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neuro Flashcards

1
Q

alpha agonists for glaucoma?

A

epinephrine (a1) and brimonidine (a2)
decrease aqueous humor synthesis (a1 via vasoconstriction)
don’t use a1 in acute angle glaucoma - mydriasis!

** SEs: blurry vision, ocular hyperemia, foreign body sensation, ocular allergic rxns, ocular pruritus

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2
Q

beta blockers for glaucoma?

A

timolol, betaxolol, carteolol
decrease aqueous humor synthesis

** no pupillary/visual SEs

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3
Q

diuretic for glaucoma?

A

acetazolamide
inhibition of CA –> decreased aqueous humor synthesis

** no pupillary/visual SEs

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4
Q

cholinomimetics for glaucoma?

A

direct: pilocarpine, carbachol
indirect: physostigmine, echothiophate
increase aqueous humor outflow - contraction of ciliary mm and open trabecular meshwork

    • pilocarpine for emergencies - very effective
    • SEs: miosis and cyclospasm
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5
Q

prostaglandin for glaucoma?

A

latanoprost = PGF(2alpha)
increases outflow of aqueous humor

** darkens iris color

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6
Q

opioid MOA?

A

agonists at mu, delta (enkephalin), kappa (dynorphin) rcptrs
open K and chlose Ca channels –> decreased synaptic transmission
inhibit Ach, NE, 5HT, glu, substance P release

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7
Q

butorphanol?

A

kappa opioid rcptr agonist and partial mu agonist
–> analgesia
used in sever pain
causes less respiratory depression

    • w/d sx if pt also taking full agonist
    • not easy to reverse OD with naloxone
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8
Q

tramadol?

A

weak opioid agonist
inhibits 5HT and NE reuptake
SEs similar to opioids

** decreases sz threshold, risk of serotonin syndrome

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9
Q

1st line for absence sz?

A

ethosux

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10
Q

1t line for status epilepticus?

A

BZOs (acute)

phenytoin (ppx)

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11
Q

1st line for simple partial sz?

A

carbamazepine

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12
Q

1st line for complex partial sz?

A

carbamazepine

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13
Q

1st line for tonic-clonic sz?

A

carbamazepine, phenytoin, VPA

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14
Q

ethosuximide?

A

absence sz
MOA: blocks thalamic T-type Ca channels

SEs: fatigue, GI distress, H/A, itching, SJS

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15
Q

BZOs?

A

status epilepticus, eclampsia sz (after Mg)
MOA: increase GABAa action

SEs: sedation, resp depression, tolerance, dependence

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16
Q

phenytoin?

A

everything except absence; fosphenytoin = parenteral
MOA: increase Na channel inactivation

SEs: nystagmus, diplopia, ataxia, gingival hyperplasia, hirsutism, teratogenesis, drug-induced lupus, CYP450 induction, SJS

** zero order kinetics

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17
Q

carbamazepine?

A

partial and tonic-clonic sz, trigeminal neuralgia
MOA: increased Na channel inactivation

SEs: diplopia, ataxia, blood dsycrasias, hepatotoxic, induction of CYP450, SIADH, SJS

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18
Q

VPA?

A

everything except status; + myoclonic sz, BPD
MOA: increased Na channel inactivation, inhibit GABA transaminase –> increased GABA

SEs: Gi distress, hepatotoxicity, NT defects, tremor, weight gain

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19
Q

gabapentin?

A

partial sz, peripheral neuropathy, postherpetic neuralgia
MOA: inhibits high-voltage activated Ca channels

SEs: sedation, ataxia

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20
Q

phenobarb?

A

partial and tonic clonic sz
MOA: increased GABAa action

SEs: sedation, tolerance, cardioresp depression, induction of CYP450

** 1st line in neonates

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21
Q

topamax?

A

partial and tonic-clonic sz, migraine prevention
MOA: blocks Na channels, increases GABA

SEs: sedation, mental dulling, kidney stones, weight loss

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22
Q

lamictal?

A

everything except status
MOA: blocks voltage-gated Na channels

SEs: SJS if not titrated slowly

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23
Q

levetiracetam?

A

partial and tonic-clonic

unknown MOA: maybe GABA/glu related?

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24
Q

tiagabine?

A

partial sz

MOA: inhibit GABA reuptake

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25
vigabatrin?
partial sz | MOA: irreversible inhibition of GABA transaminase
26
barbiturate MOA?
increased duration of Cl channel opening --> decreased neuron firing --> GABAa facilitation ** contraindicated in porphyria
27
barbiturate toxicity?
resp and cardio depression CNS depression induces CYP450
28
BZO MOA?
increase freq of Cl channel opening --> GABA facilitation ATOM = short acting (alpraz, triaz, oxaz, midaz)
29
zolpidem, zaleplon, eszopiclone?
nonBZO hypnotics MOA: BZ1 subtype of GABA rcptr tox: ataxia, HA, confusion; rapid metab by liver; modest day-after psychomotor depression
30
decreased blood solubility of anesthetic means what?
rapid induction and recovery time
31
increased lipid solubility of anesthetic means what?
increased potency
32
MAC?
min alveolar conc required for 50% of pts not to move with incision MAC = 1/potency
33
effects of inhaled anesthetics?
myocardial and respiratory depression nausea/emesis increased cerebral blood flow, decreased cerebral metabolic demand
34
which inhaled anesthetic is hepatotoxic?
halothane
35
which inhaled anesthetic is nephrotoxic?
methoxyflurane
36
which inhaled anesthetic is proconvulsant?
enflurane
37
which anesthetic causes expansion of trapped gas in body cavity?
N2O
38
which inhaled anesthetic does NOT cause NMS?
N2O
39
thiopental?
high potency, high lipid solubility effect terminated by rapid redistrib into tissue DECREASES cerebral blood flow
40
midazolam?
IV BZO - used for endoscopy | may cause severe postop resp depression and hypoT, anterograde amnesia
41
ketamine?
block NMDA rcptr cardiovascular stimulant disorientation, hallucination, bad dreams INCREASES cerebral blood flow
42
propofol?
sedation in ICU, rapid anesthesia induction, short procedures potentiates GABA
43
how do you tell the amides from the esters (local anesthetic)?
amides have 2 Is in the name
44
MOA of local anesthetic?
block Na channel (bind rcptr on inner portion) | preferentially bind activated Na channels
45
how does infected tissue affect anesthetic needs?
more acidic --> alkaline anesthetic cannot penetrate membrane --> need MORE
46
order of nerve blockade (small vs large, myelinated vs not)?
small --> large myelin --> no myelin overall: small myelin --> small unmyelin --> large myelin --> large unmyelin
47
order of sensory loss in anesthetic use?
pain T touch pressure
48
which local anesthetic causes cardiovascular toxicity?
bupivicaine
49
which local anesthetic causes methemoglobinemia?
benzocaine
50
succinyl choline?
ACh rcptr agonist --> sustained depol --> paralysis - in phase I, can't reverse; block potentiated by AChE inhib - in phase II, can reverse with AChE inhib ** complications: hypercalcemia, hyperkalemia, malignant hyperthermia
51
nondepolarizing paralytics?
tubucurarine, atracurium, vecuronium, etc - competitive antag, compete with ACh reverse with neostigmine + atropine; edrophonium, AChE inhib
52
dantrolene?
prevents Ca release from SR | used in malig hyperthermia and NMS
53
baclofen?
GABAb agonist at spinal cord --> skel mm relaxation | used in mm spasms
54
cyclobenzaprine?
centrally acting skel mm relaxant similar to TCAs used in mm spasms
55
dopa agonists?
bromocriptine = ergot | non-ergot (betteR) = pramipexole, ropinirole
56
amantadine?
increases dopa release and decreases reuptake used in PD, influenza A, rubella ** toxicity: ataxia, livedo reticularis
57
L-dopa + carbidopa?
L-dopa can cross BBB; carbidopa prevents peripheral conversion to dopa --> increased availability and decreased peripheral SEs ** toxicity: arrhythmias; long term --> on-off phenomenon (dyskinesia after admin) and akinesia b/w doses
58
selegiline?
centrally acting; MAO-B inhibitor - prevents dopa breakdown into 3MT adjunct to L-dopa ** may enhance adverse L-dopa effects
59
entacapone, tolcapone?
COMT inhibition: prevent L-dopa degradation to 3OMD entacapone: peripheral tolcapone: peripheral and central
60
memantine?
NMDA rcptr antag used in AD helps prevent excitotoxicity ** toxicity: dizziness, confusion, hallucinations
61
donepezil, galantamine, rivastigmine, tacrine?
AChE inhibitors used in AD ** nausea, dizziness, insomnia
62
NT changes in Huntington?
decreased GABA, ACh | increased dopa
63
Huntington tx?
tetrabenazine and reserpine: inhibit VMAT - limit dopamine vesicle packaging and release haldol - D2 antagonist
64
triptan MOA?
5HT1b/1d agonists inhibit trigeminal n activation prevent vasoactive peptide release induce vasoconstriction
65
triptan toxicity?
coronary vasospasm - contraindicated in CAD, Prinzmetal | mild paresthesias

step 1 - pharm (13 decks)

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