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Neurology Flashcards

1
Q

selegiline

A

selective inhibitor of MAO-B, which preferentially metabolizes dopamine over NE and 5HT –> increasing the availability of dopamine

use: adjunctive agent to L-dopa in treatment of PD
toxicity: may enhance adverse effects of L-dopa

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2
Q

memantine

A

Alzheimers drugs- nmda antagonist; helps prevent excitotoxicity mediated by ca2+

toxicity: dizziness, confusion, hallucinations

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3
Q

donepezil, galantamine, rivastigmine

A

ach esterase inhibitors for tx of Alzheimers

toxicity: nausea, dizziness, insomnia

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4
Q

reserpine + tetrabenazine

A

amine depleting for Huntington’s

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5
Q

haloperiodol

A

dopamine receptor antagonist for Huntington’s

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6
Q

sumatriptan

A

5HT(1b/1d) agonist –> vasoconstriction, inhibition of trigeminal activation and vasoactive peptide release

use: acute migraine, cluster headache attacks
toxicity: coronary vasospasm (contraindicated in pts with CAD or Prinzmetal’s angina), mild tingling

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7
Q

succinylcholine

A

used for muscle paralysis in surgery or mechanical ventilation, selective for motor nicotinic receptor

depolarizing agent

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8
Q

What are nondepolarizing agents used for muscle paralysis in surgery or mechanical ventilation?

A

tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, rocuronium

competitive antagonist that competes with Ach for receptors

reversal of blockade- neostigmine, edrophonium, and other cholinesterase inhibitors

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9
Q

dantrolene

A

used for tx of malignant hyperthermia, which is caused by inhalation anesthetics (except N2O) and succinylcholine

also used to treat neuroleptic malignant syndrome (toxicity of antipsychotic drugs)

mechanism: prevents release of ca2+ from sarcoplasmic reticulum of skeletal muscle

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10
Q

What are PD drugs that agonize dopamine receptors?

A

bromocriptine, pramipexole, ropinirole (non-ergot); non-ergots are preferred

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11
Q

What are PD drugs that increase dopamine?

A

amantadine (increase release)

L-dopa/carbidopa (converted to DA in CNS)

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12
Q

What are PD drugs that prevent dopamine breakdown?

A

selegine (selective MAOB inhibitor); entacapone, tolcapone (COMT inhibitors)

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13
Q

What are PD drugs that curb excess cholinergic activity?

A

benztropine (antimuscarinic, improves tremor and rigidity but has little effect on bradykinesia)

for essential or familiar tremors: use B-blocker

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14
Q

L-dopa/carbidopa

A

mechanism: increase level of dopamine in brain, L-dopa can cross BBB and is converted by dopa decarboxylase in the CNS to dopamine

carbidopa- peripheral decarboxylase inhibitor to increase bioavailability of L-dopa in the brain and to limit peripheral side effects

use: PD
toxicity: arrhythmias from peripheral conversion of dopamine; long term use can produce dyskinesia, akinesia between doses

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15
Q

thiopental

A

IV anesthetic barbibuate
high potency, high lipid solubility, rapid entry into brain –> induction of anesthesia and short surgical procedures

effect terminated by rapid redistribution into tissue and fat, decreased cerebral blood flow

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16
Q

midazolam

A

benzodiazepine IV anesthetic
most common drug used for endoscopy; used adjunctively with gaseous anesthetics and narcotics

may cause severe postoperative respiratory depression, decreased BP (treat overdose with flumazenil) and amnesia

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17
Q

arylcyclohexylamines (ketamine)

A

PCP analog that acts as dissociative anesthetics, blocks NMDA receptors

cause disorientation, hallucination and bad dreams

increases cerebral blood flow

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18
Q

What opiates are used as IV anesthetics?

A

morphine, fentanyl used with other CNS depressants during general anesthesia

19
Q

propofol

A

used for rapid anesthesia induction and short procedures, less postoperative nausea than thiopental

potentiates GABA(A)

20
Q

What are some local anesthetics?

A

esters- procaine, tetracaine
amides- lidocaine, mepivacaine, bupivacaine
(amides have 2 I’s in name)

21
Q

How do local anesthetics work?

A

block Na channels by binding to specific receptors on inner portion of channel, preferentially bind to activated na channels so most effective in rapid firing neurons

3* amine local anesthetics penetrate membrane in uncharged form then bind to ion channels as charged form

order of nerve blockade: pain > temp > touch > pressure

usually given with vasoconstrictors to enhance local action- decrease bleeding, increase anesthesia by decreased systemic concentration

toxicity: CNS excitation, severe CV toxicity (bupivacaine), hypertension, hypotension and arrhythmias (cocaine)

22
Q

What are some benzodiazepines?

A

diazepam, lorazepam, traizolam, temazepam, oxazepam, midazolam, chlordiazepoxide, alprazolam

23
Q

Benzodiazepams: mechanism, clinical use, toxicity

A

facilitate gaba (A) action by increasing frequency of Cl- channel opening, decreased rem sleep, most have long half-lives and active metabolites

use: anxiety, spasticity, status epilepticus (lorazepam and diazepam), detoxification ( especially alcohol withdrawal), night terrors, sleep walking, general anesthetic (amnesia, muscle relaxation), hypnotic
(insomnia)

toxicity: dependence, additive CNS depression effects with alcohol, less risk of respiratory depression and coma than with barbiturates

treat overdose with flumazenil (competitive antagonist at gaba benzodiazepine receptor)

24
Q

What are some nonbenzodiazepine hypnotics?

A

zolpidem (ambien), zaleplon (sonata), eszopiclone (lunesta)

mechanism: act via the BZ1 receptor subtype and is reversed by flumazenil

clinical use: insomnia

toxicity: ataxia, headaches, confusion. short duration bc of rapid metabolism by liver enzymes. unlike older sedative-hypnotics, cause only modest day-after psychomotor depression and few amnesic effects, lower dependence risk than benzodiazepines

25
Q

What are some inhaled anesthetics?

A

halothane, enflurane, isoflurane, sevoflurane, methoxyflurane, nitrous oxide

mechanism: unknown
effects: myocardial depression, respiratory depression, nausea/emesis, increased cerebral blood flow

toxicity: hepatotoxicity (halothane), nephrotoxicity (methoxyflurane), proconvulsant (enflurane), malignant hyperthermia (rare), expansion of trapped gas (nitrous oxide)

26
Q

What are the toxicities of benzodiazepines?

A

sedation, tolerance, dependence

27
Q

What are the toxicities of carbamazepine?

A

diplopia, ataxia, blood dyscrasias (agranulocytosis, aplastic anemia), liver toxicity, teratogenesis, induction of cytochrome P450, SIADH, Stevens-Johnson syndrome

28
Q

What are the toxicities of ethosuximide?

A

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

29
Q

What are the toxicities of phenobarbital?

A

sedation, tolerance, dependence, induction of cytochrome P-450

30
Q

What are the toxicities of phenytoin?

A

nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hirsutism, megaloblastic anemia, teratogenesis (fetal hydantoin syndrome), SLE-like syndrome, induction of cytochrome P450.

31
Q

What are the toxicities of valproic acid?

A

GI distress, rare but fatal hepatotoxicity, neural tube defects in fetus (spina bifida), tremor, weight gain

contraindicated in pregnancy

32
Q

What are the toxicities of lamotrigine?

A

stevens johnson syndrome

33
Q

What are the toxicities of gabapentin

A

sedation, ataxia

34
Q

What are the toxicities of topiramate?

A

sedation, mental dulling kidney stones, weight loss

35
Q

Phenytoin: mechanism, clinical use, toxicity

A

use-dependent blockade of Na+ channels; increased refractory period, inhibition of glutamate release from excitatory presynaptic neuron

use: tonic-clonic seizures, also a class IB antiarrhythmic
toxicity: nystagmus, ataxia, diplopia, sedation, SLE-like syndrome, induction of cytochrome P450. Chronic use produces gingival hyperplasia in children, peripheral neuropathy, hirsutism, megaloblastic anemia (decreased folate absorption); teratogenic (fetal hydantoin syndrome)

36
Q

barbituates: mechanism, use, toxicity

A

mechanism: facilitate GABA (A) opening by increasing duration of Cl- channel opening, decreasing neuron firing
use: sedation of anxiety, seizures, insomnia, induction of anesthesia (thiopental)
toxicity: dependence, additive CNS depression effects with alcohol, respiratory or cardiovascular depression, drug interactions owing to induction of liver p-450

treat overdose with symptom management (assist respiration, increase BP)

37
Q

What drugs can be used for partial seizures?

A 
phenytoin
carbamazepine
lamotrigine
gabapentine
topiramate
phenobarbital
valproic acid
tiagabine
vigabatrin
levetiracetam
38
Q

What drugs are used for generalized tonic-clonic seizures?

A

1st line:
phenytoin, carbamazepine, valproic acid

2nd line:
lamotrigine, gabapentin, topiramate, phenobarbital, levitiracetam

39
Q

What drugs can be used for generalized absence seizures?

A

1st line: ethosuximide

2nd line: valproic acid

40
Q

What drugs are used for generalized status seizures?

A

prophylaxis: phenytoin
acute: benzodiazepines

41
Q

Opioid analgesic: mechanism, use, toxicity

A

morphine, fentanyl, codeine, heroin, methadone, meperidine, dextromethorphan

mechanism: agonist at opoid receptors to modulate synaptic transmission- open K_ channels, close ca2+ channels –> decrease synaptic transmission; inhibit release of Ach, NE, 5HT, glutamate, substance P
use: pain, cough supression (dextramethorphan), diarrhea (loperamide and diphenoxylate), acute pulmonary edema, maintenance programs for addicts (methadone)
toxicity: addition, respiratory depression, constipation, pinpoint pupils, additive CNS depression with other drugs; tolerance doesnt develop to miosis and constipation; toxicity treated with naloxone or naltrexone (opioid receptor antagonist)

42
Q

butorphanol: mechanism, clinical use, toxicity

A

mechanism: partial agonist at opioid mu receptors, agonist at kappa receptors
use: pain; causes less respiratory depression than full agonists
toxicity: causes withdrawal if on full opioid agonist

43
Q

tramadol: mechanism, use, toxicity

A

very weak opioid agnoist, also inhibits serotonin and NE reuptake (works on multiple neurotransmitters) –“tram it all” in

use: chronic pain
toxicity: similar to opioids, decreases seizure threshold

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