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Neuro Drugs Flashcards

1
Q

What is the acute treatment for tension headaches?

A

1) NSAIDs
2) Caffeine
3) Butalbital (barbiturate)

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2
Q

MOA of Butalbital

A

1) Facilitaes GABA neurotransmission

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3
Q

MOA of Caffeine

A

1) Acts as a competitive antagonists for adenosine receptor

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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

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5
Q

What are the three older antidepressants used for prophylactic treatment of tension headaches?

A

1) Amitriptyline
2) Doxepin
3) Imipramine

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6
Q

What is the MOA of Sumatriptan?

A

1) 5-HT1 b/d agonist; also known as triptan class

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7
Q

Which 5-HT1 b/d agonist has the slowest time to onset?

A

1) Naratriptan

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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

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9
Q

What are the adverse effects of 5-HT1 b/d triptans?

A

1) Altered sensation
2) Pain at injection
3) Chest discomfort

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10
Q

What are the three contraindications of triptans?

A

1) Coronary artery disease
2) Uncontroled HTN
3) Prinzmetal angina

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11
Q

What is given to pt who has Sjogren’s syndrome?

A

1) Pilocarpine- direct cholinomimetic

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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

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13
Q

What is the treatment for migraine headaches?

A

1) NSAIDs
2) Triptans or Ergots
3) Dopamine Antagonists (D2)

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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

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15
Q

Inability to sit; restlessness

A

Akathisia

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16
Q

What is the drug used initially for Parkinson’s?

A

1) MAO-B inhibitors (-gilines)

2) Selegiline and Rasagiline

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17
Q

Non-selective MAO inhibitors?

A

1) Red wine

2) Aged cheese

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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

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19
Q

What are the Dopamine agonists used to treat Parkinson disease?

A

1) Pramipexole (D3 agonist)

2) Ropinirole (D2 agonist)

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20
Q

Biperiden
Trihexyphenidyl
Benztropine

A

Centrally acting Anti-muscarinics

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21
Q

What are the side effects of anti-muscarinics?

A

1) Dry mouth
2) Urinary retention
3) Constipation

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22
Q

Pramipexole

Ropinirole

A

Dopamine agonists

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23
Q

What are contraindications for amantidine?

A

1) Seizures

2) Congestive heart failure

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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

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25
Q

What is always given with L-DOPA? Why?

A

1) Carbidopa

2) Carbidopa inhibits the formation of peripheral dopamine resulting in L-DOPA use at lower doses

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26
Q

Why can’t Phenothiazine be used for treatment of L-DOPA induced nausea?

A

1) Phenothizine is a dopamine receptor antagonist resulting in increased Parkinson

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27
Q

Entacapone

A

COMT inhibitor

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28
Q

What are the adverse effects of L-DOPA?

A

1) Nausea and vomiting
2) Arrhythmias
3) Dyskinesia
4) Behavior change

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29
Q

What are the treatments for Myasthenia gravis?

A

1) Immunosuppressants
2) Plasmapheresis
3) Anticholine esterase

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30
Q

What are the immunosuppressants used in Myasthenia gravis?

A

1) Azathioprine
2) Cyclosporine
3) IV immunoglobulin

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31
Q

MOA of Azathioprine

A

1) Converted to mercaptopurine which inhibits cell proliferation by interfering with purine metabolism

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32
Q

Neostigmine

Pyridostigmine

A

Quaternary Anti-choline esterase

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33
Q

What must Quaternary anticholine esterases be given with?

A

An anti-muscarinic due to the increase in cholinergic neurons at other sites

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34
Q

GABA analogue for GABA-B receptor; useful for MS, Spinal injury, and ALS

A

Baclofen

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35
Q

MOA of Diazepam

A

Increases GABAnergic neurotranmission

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36
Q

MOA of Tizanidine

A

1) Analouge of clonidine

2) Reinforces inhibitory effects in spinal cord (alpha 2 agonist)

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37
Q

MOA of Riluzole

A

1) Inhibits glutamate release

2) Used for ALS and to delay tracheostomy

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38
Q

MOA of Gabapentin

A

1) Increases release of GABA

2) Also used for peripheral neuropathy pain reduction

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39
Q

MOA of Dantrolene

A

Skeletal muscle relaxant by interfering with release of calcium ions

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40
Q

MOA of Baclofen

A

1) GABA-B agonist

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41
Q

Adverse effects of Baclofen

A

Drowsiness

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42
Q

What in general is the adverse effects of GABAergic drugs?

A

1) Drowsiness

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43
Q

Describe the Tensilon test

A

1) Used to determine treatment effectiveness
2) Use Edrophonium
3) Improvement = under dosed
4) Worsening = over dose (cholinergic crisis)

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44
Q

What are the indications and contraindications for Na channel blockers?

A

1) Indications: generalized tonic-clonic and focal seizures

2) Contraindications: Absence seizures (makes them worse)

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45
Q

What are Calcium ion channel blockers indicated for? Contraindicated?

A

1) Indications: simple absence seizures

2) Contraindications: Generalized tonic-clonic seizures

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46
Q

What are the adverse effects of valproate?

A

1) GI epigastric distress
2) Hepatic damage
3) Teratogenic (cause neural tube defects)

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47
Q

What are the adverse effects of Lamotrigine?

A

1) May induce Stevens-Johnson syndrome
2) Insomnia
3) Nightmares and vivid dreams

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48
Q

What two drugs are effective against all types of seizures?

A

1) Valproate

2) Lamotrigine

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49
Q

What type of seizure should a Na channel drug never be given to?

A

1) Absence seizures

2) Makes seizure worse

50
Q

What are the three first line drugs used for generalized seizures?

A

1) Valproate
2) Lamotrigine
3) Topiramate

51
Q

What anti-epileptic drug causes bone marrow depression?

A

Carbamazepine

52
Q

What are the first line drugs for focal seizures?

A

1) Lamotrigine
2) Carbamazepine and Oxcarbazepine
3) Phenytoin
4) Levetiracetam

53
Q

Epileptic drug that has first order elimination in low to mid therapeutic range and zero order elimination in high therapeutic range?

A

1) Phenytoin

54
Q

What are the clinical findings of Phenytoin drug toxicity?

A

1) Cerebral and vestibular symptoms
2) Gingival hyperplasia
3) Osteomalacia
4) Teratogenic

55
Q

What are the teratogenic effects of phenytoin?

A

1) Cardiac damage

2) Cleft palate

56
Q

What anti-epileptic drug if administered wrong could results in Stevens-Johnson syndrome?

A

1) Lamotrigine

57
Q

What anti-epileptic drug is also used to treat obesity?

A

Topiramate

58
Q

What is the first line treatment for Typical Absence seizures?

A

1) Valproate

2) Ethosuximide

59
Q

Zonisamide
Tiagabine
Gabapentin
Lacosamide

A

Adjunct drugs for Focal seizures

60
Q

What is the drug of choice for status epilepticus?

61
Q

Why must Lorazepam be given quickly when given IV?

A

1) Because it causes respiratory and cardiovascular depression

62
Q

MOA of Lorazepam

A

Enhances the neurotransmission of GABA-A synapse

63
Q

MOA of Ethosuximide

A

Blocks T-type Ca channels of thalamic neurons

64
Q

What are the indications for the use of tPA with stroke?

A

1) Acute Stroke that occurred less than 3 hours
2) CT scan shows no hemorrhage or edema
3) >18 years old

65
Q

What are contraindications for the use of tPA?

A

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
Q

What is the MOA of corticosteroids?

A

1) Reduce the formation of leukotrienes and prostaglandins by inhibiting phospholipase 2 (PLA2)
2) Causes suppression and redistribution of leukocytes

67
Q

What drug inhibits phospholipase 2 (PLA2)

A

Corticosteroids

68
Q

What is the treatment of choice for an acute MS attack?

A

3-5 day treatment of corticosteroids

69
Q

What are the drugs used to treat MS attacks?

A

1) Corticosteroids
2) Plamsapheresis
3) IV immunoglobulins
4) Dimethyl fumarate

70
Q

What drugs acts both to reduce MS attacks and disease progression?

A

Dimethyl fumarate

71
Q

What are adverse effects of IFN beta-1a and 1b?

A

1) Injection site inflammation
2) Depression
3) Flu syndrome
4) Eventually doesn’t work
5) Formation of neutralizing antibodies

72
Q

What type of IFN drug has an increased occurence for production of antibodies against it?

A

IFN beta 1b

73
Q

What are the adverse effects of Glatiramer?

A

1) Injection site irritation

2) Transient reactions after several months (urticaria, flushing face, chest pain, dyspnea)

74
Q

What drugs are disease modifying for MS?

A

1) INF 1a and 1b
2) Glatiramer
3) Fingolimod
4) Mitoxantrone
5) Natalizumab
6) Teriflunomide

75
Q

Chemotherapy agent used for the treatment of MS; intercalates with DNA, RNA, and inhibits topoisomerase II

A

Mitoxantrone

76
Q

What are the adverse effects of Mitoxantrone?

A

1) Cardiotoxicity

2) Acute Myelogenous Leukemia

77
Q

Monoclonal antibody that reduces movement of immune cells into CNS; decreases the frequency of relapses

A

Natalizumab

78
Q

Adverse effects of Natalizumab

A

1) Increased incidence of Progressive multifocal leukoencephalopathy

79
Q

Adverse effects of Fingolimod

A

1) Influenza syndrome
2) Headache
3) Diarrhea
4) Shortness of breath
5) Bradycardia
6) Optic neurtis

80
Q

Active metabolite of lufunomide; oral immunomodulator

A

Teriflunomide

81
Q

MOA of Teriflunomide

A

Reversibly inhibits dihydroorotate dehydrogenase

82
Q

MOA of glatiramer

A

Unknown but believed to be involved with the conversion of TH1 to TH2

83
Q

What is the function of dimethyl fumarate?

A

1) Immunomodulatory without being immunosuppressed

2) Activation of antioxidant genes

84
Q

What are the adverse effects of dimethyl fumarate?

A

1) Decreases lymphocyte count

2) May cause eczema if given topically at low doses

85
Q

What happens if an anti-TNF is given to a pt. with MS?

A

1) Anti-TNF causes greater severity and frequency of MS attacks

86
Q

What drug is approved for all severe forms of dementia?

87
Q

Drugs approved for mild and moderate dementias

A

1) Donepazil
2) Galantamine
3) Rivastigmine

88
Q

Drug that inhibits both acetylcholine esterase and butyrylcholine esterase

A

Rivastigmine

89
Q

What should rivastigmine never be given with?

A

Muscle relaxant (succinylcholine)

90
Q

What are the adverse effects of anti-choline esterase inhibitors?

A

Think DUMBBELLS

1) Diarrhea
2) Urination
3) Miosis
4) Bronchorrhea
5) Bradycardia
6) Emesis
7) Lacrimation
8) Salivation/sweating

91
Q

NMDA uncompetitive antagonist

92
Q

MOA of Memantine

A

1) uncompetitively competes with Mg to reduce the influx of Ca

93
Q

Adverse effects of memantine

A

1) Constipation

94
Q

Adverse effects of Rivastigmine, Galantamine, or Donepazil

95
Q

When does an anticholine esterase drug have more effect in alzheimers?

A

Further in progression of disease

96
Q

What are the least tolerated drugs in dementia pt. and make them worse?

A

1) Anti-cholinergics
2) Old anti-histamines
3) Anti-psychotics
4) Benzodiazepines

97
Q

Where do dopamine antagonists work?

A

1) Mesolimbic system
2) Extra-pryamidal
3) Tubero-infundibular
4) Brainstem

98
Q

Where does excess dopamine manifest most?

A

Mesolimbic system

1) Causes psychosis

99
Q

Adverse effects of first generation antihistaminics (H1)

A

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
Q

Hydroxyzine
Promethazine
Chlorpheniramine
Diphenhydramine

A

First generation antihistamines

101
Q

First line treatment for essential tremors?

A

Propranolol

102
Q

Treatment for trigeminal neuralgia?

A

Carbemazepine

103
Q

Treatment for unknown meningitis in 2 month old?

A

1) Ceftriaxone (3rd gen) - Treatment for N. meninigitidis and Group B Strep
2) Ampicilin - treatment for Listeria

104
Q

Pt. presents with confusion, disoritentation in a tool shed. Excessive lacrimation, wheezing, flushed skin and sweating profusely

A

Acetylcholine poisoning due to Organophosphate (peseticide poisoning) inhibiting cholineesterase

105
Q

Irreversible cholineesterase inhibitor

A

Organophosphates (pesticide)

106
Q

Treatment for organophosphate poisoining

A

1) atropine (muscarinic antagonist)

107
Q

MOA of Morphine

A

1) Mu agonist

2) Causes activation of potassium channels

108
Q

What is the goal of treating glaucoma?

A

1) Decrease intraocular pressure via decreasing the amount of aqueous humor (Increase drainage or decrease synthesis)

109
Q

Drug that decreases aqueous humor synthesis via inhibiting the carbonic anhydrase

A

1) Acetazolamide

110
Q

Drugs that inhibit aqueous humor synthesis

A

1) alpha agonists (Epinephrine and brimonidine)
2) beta blockers (Timolol, betaxolol)
3) Acetazolamide

111
Q

What are the adverse effects of using epinephrine and Brimonidine?

A

1) Mydriasis (DO NOT USE in Closed angle glaucoma)

2) Blurry vision

112
Q

What should you never give to a pt. with closed angle glaucoma?

A

Any drug that causes Mydraisis (eye dilation)

113
Q

What drugs increase the outflow of aqueous humor

A

1) Pilocarpine and carbachol (contract ciliary muscles and open trabecular meshwork)
2) Physostigmine and Echothiophate (indirect)
3) Latanoprost (prostaglandin)

114
Q

MOA of Opioids

A

1) Inhibits the release of ACh, NE, 5-HT, glutamage

2) Opens K channels and closes Ca channels –> synaptic transmission

115
Q

Most lipophilic opioid that is given as a dermal patch

116
Q

Opioid used for migrane

A

Butorphanol

117
Q

What do all of these do?
Tiagabine
vigabatrin
Gabapentin

A

Increase effects of GABA

118
Q

MOA of Barbiturates

A

Think: BarbiDURATes = duration

Facilitate GABA action by increasing duration of Cl channel opening, thus decreasing neuron firing

119
Q

MOA of benzodiazepines

A

Think: FREnzodiazepine = increased FREquency

Facilitate GABA action by increased frequency of Cl channel opening

120
Q

What is the treatment for status eplipeticus

A

1) Lorazepam (BZD)
2) Phenytoin (Na channel blocker)
3) Phenobarbital (if still seizing)

Drugs (13 decks)

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