or away) the side of the lesion

towards

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in a CN X lesion the uvula will deviate _______ (towards or away) of the side of the lesion.

away

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In a unilateral lesion of the cerebellum the pt tends to fall _______ (towards or away) the side of the lesion.

towards

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In a CN XI lesion there is weakness turning head to the side _________ (ipsi or contralateral) to the lesion. There is also a shoulder droop (ipsi or contralateral) to the lesion

contralateral

ipsilateral

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pt presents with paralysis of the lower half his face only. What do you suspect.

contralateral UMN lesion

either of motor cortex or connection between cortex and facial nucleus

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pt presents with paralysis of one side of his entire face (upper and lower). What do you suspect?

ipsilater LMN lesion of CN VII

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This disorder is due to a destruction of the facial nucleus itself or it’s brancchial efferent fibers (facial nn). It results in ipsilateral facial paralysis with an inability to close the eye of the involved side. It is often idiopathic and there is gradual recovery in most cases

Bell’s palsy

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Give some diseases in which Bell’s palsy is often seen as a complicaion.

Aids, Lyme dz, Sarcoidosis, Tumors, Diabetes

mneu: ALexander BELL with STD: AIDS, Lyme, Sarcoid, Tumors, Diabetes

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This herniation syndrome can compress the anterior cerebral aa

Cingulate herniation under falx cerebri

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These 3 herniation syndrome can result in coma and death if brain stem is compressed.

1) downward transtentoral (central herniation
2) Uncal herniation (Uncus=medial temporal lobe)
3) Cerebellar tonsillar herniation into the foramen magnum

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In the case of an uncal herniation you may see ipsilateral dilated pupil/ptosis. This is due to what?

Stretching of CN III

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In the case of an uncal herniation you may see contralateral homonymous hemianopia. This is due to what?

compression of ipsilateral posterior cerebral aa

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In the case of an uncal herniation you may see ipsilateral paresis. This is due to what?

compression of contralateral crus cerebri (Kernohan’s notch)

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In the case of an uncal herniation you may see Duret hemorrhages (paramedian artery rupture). This is due to

caudal displacement of the brain stem

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Pt can’t see at all out of his right eye (right anopia) Where is the lesion?

Right optic nn

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Pts has bilateral temporal visual field defects (bitemporal hemianopia) Where is the lesion?

Optic chiasm

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Pt can’t see the left visual field in either eye (Left homonymous hemianopia) Where is the lesion?

Right Optic Tract

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Pt has Left upper quadratic anopsia (cant see up and to the right on both sides) Where is the lesion?

Right Temporal Lesion (Meyer’s loop)

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Pt has left lower quandrantic anopia (can’t see down and to the left in either eye) Where is the lesion?

Right Parietal lesion

Dorsal optic radiation

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Pt has left hemianopia with macular sparing??

???visual cortex??

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this syndrome is seen in many patients with multiple sclerosis. It results in medial rectus palsy on attempted lateral gaze & nystagmus in the abducting eye. Convergence is normal.

Internuclear opthalmoplegia (MLF syndrome)

mneu: MLF=MS

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explain the pathology of Internuclear opthalmoplegia (Medial longitudinal fasciculus [MLF] syndrome)[pic]

When looking left, the left nucleus of CN VI fires, which contracts the left lateral rectus and stimulates the contralateral (right) nucleus of CN III via the right MLF to contract the right medial rectus. Lesion in the MLF interrupts this process.

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give the dz indicated by the following neurotransmitter changes:
↑NE,↓GABA,↓5HT

Anxiety

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give the dz indicated by the following neurotransmitter changes: ↓NE & ↓5HT

depression

give the dz indicated by the following neurotransmitter changes: ↓ACh

Alzheimer's dementia

give the dz indicated by the following neurotransmitter changes: ↓GABA,↓ACh

Huntington's dz

give the dz indicated by the following neurotransmitter changes: ↑Dopamine

Schizophrenia

give the dz indicated by the following neurotransmitter changes: ↓ Dopamine

Parkinson's dz

When a person becomes disoriented they generally lose concept of person(their name, who they are), place (where they are), and time. In what order does this loss usually occur?

1st-time 2nd-place last-person

what is anosognosia?

unawareness that one is ill

what is autotopagnosia

inability to locate one's own body parts

what is depersonalization

body seems unreal or dissociated

what is ANTEROgrade amnesia?

inability to remember things that occurred afte a CNS insult mneu: antero=after

what is RETROgrade amnesia?

inability to remember things that occurred before a CNS insult mneu: retro=before

what is substance dependance?

maladaptive pattern of substance use defined as 3 or more of the follwing signs in 1 yr: 1)tolerance 2)withrawal 3)substance taken in larger amounts or over longer period of time than desired 4) persistant desire or attempts to cut down 5) significant energy spent obtaining, using, or recovering from substance 6 Important social, occupational, or recreational activities reduced because of substance use 7) continued use in spite of knowing the problems it causes

What is substance abuse

maladaptive pattern leading to clinically significant imparment or distress. Symptoms have not met criteria for substance dependance. 1 or more of the follwing in 1 yr: 1) recurrent use resulting in failure to fulfill major obligations at work, school, or home 2) recurrent use in physically hazardous situations 3) recurrent substance-related legal problems 4) Continued use in spite of problems caused by use

intoxication of this drug results in disinhibition, emotional lability, slurred speech, ataxia, coma, blackouts.

alcohol

gamma glutamyltransferase (GGT) is a sensitive indicator of this drugs use

alcohol

withdrawal from this drug results in tremor tachycardia, hypertension, malaise, nausea, seizures, delerium tremens (DTs), tremulousness, agitation, hallucinations

alcohol

intoxication of this substance results in CNS depression, nausea and vomiting, constipation, pupillary constriction (pinpoint pupils), seizures *overdose is life threatening

opiods

withdrawal from this substance results in anxiety, insomnia, anorexia, sweating, dilated pupils, piloerection (goose pimples), fever, rhinorrhea, nausea, stomach cramps, diarrhea ("flulike" symptoms), yawning

opiods

intoxication of this substance results in psychomotor agitation, impared judgement, pupillary dilation, hypertension, tachycardia, euphoria, prolonged wakefulness and attention, cardiac arrhythmias, delusions, hallucinations, fever

amphetamines

withdrawal from this substance results in post use "crash", including depression, lethargy, headache, stomach cramps, hunger, hypersomnolence

amphetamines

intoxication of with this substance results in euphoria, psychomotor agitation, impared judgement, tachycardia, pupillary dilation, hypertension, hallucinations (including tactile), paranoid ideations, angina, sudden cardiac death

cocaine

withdrawal from this substance results in a post-use "crash", including severe depression and suicidality, hypersomnolence, fatigue, malaise, and severe psychological craving

cocaine

intoxication with this substance results in belligerence, impulsiveness, fever, psychomotor agitation, vertical and horizontal nystagmus, tachycardia, ataxia, homicidality, psychosis, delirium

PCP

with this drug recurrence of intoxication symptoms can occur due to reabsorption in the GI tract, resulting in a sudden onset of severe, random, homicidal violence

PCP

intoxication with this substance can result in marked anxiety or depression, delusions, visual hallucinations, flashbacks, and pupil dilation

LSD

Intoxication with this substance can result in euphoria, anxiety, paranoid delusions, perception of slowed time, impared judgement, social withdrawal, increased appetite, dry moth, hallucinations

Marijuana

Intoxication with this drug is dangerous because of its low safety margin. higher doses result in respiratory depression

barbituates

withdrawal from this substance results in anxiety, seizures, delerium, and life-threatening cardiovascular collapse

barbiturates

These medications have a greater safety margin than barbituates. Intoxication can result in amnesia, ataxia, somnolence, minor respiratory depression.

benzodiazepines

these drugs have an additive effect with alcohol

benzodiazepines

withdrawal from these drugs results in rebound anxiety, seizures, tremor, and insomnia

benzodiazepines

excessive use of this drug results in restlessness, insomnia, increased diuresis, muscle twitching, and cardiac arrhythmias

caffeine

withdrawal from this drug results in headache, lethargy, depression, and weight gain

caffiene

use of this drug results in restlessness, insomnia, anxiety, and arrhythmias-no increased diuresis

nicotine

withdrawal from this drug results in irritability, headache, anxiety, weight gain, and extreme cravings

nicotine

use of this drug results in restlessness, insomnia, anxiety, and arrhythmias-no increased diuresis

nicotine

This dz is charachterized by physiologic tolerance and alcohol dependence with symptoms of withdrawal (tremor, tachycardia, hypertension, malaise, nausea, DTs when intake is interrupted. Pts will show continued drinking despite medical and social contradictions and life disruptions.

Alcoholism

What is a drug used in treatment of alcoholism

disulfiram

When do DTs usually appear in alcoholics?

2-5D after last drink.

In alcoholics in withdrawal what occurs 1st--autonomic system hyperactivity (tachycardia, tremors, anxiety) or psychotic symptoms (hallucinations, delusions)

1st-autonomic hyperactivity | 2nd-psychotic symptoms

How do you treat DTs in alcholics going through withdrawal?

benzodiazpenes

Long-term alcohol use leads to this involving micronodular cirrhosis with accompaning symptoms of jaundice, hypoalbuminemia, coagulation factor deficiencies, and portal hypertension.

alcoholic cirrhosis

This syndrome caused by vitamin B1 (thiamine) deficiency, is common in malnourished alcoholics. They classically present with a triad of confusion, opthallmoplegia, and ataxia. This may progress to memory loss, confabulation, and personality change. It is associated with periventricular hemorrhage/necrosis, especially in mamillary bodies.

Wernicke-Korsakoff syndrome

What is the tx of Wernicke-Korsakoff syndrome

IV vitamine B1 (thiamine)

this complication of alcoholism consists of longitudinal lacerations at the gastroesophageal junction caused by excessive vomiting. In contrast to esophageal varices it is associated with pain.

Mallory-Weiss syndrome

Heroine is a schedule __ drug

schedule I (not perscribable)

addicts of this drug are at increase risk of hepatitis, abscesses, overdose, hemorrhoids, AIDS, and right sided endocarditis.

heroine

These drugs can competatively inhibit opiods

Naloxone (narcan) and naltrexone

This long acting oral opiate is used for heroine detoxification or long term maitenance

methadone

this psychiatric illnesss involves rapid decrease in attention span and level of arousal. Pts show disorganized thinking, have hallucinations, illusions, misperceptions, disturbance in sleep wake cycle, and cognitive disfunction. The key to diagnosis is its rapid onset and the waxing and waning of level of conciousness.

delerium mneu: deliRIUM=changes in sensoRIUM

this is the most common psychiatric illness on medical and surgical floors.

delerium

delerium is often iatrogenic and reversable. Look at pts meds for ones with this effect.

anticholenergic

This psychiatric illness ivolves a gradual decrease in cognition--memory deficits, aphasia, apraxia, agnosia, loss of abstract thought, behavior/ personality changes, and impared judgement. Be sure to differentiate this from delerium. The key to diognosis is the more gradual onset and the fact that pt is alert with no change in his/her level of conciousness.

Dementia mneu: DeMEMtia is characterized by MEMory loss. Commonly irreversable.

In elderly pts this disease can often present like dementia.

depression

DSM Criteria of Major depressive episode

characterized by at least 5 of the following for 2 weeks, including either depressed mood or anhedionia: 1) Sleep disturbance 2) ↓ Interest 3) Guilt or feelings of worthlessness 4) ↓ Energy 5) ↓Concentration 6) ↕Appetite 7) Psychomotor retardation/agitation 8) Suicidal ideations mneu: SIG E CAPS

Lifetime prevalence of a major depressive episode is _____ for males and _____ for females

5-12% - males | 10-25% - females

This variation on Major depressive disorders invoves 2 or more major depressive episodes with a symptom free interval of 2 months

RRECURRENT Major Depressive Disorder

This disorder is a milder form of depression that lasts at least 2 years

dysthymia

Pts with depression typically have the follwing 3 changes in their sleep stages.

1) ↓ slow wave sleep 2) ↓REM latency 3) Early-morning awakening (important screening question

Risk factors for suicide completion

``` Sex (male) Age (teenager or elderly) Depression Previous attempt Etoh (or drug use) Rational thinking (loss of) Sickness (≥3 perscriptions) Organized plan No spouce (esp if childless) Social support lacking ``` mneu: SAD PERSONS

ECT is a treatment option when?

MDD refractory to other treatment

Major adverse effects of ECT

anterograde and retrograde amnesia, and confusion

T or F: ECT is painful.

This psychiatric disorder is characterized by a period of abnormally and persistantly elevated, expansive, or irritable mood lasting at least one week.

Manic episode

Describe the DSM criteria for a manic episode.

During a manic episode, 3 or more of the follwing are present: 1) Distractibility 2) Irresponsibility 3) Grandiosity 4) Flight of ideas 5) ↑Activity 6) ↓Sleep 7) Talkativeness mneu: DIG FAST

this psychiatric disturbance is like a manic episode except mood disturbance is not severe enough to cause marked imparement in social and/or occupational functioning or to necessitate hospitalization. There are no psychotic features

Hypomanic episode

In this disorder pt consciosly fakes or claims to have a disorder in order to attain a specific gain (e.g., avoiding work, obtaining drugs)

malingering

Drug of choice for bipolar disorder

lithium

what is cyclothymic disorder?

a milder form of bipolar disorder lasting at least 2 years

In this disorder the pt conciously creates symptoms in order to assume the "sick role" and to get medical attention.

factitious disorder

This form of factitious disorder is manifested by a chronic history of multiple hospital admissions and willingness to receive invasive procedures.

Munchausen's syndrome

This factitious disorder is seen when an illness in the child is caused by the parent. The motivation is unconscious. It is a form of child abuse and must be reported.

Muchausen's syndrome by proxy

In this psychiatric disorder both illness production and motivation are unconcious drives. These are more common in women and manifest themselves in a variety of ways.

Somatoform disorders

Type of somatoform disorder in which pt presents with motor or sensory symptoms (e.g., paralysis, pseudoseizure) that suggest neurologic of physical disorder, but tests and physical exam are negative. Onset of symptoms often follow an acute stressor. Pt may seem strangely unconcerned about symptoms

Conversion disorder

Type of somatoform disorder in which pt presents with prolonged pain that is not explained completely by an illness.

Somatoform pain disorder

Type of somatoform disorder in which pt presents with preoccupation with and fear of having a serious illness in spite of medical reassurance

hypochondriasis

Type of somatoform disorder in which pt presents with a variety of complaints in multiple organ sytems with no identifiable underlying physical findings

Somatization disorder

Type of somatoform disorder in which pt presents with preoccupation with minor or imagined physical flaws. Pts often seek cosmetic surgery

Body dysmorhic disorder

Type of somatoform disorder in which pt presents with false belief of being pregnant associated with objective physical signs of pregnancy

pseudocyesis

What type of gain: primary, secondary, tertiary? What the symmptom does for the patients internal psychic economy

primary gain

What type of gain: primary, secondary, tertiary? What the symptom gets the patient (sympathy, attention)

secondary gain

What type of gain: primary, secondary, tertiary? What the caretaker gets (like an doctor on an interesting case)

tertiary

Describe DSM characterization of panic disorder

``` recurrent periods of intense fear and discomfort peaking in 10 minutes with 4 of the following: Palpitations Paresthesias Abdominal distress Nausa, Intense fear of dying or losing control lIght headedness Chest pain Chills Choking disConnectedness Sweating Shaking Shortness of breath ``` mneu: PPANIICCCCSSS note: panic disorder is descrribed in context of occurrence (e.g., panic d/o w/ agoraphobia)

This psychiatric disorder involves a specific fear that is excessive or unreasonable. It is cued by presence or anticipation of a specific object or situation. Exposue to this object or situation provokes an anxiety response. Person recognizes the fear is excessive (insight). This fear interfears with normal routine.

specific phobia

what form of psychotherapy works well for specific phobias

systematic desensitation

gamophobia

fear of marrage

algophobia

fear of pain

acrophobia

fear of heights

agoraphobia

fear of open spaces

In this disorder person experiences or witnesses an event that involved actual or threatened death or serious injury. response involves intense fear, helplessness, or horror. The traumatic event is persistently reexperienced as nightmares or flashbacks. The person persistantly avoids stimuli associated with the trauma and experiences persistant symptoms of increased arousal. Disturbance lasts > 1mo and cuases distress or socia/occupation imparent. This disorder often follwos acute stress disorder which lasts up to 2-4 weeks.

Post-traumatic stress disorder

In this disorder emotional symptoms (anxiety, depression) causing impairment follw an identifiable psychosocial stressor (e.g., divorse, moving). This lasts less than 6 months

Adjustment disorder

This psychiatric disorder is characterized by uncontrollable anxiety for at least 6 months that is unrelated to a specific person, situation, or event. Sleep disturbance, fatigue, and difficulty concentrating are common.

generalized anxiety disorder

children with this disorder have severe communication problems and difficulty forming relationships. This disorder is characterized by repetitive behavior, unusual abilities (savants), and usually below-normal intelligence.

Autistic disorder

This disorder is a milder form of autism involving problems with social relationships and repetitive behavior. These children are of normal intellegence and lack social or cognitive deficits.

Asperger disorder

This is an X-linked disorder seen only in girls (affected males die in utero). It is characterized by a loss of development and mental reatardation appearing at approximately age 4. There is steriotyped hand-wringing.

Rett disorder

this disorder is characterized by limited attention span and hyperactivity. Children are emotionally labile, impulsive, and prone to accidents. These children typically have normal intellegence.

Attention Deficit Hyperactivity Disorder (ADHD)

What is the treatment of ADHD

methylphenidate

This psychiatric disorder of childhood is characterized by behavior that continually violates social norms. At >18 y/o this disorder is recategorized as antisocial personality disorder.

Conduct disorder

This psychiatric disorder of childhood is characterized by noncompliance in the absence of criminality.

Oppositional defiant disorder.

This psychiatric disorder of childhood is characterized by motor/vocal tics and involuntary profanity. Onset is <18 y/o.

Tourette's syndrome

What is the treatment for Tourette's syndrome

haloperidol

This psychiatric disorder of childhood is characterized by fear of loss of attachment figure leading to factitious physical complaints to avoid going to school. The common onset is age 7-8.

Seperation anxiety disorder.

This eating disorder is commonly seen in adolescent girls and coexists with depression. It is characterized by excessive dieting, body image distortion, and increased exercise. Pts often experience severe weight loss, amenorrhea, anemia and eventually electrolyte disturbance.

Anerexia nervosa

This eating disorder is characterized by binge eating followed by self-induced vomiting or use of laxitives. Body weight is typically normal. Parotitis, enamel erosion, electrolyte disturbances, alkalosis, and dorsal hand calluses are common physical exam/lab findings.

Bulimia nervosa

Hallucinations v. Illusion v. Delusions ______ are perceptions in the absense of external stimuli

Hallucinations

Hallucinations v. Illusion v. Delusions __________ are misinterpretations of actual external stimuli

illusions

Hallucinations v. Illusion v. Delusions ______ are false beliefs not shared with other members of culture/subculture that are firmly maintained in spite of obvious proof to the contrary

Delusions

Delusions v. Loose associations a _____ is a disorder in the CONTENT of the thought (the actual idea)

delusion

Delusions v. Loose associations a _____ is a disorder in the FORM of the thought (the way the ideas are tied together)

loose association

hallucination types: ______ and _____ hallucinations are common in schizophrenia

auditory and visual

hallucination types: _____ hallucination often occurs as an aura of a psychomotor siezure

olfactory

hallucination types: _____ hallucinations are rare

gustatory

hallucination types: _____ hallucinations are common in DTs. Also seen in cocaine abusers ("cocaine bugs")

tactile hallucination

formication

sensation of ants crawling on one's skin

by definition hypnagogic hallucinations occur when?

going to sleep mneu: hypnaGOgic hallucination occurs while GOing to sleep

by definition hypnopompic hallucinations occur when?

while waking from sleep

In this disorder a person stops brathing for at least 10 seconds repeatedly during sleep. It is associated with obesit, loud snoring, systemic/pulmonary hypertension, arrhythmias, and possibly sudden death. The individual may become chronically tired.

sleep apnea

In this subcagegory of sleep apnea, the pt shows no respiratory effort

central sleep apnea

In this subcagegory of sleep apnea, the pt shows respiratory effort against airway obstruction

obstructive sleep apnea

This diagnosis is categorizecd by disordered sleep-wake cycles. It may include hypnagogic (just before sleep) or hypnopompic (just before waking) hallucinations. The person's sleep episodes start off with REM sleep.

narcolepsy

This form of narcolepsy involves a loss of all muscle tone follwing a strong emotional stimulus.

cataplexy

Tx for narcolepsy

ampetamines

This psychiatric illness is characterized by periods of psychosis and disturbed behavior with adecline in functioning lasting >6months.

schizophrenia

Give the DSM criterial for schizophrenia.

2 or more of the following symptoms (1-4 are positive symptoms) 1) Delusions 2) Hallucinations 3) Disorganized thought 4) Disorganized or catatonic behavior. 5. "negative symptoms"-flat affect, social withdrawal, lack of motivation, lack of speech or thought.

What is the most common type of hallucination in schizophrenia

auditory

in schizophrenia, disorganized thought often takes the form of ______

loose associations

in the etiology of schizophrenia, what is more important, genetic or enviornmental factors

genetic

Symptoms of schizophrenia that last 1-6 mo

schizophreniform disorder

Symptoms of schizophrenia that last <1 mo

brief psychotic disorder (usually stress related)

Lifetime prevelence of schizophrenia

1.5%

schizophrenia typically presents earlier in _______ (males or females)

males

this psychiatric condition involves a combination of schizophrenia and a mood disorder

schizoaffective disorder

What are the 5 subtypes of schizophrenia

1) disorganized 2) catatonic 3) paranoid 4) undifferentiated 5) residual

This is an enduring pattern of perceiving, relating to, and thinking about the enviornment and oneself that is exhibited in a wide reange of important social and personal contexts.

personality trait

This results when personality patterns become inflexible and maladaptive, causing impairment in social or occupational functioning or subjective disress. The person is usually not aware of the problem. These disordered patterns are stable only by early adulthood and not usually diagnosed in children.

personality disorders

This cluster of personality disorders usually present as "odd" or "eccentric. They cannot develop meaningful social relationships. Give cluster and types.

Cluster A "Wierd" 1) Paranoid 2) Schizoid 3) Schizotypal

This cluster of personality disorders shows no psychosis but there is a genetic association with schizophrenia.

Cluster A "Wierd" 1) Paranoid 2) Schizoid 3) Schizotypal

personality disorder characterized by distrust and suspiciousness

paranoid personality disorder

main defence mechonism exiped by those with paranoid personality disorder

projection

personality disorder characterized by voluntary social withdrawal and limited emotional expression

schizoid

personality disorder characterized by interpersonal awkwardness, odd beliefs or magical thinking. Often eccentric in appearance.

Schizotypal

This cluster of personality disorders is dramatic, emotiona, and eratic. Give the cluster and the subtypes

Cluster B: "Wild" 1) Antisocial 2) Borderline 3) Histrionic 4) Narcissistic

This cluster of personality disorders has a genetic associateion with mood disorders and subsance abuse.

Cluster B: "Wild" 1) Antisocial 2) Borderline 3) Histrionic 4) Narcissistic

personality disorder characterized by disregard and violation of the rights of others, usually manifesting itself in criminality. It affects males > females. Before 18 y/o it is called conduct disorder

antisocial personality diosrder

personality disorder characterized by unstable mood and interpersonal relationships, impulsiveness, sense of emptiness. Effects females more than males

Borderline

personality disorder characterized by excessive emotionality, attention seeking, sexually provocative

histrionic

personality disorder characterized by grandiosity & sense of entitlement. May react to criticism with rage.

Narcissistic

This cluster of personality disorders is charicterized by anxiety and fear. Give the cluster and the types.

Cluster C: "Worried" 1) avoidant 2) obsessive-compulsive 3) dependant

This cluster of personality disorders has a genetic association with anxiety diosrders.

Cluster C: "Worried" 1) avoidant 2) obsessive-compulsive 3) dependant

personality disorder characterized by sensitivity to rejection, socially inhibited, timid, feelings of inadequacy

avoidant

personality disorder characterized by preocupation with order, perfectionism, and control

obsessive-compulsive

personality disorder characterized by submissive and clinging behavior. They have an excessive need to be taken care of and low self confidence.

dependant

This dz is due to a loss of dopaminergic neurons and excess cholinergic activity

parkinsonism

The treatments for parkinson's dz can be summarized by the mneumonic BALSA. What does this stand for

``` Bromocriptine Amantadine Levodopa (w/ carbidopa) Selegine (&COMT inhibitors) Antimuscarinics ```

This drug is an erogot alkaloid an a partial dopamine agonist. The strategy behind this drug is to antagonize dopamine receptors.

bromocriptine

This drug may increase dopamine release.

Amantadine

This drug is converted to dopamine in the CNS

L-dopa/carbidopa

This drug is a selective MAO type B ihibitor. The strategy of this Parkensons drug is that it prevents dopamine breakdown.

Selegiline

This drug is a COMT ihibitor. The strategy of these Parkensons drugs is that it prevents dopamine breakdown.

entacapone & tolcapone

This drug is an antimuscarinic and thus curbs excess cholinergic activity seen in parkinsons. It improves tremor and rigitity but has little effect on bradykinesia

Benzotropine

The MOA of this parkinson's drug is that it ↑ levels of dopamine in the brain. Unlike dopamine, this drug can cross the blood-brain barrier and is converted by dopa decarboxylase in the CNS to dopamine

L-dopa (levvodopa)/carbidopa

What is the most common toxicity of L-dopa

arrhthmias from peripheral conversion to dopamine

Why is carbidopa given with levodopa.

carbidopa is a peripheral decarboxylase inhibitor. It is given with L-dopa inorder to limit the peripheral side effects.

Long term use of ______ can lead to the of dyskinesia follwing administraiton, and akinesia between doses.

L-dopa

This parkinsons drug acts by selectively inhibiting MAO-B, therby ↑ the availabilty of dopamine.

Selegine

This drug is a 5-HT (1D) agonist. It causes vasoconstriction and is used for acute migrane or cluster headache attacks.

Sumatriptan

This drug for acute migrane & cluster headache attacks has toxicities that include coronary vasosasm, thereore it is contraindicated in pts with CAD or Prinzmetal's angina

Sumatriptan

This drug is 1st line for tonic clonic siezures and status epilepticus prophylaxis. It acts by ↑ Na+ channel inactivation

phenytoin

This drug is first line for tonic clonic siexures and trigeminal neuralgia. It acts by ↑ Na+ channel inactivation.

Carbazepine

This siezure medication blocks voltage gaited Na+ channels, but has no effect on GABA release

Lamotrigine

This epilepsy medication acts to ↑ GABA release. It is also used for peripheral neuropathy

Gabapentin

This epilepsy medication acts to block Na+ channels and ↑ GABA release.

topiramate

This epilepsy medication acts to ↑ GABA action. It is 1st line in pregnant women & children

phenobarbital

This epilepsy medication acts to ↑ Na+ channel inactivation & ↑ GABA concentration. It is 1st line for tonic-clonic/ myoclonic seizures and can be used for absence seizures.

valproic acid

This epilepsy medication is 1st line for absence seizures. It acts by blocking the thalamic T-type Ca++ channesls.

ethsuximide

This epilepsyy drug acts by ↑ GABA action. It is first line for acute status epilepticus. It is also usd for seizures of eclampsia (however NOT 1st line--which is MgSO4)

Benzodiazepines | diazepam or lorazepam

Give the epilepsy drug associated with the following toxicities: sedation, tolerance, dependence

benzodiazepines

Give the epilepsy drug associated with the following toxicities: Diplopia, ataxia, blood dyscrasias (agranulocytosis, aplastic anemia), liver toicity, teratogenesis, induction of cytochrome P-450.

Carbamazepine

Give the epilepsy drug associated with the following toxicities: GI distress, lethargy, headache, uticaria, Stevens-Johnson syndrome

Ethosuximide

Give the epilepsy drug associated with the following toxicities: Sedation, tolerance, dependance, induction of cytocrome P-450.

Phenobarbital

Give the epilepsy drug associated with the following toxicities: Nystagmus, diplopia, ataxia, sedaton, gingival hyperplasia, hirsuitism, megaloblastic anemia, teratogenesis, SLE-like syndrome, induction of cytocrome P-450.

Phenytoin

Give the epilepsy drug associated with the following toxicities: GI distress, rare but fatal hypatotoxicity (measure LFTs), neural tube defects in fetus (spinal bifida), tremor, weight gain.

Valproic acid

Give the epilepsy drug associated with the following toxicities: Stevens-Johnson syndrome

Lamotrigine

Give the epilepsy drug associated with the following toxicities: Sedation, ataxia

Gabapentin

Give the epilepsy drug associated with the following toxicities: Sedation, mental dulling, kidney stones, weight loss

Topiramate

The mechanism of this drug is blockade of Na+ channels; inhibition of glutamate release from exitatory presynaptic neurons

phenytoin

This drug is 1st line for tonic clonic siezures and for prophylaxis of status epilepticus. It is also a class IB antiarrhythmic.

phenytoin

The toxicities of this drug include: nystagmus, ataxia, diplopia, sedation, SLE-like syndrome, induciton of cytocrome P-450. Chronic use produces gingival hyperplasia in children, peripheral neuropathy, hirsutism, megaloblastic anemia (↓B12), and malignant hyperthermia (rare). It is also teratogenic.

phenytoin

This drug acts by facilitating GABA action by ↑ duration of Cl- channel opening, thus ↓ neuron firing

barbituates (phenobarbital, pentobarbital, thiopental, secobarbital) mneu: BarbiDURATe (increased DURATion)

This group of drugs is used as a sedative for anxiety, siezures, insomnia, induction of anesthesia

barbituates (phenobarbital, pentobarbital, thiopental, secobarbital)

Toxicities of this drug include dependence, additivee CNS depression effects with etoh, respiratory of CV depession (can lead to death. There are also many drug interactions owing to induction of liver microsomal enzymes (cytocrome P-450)

barbituates (phenobarbital, pentobarbital, thiopental, secobarbital)

this type of drugs is contraindicated in porphyria

barbituates (phenobarbital, pentobarbital, thiopental, secobarbital)

What do you do if someone ODs on barbituates?

symptom management (assist respiration, manage BP)

The mechanism of this drug is to facilitate GABA action by ↑ frequency of Cl- channel opening

Benzodiazepines (Diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, alprazolam) mneu: FREnzodiazepenes (increased FREquency)

Most benzodiazepines have long half-lives and active metabolites. The short acting ones are what? (3)

Triazolam, Oxazepam, Midazolam mneu: TOM Thumb

These drugs are used to treat anxiety, spasticity, status epilepticus, detoxification (esp etoh w/drawl[DTs]), night terrors, & sleep walking.

Benzodiazepines (diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, alprazolam)

Toxicity of this drug includes dependence, additive CNS depression effects with alcohol. Less risk of respiratory depressiona nd coma than with barbituates.

Benzodiazepines (diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, alprazolam)

Treat Benzodiazepine overdose with ________

Flumazenil (competitive antagonist at GABA receptor)

These drugs are used to treat anxiety, spasticity, status epilepticus, detoxification (esp etoh w/drawl[DTs]), night terrors, & sleep walking.

Benzodiazepines (diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, alprazolam)

phenobarbital, pentobarbital, thiopental, secobarbital are ________

barbituates

diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, alprazolam are _______ (drug category)

Benzodiazepines

Thioridazine, haloperidol, fluphenazine, chlorpromazine are all _______ (drug category)

Antipsychotics (neuroleptics)

This drug acts to block dopamine (D2) receptors

antipsychotics (neuroleptics

This drug category is used to treat psychosis, acute mania, and tourettes syndrome

antipsychotics

Toxicies of this group of drugs include extrapyramidal system (EPS side effects)

antipsychotics

Toxicies of this group of drugs include endocrine side effects (e.g., dopamine receptor antagonism →hyperprolactinemia→gynomastia)

antipsychotics

Toxicies of this group of drugs include side effects arising from muscarinic block (dry mouth &constipation), alpha receptors (hypotension) and histamine receptors (sedation)

antipsychotics

This toxicity of antipsychotic involves symptoms that include rigidity, myoglobinuria, autonomic instability, hyperpyrexia.

Neuroleptic malignant syndrome

How do you treat Neuroleptic malignant syndrome (antipsychotic toxicity)

dandrolene and dopamine agonists)

This antipsychotic toxicity includes stereotypic oral-facal movements, probably due to dopamine receptor sensitization, which results from long term antipsychotic use.

Tarditive dyskinesia

Evelution of EPs side effects with antipsychotic use:

``` 4 h acute dystonia 4 d akinesia 4 wk akathisia 4 mo tarditive dykinesia (often reversible) ```

The drugs clozapine, olanzapine, risperidone are of the category _________

Atypical antipsychotis mneu: i'ts not ATYPICAL for OLd CLOsets to RISPER

This group of drugs acts by blocking 5-HT2 and dopamine receptors

Atypical Antipsychotics

These drugs are used in treatment of schizophrenia; they are useful for positive and negative symptoms and they have fewer extrapyramidal and anticholinergic side effects than other antipsychotics.

Atypical antipsychotics

This atypical antipsychotic is also used for OCD, anxiety disorder, depression, mania, and tourettes syndrome

Olanzapine

This atypical antipsychotic may cause agranulocytosis and requires weekly WBC monitoring

Clozapine

The mechanism of this drug is not established. It is possibly related to an inhibition of the phosphoinositol cascade.

Lithium

This drug is used as a mood stabilizer for bipolar affective disorder. It blocks relapse and acute manic events.

Lithium

Toxicity of this drug includes tremor, hypothyroidism, polyuria (ADH antagonist causing nephrogenic diabetes insipidus), teratogenesis. This drug also has a narrow therapeutic window requiring close monitoring of serum levels.

lithium ``` mneu: LMNOP Lithium side effects: Movement (tremor) Nephrogenic dbts insipidus hypOthyroidism Pregnancy problems ```

ANTIDEPRESSANTS [image]p.371

The drugs Fluoxetine, sertraline , paroxetine, and citalopram belong to this category of drugs

Serotonin-specific reuptake Inhibitors (SSRI)

This drug is indicated for endogenous depression, and obsessive compulsive disorder

SSRIs

This drug boast fewer toxicities than TCAs but has been associated with GI distress, sexual dysfuncion (anorgasmia).

SSRIs

When used with MAO inhibitors, SSRIs can cause "serotonin syndrome." What three things does this involve.

hyperthermia, muscle rigidity, CV collapse

The drugs Imipramine, amitriptyline, desipramine, nortriptyline, clomipramine, and doxepin are of this medication category

Tricyclic antidepressants

These drugs act to block the reuptake of NE and serotonin

tricyclic antidepressants

These drugs are indicated for major depression that does not respond to SSRIs

tricyclic antidepressants

This tricyclic antidepressant is indicated for bedwetting

imipramine

This is the only tricyclic antidepressant indicated for OCD

clomipramine

The side effects of these drugs include sedation, alpha blocking effects (hypotension), atropine like (anticholinergic) side effects (tachycardia, urinary retention)

tricyclic antidepressants

Secondary TCAs like ______ have less anticholinergic side effects than do tertiary TCAs like amitriptyline

nortriptyline

This TCA is the least sedating.

desipramine

The side effects of these drugs include sedation, alpha blocking effects (hypotension), atropine like (anticholinergic) side effects (tachycardia, urinary retention)

tricyclic antidepressants

Give the 3 Cs of Tricyclic antidepressant toxicity

Convulsions, Coma, Cadiotoxicity (arrhythmias) also can have respiratory depression & hyperpyrexia?

Your elderly pt on TCAs develops confusion and hallucinations. What could this be due to and what is an alternative TCA that could be given?

This could be due to the anticholinergic side effects of TCAs. Use nortriptyline.

Bupropion, Venlafaxine, Mirtazapine, Maprotiline, Trazodone belong to what drug category

heterocyclic antidepressents mneu: You need BUtane in your VEiNs to MURder for a MAP of AlcaTRAZ

These are 2nd and 3rd generation antidepressante with varied and mixed mechanisms of action. They are used to treat major depession.

heterocyclic antidepressants

This heterocyclic antidepressant is also used for smoking cessation. Its mechanism s not well known. Toxicity includes stimulant effects (tachycardia, insomnia), headache, and siezure in bulimic pts. It does NOT cause sexual side effects.

Buproprion

This heterocyclic antidepressant is also used in generalized anxiety disorder. It inhibits serotonin, NE, & dopamine reuptake. Toxicity includes stimulant effects, sedation, nausea, constipation and increased BP.

Venlafaxine

This heterocyclic antidepressant is an alpha2 antagonist (↑ release of NE and serotonin) and a potent 5-HT(2) & 5-HT(3) receptor antagonist. Toxicity includes sedation ↑ appetite, weight gain, and dry mouth.

Mirtazapine

This heterocyclic antidepressant blocks NE reuptake. Toxicity includes sedation and orthostatic hypotension.

Maprotiline

This heterocyclic antidepressant acts primarily to inhibit seratonin reuptake. Toxicity includes sedation, nausea, priaprism, and postural hypotension

Trazodone

The drugs Phenelzine & tranylcypromine are of this catigory

Monoamine oxidase Inhibitors (MAOIs)

This drug acts by non-selectively inhibiting Monoamine oxidase (MAO)→↑ levels of amine neurotransmitters

Monoamine oxidase inhibiters (MAOIs)

These drugs are used for atypical depression (i.e., with psychotic or phobic features, anxiety, and hypochondriasis.

Monoamine oxidase inhibiters (MAOIs)

These drugs can cause a hypertensive crisis with tyramine ingestion (wine & cheese) and merperidine. They also can cause CNS stimulation.

Monoamine oxidase inhibiters (MAOIs)

These drugs are contraindicated with SSRIs or Beta agonists (to prevent seratonin syndrome)

Monoamine oxidase inhibiters (MAOIs)

CNS anesthetics must be ______ soluable in order to cross teh blood-brain barrier

lipid

anesthetics with ↓ solubility in blood have ____ induction and recovery times

rapid

anesthetics with ↑ solubility in lipids have ______ potency

increased

relative potency of inhalation anesthetics is indicated by what index

Minimal anesthetic concentration

Minimal anesthetic concentration is ________ (proportional or inversely proportional) to potency

inversely proportional potency =1/MAC

Fill in the blanks regarding general principles of anesthesia. ↑ solubility in ______ = ↑ Potency =1/MAC

lipids

N2O has low blood and lipid solubility. What is the rate of induction and what is the potency?

fast | low

Halothane has ↑ lipid and blood solubility, and thus ____ potency and ____ induction

high | slow

anesthetics with ↓ solubility in blood have ____ induction and recovery times

rapid

anesthetics with ↑ solubility in lipids have ______ potency

increased

halothane, enflurane, isoflurane, sevoflurane, methoxyflurane, and nitrous oxide are all this type of anesthetic

inhaled anesthetics

These drugs result in myocardial & respiratory depression, nausea/emesis, and increased cerebral blood and decreased cerebral metabolic demand.

inhaled anesthetics

This inhaled anesthetic has a toxicity of hepatotoxicity

halothane

This inhaled anesthetic has a toxicity of nephrotoxicity

methoxyflurane

This inhaled anesthetic has a toxicity of seizures.

enflurane

This is a rare but very dangerous toxicity of inhaled anesthetics

malignant hyperthermia

This is a barbituate intravenous anesthetic. It is high potency (high lipid solubility). It is used for induction of anesthesia and short surgical procedures. It decreases cerebral blood flow.

Thiopental

This benzodiazepine given IV is the most common anesthetic used for endoscopy. It may cause severe postoperative respiratory depression, decreased BP, and amnesia.

Midazolam

You give your pt Midazolam for his endoscopy. Postoperatively he developse hypotension. What drug do you give him?

flumazenil

Thses PCP analogs given IV act as dissociative anesthetics. They are cardiovascular stimulants. They cause hallucinations and bad dreams. They increase cerebral blood flow.

Arylcyclohexamines (Ketamine)

These opiates are given IV with other CNS depressants during general anesthesia

morphine, fentanyl

This IV anesthetic is used for rapid anesthesia induction and short procedures. It has less postoperative nausea than thiopental.

Propofol

What are the IV anesthetics?

``` Barbituates Benzodiazepines Ketamine Opiates Propofol ``` mneu: B.B. King on OPIATES PROPOses FOOLishly

This drug is used in the treatment of malignant hyperthermia and neuroleptic malignant syndrome.

dantrolene

This condition can be caused by the concomitant use of inhalation anesthetics (except N2O) and succinylcholine.

Malignant hyperthermiia

The drugs procaine, cocaine, tetracaine, lidocaine, mepivacaine, pubivacaine are in this category

local anestetics

Procaine, cocaine, tetracaine, are considered this type of local anesthetics.

esters

lidocaine, mepivacaine, pubivacaine are considered this type of local anesthetics.

amides mneu: amIdes all have 2 "I"s in their names

This group of drugs acts by blocking Na+ channels in nerves by binding to secific receptors on the inner portion of the channel

local anesthetics

Your pt has infected tissue that needs to be anesthetized. Do you need more or less local anesthetic?

More-infected tissue is acidic and therefore charged. The charged anesthetics will have trouble penetrating the membrane effectively.

Give the order of anesthetic nn block regarding diameter of nn and myelination small melinated autonomic fibers large myelinated autonomic fibers small unmyelinated pain fibers

small diameter> large diameter Myelinated>unmyelinated Overall size factor predominates over myelination factor small unmyelinated pain fibers> small melinated autonomic fibers>large myelinated autonomic fibers

What is the order of loss in sensation upon administration of a local anesthetic. touch,pain,pressure, temp

pain>temp>touch>pressure

Local anesthetics are usually given with this to enhance local action--↓bleeding, ↑ anesthesia by ↓ systemic concentration.

epinephrine (or another vasoconstrictor)

These drugs are used for minor surgical procedures and as spinal anesthesia.

local anesthetics

You want to give you're pt a local anesthetic but she is allergic to esters. Name an amide you can give her.

lidocaine, mepivacaine, bupivancaine

a toxicity of this local anesthetic is CV toxicity

bupivacaine

a toxicity of this local anesthetic is arrhythmias

cocaine

general side effects of local anesthetics may include?

CNS exitation, hypertension, hypotension

These drugs are used for muscle paralysis in surgery or mechanical ventilation. They are selective for the motor (v. autonomic) nicotinic receptor

neuromuscular blocking drug

The depolarizing neuromuscular blocking drug is __________

succinylcholine

The drugs tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, rapacuronium are of this category of neuromuscular blocking drugs

nondepolarizing

Nondepolarizing neuromuscular blocking drugs compete with ____ for receptors

ACh

In order to reverse the blockade of nondepolarizing blocking agents you can use __________

any cholinesterase inhibitor: | e.g., neostigmine, edrophonium

With depolarizing neuromuscular blocking drugs phase I is known as the ___________ phase

prolonged depolarization phase

With depolarizing neuromuscular blocking drugs phase I -prolonged depolarization - is potentiated by what?

cholinesterase inhibitors

With depolarizing neuromuscular blocking drugs phase II is known as the ___________ phase

repolarized but blocked phase

after initiating paralysis with a depolarizing neuromuscular blocking drugs, is it possible to reverse the effects.

During phase II (repolarized but blocked phase) only-- the antidote consists of cholinesterase inhibitors (e.g., neostigmine)