Neurology Flashcards
Epinephrine (in Neurology)
1) Use: Glaucoma
2) Class/MOA: alpha agonist, decreases aqueous humor synthesis due to vasoconstriction
3) Side effects/ADEs: Mydriasis, stinging: do not use in closed glaucoma
4) Fun Facts
Brimonide (in neurology)
1) Use: Glaucoma
2) Class/MOA: Alpha agonist, decreases aqueous humor synthesis
3) Side effects/ADEs: no pupillary of vision changes
4) Fun Facts
Timolol, betazolol, carteolol (in neurology)
1) Use: Glaucoma
2) Class/MOA: Beta blocker, decreases aqueous humor secretion
3) Side effects/ADEs: no pupillary or vision changes
4) Fun Facts
Acetazolamide (in Neurology)
1) Use: Glaucoma
2) Class/MOA: Diuretic, decreases aqueous humor secretion due to decreased HCO3- (via inhibition of carbonic anhydrase)
3) Side effects/ADEs: No pupillary or vision changes
4) Fun Facts
Direct Cholinomimetics (pilocarpine, carbachol) or Indirect Cholinomimetics (physostigmine, ecchothiophate)
1) Use: Glaucoma
2) Class/MOA: Cholinomimetics, increases the outflow of the aqueous humor; contract ciliary muscle and open trabecular meshwork; use pilocarpine in emergencies, very effective at opening meshwork into canal of Schlemm
3) Side effects/ADEs: Miosis, cyclospasm
4) Fun Facts
Latanoprost (PGF 2 alpha)
1) Use: Glaucoma
2) Class/MOA: Prostaglandin, increase the outflow of aqueous humor
3) Side effects/ADEs: darkens color of iris (browning)
4) Fun Facts
Opiod Analgesics (morphine, fentanyl, codeine, heroine, methandone, meperidine, dexomethophan diphenoxylate)
1) Use: Pain, cough suppression (dextromethophran), diarrhea (loperamide and diphenoxylate), acute pulmonary edema, maintenance program for addicts (methadone).
2) Class/MOA: Acts as agonists at opioid receptors (mu = morphine, delta = enkephalin, kappy = dynorphin) to modulate synaptic transmission - open K+ channels, close Ca2+ channels = decrease in synaptic transmission. Inhibit release of ACh, NE, 5-HT, glutamate, substance P.
3) Side effects/ADEs: Addiction, respiratory depression, constipation, miosis (pinpoint pupils), addictive CNS depression with other drugs. Tolerance does not develop with miosis and constipation. Toxicity treated with nalazone or naltrexone (opiod receptor antagonist).
4) Fun Facts
Butorphanol
1) Use: Pain; causes less respiratory depression than dull agonists
2) Class/MOA: Partial agonist at opiod mu receptors, agonist at kappa receptors.
3) Side effects/ADEs: Causes withdrawal if on full opiod agonist.
4) Fun Facts
Tramadol
1) Use: Chronic pain
2) Class/MOA: Very weak opiod agonist; also inhibits serotonin and NE reuptake (works on multiple neurotransmitters - “tram it all” in)
3) Side effects/ADEs: Similar to opiods. Decreases seizure threshold.
4) Fun Facts
Phenytoin
1) Use: Epilepsy drug, used in: partial simple, partial complex, 1st line for generalized tonic clonic, 1st line for prophylaxis of generalized status seizures. Also a class IB antiarrhytimic.
2) Class/MOA: Increases Na+ channel inactivation, I.E. use-dependent blockade of Na+ channels: increase refractory period, inhibition of glutamate release from excitatory presynaptic neuron
3) Side effects/ADEs: Nystagmus, diplopia, ataxias, sedation, teratogenesis (fetal hydantion syndrome), SLE-like syndrome, induction of cytrocrome P-450. Chronic use produces gingival hyperplasia in children, peripheral neuropathy, hirtuim, meglobastic anemia (decrease in folate absorption).
4) Fun Facts: fosphentoin for parenteral use
Carbamazepine
1) Use: Epilepsy drug, used in: first line in partial simple, partial complex & generalized tonic clonic seizures
2) Class/MOA: Increases Na+ channel inactivation
3) Side effects/ADEs: Diplopia, ataxia, blood dyscrasias (agranulocytosis, aplastic anemia), liver toxicity, teratogenesis, induction of cytrochrome P-450, SIADH, Steven’s-Johnson syndrome
4) Fun Facts: fist line for trigeminal neuralgia
Gabapentin
1) Use: Epilepsy drug, used in: partial simple, partial complex & generalized tonic clonic seizures
2) Class/MOA: Designed as a GABA analog, but primarily inhibits HVA Ca2+ channels
3) Side effects/ADEs: sedation, ataxia
4) Fun Facts: also used for peripheral neuropathy and bipolar disorder
Topiramate
1) Use: Epilepsy drug, used in: partial simple, partial complex & generalized tonic clonic seizures
2) Class/MOA: Blocks Na+ channels, increases GABA action
3) Side effects/ADEs: Sedation, mental dulling, kidney stones, weight loss.
4) Fun Facts
Phenobarbital
1) Use: Epilepsy drug, used in: partial simple, partial complex & generalized tonic clonic seizures
2) Class/MOA: increased GABAA
3) Side effects/ADEs: Sedation, tolerance, dependence, induction of cytrochrome P-450
4) Fun Facts: 1st line in pregnant women, children
Valproid acid
1) Use: Epilepsy drug, used in: partial simple, partial complex, 1st line in tonic clonic generalized seizures and in absence generalized seizures.
2) Class/MOA: Increases Na+ channel inactivation, increases GABA concentration
3) Side effects/ADEs: GI distress, rare but fatal hepatotoxicity (measure LFT), neural tube defects in fetus (spinal bifida), tremor, weight gain. Contraindicated in pregnancy.
4) Fun Facts: Also used for myoclonic seizures
Ethosuximide
1) Use: Epilepsy drug, used in: 1st line in generalized absence seizure
2) Class/MOA: Blocks thalamic T-type Ca2+ channels
3) Side effects/ADEs: GI distress, fatigue, headache, urticaria, Steven’s-Johnson syndrome (EFGH- Ethosuximide, Fatigue, GI, Headache)
4) Fun Facts
Benzodiazepines for epilepsy (diazepam or lorazepam)
1) Use: Epilepsy drug, used in: 1st line for acute generalized status seizures
2) Class/MOA: Increases GABAA action
3) Side effects/ADEs: sedation, tolerance, dependence
4) Fun Facts: also used for seizures of eclampsia (1st line is MgSO4)