Neuro 2 USMLE Flashcards
In a LMN lesion of CN XII the tongue will deviate _____ (away or towards) the side of the lesion?
towards
mneu: lick your wounds
In a CN V motor lesion the jaw deviates ______ (towards or away) the side of the lesion
towards
in a CN X lesion the uvula will deviate _______ (towards or away) of the side of the lesion.
away
In a unilateral lesion of the cerebellum the pt tends to fall _______ (towards or away) the side of the lesion.
towards
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
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
pt presents with paralysis of one side of his entire face (upper and lower). What do you suspect?
ipsilater LMN lesion of CN VII
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
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
This herniation syndrome can compress the anterior cerebral aa
Cingulate herniation under falx cerebri
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
In the case of an uncal herniation you may see ipsilateral dilated pupil/ptosis. This is due to what?
Stretching of CN III
In the case of an uncal herniation you may see contralateral homonymous hemianopia. This is due to what?
compression of ipsilateral posterior cerebral aa
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)
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
Pt can’t see at all out of his right eye (right anopia) Where is the lesion?
Right optic nn
Pts has bilateral temporal visual field defects (bitemporal hemianopia) Where is the lesion?
Optic chiasm
Pt can’t see the left visual field in either eye (Left homonymous hemianopia) Where is the lesion?
Right Optic Tract
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)
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
Pt has left hemianopia with macular sparing??
???visual cortex??
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
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.
give the dz indicated by the following neurotransmitter changes:
↑NE,↓GABA,↓5HT
Anxiety
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.
F
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)
