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step 1 - pharm > neuro > Flashcards

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
Q

vigabatrin?

A

partial sz

MOA: irreversible inhibition of GABA transaminase

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26
Q

barbiturate MOA?

A

increased duration of Cl channel opening –> decreased neuron firing –> GABAa facilitation

** contraindicated in porphyria

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27
Q

barbiturate toxicity?

A

resp and cardio depression
CNS depression
induces CYP450

28
Q

BZO MOA?

A

increase freq of Cl channel opening –> GABA facilitation

ATOM = short acting (alpraz, triaz, oxaz, midaz)

29
Q

zolpidem, zaleplon, eszopiclone?

A

nonBZO hypnotics
MOA: BZ1 subtype of GABA rcptr

tox: ataxia, HA, confusion; rapid metab by liver; modest day-after psychomotor depression

30
Q

decreased blood solubility of anesthetic means what?

A

rapid induction and recovery time

31
Q

increased lipid solubility of anesthetic means what?

A

increased potency

32
Q

MAC?

A

min alveolar conc required for 50% of pts not to move with incision
MAC = 1/potency

33
Q

effects of inhaled anesthetics?

A

myocardial and respiratory depression
nausea/emesis
increased cerebral blood flow, decreased cerebral metabolic demand

34
Q

which inhaled anesthetic is hepatotoxic?

A

halothane

35
Q

which inhaled anesthetic is nephrotoxic?

A

methoxyflurane

36
Q

which inhaled anesthetic is proconvulsant?

A

enflurane

37
Q

which anesthetic causes expansion of trapped gas in body cavity?

A

N2O

38
Q

which inhaled anesthetic does NOT cause NMS?

A

N2O

39
Q

thiopental?

A

high potency, high lipid solubility
effect terminated by rapid redistrib into tissue
DECREASES cerebral blood flow

40
Q

midazolam?

A

IV BZO - used for endoscopy

may cause severe postop resp depression and hypoT, anterograde amnesia

41
Q

ketamine?

A

block NMDA rcptr
cardiovascular stimulant
disorientation, hallucination, bad dreams
INCREASES cerebral blood flow

42
Q

propofol?

A

sedation in ICU, rapid anesthesia induction, short procedures
potentiates GABA

43
Q

how do you tell the amides from the esters (local anesthetic)?

A

amides have 2 Is in the name

44
Q

MOA of local anesthetic?

A

block Na channel (bind rcptr on inner portion)

preferentially bind activated Na channels

45
Q

how does infected tissue affect anesthetic needs?

A

more acidic –> alkaline anesthetic cannot penetrate membrane –> need MORE

46
Q

order of nerve blockade (small vs large, myelinated vs not)?

A

small –> large
myelin –> no myelin

overall: small myelin –> small unmyelin –> large myelin –> large unmyelin

47
Q

order of sensory loss in anesthetic use?

A

pain
T
touch
pressure

48
Q

which local anesthetic causes cardiovascular toxicity?

A

bupivicaine

49
Q

which local anesthetic causes methemoglobinemia?

A

benzocaine

50
Q

succinyl choline?

A

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
Q

nondepolarizing paralytics?

A

tubucurarine, atracurium, vecuronium, etc
- competitive antag, compete with ACh

reverse with neostigmine + atropine; edrophonium, AChE inhib

52
Q

dantrolene?

A

prevents Ca release from SR

used in malig hyperthermia and NMS

53
Q

baclofen?

A

GABAb agonist at spinal cord –> skel mm relaxation

used in mm spasms

54
Q

cyclobenzaprine?

A

centrally acting skel mm relaxant
similar to TCAs
used in mm spasms

55
Q

dopa agonists?

A

bromocriptine = ergot

non-ergot (betteR) = pramipexole, ropinirole

56
Q

amantadine?

A

increases dopa release and decreases reuptake
used in PD, influenza A, rubella

** toxicity: ataxia, livedo reticularis

57
Q

L-dopa + carbidopa?

A

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
Q

selegiline?

A

centrally acting; MAO-B inhibitor - prevents dopa breakdown into 3MT
adjunct to L-dopa

** may enhance adverse L-dopa effects

59
Q

entacapone, tolcapone?

A

COMT inhibition: prevent L-dopa degradation to 3OMD

entacapone: peripheral
tolcapone: peripheral and central

60
Q

memantine?

A

NMDA rcptr antag
used in AD
helps prevent excitotoxicity

** toxicity: dizziness, confusion, hallucinations

61
Q

donepezil, galantamine, rivastigmine, tacrine?

A

AChE inhibitors
used in AD

** nausea, dizziness, insomnia

62
Q

NT changes in Huntington?

A

decreased GABA, ACh

increased dopa

63
Q

Huntington tx?

A

tetrabenazine and reserpine: inhibit VMAT - limit dopamine vesicle packaging and release
haldol - D2 antagonist

64
Q

triptan MOA?

A

5HT1b/1d agonists
inhibit trigeminal n activation
prevent vasoactive peptide release
induce vasoconstriction

65
Q

triptan toxicity?

A

coronary vasospasm - contraindicated in CAD, Prinzmetal

mild paresthesias

step 1 - pharm (13 decks)

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