Neuro Pharm

Question 1

Linezolid

Answer 1

For: Serious Gram + infections, VR Enterococcus, MRSA
Toxicity: Serotonin Syndrome, when combined with SSRI, or SNRI
MOA: ….Weak MAOI

Question 2

Clindamycin

Answer 2

For: Clostridium Difficile

Question 3

Serotonin Syndrome

Answer 3

Neuromuscular excitation: Hyperreflexia, CLONUS, myoclonus, rigidity
Autonomic Stimulation: Hyperthermia, tachycardia, diaphoresis, vomiting/diarrhea
Altered mental status: Agitation, confusion
Often occurs w/ addition of MAOI or excess tryptophan (converted to 5-HT)
Treat w/ serotonin R antagonists - cyproheptadine or short acting anti-hypertensives

Question 4

Vancomycin

Answer 4

Toxicity: Red Man Syndrome (flushing, erythema, pruritis)

Question 5

What side effects continue after carbidopa is added to levodopa?

Answer 5

Anxiety and agitation (hot flashes, tacharrythmias, nausea/vomiting, postural hypertension would all decrease)

Question 6

Clozapine

Answer 6

For: Schizophrenia (Better in treatment resistant patients)
MOA: Acts on D4 receptors
Toxicity: Agranulocytosis (monitor with CBC to look at WBC), seizures

Question 7

Ziprasidone

Answer 7

Toxicity: Prolonged QT (monitor w/ ECG)

Question 8

Carbamazepine

Answer 8

For: Seizures (complex partial), trigeminal neuralgia, and mania.
Toxicity: Mild rise in liver enzymes (monitor w/ LFT)

Question 9

Lithium

Answer 9

For: manic and depressive episodes, maintenance
MOA: modify adenyl cyclase and PIP pathways
Toxicity: Hypothyroidism (monitor w/ TSH and T3/T4 assays), diabetes, tremor, and Ebstein’s anomaly (tricuspid doesn’t work)

Question 10

Atropine

Answer 10

For: Bradycardia (many others)
MOA: Blocks Muscarinic Receptors (dec vagal influence)
Toxicity: Mydriasis in eye may cause acute close-angled glaucoma

Question 11

Zolpidem

Answer 11

For: Insomnia
MOA: binds GABA-A, enhances GABA, non-benzodiazepine hypnotic
less dependence, not anticonvulsant, not muscle relaxant

Question 12

Modafinil

Answer 12

For: Narcolepsy (1st line), daytime sleepiness

Question 13

B-Blockers

Answer 13

Decrease aqueous humor synthesis (for glaucoma); no pupil changes

Question 14

Cholinomimetics

Answer 14

Increase aqueous humor outflow (for glaucoma); Miosis - opens trabecular meshwork

Question 15

Penicillins/Cephalosporins

Answer 15

Irreversibly bind penicillin-binding proteins aka transpeptidases

Resistance: Change in protein structure; B lactamases break down the rings

Question 16

Valproic Acid

Answer 16

For: Absence (2nd line), myoclonic and Tonic Clonic seizures. also treats mania (mood stabilizer) and trigeminal neuralgia (2nd line).
Toxicity: hepatotoxicity and neural tube defects

Question 17

Ethosuxamide

Answer 17

For: Absence (1st line)
MOA: reduces Ca++ currents in T type Ca++ channels in neurons, inhibiting propagation

Question 18

Prophylaxis for Nisseria Meningitidis

Answer 18

Rifampin

Question 19

SSRI most common side effect

Answer 19

Sexual Dysfunction

Question 20

CYP 450 Inducers

Answer 20

Chronic alcohol use, Modafinil, St. John’s Wort, Phenytoin, Phenobarbital, Nevirapine, Rifampin, Griseofulvin, Carbamazepine

Question 21

CYP 450 Inhibitors

Answer 21

Acute alcohol use, Gemifibrozil, Ciprofloxacin, Isoniazid (can cause full blown hepatitis), Grapefruit Juice, Quinidine, Amiodarone, Ketoconazole, Macrolides, Sulfonamides, Cimetidine, Ritonavir

Question 22

Carbamazepine’s BIG side effects

Answer 22

Aplastic anemia (monitor CBC), agranulocytosis, hyponatremia, neural tube defects.

Question 23

Citalopram’s BIG side effect (SSRI)

Answer 23

Sexual Dysfunction

Question 24

Clozapine’s BIG side effects

Answer 24

Agranulocytosis and seizures

Question 25

Lamotrigine

Answer 25

For: refractory partial, tonic clonic seizures. depressed phase of bipolar Toxicity: STEVEN JOHNSON SYNDROME

Question 26

Risperidone's BIG side effect

Answer 26

Hyperprolactinemia, EPS

Question 27

Trazodone's BIG side effects

Answer 27

Priapism (painful erection), orthostatic hypotension, sedation

Question 28

Lithium's BIG side effects

Answer 28

Hypothyroidism, Nephrogenic diabetes insipidus, Congenital anomalies (preggers problems)

Question 29

Phenelzine

Answer 29

For: atypical depression characterized by mood reactivity, rejection sensitivity, and increased sleep and appetite; first line didn't work MOA: MAOI

Question 30

Tranylcypromine

Answer 30

For: atypical depression characterized by mood reactivity, rejection sensitivity, and increased sleep and appetite; first line didn't work MOA: MAOI

Question 31

On Off Phenomenon

Answer 31

Characteristic of advanced Parkinson, unpredictable and dose dependent. sudden loss of L-dopa effects leads to hypokinesia and rigidity.

Question 32

Levodopa

Answer 32

For: Parkinson MOA: crosses BBB, increases dopamine levels in brain Toxicity: arrhythmias, dyskinesia from long term use Contra: vitamin B6 which increases its peripheral metabolism

Question 33

Lorazepam

Answer 33

For: active seizures, acute anxiety, and alcohol withdrawal MOA: enhances GABA affinity for its R by increasing the frequency of chloride channel openings

Question 34

Olanzapine

Answer 34

For: psychotic and mood disorders MOA: 2nd gen antipsychotic Tox: weight gain, metabolic syndrome, lower seizure threshold

Question 35

Sertraline

Answer 35

For: major depression, OCD, anxiety. MOA: SSRI

Question 36

Short Acting Benzodiazepines

Answer 36

Alprazolam, Triazolam, Oxazepam, Midazolam | less drowsiness or risk of fall. highest risk of dependence

Question 37

Long Acting Benzodiazepines

Answer 37

Chlordiazepoxide, Clorazepate, Diazepam, Flurazepam | greater daytime drowsiness and risk of fall. lower risk of dependence

Question 38

Bupropion

Answer 38

For: major depression, tobacco dependence, hypoactive sexual disorder MOA: inhibits presynaptic reuptake of DA and NE (more DA) Tox: seizures (esp. in those with AN or BN)

Question 39

Vitamin E

Answer 39

Antioxidant and neuroprotective agent that may slow functional losses in alzheimers

Question 40

Memantine

Answer 40

For: Alzheimers MOA: NMDA R antagonist

Question 41

Donepezil, Galantamine, Rivastigmine

Answer 41

ACh esterase inhibitors | For: Alzheimers

Question 42

Baclofen

Answer 42

For: trigeminal neuralgia (2nd line)

Question 43

Tiagabine

Answer 43

For: refractory partial seizures MOA: inhibits GABA reuptake

Question 44

Topiramate

Answer 44

For: refractory partial seizures MOA: blocks Na channels and enhances effect of GABA

Question 45

Vigabatrin

Answer 45

For: refractory partial seizures MOA: inhibits GABA transaminase and increases GABA concentration

Question 46

Gabapentin

Answer 46

For: refractory partial seizures MOA: increases brain GABA concentration