Neuro Drugs

Question 1

Opioids (“Poppy-Droid”)

Answer 1

Drugs: morphine; fentanyl; codeine; loperamide; methadone; meperidine; dextromethorphan; diphenoxylate.

Mechanism: agonist (“dragonists”) at mu/delta/kappa receptors (“mu/delta/kappa fraternity”); decreases synaptic transmission (“down-arrow synapse-cell-phone”) via opening K-channels and closing Ca-channels.

Indication: pain (“pain-bolts”); cough (“dragonist coughing-up coffee”, dextromethorphan); diarrhea (“dragonist on toilet”, loperamide and diphenoxylate); weaning off other opioids (“weiners”, methadone for heroin abuse); acute pulmonary edema.

Side effects: pulmonary depression (“deflated lungs”); addiction (“addict”); constipation (“cork in con-toilet”); miosis (“mice-eyes”); toxicity treated with naloxone/naltrexone; tolerance does not develop to miosis or constipation.

Question 2

Dextromethorphan

Answer 2

Class: opioid.

Indication: cough suppression (“dragonist coughing-up coffee”)

Question 3

Methadone

Answer 3

Class: opioid.

Indication: heroin addiction.

Question 4

Butorphanol (“Butter-Funnel”)

Answer 4

Mechanism: partial agonist (“partial-frat-dragonists”) at mu/kappa opioid receptors (“mu/kappa fraternity”); less respiratory depression than full opioids (“half-deflated lungs”).

Indication: severe pain (“severed-arm pain”); migraines (“mind-rain”); labor (“lady in labor”).

Side effects: can cause withdrawl when used with full opioid agonist (“ATM-withdrawl”); overdose not easily reversed with naloxone.

Question 5

Tramadol (“Trauma-Doll”)

Answer 5

Mechanism: weak opioid agonist (“weak poppy-droid”); 5-HT and NE reuptake inhibitors (“inhibiting chains on north-epi-pen and silver-tonic reuptake tube with inhibiting chains”).

Indication: chronic pain (“old-crone with pain-bolts”).

Side effects: increased seizure risk (“up-arrow Caesar climbing”); serotonin syndrome.

Question 6

Ethosuximide (“ET-Socks”)

Answer 6

Class: anti-seizure.

Mechanism: blocks thalamic T-type Ca-channels (“block-guy blocking Thor-T on calcium-cow at channel”).

Indication: first-line treatment of absence seizures (“first-place absent-minded Caesar”).

Side effects: diarrhea (“toilet”); fatigue (“sleepy-guy on toilet”); Stevens-Johnson syndrome (“Steve-Johns with rash”).

Question 7

Phenytoin (“Phone-Tow Truck”)

Answer 7

Class: anti-seizure (“Caesar in a parade”).

Mechanism: increased Na-channel inactivation (“blocked salt-shakers at the channel”); inhibits glutamate release (“glue-bottle-tomatoes with inhibiting chains”); class 1B antiarrythmic (“1-wand bee-anti-tie-arrhythmia-drummer”).

Indication: first-line for tonic-clonic seizure (“Caesar with clown-tonic”); simple and complex partial seizures; prophylaxis of status epilepticus (“statue-Caesar”).

Side effects: teratogen (“tarantula-gem”); megaloblastic anemia (“macaroni-anemone”); drug-induced lupus (“loopy-pill-butterfly caught in rocket”); peripheral neuropathy (“wavy-neuron-arm-guy waving at Caesar”); hirsutism (“bearded-lady driving phone-tow truck”); gingival hyperplasia (“gums and teeth wind-up toy”); induction of cytochrome P-450 (“side-toe-chrome pea-450 rocket”); nystagmus/diplopia.

Question 8

Carbamazepine (“Car-Bomb-Maze-Pine”)

Answer 8

Class: anti-seizure (“Caesar at race track”).

Mechanism: increased Na-channel inactivation (“salt-shakers blocked at the channel”).

Indication: first line treatment of simple, complex and tonic-clonic seizures (“Caesar winning first place at race”); trigeminal neuralgia (“Caesar winning tri-gem nerve-algea award”); bipolar disorder.

Side effects: Stevens-Johnson syndrome (“Steve-Johns sabotaging race”); teratogenic (“tarantula-gem bitting liver-race-official”); liver toxicity (“liver with toxic-green-glow after being bit my tarantula-gem”); blood dyscrasias (agranulocytosis, aplastic anemia, “blood-cell spectator being cut in half by disc-razor”); cytochrome P-450 induction (“Steve-Johns riding side-toe-chrome pea-450 rocket”); diplopia; ataxia.

Question 9

Valprotic Acid (“Vault-Pro-Lemon”)

Answer 9

Class: anti-seizure (“first-place tonic-clown Caesar at vaulting competition”).

Mechanism: increased Na-channel inactivation (“salt-shakers blocked at channel”); increased GABA by inhibiting GABA transaminase (“up-arrow GABA-goose flying vault-pro-lemon to safety”).

Indication: first-line treatment of tonic-clonic seizure (“first-place tonic-clown Caesar”); treatment of simple, complex and absence seizures; bipolar disorder (“Caesar’s bipolar-bear”); migraine prophylaxis (“mind-rain with purple-axes over bipolar-bear”).

Side effects: GI distress (“distressed GI with flare gun”); contraindicated in pregnancy (“pregnant woman waving caution-tape”, neural tube defects due to folate antagonism; rare hepatotoxicity; tremor; weight gain.

Question 10

Gabapentin (“GABA-Goose-Penguin”)

Answer 10

Class: anti-seizure (“penguins disguised as geese to get into Caesar’s zoo”).

Mechanism: GABA analog (“GABA-goose on-a-log”); blocks voltage-gated Ca-channels (“inhibited electric-gate calcium-cow”).

Indication: simple, complex and tonic-clonic seizures (“Caesar in water”); peripheral neuropathy (“Caesar with wavy-nerve-arms”); postherpatic neuralgia (“post-harp girl with nerve-algea”); bipolar disorder (“bipolar bear at zoo”); migraine prophylaxis (“mind-rain with purple-axes”).

Side effects: sedation (“cow shooting sedation dart into penguin”); ataxia (“penguin starting to stumble”).

Question 11

Barbituates (“Barbi-Dolls”)

Answer 11

Class: CNS depressants (“deflated CNS-brain”).

Drugs (think “barb-wire” for -barb- in name): phenobarbital; pentobarbital; thiopental; secobarbital.

Mechanism: facilitate GABA action by increasing the duration (vs. benzos) of Cl-channel opening (“up-arrow open-late-clock on chlorine-dispenser dance-stage”); decreases neuron firing (“throwing-out down-arrow nerve-on-fire”).

Indication: anxiety; seizure (“VIP-Caesar at club”); insomnia; induction of anesthesia (“a-nest induction-duck”).

Side effects: respiratory and CV depression (“Barbi shooting sedation-dart at deflated heart and lungs”); CNS depression (“depressed CNS-brain”, can be exacerbated by ETOH); induction of cytochrome P-450 (“pea-450 rocket shooting out of nest”); overdose treatment is supportive (respiration and BP).

Question 12

Topiramate (“Toe-Primate”)

Answer 12

Class: anti-seizure (“Caesar taken hostage by the toe-primate in the salt-shaker city”).

Mechanism: blocks voltage-gated Na-channels (“salt-shakers being blocked by electric-gate at channel”); increase GABA (“up-arrow GABA-goose”).

Indication: simple, complex and tonic-clonic seizure (“Caesar of the salt-shaker city”); migraine prophylaxis (“mind-rain purple-axes”).

Side effects: sedation (“skinny-guy shooting sedation-dart at toe-primate”); kidney stones (“kidney throwning stones at toe-primate”); weight loss (“skinny-guy”); mental dulling.

Question 13

Lamotrigine (“Lamo-Ghini”)

Answer 13

Class: anti-seizure.

Mechanism: blocks voltage-gated Na-channels (“salt-shaker security guards blocked at electric-channel”).

Indication: seizure (“Caesar stealing Steve-Johns’ lambo”); bipolar disorder (“Caesar’s bipolar bear driving lambo”).

Side effects: Stevens-Johnson syndrome (“Steve-Johns’ lambo”).

Question 14

Levetiracetam

Answer 14

Class: anti-seizure.

Mechanism: unknown; may increase GABA and glutamate release.

Indication: simple, complex and tonic-clonic seziure.

Question 15

Tiagabine

Answer 15

Class: anti-seizure.

Mechanism: increase GABA by inhibiting reuptake.

Indication: partial seizures.

Question 16

Vigabatrin

Answer 16

Class: anti-seizure.

Mechanism: increase GABA by irreversibly inhibiting GABA transaminase.

Question 17

Parkinson Disease Drugs (“Park-In-Sun Garage”)

Answer 17

Drugs (BALSA acronym, “BALSA wood factory accross the street from the park-in-sun garage”): bromocriptine (“broom-crypt-keeper”); amantadine (“a-manta-ray”); levodopa/carbidopa (“levitating L-doberman”); selegiline (“sledge-lion”); antimuscarinics (“ant-tie-mustache factory owner”, benztropine).

Mechanism: varying; increase dopamine in dopamaine-depleted brain (“dobermans diving down into sewer”); decrease acetylcholine to combat acetylcholine increase (“up-arrow seagull-colas”).

Question 18

Bromocriptine (“Broom-Crypt-Keeper”)

Answer 18

Class: dopamine agonist (“broom-crypt-keeper pulling dobermans out of sewer”).

Indication: Parkinson disease (“park-in-sun garage”).

Question 19

Pramipexole

Answer 19

Class: dopamine agonist (preferred over bromocriptine).

Indication: Parkinson disease.

Side effects: compulsive behaviors; hallucinations; not well tolerated in elderly/dementia patients.

Question 20

Ropinirole

Answer 20

Class: dopamine agonist (preferred over bromocriptine).

Indication: Parkinson disease.

Side effects: compulsive behaviors; hallucinations; not well tolerated in elderly/dementia patients.

Question 21

Amantadine (“A-Manta-Ray”)

Answer 21

Mechanism: unknown; may increase dopamine release (“a-manta-ray craddling doperman”).

Indication: Parkinson disease (“park-in-sun garage”); influenza A and rubella.

Side effects: ataxia.

Question 22

Levodopa/Carbidopa (“Levitating L-Doberman and Carpet-Doberman”)

Answer 22

Mechanism: dopamine precursor that increases dopamine levels in brain (“up-arrow doberman with brain”); levodopa crosses the BBB and is converted to dopamine by dopa decarboxylase (“doberman crossing blood brain barriar”); carbidopa is a decarboxylase inhibitor that prevents the peripheral conversion of levodopa to dopamine, which increases bioavailability to the brain (“up-arrow bio-cans”) and decreases peripheral side effects.

Indication: Parkinson disease (“park-in-sun garage”).

Side effects: arrhythmia due to increased peripheral formation of catechols (“arrythmia-drum on BBB-road”); dykinesia (“disc-kite being held by drum”); akinesia between doses.

Question 23

Selegiline (“Sledge-Lion”)

Answer 23

Class: MAO type B inhibitor (“Mao with inhibiting-chains”); preferentially increases dopamine over NE and 5-HT.

Mechanism: increase amine neurotransmitters (“up-arrow a-mines”).

Indication: Parkinson disease (“park-in-sun garage”); atypical depression (“depressed emo”).

Side effects: enhance adverse effects of levodopa.

Question 24

Benztropine (“Benz-Trooper”)

Answer 24

Class: anticholinergic (“ant-tie-cola”).

Indication: Parkinson disease (“benz-trooper giving ticket to boat crashed into park-in-sun garage”).

Other: improves tremor and rigidity, but not bradykinesia.

Question 25

Huntington Disease Drugs

Answer 25

NT changes in HD: decrease GABA, decrease ACh, increase dopamine.

Tetrabenazine and Reserpine: inhibit vesicular monoamine transporter (VMAT); limit dopamine vesicle packaging and release.

Haloperinol: dopamine receptor antagonist (antipsychotic).

Question 26

Tetrabenazine

Answer 26

Class: VMAT inhibitor; limits dopamine vesicle packaging and release.

Indication: Huntington disease.

Question 27

Reserpine

Answer 27

Class: VMAT inhibitor; limits dopamine vesicle packaging and release.

Indication: Huntington disease.

Question 28

Entacapone

Answer 28

Class: COMT inhibitor (prevents degredation of L-dopa).

Indication: Parkinson disease.

Question 29

Tolcapone

Answer 29

Class: COMT inhibitor (prevents degredation of L-dopa).

Indication: Parkinson disease.

Question 30

Benzodiazepines (“Benz-Dice”)

Answer 30

Drugs (think about “Z-Pam Anderson” for -zepam and “Z-lamb” for -zolam): diazepam; lorazepam; triazolam; temazepam; oxazepam; midazolam; chlordiazepoxide; alprazolam.

Mechanism: facilitate GABA action by increasing the frequency (vs. barbituates) of chloride channel opening (“up-arrow revolving door on chloride-dispenser channel”).

Indication: anxiety (“pregnant woman with axiety bag”); eclampsia (“pregnant woman with E-clamp rolling benz-dice at Caesar’s Palace); spasticity; status epilecticus (“statue-Caesar”, first line); detoxification (“D-tux dealer taking away the pregnant woman’s toxins”, especially DTs); night terrors and sleep walking; induction of general anesthesia (“A-nest induction-duck”); insomnia.

Side effects: decreased REM sleep (“down-arrow sleeping rum bottle”); CNS depression (“deflated CNS-brain”); dependence (“dependence ball-and-chain on CNS-brain”); treat overdose with flumazenil (“flute-mace-nail”), a competative antagonist at GABA receptor.

Question 31

Nonbenzodiazepine Hypnotics (“Nun-Benz-Dice Hypnotist”)

Question 32

Sumatriptan (“Sumo-Tripping”)

Answer 32

Class: triptan.

Mechanism: 5-HT agonist (“dragonist getting drunk on silver-tonic and tripping sumo”); inhibits trigeminal nerve activation (“sumo wrapping inhibiting chains on tri-gem-nerve hammer”); induces vasoconstriction (“vessel-constrictor with tri-gem-nerve hammer”); prevents vasoactive peptide release.

Indication: acute migrane (“mind-rain in whack-a-head game”); cluster headaches (“cluster of head-egg lumps in whack-a-head game”).

Side effects: coronary vasospasm (“heart vessel-spaceship”); contraindicated in CAD or Prinzmetal angia (“prince-metal-angel with caution-tape”).

Question 33

Inhaled Anesthetics (“A-Nest of Inhaled Anesthesia”)

Answer 33

Drugs (most end with -flurane, use HEISMN acronym, think “football scene with injuring player in a-nest”): halothane; enflurane; isoflurane; sevoflurane; methoxyflurane; nitrous oxide.

Mechanism: unknown (“question-mark mechanism”).

Indication: induce and maintain anesthesia (“a-nest”).

Effects: mycardial depression (“football player stiff-arming mayo-heart”); respiratory depression (“player stepping on deflated-lungs”); decreased cerebral metabolic demand (“player dropping down-arrow metal-ball on brain”); increased cerebral blood flow (“metal-ball pushing up-arrow blood up into the brain”); nausua/emesis.

Side effects: seizure (enflurane, “Caesar dumping toxic waste on liver and kidney coaches”); hepatotoxicity (halothane, “toxic-green-liver coach”); nephrotoxicity (methoxyflurane, “toxic-green-kidney coach”); expansion of trapped gas in body cavity (nitrous oxide; “expanded-gas blimp”); malignant hyperthermia (caused by all except NO; “malignant Michelin-man with hiker-thermometer”, treat with dantrolene).

Question 34

Halothane

Answer 34

Class: inhaled anesthetic.

Side effect: hepatotoxicity (“toxic-green-liver coach”).

Remeber: halothane = hepatotoxicity.

Question 35

Methoxyflurane

Answer 35

Class: inhaled anesthetic.

Side effect: nephrotoxicity (“toxic-green-kidney coach”).

Remeber: M…N = methoxyflurane…nephrotoxicity.

Question 36

Enflurane

Answer 36

Class: inhaled anesthetic.

Side effect: seizure (“Caesar dumping toxic-waste on liver and kidney coaches”).

Question 37

Nitrous Oxide

Answer 37

Class: inhaled anesthetic.

Side effect: expansion of trapped gas in body cavity (“gas-guy blimp”); does not cause malignant hyperthermia.

Remember: NO expands in body cavities just like nitrogen expands in the bends after scuba diving.

Question 38

IV Anesthetics (“Ivy A-Nest with Anesthetized-Guy”)

Answer 38

Drugs: barbituates (“barbi holding IV tubing”, thiopental); benzodiazepines (“benz-dice shooting out of deflated lungs”, midazolam”); ketamine (“kettle-man dumping ivy-tea on NMDA-receptor ant-toga”); opiods (“poppy-droid”, morphine and fentanyl); propofol (“purple owl holding open receptor for GABA-goose with A-apple”).

Question 39

Thiopental

Answer 39

Class: barbituate (“barbi”).

Indication: induction of anesthesia and short surgical procedures.

Notes: highly lipid soluble = high potency; decreases cerebral blood flow.

Question 40

Midazolam

Answer 40

Class: benzodiazepine (“benz dice hitting anesthetized-man in ivy-a-nest”).

Indication: endoscopy; used as adjuvant with inhaled anesthetics and narcotics.

Notes: may cause severe respiratory depression (“benz-dice shooting out deflated lungs”), hypotension (“hippo-BP stepping on lungs”), and anterograde amnesia.

Question 41

Ketamine (“Kettle-Man”)

Answer 41

Class: arylcyclohexylamine; PCP analog.

Mechanism: NMDA receptor antagonist (“kettle-man dumping ivy-tea on ant-toga with NMDA-receptor”).

Indication: anesthesia; reducing morphine tolerance.

Notes: “dissociative anesthetic”; cardivascular stimulant and preserves ventilation (can be used in unstable patients); can cause hallucinations (“halloween-hallucination pumkin”); increases cerebral blood flow.

Question 42

Propofol (“Purple-Owl”)

Answer 42

Mechanism: potentiates GABA-A (“purple-owl holding open receptor for GABA-goose with A-apple”).

Indication: sedation in ICU; rapid anesthesia induction; anesthesia in short procedures.

Notes: less postoperative nausea than thiopental.

Question 43

Succinylcholine (“Sucker-Cola”)

Answer 43

Action: depolarizing (“D-polar-bear”) neuromuscular blocker (“nerve-muscle block roller coaster”); partial agonist at nicotinic acetylcholine receptor (“dragonist drinking a-seagull-cola receptor while dumping sucker-cola on a motor-cigarette-receptor”); paralysis due to desensitization of nAChR.

Uses: muscle relaxant (“paralyzed guy in wheelchair”).

Toxicity: respiratory paralysis; malignant hyperthermia; hyperkalemia, hypercalcemia.

Other: hydrolyzed by plasma cholinesterse (pseudocholinesterase); short-acting; phase 1 = cells kept in depolarized state, cannot be reversed (“man locked in wheelchair during phase 1-wand of roller coaster”); phase 2 = cells are repolarizing, can be reversed by neostigmine (“neon-stick-man pulling man out of wheelchair during phase-tutu of roller coaster”).

Question 44

Nondepolarizing Neuromuscular Blockers (“Nun-D-Polar Bear Blocking Nerve-Muscles”)

Answer 44

Drugs (think “car rims” for -rium suffix”): tubocurarine; atracurium; mivacurium; pancuronium; vecuronium; rocuronium.

Mechanism: competative antagonist at acetylcholine receptor (“ant-toga competing with seagull-colas at race track”).

Indication: muscle paralysis during surgery.

Reversal of blockade: neostigmine (must be given with atropine to prevent bradycardia) and edrophonium (“neon-stick-man and Edward-phone-thumb reversing through blocks”).

Question 45

Local Anesthetics (“A-Nest of Local Anesthetics”)

Answer 45

Drugs: esters (“Easter-bunny”)= procaine, cocaine, tetracaine; amides (“Kind A-midis”) = lidocaine, mepivacaine, bupivicaine (amides have 2 i’s).

Mechanism: block Na-channels (“blocking salt-shaker channel at salt mine”); binds activated, rapidly firing neurons (“state-dependent mine”); tertiary amines must penetrate membrane in uncharged form, then bind to channel in charged form.

Indication: minor procedures (“miner”); epidural (“e-pick-drill”).

Properties: often combined with vasoconstrictor (epinephrine) to enhance local action (“vessel-constrictor on miner’s arm”); must increase dose in infected (acidic) tissue (“pathogen with large-needle dose”); order of sensation loss = pain - temperature - touch - pressure.

Side effects: arrythmias (cocaine, “broken arrhythmia-drum”); cardiotoxicity (bupivicaine, “toxic-green-heart”); hypertension/hypotension; CNS excitation.