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USMLE > Neurobio Pharmacology > Flashcards

Neurobio Pharmacology Flashcards

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USMLE® Step 1 flashcards
1
Q

How do glaucoma drugs function?

A

They decrease IOP by decreasing aqueous humor secretion or increasing drainage

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2
Q

Which Glaucoma drugs are alpha receptor agonists?

A

Epinephrine (alpha-1) and Brimonidine (alpha 2)

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3
Q

List the mechanism of epinephrine in glaucoma

A

alpha1 agonist; decreases aqueous humor synthesis via vasoconstriction

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4
Q

What are the adverse effects of epinephrine in glaucoma?

A

Mydriasis, blurry vision, ocular hyperemia, allergy reactions, foreign body sensation; DO NOT USE in closed-angle glaucoma!

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5
Q

What is the mechanism of Brominodine

A

alpha-2 receptor agonist, decreases aqueous humor synthesis

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6
Q

How do beta blockers function in glaucoma?

A

Decrease aqueous humor synthesis

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7
Q

What are the contraindications/side effects of beta-blockers in glaucoma

A

None

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8
Q

How does Acetazolamide function in glaucoma?

A

Diuretic that decreases aqueous humor synthesis via inhibition of carbonic anhydrase

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9
Q

Describe the function of Pilocarpine and Carbachol in Glaucoma

A

Direct M3 Cholinomimetics; increase outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular network

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10
Q

What is the use for pilocarpine?

A

Use in emergencies, very effective at opening meshwork in to Canal of Schlemm

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11
Q

How do physostigmine and echothiophate work in Glaucoma?

A

Indirect M3 Cholinomimetics, increase outflow of aqueous humor by contracting ciliary muscle and opening trabecular meshwork

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12
Q

Side effects of cholinomimetics in glaucoma?

A

Miosis and cyclospasm

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13
Q

List the prostaglandin drugs used in glaucoma

A

Brimatoprost and Latanoprost

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14
Q

How do brimatoprost and latanoprost work?

A

Increase aqeuous humor outflow, also lead to eyelash growth and darkening of iris

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15
Q

List 8 opioid analgesics

A

Morphine, fentanyl, codeine, loperamide, methadone, meperidine, dextromethorphan, diphenoxylate, pentazocine

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16
Q

How do opioid analgesics function?

A

Open K+ channels, close Ca+2 channels to decrease synaptic transmission. Inhibit release of ACh, NE, 5HT, glutamate, and substance P

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17
Q

What is dextromethorphan used for?

A

Cough suppression

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18
Q

What are Loperamide and Diphenoxylate used for?

A

Diarrhea

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19
Q

What are methadone, buprenorphine + nalaxone used for?

A

Maintenance for heroin addicts

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20
Q

What are opioid analgesics typically used for?

A

Pain

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21
Q

What are the adverse effects of opioid analgesics?

A

Addiction, respiratory depression, constipation, miosis (except meperidine), respiratory depression with other drugs

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22
Q

How to treat opioid analgesic toxicity?

A

Naloxone or Naltrexone

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23
Q

What is the clinical use of pentazocine?

A

Moderate to severe pain analgesic

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24
Q

What is the mechanism of pentazocine

A

k-agonist, mu-receptor antagonist

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25
Q

What is the clinical use of butorphanol?

A

Severe pain (migraine, labor) analgesic. Causes less respiratory depression than full opioid agonists

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26
Q

What is the mechanism of butorphanol?

A

k-opioid receptor agonist, mu opioid receptor partial agonist

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27
Q

What is the clinical use of tramadol?

A

Chronic pain

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28
Q

What are the adverse effects of Tramadol?

A

Decreases seizure threshold. Serotonin syndrome

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29
Q

What neurotransmitters does tramadol also affect?

A

Blocks NE and 5HT reuptake

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30
Q

Which drug is the first-line treatment for absence seizures?

A

Ethosuximide

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31
Q

Describe the mechanism of ethosuximide

A

Inhibit Thalamic T-Type Ca+2 channels

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32
Q

Describe the side effects of Ethosuximide (EFGHIJ)

A

Fatigue, GI distress, headaches, itching, Steven-Johnson syndrome

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33
Q

What is the first-line treatment of acute status epilepticus?

A

Benzodiazepines (Lorazepam, Diazepam, Midazolam)

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34
Q

Describe the function of benzodiazepines

A

increase GABAa action

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35
Q

List the side effects of benzodiazepines (-pams, and midazolam)

A

Sedation, tolerance, dependance, respiratory depression

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36
Q

What is the first-line treatment of simple, complex and tonic-clonic seizures in neonates?

A

Phenobarbital

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37
Q

What is the mechanism of phenobarbital?

A

increase GABAa action

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38
Q

Side effects of Phenobarbital

A

Sedation, tolerance, dependence, induction of P450, cardiorespiratory depression

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39
Q

Which two drugs are first-line treatments for grand mal (tonic-clonic) seizures?

A

Phenytoin and Valproate

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40
Q

What is the mechanism of Phenytoin

A

Block Na+ channels, zero-order kinetics

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41
Q

Which seizure medication leads to gingival hyperplasia?

A

Phenytoin

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42
Q

Which seizure drugs induce P450?

A

Phenobarbital, Phenytoin, Carbamazepine

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43
Q

What are the MSK side effects of phenytoin?

A

Osteopenia, SLE-like syndrome

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44
Q

What are the hematologic side effects of phenytoin?

A

Megaloblastic anemia

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45
Q

Which seizure medications are contraindicated in pregnancy?

A

Phenytoin and Valprate

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46
Q

Which medication if first-line prophylactic against status epilepticus?

A

Phenytoin

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47
Q

Which drug is first-line for partial simple and complex seizures?

A

Carbamazepine

48
Q

How does carbamazepine function?

A

Blocks Na+ channels

49
Q

List 7 major side effects of carbamazepine

A

SIADH!! Ataxia, liver toxicity, aplastic anemia, agranulocytosis, teratogenesis, Steven-Johnson

50
Q

Which drug is first-line for trigeminal neuralgia?

A

Carbamazepine

51
Q

Which drugs are used as migraine prophylaxis?

A

Valproate and Topiramate

52
Q

What are 2 mechanisms of Valproate?

A

Increase Na+ channel inactivation, increase GABA concentration by inhibiting GABA transaminase

Block NMDA receptors and affect potassium current

53
Q

What should be monitored in a patient on Valproate?

A

LFTs

54
Q

What other treatments is Valproate used for?

A

Migraine prophylaxis, Bipolar disorder, myoclonic seizures

55
Q

Which condition contraindicates use of barbiturates?

A

Porphyria

56
Q

Describe the function of barbiturates (phenobarbital, pentobarbital, thiopental, secobarbital)

A

Increases duration of Cl- channel to facilitate GABAa action

57
Q

What are barbiturates used for?

A

Sedative agents, used for anxiety, seizures, insomnia, induction of anesthesia

58
Q

Side effects of barbiturates

A

Risky CV depression, CNS depression (worsened by alcohol use), drug interactions (P450)

59
Q

How to treat barbiturate overdose

A

Supportive

60
Q

What is mechanism of Benzodiazepines?

A

Facilitate GABAa action by increasing frequency of Cl- channel opening

61
Q

What are the addictive benzodiazepine?

A

ATOM: Alprazolam, Triazolam, Oxazepam, Midazolam

62
Q

What are benzodiazepines used for?

A

Anxiety, status epilepticus, eclampsia, detox from alcohol withdrawal, night terrors, general anesthetic, hypnotic

63
Q

How to treat benzo overdose?

A

Flumazenil

64
Q

What is a complication of Benzodiazepines?

A

Can precipitate seizures

65
Q

What are the nonbenzodiazepine hypnotics?

A

Zolpidem, Zaleplon, esZopiclone

66
Q

What are the benefits of Zolpidem vs benzos?

A

Lowered risk of dependence, milder day-after psychomotor depression and few amnestic effects

67
Q

Mechanism of nonbenzo hypnotics

A

BZ1 subtype of GABA receptor. Sleep cycle less affected. Side effects include headache, ataxia, confusion. Short duration bc fast liver metabolism

68
Q

What predisposes someone to Malignant hyperthermia?

A

AD mutation of voltage-sensitive ryanodine receptor

69
Q

Trigger and treatment of Malignant hyperthermia

A

Trigger: Inhaled anesthetics
Treatment: Dantrolene (ryanodine receptor antagonist)

70
Q

What is thiopental used for

A

Induction of anesthesia

71
Q

What is midazolam used for

A

Endoscopy

72
Q

Order of nerve blockade of local anesthetics

A

small myelinated -> small unmyelinated -> large myelinated -> large unmyelinated

73
Q

Order of sensory loss of local anesthetic

A

Pain, temperature, touch, pressure

74
Q

How is carbidopa more potent than levodopa?

A

Inhibits peripheral conversion of L-dopa making it more available to the brain

75
Q

Which central side effects are associated with levodopa and carbidopa?

A

Anxiety and agitation

76
Q

How can tachyarrhythmias be reduced as a side effect when prescribing levo/carbidopa?

A

Peripheral decarboxylase inhibitor

77
Q

Which drug leads to aplastic anemia, SIADH, liver toxicity, thrombocytopenia?

A

Carbamazepine

78
Q

Which 3 drugs block NMDA receptors in hippocampus?

A

Ketamine, Felbamate, Memantine

79
Q

What is Ketamine used for

A

General anesthesia

80
Q

What is felbamate used for

A

anticonvulsant

81
Q

What is memantine used for

A

Treatment of Alzheimer dementia

82
Q

What should be monitored in a patient on carbamazepine?

A

CBCs

83
Q

What type of medication is amitryptiline?

A

Tricyclic antidepressant

84
Q

What are tricyclic antidepressants used for?

A

Insomnia, adjunctive pain medications

85
Q

5 ways TCAs function

A
  1. Block presynaptic reuptake of NE and 5HT,
  2. block cardiac fast Na+ channels,
  3. antagonize ACh muscarinic receptors,
  4. antagonize peripheral alpha-1R,
  5. antagonize H1 receptors
86
Q

Side effects of TCAs

A

Tremor, hypotension (arrhythmias), confusion, constipation, urinary retention, orthostatic hypotension, sedation

87
Q

What is gabapentin used for?

A

Diabetic neuropathy

88
Q

Which receptors does botulinim toxin inhibit?

A

Muscarinic (dry mouth, mydriasis, no pupil reflex) and nicotinic (muscle weakness)

89
Q

Which receptors do TCAs inhibit?

A

Muscarinic (impaired autonomic symptoms)

90
Q

What is Topiramate used for

A

Anticonvulsant to treat epilepsy in children and adults

91
Q

How does capsaicin inhibit pain?

A

causes excessive activation of TRPV1, buildup of intracellular calcium that results in dysfunction of nociceptive nerve fibers. Causes release and depletion of substance P

92
Q

How is postherpatic (shingles) pain typically managed?

A

with TCAs (amitryptiline) or anticonvulsants (gabapentin, pregabalin)

93
Q

First-line therapy for depression

A

SSRIs

94
Q

Symptoms of serotonin syndrome

A

hyperreflexia, clonus, rigidity, tremor, agitation, confusion, hyperthermia, tachycardia, vomiting/diarrhea, sweating

95
Q

Treatment for serotonin syndrome

A

Cyproheptadine (antihistamine with anti-serotonergic properties)

96
Q

What is the initial treatment for status epilepticus?

A

Benzodiazepine (lorazepam) + Phenytoin

97
Q

Which agents are the best to administer to decrease morbidity/mortality in cerebral vasospasm following SAH?

A

Calcium channel blockers

98
Q

What is the most common cause of bacterial meningitis in adults of all ages

A

Strep pneumo

99
Q

Which chromosome is amyloid precursor protein located on?

A

Chromosome 21

100
Q

How does liquefactive necrosis occur in the brain?

A

Ischemic neurons release lipids and lysosomes. Microglia migrate into the area and remove the necrotic tissue leaving a cavity. Astrocytes surround cavity to form scar (gliosis)

101
Q

VDRL positive CSF is indicative of

A

Neurosyphilis and tabes dorsalis

102
Q

Propanolol is first-line treatment for

A

Familial essential tremor

103
Q

Which drug is most commonly used to treat positive symptoms of psychosis (hallucinations, delusions)

A

Haloperidol

104
Q

How do organophosphates leads to excess ACh accumulation

A

Irreversible achetylcholinesterase inhibitors

105
Q

Treatment for organophosphate poisoning

A

Muscarinic antagonists (atropine) and pralidoxamine (binds organophosphates and decouples from AChE)

106
Q

Restless leg syndrome can be treated with

A

Dopamine agonists (pramiprexole, ropinirole)

107
Q

Restless leg syndrome is related to deficiency of which mineral in the substantia nigra?

A

Iron

108
Q

Partial opioid agonist that can precipitate opioid withdrawal symptoms in patients with increased opioid tolerance

A

Buprenorphine

109
Q

Reduces Parkinson’s symptoms by inhibiting COMT and thus Levodopa breakdown in periphery

A

Entacapone

110
Q

Prevents Levodopa breakdown in brain by inhibiting COMT

A

Tolcapone

111
Q

Halothane, Enflurane, Isoflurane and Sevoflurane

A

Halogen inhaled anesthetics

112
Q

Adverse effect of Halogenated anesthetics

A

Hepatitis (centrilobular hepatic necrosis)

113
Q

Which antiepileptic is preferred in patients with combined absence and tonic-clonic seizures?

A

Valproate

114
Q

Best treatment for restless leg syndrome

A

Dopamine agonsit (ropinirole or pramiprexole)

115
Q

First-line treatment for psychomotor agitation associated with alcohol withdrawal

A

Benzodiazepines

116
Q

How does long-term use of first and second generation antipsychotics cause tardive dyskinesia

A

Prolonged D2 blockade leads to upregulation of dopamine receptors in substantia nigra

USMLE (36 decks)

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