Neuro Drugs 2 Flashcards
1
Q
Acetazolamide
A
- Inhibits CA used to treat open angle and closed angle glaucoma
- Decreaes HCO3 and decreases humor production
- Causes metabolic acidosis and alkalinization of urine
2
Q
Epinephrine
A
- Constriction via alpha 2 leading to decreased humor production
- S/E is myadriasis, blurry vision, optic pruritis, can precipitate closed angle glaucoma
3
Q
Brimonidine
A
- Alpha 2 agonist leads to decrease B2 activation and decreased humor production
- Causes
4
Q
Litanaprosct
A
-PGF2a agonist causes opening of canals and increased flow
5
Q
Pilocarpine, carbachol, physostigmine, ecothiophate
A
- Cholinergic agonists cause contriction of pupillary and opening of angle
- DOC in closed angle glaucoma
- Cholinergic S/E, miosis, cyclospasm (Ciliary muscle paralysis)
6
Q
Timlol
A
- Beta antagonist leads to decreased humor production
- No effect on vision
7
Q
Opiod
A
- Mu is morphine, kappa is enkephalin, dela is dynoprhin
- All work to open Cl and decrease Ca and NT release in pain neurons (inhibiitory interneurons)
- Leads to decreasd Pain
- Can also be used to treat diahrrea (Loperamide, diphenoxylate) Cought (Dextromethophan), acute pulmonary edema
- Methadone has a longer half life and can be used to decrease addiction, Naloxone combined with buprenoprhine can do the same thing
- S/E: respn depression, constipation, miosis
- Overdose treat with naloxone (competetive antagonist of mu R)
8
Q
Butorphanol
A
- Partial mu agonist and kappa agonist used to treat chornic pain with fewer S/E
- Partial agonist activities can precipitate withdrawl
9
Q
Tramadol
A
- Partial mu agnost and also seretonoin and other effects
- Used in chronic pain to cause fewer S/E
- Lower siexure threshold is major S/E
10
Q
Partial Siezures
A
- First line is carbemezapine
- Also phenytoin, valproate, new drugs, all but bezos and ethosuximide
11
Q
Complex
A
- First line is phenytoin, carbemezapine, valproate
- Other new drugs can be used (lamotragine, topiramate, gabapentin, etc)
12
Q
Absence
A
Ethosuximide first and Valproate second (T type Ca)
13
Q
Status Epilepticus
A
Benzos are given for aute phase also IV phenytoin
14
Q
Phenytoin
A
- Use dependent Na channel block, also inhibits glutamate release
- Use in simple and complex siezures and also for status
- S/E: Gingival Hyperplasia, Fetal hydantoin (neural tube defects, heart defects, cleft lip, microcephaly), Hirsuitism, Megaloblastic Anemia (folate), SLE like syndrome, ataxia, diplopia
15
Q
Carbemezapine
A
- Similiar to phenytoin, Except add agranulocytosis and aplastic anemia to list
- DOC for partial siezures, SIADH
- All epileptic drugs could cause stevens johsnons (Fatigue and fever followed by mucosal desquamating rash and epidermal necrolysis at Epi/dermal junction)
16
Q
Valproate
A
- Multiple, Na, increase GABA, T type Ca
- Second line for absence, second line for partial, first line for diffuse
- Causes neural tube defects, fatal hepatotoxicity, weight gain
17
Q
Ethosuximide
A
- DOC for absence siezures, blocks T type Ca channels
- Stevens Johsnons and GI, uticaria
18
Q
Phenobarbtol
A
- DOC for pregnancy and children, protein binding limits transplacental transfer
- Causes GABA duration increase leading to potentiation
- S/E: Resp depression, P450 inducer
19
Q
Lamotrigne
A
Na channel blocker
-Second line for complex and partial, minimal S/E
20
Q
Gabapentin
A
V gated Ca channels
Can be used in siezures, but often used in peripheral neural pain syndromes
21
Q
Topirimate
A
- Increase GABA and decrease Na
- Second line siezure and prophylaxis for migranes
- S/E: kidney stones and weight loss
22
Q
Tiagabine, Vigaartin
A
- Tiagabine blocks GABA uptake, second line for partial
- Vigabatrin blocks GABA deamination, second line for partial
23
Q
Levitracetam
A
-Unkown mechanism , scond line for parital and diffuse
24
Q
Barbs
A
-Bind to GABAa receptor and increase duration of opening leading to increased Cl Flux
-Leads to depression of neural signals
-Siezures (phenobarbitol), anesthesiaamnesia (Thiopental, decreased T1/2)
S/E: Respiratory depresion, inducers of P450s
-Contraindicated in porphyria
25
Benzos
- GABAa inreased frequency of opening, decreased S/E, reversed by flumezanil
- Used as amnestic, anxiolytic. Anterograde amnesia
- Used in status, DT, secondary to MgSO4 for ecplamptic siezures
- S/E: Resp depression in the context of alcohol
- Long is Diazepam (Metabolized to active)
- Med (Lorazepam)
- Short (Triazolam)
- US (Midazolam)
- Often used in anesthesia protocol
26
Z Drugs
- Milder side effects because of shorter half life and not metabolized to active products when compared to benzos.
- Used as sleep aid
27
Inhaled Anesthetics
- Speed of induction is inversely proportional to blood solubility. N2O is minimally bloo soluble leads to rapid iduction while halothane is highly lipid soluble and leads to slow induction.
- MAC minimum Concentration to anesthetize 50% of population. Inversely correlated to potency. High potency halothane has low MAC while low potency N2O has high MAC
- Increase Cerebral Blood flow but decrease demand
28
N2O
Rapid induction, not blood soluble. Need high MAC
| -Can cause gas expansion and spontaneous abortions
29
Halothane
- Potent, low MAC but slow indcution
| - Can cause hepatic necrosis days after surgery
30
Other S/e
Methoxyflurane is nephrotoxic
- Enflurane is proconvulsant
- All can cause malignant hyperthermia excpet N20 due to genetic mutation in RyR
31
Barbituates
- Thiopental, IV
- Highly lipid soluble, rapid induction, but also rapidly redistributes to fat leading to rapid stop of function
- Decrease Cerebral Blood Flow
32
Benzos
- Most common is midazolam which is ultra short acting, combined with oiods and inhaled
- Anterograde amnesia
- Post surgical decrease in Resp/BP, tx with flumezanil
33
ketamine (Arylcyclohylamines)
- NMDA receptor antagoinst
- Leads to dissociative amnesia, hallucinations, bad dreams
- Commonly used for short procedures in kids like bone setting
- Increase Cerebral Blood flow, don't use in trauma
34
Propofol
- GABAa potentiator
| - Rapid induction and rapid recvery with minimal post surgical N/V
35
Local Anestetics
- Esthers: CocaIne, (Slow acetylators, increase hypersensitivity, PABA cross react)
- Amides: LIdoaIne
- Present in uncharged amine form that enters cell, then protonated and blocks Na channels from inner membrane in a use dependent fashion
- Blockage occurs from small to large diameter neurons. Pain, Temp, Touch, Pressure, and rarely motor
- Often administered with epinephrine or alpha agonist to constrict vessels and maintain high local concentration
- If infected and acid tissues will stay in charged amide form and can't enter cell, more is needed
- S/E is Arryhtmias, BP Changes, and cardiotox
36
Succinylchline
- Depolarizing neuromuscular blocker leads to depolarization of membrane and stuck in that state. Binds tighly to AchR
- Phase I is complete depolarization and no antidote is possible, treatment with AchEI will potentiate block
- Phase 2 is repolarization, but desensitization. Tx with AchEI can lead to recovery
- S/E: Hyper Ca, and K. Also malignant hyperthermia, treat with dantolene
37
Tubocurarine (Curium)
- Used in intubaion, non depolarizing
- AchR antagonist leads to blockage of receptors
- Antidote is AchEI (Neostigmine and edrophonium)
38
Dantrolene
-Prevents Ca release from SR used in malignant Hyperthermia caused by succinylcholine or typical antispychotics
39
Parkinsons Basics
- Decreasd DA leads to bradykinesia
| - Increased Ach leads to tremor and rigidity
40
DA agonists
- Bromocriptine
| - Repriridne, paramexole (preferred)
41
Increase DA centrally
- Carbidopa/L-Dopa: L Dopa can cross BBB and be converted into DA by L-Dopa decarboylase
- Carbidopa prevents peripheral conversion via AAAD (Leads to increase Central effects and decreasd peripheral effects)
- Dosing problems leads to akinesia and dyskinesia
- Also arrytjmias from peripheral effects
42
Increase DA release
-Amantadine: Causes DA release, also antiviral against rubella and influenza
43
Prevent DA breakdown
-MAO-B inhibitor prevents DA breakdown with minimal effect on MAO-A (Decrease risk of tyramine induced hypertensive crisis or seretonin syndrome)
44
Entacapone, Tolcapone
-Prevent the conversion of L-Dopa to 3-O-mehtyldopa (inactive) by COMT
45
Benztropine
- Muscarinic antagonist
- Curbs elevated Ach leads to improvment in tremor and rigidity
- Causes anticholinergic S/E (Angle closure glaucoma)
46
Memantine
-NMDA receptor antagonist, used to inhbit ecititoxicity in Alzhiemers
47
Donepazil, galantamine, rivastigmine
-Central AchEI
48
Huntingtons
- Increased DA and decreased GABA/Ach
- Haloperidol blocks D2 Receptors
- Reserpine, blocks VMAT mediated loading of DA into vesiceles
49
Sumitriptan
- Seretonin analog used in abortive treatment of cluster and migrane headaches
- Causes vasoconstriction and decreasd trigeminal activation
- Contraindicated in patienst with prinmetal angina, may also precipitate hypertensive crisis (sereTONIN)
- Short T1/2
50
Propsognosia
-Inability to recognize the meanings and associations of objects. Propsognosia. Associaed with infarction in Occipitotemporal association corticies (MCA)
