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Neurology druuggz Flashcards

1
Q

list the strategies for treating glaucoma

A

alpha agonists - decrease synthesis (hurts my brain bc on dilator muscles and that’s it)
beta blockers - decrease synthesis
diuretics - to decreased IOP
cholinomimetics - to increase outflow fo aqueous humor
prostaglandins - to increase outflow of aqueous humor

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2
Q

what durg is not to be used in closed angle galucoma

A

epinephrine bc causes mydriasis - bad news bears

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3
Q

how does epinephrine decreased aqueous humor

A

alpha 1 agonist - decreases aqeous humor production by vasoconstriction

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4
Q

how does brimonidine work for glaucoma

A

alpha two agonist - decreases aqueous humor production

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5
Q

what are the side effects of epinephrine and brominidine for glaucoma treatment

A 
blurry vision
ocular hyperemia
doreign body sensation
ovcular allergic reactions 
ocular pruritis
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6
Q 
which drug?
blurry vision
ocular hyperemia
foreing body sensation
ocular allergic reactions
ocular pruritus
A

epinephrine - alpha 1 agonist

brimodine - alpha 2 agonist

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7
Q

what beat blockers are used to treat glaucoma

A

timolol
betaxolol
carteolol

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8
Q

what are betaxolol and carteolol used for

A

glaucoma with timolol

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9
Q

how to timolol betaxolol and carteolol treat glaucoma

A

beta blockers - decreasd aqueous humor production

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10
Q

what are the s/e of betaxolol and carteolol and timolol when used for glaucoma treatment?

A

no pupillary or vision chances

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11
Q

what diuretic is used for glaucoma treatment

A

acetazoloamide

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12
Q

how does acetazolamide help in glaucoma

A

decreases aqueoue humor synthesis via inhibition of carbonic anhydrase

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13
Q

a/se relevated to acetazolamide treatment for glaucoma

A

no pupillary or vision changes

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14
Q

what are the direct cholinomimetics used to treat gluacoma

A

pilocarpine and carbachol

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15
Q

how do pilocarpine and carbachol help with galucoma

A

increased outflow by constricting the ciliary muscle and opening the trabecular meshwork

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16
Q

what are the indirect cholinomimetics used to treat gluacoma

A

physostigmine and echothiophate

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17
Q

how do physostigmine and echothiophate work to help with glaucoma

A

increased outflow of aqueous humor via contraction of ciliary muscle
open trabecular meshwork

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18
Q

what are a/se of cholinomimetics when used for gluacoma

A

miosis and cyclospam - contraction of ciliary msucle

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19
Q

what drugs to choose if done want any pupillary of vision a/se for glaucoma

A

beta blockers: timolol, betaxolol, carteolol

diuretics: acetazolamide

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20
Q

what durgs to choose for glaucoma if don’t mind pupillary or vision a/se

A

alpha agonists: epinephrine and brimonidine

cholinomimetis: carbachol, pilocarpine, physostigmine, echothiophate

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21
Q

what drug to use in glaucoma emergencies and why please

A

pilocarpine - bc especially good at opening meschwork into the canal of schlemm

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22
Q

what pg is used for glaucoma treatment

A

latanoprost PGF2a analog

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23
Q

what does latanoprost/PGF2a do for help in glaucoma

A

increases outflow of aqueous humor

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24
Q

what are a/se of latanoprost

A

browns up the iris

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25
list the opioid analgesics please
``` morphine fentanyl codeine loperamide methadone meperidine destromethrophan diphenoxylate pentazocine ```
26
what is the MOA of opioid analgesics
agonists at opiod recetors, m, d, k to modulate synaptic transmission - increase K and decreased Ca - decreases synaptic transmission - inhibits the release of a) Ach b( NE c) 5Ht, d) flutamate and e) substance P
27
what neurotransmitters do opiod analgesics decrease release of
NE, Ach, glutamate, substance P, 5Ht
28
again what neurotransmitters do opioid analgesics decrease
Ach, NE, glutamate, 5 Ht, substance P
29
what is destromethrophan used for
opioid | cough suppression
30
what is loperamide and diphenoxylate used for
diarrhoea
31
what is methadone used for
maintaince program for heroin addicts
32
what is buprenorphine and naloxone combo used for
maintenance program for heroin addicts
33
what are all opioids used for
pain | acute pulmonary oedema
34
opiod used for cough suppression
dextromethorphan
35
opioid used for diarrhoea
loperamide and diphenoxylate
36
opioid used for maintenance of heroin addiction
methadone OR buprenorphine with naloxone
37
what are the toxo risks of opioids
``` addiction respiratory depression constipation miosis additive CNS depression with other drugs ```
38
how to treat opioid toxicity
naloxone or naltrexone - opioid receptor antagoinsts
39
what a/se do not build up tolerance in opioid tox
miosis | constipation
40
MOA of butorphanol
k opoiod receptor agonist mew opioid receptor partial agonist produces ANALGESIA
41
clinical use of butorphanol
severe pain - migraine and labour
42
who cares about butorphanol
k opioid agonist and mew opioid receptor agonist | less respiratory depresion
43
toxo of butorphanol
can cause opioid withdrawal symptoms if patient is also taking full opiod agonist due to competition for recptors
44
how to treat o/d of butrophanol
NOT Easily with naloxone
45
what is tramadol
very weak opioid agonist also inhibits 5HT reuptake and NE reuptake TRAM IT ALL with TRAMADOL
46
what is tramadol used for
chronic pain
47
toxo of tramadol
similar to opioids DECREASED SEIZURE THRESHOLD SEROTONIN SYNDROME
48
whath opioid causes decrease seizure threshold
tramadol
49
what opioid causes less resp depression
butorphanol
50
what opioid can cause serotonin syndrome
tramadol - increases 5ht reuptake
51
list the barbituates please
``` phenobarbital pentobarbital thiopental secobarbital BARBITAL and pental ```
52
what is the moa of barbituates
favilirate GABAa by increasing DURATION Cl channels are open - decreases neuronal firing
53
what are barbituates used for
sedative for anxiety seizures insomnia induction of anesthesia = thipental
54
use of thiopental
induction of anesthesia
55
what can cause increased CNS depression fo barbituates
alcohol
56
what are the a/se of barbituates
resp and cardiovascular depression CAN BE FATAL CNS depression - can be made worse with alcohol dependence induces P450
57
how to treat overdose of barbituates
supportive | assist respiration and maintain blood pressure
58
list the benzodiazepines
diazepam, lorazepam, trazolam, temazepam, oxazepam, midazolam, chlordiazepoxide ,alprazolam OLAM and chlordiazepoxides
59
moa of benzodiazepines
facilitate GABAa action by increasing FREQUENCY of Cl channel opening
60
effect of benzos on sleep
decreases REM - treat night terrors and sleep waling whih makes no sense to me bc night terros and sleep walking happen in NON REM STAGE III but anywho
61
list the short acting benzodiazepines
ATOM: alprazolam, triazolam, oxazepam, midazolam
62
whats different between benzos with a long or a short half life
short half life - more addictive potential ie alprazolam, triazolam, oxazepam and midazolam are more addictive tha diazepam, lrazepma, temazepam, chlordiazepxoide that have long half lifes
63
list the benzodiazepines with longer hald lifes
diazepam lorazepam temazepam chlordiazepoxide
64
clinical use of benzos please
``` anxiety spasticicty status epilepticus detox from alcohol withdrawal/delirium tremens night terros sleepwalking cneral anesthetics - amnesia and muscle relaxants hypnotics - insomnia ```
65
which benzs are used for status epilepticus
lorazepam and diazepam
66
what are the toxos of benzos
dependence addictive CNS depression effects with alcohol less risk of respi depression an d coma that barbituatesa
67
how to treat o/d of benzos
FLUMAZENIL
68
what is flumazenil
treatment of o/d benzos (and nonbenzo hypnotics the zzzs)- acuts by competitive antag at GABA benzo receptor
69
which has more risk of resp depression and coma, barbs or benzos
barbs.
70
list the nonbenzodiazepine hypnotics
zolpidem zaleplon eszopiclone
71
what are zolpidem, zaleplon, eszopiclone
nonbenzodiazepine hypnotics
72
what is the MOA of zolpidem, zalephlon, eszopiclone
act via the BZ1 subtype of the GABA receptor
73
how to reverse effects of zolpidem, zaleplon, eszopiclone
flumazenil
74
what are zolpidem, zaleplon and eszopiclone used fro
insomnia
75
toxo risks of zolpidem, zalephlon, eszopiclone
``` ataxia headache confusion only modest day after psychomotor depression and fefw amniestic effects decreased risk of dependency ```
76
what are the benefits of zolpidem, zaleplon and eszopiclone over benzos
less day after amniestic effects and less psychomotor depression less risk of dependency
77
why do zolpidem, zaleplon and eszopiclone have a short durcation of action
rapid metabolism by liver enzymes
78
how do anesthetis reach the BBB
either are lipid soluble or are actively transported
79
what does it mean if an anesthetic has decreased blood solubility
faster onset and faster recovery
80
what does it mean if an anesthetic has increased lipid solubility
increased potency
81
what does potency equal
1/MAC
82
what is the MAC
MAC: minimal alveolar concentraction of inhaled anesthetic required to prevent 50% of subjects from moving in response to noxious stimulus ie skin incision the higher the MAC the less potent (less lipid soluble)
83
N2O is low blood soluble and low lipid soluble.... describe it as an anesthetic
fast induction and fast recovery - low blod osolubility | low potency - low lipid solbulity
84
halothane has high blood solubility and high lipid solubility ...describe it as an anesthetic
high blood solubility - longer to induce and longer to recovery high lipid solubility - more potent. lower MAC
85
list the inhaled anesthetics
``` halothane enflurane isoflurane sevofulrane methoxyflurane N2O FLURANEs or THANEs or N2O ```
86
describe the MOA of inhaled anesthetics
we don't know :)
87
what are the effects of inhaled anesthetics
myocardial depression respiratory depression nausea/emesis increased cerebral blood flow - decreased metabolic demand
88
a/se of halothane
hepatoxicity
89
a/se of methoxyflurane
nephrotoxicity
90
a/se of enflurane
proconvulsant
91
a/se of N2O
expansion of trapped gas I a body cavity
92
a/se of which inhaled anesthetic? hepatoxicity
halothane
93
a/se of which inhaled anesthetic? nephrotoxivity
methoxyflurane
94
a/se of which inhaled anesthetic? proconvulsant
enflurane
95
a/se of which inhaled anesthetic? expansion of trapped gas in body cavities
N2O
96
what is the major concern of inhaled anesthetics
MALIGNANT HYPERTHERMIA doesn't happen with N2O
97
what is malignant hyperthermia
rare life threatening heritable inhaled anetsthics (NOT N2O) and succinylcholine induce FEVER and SEVERE MUSCLE CONTRACTIONS
98
how to treat malignangy hyperthermia
dantrolene
99
what is dantrolene MOA
blocks Ca release from the SR of skeletal muscle
100
what is dantrolene used for
malignant hyperthermia from inhaled anesthetics and succinhylcholine ;use
101
please list the IV anesthetics and their families
``` thiopental/barbiturate midazolam/benzo ketamine/arylcyclohexylamine morphine + fentanyl/opioid propofol/not listed :) ```
102
describe the pharmacokinetics of thiopental
highly lipid soluble - high potency - rapidly gets in the braine
103
what is thiopental used for
induction into anesthesia | short surgical procedures
104
how does effect of thiopental get terminated
rapid redistribution into skeletal muscle and fat
105
effect of thiopental on CNS blood flow
decreases
106
how is midazolam used
endoscopy | and in conjunction with narcotis and gaseous anesthetics
107
what are a/se of midazolam
may cause severe postop respiratoyr depression decreased bp anterograde amnesia
108
how to treat severe post op resp depression, decreasd bp and anterograde amnesina of midazolam
flumazenil
109
what is ketamine
a pcp analog that acts as a dissociative anesthetic blocks NMDA receptors cardiovascular stimulatin
110
what are effects of ketamine
cardiovascular stiulate hallucionat sdisorientation bad dreams
111
effet of ketamine on cerebral blood flow
increases vrs thiopental that decreases it
112
what opiodis are use with other CNS depressnats during general anesthesia?
morphine and fentanyl
113
what is propofol used for
sedation int eICU rapid anetsthesia induction short procedures
114
what is MOA of propofol
potentiates GABAa receptor
115
what is benefit of propofol over thiopental
less postop nausea than thiopental
116
name the IV anesthetic used for endoscopy
midazolam
117
name the IV anesthetic used for induction to anesthesia
thiopental
118
name the IV anesthetic used for short procedures
propafol > thiopental, because less nauceas
119
name the IV anesthetic used for sedation in the ICU
propafol
120
name the IV anesthetic used for dissociation
ketamine
121
list the IV anesthetics that make you forget
ketamine - dissociative desired s/e | midazolam - anteriograde amnesia a/se
122
list the local anesthetic esters
procaine cocaine tetracaine ONLY ONE I
123
list the local anesthetic amides
lidocaine mepivacaine bupivavaine AMIDES have TWO Is
124
what is uslaly given with local anesthetics
a vasoconstrictor like epinephrine -- enhances local action - decreases bleeding and increases local anesthetics by decreases systemic concentation
125
what is the moa of local anesthetics
block na channels by binding to inner portion of channel preferentially bind to active channgels - so most effective in rapidly firing nerutions enter as non charged and bind as charged
126
how does infected tissue affect local anesthetics
infected tissue is acidic - traps alkaline anethetics in charged form so can t enter tissues. - need more of it bc effectiveness is decreased
127
which fibres are blocked first
matters less - myelinated | matters more - small
128
list the order of fibres that are blocked
small myelinated > small unmyelinated > large myelinated > large unmyelinated
129
list the modalities sequentially blocked with local anesthetics
pain > temp > touch > pressure
130
what are local anesthetics used for
minor surgical procedures and spinal anesthesia
131
what if someone is allergic to procaine
give an amide with two is
132
what are neuromuscular blocking drugs used for
muscle paralysis in surgery or mechanical ventilation
133
what receptors do neuromuscular blockers act on
Nm not Nn
134
what are the depol NMJ blockers
succinylcholine
135
how does succinylcholine work
strong Ach receptor agonist - produces sustained depol and prevents muscle contraction
136
what are the phases of reversal of blockade in succinylcholine
phase 1 - prolonged depol: no antidote | phase 2 - repol but blocked; ach receptors available but desensitized; antidote is cholinesterase inhibitors
137
how do you reverse the blockade of succinylcholine
during phase 1, prolonged depol no antidote, achase inhibitors will make worse during phase2, repol but blocked aka ach receptors are available but are desensicity;es used achase inhibitors
138
what are the complications of succinychloine
hypercalcemia hyperkalemia malignant hyperthermia
139
what are the nondepolarizating NMJ blockers
``` tubocurarine atracurirum mivacurium pancuronium vecuronium rocuronium ```
140
how do non depol NMJ blockers work
competitive antagoinsts - cometep with ACh for receptors
141
how to reverse blockage of nondepol NMJ blockers
with neostigmine - have o give with atropine to prevent muscarinic effects - bradycardia edrophonium other cholinesterase inhibitors
142
what is baclofen
inhibits GABA b receptors at spinal cord - induces skeletal muscle relaxation
143
uses of baclofen
muscle spasms ie lower back pain
144
what is cyclobenzaprine
centrally acting skeletal muscle relaxant; structurally similar to TCAs with anticholi a/se too
145
what is cyclobenzaprine used for
muscle spams
146
list treatment for muscle spasms please
baclofen - gaba b agonist | cyclobenzaprine - central like a tca
147
list the strategies for treating Parkinson disease
want to increased DA and dereased ACh - DA agonists - increase DA availaibility central - increased Ldopa availability peripheral - prevent DA breakdown- central - stop excess cholinergic activity
148
list the drugs that act as DA agonists
bromocriptin - ergot pramipexole and ropinirole Ro-PIN- ROLLING (resting tremor)
149
list the drugs that increase DA availability centrally
amantadine - increases release and decrease DA uptake
150
list the drugs that increase ldopa availability
levodopa and carbidopa | entacapnoe and tolcapone - inhibit COMT
151
list the durgs that precent DA breakdown centrally
seleglitine - inihibts MAOB | tolcapone - inhibits COMT peri and centrally
152
list the drugs that curb excess ach activity
benztropine
153
MOA of bromocriptine pelase
DA agonist, ergot. not preferred to pramipexole and ropinirole
154
MOA of ropinirole pelase
DA agonist, non ergot preferred over bromocriptine
155
MOA of pramipexole pelase
DA agonist, non ergot preferred over bromocription | PRAMIPEXOLE
156
moa of amantadine please
increase DA release and prevents uptake of DA | antiviral vrs influenze A and rubella
157
toxo of amantadine pelase
livedo reticularis | ataxia
158
anti Parkinson used as an antiviral
amantadine - anit influenza A and rubella
159
what is the MOA of levodopa/carbidopa combo
caridopa blocks peripheral DOPA decarboxylase and reduces a/se of increase da in peripherly
160
oa of entacapone
peripheral block of COMT - no breakdown of L DOPA to 3- O methyldopa
161
MOA of talcapone
peripheral and central block of COMT - no breakdown of LDOPA to 3-o methyl dopa in periphery nor DA to DOPAC centrally
162
MOA of selefiline
blocks conversion of dopamine into 3MT by inhibiting MAOB
163
effects of benztropine
park your benz | antimuscarinic - has effects on tremor and rigidity but not bradykinesia
164
which can cross the bbb da or ldopa
ldopa waddup | tis why we need carbidopa to inhibit dopa decarboxylase in the periphery
165
toxo of lecodopa/carbidopa
arrthymias deom increased peripheral formation of catecholamines
166
what can long term use of levodopa/carbidopa cause
dyskinesia after administration and akinesia between doses
167
what is selsgiline
MAO b inhibitor - increases DA degradation more than norephinephirine
168
use od selegiline
adjunctive agent to l dopa for parkinson
169
toxo of selegiline
may enhacen arrhythmias, od dyskinesia and akinesia with use of levo and carbidopa
170
list drugs used to treat Alzheimer disease
memantine donepezilgalantamine rivastigmine tacrine
171
what is the moa of memantine
NMDA receptor antagonist | helps prevent excitatoxicity mediated by Ca++
172
what is memantine used for
alzhemier
173
what are toxos of memantine
dizziness, confusion, hallucinations
174
alxhemier disease is associated with low Ach levels. therapeutically how can this be corrected
can use AChase inhibitors
175
what are donepezil galantamine rivastigmine tacrine
achase inhibitors used in alxehmier donepezil, galantamine, rivastigmine, tacrine
176
what are the toxos fo donepezil, galantamine, rivastigine tacrine
nausea, dizziness, insomnia
177
what are the nt changes inhuntingtons
decreased gaba decreasd ach increasd da
178
how do you treat Huntington disease
tetrabenazine and reserpine: inhibit VMAT - limit DA vesicle packaging and release haloperidol - D2 receptor antagonist
179
tetrabenazine and reserpine?
Huntington treatment | inhibit VMAT - limit DA vesicle packaging and release
180
haloperidol use?
Huntington disease | D2 receptor antagonist (indirect pathway )
181
sumatriptan moa pelase
5ht1b/1d agonist inhibit trigeminal nerve activation prevent vasoactive pepride relase iduce vasocsotnrtion
182
why are tripasn effective treatment for acute migrains and cluster headaches
agonist and 5HT1/d/b inhibit trigeminal nerve actiation prevent vasoactive peptide release induce vasoconstriction
183
as/e of triptans
coronary vasospasm | mild parethesias
184
where are triptans contraindicated
coronary artery disease | praziqnautel disease
185
doc at absent seizures
ethosuximide | sucs to have silent seizures
186
doc at acute status epilepticus
benzodiazepines - diazepam and lorazepam
187
doc at prophylaxis for status epilepticus
phenytoin
188
doc for tonic clonics
phenytoin valproid acid carbamaezepine
189
doc at simple seizures
carbamazepine
190
doc at complex seizures
carbamazepine
191
which seizure drugs act by blocking ca channels t type at thalamus
ethosuximide | doc at absence seizures
192
which seizure drugs act by increase action at GABA a receptors
``` benzodiazepines phenobarbital topiramate levetiracetma tigabine vigabatrin ```
193
which seizure drugs act by increase na channel inactivation
``` phenytoin carbamazepine valproid acid topiramate lamotrigine ```
194
which seizure drugs act by inhibiting GABA transaminase
valproid acid | vigabatrin
195
which seizure drugs are teratogens
phenytoin carbamazepine valproic acid
196
which seizure drugs can cause steven Johnson syndrome
ethosuximide phenytoin carbamazepine lamotrigine
197
what seizure drugs can induce P450
phenytoin carbamazepine phenobarbital
198
what seizure drug casues kidney stones
topiramate
199
what seizure drugs can cause ataxia
phenytoin | gabapentin
200
which seizure drugs can mess with blood
phenytoin- megaloblastic | carbamazepine - agranulocytosis and aplastic anemia
201
which seizure drug causes gingiaval hyeprplasi
phenytoin
202
what seizure drug causes DSIADH
carbamazepine
203
what seizure drug causes SLE like syndrome
phenytoin
204
what seizure drug casues neural tube defects
valproic acid
205
what is DOC for trigeminal neuralgia
carbamazepine
206
what is DOC for exlampsia
MgSO4 first and then benzodiazepines
207
what drug used for myoclonic seizures
valproid caid
208
what seizure drug used for migraine prophylaxis
topiramte
209
what drug also used for peripheral neuropathy
gapapentin

Pharmocology - step (16 decks)

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