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NEUROLOGY Flashcards

1
Q

If you wanted to give phenytoin parenterally, which drug would you give?

A

Fosphenytoin

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2
Q

Aside from its use as an anticonvulsant, topiramate is also used to _________

A

prevent migraine headaches

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2
Q

What is DOC for myoclonic seizures?

A

Valproic acid

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2
Q

What drugs should be used for essential or familial tremors?

A

beta blockers (propanolol)

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3
Q

Which IV anesthetic is an arylcyclohexamine?

A

ketamine (BAD DREAMS)

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3
Q

What is the MOA of tolcapone and entacapone?

A

COMT inhibitors that prevent the breakdown of dopamine

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4
Q

What is the AE of tramodol?

A

decreases seizure threshold

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5
Q

Name 2 alpha agonists used to treat glaucoma

A

Brimonidine and epinephrine

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5
Q

Which barbiturate is used to induce anesthesia?

A

thiopental

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5
Q

Which anticonvulsants are first line in children?

A

phenobarbital (ethosuximide for absence)

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5
Q

Name 3 short acting benzos. Significance?

A

triazolam, oxazepam, and midazolam? Higher addictive potential

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5
Q

Name the depolarizing neuromuscular blocker

A

succinylcholine

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5
Q

How is the reversal of depolarizing and nondepolarizing neuromuscular blockers different?

A

non-depolarizings can be reversed with anti-cholinesterases? depolarizing ones can only be reversed in phase II as in phase I there is no antidote

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6
Q

Which glaucoma drugs cause mydriasis?

A

Epinephrine and brimonidine (don?t give in closed angle glaucoma)

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6
Q

What is the MOA of ethosuximide?

A

Blocks thalamic T-type Ca channels

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6
Q

Why is haloperidol used in Huntington’s chorea?

A

it is a dopamine receptor antagonist

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7
Q

What antiepileptic often cause fetal hydantoin syndrome? Which causes neural tube defects?

A

phenytoin; valproate

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8
Q

What are pramipexole and ropinirole?

A

non-ergot dopamine agonists (preferred)

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9
Q

Which antimuscarine agent is used in the treatment of Parkinsons disease?

A

Benztropine (Park your Benz)

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10
Q

How would you reverse the effects of the most common drug used in endoscopy?

A

The most common drug inducing anesthesia for this procedure is midazolam, reverse with flumazenil

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12
Q

Which drug irreversibly inhibits GABA transaminase?

A

Vigabatrin

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13
Q

What is the MOA of barbiturates?

A

facilitate GABAa action by increasing duration of chloride channel opening

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14
Q

Which glaucoma drug has the AE of darkening the pigment of the iris?

A

Latanoprost

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14
Q

What 2 drugs can be used to treat absence seizures?

A

Ethosuximide and valproic acid

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14
Q

Explain why the anticonvulsant that causes gingival hyperplasia can also result in megaloblastic anemia

A

This is phenytoin. Inhibition of intestinal conjugase impairs folic acid absorption leading to megaloblastic anemia

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14
Q

What is the MOA of propofol?

A

potentiates GABAa

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15
Q

What are the AE of halothane?

A

hepatotoxicity, malignant hyperthermia

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16
Q

What are the AE of cholinomimetics used to Tx glaucoma?

A

cyclospasm and miosis

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17
Q

What drug is DOC for prophylaxis of status epilepticus?

A

Phenytoin

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17
Q

Which inhaled anesthetic causes hepatotoxicity?

A

Halothane

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19
Q

Which drug is used in glaucoma that decreases the synthesis of aqueous humor by blocking carbonic anhydrase?

A

acetazolamide

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19
Q

What is fosphenytoin?

A

Parenteral version of phenytoin

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20
Q

What drug is DOC for acute status epilepticus?

A

Benzodiazepines (diazepam or lorazepam)

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22
Q

Which inhaled anesthetic is proconvulsant?

A

enflurane

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23
Q

What kind of drug is tubocurarine?

A

non-depolarizing neuromuscular blocker

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23
Q

What is the MOA of selegiline?

A

an MAO type B inhibitor that prevents dopamine degradation

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23
Q

What are the AE carbidopa/levodopa?

A

Arrhythmias from failure to breakdown peripheral catecholamines? Also long term use = dyskinesia after dose, akinesia in between

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23
Q

What is the MOA of tetrabenazine?

A

VMAT inhibitor for Huntington’s, limits dopamine vesicle packaging and release

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24
Q

Which opioid analgesics are used to treat diarrhea?

A

loperamide and diphenoxylate

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24
Q

How would you treat an overdose of nonbenzodiazepine hypnotics?

A

Still flumazenil

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24
Q

Which parkinson drugs are COMT inhibitors (2)

A

tolcapone and entacapone

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25
Q

Name 3 beta blockers used in the treatment of gluacoma

A

betaxolol, carteolol, and timolol

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27
Q

What are the AE of methoxyflurane?

A

nephrotoxicity, malignant hyperthermia

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28
Q

MgSO4 is DOC for what neurologic disorder?

A

Seizures of eclampsia

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29
Q

What is a serious AE of all inhaled anesthetics except nitrous oxide?

A

malignant hyperthermia (tx with dantrolene)

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30
Q

Name 4 anticonvulsants that can cause Stevens-Johnson syndrome

A

phenytoin, lamotrigine, ethosuximide, and carbamazepine

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31
Q

Which drug was designed as a GABA analog but actually inhibits high voltage activated Ca channels?

A

Gabapentin

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32
Q

How do you know whether a local anesthetic is an ester or an amide?

A

esters only have one “I” in the name whereas amides have 2

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33
Q

What kind of drug is succinylcholine?

A

A depolarizing neuromuscular blocker

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34
Q

In which order are nerve fibers affected by local anesthetics?

A

small diameter > large diameter; myelinated > unmyelinated

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35
Q

What are galantamine, rivastigmine, and donepazil used for?

A

central acting anticholinesterases for Alzheimer’s (since they lose Acetylcholine)

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36
Q

Which drug functions to increase dopamine RELEASE?

A

amantidine (an adamantane that is also used to treat influenza and rubella)

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37
Q

How do you treat barbiturate toxicity?

A

supportive care

38
Q

What are the adverse ocular effects for acetazolamide and beta blockers when used to tx glaucoma?

A

none (but keep in mind that acetazolamide can cause a hyperchloremic metabolic acidosis)

38
Q

What 3 drugs prevent dopamine degradation?

A

selegiline (MAO type B inhibitor) and Tolcapone and Entacapone (COMT inhibitors)

40
Q

Which drugs are converted to dopamine in the CNS?

A

levodopa with carbidopa

42
Q

What kind of drugs are eszopiclone, zalepon, and zolpidem?

A

nonbenzodiazepine hypnotics

43
Q

What is the utility of phenytoin for cardiac arrhythmias?

A

it can also be used as a class Ib antiarrhythmic

44
Q

What is the most common drug used for endoscopy?

46
Q

Name 3 dopamine agonists used for treating parkinsons

A

bromocriptine (ergot), pramipexole and ropinirole (non-ergots)

47
Q

Which drug inhibits GABA reuptake?

49
Q

Which nucleus is most affected in Alzheimer’s disease? Which drugs are used to counteract this (3)?

A

Nucleus Basalis of Meynert (an acetylcholine producing nucleus)? Central-acting anticholinesterases = rivastigmine, donepazil, galantamine

50
Q

Which opioid analgesic is used for cough suppression?

A

Dextromethorphan

51
Q

How do you treat opioid toxicity?

A

naltrexone (PO) and naloxone (IV)

53
Q

Which anticonvulsant may cause kidney stones?

A

topiramate

55
Q

Which parkinson drugs are MAO B inhibitors?

A

selegiline

57
Q

What is the MOA of vigabatrin?

A

irreversibly inhibits GABA transaminase

59
Q

How is the MOA of vigabatrin different from tiagabine?

A

vigabatrin irreversibly inhibits GABA transaminase and tiagabine prevents GABA reuptake

59
Q

What is the MOA of ketamine?

A

blocks NMDA receptors

60
Q

Which glaucoma drugs should not be given in closed angle glaucoma?

A

Alpha agonists (brimonidine and epinephrine)

60
Q

What is benztropine used for?

A

An antimuscarinic used for Parkinson’s tremor and rigidity but not for the bradykinesia

62
Q

Which drug is a 5HT 1b/1d agonist?

A

sumatriptan

64
Q

Which local anesthetic can have the AE of severe cardiotoxicity?

A

bupivicaine (although, cocaine can cause arrhythmias)

65
Q

3 drugs for Huntington’s

A

Haloperidol, Tetrabenazine, and Reserpine

66
Q

In whom are barbiturates contraindicated?

68
Q

Name a mu-opioid partial agonist for analgesia

A

butorphanol

69
Q

Which anticonvulsant can cause SIADH?

A

carbamazepine

70
Q

What determines potency and induction time for inhaled anesthetics?

A

How soluble it is in the blood and lipids. A highly soluble drug (halothane) in lipids has high potency but long recovery time and induction time? A slightly soluble drug like N2O is quick but not highly potent

72
Q

Which drug is a peripheral DOPA decarboxylase inhibitor?

A

carbidopa, co-administered with L-DOPA to prevent its peripheral conversion to dopamine

74
Q

What kind of drugs are pancuronium, vecuronium, and rocuronium?

A

non-depolarizing neuromuscular blockers

75
Q

Which parkinson drug is also an antiviral? Used for?

A

amantidine (influenza A and rubella)

76
Q

Which IV anesthetic is a dissoicative anesthetic notorious for bad dreams?

78
Q

Which anticonvulsant inhibits folic acid absorption by inhibiting intestinal conjugase?

79
Q

What is the MOA of local anesthetics?

A

Sodium channel blockers on activated nerves (mainly)

80
Q

What 3 drugs are all considered first line for tonic clonic seizures?

A

Valproic acid, Carbamazepine, and Phenytoin

81
Q

What kind of drugs are atracurium and mivacurium?

A

non-depolarizing neuromuscular blockers

82
Q

What is cyclospasm?

A

Contraction of the ciliary muscle

83
Q

What effect do inhaled anesthetics have on cerebral blood flow?

A

increase cerebral blood flow and decrease metabolic demand

84
Q

What is the MOA of tiagabine?

A

Inhibits GABA reuptake

86
Q

How do opiod analgesics work to slow synaptic transmission?

A

They open K channels and close Ca channels

87
Q

What are diphenoxylate and loperimide used for?

A

opioids used in diarrhea (AE = constipation)

88
Q

Which effects of opioids (2) can’t you develop tolerance to?

A

constipation and miosis

89
Q

What is the MOA of memantine? What Dz is it used for?

A

it is an NMDA receptor antagonist used to treat Alzheimer’s? It prevents excitotoxicity

91
Q

Which 3 anticonvulsants are inducers of CYP 450

A

carbamazepine, phenytoin, barbiturates

93
Q

Which aspect of the sleep cycle is affected by benzos?

A

decreases REM sleep

94
Q

What is DOC for seizures of pre-ecclampsia? What else can be used?

A

MgSO4 = 1st line but Benzo’s = diazepam and lorazepam can also be used

95
Q

Name 2 direct cholinomimetics used to treat glaucoma

A

Carbachol and Pilocarpine

96
Q

What are the AE of enflurane?

A

proconvulsant, malignant hyperthermia

97
Q

What receptor do non-benzodiazepine hypnotics work on?

A

GABA receptor BZ1 subtype

98
Q

Which AE does succinylcholine share with inhaled anesthetics?

A

malignant hyperthermia

99
Q

What is the MOA of gabapentin?

A

It is an anticonvulsant (with other indications) that is a GABA analog but actually inhibits high voltage gated Ca channels

100
Q

What drug is DOC for Simple partial seizures and Complex Partial Siezures?

A

Carbamazepine

101
Q

How is the MOA of phenytoin and carbamazepine different from lamotrigine?

A

Phenytoin and carbamazepine increase sodium channel INACTIVATION whereas lamotrigine blocks Na channels

103
Q

Which inhaled anesthetic causes nephrotoxicity?

A

Methoxyflurane

105
Q

How do cholinomimetics (direct and indirect) work to treat glaucoma?

A

They increase the outflow of aqueous humor by contracting the ciliary muscle and opening the trabecular meshwork

106
Q

Name the non-depolarizing neuromuscular blockers (6)

A

Tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, rocuronium

107
Q

What are the 2 indications for dantrolene?

A

malignant hyperthermia and neuroleptic malignant syndrome

108
Q

Which anticonvulsant may cause a rare but fatal hepatotoxicity and requires that LFT’s be checked?

A

valproic acid

109
Q

Which Alzheimer’s drug is targeted at preventing excitotoxicity?

A

memantine (an NMDA receptor antagonist)

110
Q

How are epinephrine and brimonidine used to treat glaucoma?

A

They are alpha agonists used to decrease the synthesis of aqueous humor via vasoconstriction

111
Q

Which opioid is used in maintenance programs for addicts?

112
Q

Which drug is used for sedation in ICU and short procedures?

113
Q

Which inhaled anesthetic does NOT cause malignant hyperthermia?

114
Q

Name 2 indirect cholinomimetics used to treat glaucoma

A

physostigmine and echothiophate

115
Q

What are the indications for sumatriptan?

A

ACUTE migraine and cluster headaches

116
Q

What is the MOA of levetiracetam?

A

unknown but may modulate GABA and glutamate release (is an anticonvulsant)

117
Q

What is DOC for absence seizure?

A

Ethosuximide

118
Q

What is the MOA of latanoprost for treating glaucoma?

A

it is a PGF2alpha analog that increases the outflow of aqueous humor

119
Q

In whom is sumatriptan contraindicated? Which cardiac drug is also contraindicated in this population?

A

CAD and Prinzmetal’s (vasospasm); hydralazine is CI for angina and CAD because of the reflex tach

120
Q

What is the MOA of topiramate?

A

Sodium channel blocker and increases GABA transmission

121
Q

What is the MOA of carbidopa?

A

It is a peripheral DOPA decarboxylase inhibitor co-administered with L-dopa to prevent it from being converted to dopamine in the periphery

122
Q

Which cholinomimetic is best for use in emergencies because it opens the meshwork into the canal of Schlemm?

A

pilocarpine

123
Q

How is the MOA of benzodiazepines different from barbiturates?

A

barbiturates prolong chloride channel opening whereas benzos increase the frequency of them opening

124
Q

What autoantibodies may develop in a patient taking phenytoin?

A

anti-histone (causes lupus like syndrome)

125
Q

What are tetrabenazine and reserpine used to treat? MOA?

A

Huntington’s chorea (VMAT inhibitors)

126
Q

What kind of drug is chlordiazepoxide?

A

a benzo just a weird name

127
Q

How do you treat overdose of benzo’s vs. barbiturates?

A

Benzo’s = flumazenil; Barbs = supportive care

128
Q

How do beta blockers work to treat glaucoma?

A

Decrease the production of aqueous humor

129
Q

What is butorphanol used for?

A

severe pain in labor or migraines (partial mu receptor agonist)

130
Q

What is the MOA of tramodol?

A

Very weak opioid agonist that also inhibits NE and 5HT

131
Q

Which receptor does sumatriptan work on?

A

5HT 1b/1d (a serotonin agonist)

132
Q

What is the MOA of phenobarbital as an anticonvulsant? In whom is it first line?

A

increases GABAa activity; 1st line in children (unless absence seizure = ethosuximide)

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