Neuro Drugs Flashcards
Most of the effects of opioids are mediated by the _________ receptors.
Mu (Mu-ssage)
Pramipexole is a _____________.
D3 agonist
What activates L-DOPA?
Decarboxylation
What are the side effects of ketamine?
Dissociative state (eyes open, but unconscious); unpleasant hallucinations; increased cardiac output (the heart-shaped cobra hood)
TCAs are not used frequently due to their adverse effects. What are they?
Sexual dysfunction (gym teacher getting rejected)Anticholinergic effects (atropine Alice’s tea party)H1 histamine antagonism (guy swatting a bee-ball away)Alpha-1 antagonism (vasodilation -> girl falling over by Alice) Cardiac arrhythmia (the broken peaNAT cookies representing the blocking of fast sodium channels, with widening of QRS) Convulsions – due to antagonist effect on GABA A (guy shaking on court)
Sliding down the banner, the escaping asylee represents the side effects of _____________.
Torsades (the twisting banner) and seizure (because he’s shaking)
What drug is an antagonist to serotonin?
Cyproheptadine (Jim’s “SIlly pranks are PROHibited”)
What kind of seizures can carbamazepine treat?
Focal (think of the waitress shaking just her arm)
________ metabolism accounts for degradation of all benzodiazepines.
Hepatic (recall the ox with the liver spot)
Pharmacokinetically, most FGAs are _____________.
lipid-soluble with high protein binding –leads to a long, tapering half life
What is the antidote to zolpidem, zaleplon, and eszolpiclone?
Flumazenil
Many narrow-spectrum anti-epileptics can ______________ generalized seizures (such as carbamazepine).
worsen/exacerbate
Your uncle just went to France and ate a lot of wine and cheese and calls you saying that he has palpitations and is sweating excessively. What medications might you ask him about?
Tranylcypramine, phenylzine, or isocarboxazid. If he’s taking MAOIs, then have him get phentolamine to treat the potentially fatal hypertension that can come with excess catecholamines. Aged foods contain tyramine, which is normally broken down by MAO in the gut. If you’re taking a MAOI, however, then that won’t be broken down and can thus build up.
Which TCAs have the fewest side effects?
Nortriptyline and desipramine (the ball bouncing off of NORThside PRep academy)
Central side effects of dopamine include ____________.
anxiety and hallucinations (the hostage freaking out… not sure why he’s not in the vault)
Lithium has a __________ therapeutic window.
narrow (just like the “narrow window” to deboard the chair lift)
All first-generation antipsychotics work by _______________.
blocking postsynaptic D2 receptors in the CNS (think of the two cuts ropes held by Van Gogh) especially in the striatal and mesolimbic systems
What are the second-generation (atypical) antipsychotics?
Quetiapine, olanzapine, risperidone, and aripiprazole (“QUiET, OnLy whISPERIng AllOwed”)Ziprasidone, clozapine ( ZIPper on the woman’s dress; CLOset)
How does mirtazipine work?
It decreases alpha-2 input on presynaptic neurons, thereby leading to increased catecholamine release; additionally, it has mild 5HT-2 and 5HT-3 receptor antagonist properties.
Although both the benzodiazepines and barbiturates activate the GABA(A) channel, they have different effects. Explain!
Benzodiazepines cause GABA(A) to open more frequently (just like how the pamcakes cause Ben’s diner to open more frequently), while barbiturates cause it to stay open longer (like how you get LONG hair cut at the BARBershop).
True or false: benztropine and trihexyphenidyl treat the bradykinesia, tremor, and rigidity of Parkinson’s.
False! They only treat the tremor and rigidity… dopamine is needed to treat the bradykinesia
Avoid the use of levodopa in _______________.
patients with psychosis
What are the indications of gabapentin?
- post-herpetic neuralgia (Zeus –representing zoster –on the ice cream truck)- diabetic neuropathy (diasweeties with the frayed wire on the side of the truck)- narrow-spectrum anti-convulsant
SSRIs and SNRIs are used to treat what disorders?
PTSD (Reed with the dogtags)GAD and PD (nervous “Randy”) Depression (5H-TV)
Chronic side effects of levodopa use include ______________.
wearing-off effects at the end of each dosing period (the tapering, worn out rope) and an on-off appearance of Parkinson’s symptoms
Trazodone is a __________ modulator.
serotonin (guy playing the happy face drum next to the trombone player)
SNRI stands for _______________.
serotonin and norepinephrine reuptake inhibitor
All FGAs –and especially the high potency ones –can cause a life-threatening condition characterized by lead-pipe rigidity, agitation, fever, and tachycardia (dysautonomic regulation). What is it?
Neuroleptic malignant syndrome (“Now More Spicy”)
Side effects of gabapentin include ______________.
ataxia (stack of ice cream falling over)
Most of the SGAs cause fewer extrapyramidal side effects than the FGAs. Which, however, still causes some?
Risperidone (the guy whispering to the extrapyramidal-hat-wearing patron getting kicked out of the gallery); risperidone can also cause prolactinemia and neuroleptic malignant syndrome
The two mu-opioid antagonists are ____________.
naloxone (no lax zone –don’t relax) and naltrexone (no tricks zone)
The side effects of valproate include ________________.
GI upset (the sick emperor, about to vomit) Weight gain (the fat emperor) Tremor (the trembling Inca) Hepatotoxicity (the cow with the liver spot) Acute pancreatitis (sponge on gold)Neural-tube defects (tarantula-teratogens on the shields, mother with baby playing the TUBEs wearing the neural hat)
Potency is equal to ________.
1/MAC
Which of the first-generation antipsychotics are high potency?
Haldol (the halos floating “high”) and the drugs with -flu- in them (“fluing” high with trifluperazine and fluphenazine)
The broad-spectrum antiepileptics include ________________.
lamotrigine, levetiracetam, topiramate, and valproate
There is a barbiturate that takes effect quickly and has its effect wear off quickly. What is it and why does this occur?
Thiopentol (THe Ol’ quick shave); it goes straight to the brain and then redistributes to adipose tissue – used for intubation, given IV.
COMT inhibitors include ____________.
entacapone (the “entrance guy”) and tolcapone (the tall gangster in Al CAPONE’s gang)
___________ work well for acute migraine flares.
NSAIDs
Fentanyl and morphine stimulate ___________.
the mu-receptor (MORe fuN; make your pain a FaNTAsy)
Dopamine in the periphery leads to what side effects?
Nausea (the tied up hostage about to vomit OUTSIDE the vault), postural hypotension (the hostage about to faint)
Side effects of topiramate include ______________.
somnolence (sleepy soldier behind Pizarro)confusion (soldier scratching his head) weight loss (thin soldier) nephrolithiasis (cannon –with stone-like cannonballs –with kidney-shaped wheels) closed-angle glaucoma (tea kettle eyeball)
Benzodiazepines can be used to treat ___________, but they’re not first line due to potential for physical dependence.
insomnia/parasomnias
Why does bupropion reduce the urge to smoke?
It’s not clear.
What MAOI might be given to someone with Parkinson’s and why?
Selegiline (the guy with the sledge hammer) because it is a MAO-B selective inhibitor, and thus raises levels of available of dopamine. (Recall also in this sketch that this helps with the “cogwheel rigidity” of Parkinson’s, as depicted on the wall behind the man with the sledge hammer.)
What side effect are SNRIs more likely to cause?
Hypertension (Stanley taking the fax machine out)
You might administer what NET- and DAT-reuptake inhibiting agent to someone trying to quit smoking?
Bupropion (NET DAT Ball, PRO)
What is the mechanism of vigabatrin?
It inhibits GABA transaminase, thereby increasing amounts of GABA in the CNS (the GABA cab getting raised to have its TRANSmission service).
What is the antidote for benzodiazepine overdose?
Flumazenil (GABA A antagonist) –think of the “fluffy muzzled dog” blocking the delivery boy trying to get to the cab; its use remains controversial, though, because it has been known to induce seizures in those addicted to benzodiazepines.
What is unique about ramelteon?
It has been shown to be safe in the geriatric population –with few side effects.
The volatile anesthetics have ___________ groups (chemical part).
halogen (enflurane, isoflurane, halothane)
What are the side effects of opioids?
CNS depression, causing respiratory depressionMiosis (hoodie)Constipation
One of the big side effects of SGAs that is not associated with FGAs is ____________.
weight gain (the bloated Dalí painting) and metabolic syndrome (diabetes – candy –and dyslipidemia –butter); ziprasidone has the lowest risk (“just think of that sleek black dress”)
Enflurane has what potential side effect?
Renal toxicity (eNflurane = Nephrological effects)
Most of the body’s histamine is stored in __________.
mast cells and basophils
What is a partial agonist that is used to treat opiate withdrawal?
Buprenorphine (the buprenorphine blueprint)
Just in terms of names, what are the first-generation antipsychotics?
Haldol (haloperidol) –think of Van Gogh’s halosDrugs that end in -azine: trifluoperazine, chlorpromazine, thioridazine, and fluphenazine (think of Starry Gazing)
What is the useful difference between propofol, ketamine, and etomidate?
All three can be used as induction anesthetics (that is, for inducing sedation), but only propofol can be used to maintain anesthesia.
Fluorinated anesthetics do what to brain blood flow?
Increase it (undesirably so)(Think of the clown’s hat that looks like blood vessels.)
The first-generation antipsychotics are called ____________, while the second-generation antipsychotics are called __________.
typical; atypical
Side effects of ropinirole include ______________.
gambling, hypersexuality, and impulse control (ropinirole = rock n’ roll)
A low dose of _________, along with propranolol, can treat essential tremor.
primidone (Perm is Done!)
Other than acute dystonia, what other side effects do high-potency FGAs cause?
Akathisia (restlessness) and Parkinson’s – think of the guy jumping out of his chair (unable to sit) and the guy getting into the carriage with cog wheels
What foods can contain toxic levels of tyramine?
Aged wine, cheese, and meat
In addition to treating acute psychosis, FGAs also treat ______________.
acute agitation/aggression and Tourette’s
Why might you administer a COMT inhibitor with carbidopa?
Because COMT can methylate (and thus inactivate) levodopa!
What kind of receptors are H1 and H2?
H1: G(q) – think of Lisander with the Q-shaped dandelion (he’s about to get allergies, and that is H1) H2: G(s) –think of the stomach with the two S-shaped handles
The main benefit of etomidate is _____________.
absence of cardiac side effects – specifically, etomidate does not cause vasodilation (think of the Intimidator balancing the hypnotized person)
By what mechanism do TCAs work?
They block the norepinephrine and serotonin reuptake channels
What side effect does trazodone have?
Because it antagonizes alpha-1 receptors, it leads to vasodilation –this can lead to hypotension or priapism (erection in the absence of sexual arousal); think of the nickname trazobone. Also, sexual dysfunction and serotonin syndrome (band member and spilled happy faces).
The partial mu-opioid agonists have what commonality in their names?
Bu-phine: buprenorphine, nalbuphine, and butorphanolThink of the Blue Fin grill with the partial massage (the foot massage)
What are the symptoms of opioid withdrawal?
LacrimationSalivationDiarrheaMydriasisAnxietyHyperventilationHyperthermiaAll things opposite of what opiates do.
True or false: most MAO inhibitors are nonselective and irreversible.
True! Think of the mouse trap (which represents MAOIs) –it doesn’t care what color the mouse is and its effects can’t be undone.
Why is entacapone generally preferred over tolcapone?
Because tolcapone has a risk of hepatotoxicity (think of the TaLl gangster’s hepatic clip on his tommy gun)
H1-blocking agents enter the _____________ to alleviate seasickness.
vestibular system
What is another drug with similar properties to loperamide?
Diphenoxylate (the dolphin fountain)
Methadone is a potent opioid agonist. Why not just give them morphine or heroin?
Methadone has a loooooong half-life and thus the withdrawal effects of methadone are not as acute (think of the long tapering flag above the DONE timer where the guy is getting out of the withdrawal pool).
