Neurology Flashcards

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1
Q

Glaucoma drugs

Decrease IOP and amount of aqueous humor

A
a-agonists (epinephrine, brimonidine/a2)
B-blockers (timolol, betaxol, carteolol)
Diuretics (acetazolamide)
Cholinomimetics (direct = pilocarpine, carbachol; indirect = physostigmine, echothiophate)
Prostaglandin = latanoprost (PGF2a)
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2
Q

Epinephrine and Brimonidine (a2)

Use/MOA/SE

A

Glaucoma
Decrease aqueous humor synthesis via vasoconstriction
SE = mydriasis (don’t use in closed angle glaucoma); blurry vision, ocular hyperemia, foreign body sensation, ocular allergic reactions, ocular pruritus

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3
Q

Timolol, betaxolol, carteolol

Use/MOA/SE

A

Glaucoma
Decrease aqueous humor synthesis
SE = no pupillary or vision changes

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4
Q

Acetazolamide

A

Glaucoma
Decrease aqueous humor synthesis via inhibition of carbonic anhydrase
SE = no pupillary or vision changes

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5
Q

Direct and indirect cholinomimetics for glaucoma

A

D = Pilocarpine, Carbachol
I = Physostigmine, Echothiophate
Increase outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork
SE = miosis and cyclospasm (contraction of ciliary muscle)

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6
Q

Drug used in glaucoma emergencies

A

Pilocarpine

Very effective at opening meshwork into canal of Schlemm

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7
Q

Latanoprost

A

PGF2a for glaucoma
Increase outflow of aqueous humor
SE = darkens color of iris (browning)

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8
Q

Opioid analgesics

A

Morphine, fentanyl, codeine, loperamide, methadone, meperidine, dextromethorphan, diphenoxylate
Agonists at opioid receptors (mu = morphine, delta = enkephalin, kappa = dynorphin)
Modulate synaptic transmission = open K, close Ca channels = decrease transmission
Inhibit release of ACh, NE, 5HT, glutamate, substance P

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9
Q

Opioid analgesic - pain and cough suppression

A

Dextromethorphan

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10
Q

Opioid analgesic - diarrhea

A

Loperamide

Diphenoxylate

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11
Q

Acute pulmonary edema and maintenance programs for heroin addicts

A

Methadone

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12
Q

Opioid analgesic toxicity

A
Addiction
Respiratory depression
CONSTIPATION
MIOSIS (PINPOINT PUPILS)
Additive CNS depression with other drugs
Tolerance does not develop to miosis and constipation
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13
Q

Treatment for opioid toxicity

A

Naloxone

Naltrexone (opioid receptor antagonist)

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14
Q

Butorphanol

A

Mu opioid receptor partial agonist and kappa-opioid receptor agonist
Produces analgesia
Use = severe pain (migraine, labor)
Less respiratory depression

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15
Q

Butorphanol toxicity

A

Opioid withdrawal symptoms if also taking full opioid agonist
Overdose NOT easily reversed with naloxone

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16
Q

Tramadol

A
Weak opioid agonist
Also inhibits 5HT and NE reuptake
"Tram it all with Tramadol"
Use = chronic pain
Toxicity = decreases seizure threshold, serotonin syndrome
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17
Q

Ethosuximide

A

Absence
Blocks thalamic T-type Ca channels
SE = fatigue, GI distress, headache, itching (urticaria), Stevens-Johnson syndrome

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18
Q

Benzodiazepines

A

Status epilepticus
Increase GABAa action
SE = sedation, tolerance, dependence, respiratory depression

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19
Q

Eclampsia seizures

A

MgSO4

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20
Q

Phenytoin

A

All seizures
Prophylaxis status epilepticus, first line tonic-clonic
Increase Na channel inactivation; zero-order kinetics
SE = gingival hyperplasia, megaloblastic anemia, teratogenic (fetal hydantoin syndrome), SLE like syn, induction P450, Stevens Johnson, osteopenia, nystagmus/diplopia, ataxia, sedation

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21
Q

Carbamazepine

A

First line simple, complex, tonic-clonic
Increase Na channel inactivation
SE = blood dyscrasias (agranulocytosis, aplastic anemia), induction P450, SIADH, Stevens-Johnson syn

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22
Q

Trigeminal neuralgia

A

Carbamazepine

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23
Q

Valproic acid

A

All, first line tonic clonic
Increase Na channel inactivation
Increase GABA concentration by inhibiting GABA transaminase
SE = fatal hepatotoxicity (measure LFTs!!!), NTD, tremor, WG

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24
Q

Myoclonic seizures, bipolar disorder

A

Valproic acid

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25
Q

Gabapentin

A

Simple, complex, tonic-clonic
Inhibits high-voltage-activated Ca channels
Designed as GABA analog
SE = sedation, ataxia

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26
Q

Peripheral neuropathy, postherpetic neuralgia, migraine prophylaxis, bipolar disorder

A

Gabapentin

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27
Q

Phenobarbital

A

Simple, complex, tonic-clonic
Increase GABAa action
SE = sedation, induction P450, cardiorespiratory depression
First line in neonates

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28
Q

Topiramate

A

Simple, complex, tonic-clonic
Blocks Na channels, increase GABA action
SE = sedation, MENTAL DULLING, kidney stones, WL

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29
Q

Migraine prevention

A

Topiramate

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30
Q

Lamotrigine

A

All
Blocks voltage-gated Na channels
SE = Stevens-Johnson syn (titrate slowly)

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31
Q

Levetiracetam

A

Simple, complex, tonic-clonic

May modulate GABA and glutamate release

32
Q

Tiagabine

A

Simple, complex

Increase GABA by inhibiting reuptake

33
Q

Vigabatrin

A

Simple, complex

Increase GABA by irreversibly inhibiting GABA transaminase

34
Q

Stevens-Johnson syndrome

A

Prodrome of malaise and fever followed by rapid onset of erythematous/purpuric macules (oral, ocular, genital)
Skin lesions progress to epidermal necrosis and sloughing

35
Q

Barbiturates (4)

A

Phenobarbital, pentobarbital, thiopental, secobarbital
Facilitate GABAa action by INCREASING DURATION of Cl- channel opening = decreases neuron firing
Sedative (anxiety, seizures, insomnia); induction anesthesia (thiopental)

36
Q

Barbiturate toxicity

A

Respiratory and cardiovascular depression
CNS depression (exacerbated by EtOH)
Dependence
Induces P450 = drug interactions

37
Q

Barbiturate overdose treatment

A

Supportive = assist respiration and maintain BP

38
Q

Benzodiazepines

A

Diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, alprazolam
Facilitate GABAa action by INCREASING FREQUENCY of Cl- channel opening
Decrease REM sleep
Long half-lives and active metabolites (except short acting “TOM” = trizolam, oxazepam, midazolam = higher addictive potential)

39
Q

Benzo use

A

Anxiety, spasticity, status epilepticus (lorazepam/diazepam)
Detox = alcohol withdrawal DTs
Night terrors, sleepwalking, general anesthetic, hypnotic

40
Q

Benzo toxicity

A

Additive with alcohol
Less risk respiratory depression and coma than barbs
Overdose = FLUMAZENIL (comp antag at GABA benzo receptor)

41
Q

Which three substances bind GABA a receptor

A

Benzos
Barbs
EtOH

42
Q

Nonbenzodiazepine hypnotics

“All ZZZs put you to sleep”

A
Zolpidem = Ambien
Zaleplon = Sonata
esZopiclone = Lunesta
Act via BZ1 subtype of GABA receptor
Effects reversed by flumazenil
Use = insomnia
43
Q

Zolpidem, Zaleplon, Eszopiclone toxicity

A

Ataxia, HA, confusion
Short duration = rapid met by liver
Cause only modest day-after psychomotor depression and few amnestic effects
Decreased dependence risk

44
Q

Anesthetic general principles
CNS drugs must be ___ or ___
Drugs with decreased solubility in blood have ___ induction and recovery times
Drugs with increased solubility in lipids have ___ potency
MAC?

A

CNS drugs must be LIPID soluble (cross BBB) or actively transported
Drugs with DECREASED solubility in BLOOD = RAPID induction/recovery times
Drugs with INCREASED solubility in LIPIDS = INCREASED potency = 1/MAC
MAC = minimal alveolar concentration of inhaled anesthetic required to prevent 50% of subjects from moving in response to noxious stimuli

45
Q

N2O with decreased blood and lipid solubility

A

Fast induction

Low potency

46
Q

Halothane with high blood and lipid solubility

A

Slow induction

High potency

47
Q

Inhaled anesthetics

A

Halothane, enflurane, isoflurane, sevoflurane, methoxyflurane, nitrous oxide
MOA unknown
Effects = myocardial depression, respiratory depression, nausea/emesis, INCREASED cerebral blood flow (decreased metabolic demand)

48
Q

Inhaled anesthetic toxicity

A

Malignant hyperthermia = rare, life-threatening hereditary condition in which inhaled anesthetics (except NO) and succinylcholine induce fever and severe muscle contractions
Tx = DANTROLENE

49
Q

Treatment for malignant hyperthermia induced by inhaled anesthetic + succinylcholine?

A

Dantrolene

50
Q

IV anesthetics

A

Barbiturates = thiopental (induction, short procedures)
Benzodiazepines = midazolam (endoscopy; can cause resp depression, hypotension, anterograde amnesia)
Arylcyclohexylamines (Ketamine) = PCP analogs, dissociative anesthetics, block NMDA receptors (CV stimulant; disorientation, hallucination, bad dreams)
Opioids = morphine, fentanyl (general anesthesia)
Propofol = RAPID INDUCTION, sedation ICU, short procedure (potentiates GABA a, less post op nausea)

51
Q

Local anesthetic esters

A

Procaine
Cocaine
Tetracaine
One “i”

52
Q

Local anesthetic amides

A

Lidocaine
Mepivacaine
Bupivacaine
Two “i’s”

53
Q

Local anesthetics

A

Block Na channels (bind activated so effective in rapidly firing neurons)
Given with vasoconstrictors (epi) to enhance local action = decrease bleeding and increase anesthesia by decreasing systemic concentration

54
Q

Order of nerve blockage - local anesthetics

A

Small diameter fibers > large
Myelinated fibers > unmyelinated

Small myelinated fibers > small unmyelinated fibers > large myelinated fibers > large unmyelinated fibers

55
Q

Order of sensation loss - local anesthetics

A

Pain
Temperature
Touch
Pressure

56
Q

Local anesthetic toxicity

A

CNS excitation
Severe CV toxicity (bupivacaine)
HTN/hypotension
Arrhythmias (cocaine)

57
Q

Neuromuscular blocking drugs

A

Muscle paralysis in surgery or mechanical ventilation

Motor nicotinic receptor specific

58
Q

Depolarizing NM blocking drugs

A
Succinylcholine = strong ACh receptor AGONIST = produces sustained depolarization and prevents muscle contraction
Complications = hypercalcemia, hyperkalemia, malignant hyperthermia
59
Q

Reversal of depolarizing NM blockers/succinylcholine (2 phases)

A
Phase I (prolonged depol) = no antidote; block potentiated by cholinesterase inhibitors
Phase II (repolarized by blocked; ACh receptors available but desensitized) = antidote of CHOLINESTERASE INHIBITORS
60
Q

Nondepolarizing NM blocking drugs

A

Tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, rocuronium
Competitive antagonists = compete with ACh for receptors

61
Q

Reversal of nondepolarizing NM blockers

A

Neostigmine (given with atropine), edrophonium, and other cholinesterase inhibitors

62
Q

Dantrolene

A

Muscle relaxant
Prevents release of Ca from sarcoplasmic reticulum of skeletal muscle
Use = tx malignant hyperthermia and neuroleptic malignant syndrome (toxicity of antipsychotic drugs)

63
Q

Parkinson disease

A

Loss dopaminergic neurons and excess cholinergic activity

Decreased Da, increased ACh

64
Q

Parkinson drugs

A

Dopamine agonists = Bromocriptine (ergot); pramipexole, ropinirole (non-ergot, preferred)
Increase dopamine = Amantadine; L-dopa/carbidopa
Prevent breakdown = Selegiline (MAO B inhibitor); entacapone, tolcapone (COMT inhibitors = prevent L-dopa degradation)
Curb excess cholinergic acitivity = Benztropine (antimuscarinic; improves tremor and rigidity but has little effect on bradykinesia)

65
Q

Bromocriptine, pramipexole, ropinirole

A

Da agonists

Parkinsons

66
Q

Amantadine, L-dopa/carbidopa

A

Increase Da

Parkinsons

67
Q

Selegiline

A

MAO B inhibitor = preferentially metabolizes Da over NE and 5HT
Parkinsons

68
Q

Entacapone, tolcapone

A

COMT inhibitors

Parkinsons

69
Q

Benztropine

A

Antimuscarinic = improves Parkinson tremor and rigidity; little effect on bradykinesia

70
Q

L-dopa (levodopa)/carbidopa

A

Increase dopamine in brain
Levodopa = crosses BBB and is converted by dopa decarboxylase to dopamine
Carbidopa = peripheral decarboxylase inhibitor; increases bioavailability in brain and limits peripheral SE
Car

71
Q

Levodopa/carbidopa SE

A

Arrhythmias from peripheral formation catecholamines
Dyskinesia following administration (on-off phenomenon)
Akinesia between doses

72
Q

Alzheimer drugs

A

Alzheimer = decreased ACh
Memantine
Donepezil, galantamine, rivastigmine

73
Q

Memantine

A

NMDA receptor antagonist for Alzheimer disease
Helps prevent excitotoxicity (mediated by Ca)
Tox = dizziness, confusion, hallucinations

74
Q

Donepezil, galantamine, rivastigmine

A

AChE inhibitors for Alzheimer disease

Tox = nausea, dizziness, insomnia

75
Q

Huntington drugs

A

Decreased GABA and ACh
Increased Da
Tetrabenazine and reserpine = inhibit vesicular monoamine transporter (VMAT); limit Da vesicle packaging and release
Haloperidol = dopamine receptor antagonist

76
Q

Sumatriptan

A

5HT1B/1D AGONIST
Inhibits trigeminal nerve activation, prevents vasoactive peptide release, induces VASOCONSTRICTION
Half life

77
Q

Sumatriptan contraindications

A

Patients with CAD or Prinzmetal angina due to SE of coronary vasospasm