NEUROLOGY Flashcards
1
Q
If you wanted to give phenytoin parenterally, which drug would you give?
A
Fosphenytoin
2
Q
Aside from its use as an anticonvulsant, topiramate is also used to _________
A
prevent migraine headaches
2
Q
What is DOC for myoclonic seizures?
A
Valproic acid
2
Q
What drugs should be used for essential or familial tremors?
A
beta blockers (propanolol)
3
Q
Which IV anesthetic is an arylcyclohexamine?
A
ketamine (BAD DREAMS)
3
Q
What is the MOA of tolcapone and entacapone?
A
COMT inhibitors that prevent the breakdown of dopamine
4
Q
What is the AE of tramodol?
A
decreases seizure threshold
5
Q
Name 2 alpha agonists used to treat glaucoma
A
Brimonidine and epinephrine
5
Q
Which barbiturate is used to induce anesthesia?
A
thiopental
5
Q
Which anticonvulsants are first line in children?
A
phenobarbital (ethosuximide for absence)
5
Q
Name 3 short acting benzos. Significance?
A
triazolam, oxazepam, and midazolam? Higher addictive potential
5
Q
Name the depolarizing neuromuscular blocker
A
succinylcholine
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
6
Q
Which glaucoma drugs cause mydriasis?
A
Epinephrine and brimonidine (don?t give in closed angle glaucoma)
6
Q
What is the MOA of ethosuximide?
A
Blocks thalamic T-type Ca channels
6
Q
Why is haloperidol used in Huntington’s chorea?
A
it is a dopamine receptor antagonist
7
Q
What antiepileptic often cause fetal hydantoin syndrome? Which causes neural tube defects?
A
phenytoin; valproate
8
Q
What are pramipexole and ropinirole?
A
non-ergot dopamine agonists (preferred)
9
Q
Which antimuscarine agent is used in the treatment of Parkinsons disease?
A
Benztropine (Park your Benz)
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
12
Q
Which drug irreversibly inhibits GABA transaminase?
A
Vigabatrin
13
Q
What is the MOA of barbiturates?
A
facilitate GABAa action by increasing duration of chloride channel opening
14
Q
Which glaucoma drug has the AE of darkening the pigment of the iris?
A
Latanoprost
14
Q
What 2 drugs can be used to treat absence seizures?
A
Ethosuximide and valproic acid
14
Explain why the anticonvulsant that causes gingival hyperplasia can also result in megaloblastic anemia
This is phenytoin. Inhibition of intestinal conjugase impairs folic acid absorption leading to megaloblastic anemia
14
What is the MOA of propofol?
potentiates GABAa
15
What are the AE of halothane?
hepatotoxicity, malignant hyperthermia
16
What are the AE of cholinomimetics used to Tx glaucoma?
cyclospasm and miosis
17
What drug is DOC for prophylaxis of status epilepticus?
Phenytoin
17
Which inhaled anesthetic causes hepatotoxicity?
Halothane
19
Which drug is used in glaucoma that decreases the synthesis of aqueous humor by blocking carbonic anhydrase?
acetazolamide
19
What is fosphenytoin?
Parenteral version of phenytoin
20
What drug is DOC for acute status epilepticus?
Benzodiazepines (diazepam or lorazepam)
22
Which inhaled anesthetic is proconvulsant?
enflurane
23
What kind of drug is tubocurarine?
non-depolarizing neuromuscular blocker
23
What is the MOA of selegiline?
an MAO type B inhibitor that prevents dopamine degradation
23
What are the AE carbidopa/levodopa?
Arrhythmias from failure to breakdown peripheral catecholamines? Also long term use = dyskinesia after dose, akinesia in between
23
What is the MOA of tetrabenazine?
VMAT inhibitor for Huntington's, limits dopamine vesicle packaging and release
24
Which opioid analgesics are used to treat diarrhea?
loperamide and diphenoxylate
24
How would you treat an overdose of nonbenzodiazepine hypnotics?
Still flumazenil
24
Which parkinson drugs are COMT inhibitors (2)
tolcapone and entacapone
25
Name 3 beta blockers used in the treatment of gluacoma
betaxolol, carteolol, and timolol
27
What are the AE of methoxyflurane?
nephrotoxicity, malignant hyperthermia
28
MgSO4 is DOC for what neurologic disorder?
Seizures of eclampsia
29
What is a serious AE of all inhaled anesthetics except nitrous oxide?
malignant hyperthermia (tx with dantrolene)
30
Name 4 anticonvulsants that can cause Stevens-Johnson syndrome
phenytoin, lamotrigine, ethosuximide, and carbamazepine
31
Which drug was designed as a GABA analog but actually inhibits high voltage activated Ca channels?
Gabapentin
32
How do you know whether a local anesthetic is an ester or an amide?
esters only have one "I" in the name whereas amides have 2
33
What kind of drug is succinylcholine?
A depolarizing neuromuscular blocker
34
In which order are nerve fibers affected by local anesthetics?
small diameter \> large diameter; myelinated \> unmyelinated
35
What are galantamine, rivastigmine, and donepazil used for?
central acting anticholinesterases for Alzheimer's (since they lose Acetylcholine)
36
Which drug functions to increase dopamine RELEASE?
amantidine (an adamantane that is also used to treat influenza and rubella)
37
How do you treat barbiturate toxicity?
supportive care
38
What are the adverse ocular effects for acetazolamide and beta blockers when used to tx glaucoma?
none (but keep in mind that acetazolamide can cause a hyperchloremic metabolic acidosis)
38
What 3 drugs prevent dopamine degradation?
selegiline (MAO type B inhibitor) and Tolcapone and Entacapone (COMT inhibitors)
40
Which drugs are converted to dopamine in the CNS?
levodopa with carbidopa
42
What kind of drugs are eszopiclone, zalepon, and zolpidem?
nonbenzodiazepine hypnotics
43
What is the utility of phenytoin for cardiac arrhythmias?
it can also be used as a class Ib antiarrhythmic
44
What is the most common drug used for endoscopy?
midazolam
46
Name 3 dopamine agonists used for treating parkinsons
bromocriptine (ergot), pramipexole and ropinirole (non-ergots)
47
Which drug inhibits GABA reuptake?
Tiagabine
49
Which nucleus is most affected in Alzheimer's disease? Which drugs are used to counteract this (3)?
Nucleus Basalis of Meynert (an acetylcholine producing nucleus)? Central-acting anticholinesterases = rivastigmine, donepazil, galantamine
50
Which opioid analgesic is used for cough suppression?
Dextromethorphan
51
How do you treat opioid toxicity?
naltrexone (PO) and naloxone (IV)
53
Which anticonvulsant may cause kidney stones?
topiramate
55
Which parkinson drugs are MAO B inhibitors?
selegiline
57
What is the MOA of vigabatrin?
irreversibly inhibits GABA transaminase
59
How is the MOA of vigabatrin different from tiagabine?
vigabatrin irreversibly inhibits GABA transaminase and tiagabine prevents GABA reuptake
59
What is the MOA of ketamine?
blocks NMDA receptors
60
Which glaucoma drugs should not be given in closed angle glaucoma?
Alpha agonists (brimonidine and epinephrine)
60
What is benztropine used for?
An antimuscarinic used for Parkinson's tremor and rigidity but not for the bradykinesia
62
Which drug is a 5HT 1b/1d agonist?
sumatriptan
64
Which local anesthetic can have the AE of severe cardiotoxicity?
bupivicaine (although, cocaine can cause arrhythmias)
65
3 drugs for Huntington's
Haloperidol, Tetrabenazine, and Reserpine
66
In whom are barbiturates contraindicated?
porphyria
68
Name a mu-opioid partial agonist for analgesia
butorphanol
69
Which anticonvulsant can cause SIADH?
carbamazepine
70
What determines potency and induction time for inhaled anesthetics?
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
Which drug is a peripheral DOPA decarboxylase inhibitor?
carbidopa, co-administered with L-DOPA to prevent its peripheral conversion to dopamine
74
What kind of drugs are pancuronium, vecuronium, and rocuronium?
non-depolarizing neuromuscular blockers
75
Which parkinson drug is also an antiviral? Used for?
amantidine (influenza A and rubella)
76
Which IV anesthetic is a dissoicative anesthetic notorious for bad dreams?
ketamine
78
Which anticonvulsant inhibits folic acid absorption by inhibiting intestinal conjugase?
phenytoin
79
What is the MOA of local anesthetics?
Sodium channel blockers on activated nerves (mainly)
80
What 3 drugs are all considered first line for tonic clonic seizures?
Valproic acid, Carbamazepine, and Phenytoin
81
What kind of drugs are atracurium and mivacurium?
non-depolarizing neuromuscular blockers
82
What is cyclospasm?
Contraction of the ciliary muscle
83
What effect do inhaled anesthetics have on cerebral blood flow?
increase cerebral blood flow and decrease metabolic demand
84
What is the MOA of tiagabine?
Inhibits GABA reuptake
86
How do opiod analgesics work to slow synaptic transmission?
They open K channels and close Ca channels
87
What are diphenoxylate and loperimide used for?
opioids used in diarrhea (AE = constipation)
88
Which effects of opioids (2) can't you develop tolerance to?
constipation and miosis
89
What is the MOA of memantine? What Dz is it used for?
it is an NMDA receptor antagonist used to treat Alzheimer's? It prevents excitotoxicity
91
Which 3 anticonvulsants are inducers of CYP 450
carbamazepine, phenytoin, barbiturates
93
Which aspect of the sleep cycle is affected by benzos?
decreases REM sleep
94
What is DOC for seizures of pre-ecclampsia? What else can be used?
MgSO4 = 1st line but Benzo's = diazepam and lorazepam can also be used
95
Name 2 direct cholinomimetics used to treat glaucoma
Carbachol and Pilocarpine
96
What are the AE of enflurane?
proconvulsant, malignant hyperthermia
97
What receptor do non-benzodiazepine hypnotics work on?
GABA receptor BZ1 subtype
98
Which AE does succinylcholine share with inhaled anesthetics?
malignant hyperthermia
99
What is the MOA of gabapentin?
It is an anticonvulsant (with other indications) that is a GABA analog but actually inhibits high voltage gated Ca channels
100
What drug is DOC for Simple partial seizures and Complex Partial Siezures?
Carbamazepine
101
How is the MOA of phenytoin and carbamazepine different from lamotrigine?
Phenytoin and carbamazepine increase sodium channel INACTIVATION whereas lamotrigine blocks Na channels
103
Which inhaled anesthetic causes nephrotoxicity?
Methoxyflurane
105
How do cholinomimetics (direct and indirect) work to treat glaucoma?
They increase the outflow of aqueous humor by contracting the ciliary muscle and opening the trabecular meshwork
106
Name the non-depolarizing neuromuscular blockers (6)
Tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, rocuronium
107
What are the 2 indications for dantrolene?
malignant hyperthermia and neuroleptic malignant syndrome
108
Which anticonvulsant may cause a rare but fatal hepatotoxicity and requires that LFT's be checked?
valproic acid
109
Which Alzheimer's drug is targeted at preventing excitotoxicity?
memantine (an NMDA receptor antagonist)
110
How are epinephrine and brimonidine used to treat glaucoma?
They are alpha agonists used to decrease the synthesis of aqueous humor via vasoconstriction
111
Which opioid is used in maintenance programs for addicts?
methadone
112
Which drug is used for sedation in ICU and short procedures?
propofol
113
Which inhaled anesthetic does NOT cause malignant hyperthermia?
N2O
114
Name 2 indirect cholinomimetics used to treat glaucoma
physostigmine and echothiophate
115
What are the indications for sumatriptan?
ACUTE migraine and cluster headaches
116
What is the MOA of levetiracetam?
unknown but may modulate GABA and glutamate release (is an anticonvulsant)
117
What is DOC for absence seizure?
Ethosuximide
118
What is the MOA of latanoprost for treating glaucoma?
it is a PGF2alpha analog that increases the outflow of aqueous humor
119
In whom is sumatriptan contraindicated? Which cardiac drug is also contraindicated in this population?
CAD and Prinzmetal's (vasospasm); hydralazine is CI for angina and CAD because of the reflex tach
120
What is the MOA of topiramate?
Sodium channel blocker and increases GABA transmission
121
What is the MOA of carbidopa?
It is a peripheral DOPA decarboxylase inhibitor co-administered with L-dopa to prevent it from being converted to dopamine in the periphery
122
Which cholinomimetic is best for use in emergencies because it opens the meshwork into the canal of Schlemm?
pilocarpine
123
How is the MOA of benzodiazepines different from barbiturates?
barbiturates prolong chloride channel opening whereas benzos increase the frequency of them opening
124
What autoantibodies may develop in a patient taking phenytoin?
anti-histone (causes lupus like syndrome)
125
What are tetrabenazine and reserpine used to treat? MOA?
Huntington's chorea (VMAT inhibitors)
126
What kind of drug is chlordiazepoxide?
a benzo just a weird name
127
How do you treat overdose of benzo's vs. barbiturates?
Benzo's = flumazenil; Barbs = supportive care
128
How do beta blockers work to treat glaucoma?
Decrease the production of aqueous humor
129
What is butorphanol used for?
severe pain in labor or migraines (partial mu receptor agonist)
130
What is the MOA of tramodol?
Very weak opioid agonist that also inhibits NE and 5HT
131
Which receptor does sumatriptan work on?
5HT 1b/1d (a serotonin agonist)
132
What is the MOA of phenobarbital as an anticonvulsant? In whom is it first line?
increases GABAa activity; 1st line in children (unless absence seizure = ethosuximide)
