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neurology Flashcards

0
Q

brimonidine

A

alpha2-agonists: decrease aqueous humor synthesis
TOX: blurry vision, ocular hyperemia
foreign body sensation, ocular allergic reaction, ocular pruritus

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1
Q

epinephrine

A

glaucoma drug,
alpha-agonist: decrease aqueous humor synthesis via vasoconstriction
mydriasis, do not use in closed-angle glaucoma

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2
Q

Timolol

A

beta-blockers
decrease humor synthesis
no pupillary or vision changes
topical treatment of chronic open-angle glaucoma

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3
Q

betaxolol

A

beta-blockers
decrease humor synthesis
no pupillary or vision changes

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4
Q

carteolol

A

beta-blockers
decrease humor synthesis
no pupillary or vision changes

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5
Q

nadolol

A

beta-blockers
decrease humor synthesis
no pupillary or vision changes
topical treatment of chronic open-angle glaucoma

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6
Q

acetazolamide

A

decrease aqueous humor synthesis via inhibition of carbonic anhydrase
no pupillary or vision changes
*TOX: acidosis, hypo K, NH3 toxocity

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7
Q

pilocarpine

A

Direct cholinominetics
increase out flow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork,use pilocarpine in emergencies- very effective at opening meshwork into canal of schlemm
TOX: miosis and cyclospasm (contraction of ciliary muscle)
*diagnosis for CF

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8
Q

carbachol

A

Direct cholinominetics
increase out flow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork
TOX: miosis and cyclospasm (contraction of ciliary muscle)

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9
Q

physostigmine

A

indirect cholinomimetics
increase out flow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork
TOX: miosis and cyclospasm (contraction of ciliary muscle)

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10
Q

echothiophate

A

indirect cholinominetics
increase out flow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork
TOX: miosis and cyclospasm (contraction of ciliary muscle)

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11
Q

latanoprost

A

PGF 2alpha
increase outflow of aqueous humor
darkens color of iris (browning)

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12
Q

morphine

A

act as agonist at “mu” opioid receptors- open K close Na–>decrease synaptic transmission
inhibit release of ACh, NE, 5-HT, glutamate, substance P
Use: Pain, acute pulmonary adema
TOX: addiction, resp depression, constipation, miosis(pinpoint pupil), Tolerance not happen to miosis and constipation. treat with naloxone and naltrexone

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13
Q

fentanyl

A

act as agonist at “mu” opioid receptors- open K close Na–>decrease synaptic transmission
inhibit release of ACh, NE, 5-HT, glutamate, substance P
Use: Pain, acute pulmonary adema
TOX: addiction, resp depression, constipation, miosis(pinpoint pupil), Tolerance not happen to miosis and constipation. treat with naloxone and naltrexone

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14
Q

codeine

A

act as agonist at “mu” opioid receptors- open K close Na–>decrease synaptic transmission
inhibit release of ACh, NE, 5-HT, glutamate, substance P
Use: Pain, acute pulmonary adema
TOX: addiction, resp depression, constipation, miosis(pinpoint pupil), Tolerance not happen to miosis and constipation. treat with naloxone and naltrexone

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15
Q

heroin

A

act as agonist at “mu” opioid receptors- open K close Na–>decrease synaptic transmission
inhibit release of ACh, NE, 5-HT, glutamate, substance P
TOX: addiction(clonidine, methadone, buprenorphine), resp depression, constipation, miosis(pinpoint pupil), Tolerance not happen to miosis and constipation. treat with naloxone and naltrexone

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16
Q

methadone

A

act as agonist at “mu” opioid receptors- open K close Na–>decrease synaptic transmission
inhibit release of ACh, NE, 5-HT, glutamate, substance P
Use: maintenance program for addicts(more addictive)
TOX: addiction, resp depression, constipation, miosis(pinpoint pupil), Tolerance not happen to miosis and constipation. treat with naloxone and naltrexone

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17
Q

meperidine

A

act as agonist at “mu” opioid receptors- open K close Na–>decrease synaptic transmission
inhibit release of ACh, NE, 5-HT, glutamate, substance P
Use: Pain, acute pulmonary adema
TOX: addiction, resp depression, constipation, miosis(pinpoint pupil), Tolerance not happen to miosis and constipation. treat with naloxone and naltrexone

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18
Q

dextromethorphan

A

act as agonist at “mu” opioid receptors- open K close Na–>decrease synaptic transmission
inhibit release of ACh, NE, 5-HT, glutamate, substance P
Use: cough suppression
TOX: addiction, resp depression, constipation, miosis(pinpoint pupil), Tolerance not happen to miosis and constipation. treat with naloxone and naltrexone

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19
Q

diphenoxylate

A

act as agonist at “mu” opioid receptors- open K close Na–>decrease synaptic transmission
inhibit release of ACh, NE, 5-HT, glutamate, substance P
Use: DIARRHEA
TOX: addiction, resp depression, constipation, miosis(pinpoint pupil), Tolerance not happen to miosis and constipation. treat with naloxone and naltrexone

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20
Q

loperamide

A

act as agonist at “mu” opioid receptors- open K close Na–>decrease synaptic transmission
inhibit release of ACh, NE, 5-HT, glutamate, substance P
Use: DIARHEA
TOX: addiction, resp depression, constipation, miosis(pinpoint pupil), Tolerance not happen to miosis and constipation. treat with naloxone and naltrexone

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21
Q

DELTA OPIOID

A

enkepholins

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22
Q

kappa opioid

A

dynorphin

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23
Q

tolerance mechanism?

A

normal: Gi–>cAMP decrease
tolenrace: increase cAMP through other pathway, need more to decrease cAMP.
withdraw, NE decrease, receptor increase, if with draw then NE increase, 作用于增多的receptor，作用放大。

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24
Q

butorphanol

A

mu-opioid receptor partial and kappa-opioid receptor agonist;
produce analgesia
use in severe ain(migragrain, labor), causes less resp depression than full agonist.
TOX: causes opioid withdrawal symptoms if patient is also taking full opioids agonist(competition for receptors). overdose do not reverse with naloxone

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25
Q

tramadol

A

weak opioid agonist, inhibits serotonin and NE reuptake (works on multiple neurotransmitters-tram it all with tramadol)
use: chronic pain
Tox: similar to opioids. “DECREASES SEIZURE THRESHOLD”

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26
Q

phenytoin

fosphenytoin for parenteral use

A

Mech: increase Na inactivation, inhibition of glutamate
*partial, tonic-clonic, 1st line prophylaxis for status epilepticus
*class IB antiarrhythmic
TOX: nystagmus, diplopia, SLE, gingival hyperplasia, hirsutism, ataxia, sedation, megaloblastic anemia(decrease folate absorb), teratogenesis(fetal hydantoin syndrome), inducer of CYP450, lymphadenopathy, Steven-johnson, osteopenia

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27
Q

carbamazepine

A

1st line for partial, 1st line for tonic-clonic
mech: increase Na channel inactivation
1st line for Trigeminal neuralgia
TOX: diplopia, ataxia, blood dyscrasia(agranulocytosis, Aplastic anemia),liver toxicity, teratogenic, inducer of P450, SIADH, Steven Johnson

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28
Q

lamotrigine

A

Partial
tonic-clonic
Mech: Blocks voltage-gated Na channel
TOX: Stevens-Johnson syndrome, hepatoxic

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29
Q

Gabapentin

A

Partial
tonic-clonic
Mech: Designed as GABA analog, but primarily inhibits high-voltage-activated Ca channel
TOX: peripheral neuropathy, post-therapy neuralgia,migraine prophylaxis, bipolar disorder

30
Q

Topiramate

A

Partial
tonic-clonic
Mech: Blocks voltage-gated Na channel, increase GABA
TOX: sedation, mental dulling, kidney stones, weight loss
Also used for migraine prevention

31
Q

Phenobarbital

A

Partial, tonic-clonic,(1st line in children seizure)
sedative for anxiety, seizure, insomia, induction of anesthesia
Mech: increase GABA action by increasing duration, CI in porphyria
TOX: sedation, tolerance,, dependence, induction of P450
treat with supprtive

32
Q

Valproic acid

A

Partial
1st line tonic-clonic, absence generalized and General myoclonic
Mech: increase voltage-gated Na channel inactivation, increase GABA concentration
TOX: Gi distress, hepatotoxicity (LFT), neural tube defects(spinal bifida), tremor, weight gain. CI in pregnancy

33
Q

Ethosuximide

A

1st line for absence
Mech: Blocks thalamic T-type Ca channel
TOX: GI distress, fatigue, headache, urticaria, Steven Johnson

34
Q

benzodiazepine

diazepam, lorazepam

A

1st line for acute status epilepticus
Mech: increase GABA action
TOX: sedation, tolerance, dependence
also used for seizure of eclampsia(1st line MgSO4)

35
Q

tiagabine

A

Partial
Mech: inhibits GABA reuptake
TOX:

36
Q

vigabatrin

A

Partial
Mech: inhibits GABA reuptake
TOX:

37
Q

levetiracetam

A

Partial
tonic-clonic
Mech: modulate GABA and glutamate relase
TOX:

38
Q

pentobarbital

A

Partial, tonic-clonic,(1st line in children seizure)
sedative for anxiety, seizure, insomia, induction of anesthesia
Mech: increase GABA action by increasing duration, CI in porphyria
TOX: sedation, tolerance,, dependence, induction of P450
treat with supprtive

39
Q

thiopental

A

Partial, tonic-clonic,(1st line in children seizure)
sedative for anxiety, seizure, insomia,
*induction of anesthesia(SHORT ACTING)
Mech: increase GABA action by increasing duration, CI in porphyria
TOX: sedation, tolerance,, dependence, induction of P450
treat with supportive

40
Q

secobarbital

A

Partial, tonic-clonic,(1st line in children seizure)
sedative for anxiety, seizure, insomia, induction of anesthesia
Mech: increase GABA action by increasing duration, CI in porphyria
TOX: sedation, tolerance,, dependence, induction of P450
treat with supprtive

41
Q

Primidone

A

primidone->phenobarbital + PEMA

42
Q

Diazepam

A

benzodiazepine, increase GABA action by increase freq of Cl-
decrease REM sleep
long half life
used in anxiety, spasticity, status epilepticus,detoxification
TOX: dependence, additive with alcohol, less risk of resp depression and coma than barbiturate.
Treat over dose with flumazenil

43
Q

lorazepam

A

benzodiazepine, increase GABA action by increase freq of Cl-
decrease REM sleep
long half life
used in anxiety, spasticity, status epilepticus,detoxification
TOX: dependence, additive with alcohol, less risk of resp depression and coma than barbiturate.
Treat over dose with flumazenil

44
Q

triazolam

A

benzodiazepine, increase GABA action by increase freq of Cl-
decrease REM sleep
short-acting, used in insomnia,
TOX: dependence, additive with alcohol, less risk of resp depression and coma than barbiturate. more addictive
Treat over dose with flumazenil

45
Q

midazolam

A

benzodiazepine, increase GABA action by increase freq of Cl-
decrease REM sleep
short-acting, used in insomnia,
TOX: dependence, additive with alcohol, less risk of resp depression and coma than barbiturate. more addictive
Treat over dose with flumazenil

46
Q

oxazepam

A

benzodiazepine, increase GABA action by increase freq of Cl-
decrease REM sleep
short-acting, used in insomnia, do not meta by liver(can be used in liver defect)
TOX: dependence, additive with alcohol, less risk of resp depression and coma than barbiturate. more addictive
Treat over dose with flumazenil

47
Q

temazepam

A

benzodiazepine, increase GABA action by increase freq of Cl-
decrease REM sleep
long-acting, do not meta by liver(can be used in liver defect)
TOX: dependence, additive with alcohol, less risk of resp depression and coma than barbiturate. more addictive
Treat over dose with flumazenil

48
Q

chloridazepoxide

A

benzodiazepine, increase GABA action by increase freq of Cl-
decrease REM sleep
long-acting, meta by liver with 3 active metabolites,
TOX: dependence, additive with alcohol, less risk of resp depression and coma than barbiturate. more addictive
Treat over dose with flumazenil

49
Q

alprazolam

A

benzodiazepine, increase GABA action by increase freq of Cl-
decrease REM sleep
long-acting, panic and phobic
TOX: dependence, additive with alcohol, less risk of resp depression and coma than barbiturate. more addictive
Treat over dose with flumazenil

50
Q

Flurazepam

A

benzodiazepine, increase GABA action by increase freq of Cl-
decrease REM sleep
long-acting
TOX: dependence, additive with alcohol, less risk of resp depression and coma than barbiturate. more addictive
Treat over dose with flumazenil

51
Q

Zolpidem

ambien

A

act via BZ1 subtype of GABA receptor
effects reversed by flumazenil
use in insomnia
tox: ataxia, hadache, confusion,
short duration meta by liver, mild psychmotor depression
lower depandence risk than benzodiazepine

52
Q

zaleplone

A

act via BZ1 subtype of GABA receptor
effects reversed by flumazenil
use in insomnia
tox: ataxia, hadache, confusion,
short duration meta by liver, mild psychmotor depression
lower depandence risk than benzodiazepine

53
Q

eszopiclone

A

act via BZ1 subtype of GABA receptor
effects reversed by flumazenil
use in insomnia
tox: ataxia, hadache, confusion,
short duration meta by liver, mild psychmotor depression
lower depandence risk than benzodiazepine

54
Q

Halothane

A

inhaled anethetics
low MAC, high potency
effects: myocardial, resp depression, N/V, increase cerebral blood flow
TOX: hepatotoxicity, malignant hyperthermia

55
Q

enflurance

A

inhaled anethetics
effects: myocardial, resp depression, N/V, increase cerebral blood flow
TOX: proconvulsant, malignant hyperthermia

56
Q

isoflurane

A

inhaled anethetics
effects: myocardial, resp depression, N/V, increase cerebral blood flow
TOX: malignant hyperthermia

57
Q

sevoflurance

A

inhaled anethetics
effects: myocardial, resp depression, N/V, increase cerebral blood flow
TOX: malignant hyperthermia

58
Q

methoxyflurane

A

inhaled anethetics
effects: myocardial, resp depression, N/V, increase cerebral blood flow
TOX: nephrotoxicity, malignant hyperthermia

59
Q

nitrous oxide

A

inhaled anethetics
high MAC, low potency->good induce, no metabolism, rapid effect,minimal cardioeffect
effects: myocardial, resp depression, N/V, increase cerebral blood flow
TOX: expansion of trapped gas in a body cavity diffusional hypoxia

60
Q

thiopental in iv anesthetics

A

high potency, high lipid solubility, rapid entry to brain
used for induction of anesthesia and short procedures
effects terminated by rapid redistribution into tissue and fat
decrease cerebral blood flow

61
Q

Midazolam in iv anesthetics

A

most commonly used for endoscopy,
used with gaseous anesthetics and narcotics
cause severe postoperative respiratory depression
decrease BP with overodse, treat flumazenil

62
Q

arylcyclohexylamines

ketamine

A 
PCP analogs, dissociative anesthetics
block NMDA receptors
cardiovascular stimulants
TOX: cause disorientation, hallucination and bad dream
increase cerebral blood flow
63
Q

opioids in iv anesthetics

A

morphine fentanyl used with other CNS depressants during general anesthesia

64
Q

propofol

A

used for sedation in ICU
rapid anesthesia induction and short procedures
loss post-op nausea than thiopental, potentiates GABA

65
Q

procaine

A

local anesthetics- esters
Block Na channel by binding receptor on inner portion of channel
bind to active Na, most effective in firing neurons.
3’amine penetrate membrane in uncharged form and bind in charged form(more needed in acidic wound)
used in minor surgical procedure, if allergic give amides
TOX: CNS excitation, hypo/hyperTN,

66
Q

cocaine

A

local anesthetics- esters
Block Na channel by binding receptor on inner portion of channel
bind to active Na, most effective in firing neurons.
3’amine penetrate membrane in uncharged form and bind in charged form(more needed in acidic wound)
used in minor surgical procedure, if allergic give amides
TOX: CNS excitation, hypo/hyperTN, “arrhythmia”

67
Q

tetracaine

A

local anesthetics- esters
Block Na channel by binding receptor on inner portion of channel
bind to active Na, most effective in firing neurons.
3’amine penetrate membrane in uncharged form and bind in charged form(more needed in acidic wound)
used in minor surgical procedure, if allergic give amides
TOX: CNS excitation, hypo/hyperTN,

68
Q

Ildocaine

A

local anesthetics- amides
Block Na channel by binding receptor on inner portion of channel
bind to active Na, most effective in firing neurons.
3’amine penetrate membrane in uncharged form and bind in charged form(more needed in acidic wound)
used in minor surgical procedure
TOX: CNS excitation, hypo/hyperTN,

69
Q

mepivacaine

A

local anesthetics- amides
Block Na channel by binding receptor on inner portion of channel
bind to active Na, most effective in firing neurons.
3’amine penetrate membrane in uncharged form and bind in charged form(more needed in acidic wound)
used in minor surgical procedure
TOX: CNS excitation, hypo/hyperTN,

70
Q

bupivacaine

A

local anesthetics- amides
Block Na channel by binding receptor on inner portion of channel
bind to active Na, most effective in firing neurons.
3’amine penetrate membrane in uncharged form and bind in charged form(more needed in acidic wound)
used in minor surgical procedure
TOX: CNS excitation, hypo/hyperTN,” CV toxicity”

71
Q

Local anesthesia points

can be given with?

A

vasoconstrictor-alpha1-epi: enhance local action, decrease bleeding and increase anesthesia by decrease systemic concentration

72
Q

Local anesthesia points

order of blockage

A

small-diameter fibers>large diameter
myelinated>demye
small mye>small unmye>large mye>large unmye
order:pain>temp>touch>pressure

Pharm (13 decks)

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