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Pharm > Neuro Exam 2 > Flashcards

Neuro Exam 2 Flashcards

1
Q

bacterial meningitis treatment age 0-4 wks

A

ampicillin + cefoxatime or aminoglycoside (gentamicin/tobramycin)

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2
Q

bacterial meningitis treatment 1 mo-50yo

A

vancomycin + cefoxatime or ceftriaxone

+ampicillin if Listeria

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3
Q

bacterial meningitis treatment >50yo

A

vancomycin + ampicillin +cefoxatime

vancomycin +ceftriaxone (+ampicillin if Listeria_

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4
Q

bacterial meningitis treatment w/ impaired cellular immunity

A

vancomycin + ampicillin + cefepime or meropenem

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5
Q

bacterial meningitis treatment if recurrent

A

vancomycin + cefoxatime or ceftriaxone

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6
Q

bacterial meningitis treatment if basilar skull fracture

A

vancomycin + cefoxatime or ceftriaxone

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7
Q

bacterial meningitis treatment w/ head trauma, neurosurgery, or CSF shunt

A

Vancomycin + ceftazadime, cefepime, or meropenem

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8
Q

gentamycin and tobramycin MAO

A

aminoglycoside
binds 30s ribosome subunit
bactericidal

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9
Q

gentamycin and tobramycin AE

A

nephrotoxicity
ototoxicity
Teratogenic
Dose adjust in renal impairment

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10
Q

ampicillin MAO

A

inhibit PBPs of bacterial cell wall synthesis

bactericidal

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11
Q

cefoxatime MAO

A

3rd gen cephalosporin
inhibit PBPs of bacterial cell wall synthesis
bactericidal

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12
Q

ceftriaxone MAO

A

3rd gen cephalosporin
inhibit PBPs of bacterial cell wall synthesis
bactericidal

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13
Q

ampicillin AE

A

pseudomembranous colitis

Dose adjust in renal impairment

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14
Q

Cefoxatime AE

A

Rose adjust in renal impairment
Injection site pain/phlebitis
Rash, diarrhea, vomiting
(Same as meropenem)

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15
Q

Ceftriaxone AE

A

Rose adjust in renal impairment

eosinophilia, thrombocytosis

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16
Q

Meropenem MAO

A

inhibit PBPs of bacterial cell wall synthesis

bactericidal

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17
Q

Meropenem AE

A

Rose adjust in renal impairment
Injection site pain/phlebitis
Rash, diarrhea, vomiting
(same as cefoxatime)

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18
Q

Vancomycin MAO

A

inhibition of transpeptidation and transglycosylation

bactericidal

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19
Q

Vancomycin AE

A

nephrotoxicity
Ototoxicity
Dose adjust in renal impairment

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20
Q

Dexamethasone adjunct for bacterial meningitis

A

Lower host responses that cause hearing loss

Reduce CSF TNFa, IL-1, inflammation, and edema

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21
Q

Aspergillus tx

A

1) voriconazole 2) ampho b

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22
Q

mild blasto tx

A

1) itraconazole 2) fluconazole

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23
Q

severe blasto tx

A

ampho b then itraconazole

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24
Q

candidiasis tx

A

fluconazole

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25
Q

Coccidiomycosis tx

A

1) fluconazole or itra 2) ampho b

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26
Q

cryptococcus tx

A

ampho b + flucytosine then fluconazole

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27
Q

histoplasmosis tx

A

1) ampho b + itraconazole 2) fluconazole

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28
Q

mucormycosis tx

A

1) ampho b 2) posaconazole

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29
Q

sporotrichosis tx

A

ampho b or itra

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30
Q

Amphotericin B MOA

A

forms pores in fungal cell membrane

fungicidal

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31
Q

Amophotericin B AE

A

nephrotoxic- reduced w/ liposomal form
Given IV due to poor CNS entry
Infusion rxn- pretreat with NSAIDs, steroids, antihistamines

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32
Q

“Azoles” MOA

A

block 14a-sterol demethylase, disrupting fungal cell membrane phospholipids
Fungistatic, possible -cidal at high doses

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33
Q

“Azoles” that can penetrate BBB

A

Fluconazole and voriconazole

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34
Q

“Azoles” AE

A

Cyp inhibitors
Drug-drug reactions
GI upset, nausea

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35
Q

Flucytosine MOA

A

converted by fungal cytosine deaminase to 5-FU, which blocks thymidylate synthase and disrupts DNA synthesis

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36
Q

Flucytosine AE

A

Orally active, enters CSF
Not used alone- rapid resistance
Bone marrow toxicity: anemia, leukopenia, thrombocytopenia
abnormal LFTs
Adverse effects result from metabolism to 5-FU, possibly by intestinal flora

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37
Q

analgesia

A

relief of pain without intentional production of AMS

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38
Q

anxiolysis

A

decreased apprehension with no change in level of awareness

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39
Q

sedation

A

Conscious: dose dependent
protective reflexes intact
independent maintenance of airway
Response to physical or verbal stimulation
Unconscious: loss of 1+ of above components

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40
Q

general anesthesia

A

concurrent loss of all protective reflexes

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41
Q

preferred route of general anesthesia

A

inhalational and IV

more immediate control over dose/duration

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42
Q

minimum alveolar concentration

A

concentration in the inspired gas required to render half of a group of patients unconscious (unresponsive to painful stimuli)
Measure of potency

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43
Q

Meyer-Overton hypothesis

A 
anesthetic activity is directly linked to lipid solubility
Greater potency (smaller MAC) with more lipophilic drugs
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44
Q

MOA inhaled anesthetics

A

potentiation of inhibitory neural pathways: GABA(A) and glycine signaling, reinforcement of 2 pore K channels
Inhibition of glutamatergic signaling

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45
Q

transfer entropy

A

measure of directional interactions around brain areas
During anesthesia, feedback TE is reduced
Reduced cortical interactions (reduced integration)

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46
Q

Guedel stage/plane 1

A

delirium, breath holding, increased BP, increased muscle tone, pupil dilation

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47
Q

structure of volatile agents

A

contain halogens to remove risk of sparking

isoflurane, desflurane, sevoflurane

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48
Q

blood/gas partition

A

absolute mass of anesthetic is determined by the amount needed to be accumulated in the blood in order to reach equilibrium with the alveolar gas
Dependent upon lipophilicity
Less lipophilic=smaller compartment in the blood that needs to be saturated

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49
Q

speed of induction

A

insoluble anesthetics (ex N2O) reach equilibrium in the blood very rapidly in comparison to anesthetics that are more lipophilic and tightly bind plasma proteins (ex halothane)

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50
Q

factors affecting anesthetic equilibration

A

concentration of inspired gas (only variable that can be modified by anesthetist), respiratory rate, solubility (partition coefficient), rate of blood flow to lungs, cardiac output, tissue distribution

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51
Q

reflex response to PaCO2

A

PaCO2 rises in response to inhaled anesthetics

reflex response is lost in all agents except N2O

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52
Q

N2O + opiod CV effects

A

opiod blocks the reflexive sympathomimetic effect and unmasks the direct depressive action of N2O

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53
Q

mechanisms of CV depression by anesthetics

A 
decreased sympathetic outflow
peripheral ganglion blockade
decreased adrenal catecholamine release
baroreceptor attenuation
decreased Ca influx
vagal stimulation
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54
Q

inhaled anesthetics with an irritating odor

A

enflurane, isoflurane, desflurane

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55
Q

inhaled anesthetics with analgesia

A

N2O

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56
Q

inhaled anesthetics that cause muscle relaxation

A

enflurane, isoflurane

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57
Q

inhaled anesthetics that cause arrythmias

A

halothane, sensitizes the myocardium to circulating catecholamines

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58
Q

inhaled anesthetics that cause hepatic toxicity

A

halothane

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59
Q

inhaled anesthetics that cause seizures

A

enflurane

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60
Q

N2O adverse effects

A

N/V
increased rates of spontaneous abortions, inhibitor of vitamin B12 synthetase, myelin sheath degeneration, second gas effect, diffusional hypoxia, air space perforation

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61
Q

N2O benefits

A

additive anesthetic effects with volatile component (vapor sparing effect)
reduced inspired volatile concentration
mild analgesic

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62
Q

MOA IV anesthetics

A

reinforce inhibitory actions of GABA/glycine

Ketamine also inhibits NMDA receptor system for glutamate (bind at different sites)

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63
Q

Anasthetics that reinforce GABA inhibitory actions

A

Benzodiazepines- shift the dose response curve for GABA to the left, increasing potency not efficacy
Barbituates- prolong binding of GABA to its receptor (increased efficacy), at high concentrations can open Cl- channel in absence of GABA)
Etomidate
Propofol- can function like GABA itself in high concentrations

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64
Q

CNS depression w/ anesthetics

A

Barbituates- dose increases depression, can lead to coma and death
Benzodiazepines- reach a ceiling effect, unless added with other depressants

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65
Q

rate limiting step of IV anesthetic elimination

A

release of drug from adipose tissue
accumulation in fat is due to relatively poor blood supply
Lipophilic- half life increases over time with continued administration

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66
Q

anesthetic drugs with high half lives

A

diazepam and thiopental

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67
Q

anesthetic drugs with short half lives

A

etomidate and propofol

etomidate- less significant changes in half life over time

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68
Q

IV anesthetics that increase cerebral blood flow

A

Ketamine

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69
Q

IV anesthetics that decrease cerebral blood flow oxygen requirements and decrease RR

A

thiopental, etomidate, propofol

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70
Q

IV anesthetics that increase ICP

A

Ketamine

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71
Q

IV anesthetics that stimulate HR and inhibit CO/MAP

A

thiopental and propofol

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72
Q

IV anesthetics that have no effect on CV system

A

Etomidate

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73
Q

IV anesthetics that increase HR and CO/MAP

A

Ketamine

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74
Q

Thiopental AE

A

porphyria (via CYP induction)

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75
Q

IV anesthetics that are anti-emetic

A

propofol

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76
Q

Propofol AE

A

infusion syndrome: metabolic acidosis, rhabdomyolysis, arrhythmias, renal failure
usually minimally responsive to inotropes or cardiac pacing

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77
Q

Etomidate AE

A

inhibits steriodogenesis
Lowers cortisol
Not used in ICU

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78
Q

Ketamine effects

A 
analgesic
intact pharyngeal/laryngeal reflexes
bronchodilator
hallucinations
dissociative anesthetic- little effect on the cortex/neuronal activity
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79
Q

most rapid acting inhaled anesthetic

A

desflurane

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80
Q

Mechanism of emergence from unconsciousness

A

distribution of drug to non-neuronal tissue

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81
Q

Succinylcholine AE

A 
acts on ryanodine receptor in SR
releases Ca
Causes muscular contraction, stimulated metabolism (increased temperature)
Myoglobinuria?
Antidote- dantrolene
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82
Q

Lidocaine MAO

A

needs both hydrophilic and lipophilic characteristics in order to dissolve into nerve to block sodium channel activity from the inside
preferentially binds to receptors in the activated or inactivated state

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83
Q

pH>pKa by 1.0 unit

A

90% of dose will be uncharged (unionized)

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84
Q

% solution

A

x % solution = x grams/ 100 mL

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85
Q

x : y solution

A

x grams/ y mL

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86
Q

drugs that cause pupillary dilation (mydriasis)

A

sympathomimetics

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87
Q

drugs that cause pupillary constriction (mitosis)

A

parasympathomimetics

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88
Q

drugs that cause pinpoint pupils

A

opiods inhibit the inhibitory neurons that act on the Edinger-Westphal nucleus

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89
Q

Gardner’s eye

A

unilateral, fixed mydriasis and photophobia
eye is unresponsive to pupillary light and accommodation reflex
Caused by contact with plants containing alkaloids scopolamine and atropine (Datura, Angel’s trumpets)

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90
Q

Absorption of topical conjunctival drugs

A

1) spillage onto cheeks- vasoconstriction
2) systemic via lacrimal drainage+absorption through GI mucosa or direct absorption into ocular vessels
3) cornea- absorbs small, lipophilic drugs for transfer to AH
4) Conjunctiva/sclera- absorb large, hydrophilic drugs

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91
Q

Dipivefrin

A

prodrug for epinephrine (sympathomimetic)
activated by esterases for better corneal penetration
used to treat glaucoma

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92
Q

effects of muscarinic antagonists

A

cycloplegia- loss of accommodation
mydriasis- pupils dilate, loss of adaptation
increased IOP
systemic effects- xerostomia, tachycardia, HA, somnolence

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93
Q

indications for use of muscarinic antagonists

A

iris/uveal tract inflammatory conditions

eye examination

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94
Q

muscarinic antagonist contraindications

A

glaucoma- by interrupting flow of AH, retina and optic nerve are compressed
sulfite preservative allergy

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95
Q

muscarinic antagonists for ocular therapy

A 
atropine
cyclopentolate
homotropine
scopolamine
tropicamide
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96
Q

open angle glaucoma treatment

A

decrease AH production and increase AH outflow by sympathomimetics

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97
Q

closed angle glaucoma treatment

A

surgical iridectomy

decrease IOP pre-op by muscarinic agonists

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98
Q

Contraindications for direct acting miotics

A

phakic lens- promotes cataracts
Previous history of retinal detachment/tears
iritis, uveitis, inflammatory conditions of anterior chamber
Cholinergic-mediated medical conditions (CV failure, asthma, peptic ulcer, GI spasm)

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99
Q

Glaucoma first line tx

A

prostaglandin analogs

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100
Q

Prostaglandin analog AE

A

brown pigmentation of iris, eyelid, and eyelashes

Increased eyelash length/thickness

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101
Q

prostaglandin PGFa2 analogs

A

latanoprost
travoprost
bimatoprost (Latisse)
prodrugs activated by esterases for better corneal penetration

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102
Q

Glaucoma tx alternatives

A 
B-receptor antagonists
Carbonic anhydrase (II) inhibitors
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103
Q

B-receptor antagonists

A

Timolol
Levobunolol
Metipranolol
Carteolol

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104
Q

Carbonic anhydrase II inhibitors

A

Dorzolamide

Brinzolamide

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105
Q

B2 blockers MOA

A

Reduce IOP by inhibiting production of AH by decreasing caMP/PKA stimulation

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106
Q

CA2 inhibitors MOA

A

reduce IOP by reducing HCO3 secretion and fluid transport

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107
Q

CA2 inhibitors AE

A 
taste disturbances (dysgeusia= bitter taste)
Sulfonamides: allergic rxn, agranulocytosis, aplastic anemia, fulminant hepatic necrosis, SJS, toxic epidermal necrolysis, other blood dyscrasias
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108
Q

direct acting miotics drug classes

A

muscarinic agonists

cholinesterase inhibitors

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109
Q

Contraindications for Echothiophate

A

closed angle glaucoma (due to increase in IOP)

additive toxicity with organophosphates and carbamate

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110
Q

phenylephrine MOA

A

sympathomimetic
a agonist
decrease IOP by increased outflow of AH from the eye

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111
Q

apraclonidine MOA

A

sympathomimetic
a2 agonist
decrease IOP by increased outflow of AH from the eye

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112
Q

Brimonidine MOA

A

sympathomimetic
a2 agonist
decrease IOP by increased outflow of AH from the eye

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4
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113
Q

Naphazoline MAO

A

sympathomimetic
a agonist
decrease IOP by increased outflow of AH from the eye

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5
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114
Q

Tetrahydrozoline MOA

A

sympathomimetic
a agonist
decrease IOP by increased outflow of AH from the eye

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115
Q

Phenylephrine indications

A

glaucoma, mydriasis, vasoconstriction, decongestion

116
Q

Echothiophate MOA

A

Cholinesterase inhibitor

Increased AH flow and increase IOP

117
Q

Muscarinic agonists MOA

A

Increased AH flow and increase IOP

118
Q

Muscarinic agonists

A

Carbachol
Pilocarpine
Acetylcholine

119
Q

Apraclonidine indications

A

glaucoma, ocular HTN

120
Q

Brimonidine indications

A

glaucoma, ocular HTN

121
Q

Naphazoline indications

A

glaucoma, decongestant

122
Q

Tetrahydrazoline indications

A

glaucoma, decongestant

123
Q

Aflibercept MAO and indications

A

VEGF decoy receptor

Intravitreal injection treats macular degeneration

124
Q

Pegaptanib MAO and indications

A

VEGF antagonist

Intravitreal injection treats macular degeneration

125
Q

Ranibizumab MAO and indications

A

VEGF monoclonal antibody

Intravitreal injection treats macular degeneration

126
Q

Bevacizumab MAO and indications

A

VEGF monoclonal antibody

Intravitreal injection treats macular degeneration

127
Q

VEGF inhibitors AE

A

arterial thromboembolic events

128
Q

Verteporfin MOA and indications

A

IV non-thermal laser activator generates free radicals, causing vessel damage and preventing neovascularization
treats macular degeneration

129
Q

Verteporfin AE

A

HA, injection site rxns, visual disturbances

Temporary photosensitization- avoid direct sunlight for 5+ days

130
Q

Orexin containing neurons

A

posterior lateral hypothalamus

mediate the very rapid transition between sleep and awake

131
Q

benzodiazepines for insomnia (on label)

A 
estazolam
flurazepam
quazepam
temazepam
triazolam
132
Q

antidepressants for insomnia

A

doxepin
mirtazaoine
trazodone

133
Q

benzodiazepine receptor agonists for insomnia (on label)

A

zolpidem
zaleplon
eszopiclone

134
Q

melatonin receptor agonists for insomnia

A

ramelteon

135
Q

1st generation antihistamines for insomnia

A

diphenhydramine
doxylamine
anticholinergic action- avoid in elderly/glaucoma

136
Q

suvorexant MOA

A

dural orexin receptor antagonist for insomnia

take w/o food

137
Q

barbituate binding to GABA

A

greater persistence in channel opening time

creates CNS depression

138
Q

benzodiazepine binding to GABA

A

causes allosteric modification
left shift in dose response curve to endogenous GABA action
“ceiling effect” at very high doses

139
Q

BZ1 alpha subunit

A

binding produces sedation and amnesia

acted upon by benzodiazepines and benzodiazepine receptor agonists

140
Q

BZ2 alpha subunit

A

binding produces anxiolysis

acted upon by benzodiazepines

141
Q

BZ3 alpha subunit

A

binding produces myorelaxation and anti-convulsant action

acted upon by benzodiazepines

142
Q

benzodiazepines with short half lives

A

midazolam, estazolam, oxazepam, lorazepam
metabolized directly to inactive glucoronides for urinary elimination
less cumulative/residual effects

143
Q

benzodiazepines with long half lives

A

diazepam

causes cumulative effects with multiple doses

144
Q

benzodiazepines AE

A

pregnancy category X, COPD, glaucoma, cognitive dysfunction, CYP interactions

145
Q

benzodiazepine receptor agonists AE

A

pregnancy category C, COPD, hepatic disease, cognitive dysfunction, CYP interactions

146
Q

Zolpidem indications

A

benzodiazepine receptor agonist
sublingual/oral spray preps
approved for “middle of the night” waking
slower elimination by women (dose reduced)

147
Q

Flumazenil MOA

A

BNZ and BZR agonist
reversal of sedation or BNZ overdose
Inhibits the inhibitory effect of GABA
Causes abrupt waking, dysphoria, agitation, seizures/withdrawal in chronic BNZ users

148
Q

melatonin receptors in sleep regulation

A

MT1- binding attenuates SCN activity and induces sleep

MT2- binding maintains circadian rhythm

149
Q

ramelteon MOA

A

melatonin receptor agonist
not a schedule drug, doesn’t accumulate
hepatic metabolism, CYP interaction
AE- HA, somnolence, nausea, upper RTI

150
Q

Doxepin MOA

A

FDA approved, low dose
antidepressant used for insomnia
H1 antagonist in tuberomammillary nucleus

151
Q

Mirtazapine MOA

A

antidepressant used for insomnia

a2 antagonism, reinforces NE and 5-HT release

152
Q

Trazodone MOA

A

antidepressant used for insomnia

5-HT reuptake blocker

153
Q

Antidepressants used for insomnia AE

A

CYP interactions
additive CNS depression
Suicidal ideation
Precipitate psychotic episodes

154
Q

Suvorexant AE

A

CYP metabolism, lower dose recommended in obese females, CNS additive depression, sleep paralysis, suicidal ideation

155
Q

migraine symptoms

A 
unilateral
gradual onset
crescendo pattern
rest in quiet, dark room
4-72 hr duration
N/V, photophobia, phonophobia, aura
156
Q

tension headache

A

bilateral
waxes and wanes
treat with NSAIDS

157
Q

cluster headache

A

unilateral
begins around eye or temple
quick onset, explosive pain within minutes
patients remains active
0.5-3 hr duration
ipsilateral lacrimation, eye redness, Horner’s syndrome, sensitivity to alcohol
More prevalent in male smokers
Treat w/ triptans or ergots + steroid like prednisone

158
Q

treatment of mild/moderate/menstrual pain

A

NSAIDS

159
Q

moderate-severe migraine treatment

A

short acting triptan

S.C. sumatriptan most effective

160
Q

migraine prophylaxis

A

topiramate- blocks NA/glutamate, increases GABA
valproate- Na channel blocker, increases GABA
propanolol/timolol- B blocker, decreases arterial dilation
amitriptyline- NE/5HT reuptake inhibitor
botox injection- decrease release of mediators or decreased muscle activation of nerves

161
Q

analgesic overuse syndrome criteria

A

too frequent use of anti-migraine drugs can lead to a paradoxical worsening of the clinical syndrome

1) HA >15 days/mo
2) Med overuse >3 mos
3) HA severity increased since starting meds
4) HA severity resolves within 2 mos after stopping meds

162
Q

migraine pathogenesis

A

With aura: abnormal neuronal discharge leads to localized spreading depression, causing aura and sensitization of central pain pathways
Without aura: excitation of nociceptive nerve terminals in the meningeal vessels leads to cyclic neurogenic inflammation

163
Q

NSAIDS MOA

A

inhibit COX to decrease prostaglandin production, reducing the production of inflammatory signals that would trigger MAPK up regulation and the increased production of CGRP and SP from nerve endings

164
Q

triptans MOA

A

serotonin agonists
selective carotid vasoconstriction via 5-HT1B receptors and presynaptic inhibition of the trigeminovascular inflammatory responses via 5-HT1D receptors

165
Q

NSAIDS used for migraine tx

A 
Ketoprofen
fenoprofen
nabumetone
ibuprofen
naproxen
166
Q

NSAIDS AE

A

gastric irritation
additive nephrotoxicity (especially in elderly)
potentiation of nausea
drug interactions
pregnancy- patent ductus arterioles and prolongs labor/delivery
inhibit ossification process

167
Q

NSAIDS with 1-2 doses/day

A

naproxen

nabumetone

168
Q

Butalbital MOA

A

barbituate sedative via thalamic GABA enhancement
added to acetaminophen/caffeine and ASA/caffeine
strongly linked to analgesic overuse syndrome
CYP inducers
CNS/respiratory depression

169
Q

Triptan nasal sprays

A

sumatriptan

zolmitriptan

170
Q

triptan S.C.

A

sumatriptan
quickest onset of drug action, most effective delivery route
most prominent side effects: CNS effects, tightness of chest

171
Q

triptans with longer T1/2

A

1) frovatriptan
2) naratriptan
more durable effect (better for chronic use) but with slower onset of action

172
Q

triptans AE

A

coronary and peripheral vasospasm, interaction with ergots, MAO inhibitors, CYP inhibitors, serotonin syndrome

173
Q

ergotism symptoms

A

mental disorientation, convulsions, muscle cramps, ischemia –> dry gangrene

174
Q

Ergots MOA

A

Central 5-HT receptor agonists and peripheral alpha receptor agonists crease vasoconstriction

175
Q

Ergots AE

A

vasospastic predisposing conditions: CAD, PVD, sepsis, MI, HTN
Category X, no breastfeeding

176
Q

migraine treatment during pregnancy

A

1st trimester- acetaminophen

later- opiods

177
Q

migraine and oral contraceptives risk

A

multiplicative risk of ischemic stroke with OCP and history of migraine with aura

178
Q

allodynia treatment

A

hypersensitivity produced by migraines
hydrocodone, oxycodone, codeine
IM ketorolac

179
Q

metoclopramide MOA, AE

A

central D2 antagonist, anti-emetic and accelrates gastric emptying
increases PRL, can cause gynecomastia

180
Q

prochlorperazine and chlorpromazine MOA, AE

A

central D2 antagonist, anti-emetic/vertigo treatment
Cholinergic and a-adrenergic blockade
causes dyskinesia, hypotension, glaucoma, urinary retention, BPH
chronic use associated with bone marrow suppression and blood dyscrasias

181
Q

promethazine MOA, AE

A

anticholinergic, anti-emetic
anti-anxiety for surgery
antihistamine, weak D2 antagonist
causes glaucoma, urinary retention, BPH, drowsiness, Parkinson’s like symptoms

182
Q

migraine prophylaxis in children

A

propanolol

183
Q

analgesic overuse pathogenesis

A

tigeminovascular system sensitization
reduced 5HT levels
increased 5-HT2 receptor density
free radical damage in PAG

184
Q

drugs with a high risk of developing analgesic overuse syndrome

A

ASA, tylenol, caffeine
Butalbital containing combinations
Opiods

185
Q

HA alternative therapy

A

riboflavin and coenzyme Q 10

186
Q

migraine HA alternative therapy

A

feverfew and butterbur

187
Q

brain metastases edema tx

A

steroids

188
Q

brain metastases seizure tx

A

anticonvulsants

189
Q

brain metastases resistance to chemo

A

BBB
P-gp
astrocytes directly contact tumor cells

190
Q

Carmustine MOA

A

alkylator
decomposition products carbamolyate proteins
inhibit DNA repair
IV, hepatic metabolism

191
Q

Lomustine MOA

A

akylator
inhibit DNA repair
oral, hepatic metabolism

192
Q

Carmustine AE

A

blood dyscrasias, N/V, pulmonary fibrosis, endocrine dysfunction, encephalopahthy, seizures, elevated liver enzymes

193
Q

Lomustine AE

A

blood dyscrasias, N/V, pulmonary fibrosis, endocrine dysfunction, encephalopahthy, seizures, elevated liver enzymes

194
Q

Temzolomide MOA

A

non-enzymatically activated prodrug is converted to DNA methylating agent

195
Q

Temzolomide AE

A

teratogenic, myelosupression, blood dyscrasia, N/V, chills, fever, malaise, myalgia

196
Q

Temzolomide resistance

A

tumor cells express wild type methylgyanine methyltransferase to excise methyl lesions from the O6 position of guanine to prevent apoptosis

197
Q

anesthetics that inhibit glutamate signaling

A

ketamine and propofol

198
Q

IV anesthetic distribution

A

plasma –> brain, heart, liver, kidneys –> skeletal muscle and skin –> adipose tissue (accumulation)
Redistribution explains short duration of action

199
Q

benzodiazepines used as anesthetics

A

diazepam
lorazepam
midazolam
anticonvulsant and amnesic action

200
Q

homeostatic responses to IV benzodiazepines

A

venodilation

decreased CO

201
Q

opiods used as anesthetics

A

morphine- long lasting, causes N/V

fetanyl- short lasting

202
Q

opiods AE

A 
dose dependent respiratory depression (unresponsive to PaCO2)
muscle rigidity: wooden chest syndrome
increased ICP
N/V
pinpoint pupils
inhibits GI motility
203
Q

neurolept analgesia

A

drug combination used to produce pain relief and a state of indifference

204
Q

neurolept analgesia agents

A

N2O plus anesthesia
atropine + morphine or meperidine
droperidol + fetanyl

205
Q

Remifentanil MOA

A

ultra short acting anilidopiperidines (opiate)
potent analgesic
rapid recover without accumulation

206
Q

malignant hyperthermia

A

2-3x increase in end tidal CO2
rigidity, tachycardia, respiratory and metabolic acidosis, unexplained cardiac arrest in young males
caused by intracellular calcium release from SR
triggers- succinylcholine and volatile anesthetics

207
Q

amide type, infiltration/injection local anesthetics

A 
i in the name before "caine"
lidocaine
mepivacaine
prilocaine
bupivacaine
ropivacaine
articaine
208
Q

ester type, infiltration/injection local anesthetics

A

no i in the name before “caine”
procaine- risk of allergic rxn
chloroprocaine
tetracaine

209
Q

topical local anesthetics: skin and mucous membranes

A

benzocaine

dyclonine

210
Q

phentolamine MOA

A

local anesthetic reversal agent via vasodilation

alpha blocker

211
Q

local anesthetics characteristics

A 
fully reversible neuronal blockade
lipophilic and hydrophilic
structure: amine + aromatic appendage
low toxicity
no long lasting effects
neutral/uncharged, weak bases with Pka=8
212
Q

local anesthetics MOA

A

block voltage gated sodium channels located in the nerve axon
frequency dependent blockade: anesthetic can physically only reach the binding site when the channel is inactivated or activated (not resting)
The higher the extra neural pH, the greater the nerve block because more anesthetic is available in the uncharged form to pass into the neural space

213
Q

differential blockade of local anesthetics

A

greater impact on smaller diameter nerves and myelinated nerves (B fibers affected first, A fibers least sensitive)

214
Q

articaine MOA

A

contains thiophene ring instead of benzene ring to be lipophilic
loss of biological activity occurs after ester cleavage
better penetration into bone (dental procedures)

215
Q

amide type local anesthetic metabolism

A

hepatic

urinary elimination

216
Q

ester type local anesthetic metabolism

A

metabolized in any tissue except CSF by non-specific esterase enzymes
urinary elimination

217
Q

systemic toxicities of local anesthetics

A

ringing in ears, metallic taste, numbness in lips/tongue, seizures

218
Q

vasoconstrictive additives to local anesthetics

A

increases duration and intensity of blockade by increasing dose penetration
epinephrine
levonordefrin

219
Q

short acting local anesthetics

A

procaine (slow onset)

chloroprocaine (rapid onset)

220
Q

long acting local anesthetics

A

bupivacaine- cardio toxic
ropivacaine- less cardio toxic
tetracaine

221
Q

pKa of local anesthetics

A

pKa=8

lower pKa = greater portion can diffuse into nerve = shorter time of onset

222
Q

methemoglobulinemia

A

accumulation of ferric hemoglobin that cannot release O2 to tissue
blue skin, HA, SOB, fatigue
caused by prilocaine and benzocaine

223
Q

topical local anesthetics: skin only

A

dibucaine

pramoxine

224
Q

EMLA components

A

lidocaine and procaine

225
Q

LET components

A

lidocaine, epinephrine, tetracaine

226
Q

Lidocaine-oxymetazoline indications

A

a1/2 agonist added to reduce engorgement of nasal passages

227
Q

baricity

A

density of solution compared with CSF

may be adjusted to control drug distribution

228
Q

local anesthetic + CSF

A

isobaric, will remain at level of injection

229
Q

local anesthetic + dextrose

A

hyperbaric, will migrate downwards relative to gravity

230
Q

local anesthetic + sterile water

A

hypobaric, will migrate upwards relative to gravity

231
Q

drugs used with anesthetics for sedation

A 
diazepam
lorazepam
promethazine
hydroxyzine
diphenhydramine
232
Q

drugs used with anesthetics for analgesia

A 
morphine
codeine
fentanyl
ketorolac
ibuprofen
233
Q

antimicrobial drugs used with anesthetics

A

cefazolin- staph and strep
cefotetan/cefoxitin- bowel anaerobes
vancomycin- MRSA

234
Q

drugs used with anesthetics for rapid sequence intubation

A 
lidocaine- decrease ICP
vecuronium- decrease ICP
atropine- decrease bradycardia
fentanyl- decrease sympathetic response
succinylcholine- NMB
235
Q

drugs used with anesthetics for anaphylaxis

A

epinephrine
aminophylline- treats bronchospasm
hydrocortisone
methylprednisolone

236
Q

drugs used with anesthetics for aspiration pneumonia

A 
cimetidine
ranitidine
bicitra
polycitra
metoclopramide
237
Q

anti-cholinergic drugs used with anesthetics

A

atropine- vagolytic > antisialogogue
glycopyrrolate- sedation > antisialogoue > vagolytic
scopolamine- antisialogogue > vagolytic

238
Q

drugs used with anesthetics for CV support

A

dopamine- hypotension
phenylephrine- hypotension
nitroprusside- HTN
trimethaphan- HTN

239
Q

drug given night before surgery

A

benzodiazepine- anxiety

240
Q

drugs given 1-2 hrs before surgery

A 
benzodiazepine- anxiety
water
opiod- analgesia
scopolamine- amnesia/sedation
cimetidine/metoclopromide
glycopyrrolate/atropine
241
Q

first generation H1 antagonists pre-op

A

sedative, anti-cholinergic, anti-emetic
hydroxyzine
diphenhydramine

242
Q

Cimetidine MOA and indications

A

H2 antagonist

produces sedation and decreases gastric acid secretion (less aspiration PNA)

243
Q

Ranitidine MOA and indications

A

H2 antagonist

decreases gastric acid secretion (less aspiration PNA)

244
Q

Bacitra, polycitra indications

A

antacid to neutralize existing stomach contents
non-particulate products
Na + Potassium citrate

245
Q

post-op respiratory depression treatment

A

failure of reversal of NMB blockers- inadequate elimination, drug-drug interaction, hypermagnesemia, hypothermia
treat w/ small doses of narcotic antagonists

246
Q

seizure pathogenesis

A

1) high-frequency bursts of APs- Ca influx, Na channel activation
2) hypersynchronization- hyperpolarization via GABA and K channels

247
Q

MOAs of AEDs

A

1) Na channel inactivation
2) GABA enhancement
3) T-type Ca channel blockade

248
Q

AEDs AE

A

suicidal ideation

249
Q

Carbamazepine MOA

A

Na channel blocker

AED

250
Q

Lacosamide MOA

A

Na channel blocker
AED
NO SJS

251
Q

Lamotrigine MOA

A

Na channel blocker

AED

252
Q

Phenytoin MOA

A

Na channel blocker

AED

253
Q

Clonazepam MOA

A

GABA allosteric agonist

NO SJS

254
Q

Ethosuximide

A

T-type Ca channel blocker

255
Q

Gabapentin MOA

A

inhibits a2d subunit of Ca channel

256
Q

Oxycarbazepine MOA

A

Na channel blocker*
Ca channel blocker
K channel agonist

257
Q

Pregabalin MOA

A

inhibits a2d subunit of Ca channel

258
Q

Topiramate MOA

A

Na channel blocker
GABA agonist
increased K current
decreased glutamate activity

259
Q

Valproate MOA

A

GABA agonist

Na channel blocker

260
Q

Zonisamide MOA

A

Na channel blocker

T-type Ca channel blocker

261
Q

Topiramate AE

A

CA inhibitor, causes kidney stones and acidosis

262
Q

Zonisamide AE

A

CA inhibitor, causes kidney stones and acidosis

263
Q

phenytoin AE

A 
0-order pharmacokinetic behavior- half-life varies with drug dose
Nystagmus
Gingival hyperplasia
Hypertrichosis/hirsutism
Blood dyscrasia
264
Q

Carbamazepine AE

A

CNS effects- dizziness, drowsiness, ataxia, blurred vision
Agranulocytosis
N/V
Constipation, dry mouth

265
Q

HLA-B genotyping

A

SNP 1502 allele increases risk of SJS
Asian
carbamazepine, phenytoin, fosphenytoin, lamotrigine

266
Q

Valproate AE

A

Teratogenic- category X
CNS effects
thrombocytopenia, increased bleeding time
N/V/D

267
Q

Lamotrigine AE

A

SJS, TEN, DRESS

268
Q

Felbamate AE

A

aplastic anemia, bone marrow suppression, hepatic disease, N/V

269
Q

teratogenic AEDs

A 
valproate
lamotrigine
carbamazepine
phenytoin
phenobarbital
topiramate
270
Q

fetal hydantoin syndrome

A

upturned nose, mild midfacial hypoplasia, long upper lip

Distal digital hypoplasia

271
Q

partial seizures drug of choice

A

lamotrigine
carbamazepine
levetiracetam
oxcarbazepine

272
Q

generalized seizures treatment

A

valproate
lamotrigine
levetiracetam

273
Q

absence seizures treatment

A

ethosuximide

valproate

274
Q

status epilepticus treatment

A 
prolonged seizure or cluster of seizers without a return to baseline, lasting longer than 30 mins
due to change in AED regiment of stroke
IV BNZ (Lorazepam/midazolam) + AED (valproate)
275
Q

Phenobarbital MOA

A

barbituate, binds GABA receptor to prolong opening time of Cl channel
CYP inducer
Can be given by rapid IV

276
Q

irreversible ototoxics

A 
aminoglycosides- caspase dependent and independent
cisplatin (cytostatic drugs)- caspase dependent
loop diuretics (sometimes)- upset fluid balance in stria vascularis
277
Q

reversible ototoxics

A 
erythromycin
minocycline
fluoroquinolones
NSAIDs
loop diuretics
antimalarials
278
Q

dose dependent ototoxics

A

aminoglycosides, loop diuretics, cisplatin

279
Q

vertigo therapy

anti H1 and anti M1

A

Diphenhydramine
Meclizine
Promethazine- BBW for use by injection
Beers criteria- can’t use with elderly

280
Q

vertigo therapy

anti M1

A

scopolamine- transdermal patch, longest duration of action

Beers criteria- can’t use with elderly

281
Q

central emesis center

A

chemoreceptor trigger zone (CTZ) in the area postrema

No BBB allows for monitoring of toxic substances

282
Q

“setrons” MOA

A

serotonin 5-HT3 antagonists
act in CTZ and STN
treats vertigo

283
Q

“setrons” AE

A

hypersensitivity rxns
odansetron- hepatic dose adjustment
QT prolongation
HA, diarrhea, constipation

284
Q

“pitants” MOA

A

substance P/neurokinin 1 receptor antagonist
works in solitary tract and GI
major CYP inhibitor
treats vertigo

285
Q

Dronabinol MOA

A

cannabinoid agonist decreases GPCR neuronal activity in AP and STN
treats vertigo
produces high- elation and heightened awareness

286
Q

chemo N/V prophylaxis

A

NK1 antagonist + serotonin antagonist + corticosteroid

Pharm (3 decks)

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