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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
antidepressant tx for insomnia
(amitriptyline, trazodone, doxepin); anticholinergic effects, dry mouth
26
benzodiazepines tx for insomnia
(triazolam, temazepam, lorazepam); increases GABA, addictive, short term only
27
zolpidem, zaleplon tx for insomnia
act at the benzo receptor; short term only (<35 days), rebound insomnia when discontinued
28
Eszopiclone tx for insomnia
longer half life than zolpidem, may be used long term
29
Ramelteon tx for insomnia
nonaddictive, works at melatonin receptors, avoid if hepatic insufficiency
30
Orexin receptor antagonists tx for insomnia
block effects of orexin A and B, which promote wakefulness
31
Inhaled anesthetics: Nitrous oxide
low blood solubility, low lipid solubility
32
Inhaled anesthetics: Halothane
high blood solubility, hepatotoxicity
33
Inhaled anesthetics: sevoflurane, desflurane
low blood solubility, high lipid solubility
34
Inhaled anesthetics: isoflurane
moderate blood and lipid solubility
35
IV anesthetics: propofol
increases GABA, rapid onset, rapid recovery, high triglyceride content (can cause pancreatitis long term)
36
IV anesthetics: ketamine
dissociative anesthetic, hallucinations, increases cerebral blood flow; PCP analog, blocks NMDA receptors
37
IV anesthetics: barbiturates (phenobarbital, pentobarbital, secobarbital)
decreases cerebral blood flow, increase duration of chloride channel opening on GABA receptors thiopental - good for brain surgery
38
IV anesthetics: benzodiazepines (diazepam, lorazepam, alprazolam)
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
IV anesthetics: opioids (morphine, fentanyl, remifentanil, sufentanil)
analgesia; mu (beta-endorphins), delta (enkephalin), and kappa receptors (dynorphin) reverses with opioid receptor antagonists (naloxone, naltrexone)
40
butorphanol (opioid):
partial opioid, causes less respiratory depression
41
dextromethorphan (opioid):
weak opioid used for cough suppression
42
tramadol (opioid)
less-addictive opioid used for analgesia
43
loperamide and diphenoxylate (opioids)
treatment of diarrhea
44
neuromuscular blocking agents: non-depolarizing
tubocurarine, atracurium, mivacurium, vecuronium, rocuronium, pancuronium competitive inhibitors of postsynaptic nicotinic acetylcholine receptors at NMJ can reverse with acetylcholinesterase inhibitor
45
neuromuscular blocking agents: depolarizing
succinylcholine Phase I: rapid onset and recovery, cannot be reversed Phase II: larger dose, longer recovery, can be reversed with acetylcholinesterase inhibitor
46
What is the dangerous side effect of succinylcholine?
succinylcholine + inhaled anesthetics in patient with RYR1 gene mutation -> possible malignant hyperthermia
47
Local anesthetics
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
What is the order of activity of local anesthetics on different fiber types?
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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