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Pharmacology Step 1 > Neuro Pharm > Flashcards

Neuro Pharm Flashcards

1
Q

Triptans

A

sumatriptan

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2
Q

What is the MOA of triptans?

A

5-HT agonists, inhibit trigeminal nerve activation; induce vasoconstriction

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3
Q

What is the clinical use of the triptans?

A

acute migraine, cluster headache attacks

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4
Q

What are the adverse effects of the triptans?

A

coronary vasospasm (C/I in patients with CAD or prinzmetal angina), mild paresthesia, serotonin syndrome, relative C/I in pregnancy

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5
Q

Side effects of phenytoin

A

Phenytoin Has Given MDs Frustration:

  • Peripheral neuropathy
  • Hirsutism
  • Gingival hyperplasia
  • Megaloblastic anemia (d/t decreased folate absorption)
  • Drug-induced lupus
  • Stevens-Johnson syndrome
  • Fetal hydantoin syndrome
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6
Q

Which seizure drugs block Na+ channels?

A

phenytoin, carbamazepine, lamotrigine, topiramate, valproic acid

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7
Q

Which seizure drugs increase GABA activity?

A

gabapentin, phenobarbital, valproic acid, benzodiazepines, tigabine, vigabatrin, levetiracetam

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8
Q

Which seizure drugs block T-type Ca2+ channels?

A

gabapentin, ethosuximide, phenytoin (high doses)

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9
Q

Which antiepileptics are teratogens?

A

phenytoin, carbamazepine, valproic acid (spina bifida)

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10
Q

What drugs cause Stevens-Johnson syndrome?

A

Steve Jobs made APPLE PCs

  • Allopurinol
  • Phenytoin
  • Phenobarbital
  • Lamotrigine
  • Ethosuximide
  • Penicillin
  • Carbamazepine
  • Sulfonamide
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11
Q

What drugs are known to cause agranulocytosis?

A

“C’s”

  • carbamazepine
  • clozapine
  • colchicine
  • PTU & methimazole
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12
Q

What antiepileptics are hepatotoxic?

A

valproic acid & carbamazepine

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13
Q

What drugs induce the P450 system?

A

Coronas, Guinness, & PBRs induce chronic alcoholism

  • Carbamazepine
  • Griseofulvin
  • Phenytoin
  • Barbiturates
  • Rifampin
  • St. John’s wort
  • chronic alcoholism
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14
Q

Parkinson Disease drugs

A

(BALSA)

  • Bromocriptine
  • Amantadine
  • Levodopa/Carbidopa
  • Selegiline/Rasagiline
  • Antimuscarinics
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15
Q

Bromocriptine

A

Dopamine agonist - ergot (peripheral vasoconstrictor, so increases BP)

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16
Q

Pramipexole, ropinirole

A

Dopamine agonists, non ergots

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17
Q

Amantadine

A

increases dopamine availability (increases dopamine release and decreases dopamine reuptake)

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18
Q

Carbidopa

A

given with levodopa; blocks peripheral conversion of L-DOPA into dopamine by inhibiting DOPA decarboxylase

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19
Q

Entacapone, tolcapone

A

prevent peripheral conversion of L-DOPA into 3-OMD by inhibiting COMT
(tolcapone acts both peripherally with L-DOPA and centrally with dopamine)

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20
Q

Selegiline, Rasagiline

A

blocks conversion of dopamine into DOPAC by selectively inhibiting MAO-B

21
Q

Benztropine

A

antimuscarinic that improves some of the symptoms of Parkinsons (improves tremor and rigidity, but has little effect on bradykinesia)

22
Q

Medications that are common Tx for insomnia

A

melatonin, antihistamines, antidepressants, benzodiazepines, zolpidem & zaleplon, eszopiclone, ramelteon, orexin rector antagonists

23
Q

melatonin tx for insomnia

A

nonaddictive, OTC, good safety profile, questionable efficacy

24
Q

antihistamines tx for insomnia

A

commonly used OTC by patients first line; anticholinergic side effects (avoid in the elderly), next-day fatigue

25
Q

antidepressant tx for insomnia

A

(amitriptyline, trazodone, doxepin); anticholinergic effects, dry mouth

26
Q

benzodiazepines tx for insomnia

A

(triazolam, temazepam, lorazepam); increases GABA, addictive, short term only

27
Q

zolpidem, zaleplon tx for insomnia

A

act at the benzo receptor; short term only (<35 days), rebound insomnia when discontinued

28
Q

Eszopiclone tx for insomnia

A

longer half life than zolpidem, may be used long term

29
Q

Ramelteon tx for insomnia

A

nonaddictive, works at melatonin receptors, avoid if hepatic insufficiency

30
Q

Orexin receptor antagonists tx for insomnia

A

block effects of orexin A and B, which promote wakefulness

31
Q

Inhaled anesthetics: Nitrous oxide

A

low blood solubility, low lipid solubility

32
Q

Inhaled anesthetics: Halothane

A

high blood solubility, hepatotoxicity

33
Q

Inhaled anesthetics: sevoflurane, desflurane

A

low blood solubility, high lipid solubility

34
Q

Inhaled anesthetics: isoflurane

A

moderate blood and lipid solubility

35
Q

IV anesthetics: propofol

A

increases GABA, rapid onset, rapid recovery, high triglyceride content (can cause pancreatitis long term)

36
Q

IV anesthetics: ketamine

A

dissociative anesthetic, hallucinations, increases cerebral blood flow; PCP analog, blocks NMDA receptors

37
Q

IV anesthetics: barbiturates (phenobarbital, pentobarbital, secobarbital)

A

decreases cerebral blood flow, increase duration of chloride channel opening on GABA receptors

thiopental - good for brain surgery

38
Q

IV anesthetics: benzodiazepines (diazepam, lorazepam, alprazolam)

A

Increase frequency of chloride channel opening on GABA receptors, reverse with fumazenil

midazolam - used for endoscopy
may cause severe post op respiratory depression
AE - decrease BP

39
Q

IV anesthetics: opioids (morphine, fentanyl, remifentanil, sufentanil)

A

analgesia; mu (beta-endorphins), delta (enkephalin), and kappa receptors (dynorphin)
reverses with opioid receptor antagonists (naloxone, naltrexone)

40
Q

butorphanol (opioid):

A

partial opioid, causes less respiratory depression

41
Q

dextromethorphan (opioid):

A

weak opioid used for cough suppression

42
Q

tramadol (opioid)

A

less-addictive opioid used for analgesia

43
Q

loperamide and diphenoxylate (opioids)

A

treatment of diarrhea

44
Q

neuromuscular blocking agents: non-depolarizing

A

tubocurarine, atracurium, mivacurium, vecuronium, rocuronium, pancuronium
competitive inhibitors of postsynaptic nicotinic acetylcholine receptors at NMJ
can reverse with acetylcholinesterase inhibitor

45
Q

neuromuscular blocking agents: depolarizing

A

succinylcholine
Phase I: rapid onset and recovery, cannot be reversed
Phase II: larger dose, longer recovery, can be reversed with acetylcholinesterase inhibitor

46
Q

What is the dangerous side effect of succinylcholine?

A

succinylcholine + inhaled anesthetics in patient with RYR1 gene mutation -> possible malignant hyperthermia

47
Q

Local anesthetics

A

esters - procaine, cocaine, tetracaine, benzocaine
amides - lidocaine, mepivacaine, bupivacaine (amides have 2 I’s)
- block Na+ channels
- can be given with vasoconstrictors (epinephrine) to enhance local action (only in tissues with collateral circulation)
- in infected (acidic) tissues, you need more drugs

48
Q

What is the order of activity of local anesthetics on different fiber types?

A

small-diameter > large-diameter myelinated > unmyelinated (but size predominates)
sensory fibers = small
SNS = medium myelinated
motor = large myelinated

Pharmacology Step 1 (8 decks)

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