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Pharmacology > Neuro-psych > Flashcards

Neuro-psych Flashcards

1
Q

Benzodiazepines

A 
"pam" 
" OLAM"- short acting 
can cause dependence 
bind to allosteric site on the GABA -A receptor
increase the frequency of Cl
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2
Q

What else can bind to the GABA-A receptor ?

A

alcohol

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3
Q

What are the alcohol withdrawal symptoms?

A

8-12hrs: insomnia, tremulousness, anxiety, autonomic instability

12-48 hrs: seizures

48-96hrs : delirium tremes

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4
Q

What illnesses are benzodiazepines indicated for?

A 
Alcohol withdrawal -given IV
status epilepticus 
general anesthesia 
insomnia 
parasomnias in children 
spasticity by UPM
generalized anxiety disorder 
panic disorder 
 minor procedures- colonoscopy
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5
Q

What are the side effects of benzos?

A

tolerance - decreased sensitivity to GABA
sedation
anterograde amnesia
in elderly pts- somnolence, confusion, disorientation
central ataxia
should be avoided with other CNS depressant

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6
Q

What is used as tx for bees toxicity ?

A

Flumazenil

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7
Q

Zolpidem, Zaleplon

A 
rapid onset of action 
short duration of action
bind to GABA -A receptor 
metabolism;ized by CYP450 
tx: sleep onset
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8
Q

esZopiclone

A

longer half life

tx: sleep onset & sleep maintenance

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9
Q

What are the side effects of nonbenzo hypnotics ?

A

sensitivity in elderly pts

should not be given with other CNS drugs

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10
Q

What is given to treat toxicity of nonbenzo hypnotics ?

A

flumazenil

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11
Q

Melatonin & ramelteon

A

tx: insomnia
maintain circadian rhythm
MT1 & MT2 receptors are in the suprachiasmatic nucleus of hypothalamus
safe in elderly patients

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12
Q

Barbiturates

A 
bind GABA -A receptor allosteric site 
 increase the duration of cl channel 
long duration of action
given IV 
inducer of cytochrome p450
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13
Q

Thiopental

A

rapid onset , short duration of action
used for induction of anesthesia
highly lipid soluble

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14
Q

Phenobarbital

A

management of seizures

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15
Q

Why does thiopental leave the plasma so quickly?

A

rapid decay –>brain –> redistribution to muscle and adipose

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16
Q

Primidone

A

tx: seizures & essential tremor

given with propranolol

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17
Q

What are the side effects of barbiturates?

A

hypotension
cardiac and respiratory depression
sever CNS depression esp in elderly
addictive

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18
Q

Propofol

A

Iv anesthetics
induction & maintenance
potentiation the chloride current through GABA-A receptors
decrease BP due to vasodilation of arterial and veins

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19
Q

Etomidate

A

induction of anesthesia
potential chloride channels through GABA-A
minimal changes to CO,BP, HR

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20
Q

Ketamine

A

induction anesthesia
inhibit NMDA receptor –> dissociative anesthesia ( eyes remain open )
gien to mentally challenged & pediatric patients

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21
Q

What are the side effects of ketamine ?

A

increase BP,CO, HR

unpleasant emergence reactions- hallucinations, vivid colour dreams, out of body experiences

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22
Q

N20 nitric oxide

A 
helps potentiate other anesthetics 
tx:wisdom teeth extraction 
gas @ room temp 
less soluble= lower partition 
faster onset 
short duration --> faster recovery
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23
Q

Volatile anesthetics

A

enflurane isoflurane , halothane
liquid @ room temp
fluorinated

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24
Q

Halothane

A

highly soluble = high partition
slower onset od action
longer duration
Saturation of blood is delayed –> delayed CNS effects

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25
Q

MAC

A

minimum alveolar concentration

it is the point where 50% patients become unresponsive to painful stimuli

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26
Q

What is the relationship between MAC and potency ?

A

inversely proportionate

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27
Q

What are the side effects of inhaled anesthetics ?

A 
myocardial depression 
respiratory depression 
increase cerebral blood flow 
halohtane- hepatotoxicity 
enflurane - nephrotoxicity  
Malignant hyperthermia
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28
Q

Malignant hyperthermia

A

caused by inhaled anesthetics, succinylcholine
defect in Ryanodine receptors in the SR -release excess Ca–> excessive ATP uptake by SR-> heat production –> muscle damage

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29
Q

What treats malignant hyperthermia

A

dantrolene

by blocking ryanodine receptors

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30
Q

Opiates

A

open K channels & close Ca channels on the presynaptic end –> decrease release of NTS

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31
Q

Fentanyl

A

post -op chronic pain

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32
Q

Morphine , codeine

A

sever or chronic pain

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33
Q

Tramadol

A

weak mu receptor
manage chronic pain
inhibit reuptake of NE and 5HT

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34
Q

Antidiarrheal agents

A

opioids
loperamide
diphenoxylate

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35
Q

dextromethorphan

A

antagonizes NMDA receptors

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36
Q

What are the side effects of opioids ?

A 
CNS depression 
 respiratory depression 
miosis - always
constipation -always 
biliary colic 
development of tolerance to opiates 
 hyperalgesia
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37
Q

What are the withdrawal symptoms of opioids?

A

rhinorrhea, lacrimation, yawing, hyperventilation, hyperthermia, muscle aches , vomiting, diarrhea, anxiety

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38
Q

Methadone

A

full mu opioid receptor agonist

long acting

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39
Q

Buprenorphine ,nalbuphine, butorphanol

A

long half life

safer than methadone -partial agonist

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40
Q

What is neonatal abstinence syndrome ?

A

diarrhea , sweating, sneezing, crying , tachypnea, irritability seen in a neonate

tx: methadone or morphine

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41
Q

What is the side effect of partial mu agonist ?

A

induce withdrawal symptoms

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42
Q

Naloxone

A

reverse opiod toxicity

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43
Q

Naltrexone

A

helps maintain abstinence in heroin addicts
can help reduce alcohol & nicotine cravings
helps with weight loss

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44
Q

Fluoxetine
Paroxetine
Sertaline
Citalopram

A

SSRI

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45
Q

Venlafaxine

Dulocetine

A

SNRI

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46
Q

SSRIs & SNRI are used to trade?

A

depression
Generalized anxiety disorder
PTSD
take 1-2 months to have max effect

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47
Q

What are the side effects of SSRI,SNRIs?

A

serotonin syndrome - hyperthermia & HTN , hyperreflexia, clonus
should not be given with other drugs that increase serotonin

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48
Q

What treat serotonin syndrome

A

cyproheptadine -5HT2 inhibitor

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49
Q

What is a withdrawal sign from SSRI/SNRI?

A

flu like symptoms –> needs to be tappered off

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50
Q

What are SSRI features ?

A

manages OCD
manages bulimia
manages social anxiety disorder

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51
Q

What are the side effects of SSRIs?

A

hyponatermia - SIADH
sexual dysfunction
weight gain
drowsiness

52
Q

What are SNRI features

A

diabetic neuropathy
chronic neuropathic pain
fribromyalgia

53
Q

What are the side effects of SNRIs

A

HTN

54
Q 
Imipramine 
desipramine 
clomipramine 
amitryptyline 
nortryptyline
A

Tricyclic antidepressants

55
Q

TCAs

A 
tx: resistant depression 
diabetic neuropathy 
chronic pain 
migraine prophylaxis 
OCD- clomipramine
56
Q

What are the side effects of TCAs?

A

sexual dysfunction
inhibition of muscarinic ACH receptors–> dry mouth ,constipation, blurred vision, urinary retention
contraindicated in elderly- anticholinergic & antihistamine effects–> sedation, delirium, falls
weight gain, increased appetite
sedation
block alpha 1 receptors –> orthostatic hypotension
cardio toxicity - MCC of death
widen QRS–> torsade de point

57
Q

What is the benefit of using nortriptyline & desipramine?

A

secondary amines

less cholinergic effects

58
Q

What is given to combat tornadoes seen with TCAs

A

sodium bicarbonate

59
Q

What are the 3 adverse effects of TCAs?

A

Cardiac , Coma , Convulsions

seizures , serotonin syndrome

60
Q

MAO- A

A

breaks down serotonin, NE, dopamine
tranylcypromine, phenelzine, isocarboxazid
used when other dx are unresponsive for depression

61
Q

MAO-B

A

break down dopamine

increase dopamine levels in the CNS–> parkinson’s disease

62
Q

Where is tyramine broken down ?

A

GI tract

63
Q

MAO inhibitors

A

increase tyramine in circulation –> increased sympathetics

should be avoided with tyramine containing foods( age meat, wine, cheese)

64
Q

What are the side effects of MAO inhibitors

A

tyramine toxicity–> hypertensive crisis
serotonin syndrome
should be avoided with other drugs that increase serotonin

65
Q

What drug treat tyramine toxicity?

A

phentolamine

66
Q

Bupropion
Mirtazapine
Trazodone

A

Atypical anti-depressants

67
Q

Buproprion

A 
inhibit NE transporter & dopamine transporter
no serotonin effect 
CNS activation 
tobacco dependence 
no sexual dysfunction
less likely to cause weight gain
68
Q

What are the side effects pf bupropion ?

A

seizures

contraindicated in bulimia & anorexia nervosa

69
Q

Mirtazapine

A 
tx: depression
block alpha 2  receptors 
block 5HT2, 5HT3 
increase presynaptic release serotonin & norepinephrine 
inhibit  H1 receptors 
does not cause sexual dysfunction
70
Q

What are the side effects of mirtazapine ?

A

weight gain

sedation

71
Q

Trazodone

A

antagonizes 5HT2 receptors , weakly inhibiting serotonin reuptake
antagonizes alpha 1 receptors

72
Q

What are the side effects of trazodone ?

A 
priapism 
orthostatic hypotension
sedation 
sexual dysfunction 
inhibitor of H1 receptors 
serotonin syndrome
73
Q

Mood stabilizers

A 
Lithium
valproate 
carbamazepine 
lamotrigine 
antipyschotics
74
Q

Lithium

A

tx: bipolar disorder

narrow therapeutic index

75
Q

What are the side effects of lithium ?

A

acute - GI effects (N/V/D)
chronic- neurologic symptoms (tremor, ataxia)
induce hypothyroid–> weight gain, dry skin, hair loss, constipation
nephrogenic diabetes insipidus
thiazides decrease renal clearance of lithium
Teratogenic - abstain anomaly
atrialization of R ventricle

76
Q

Valproate

A

bipolar disorder

77
Q

Carbamazepine

A

bipolar disorder

78
Q

Lamotrigine

A

bipolar disorder maintenance

79
Q

haloperidol & quetiapine

A

1st & 2nd generation antipsychotics

haloperidol tx schizophrenia

80
Q

Antiepileptic drugs ?

A

Valproate
topiramate
lamotrigine
levetiracetam

Generalized seizures
metabolized by cup 450

81
Q

Valproate

A

tx: focal, generalized, juvenile myoclonic
increase Na channel inactivation
increase GABA levels in CNS

82
Q

What are the side effects of Valproate?

A 
GI distress(N/V)
increased appetite and weight gain 
tremor with high levels 
fatal hepatotoxicity 
pancreatitis 
teratogenic 
during pregnancy --> neural tube defects
83
Q

Topiramate

A

increases Na channel inactivation
allosterically binds to GABA-A receptor
given for various seizures

84
Q

What are the side effects of topiramate ?

A 
somnolence 
fatigue 
confusion
cognitive slowing 
weight loss
urothioliasis 
acute angle closure glaucoma
85
Q

Lamotrigine

A

broad spectrum

increased Na channel inactivation

86
Q

What are the side effects of lamotrigine ?

A

steven johnson syndrome

diplopia

87
Q

Levetriacetam

A

broad spectrum

SE: somnolence

88
Q

Narrow spectrum antiepleptic

A 
carbamazepine 
phenytoin 
phenobarbital 
gabapentin 
vigabatrin 
tiagabine
89
Q

Carbamazepine

A

tx: focal seizures
trigeminal neuralgia

increases Na channel inactivation

90
Q

What are the side effects of carbamazepine ?

A 
ataxia 
diplopia 
SIADH
agranulocytosis 
induction of P450 
eosinophilia- DRESS syndrome 
teratogenic - neural tube defects 
steven johnson syndrome ( more common with HLA B1502- increased in asians
drug induced lupus
91
Q

Phenytoin

A

tx: focal seizures

increase Na channel inactivation

92
Q

What are the side effects of phenytoin ?

A 
ataxia 
diplopia  & nystagmus 
megoblastic anemia 
gingival hyperplasia
hirstuisim 
eosinophilia - DRESS syndrome 
drug induced lupus
steven johnson syndrome 
teratogenic - cleft palate
induces cyp p450 
decrease bone density
93
Q

Benzodiazepines + phenytoin can be used to treat?

A

status epilepticus

94
Q

What is used to treat refractory seizures ?

A

barbiturates

95
Q

Gabapentin

A 
block voltage gated Ca channels (presynaptic)
tx: chronic pain 
painful diabetic neuropathy 
fibromyalgia 
postherapeitc neuralgia  with VZV

SE: ataxia

96
Q

Vigabatrin , tiagabine

A

V; irreversible inhibitor of GABA tranaminase –> increased GABA concentration

T; inhibits GABA reuptake

tx: used together to treat partial seizures

97
Q

Ehosuximide

A

tx: absence seizures
absence seizures= momentary lapse in awareness , with staring ,blinking , cloning jerks

block Ca channels - T type channels in thalamus

98
Q

What can be seen on EEG when an absence seizure is occurring ?

A

3 Hz spikes

99
Q

What are the side effects of absence seizures?

A

Gi distress (N/V)
lethargy
fatigue

100
Q

What other two drugs can be given for absence seizure

A

Valproate

Lamotrigine

101
Q

First generation antipsychotics?

A 
haloperidol
trifluoperazine 
fluphenazine 
chlorpromazine 
thioridazine
102
Q

How do FGA s function ?

A

block D2 receptors in the CNS

103
Q

Which two first generation antipsychotics are low potency?

A

thioridazine

chlorpromazine

104
Q

What two first generation antipsychotics are high potency ?

A

haloperidol

fluphenazine

105
Q

What do FGAs treat ?

A

positive symptoms of schizophrenia
Agitation or aggression
tourette syndrome
acute psychosis

106
Q

What are the side effects of low potency FGAs?

A

orthostatic hypotension
block alpha 1 receptors
block H1 receptors
sedation

107
Q

What are the side effects of high potency FGAs?

A

extrapyramidal sx
acute dystonia
akathisia
drug induced parkinsonism
tardive dykinesia
hyperprolactinemia –> galactorrhea, amenorrhea, impotence
neuroleptic malignant syndrom- lead pipe rigidity, altered mental status , fever, autoomic instability , rhabdomyolysis

108
Q

What are side effects of all FGAs?

A

torsade de point
lower seizure threshold
chlorpromazine –> corneal deposits
thioridazine –> retinal deposits

109
Q

Second generation antipsychotics

A

Quietapine , olanzapine, risperidone, aripiprazole . ziprasidone , closzapine

110
Q

How do second generation antipsychotics ?

A

block D2 receptors in CNS

block serotonin receptors in CNS

111
Q

What are second generation antipsychotics used to treat?

A

schizophrenia -+ & - symptoms
resistant depression
manage OCD
tourette syndrome

112
Q

What are the side effects of second generation antipsychotics ?

A 
block H1 --> sedation 
block alpha 1--> muscarinic - dry mouth , constipation, blurred vision (lower affinity)
orthostatic hypotension 
weight gain 
dyslipidemia 
hyperglycemia 
extrapyramidal effects 
prolactin increase from anterior pituitary 
neuroleptic malignant syndrome 
torsade de pointe
113
Q

What are the side effects of clozapine?

A

agranulocytosis
myocarditis, cardiomyopathy
reduce seizure threshold

114
Q

Levodopa

A

cross the BBB
connected to dopamine by DOPA decarboxylase in CNS
can be converted in the periphery but does not cross the BBB
narrow therapeutic index

115
Q

What are the side effects of levodopa?

A 
GI distress
orthostatic hypotension 
cardiac arrhythmia 
neuropsychotic  symptoms 
wearing off- akinesia & dyskinesia 
response fluctuations 
periods of akinesia & then periods of normalcy 
dyskinesia in the extremities
116
Q

Carbidopa

A

increases the bioavailability of levodopa

decreases peripheral side effects of levodopa

117
Q

Catechol-O methyltransferse

A

COMT converts levodopa to 3-O-methyldopa

118
Q

tolcapone

A

peripheral & central COMT inhibitor –> increase levodopa

119
Q

Entacapone

A

peripheral COMT inhibitor–> increase bioavailability of levodopa

120
Q

Tolcapone

A

peripheral & central COMT inhibitor –> increased dopamine levels in CNS

SE: hepatic toxicity

121
Q

Selegiline

A

MAO-B inhibitor –> increases dopamine levels in CNS

122
Q

Pramipexole

A

D3 dopamine receptor agonist
initial tx of parkinson’s
tx: restless leg syndrome

123
Q

What does dopamine receptor agonist cause the potentiation of ?

A

enhances impulses control disorders - gambling, shopping, hyper sexual

124
Q

Amantadine

A

tx: motor symptoms of Parkinsonism

enhances the effect of endogenous dopamine

125
Q

Trihexyphenidyl , benztropine

A

improve the tremor & rigidity of parkinson

no effect on bradykinesia

Pharmacology (15 decks)

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