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Step 1 Pharm > Neurology > Flashcards

Neurology Flashcards

1
Q

Decrease aqueous humor synthesis

via vasoconstriction

For open-angle glaucoma

SE: mydriasis

Contra: closed-angle glaucoma

A

Epinephrine

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2
Q

Alpha-agonist

Decreases aqueous humor synthesis

For glaucoma

SE: blurry vision, ocular hyperemia, foreign body sensation, ocular allergic reactions, ocular pruritis

A

Brimonidine

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3
Q

Beta-blockers (3)

Decrease aqueous humor synthesis

For glaucoma

A

Timolol, betaxolol, carteolol

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4
Q

Decreases aqueous humor synthesis

via inhibition of carbonic anhydrase

A

Acetazolamide

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5
Q

Increase outflow of aqueous humor

via contraction of ciliary muscle, opening of trabecular meshwork

SE: miosis, cyclospasm (ciliary muscle)

Which one for emergencies?

A

Direct cholinomimetics

Pilocarpine, carbachol

Indirect

Physostigmine, echothiophate

Emergencies- pilocarpine

open meshwork into canal of Schlemm

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6
Q

Increase outflow of aqueous humor

Darkens color of iris (browning)

A

Latanoprost

(prostaglandin F2alpha)

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7
Q

Opioid receptor agonist for:

Mu

Delta

Kappa

A

Mu - morphine

Delta- enkephalin

Kappa- dynorphin

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8
Q

Opioid receptor agonists

Open K+, close Ca2+ channels, limit synaptic transmission

Inhibit release of ACh, NE, 5-HT, glutamate, substance P

For pain, cough supression (1), diarrhea (2), acute pulmonary edema, maintenance for addicts (1)

SEs: addiction, respiratory depression, constipation, miosis, CNS depression.

Toxicity treatment?

A

Opioid analgesics

Morphine, fentanyl, codeine, heroin, methadone, meperidine, dextromethorphan, diphenoxylate

cough- dextromethorphan

diarrhea- loperamide, diphenoxylate

addiction- methadone

OD Tx: naloxone, naltrexone

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9
Q

Mu receptor partial agonist, kappa receptor agonist

For severe pain (migraine, labor)

Less resp depression

SE: opioid withdrawal if given with full opioid agonists

A

Butorphanol

OD not reversed with naloxone

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10
Q

Weak opioid agonist

inhibits serotonin, NE reuptake

For chronic pain

SE: similar to opioids, decreased seizure threshold

A

Tramadol

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11
Q

Na+ channel inactivation

inhibits glutamate release from excitatory presynaptic neuron

1st line: status epilepticus (prophylaxis), tonic-clonic seizure

Also for simple and complex partial seizures

SEs: many

A

Phenytoin

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12
Q

Nystagmus, diplopia, ataxia, sedation,

gingival hyperplasia, hirsutism, megaloblastic anemia,

teratogenesis, SLE-like syndrome, P450 inducer,

lymphadenopathy, Stevens-Johnson syndrome,

osteopenia

A

Phenytoin toxicity

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13
Q

Increases Na+ channel inactivation

1st line: simple and complex partial seizures, tonic-clonic seizures, trigeminal neuralgia

Diplopia, ataxia, blood dyscrasias (agranulocytosis, aplastic anemia), liver toxicity, teratogenesis, P450 inducer, SIADH, Stevens-Johnson syndrome

A

Carbamazepine

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14
Q

Prodrome of malaise, fever

Rapid onset erythematous/purpuric macules (oral, ocular, genital)

Progress to epidermal necrosis and sloughing

A

Stevens-Johnson syndrome

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15
Q

Blocks voltage-gated Na+ channels

For simple and complex partial seizures, tonic-clonic

Stevens-Johnson syndrome

A

Lamotrigine

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16
Q

GABA analog

inhibits high-voltage activated Ca2+ channels

For simple, complex partial seizures and tonic-clonic

Also for peripheral neuropathy, postherpetic neuralgia, migraine prophylaxis, bipolar

SE: sedation, ataxia

A

Gabapentin

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17
Q

Blocks Na+ channels, increase GABA action

For simple, partial complex and tonic-clonic seizures

Also for migrain prevention

SE: sedation, mental dulling, kidney stones, weight loss

A

Topiramate

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18
Q

Increase GABA-A action

1st line in children

for simple, partial complex seizures and tonic-clonic

SE: sedation, tolerance, dependence, P450 inducer

A

Phenobarbital

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19
Q

Increase Na+ channel inactivation

Increase GABA concentration

1st line for tonic-clonic

Also for simple, complex partial and absence seizures

Also for myoclonic seizures

SE: GI distress, rare hepatotoxicity, neural tube defects, tremor, weight gain

Contra: pregnancy

A

Valproic acid

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20
Q

Blocks thalamic T-type Ca2+ channels

For absence seizures

SE: GI distress, fatigue, headache, urticaria, Stevens-Johnson syndrome

A

Ethosuximide

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21
Q

Increases GABA-A action

1st line: status epilepticus (acute)

Also for seizures of eclampsia

SE: sedation, tolerance, dependence

A

Benzodiazepines

(diazepam, lorazepam)

22
Q

Inhibits GABA reuptake

For simple, complex partial seizures

A

Tiagabine

23
Q

Irreversible GABA transaminase inhibitor

Increases GABA

For simple, complex partial seizures

A

Vigabatrin

24
Q

Unknown mechanism

May modulate GABA, glutamate release

For simple, complex partial and tonic-clonic seizures

A

Levetiracetam

25
Q

Increases duration of Cl- channel opening

Facilitates GABA-A action, decreased neuron firing

For anxiety, seizures, insomnia, anesthesia

SE: respiratory, cardiovascular depression, CNS depression, dependence, drug interactions (P450 inducer)

Contra: porphyria

OD Tx: supportive

A

Barbiturates

phenobarbital, pentobarbital, thiopental, secobarbital

26
Q

Increases frequency of Cl- channel opening

Facilitates GABA-A

For anxiety, spasticity, status epilepticus (2), detoxification (DT), night terrors, sleepwalking, general anesthetic, hypnotic (insomnia)

SE: dependence, CNS depression (esp. w/EtOH), some respiratory depression.

OD Tx: flumazenil

A

Benzodiazepines

Diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, alprazolam

Short-acting:

triazolam, oxazepam, midazolam

increased risk for addiction

27
Q

Acts on BZ1 subtype of GABA receptor (3)

For insomnia

SE: ataxia, headaches, confusion

Modest day-after psychomotor depression, little amnesia, lower dependence risk

OD Tx: flumazenil

A

Nonbenzodiazepine hypnotics

Zolpidem (Ambien), zaleplon, eszopiclone

28
Q

Anesthetics

Rapid induction, recovery increases with?

Potency increases with?

Increased potency = increased 1/MAC

What is MAC?

A

Rapid induction, recover increases with low blood solubility

Potency increases with high lipid solubility

MAC is minimal alveolar concentration at which 50% of population in anesthetized.

N2O- low solubility - fast induction, low potency

Halothane- high solubility- slow induction, high potency

29
Q

Unknown mechanism

For general anesthesia

Causes myocardial depression, respiratory depression, nausea/emesis, increased cerebral blood flow

SE: hepatotoxicity (1), nephrotoxicity (1), proconvulsive (1), malignant hyperthermia, expansion of trapped gas (1)

A

Inhaled anesthetics

Halothane, enflurane, isoflurane, sevoflurane, methoxyflurane, nitrous oxide

hepatotoxicity- halothane

nephrotoxicity- methoxyflurane

proconvulsive- enflurane

malignant hyperthermia- all but nitrous oxide

expansion of trapped gas- nitrous oxide

30
Q

Highly potent, lipid soluble anesthetic

Barbiturate

Rapid induction of anesthesia for short procedures

Effects terminated by redistribution into tissue and fat

Decrease cerebral blood flow

A

Thiopental

31
Q

Benzodiazepine

Most commonly used in endoscopy

(with inhaled anesthetics and narcotics)

SE: respiratory depression, drop in BP, amnesia

OD Tx: flumazenil

A

Midazolam

32
Q

Dissociative anesthetic

PCP analog

Blocks NMDA receptors

Cardiovascular stimulant

SE: disorientation, hallucination, bad dreams

Increased cerebral blood flow

A

Ketamine

(arylcyclohexylamines)

33
Q

Opioids (2)

For general anesthesia

with other CNS depressants

A

Morphine

Fentanyl

34
Q

For rapid anesthesia induction

Sedation in ICU

Potentiates GABA-A

Less nausea than thiopental

A

Propofol

35
Q

Preferentially bind activated Na+ channels

Bind specific receptors on inner portion of channel

Epinephrine increases local action

For minor surgical procedures, spinal anesthesia

SE: CNS excitation, cardiovascular toxicity (1), HTN, hypotension, arrhythmias (1)

A

Local anesthetics

Esters (may cause allergy)- procaine, cocaine, tetracaine

Amides- lidocaine, mepivacaine, bupivacaine

Order of loss: pain, temp, touch, pressure

Cardiovascular toxicity- bupivacaine

Arrhythmias- cocaine

More anesthetic needed if tissue infected.

36
Q

ACh receptor agonist

Prevents muscle contraction w/sustained depolarization

For muscle paralysis in surgery or mechanical ventilation

Selective for motor nicotinic receptors

SE: hypercalcemia, hyperkalemia, malignant hyperthermia

A

Succinylcholine

37
Q

Reversal of blockade

Phase I - prolonged depolarization

Antidote, what potentiates?

Phase II- repolarized, but blocked (receptors desensitized)

Antidote

A

Phase I

No antidote

Potentiated by cholinesterase inhibitors

Phase II

Antidote is cholinesterase inhibitor

(neostigmine)

38
Q

Competitive ACh antagonists

Nondepolarizing

Antidote?

A

Curare drugs

Tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, rocuronium

Antidote: cholinesterase inhibitor

(neostigmine, edrophonium)

39
Q

Blocks Ca2+ release from sarcoplasmic reticulum

For malignant hyperthermia

(side-effect of inhalation anesthetics and succinylcholine)

And neuroleptic malignant syndrome

(antipsychotic toxicity)

A

Dantrolene

40
Q

Dopamine agonists

(3)

For Parkinson’s

A

Ergot:

Bromocriptine

Non-ergot:

Pramipexole, ropinirole

(Non-ergots preferred)

41
Q

Increases dopamine levels

(2)

For Parkinson’s

A

Amantadine

(SE: ataxia)

L-DOPA/carbidopa

42
Q

Prevents dopamine breakdown

(1 MAOI, 2 COMTI)

For Parkinson’s

A

MAO-B inhibitor:

Selegiline

COMT inhibitors:

entacapone, tolcapone

43
Q

Antimuscarinic

Curbs excess cholinergic activity

For Parkinson’s

Improves tremor, rigidity

Little effect on bradykinesia

A

Benzotropine

(park your benz)

44
Q

Increases level of dopamine in brain

Converted to dopamine by dopa decarboxylase

Adjunct is peripheral decarboxylase inhibitor

For Parkinson’s

SE: arrhythmias (increased catecholamine production), dyskinesia after use, akinesia between uses

A

L-dopa/carbidopa

45
Q

Selectively inhibits MAO-B

(metabolizes DA over NE, 5HT)

For Parkinson’s

Adjunct to L-dopa, may enhance side effects

A

Selegiline

46
Q

NMDA receptor antagonist

Prevents excitotoxicity (Ca2+ mediated)

For Alzheimer’s

SE: dizziness, confusion, hallucinations

A

Memantine

47
Q

Acetylcholinesterase inhibitors

(3)

For Alzheimer’s

SE: nausea, dizziness, insomnia

A

Donepezil, galantamine, rivastigmine

48
Q

Inhibit VMAT

(2)

Limit dopamine packaging and release

For Huntington’s

A

Tetrabenazine, reserpine

49
Q

DA receptor antagonist

For Huntington’s

A

Haloperidol

50
Q

5-HT 1B/1D agonist

Inhibits CN V activation

Prevents vasoactive peptide release –> vasoconstriction

For acute migraine, cluster headache attacks

SE: coronary vasospasm, tingling

Contra: Prinzmetal’s angina, CAD

A

Sumatriptan

51
Q
A

Step 1 Pharm (19 decks)

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