Neuro Drugs Flashcards
1
Q
Most of the effects of opioids are mediated by the _________ receptors.
A
Mu (Mu-ssage)
2
Q
Pramipexole is a _____________.
A
D3 agonist
3
Q
What activates L-DOPA?
A
Decarboxylation
4
Q
What are the side effects of ketamine?
A
Dissociative state (eyes open, but unconscious); unpleasant hallucinations; increased cardiac output (the heart-shaped cobra hood)
5
Q
TCAs are not used frequently due to their adverse effects. What are they?
A
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)
6
Q
Sliding down the banner, the escaping asylee represents the side effects of _____________.
A
Torsades (the twisting banner) and seizure (because he’s shaking)
7
Q
What drug is an antagonist to serotonin?
A
Cyproheptadine (Jim’s “SIlly pranks are PROHibited”)
8
Q
What kind of seizures can carbamazepine treat?
A
Focal (think of the waitress shaking just her arm)
9
Q
________ metabolism accounts for degradation of all benzodiazepines.
A
Hepatic (recall the ox with the liver spot)
10
Q
Pharmacokinetically, most FGAs are _____________.
A
lipid-soluble with high protein binding –leads to a long, tapering half life
11
Q
What is the antidote to zolpidem, zaleplon, and eszolpiclone?
A
Flumazenil
12
Q
Many narrow-spectrum anti-epileptics can ______________ generalized seizures (such as carbamazepine).
A
worsen/exacerbate
13
Q
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?
A
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.
14
Q
Which TCAs have the fewest side effects?
A
Nortriptyline and desipramine (the ball bouncing off of NORThside PRep academy)
15
Q
Central side effects of dopamine include ____________.
A
anxiety and hallucinations (the hostage freaking out… not sure why he’s not in the vault)
16
Q
Lithium has a __________ therapeutic window.
A
narrow (just like the “narrow window” to deboard the chair lift)
17
Q
All first-generation antipsychotics work by _______________.
A
blocking postsynaptic D2 receptors in the CNS (think of the two cuts ropes held by Van Gogh) especially in the striatal and mesolimbic systems
18
Q
What are the second-generation (atypical) antipsychotics?
A
Quetiapine, olanzapine, risperidone, and aripiprazole (“QUiET, OnLy whISPERIng AllOwed”)Ziprasidone, clozapine ( ZIPper on the woman’s dress; CLOset)
19
Q
How does mirtazipine work?
A
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.
20
Q
Although both the benzodiazepines and barbiturates activate the GABA(A) channel, they have different effects. Explain!
A
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).
21
Q
True or false: benztropine and trihexyphenidyl treat the bradykinesia, tremor, and rigidity of Parkinson’s.
A
False! They only treat the tremor and rigidity… dopamine is needed to treat the bradykinesia
22
Q
Avoid the use of levodopa in _______________.
A
patients with psychosis
23
Q
What are the indications of gabapentin?
A
- 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
24
Q
SSRIs and SNRIs are used to treat what disorders?
A
PTSD (Reed with the dogtags)GAD and PD (nervous “Randy”) Depression (5H-TV)
25
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
26
Trazodone is a __________ modulator.
serotonin (guy playing the happy face drum next to the trombone player)
27
SNRI stands for _______________.
serotonin and norepinephrine reuptake inhibitor
28
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")
29
Side effects of gabapentin include ______________.
ataxia (stack of ice cream falling over)
30
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
31
The two mu-opioid antagonists are ____________.
naloxone (no lax zone – don't relax) and naltrexone (no tricks zone)
32
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)
33
Potency is equal to ________.
1/MAC
34
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)
35
The broad-spectrum antiepileptics include ________________.
lamotrigine, levetiracetam, topiramate, and valproate
36
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.
37
COMT inhibitors include ____________.
entacapone (the "entrance guy") and tolcapone (the tall gangster in Al CAPONE's gang)
38
___________ work well for acute migraine flares.
NSAIDs
39
Fentanyl and morphine stimulate ___________.
the mu-receptor (MORe fuN; make your pain a FaNTAsy)
40
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)
41
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)
42
Benzodiazepines can be used to treat ___________, but they're not first line due to potential for physical dependence.
insomnia/parasomnias
43
Why does bupropion reduce the urge to smoke?
It's not clear.
44
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.)
45
What side effect are SNRIs more likely to cause?
Hypertension (Stanley taking the fax machine out)
46
You might administer what NET- and DAT-reuptake inhibiting agent to someone trying to quit smoking?
Bupropion (NET DAT Ball, PRO)
47
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).
48
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.
49
What is unique about ramelteon?
It has been shown to be safe in the geriatric population – with few side effects.
50
The volatile anesthetics have ___________ groups (chemical part).
halogen (enflurane, isoflurane, halothane)
51
What are the side effects of opioids?
CNS depression, causing respiratory depressionMiosis (hoodie)Constipation
52
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")
53
Enflurane has what potential side effect?
Renal toxicity (eNflurane = Nephrological effects)
54
Most of the body's histamine is stored in __________.
mast cells and basophils
55
What is a partial agonist that is used to treat opiate withdrawal?
Buprenorphine (the buprenorphine blueprint)
56
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)
57
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.
58
Fluorinated anesthetics do what to brain blood flow?
Increase it (undesirably so)(Think of the clown's hat that looks like blood vessels.)
59
The first-generation antipsychotics are called ____________, while the second-generation antipsychotics are called __________.
typical; atypical
60
Side effects of ropinirole include ______________.
gambling, hypersexuality, and impulse control (ropinirole = rock n' roll)
61
A low dose of _________, along with propranolol, can treat essential tremor.
primidone (Perm is Done!)
62
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
63
What foods can contain toxic levels of tyramine?
Aged wine, cheese, and meat
64
In addition to treating acute psychosis, FGAs also treat ______________.
acute agitation/aggression and Tourette's
65
Why might you administer a COMT inhibitor with carbidopa?
Because COMT can methylate (and thus inactivate) levodopa!
66
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
67
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)
68
By what mechanism do TCAs work?
They block the norepinephrine and serotonin reuptake channels
69
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).
70
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)
71
What are the symptoms of opioid withdrawal?
LacrimationSalivationDiarrheaMydriasisAnxietyHyperventilationHyperthermiaAll things opposite of what opiates do.
72
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.
73
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)
74
H1-blocking agents enter the _____________ to alleviate seasickness.
vestibular system
75
What is another drug with similar properties to loperamide?
Diphenoxylate (the dolphin fountain)
76
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).
77
A patient's mother tells you that her son is having absence seizures at school. You start to type "ethosuximide" into your electronic chart, but then she starts telling you something that makes you reconsider your prescription. What is she telling you and what other drug are you now considering?
That her son has also had generalized tonic-clonic seizures! Ethosuximide is not effective in treating tonic-clonic seizures; valproate and lamotrigine are, however, and they can also treat absence seizures! (Think of the farm festiVAL with lLAMas outside th classroom.)
78
True or false: N2O can cause malignant hyperthermia.
False. Only the volatile anesthetics.
79
The benzodiazepines activate the ___________ receptor.
GABA A (think of the "Cab-A" cab)
80
When given to pregnant women, lithium can cause __________________.
Ebstein's anomaly (ASD, hypoplastic right ventricle, and failure of the tricuspid valve to develop)
81
Although trazodone started out as an anti-depressant, it is now mostly used for ____________.
sedating those with insomnia (because it is an H1 antagonist)
82
What are the side effects of carbamazepine?
- Diplopia (misaligned headlights)- Ataxia (falling stack) - SIADH (guy with water cup on his head in the car) - Leukopenia (hour glass with falling grains) - CYP inducer - Teratogenesis (spider on guy's shirt and neural exhaust tube)- DRESS syndrome (eosinophilia represented on dress with pink dots) - SJS (driver with mask)
83
What action does ropinirole have?
D2 receptor agonist (rope – as in dope rope – in a roll)
84
SGAs, unlike FGAs, can treat the __________ symptoms of schizophrenia.
positive and negative
85
By what mechanisms does valproate exert its effect?
Inactivating voltage-gated sodium channels (the spilled peanut basket) and increasing levels of GABA (the taxi design on the emperor's chair)
86
What is status epilepticus?
Continuous seizures without breaks – treat with IV benzodiazepines, phenobarbital, and phenytoin
87
What is a major side effect of bupropion?
Seizures (think of the basketball player shaking) – do not give bupropion to anyone with a history of seizures, anorexia, or bulimia (both of the last two have lower seizure thresholds).
88
The -olam suffix is typical of _________ benzodiazepines.
short-acting
89
What are the indications for D2/D3 agonists?
Restless leg syndrome (guy shaking his leg climbing up the ladder) Early Parkinson's (has been shown to decrease need for levodopa treatment)
90
Benzodiazepines used alone can provide ___________ sedation.
conscious (such as for a colonoscopy – think of the patient with the "lite" drink representing lite anesthesia)
91
Why can't you just give dopamine to people with Parkinson's?
Because it doesn't cross the BBB, while levodopa does
92
What is akathisia?
Subjective restlessness with the inability to sit still ("Aye KAn't THIt")
93
Topiramate has two main mechanisms: _______________.
directly binding to the GABA-A receptor (Pizarro – sans Toupee – is directly shaking the CABA-A cab driver's hand) blocking voltage-gated sodium channels
94
What is the phenomenon of opioid hyperalgesia?
The reason it occurs is not known, but some patients develop hyperalgesia with chronic opioid use.
95
What drugs are tricyclic antidepressants?
The -pramines: imipramine (the "IMPRInt" on Amy's cheek), desipramine, and clomipramineThe -triptylines: amitriptyline and nortriptyline (Amy tripping on the tricycle)
96
Which SGA has the greatest antimuscarinic ability?
Clozapine (the clozapine closet blocking the Alice in Wonderland painting)
97
What are the three nonbenzodiazepine hypnotics?
Catching some Zs? Try zolpidem, zaleplon, and eszolpiclone.
98
The acute side effects of lithium include ____________.
nausea and vomiting (the guy almost at the end of the lift)
99
There is another mnemonic on the cough-drop bag with the dextromethorphan orphan. What is it?
The camel! It represents NMDA (because camels are nomadic) and it is tethered to a post – symbolizing how dextromethorphan antagonizes NMDA receptors.
100
What are the three MAOIs we need to know for Step 1?
Tranylcypramine (TRy a SIP of wINE), isocarboxazid (boxed wine), and phenylzine (funnels-in wine)
101
Phenobarbital and other barbiturates are potent ________ of the CYP450 system.
inducers (the kid getting cranked up with his CYP450 chrome bumper) – so they increase the metabolism of warfarin and other hepatically metabolized drugs –
102
Acute mania is usually treated with _______________.
first- or second-generation antipsychotics (think of the PEAK of mania)
103
Most of the effects of opiates develop tolerance, but two do not. What are they?
Miosis and constipation (these are big, remember!); this is represented by the janitor showing that not all are tolerated
104
The volatile anesthetics are ___________ at room temperature.
liquid (think of the kiddie pool with the gas tank falling into it)
105
Antihistamines can also lead to increased ____________ and _________ antagonism.
appetite (with weight gain); serotonin and alpha-1
106
__________-generation antihistamines easily enter the CNS.
First (where they bind H1)
107
What side effects can SSRIs and SNRIs cause?
SIADH (Darryl with the ADH water cooler), weight gain (fat Roy), drowsiness (Erin asleep next to Pam because of the lackluster later seasons), and sexual dysfunction (spurned advances)
108
For what disorders are SSRIs given that SNRIs are not?
OCD (Dwayne near the SSRI posters) Bulimia (Pam at the reception desk vomiting into the drawer) Social anxiety (Shy Guy hiding behind Pam)
109
The main side effects of ethosuximide are _______________.
GI distress such as nausea, vomiting, and pain (the kid getting punched in the belly by the bully) Fatigue (kid sleeping in front row)
110
Although bupropion (Wellbutrin) is not first-line for unipolar depression in a non-smoker, it has two advantages over other antidepressants. What are they?
It is not associated with sexual dysfunction (think of the kissing couple), and it does not lead to weight gain
111
Other than resistant depression, for what disorders are TCAs used?
Diabetic neuropathy, OCD, and migraine (the bell, Dwayne and the marbles, and the guy with his hand stuck in the diasweeties machine)
112
What is the mechanism of sumotriptan?
It is an agonist of the 5HT-1d and 5HT-1b receptors (in the meningeal vessels, trigeminal nerve, and brainstem – the tri-gem hat, the meningeal headband, and the brainstem hair)
113
In terms of gross categories, how do the side effects of high and low potency first-generation antipsychotics compare?
High: more specific binding to D2 receptors leads to a greater chance of extrapyramidal effects (motor) Low: less specific binding to D2 receptors leads to greater chance of antimuscarinic effects, anti-alpha-1 effects (specifically orthostatic hypotension), and antimuscarinic effects (specifically sedation) – think of the Alice party, the extinguished alpha candle held by the nurse, and the sunflowers with bees being swatted
114
What is the mechanism by which second-generation antipsychotics work?
They, like the first-generation antipsychotics, block D2 receptors in the mesolimbic system. Additionally, however, they also block 5-HT 2A receptors. (Think of Dalí with the double dope-rope and the smiley face with the slice taken.)
115
Explain the differences between MAO-A and MAO-B.
MAO-A deaminates dopamine, norepinephrine, and serotonin (albino mouse eating smiley face, dope rope, and north compass), while MAO-B deaminates only dopamine.
116
The most important side effect of propofol is ____________.
"profound" vasodilation (think of the hypnotist's sleeves); this can induce tachycardia
117
Describe the use and effect of zaleplon and zolpidem.
They are fast-acting sleep aids – without the anxiolytic effect of the benzodiazepines – that are hepatically metabolized; because they are fast-acting, they are best at helping people get to sleep, but may not help people stay asleep. (Think of the sheep jumping quickly over the fence and returning to the ground.)
118
What are the side effects specific to clozapine?
Agranulocytosis MyocarditisLowered seizure threshold(failing grains of sand, heart on the beach, and shaking alarm clock)
119
What side effects are associated with mirtazipine?
H1 histamine antagonist, sleepiness, weight gain (overweight, sleepy fan in the box with the chef swatting a bee) – like bupropion, though, it does not lead to sexual dysfunction.
120
Why is tramadol such a great drug for neuropathic pain?
Because it is not only a weak mu-opioid agonist, it also inhibits the reuptake of norepinephrine and serotonin!
121
Why is halothane not used in the United States?
Because it can cause hepatic necrosis (Halothane = Hepatic side effects). This occurs 2 days - 4 weeks after anesthesia.
122
All of the SGAs can cause ____________.
torsades
123
You should not combine zolpidem and zaleplon with ____________.
any other CNS depressant (alcohol, barbiturates, benzodiazepines, and 1st gen antihistamines)
124
What physical property makes loperamide an interesting and useful opioid?
Loperamide (lop-eared rabbits) cannot pass through the BBB and so has no analgesic effects. It can, however, be used as a great anti-diarrheal.
125
How is the trigeminal nerve involved in migraines?
Its afferents from the cranial arteries seem to be unusually activated; this results in release of neurokinin A, substance P, and GCRP onto the meningeal arteries – leading to vasodilation and protein extravasation
126
_________ is a weak mu-opioid agonist.
Tramadol (the tramadol train in the background – the background representing weakness)
127
H2 receptors, when stimulated, induce ______________.
gastric acid secretion
128
Be careful prescribing _____________ to patients taking lithium.
thiazides and NSAIDs – both of which lower GFR and decrease lithium clearance (think of the pasty thighs of the diver over the Low Clearance chair lifts)
129
What drug, like codeine, is an opioid that suppresses cough?
Dextromethorphan (the dextromethorphan orphan – mascot of the cough drops)
130
What condition is characterized by bilateral convulsions without loss of consciousness?
Juvenile myoclonic epilepsy (the Incan boy shaking both arms)
131
What treatments are used for long-term migraine prophylaxis?
Calcium blockers (the soft-serve – which contains lots of calcium – with blocked channels next to the long-time fans)Beta-blockersValproic acid (an antiepileptic; think of the festiVAL of PRO wrestling) Topiramate (another anti-epileptic; think of the child with the toupee) TCAs (child on tricycle)
132
What is the mechanism of tiagabine?
It blocks GABA reuptake channels, leading to increased CNS levels of GABA (the tie stuck in the GABA cab getting lifted).
133
What non-anesthetic drug can also cause malignant hyperthermia?
Succinylcholine (the depolarizing muscle relaxant)
134
Tardive dyskinesia presents after ______________.
months to years of treatment with high-potency FGAs
135
What else binds to the GABA (A) receptor?
Alcohol (hence, benzodiazepines are given in alcohol withdrawal) BarbituratesPhenytoinNeurosteroids
136
H1 receptors, when stimulated from mast-cell histamine, induce _______________.
nasal and bronchial mucus secretion; bronchoconstriction on smooth muscle; and vasodilation with increased vascular permeability
137
What side effects can lamotrigine cause?
Stevens-Johnson syndrome (the old, llama-riding man is wearing an easily sloughed off red mask, just like the skin of someone with toxic epidermal necrolysis) diplopia (cross-eyed llama)
138
Levetiracetam's main side effect is ______________.
somnolence (the sleeping elevator operator)
139
The side effects of phenytoin include ____________.
- diplopia (headlights crossed)- nystagmus - ataxia (falling burger stack)- low folate (salad – foliage – falling onto hood of TOw truck)- gingiva hyperplasia (bubble gum expanding)- hirsutism (hairy beard) - lupus (the tow truck driver's wolf companion)- DRESS eosinophilia (pink dots on DRESS)- SJS (guy whose car is getting towed removing mask – also more common in the HLA B1502 phenotype)- teratogenicity (cleft hat bill) - CYP inducer - osteoporosis (cracked bone axle)
140
What receptor do the nonbenzodiazepine hypnotics target?
The GABA(A) receptor (think of the Cab-a A cab)
141
What effect does stimulating the 5HT-1d and 5HT-1b receptors have?
It causes vasoconstriction of the meningeal arteries and causes less vasodilatory cytokines to be released from the trigeminal nerve.
142
Codeine is an _____________.
opioid antitussive
143
Describe the side effects of high-potency FGAs.
Torticollis and other forms of acute dystonia (including oculomotor symptoms)
144
Ethosuximide works by __________________.
blocking T-type calcium channels in the thalamus (the "Calci-Yum" chocolate milk next to the Tea thermos)
145
True or false: first-generation antihistamines block muscarinic channels in the CNS and PNS.
True (this is why they lead to some of the same side effects); they can thus also be used to treat motion sickness and the extrapyramidal effects of Parkinson's by reestablishing the dopamine-choline balance
146
What is the mechanism of amantadine?
It releases and enhances endogenous dopamine (think of the MANaTee statue breaking open the box of DOPe rope)
147
The chronic side effects of lithium include ______________.
tremor and ataxia (like the skiers who stayed on the chair lift too long); hypothyroidism (represented by the penguin with the untied bowtie – symbolizing the bowtie-shaped thyroid – and the hefty, bald snowboarder); nephrogenic diabetes (kidney damage, represented by the fountain)
148
For what disorders are SNRIs used that SSRIs are not?
Diabetic neuropathy ("Evan" pinching his distal nerves in the diasweeties machine) Fibromyalgia (the fiber bars in the top of the vending machine)
149
What are two SNRIs?
Venlafaxine (the fax machine) and duloxetine (the dual-copy faxer scanner)
150
In what patients are triptans contraindicated?
Those with angina; triptans work by causing vasoconstriction. Vasoconstricting the coronary arteries can worsen angina. (Guy falling on the artisan working the angina anvil.)
151
What is the main adverse effect of nonbenzodiazepines?
Confusion and delirium (particularly in the elderly) – same as the benzodiazepines (think of the confused man stacking blankets).
152
True or false: patients with drug-induced Parkinson's should be treated with L-dopa.
False! Giving a dopamine agonist will likely trigger psychotic symptoms. Instead, give an antimuscarinic for the motor symptoms – such as trihexyphenidyl or benztropine
153
Antiepileptics such as ______________ can be given to help stabilize those with bipolar disorder.
valproic acid (winter festiVAL), carbamazepine (classic CAR), and lamotrigine (lLAMa costume on kid)
154
The first-line treatment for absence seizures is ___________.
ethosuximide
155
Long-term use of levodopa unfortunately leads to ____________ of the therapeutic window.
narrowing
156
How would you treat the cardiac complications of TCA overdose?
Bicarb. This promotes the unionized version of TCAs to predominate, which is less able to block the sodium channels.
157
Melatonin and ramelteon bind to the __________ receptors.
MT1 and MT2 in the suprachiasmatic nucleus of the hypothalamus (think of the base of the x-shaped fan)
158
What are the three main 2nd-generation antihistamines?
Fexofenadine, cetirizine, and loratidine
159
Solubility of inhaled anesthetics is also referred to with the unwieldy term _____________.
blood-gas partition coefficient; molecules that are more soluble are said to have a high partition coefficient
160
What is a short-acting benzodiazepine?
Oxazepam (the running bull, charging fast)
161
High-potency FGAs can also cause __________ in women.
symptoms of prolactinemia (breast soreness and galactorrhea)
162
Carbamazepine, in addition to being used for focal seizures, is used for ______________.
trigeminal neuralgia (a condition of usually unilateral, electric-shock like pain that lasts for a few seconds but repeats)
163
The broad-spectrum antiepileptics are metabolized ______________.
hepatically (just think of the CYP-450 license plate on Pizarro's ship)
164
What is a major risk of benzodiazepine use?
Tolerance! Using anything that stimulates GABA channels will cause them to down-regulate. Thus, you will need more GABA-channel inducer to get the same effect.
165
What disorders other than schizophrenia can be treated with SGAs?
OCD (the guy obsessively adjusting the painting), treatment resistant depression (the guy struggling with the wine bottle), Tourette's (elephant marionette)
166
The first inhaled anesthetic to be developed was _________.
N2O (still used in dental clinics)
167
What is the first-line treatment for migraines?
Triptans – specifically sumotriptan
168
What is ramelteon?
An agonist to the melatonin receptors ("let your worries melt away")
169
What is the mechanism of carbamazepine and phenytoin?
Binds to and prolongs the inactivation of voltage-gated sodium channels
170
Which neurons are most susceptible to opioid stimulation?
Presynaptic neurons (the guy unplugging the presynaptic extension cord)
171
When are TCAs used?
When SSRIs and SNRIs fails
172
Of the low-potency first-generation antipsychotics, what do chlorpromazine and thioridazine cause?
Chlorpromazine: corneal deposits (Corn Yellow painting)Thioridazine: retinal deposits (retinal pallet)
173
The side effects of all inhaled anesthetics include ______________.
decreased cardiac output, respiratory depression, and post-op atelectasis (possibly due to decreased mucus production)
174
Less soluble anesthetics have what property in the blood and what effect for the patient?
They saturate the blood quickly and thus go to the brain quicker; this results in quicker onset and offset of anesthesia.(Think of the two lanes of the ball pit: the heftier kid didn't go far and had to get pulled out quickly, while the smaller kid had a longer run.)
175
FGAs are better at blocking the __________ effects of schizophrenia.
positive (e.g., hallucinations)
176
Describe the symptoms of excessive SSRI use?
Serotonin syndrome (symbolized by Michael) can lead to symptoms of excessive sympathetic input: hypertension, agitation, hyperthermia, and hyperreflexia
177
What is the mechanism of propofol and etomidate?
They – like benzodiazepines, barbiturates, alcohol, and the non-sedative hypnotics – activate the GABA-A receptor. (Think of the old-fashioned Caba cab.)
178
What are the three kinds of opioid receptors?
Mu, kappa, and delta
179
Why is phenobarbital not first-line for seizure treatment?
It has some bad side effects: hypoventilation, cardiac depression, CNS depression to the point of coma, and an extremely long half-life (think of the long, tapering barber flag).
180
Other than blocking 5-HT 2A receptors and D2 receptors, many SGAs also block _________.
H1 histamine receptors and alpha-1 (the guy swatting the bee painting and the extinguished alpha candle)
181
Overuse of sedative hypnotics is a major cause of ____________ (gerontologic concern).
confusion in the elderly
182
Again, what is the mnemonic for depression symptoms?
SIG E CAPSSleep disturbancesInterest (loss of...) GuiltEnergyConcentration difficultyAppetite changes Psychomotor agitationSuicidality
183
What can cause serotonin syndrome?
Use of SSRIs/SNRIs with tricyclic antidepressants or MAO inhibitors
184
What is MAC?
Minimum Alveolar Concentration – the concentration needed to make 50% of people unresponsive to pain (also called ED50). (Think of the two kids eating MAC and cheese; one is asleep and the other is awake and poking the asleep kid.)
185
Lamotrigine works by what mechanism?
Inactivating voltage-gated sodium channels (more baskets of peanuts by the llama in the back of the procession)
186
Describe the basic working of monoamine oxidase inhibitors.
Monoamine oxidase degrades dopamine, norepinephrine, and serotonin, so inhibiting it increases its availability.
187
What are the first-generation antihistamines?
DiphenhydramineChlorpheniraminePromethazineHydroxyzineMeclizine
188
What type of receptor is the mu opioid receptor – and what is the effect of agonizing it?
It is a G-protein that leads to the closure of calcium channels and opening of potassium channels – particularly on neurons – which leads to the hyperpolarization of the membrane and lessened likelihood of action potential transmission. (Think of the open banana barrels and the closed Cali-Yum cooler.)
189
Which parts of the GI tract have mu-opioid receptors?
Stomach, small intestine, and large intestine
190
What other condition can be treated with triptans?
Cluster headaches – think of the cluster of lanterns behind the wrestlers.
191
True or false: children can usually remember their absence seizures (that is, they're aware that they've had one).
False.
192
True or false: gabapentin activates GABA channels.
False! They close voltage-gated calcium channels ("GrAB A PiNT" ice-cream truck with closed calci-yum door)
