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Drugs- Basic High Yield Stuff for Boards > Neuro > Flashcards

Neuro Flashcards

1
Q

Name 3 drugs which:

decrease REM/delta sleep

A
  1. Alcohol
  2. Benzos
  3. Barbs
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2
Q

Name 1 drug which:

decreases REM only

A

Norepinephrine

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3
Q

2 drugs for treating Bedwetting (sleep enuresis).

Which is preferred? Why?

A
  1. oral desmopressin (ADH analog)
  2. imipramine

Desmopressin > Imipramine (too many side effects)

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4
Q

Drug for treating Night terrors/ Sleepwalking

A

Benzos

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5
Q

Name the 4 dopaminergic pathways in the brain

A
  1. mesocortical
  2. mesolimbic
  3. Nigrostriatal
  4. tuberoinfudibular
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6
Q

Which dopaminergic pathway…

  1. is affected little by antipsychotic drugs?
  2. is the therapeutic target for positive symptoms?
  3. is the major dopaminergic pathway in the brain?
  4. is affected significantly by Movement disorders?
  5. is affected significantly by antipsychotic drugs?
A
  1. Mesocortical
  2. Mesolimbic
  3. Nigrostriatal
  4. Nigrostriatal
  5. Nigrostriatal
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7
Q

effects of prolactin (5)

A
  1. decrease libido/ sex dysfunction
  2. galactorrhea
  3. gynecomastia
  4. amenorrhea
  5. infertility
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8
Q

Antipsychotic drugs help treat which better- + or - symptoms

A

+ (mesolimbic)> - (mesocortical)

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9
Q

treatment for essential tremor (2)

A
  1. nonselective BB (propranolol)

2. primidone

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10
Q

Treatment of Subarachnoid Hemorrhage(2)

A
  1. stabilize

2. start on Ca+2 blocker to decrease cerebral ischemia

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11
Q

Treatment of TIA(2)

A
  1. full work up

2. prescribe low-dose aspirin

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12
Q

Treatment of Ischemic Stroke (4)

A
  1. tPA (within 3-4.5hrs)
  2. aspirin/clopidogrel
  3. BP control/ BS control/ lipids
  4. treat condition (like A.fib)
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13
Q

Treatment of Pseudotumor Cerebri

A
  1. weight loss
  2. acetazolamide
  3. topiramate
  4. invasive procedures (repeat LP, CSF shunt, optic nerve fenestration surgery)
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14
Q

ALS treatment

A

Riluzole (increase survival by 6mos)

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15
Q

Treatment of Facial nerve palsy (Bell’s palsy)

2

A
  1. Corticosteroids

2. Acyclovir

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16
Q

Sensorineural hearing loss due to otoxoic drug presents as:

A
  1. Tinnitus

2. Vertigo

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17
Q

Lens for correcting Hyperopia

A

“Far-sighted”

Convex

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18
Q

Lens for correcting Myopia

A

“Nearsighted”

Concave

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19
Q

Lens for correcting Presbyopia

A

Reading glasses

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20
Q

What medicine should be avoided with acute closed angle glaucoma?
When can this drug be used?

A

Epinephrine (b/c of its mydriatic effect)

  • useful in chronic glaucoma to decrease aqueous humor production
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21
Q

Treatment for Uveitis

A

Steroids

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22
Q

Treatment for Conjunctivits:
Bacterial
Viral

A

Bacterial= abx

Viral (commonly adenovirus) self-resolving

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23
Q

Treatment of Wet Age-related macular degeneration

A

anti-VEGF injections (like RANibizumab)

(remember “BEVerly RAN for her VEGtables” Bev=bevacizumab”

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24
Q

Prevention of Dry Age-related macular degeneration

A

multivitamin/ antioxidant supplement

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25
Q

Treatment of Nonprolif. Diabetic Retinopathy

A

blood sugar control

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26
Q

Treatment of Prolif. Diabetic Retinopathy

A
  1. peripheral retinal photocoagulation
  2. surgery
  3. anti-VEGF(like ranibizumab)
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27
Q

Treat Multiple Sclerosis:

Slow progression of disease-modifying therapies (3)

A
  1. IFN-B
  2. glatiramer (polymer of 4a.a. in Myelin Basic Protein)
  3. natalizumab (alpha4-integrin, check for JC virus)
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28
Q 
Treat Multiple Sclerosis:
acute flares (1)
A
  1. IV steroids
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29
Q 
Treat Multiple Sclerosis:
symptomatic treatment for 
Neurogenic bladder(2)
spacticity(2)
pain(1)
A

Neurogenic bladder:

  1. catheterization
  2. muscarinic antagonists(“On The Darn Toilet, Sorry”)

Spacticity:

  1. Baclofen
  2. GABA-b-R agonists

Pain:
1. opioids

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30
Q

Treatment of Acute Inflammatory Demyelinating Polyradiculopathy(3)

A

(subtype of Guillain-Barre)

  1. Respiratory support
  2. Plasmapheresis
  3. IVIG
  • NO STEROIDS
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31
Q

Treatment of Cluster HA: (2)

Prophylaxis of Cluster HA: (1)

A

Tx: 1. Sumatriptan
2. 100% O2

Px: Verapamil

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32
Q

Treatment of Tension HA (3)

Chronic tension HA (1)

A

Tx: 1. Analgesics

  1. NSAIDs
  2. Acetaminophen

Chronic: Amitriptyline

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33
Q

Treatment of Acute Migraines (3)

A
  1. NSAIDs
  2. Triptans
  3. Dihydroergotamine
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34
Q

Prophylaxis of Migraines(6)

A
  1. lifestyle changes (sleep, exercise, diet)
  2. BB
  3. Ca+2 Channel blocker
  4. amitriptyline
  5. topiramate
  6. valproate
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35
Q

2 uses for Triptan

A
  1. Migraines

2. Cluster HA

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36
Q

Treatment of Trigeminal Neuralgia

Symptoms (3)

A

Tx: Carbamazepine

  1. repetitive
  2. unilateral
  3. shooting pain in distribution of CN V that lasts typically less than 1 min
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37
Q 
Epinephrine, Brimonidine:
Use/drug class
MOA
Adverse(6)
Contra
A

Glaucoma
Epi (a1 agonist)= decrease Aqueous production via Vasoconstriction
Brimonidine (a2 agonist)= decrease Aqueous production

  1. Mydriasis (a1)
  2. Blurry vision
  3. Ocular hyperemia
  4. foreign body sensation
  5. ocular allergic rxn
  6. ocular pruritus

Contra: CLOSED-ANGLE GLAUCOMA

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38
Q 
Timolol, Betaxolol, Carteolol:
Use/drug class
MOA
Adverse
Which has the most systemic effects?
A

Glaucoma/ BB (‘-olol’)
decrease Aqueous production

  • No pupillary or vision changes
  • Timolol most likely to have systemic effects if drained into lacrimal system
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39
Q

Acetazolamide:
Use/drug class
MOA
Adverse

A

Glaucoma/ CA inhib (diuretic)

  • decrease aqueous humor synthesis via CA inhib
  • No pupillary or vision changes
40
Q 
Pilocarpine, Carbachol:
Use/drug class
MOA
Adverse
Which is used in an emergency? Why?
A

Glaucoma/ Direct M3 cholinomimetic

  1. increase outflow of aqueous via contraction of ciliary muscle
  2. open trabecular meshwork

Adverse: Miosis & cyclospasm

Emergency: Pilocarpine is very effective at opening meshwork into canal of Schlemm

41
Q

Physostigmine, Echothiophate:
Use/drug class
MOA
Adverse

A

Glaucoma/ Indirect M3 cholinomimetic

  1. increase outflow of aqueous via contraction of ciliary muscle
  2. open trabecular meshwork

Adverse: Miosis & cyclospasm

42
Q

Which muscle controls miosis?

Which muscle controls cyclospasm?

A

miosis=contraction of pupillary sphincter m.

cyclospasm= contraction of ciliary m.

43
Q

Bimatoprost, Iatanoprost:
Use/drug class
MOA
Adverse

A

1st line treatment of Glaucoma/ Prostaglandins (Iatanoprost= PGF-2a)
- increase aqueous outflow through canal of Schlem

Adverse: 1. Darkens color of iris (Browning) 2. Eyelash growth

44
Q

Opioid Analgesics:

Name (9)

A
  1. Morphine
  2. Fentanyl
  3. Codeine
  4. Loperamide
  5. Methadone
  6. Meperidine
  7. Dextromethrophan
  8. Diphenoxylate
  9. pentazocine
45
Q

Opioid Analgesics:
Name 3 opioid-R
MOA
Release modulation(all decrease)(5)

A

mu-R: B-endorphin
delta-R: enkephalin
kappa-R: dynorphin

open K+ channels, close Ca+2 channels–> decrease pain transmission.

  1. Ach
  2. NE
  3. 5-HT
  4. Glu
  5. Substance P
46
Q

Opioid Analgesics:

to treat pain/cough suppression

A

dextromethorphan

47
Q

Opioid Analgesics:

to treat diarrhea

A
  1. loperamide

2. diphenoxylate

48
Q

Opioid Analgesics:

Acute pulmonary edema

A

Methadone, buprenorphine + naloxone

49
Q

Opioid Analgesics:

Maintenance programs for heroin addicts

A

Methadone, buprenorphine + naloxone

50
Q

Opioid Analgesics:

Adverse(5)

A
  1. Addiction
  2. respiratory depression
  3. constipation
  4. miosis
  5. additive CNS depression with other drugs
51
Q

Opioid Analgesics:

which opioid doesn’t cause miosis?

A

meperidine (causes mydriasis)

52
Q

Opioid Analgesics:

Tolerance does not develop to what symptoms of opioid use?

A

No tolerance to miosis and constipation

53
Q

Opioid Analgesics:

treatment of opioid toxicity

A

Naloxone or Naltrexone (opioid-R antagonist)

54
Q

Pentazocine:
MOA
Clinical Use

A
  1. Kappa-R agonist
  2. Mu-R antagonist

Moderate-Severe Pain

55
Q

Pentazocine:
What happens when co-admin with full opioid ANTAGONIST (like Naloxone)?
Why?

A

Opioid withdrawal symptoms
(muscle aches, sweating, D/N/V, dilated pupils)

-competition for opioid-R

56
Q

Butorphanol:
MOA
Clinical Use
Benefit to use over other opioids?

A
  1. Kappa-R agonist
  2. Mu-R partial agonist
  • Severe Pain (migraine/labor)
  • Less respiratory depression than full opioid agonist
57
Q

Butorphanol:
What happens when co-admin with full opioid AGONIST?
Why?
Effect of Naloxone on Butorphanol?

A

Opioid withdrawal symptoms
(muscle aches, sweating, D/N/V, dilated pupils)

  • competition for opioid-R
  • Overdose not easily reversed with Naloxone
58
Q

Tramadol:
MOA
Clinical Use

A

“‘Tram it all’ in with Tramadol” (meaning it works on many NTs)

  • very weak opioid agonist
  • inhib 5-HT & NE reuptake

-Chronic Pain (people beat up their dog to get their hands on this medication)

59
Q

Tramadol:

Adverse

A
  1. similar to Opioids
  2. increase seizure risk (decreases threshold)
  3. Serotonin Syndrome
60
Q

Whats the difference btw Tolerance, Dependence, and Withdrawal?

A

Tolerance-must increase drug amount–>decrease effect
Dependence- drug needed for normal function
Withdrawal- ill effects of drug use

61
Q

Ethosuximide:
First line treatment for…
MOA

A

Absence Seizures
“Sucks to have Silent Seizures”

  • Block T-type Ca+2 channels (thalamus)
62
Q

Ethosuximide:

Adverse(5*)

A 
"EFGHIJ"
Ethosuximide causes
1.Fatigue
2.GI upset
3.HA
4. Itching
5. Steven-Johnsons
63
Q 
Benzodiazepines:
Name 3 seizure drug examples
MOA
First line for acute treatment for...
Additional Use
A
  1. Diazepam 2. Lorazepam 3. Midazolam
    - increase GABA-A action via increase frequency of Cl- channel opening
  • Status Epilepticus
  • Eclampsia Seizures
64
Q

First line treatment for Eclampsia seizures?

65
Q

Benzodiazepines:

Adverse (3)

A
  1. Sedation –> Respiratory Depression
  2. Tolerance
  3. Dependence
66
Q

Phenobarbital:
MOA
First line of treatment for…
other seizure uses (3)

A

-increase GABA-A action via increase duration of Cl- channel opening

  • First line in Neonates
    1. Simple
    2. Complex
    3. Tonic-clonic
67
Q

Phenobarbital:

Adverse(4)

A
  1. Sedation–> cardiovascular depression
  2. Tolerance
  3. Dependence
  4. induction of P450 (“Chronic Alcoholics Steal Phen-Phen & Never Refuses Greasy Carbs”)
68
Q 
Phenytoin & Fosphenytoin(oral):
MOA & important metabolism note
First line prophylaxis for ...
First line treatment for...
Other seizure uses (2)
A

Block Na+ channels (ZERO-ORDER: “PEA”)

  • 1st px: Status epilepticus
  • 1st tx: Tonic-Clonic
    1. Simple
    2. Complex
69
Q

Phenytoin & Fosphenytoin(oral):
Adverse
-Neuro(4)
-Derm (4)

A

Neuro:

  1. Nystagmus/Diplopia
  2. Ataxia
  3. Peripheral Neuropathy
  4. Sedation

Derm:

  1. Hirsutism
  2. Steven-Johnson’s rash
  3. Gingival Hyperplasia
  4. DRESS-syndrome (drug rash w/ eosinophils and systemic symptoms)
70
Q 
Phenytoin & Fosphenytoin(oral):
Adverse
-MSK (2)
-Hematologic (1)
-Reproductive (1)
-Other (1)
A

MSK: 1. osteoporosis 2. SLE-like syndrome

Hematologic: Megaloblastic anemia

Reproductive: Teratogenesis (Fetal hydantoin Synd)

Other: P450 induction

71
Q

Drugs causing Megaloblastic Anemia (3)

A

“having a BLAST with PMS”

  1. Phenytoin
  2. Methotrexate
  3. Sulfa drugs
72
Q

Drugs causing Gingival Hyperplasia (3)

A
  1. Phenytoin
  2. Ca+2 channel blockers (rare)
  3. cyclosporine
73
Q

Drugs causing Steven-Johnsons

A

“CLAPPPERS”

  1. Carbamazepine
  2. Lamotrigine
  3. Allopurinol
  4. Phenytoin
  5. Phenobarbital
  6. Penicillin
  7. Ethosuximide
  8. Rash
  9. Sulfa drugs
74
Q

Drugs causing SLE-like syndrome

A

“having lupus is SHIPP-E”

  1. Sulfa drugs
  2. Hydralazine
  3. Isoniazid
  4. Procainamide
  5. Phenytoin
  6. Etanercept
75
Q

Carbamazepine:
MOA
First line treatment for (2, 1)
other seizure use (1)

A

Blocks Na+ channel

  1. Simple
  2. Complex
  3. Trigeminal neuralgia

-Tonic-Clonic Seizures

76
Q

Carbamazepine:

Adverse (7)

A
  1. Diplopia
  2. Ataxia
  3. Agranulocytosis/ Aplastic Anemia (Monitor ‘C’BC)
  4. Hepatotox & P450 induction
  5. Teratogenesis
  6. SIADH
  7. Steven-Johnson
77
Q

Valproic Acid:

MOA (2)

A
  1. Na+ channel inactivation

2. increase GABA concentration by inhibiting GABA-transaminase

78
Q

Valproic Acid:
First line treatment for…
Other seizure uses (4)
Additional uses (2)

A

First line: Tonic Clonic

  1. Simple
  2. Complex
  3. Absence
  4. Myoclonic Seizures
  5. Bipolar DO
  6. Migrane prophylaxis
79
Q

Valproic Acid:
Adverse (5)
Contra-Why?

A
  1. GI distress
  2. Fatal Hepatotox (rare but must monitor LFTs)
  3. Pancreatitis
  4. Trmeor
  5. Weight gain

Contra: Pregnancy- Neural Tube defects

80
Q

Vigabatrin:
MOA
Clinical uses (2)

A

increase GABA concentration by IRREVERSIBLY inhibiting GABA-transaminase

  1. Simple
  2. Complex
81
Q

Gabapentin:
MOA
Seizure uses (2)
Additional uses (2)

A
  • inhib VG-Ca+2 channels (designed as GABA analog)
    1. Simple 2. Complex
  1. Peripheral Neuropathy
  2. Post-herpetic Neuralgia
82
Q

Gabapentin:

Adverse(2)

A
  1. Sedation

2. ataxia

83
Q

Topiramate:
MOA
Seizure uses (3)
Additional use (1)

A
  • Blocks Na+ channels –>increase GABA action
  1. Simple
  2. Complex
  3. Tonic-Clonic
  4. Migrane prevention
84
Q

Topiramate:

Adverse (3)

A
  1. Sedation/Mental dulling (“topey makes you dopey”)
  2. Kidney Stones (Topey makes it hard TO pee)
  3. weight loss
85
Q 
Lamotrigine:
MOA
Clinical uses (4)
Benefit over Carbamazepine/Phenytoin
Adverse (1)
A
  • Block VG-Na+ channel
    1. Simple
    2. Complex
    3. Tonic-clonic
    4. Absence
  • fewer side effects when compared to Carbamazepine/Phenytoin

-Adverse: Steven-Johnsons (must titrate slowly)

86
Q

3 drugs to treat Absence seizures?

Whats the first line?

A
  1. Ethosuximide
  2. Valproic acid
  3. Lamotrigine
87
Q

Treatment of Myoclonic seizures

A

Vlaproic acid

88
Q

Levetiracetam:
MOA
Clinical uses (3)

A
  • Unknown modulation of GABA&Glutamate release
  1. simple
  2. complex
  3. tonic-clonic
89
Q

Tiagabine:
MOA
Clinical uses (2)

A

-increase GABA concentration by inhibiting GABA-REUPTAKE

  1. Simple
  2. Complex
90
Q

Seizure drugs which induce P450 (3)

A
  1. phenobarbital
  2. Phenytoin/ Fosphenytoin
  3. Carbamazepine
91
Q

1 drugs which increase Na+ Channel inactivation

4 drugs which block Na+ channels

A
  1. Valproic Acid
  2. Phenytoin/Fosphenytoin
  3. Lamotrigine
  4. Topirimate
  5. Carbamazipine
92
Q

3 drugs which increase GABA action

3 drugs which increase GABA level

A
  1. Topirimate
  2. Phenobarbital
  3. Benzodiazepines
  4. Valproic Acid
  5. Tiagabine
  6. Vigabatrin
93
Q

2 drugs which block Ca+2 channel

A
  1. Gabapentin

2. Ethosuximide

94
Q

1 drug which modulates GABA & Glutamate release

A
  1. Levetiracetam
95
Q

What is dressler syndrome?

A

autoimmune phenomenon resulting in fibrous pericarditis several weeks post MI (associated with Phenytoin)

Drugs- Basic High Yield Stuff for Boards (20 decks)

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