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Neurology > Neuro Drugs > Flashcards

Neuro Drugs Flashcards

1
Q

Opioid Mechanism

A

Open K+ channels, close Ca2+ channels (presynaptically)> decreased synaptic transmission

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2
Q

Opioid Clinical Use

A

Pain,cough suppression, diarrhea, pulmonary edema, maintenance program for addicts

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3
Q

Opioid Drugs

A

Morphine, fentanyl, codeine (cough), dextromethorphan (cough), loperamide (diarrhea), diphenoxylate (diarrhea), methadone (addiction help), meperidine

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4
Q

Opioid Toxicity

A

Addiction, respiratory depression, constipation, miosis, additive CNS depression with other drugs

ANTIDOTE: Naloxone or Naltrexone

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5
Q

Butorphanol

A

Mu/kappa-opiod receptor partial agonist
Produces Analgesia
Used for : Migraines, Labor, Severe Pain

Can cause withdrawal symptoms

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6
Q

Tramadol

A

Weak opioid agonist, inhibits Serotonin and NE reuptake
Used for Chronic Pain
Toxicity: Similar to opioids, increased risk of seizures, can cause Serotonin Syndrome

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7
Q

Benzodiazepines Mechanism

A

Binds to GABA Cl- receptor complex > increased frequency of Cl channel opening > hyperpolarization > decreased excitation
Facilitates GABA action

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8
Q

Benzodiazepines Use

A 
1st line for Status Epilepticus 
Anesthesia Induction 
Anxiety 
Eclampsia 
Detox (alcohol withdrawal) 
Hypnotic (insomnia)
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9
Q

Benzodiazepines Drugs

A 
Diazepam (Status Epilepticus, Detox)
Lorazepam(Status Epilepticus)
Triazolam, temazepam, oxazepam  
Midazolam (Anesthesia), 
Chlordiazepoxide (Detox) 
Alprazolam
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10
Q

Benzodiazepines Toxicity

A

Decreased REM sleep, CNS depression (less than barbituates), Dependence

ANTIDOTE: Flumazenil

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11
Q

Barbiturates Mechanism

A

Allosterically modulate GABA receptors > increased duration of Cl channel opening > increased efficacy of GABA

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12
Q

Barbiturates Use

A

Partial and Tonic-Clonic seizures, Anesthesia Induction, Anxiety, Insomnia

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13
Q

Barbiturates Drugs

A

Phenobarbital (Seizures)
Pentobarbital
Thiopental (Anesthesia)
Secobarbital

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14
Q

Barbiturates Toxicity

A

Respiratory and Cardio depression, CNS depression, dependence
Induces P-450

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15
Q

NonBenzodiazepine hypnotics

A

Zolpidem (Ambien), Zaleplon, esZopiclone (ZZZ’s)
Used for Insomnia, short duration
Mechanism: increases Cl conductance of GABA receptor (BZ1 subtype)
Antidote: Flumazenil
Can cause: ataxia, headaches, confusion.

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16
Q

Ethosuximide

A

Used for Absence seizures

Mechanism: Blocks Thalamic T-type Ca channels

Side effects: Fatigue, GI distress, Headache, Itching, Stevens-Johnson syndrome

17
Q

Phenytoin

A

Used for partial, tonic-clonic (1st line), and status epilepticus (prophylaxis)

Mechanism: Na Channel inactivation > inhibition of Glutamate release and enhanced GABA release

Side effects: Teratogenic, Megaloblastic Anemia, Drug induced Lupus (SLE), Neuropathy, Gingival hyperplasia, hirsutism (bearded lady), Stevens-Johnson syndrome
P-450 inducer

18
Q

Carbamazepine

A

1st line medication for partial and tonic-clonic seizures, as well as trigeminal neuralgia

Mechanism: Na Channel inactivation

Side effects: Teratogenic, Hepatoxicity, Stevens-Johnson syndrome, blood dyscrasias (agranulocytosis, aplastic anemia), SIADH, P-450 inducer

19
Q

Valproic Acid

A

1st line medication for tonic-clonic seizures, also used for partial and absence seizures, bipolar disorder

Mechanism: Na Channel inactivation, and inhibits GABA transaminase> increases GABA concentration

Side effects: GI distress, hepatotoxicty, neural tube defects (spina bifida), tremor, weight gain

20
Q

Lamotrigine

A

Used for all seizures but not in status epilepticus

Mechanism: Blocks voltage-gated Na channels

Side effects: Stevens-Johnson syndrome

21
Q

Gabapentin

A

Used for partial and tonic-clonic seizures
Also used for peripheral neuropathy, postherpetic neuralgia, migraine prophylaxis, and bipolar disorder

Mechanism: Inhibits voltage-gated Ca channels, designed as GABA analog but doesn’t work this way

Side effects: Sedation, ataxia

22
Q

Topiramate

A

Used for partial and tonic-clonic seizures
Migraine prophylaxis

Mechanism: Inhibits voltage-gated Na channels, potentiates GABA action

Side effects: Kidney stones, weight loss, sedation

23
Q

Tiagabine

A

Used for partial seizures

Mechanism: Inhibits GABA reuptake

24
Q

Vigabatrin

A

Used for partial seizures

Mechanism: Inhibits GABA transaminase

25
Q

Levetiracetam

A

Used for partial and tonic-clonic seizures

Unknown mechanism

26
Q

Sumatriptan

A

Used for acute migraine, cluster headaches

Mechanism: 5-HT agonist, inhibits trigeminal nerve activation, induces vasoconstriction

Side effects: Coronary vasospasm, tingling

Contraindicated in patients with Prinzmetal’s Angina and CAD

27
Q

Inhaled anesthetics

A 
Halothane (hepatotoxcity)
Enflurane (proconvulsant)
Isoflurane 
Sevoflurane 
Methoxyflurane (nephrotoxcity)
Nitrous Oxide (expansion of trapped gas)

Causes myocardial/respiratory depression, nausea/emesis, increases cerebral blood flow and decreases cerebral metabolic demand

Can all (except NO) cause malignant hyperthermia > treat with Dantroline

28
Q

Intravenous anesthetics

A

Barbiturates (thiopental), benzodiazepines (midazolam), Ketamine (NMDA receptor blocker), Opioids (morphine, fentanyl), and Propofol (potentiates GABA)

Michael Jackson died from home use of Propofol (now you can’t forget it)

29
Q

Local anesthetics

A

Esters (procaine, cocaine, tetracaine)
Amides (lidocaine, mepivacaine, bupivacaine) 2 I’s

Mechanism: block Na channel, preferentially activated channels

Used for minor procedures and spinal anesthesia(epidurals). Given with vasoconstrictors (epinephrine) to enhance local action. Infected tissue requires higher dose.

If allergic to esters, give amides

Order of loss: pain, temperature, touch, pressure
Order of nerve blockade: small myelinated fibers > small unmyelinated fibers > large myelinated fibers > large unmyelinated fibers

30
Q

Succinycholine

A

Depolarizing neuromuscular block
Used for muscle paralysis in surgery and intubation, very short acting

Mechanism: ACh receptor agonist > sustained depolarization > repolarized but blocked

Side Effects: hypercalcemia, hyperkalemia, malignant hyperthermia

ANTIDOTE: Neostigmine and other AChE inhibitors

31
Q

Nondepolarizing neuromuscular blocks

A

Tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, rocuronium

Competitive ACh antagonists

ANTIDOTE: Neostigmine and other AChE inhibitors

32
Q

Dantrolene

A

Treats malignant hyperthermia and neuroleptic malignant syndrome
Ryanodine inhibitor

33
Q

Parkinson drugs

A

BALSA
Bromocriptine (dopamine agonist)
Amantadine (increase dopamine release)
Levodopa (increase dopamine. Used with carbidopa)
Selegiline (MAO- inhibitor, prevents dopamine breakdown)
Antimuscarinics (Benztropine)

Can use COMT inhibitors (entacapone, tolcapone)

34
Q

Alzheimer drugs

A

Memantine (NMDA receptor antagonist, helps prevent excitotoxicity) can cause confusion and hallucinations

Donepezil, rivastigmine, galantamine (AChE inhibitors)

35
Q

Huntington drugs

A

Haloperidol (dopamine receptor antagonist)

Tetrabenazine/reserpine (inhibit VMAT -> limit dopamine vesicle packaging and release)

36
Q

Epilepsy drugs that cause Stevens-Johnson syndrome

A

Lamotrigine, phenytoin, carbamazepine, ethosuximide, phenobarbital

Neurology (4 decks)

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