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Step 1 2019 First Aid Flashcards > Neuro - FA Pharm p532 - 539 > Flashcards

Neuro - FA Pharm p532 - 539 Flashcards

1
Q

DOC in status epilepticus & MoA

A

Benzos, !nc GABAA action

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2
Q

MoA of Carbamazepine

A

Blocks Na+ channels

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3
Q

1st and 2nd line treatment for eclampsia seizures

A
  1. MgSO4
  2. Benzos
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4
Q

DOC for trigeminal neuralgia

A

Carbamazepine

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5
Q

SE of Carbamazepine

A

Diplopia, ataxia, blood dyscrasias (agranulocytosis, aplastic anemia), liver toxicity, teratogenesis (cleft lip/palate, spina bifida), induction of cytochrome P-450, SIADH, SJS

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6
Q

Tx and MoA of Rx that treats absence seizures

A

Ethosuximide

Blocks thalamic T-type Ca2+ channels

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7
Q

(-) high voltage activated Ca channels

A

Gabapentin

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8
Q

SE of Ethosuximide

A

EFGHIJ—Ethosuximide causes Fatigue, GI distress, Headache, Itching (and urticaria), SJS

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9
Q

Other uses of Gabapentin other than seizures

A

Also used for peripheral neuropathy, postherpetic neuralgi

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10
Q

What epileptic drug needs to be titrated slowly bc of SJS

A

Lamotrigine

(Carbamazepine also, and rarely, Phenytoin)

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11
Q

Lamotrigine has a black box warning for what?

A

causing hemophagocytic lymphohistiocytosis

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12
Q

MoA of Lamotrigine

A

Blocks voltage gated Na channels - (-) Glu release

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13
Q

Which epileptic drug has personality changes as a SE?

A

Levetiracetam

He’s on another level

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14
Q

Which epileptic drugs (+) p450?

A

Phenobarbital
Carbamazepine
Phenytoin

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15
Q

Which 3 drugs are used for status epilepticus

A

Benzo - 1st line

Phenobarbital

Phenytoin - 1st line for recurrent seizure

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16
Q

1st line for neonatal seizures

A

phenobarbital

PhenoBabytal

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17
Q

Which epileptic drug has zero order kinetics

A

Phenytoin

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18
Q

List Ca2+ blockers for antiseizures

A

EGL

Ethosuximide
Gabapentin

Levetiracetam

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19
Q

Antiepileptic causing SIADH

A

carbamazepine

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20
Q

tonic-clonic DOC

A

valproic acid

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21
Q

patient with tonic clonic and absence seizures

A

valproic

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22
Q

gingival hyperplasia is caused by

A

phenytoin

Also Cyclosporin, CCB (verapamil)

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23
Q

baby with cleft palate, cardiac
defects, phalanx/fingernail hypoplasia

A

fetal phenytoin syndrome

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24
Q

kidney stones are caused by

A

topiramate

Sedation, slow cognition,
kidney stones, skinny (weight
loss), sight threatened
(glaucoma), speech

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25
Q

2 drugs that are used for migraine prophylaxis

A

Valproic acid

Topiramate

Also: TCAs, and BBs/CCBs (CCB only in VC phase)

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26
Q

What drug group is contraindicated in porphyria?

A

Barbituates

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27
Q

SE of Phenytoin

A

PHENYTOIN:

P-450 induction,
Hirsutism,
Enlarged gums,
Nystagmus,
Yellow-brown skin,
Teratogenicity (fetal hydantoin syndrome),
Osteopenia,
Inhibited folate absorption,
Neuropathy.

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28
Q

For which epileptic rx do you need to monitor LFTs

A

Valproic acid - rare but fatal hepatotox

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29
Q

CI in pregnancy

A

valproic acid

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30
Q

black box warning with vigabatrin?

A

permanent vision loss

Vision gone all bad with Vigabatrin

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31
Q

Which two drugs block GABA transaminase?

A

Valproic acid

Vigabatrin

The Vs block the enzyme

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32
Q

MoA of Barbituates

A

Facilitate GABAA action by INC duration of Cl− channel opening, thus dec neuron firing (barbidurates INC duration)

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33
Q

Which barb is used to induse anesthesia?

A

thiopental

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34
Q

MoA of Benzo?

A

Facilitate GABAA action by INC frequency of Cl– channel opening (“frenzodiazepines” inc frequency).

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35
Q

How does benzo affect sleep?

A

Dec REM sleep, dec N3 stage of sleep (delta )

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36
Q

Which benzos are short acting? what does that mean for addiction?

A
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37
Q

Which benzos are safe for those with liver problems

A

Lorazepam, Oxazepam, and Temazepam can be used for those with liver disease who drink a LOT due to minimal first-pass metabolism.

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38
Q

Which 3 benzos are used in status epilepticus?

A

lorazepam, diazepam, midazolam

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39
Q

How to tx Benzo OD? MoA? What is the potential post tx issue?

A

Treat overdose with flumazenil (competitive antagonist at GABA benzodiazepine receptor). Can precipitate seizures by causing acute benzodiazepine withdrawal.

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40
Q

Nonbenzo hypnotics?

A

Zolpidem, Zaleplon, esZopiclone. “These ZZZs put you to sleep.”

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41
Q

MoA of non benzo hypnotics

A

Act via the BZ1 subtype of the GABA receptor.

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42
Q

Why do non benzo hypnotics have a short duration of action?

A

Short duration because of rapid metabolism by liver enzymes

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43
Q

orexin receptor antagonist?

A

Suvorexant

Orexin - antagonist

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44
Q

CI of Suvorexant

A

Can’t be used with narcolepsy, combination with strong CYP3A4 inhibitors. Not recommended in patients with liver disease

45
Q

melatonin receptor agonist?

46
Q

Ramelteon binds to which rec’r in what nucleus?

A

MT1 & MT2
suprachiasmatic nucleus

47
Q

Triptans have what MoA?

A

5-HT1B/1D agonists.
Inhibit trigeminal nerve activation,
prevent vasoactive peptide release,
induce vasoconstrition

48
Q

Triptans are used for what type of headaches

A

Migraines and cluster headache attacks

49
Q

Triptans CI in which patients

A

Peole with CAD/ vasospastic angina, bc causes coronary vasospasm

50
Q

Which rx should not be mixed with triptans

A

Any serotonin agonists, bc could lead to serotonin syndrome

Psychiatric drugs: MAO
inhibitors, SSRIs, SNRIs,
TCAs,

vilazodone - (-) 5HT reuptake, 5HT1A partial agonist
vortioxetine - (-) 5HT reuptake, 5HT1A agonist, 5HT3 antagonist

Nonpsychiatric drugs:
tramadol, ondansetron,
triptans, linezolid, MDMA,
dextromethorphan,
meperidine, St. John’s wort

51
Q

Name 2 Non-ergot (preferred) Tx for Parkinson?

A

pramipexole (restless leg syn Tx), ropinirole

52
Q

Which drug incr dopamine release and decr reuptake?

A

Amantadine

53
Q

Which agent blocks DOPA decarboxylase?

54
Q

Which drugs prevent peripheral l-dopa degradation to 3-O-methyldopa (3‑OMD) by inhibiting COMT?

A

Entacapone, tolcapone

55
Q

Drug that blocks conversion of dopamine into 3-MT by selectively inhibiting MAO-B?

A

Selegiline

56
Q

2 MOA of Tolcapone

A

—blocks conversion of dopamine to 3-MT (3 - methoxytyramine) by inhibiting central COMT
—prevent peripheral l-dopa degradation to 3-O-methyldopa (3‑OMD) by inhibiting COMT.

57
Q

BALSA mneumonic stands for what? It treats what?

A

Parkinsons

Bromocriptine
Amantadine
Levodopa (with carbidopa)
Selegiline (and COMT inhibitors)
Antimuscarinics

58
Q

How to curb excess cholinergic activity?

A

Benztropine, trihexyphenidyl (Antimuscarinic; improves tremor and rigidity but has little effect on bradykinesia in Parkinson disease). Park your Mercedes-Benz.

60
Q

What enzyme converts L- Dopa to dopamine?

A

dopa decarboxylase

61
Q

long termSE of L-Dopa

A

With progressive disease, l-DOPA can lead to “onoff” phenomenon with improved mobility during “on” periods, then impaired motor function during “off” times when patient responds poorly to l-DOPA or medication wears off.

62
Q

Name a NMDA receptor antagonist that helps prevent excitotoxicity (mediated by Ca2+)?

A

Memantine used for Alzheimer

63
Q

Rx used in ALS ?

A

Riluzole

Rilouzole - for Lou Gehrig
dec neuron glutamate

64
Q

Huntington disease Rx and MoA

A

Tetrabenazine
Inhibit vesicular monoamine transporter (VMAT) –> dec dopamine vesicle packaging and release

Tetra = 4 , Huntington on Chr 4

65
Q

high potency –> lipid or blood solubility

A

potency–> think lipid! want high solubility in lipid for high potency

66
Q

rapid induction, want B/G ratio to be?

A

low–> increased free fraction

67
Q

Side effect of Halothane

A

Hepatotoxicity

68
Q

Methyoxyflurane SE

69
Q

Proconvulsant

70
Q

Pathomech of Malignant hyperthermia

A

Mutations in voltage-sensitive ryanodine receptor (RYR1 gene) cause  Ca2+ release from sarcoplasmic reticulum.

71
Q

List 4 IV anesthetics

A

Thiopental, Midazolam, Propofol, Ketamine

72
Q

How do the IV anesthetics affect GABA

A

Thiopental - barb - inc duration of Cl’ channel opening - faciliate GABAa

Midazolam - inc freq of Cl channel opening - facilitate GABAa

Propofol - potentiates GABAa

73
Q

MoA of Ketamine

A

NMDA -R antagonist

74
Q

Which IV anesthetic causes anterograde amnesia, and which causes hallucinations

A

Midazolam ; Ketamine

75
Q

Why are local anesthetics given with epinephrine

A

Can be given with vasoconstrictors (usually epinephrine) to enhance local action—dec bleeding, inc anesthesia by dec systemic concentration.

76
Q

In which conditions may you have to give a larger dose of anesthetic

A

In infected (acidic) tissue, alkaline anesthetics are charged and cannot penetrate membrane effectively = need more anesthetic

77
Q

Which local anesthetic leads to cardiovasc tox and which leads to methemoglobinemia?

A

Cardio tox - Bupivacaine

BuPumpacaine
Methemoglobinemia - Benzocaine

BenZO MetheMO

78
Q

Succinyl choline - MoA

A

strong Ach-R agonist

79
Q

How to reverse blockade of Succinyl choline

A

ƒ Phase I (prolonged depolarization)—no antidote. Block potentiated by cholinesterase inhibitors.
ƒ Phase II (repolarized but blocked; ACh receptors are available, but desensitized)—may be reversed with cholinesterase inhibitors

80
Q

Ex of nondepolarizing neuromuscular blocking drugs - MoA

A

Atracurium, cisatracurium, pancuronium, rocuronium, tubocurarine, vecuronium - competitive ACh antagonist

81
Q

How to reverse nondepolarizing neuromuscular blocking drugs?

A

neostigmine
edrophonium
(cholinesterase blockers)

82
Q

What must be given with neostigmine to (-) bradycardia

A

atropine + glycopyrrolate

83
Q

a GABAB-R agonist in spinal cord

A

Baclofen

B- for back and GABAB

84
Q

CNS acting spasmolytic

A

Cyclobenzaprine, mainly at the brain stem

85
Q

Dantrolene MoA

A

(-) release of Ca2+ from SR of skeletal musc by (-)’d ryanodine receptor

86
Q

Use of Dantrolene

A

Malignant hyperthermia (toxicity of inhaled anesthetics and succinylcholine) and neuroleptic malignant syndrome (toxicity of antipsychotic drugs)

87
Q

centrally acting α2 agonist?

A

Tizanidine

88
Q

Which channels do opiods affect and how?

A

close presynaptic Ca2+ channels, open postsynaptic K+ channels

89
Q

Opoids stop the release of ?

A

ACh, norepinephrine, 5-HT, glutamate, substance P.

90
Q

Partial opiod agonist

A

Buprenorphine

91
Q

Mixed opiod agonist/antagonist

A

nalbuphine, pentazocine, butorphanol

92
Q

Opiod antagonist

A

naloxone, naltrexone, methylnaltrexone

93
Q

Opiods used for diarrhea

A

loperamide, diphenoxylate

94
Q

Which opiod causes mydriasis instead of miosis

A

Meperidine

95
Q

What is the risk with mixing pentazocine or Butorphanol with other opiods?

A

Can ppt withdrawal if a patient is taking a full agonist too

96
Q

Tramadol, along with being a weak opiod agonist also acts on what other nt?

A

also inhibits the reuptake of norepinephrine and serotonin.

97
Q

List 3 drugs that dec aq humor synthesis

A

BB
α-agonists
Acetazolamide

98
Q

2 drugs that inc outflow of aq humor

A

Prostaglandins - Bimatoprost, latanoprost
Cholinomimetics - pilocarpine, carbachol, physiostigmine, echothiophate

99
Q

Which two glaucoma drugs cause no vision or pupillary changes

A

BB
Acetazolamide

100
Q

Diff between epinephrine and apraclonidine in terms of glaucoma tx

A

Epinephrine dec aq humor synthesis via VC, Apraclonidine (Brimondine) will dec synthesis directly

101
Q

Which glaucoma drug should not be used in closed angle glaucoma

A

Epinephrine - will cause mydriasis

102
Q

Which glaucoma drug causes miosis and cyclospasm

A

cholinomimetics (M3R)

103
Q

Rx for acute angle closure glaucoma?

A

Pilocarpine (very effective at opening meshwork into canal of Schlemm)

104
Q

SE of PGF2α

A

latanoprost, bimatoprost

darkens irises, and eyelash growth

105
Q

what 2 drugs are used for maintenance programs for heroin addicts?

A

methadone, buprenorphine + naloxone

106
Q

What do you use for Spasticity in MS

A

Baclofen (GABAb agonist)

107
Q

list Muscarinic antagonist to treat neurogenic bladder

A

oxybutynin
Tolterodine

108
Q

treatment for

  1. malignant hyperthermia
  2. Neuroepileptic syndrome
  3. serotonin syndrome
  4. extrapyramidal systems SE of antipyschotics
A
  1. dantrolene (fever+severe muscle contractions) (SSRI+inhaled anesthetics except N2O)
  2. dantrolene and D2 agonists (bromocriptine) (myoglobinuria + ridigity)
  3. cyproheptadine - 5hT2-R (-)’r (myoclonus + diarrhea)
  4. benztropine (anti muscuranic) or diphenhydramine
109
Q

for endoscopy, what anesthetics are used?

Step 1 2019 First Aid Flashcards (63 decks)

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