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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
MAC
minimum alveolar concentration | it is the point where 50% patients become unresponsive to painful stimuli
26
What is the relationship between MAC and potency ?
inversely proportionate
27
What are the side effects of inhaled anesthetics ?
``` myocardial depression respiratory depression increase cerebral blood flow halohtane- hepatotoxicity enflurane - nephrotoxicity Malignant hyperthermia ```
28
Malignant hyperthermia
caused by inhaled anesthetics, succinylcholine defect in Ryanodine receptors in the SR -release excess Ca--> excessive ATP uptake by SR-> heat production --> muscle damage
29
What treats malignant hyperthermia
dantrolene | by blocking ryanodine receptors
30
Opiates
open K channels & close Ca channels on the presynaptic end --> decrease release of NTS
31
Fentanyl
post -op chronic pain
32
Morphine , codeine
sever or chronic pain
33
Tramadol
weak mu receptor manage chronic pain inhibit reuptake of NE and 5HT
34
Antidiarrheal agents
opioids loperamide diphenoxylate
35
dextromethorphan
antagonizes NMDA receptors
36
What are the side effects of opioids ?
``` CNS depression respiratory depression miosis - always constipation -always biliary colic development of tolerance to opiates hyperalgesia ```
37
What are the withdrawal symptoms of opioids?
rhinorrhea, lacrimation, yawing, hyperventilation, hyperthermia, muscle aches , vomiting, diarrhea, anxiety
38
Methadone
full mu opioid receptor agonist | long acting
39
Buprenorphine ,nalbuphine, butorphanol
long half life | safer than methadone -partial agonist
40
What is neonatal abstinence syndrome ?
diarrhea , sweating, sneezing, crying , tachypnea, irritability seen in a neonate tx: methadone or morphine
41
What is the side effect of partial mu agonist ?
induce withdrawal symptoms
42
Naloxone
reverse opiod toxicity
43
Naltrexone
helps maintain abstinence in heroin addicts can help reduce alcohol & nicotine cravings helps with weight loss
44
Fluoxetine Paroxetine Sertaline Citalopram
SSRI
45
Venlafaxine | Dulocetine
SNRI
46
SSRIs & SNRI are used to trade?
depression Generalized anxiety disorder PTSD take 1-2 months to have max effect
47
What are the side effects of SSRI,SNRIs?
serotonin syndrome - hyperthermia & HTN , hyperreflexia, clonus should not be given with other drugs that increase serotonin
48
What treat serotonin syndrome
cyproheptadine -5HT2 inhibitor
49
What is a withdrawal sign from SSRI/SNRI?
flu like symptoms --> needs to be tappered off
50
What are SSRI features ?
manages OCD manages bulimia manages social anxiety disorder
51
What are the side effects of SSRIs?
hyponatermia - SIADH sexual dysfunction weight gain drowsiness
52
What are SNRI features
diabetic neuropathy chronic neuropathic pain fribromyalgia
53
What are the side effects of SNRIs
HTN
54
``` Imipramine desipramine clomipramine amitryptyline nortryptyline ```
Tricyclic antidepressants
55
TCAs
``` tx: resistant depression diabetic neuropathy chronic pain migraine prophylaxis OCD- clomipramine ```
56
What are the side effects of TCAs?
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
What is the benefit of using nortriptyline & desipramine?
secondary amines | less cholinergic effects
58
What is given to combat tornadoes seen with TCAs
sodium bicarbonate
59
What are the 3 adverse effects of TCAs?
Cardiac , Coma , Convulsions | seizures , serotonin syndrome
60
MAO- A
breaks down serotonin, NE, dopamine tranylcypromine, phenelzine, isocarboxazid used when other dx are unresponsive for depression
61
MAO-B
break down dopamine | increase dopamine levels in the CNS--> parkinson's disease
62
Where is tyramine broken down ?
GI tract
63
MAO inhibitors
increase tyramine in circulation --> increased sympathetics | should be avoided with tyramine containing foods( age meat, wine, cheese)
64
What are the side effects of MAO inhibitors
tyramine toxicity--> hypertensive crisis serotonin syndrome should be avoided with other drugs that increase serotonin
65
What drug treat tyramine toxicity?
phentolamine
66
Bupropion Mirtazapine Trazodone
Atypical anti-depressants
67
Buproprion
``` inhibit NE transporter & dopamine transporter no serotonin effect CNS activation tobacco dependence no sexual dysfunction less likely to cause weight gain ```
68
What are the side effects pf bupropion ?
seizures | contraindicated in bulimia & anorexia nervosa
69
Mirtazapine
``` tx: depression block alpha 2 receptors block 5HT2, 5HT3 increase presynaptic release serotonin & norepinephrine inhibit H1 receptors does not cause sexual dysfunction ```
70
What are the side effects of mirtazapine ?
weight gain | sedation
71
Trazodone
antagonizes 5HT2 receptors , weakly inhibiting serotonin reuptake antagonizes alpha 1 receptors
72
What are the side effects of trazodone ?
``` priapism orthostatic hypotension sedation sexual dysfunction inhibitor of H1 receptors serotonin syndrome ```
73
Mood stabilizers
``` Lithium valproate carbamazepine lamotrigine antipyschotics ```
74
Lithium
tx: bipolar disorder | narrow therapeutic index
75
What are the side effects of lithium ?
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
Valproate
bipolar disorder
77
Carbamazepine
bipolar disorder
78
Lamotrigine
bipolar disorder maintenance
79
haloperidol & quetiapine
1st & 2nd generation antipsychotics | haloperidol tx schizophrenia
80
Antiepileptic drugs ?
Valproate topiramate lamotrigine levetiracetam Generalized seizures metabolized by cup 450
81
Valproate
tx: focal, generalized, juvenile myoclonic increase Na channel inactivation increase GABA levels in CNS
82
What are the side effects of Valproate?
``` GI distress(N/V) increased appetite and weight gain tremor with high levels fatal hepatotoxicity pancreatitis teratogenic during pregnancy --> neural tube defects ```
83
Topiramate
increases Na channel inactivation allosterically binds to GABA-A receptor given for various seizures
84
What are the side effects of topiramate ?
``` somnolence fatigue confusion cognitive slowing weight loss urothioliasis acute angle closure glaucoma ```
85
Lamotrigine
broad spectrum | increased Na channel inactivation
86
What are the side effects of lamotrigine ?
steven johnson syndrome | diplopia
87
Levetriacetam
broad spectrum | SE: somnolence
88
Narrow spectrum antiepleptic
``` carbamazepine phenytoin phenobarbital gabapentin vigabatrin tiagabine ```
89
Carbamazepine
tx: focal seizures trigeminal neuralgia increases Na channel inactivation
90
What are the side effects of carbamazepine ?
``` 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
Phenytoin
tx: focal seizures increase Na channel inactivation
92
What are the side effects of phenytoin ?
``` 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
Benzodiazepines + phenytoin can be used to treat?
status epilepticus
94
What is used to treat refractory seizures ?
barbiturates
95
Gabapentin
``` block voltage gated Ca channels (presynaptic) tx: chronic pain painful diabetic neuropathy fibromyalgia postherapeitc neuralgia with VZV ``` SE: ataxia
96
Vigabatrin , tiagabine
V; irreversible inhibitor of GABA tranaminase --> increased GABA concentration T; inhibits GABA reuptake tx: used together to treat partial seizures
97
Ehosuximide
tx: absence seizures absence seizures= momentary lapse in awareness , with staring ,blinking , cloning jerks block Ca channels - T type channels in thalamus
98
What can be seen on EEG when an absence seizure is occurring ?
3 Hz spikes
99
What are the side effects of absence seizures?
Gi distress (N/V) lethargy fatigue
100
What other two drugs can be given for absence seizure
Valproate | Lamotrigine
101
First generation antipsychotics?
``` haloperidol trifluoperazine fluphenazine chlorpromazine thioridazine ```
102
How do FGA s function ?
block D2 receptors in the CNS
103
Which two first generation antipsychotics are low potency?
thioridazine | chlorpromazine
104
What two first generation antipsychotics are high potency ?
haloperidol | fluphenazine
105
What do FGAs treat ?
positive symptoms of schizophrenia Agitation or aggression tourette syndrome acute psychosis
106
What are the side effects of low potency FGAs?
orthostatic hypotension block alpha 1 receptors block H1 receptors sedation
107
What are the side effects of high potency FGAs?
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
What are side effects of all FGAs?
torsade de point lower seizure threshold chlorpromazine --> corneal deposits thioridazine --> retinal deposits
109
Second generation antipsychotics
Quietapine , olanzapine, risperidone, aripiprazole . ziprasidone , closzapine
110
How do second generation antipsychotics ?
block D2 receptors in CNS | block serotonin receptors in CNS
111
What are second generation antipsychotics used to treat?
schizophrenia -+ & - symptoms resistant depression manage OCD tourette syndrome
112
What are the side effects of second generation antipsychotics ?
``` 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
What are the side effects of clozapine?
agranulocytosis myocarditis, cardiomyopathy reduce seizure threshold
114
Levodopa
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
What are the side effects of levodopa?
``` 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
Carbidopa
increases the bioavailability of levodopa | decreases peripheral side effects of levodopa
117
Catechol-O methyltransferse
COMT converts levodopa to 3-O-methyldopa
118
tolcapone
peripheral & central COMT inhibitor --> increase levodopa
119
Entacapone
peripheral COMT inhibitor--> increase bioavailability of levodopa
120
Tolcapone
peripheral & central COMT inhibitor --> increased dopamine levels in CNS SE: hepatic toxicity
121
Selegiline
MAO-B inhibitor --> increases dopamine levels in CNS
122
Pramipexole
D3 dopamine receptor agonist initial tx of parkinson's tx: restless leg syndrome
123
What does dopamine receptor agonist cause the potentiation of ?
enhances impulses control disorders - gambling, shopping, hyper sexual
124
Amantadine
tx: motor symptoms of Parkinsonism | enhances the effect of endogenous dopamine
125
Trihexyphenidyl , benztropine
improve the tremor & rigidity of parkinson | no effect on bradykinesia

Pharmacology (15 decks)

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