Neuro Drugs Flashcards
1
Q
What is the acute treatment for tension headaches?
A
1) NSAIDs
2) Caffeine
3) Butalbital (barbiturate)
2
Q
MOA of Butalbital
A
1) Facilitaes GABA neurotransmission
3
Q
MOA of Caffeine
A
1) Acts as a competitive antagonists for adenosine receptor
4
Q
What is the prophylactic treatment for tension headaches? How long do these drugs take to work?
A
1) Older anti-depressants
2) 2-6 weeks to be efficacious
5
Q
What are the three older antidepressants used for prophylactic treatment of tension headaches?
A
1) Amitriptyline
2) Doxepin
3) Imipramine
6
Q
What is the MOA of Sumatriptan?
A
1) 5-HT1 b/d agonist; also known as triptan class
7
Q
Which 5-HT1 b/d agonist has the slowest time to onset?
A
1) Naratriptan
8
Q
What is the physiological effect of 5-HT1 b/d (triptans)?
A
1) Cause the inhibition of the release of vasodilators substance P and CGRP
9
Q
What are the adverse effects of 5-HT1 b/d triptans?
A
1) Altered sensation
2) Pain at injection
3) Chest discomfort
10
Q
What are the three contraindications of triptans?
A
1) Coronary artery disease
2) Uncontroled HTN
3) Prinzmetal angina
11
Q
What is given to pt who has Sjogren’s syndrome?
A
1) Pilocarpine- direct cholinomimetic
12
Q
Why should triptans and ergots, both drugs used to treat migraines, should never be used together?
A
1) Both have a vasoconstrictive effect
13
Q
What is the treatment for migraine headaches?
A
1) NSAIDs
2) Triptans or Ergots
3) Dopamine Antagonists (D2)
14
Q
What is the adverse effect of D2 Antagonsits?
A
1) Result in blockage of dopamine receptors in the basal ganglia
2) Causes parkinsonisms, dystonias, and neuroleptic malignant syndrome
15
Q
Inability to sit; restlessness
A
Akathisia
16
Q
What is the drug used initially for Parkinson’s?
A
1) MAO-B inhibitors (-gilines)
2) Selegiline and Rasagiline
17
Q
Non-selective MAO inhibitors?
A
1) Red wine
2) Aged cheese
18
Q
Why should non-selective MAOs not be used for the treatment of parkinson’s?
A
1) They will cause hypertensive crisis when combined with L-DOPA
19
Q
What are the Dopamine agonists used to treat Parkinson disease?
A
1) Pramipexole (D3 agonist)
2) Ropinirole (D2 agonist)
20
Q
Biperiden
Trihexyphenidyl
Benztropine
A
Centrally acting Anti-muscarinics
21
Q
What are the side effects of anti-muscarinics?
A
1) Dry mouth
2) Urinary retention
3) Constipation
22
Q
Pramipexole
Ropinirole
A
Dopamine agonists
23
Q
What are contraindications for amantidine?
A
1) Seizures
2) Congestive heart failure
24
Q
What is the window of effectiveness for L-DOPA? Why is L-DOPA used last in the treatment for Parkinson?
A
1) 5 years
2) Once L-DOPA is ineffective, treatment becomes extremely difficult
25
What is always given with L-DOPA? Why?
1) Carbidopa
| 2) Carbidopa inhibits the formation of peripheral dopamine resulting in L-DOPA use at lower doses
26
Why can't Phenothiazine be used for treatment of L-DOPA induced nausea?
1) Phenothizine is a dopamine receptor antagonist resulting in increased Parkinson
27
Entacapone
COMT inhibitor
28
What are the adverse effects of L-DOPA?
1) Nausea and vomiting
2) Arrhythmias
3) Dyskinesia
4) Behavior change
29
What are the treatments for Myasthenia gravis?
1) Immunosuppressants
2) Plasmapheresis
3) Anticholine esterase
30
What are the immunosuppressants used in Myasthenia gravis?
1) Azathioprine
2) Cyclosporine
3) IV immunoglobulin
31
MOA of Azathioprine
1) Converted to mercaptopurine which inhibits cell proliferation by interfering with purine metabolism
32
Neostigmine
| Pyridostigmine
Quaternary Anti-choline esterase
33
What must Quaternary anticholine esterases be given with?
An anti-muscarinic due to the increase in cholinergic neurons at other sites
34
GABA analogue for GABA-B receptor; useful for MS, Spinal injury, and ALS
Baclofen
35
MOA of Diazepam
Increases GABAnergic neurotranmission
36
MOA of Tizanidine
1) Analouge of clonidine
| 2) Reinforces inhibitory effects in spinal cord (alpha 2 agonist)
37
MOA of Riluzole
1) Inhibits glutamate release
| 2) Used for ALS and to delay tracheostomy
38
MOA of Gabapentin
1) Increases release of GABA
| 2) Also used for peripheral neuropathy pain reduction
39
MOA of Dantrolene
Skeletal muscle relaxant by interfering with release of calcium ions
40
MOA of Baclofen
1) GABA-B agonist
41
Adverse effects of Baclofen
Drowsiness
42
What in general is the adverse effects of GABAergic drugs?
1) Drowsiness
43
Describe the Tensilon test
1) Used to determine treatment effectiveness
2) Use Edrophonium
3) Improvement = under dosed
4) Worsening = over dose (cholinergic crisis)
44
What are the indications and contraindications for Na channel blockers?
1) Indications: generalized tonic-clonic and focal seizures
| 2) Contraindications: Absence seizures (makes them worse)
45
What are Calcium ion channel blockers indicated for? Contraindicated?
1) Indications: simple absence seizures
| 2) Contraindications: Generalized tonic-clonic seizures
46
What are the adverse effects of valproate?
1) GI epigastric distress
2) Hepatic damage
3) Teratogenic (cause neural tube defects)
47
What are the adverse effects of Lamotrigine?
1) May induce Stevens-Johnson syndrome
2) Insomnia
3) Nightmares and vivid dreams
48
What two drugs are effective against all types of seizures?
1) Valproate
| 2) Lamotrigine
49
What type of seizure should a Na channel drug never be given to?
1) Absence seizures
| 2) Makes seizure worse
50
What are the three first line drugs used for generalized seizures?
1) Valproate
2) Lamotrigine
3) Topiramate
51
What anti-epileptic drug causes bone marrow depression?
Carbamazepine
52
What are the first line drugs for focal seizures?
1) Lamotrigine
2) Carbamazepine and Oxcarbazepine
3) Phenytoin
4) Levetiracetam
53
Epileptic drug that has first order elimination in low to mid therapeutic range and zero order elimination in high therapeutic range?
1) Phenytoin
54
What are the clinical findings of Phenytoin drug toxicity?
1) Cerebral and vestibular symptoms
2) Gingival hyperplasia
3) Osteomalacia
4) Teratogenic
55
What are the teratogenic effects of phenytoin?
1) Cardiac damage
| 2) Cleft palate
56
What anti-epileptic drug if administered wrong could results in Stevens-Johnson syndrome?
1) Lamotrigine
57
What anti-epileptic drug is also used to treat obesity?
Topiramate
58
What is the first line treatment for Typical Absence seizures?
1) Valproate
| 2) Ethosuximide
59
Zonisamide
Tiagabine
Gabapentin
Lacosamide
Adjunct drugs for Focal seizures
60
What is the drug of choice for status epilepticus?
Lorazepam
61
Why must Lorazepam be given quickly when given IV?
1) Because it causes respiratory and cardiovascular depression
62
MOA of Lorazepam
Enhances the neurotransmission of GABA-A synapse
63
MOA of Ethosuximide
Blocks T-type Ca channels of thalamic neurons
64
What are the indications for the use of tPA with stroke?
1) Acute Stroke that occurred less than 3 hours
2) CT scan shows no hemorrhage or edema
3) >18 years old
65
What are contraindications for the use of tPA?
1) Stroke symptoms lasting longer than 3 hours
2) Thrombocytopenia
3) Use of heparin
4) Prior stroke within 3 months
5) Major surgery
6) No witness to onset
66
What is the MOA of corticosteroids?
1) Reduce the formation of leukotrienes and prostaglandins by inhibiting phospholipase 2 (PLA2)
2) Causes suppression and redistribution of leukocytes
67
What drug inhibits phospholipase 2 (PLA2)
Corticosteroids
68
What is the treatment of choice for an acute MS attack?
3-5 day treatment of corticosteroids
69
What are the drugs used to treat MS attacks?
1) Corticosteroids
2) Plamsapheresis
3) IV immunoglobulins
4) Dimethyl fumarate
70
What drugs acts both to reduce MS attacks and disease progression?
Dimethyl fumarate
71
What are adverse effects of IFN beta-1a and 1b?
1) Injection site inflammation
2) Depression
3) Flu syndrome
4) Eventually doesn't work
5) Formation of neutralizing antibodies
72
What type of IFN drug has an increased occurence for production of antibodies against it?
IFN beta 1b
73
What are the adverse effects of Glatiramer?
1) Injection site irritation
| 2) Transient reactions after several months (urticaria, flushing face, chest pain, dyspnea)
74
What drugs are disease modifying for MS?
1) INF 1a and 1b
2) Glatiramer
3) Fingolimod
4) Mitoxantrone
5) Natalizumab
6) Teriflunomide
75
Chemotherapy agent used for the treatment of MS; intercalates with DNA, RNA, and inhibits topoisomerase II
Mitoxantrone
76
What are the adverse effects of Mitoxantrone?
1) Cardiotoxicity
| 2) Acute Myelogenous Leukemia
77
Monoclonal antibody that reduces movement of immune cells into CNS; decreases the frequency of relapses
Natalizumab
78
Adverse effects of Natalizumab
1) Increased incidence of Progressive multifocal leukoencephalopathy
79
Adverse effects of Fingolimod
1) Influenza syndrome
2) Headache
3) Diarrhea
4) Shortness of breath
5) Bradycardia
6) Optic neurtis
80
Active metabolite of lufunomide; oral immunomodulator
Teriflunomide
81
MOA of Teriflunomide
Reversibly inhibits dihydroorotate dehydrogenase
82
MOA of glatiramer
Unknown but believed to be involved with the conversion of TH1 to TH2
83
What is the function of dimethyl fumarate?
1) Immunomodulatory without being immunosuppressed
| 2) Activation of antioxidant genes
84
What are the adverse effects of dimethyl fumarate?
1) Decreases lymphocyte count
| 2) May cause eczema if given topically at low doses
85
What happens if an anti-TNF is given to a pt. with MS?
1) Anti-TNF causes greater severity and frequency of MS attacks
86
What drug is approved for all severe forms of dementia?
Donepazil
87
Drugs approved for mild and moderate dementias
1) Donepazil
2) Galantamine
3) Rivastigmine
88
Drug that inhibits both acetylcholine esterase and butyrylcholine esterase
Rivastigmine
89
What should rivastigmine never be given with?
Muscle relaxant (succinylcholine)
90
What are the adverse effects of anti-choline esterase inhibitors?
Think DUMBBELLS
1) Diarrhea
2) Urination
3) Miosis
4) Bronchorrhea
5) Bradycardia
6) Emesis
7) Lacrimation
8) Salivation/sweating
91
NMDA uncompetitive antagonist
Memantine
92
MOA of Memantine
1) uncompetitively competes with Mg to reduce the influx of Ca
93
Adverse effects of memantine
1) Constipation
94
Adverse effects of Rivastigmine, Galantamine, or Donepazil
Diarrhea
95
When does an anticholine esterase drug have more effect in alzheimers?
Further in progression of disease
96
What are the least tolerated drugs in dementia pt. and make them worse?
1) Anti-cholinergics
2) Old anti-histamines
3) Anti-psychotics
4) Benzodiazepines
97
Where do dopamine antagonists work?
1) Mesolimbic system
2) Extra-pryamidal
3) Tubero-infundibular
4) Brainstem
98
Where does excess dopamine manifest most?
Mesolimbic system
| 1) Causes psychosis
99
Adverse effects of first generation antihistaminics (H1)
1) muscarinic blockade (blurry vision, dry mouth, urinary retention)
2) serotonergic blockage (Appetite stimulation)
3) alpha adrenergic (postural dizziness)
4) Cross blood brain barrier and cause sedation and cognitive dysfunction
100
Hydroxyzine
Promethazine
Chlorpheniramine
Diphenhydramine
First generation antihistamines
101
First line treatment for essential tremors?
Propranolol
102
Treatment for trigeminal neuralgia?
Carbemazepine
103
Treatment for unknown meningitis in 2 month old?
1) Ceftriaxone (3rd gen) - Treatment for N. meninigitidis and Group B Strep
2) Ampicilin - treatment for Listeria
104
Pt. presents with confusion, disoritentation in a tool shed. Excessive lacrimation, wheezing, flushed skin and sweating profusely
Acetylcholine poisoning due to Organophosphate (peseticide poisoning) inhibiting cholineesterase
105
Irreversible cholineesterase inhibitor
Organophosphates (pesticide)
106
Treatment for organophosphate poisoining
1) atropine (muscarinic antagonist)
107
MOA of Morphine
1) Mu agonist
| 2) Causes activation of potassium channels
108
What is the goal of treating glaucoma?
1) Decrease intraocular pressure via decreasing the amount of aqueous humor (Increase drainage or decrease synthesis)
109
Drug that decreases aqueous humor synthesis via inhibiting the carbonic anhydrase
1) Acetazolamide
110
Drugs that inhibit aqueous humor synthesis
1) alpha agonists (Epinephrine and brimonidine)
2) beta blockers (Timolol, betaxolol)
3) Acetazolamide
111
What are the adverse effects of using epinephrine and Brimonidine?
1) Mydriasis (DO NOT USE in Closed angle glaucoma)
| 2) Blurry vision
112
What should you never give to a pt. with closed angle glaucoma?
Any drug that causes Mydraisis (eye dilation)
113
What drugs increase the outflow of aqueous humor
1) Pilocarpine and carbachol (contract ciliary muscles and open trabecular meshwork)
2) Physostigmine and Echothiophate (indirect)
3) Latanoprost (prostaglandin)
114
MOA of Opioids
1) Inhibits the release of ACh, NE, 5-HT, glutamage
| 2) Opens K channels and closes Ca channels --> synaptic transmission
115
Most lipophilic opioid that is given as a dermal patch
Fentanyl
116
Opioid used for migrane
Butorphanol
117
What do all of these do?
Tiagabine
vigabatrin
Gabapentin
Increase effects of GABA
118
MOA of Barbiturates
Think: BarbiDURATes = duration
| Facilitate GABA action by increasing duration of Cl channel opening, thus decreasing neuron firing
119
MOA of benzodiazepines
Think: FREnzodiazepine = increased FREquency
| Facilitate GABA action by increased frequency of Cl channel opening
120
What is the treatment for status eplipeticus
1) Lorazepam (BZD)
2) Phenytoin (Na channel blocker)
3) Phenobarbital (if still seizing)
