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Pharmocology - step > Neurology druuggz > Flashcards

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
Q

list the opioid analgesics please

A 
morphine
fentanyl
codeine
loperamide
methadone
meperidine
destromethrophan
diphenoxylate
pentazocine
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26
Q

what is the MOA of opioid analgesics

A

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

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27
Q

what neurotransmitters do opiod analgesics decrease release of

A

NE, Ach, glutamate, substance P, 5Ht

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28
Q

again what neurotransmitters do opioid analgesics decrease

A

Ach, NE, glutamate, 5 Ht, substance P

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29
Q

what is destromethrophan used for

A

opioid

cough suppression

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30
Q

what is loperamide and diphenoxylate used for

A

diarrhoea

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31
Q

what is methadone used for

A

maintaince program for heroin addicts

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32
Q

what is buprenorphine and naloxone combo used for

A

maintenance program for heroin addicts

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33
Q

what are all opioids used for

A

pain

acute pulmonary oedema

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34
Q

opiod used for cough suppression

A

dextromethorphan

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35
Q

opioid used for diarrhoea

A

loperamide and diphenoxylate

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36
Q

opioid used for maintenance of heroin addiction

A

methadone
OR
buprenorphine with naloxone

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37
Q

what are the toxo risks of opioids

A 
addiction
respiratory depression
constipation
miosis
additive CNS depression with other drugs
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38
Q

how to treat opioid toxicity

A

naloxone or naltrexone - opioid receptor antagoinsts

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39
Q

what a/se do not build up tolerance in opioid tox

A

miosis

constipation

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40
Q

MOA of butorphanol

A

k opoiod receptor agonist
mew opioid receptor partial agonist
produces ANALGESIA

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41
Q

clinical use of butorphanol

A

severe pain - migraine and labour

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42
Q

who cares about butorphanol

A

k opioid agonist and mew opioid receptor agonist

less respiratory depresion

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43
Q

toxo of butorphanol

A

can cause opioid withdrawal symptoms if patient is also taking full opiod agonist due to competition for recptors

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44
Q

how to treat o/d of butrophanol

A

NOT Easily with naloxone

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45
Q

what is tramadol

A

very weak opioid agonist
also inhibits 5HT reuptake and NE reuptake
TRAM IT ALL with TRAMADOL

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46
Q

what is tramadol used for

A

chronic pain

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47
Q

toxo of tramadol

A

similar to opioids
DECREASED SEIZURE THRESHOLD
SEROTONIN SYNDROME

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48
Q

whath opioid causes decrease seizure threshold

A

tramadol

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49
Q

what opioid causes less resp depression

A

butorphanol

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50
Q

what opioid can cause serotonin syndrome

A

tramadol - increases 5ht reuptake

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51
Q

list the barbituates please

A 
phenobarbital
pentobarbital
thiopental
secobarbital
BARBITAL and pental
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52
Q

what is the moa of barbituates

A

favilirate GABAa by increasing DURATION Cl channels are open - decreases neuronal firing

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53
Q

what are barbituates used for

A

sedative for anxiety
seizures
insomnia
induction of anesthesia = thipental

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54
Q

use of thiopental

A

induction of anesthesia

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55
Q

what can cause increased CNS depression fo barbituates

A

alcohol

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56
Q

what are the a/se of barbituates

A

resp and cardiovascular depression CAN BE FATAL
CNS depression - can be made worse with alcohol
dependence
induces P450

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57
Q

how to treat overdose of barbituates

A

supportive

assist respiration and maintain blood pressure

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58
Q

list the benzodiazepines

A

diazepam, lorazepam, trazolam, temazepam, oxazepam, midazolam, chlordiazepoxide ,alprazolam
OLAM and chlordiazepoxides

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59
Q

moa of benzodiazepines

A

facilitate GABAa action by increasing FREQUENCY of Cl channel opening

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60
Q

effect of benzos on sleep

A

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

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61
Q

list the short acting benzodiazepines

A

ATOM: alprazolam, triazolam, oxazepam, midazolam

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62
Q

whats different between benzos with a long or a short half life

A

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

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63
Q

list the benzodiazepines with longer hald lifes

A

diazepam
lorazepam
temazepam
chlordiazepoxide

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64
Q

clinical use of benzos please

A 
anxiety
spasticicty
status epilepticus
detox from alcohol withdrawal/delirium tremens
night terros
sleepwalking
cneral anesthetics - amnesia and muscle relaxants
hypnotics - insomnia
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65
Q

which benzs are used for status epilepticus

A

lorazepam and diazepam

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66
Q

what are the toxos of benzos

A

dependence
addictive CNS depression effects with alcohol
less risk of respi depression an d coma that barbituatesa

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67
Q

how to treat o/d of benzos

A

FLUMAZENIL

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68
Q

what is flumazenil

A

treatment of o/d benzos (and nonbenzo hypnotics the zzzs)- acuts by competitive antag at GABA benzo receptor

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69
Q

which has more risk of resp depression and coma, barbs or benzos

A

barbs.

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70
Q

list the nonbenzodiazepine hypnotics

A

zolpidem
zaleplon
eszopiclone

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71
Q

what are zolpidem, zaleplon, eszopiclone

A

nonbenzodiazepine hypnotics

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72
Q

what is the MOA of zolpidem, zalephlon, eszopiclone

A

act via the BZ1 subtype of the GABA receptor

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73
Q

how to reverse effects of zolpidem, zaleplon, eszopiclone

A

flumazenil

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74
Q

what are zolpidem, zaleplon and eszopiclone used fro

A

insomnia

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75
Q

toxo risks of zolpidem, zalephlon, eszopiclone

A 
ataxia
headache
confusion
only modest day after psychomotor depression and fefw amniestic effects
decreased risk of dependency
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76
Q

what are the benefits of zolpidem, zaleplon and eszopiclone over benzos

A

less day after amniestic effects and less psychomotor depression
less risk of dependency

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77
Q

why do zolpidem, zaleplon and eszopiclone have a short durcation of action

A

rapid metabolism by liver enzymes

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78
Q

how do anesthetis reach the BBB

A

either are lipid soluble or are actively transported

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79
Q

what does it mean if an anesthetic has decreased blood solubility

A

faster onset and faster recovery

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80
Q

what does it mean if an anesthetic has increased lipid solubility

A

increased potency

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81
Q

what does potency equal

A

1/MAC

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82
Q

what is the MAC

A

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)

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83
Q

N2O is low blood soluble and low lipid soluble…. describe it as an anesthetic

A

fast induction and fast recovery - low blod osolubility

low potency - low lipid solbulity

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84
Q

halothane has high blood solubility and high lipid solubility …describe it as an anesthetic

A

high blood solubility - longer to induce and longer to recovery
high lipid solubility - more potent. lower MAC

85
Q

list the inhaled anesthetics

A 
halothane
enflurane
isoflurane
sevofulrane
methoxyflurane
N2O
FLURANEs or THANEs or N2O
86
Q

describe the MOA of inhaled anesthetics

A

we don’t know :)

87
Q

what are the effects of inhaled anesthetics

A

myocardial depression
respiratory depression
nausea/emesis
increased cerebral blood flow - decreased metabolic demand

88
Q

a/se of halothane

A

hepatoxicity

89
Q

a/se of methoxyflurane

A

nephrotoxicity

90
Q

a/se of enflurane

A

proconvulsant

91
Q

a/se of N2O

A

expansion of trapped gas I a body cavity

92
Q

a/se of which inhaled anesthetic? hepatoxicity

A

halothane

93
Q

a/se of which inhaled anesthetic? nephrotoxivity

A

methoxyflurane

94
Q

a/se of which inhaled anesthetic? proconvulsant

A

enflurane

95
Q

a/se of which inhaled anesthetic? expansion of trapped gas in body cavities

A

N2O

96
Q

what is the major concern of inhaled anesthetics

A

MALIGNANT HYPERTHERMIA doesn’t happen with N2O

97
Q

what is malignant hyperthermia

A

rare
life threatening
heritable
inhaled anetsthics (NOT N2O) and succinylcholine induce FEVER and SEVERE MUSCLE CONTRACTIONS

98
Q

how to treat malignangy hyperthermia

A

dantrolene

99
Q

what is dantrolene MOA

A

blocks Ca release from the SR of skeletal muscle

100
Q

what is dantrolene used for

A

malignant hyperthermia from inhaled anesthetics and succinhylcholine ;use

101
Q

please list the IV anesthetics and their families

A 
thiopental/barbiturate
midazolam/benzo
ketamine/arylcyclohexylamine
morphine + fentanyl/opioid
propofol/not listed :)
102
Q

describe the pharmacokinetics of thiopental

A

highly lipid soluble - high potency - rapidly gets in the braine

103
Q

what is thiopental used for

A

induction into anesthesia

short surgical procedures

104
Q

how does effect of thiopental get terminated

A

rapid redistribution into skeletal muscle and fat

105
Q

effect of thiopental on CNS blood flow

A

decreases

106
Q

how is midazolam used

A

endoscopy

and in conjunction with narcotis and gaseous anesthetics

107
Q

what are a/se of midazolam

A

may cause severe postop respiratoyr depression
decreased bp
anterograde amnesia

108
Q

how to treat severe post op resp depression, decreasd bp and anterograde amnesina of midazolam

A

flumazenil

109
Q

what is ketamine

A

a pcp analog that acts as a dissociative anesthetic
blocks NMDA receptors
cardiovascular stimulatin

110
Q

what are effects of ketamine

A

cardiovascular stiulate
hallucionat
sdisorientation
bad dreams

111
Q

effet of ketamine on cerebral blood flow

A

increases vrs thiopental that decreases it

112
Q

what opiodis are use with other CNS depressnats during general anesthesia?

A

morphine and fentanyl

113
Q

what is propofol used for

A

sedation int eICU
rapid anetsthesia induction
short procedures

114
Q

what is MOA of propofol

A

potentiates GABAa receptor

115
Q

what is benefit of propofol over thiopental

A

less postop nausea than thiopental

116
Q

name the IV anesthetic used for endoscopy

A

midazolam

117
Q

name the IV anesthetic used for induction to anesthesia

A

thiopental

118
Q

name the IV anesthetic used for short procedures

A

propafol > thiopental, because less nauceas

119
Q

name the IV anesthetic used for sedation in the ICU

A

propafol

120
Q

name the IV anesthetic used for dissociation

A

ketamine

121
Q

list the IV anesthetics that make you forget

A

ketamine - dissociative desired s/e

midazolam - anteriograde amnesia a/se

122
Q

list the local anesthetic esters

A

procaine
cocaine
tetracaine
ONLY ONE I

123
Q

list the local anesthetic amides

A

lidocaine
mepivacaine
bupivavaine
AMIDES have TWO Is

124
Q

what is uslaly given with local anesthetics

A

a vasoconstrictor like epinephrine – enhances local action - decreases bleeding and increases local anesthetics by decreases systemic concentation

125
Q

what is the moa of local anesthetics

A

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
Q

how does infected tissue affect local anesthetics

A

infected tissue is acidic - traps alkaline anethetics in charged form so can t enter tissues. - need more of it bc effectiveness is decreased

127
Q

which fibres are blocked first

A

matters less - myelinated

matters more - small

128
Q

list the order of fibres that are blocked

A

small myelinated > small unmyelinated > large myelinated > large unmyelinated

129
Q

list the modalities sequentially blocked with local anesthetics

A

pain > temp > touch > pressure

130
Q

what are local anesthetics used for

A

minor surgical procedures and spinal anesthesia

131
Q

what if someone is allergic to procaine

A

give an amide with two is

132
Q

what are neuromuscular blocking drugs used for

A

muscle paralysis in surgery or mechanical ventilation

133
Q

what receptors do neuromuscular blockers act on

A

Nm not Nn

134
Q

what are the depol NMJ blockers

A

succinylcholine

135
Q

how does succinylcholine work

A

strong Ach receptor agonist - produces sustained depol and prevents muscle contraction

136
Q

what are the phases of reversal of blockade in succinylcholine

A

phase 1 - prolonged depol: no antidote

phase 2 - repol but blocked; ach receptors available but desensitized; antidote is cholinesterase inhibitors

137
Q

how do you reverse the blockade of succinylcholine

A

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
Q

what are the complications of succinychloine

A

hypercalcemia
hyperkalemia
malignant hyperthermia

139
Q

what are the nondepolarizating NMJ blockers

A 
tubocurarine
atracurirum
mivacurium
pancuronium
vecuronium
rocuronium
140
Q

how do non depol NMJ blockers work

A

competitive antagoinsts - cometep with ACh for receptors

141
Q

how to reverse blockage of nondepol NMJ blockers

A

with neostigmine - have o give with atropine to prevent muscarinic effects - bradycardia
edrophonium
other cholinesterase inhibitors

142
Q

what is baclofen

A

inhibits GABA b receptors at spinal cord - induces skeletal muscle relaxation

143
Q

uses of baclofen

A

muscle spasms ie lower back pain

144
Q

what is cyclobenzaprine

A

centrally acting skeletal muscle relaxant; structurally similar to TCAs with anticholi a/se too

145
Q

what is cyclobenzaprine used for

A

muscle spams

146
Q

list treatment for muscle spasms please

A

baclofen - gaba b agonist

cyclobenzaprine - central like a tca

147
Q

list the strategies for treating Parkinson disease

A

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
Q

list the drugs that act as DA agonists

A

bromocriptin - ergot
pramipexole and ropinirole
Ro-PIN- ROLLING (resting tremor)

149
Q

list the drugs that increase DA availability centrally

A

amantadine - increases release and decrease DA uptake

150
Q

list the drugs that increase ldopa availability

A

levodopa and carbidopa

entacapnoe and tolcapone - inhibit COMT

151
Q

list the durgs that precent DA breakdown centrally

A

seleglitine - inihibts MAOB

tolcapone - inhibits COMT peri and centrally

152
Q

list the drugs that curb excess ach activity

A

benztropine

153
Q

MOA of bromocriptine pelase

A

DA agonist, ergot. not preferred to pramipexole and ropinirole

154
Q

MOA of ropinirole pelase

A

DA agonist, non ergot preferred over bromocriptine

155
Q

MOA of pramipexole pelase

A

DA agonist, non ergot preferred over bromocription

PRAMIPEXOLE

156
Q

moa of amantadine please

A

increase DA release and prevents uptake of DA

antiviral vrs influenze A and rubella

157
Q

toxo of amantadine pelase

A

livedo reticularis

ataxia

158
Q

anti Parkinson used as an antiviral

A

amantadine - anit influenza A and rubella

159
Q

what is the MOA of levodopa/carbidopa combo

A

caridopa blocks peripheral DOPA decarboxylase and reduces a/se of increase da in peripherly

160
Q

oa of entacapone

A

peripheral block of COMT - no breakdown of L DOPA to 3- O methyldopa

161
Q

MOA of talcapone

A

peripheral and central block of COMT - no breakdown of LDOPA to 3-o methyl dopa in periphery nor DA to DOPAC centrally

162
Q

MOA of selefiline

A

blocks conversion of dopamine into 3MT by inhibiting MAOB

163
Q

effects of benztropine

A

park your benz

antimuscarinic - has effects on tremor and rigidity but not bradykinesia

164
Q

which can cross the bbb da or ldopa

A

ldopa waddup

tis why we need carbidopa to inhibit dopa decarboxylase in the periphery

165
Q

toxo of lecodopa/carbidopa

A

arrthymias deom increased peripheral formation of catecholamines

166
Q

what can long term use of levodopa/carbidopa cause

A

dyskinesia after administration and akinesia between doses

167
Q

what is selsgiline

A

MAO b inhibitor - increases DA degradation more than norephinephirine

168
Q

use od selegiline

A

adjunctive agent to l dopa for parkinson

169
Q

toxo of selegiline

A

may enhacen arrhythmias, od dyskinesia and akinesia with use of levo and carbidopa

170
Q

list drugs used to treat Alzheimer disease

A

memantine
donepezilgalantamine
rivastigmine
tacrine

171
Q

what is the moa of memantine

A

NMDA receptor antagonist

helps prevent excitatoxicity mediated by Ca++

172
Q

what is memantine used for

A

alzhemier

173
Q

what are toxos of memantine

A

dizziness, confusion, hallucinations

174
Q

alxhemier disease is associated with low Ach levels. therapeutically how can this be corrected

A

can use AChase inhibitors

175
Q

what are donepezil
galantamine
rivastigmine
tacrine

A

achase inhibitors
used in alxehmier
donepezil, galantamine, rivastigmine, tacrine

176
Q

what are the toxos fo donepezil, galantamine, rivastigine tacrine

A

nausea, dizziness, insomnia

177
Q

what are the nt changes inhuntingtons

A

decreased gaba
decreasd ach
increasd da

178
Q

how do you treat Huntington disease

A

tetrabenazine and reserpine: inhibit VMAT - limit DA vesicle packaging and release
haloperidol - D2 receptor antagonist

179
Q

tetrabenazine and reserpine?

A

Huntington treatment

inhibit VMAT - limit DA vesicle packaging and release

180
Q

haloperidol use?

A

Huntington disease

D2 receptor antagonist (indirect pathway )

181
Q

sumatriptan moa pelase

A

5ht1b/1d agonist
inhibit trigeminal nerve activation
prevent vasoactive pepride relase
iduce vasocsotnrtion

182
Q

why are tripasn effective treatment for acute migrains and cluster headaches

A

agonist and 5HT1/d/b
inhibit trigeminal nerve actiation
prevent vasoactive peptide release
induce vasoconstriction

183
Q

as/e of triptans

A

coronary vasospasm

mild parethesias

184
Q

where are triptans contraindicated

A

coronary artery disease

praziqnautel disease

185
Q

doc at absent seizures

A

ethosuximide

sucs to have silent seizures

186
Q

doc at acute status epilepticus

A

benzodiazepines - diazepam and lorazepam

187
Q

doc at prophylaxis for status epilepticus

A

phenytoin

188
Q

doc for tonic clonics

A

phenytoin
valproid acid
carbamaezepine

189
Q

doc at simple seizures

A

carbamazepine

190
Q

doc at complex seizures

A

carbamazepine

191
Q

which seizure drugs act by blocking ca channels t type at thalamus

A

ethosuximide

doc at absence seizures

192
Q

which seizure drugs act by increase action at GABA a receptors

A 
benzodiazepines
phenobarbital
topiramate
levetiracetma
tigabine
vigabatrin
193
Q

which seizure drugs act by increase na channel inactivation

A 
phenytoin
carbamazepine
valproid acid
topiramate
lamotrigine
194
Q

which seizure drugs act by inhibiting GABA transaminase

A

valproid acid

vigabatrin

195
Q

which seizure drugs are teratogens

A

phenytoin
carbamazepine
valproic acid

196
Q

which seizure drugs can cause steven Johnson syndrome

A

ethosuximide
phenytoin
carbamazepine
lamotrigine

197
Q

what seizure drugs can induce P450

A

phenytoin
carbamazepine
phenobarbital

198
Q

what seizure drug casues kidney stones

A

topiramate

199
Q

what seizure drugs can cause ataxia

A

phenytoin

gabapentin

200
Q

which seizure drugs can mess with blood

A

phenytoin- megaloblastic

carbamazepine - agranulocytosis and aplastic anemia

201
Q

which seizure drug causes gingiaval hyeprplasi

A

phenytoin

202
Q

what seizure drug causes DSIADH

A

carbamazepine

203
Q

what seizure drug causes SLE like syndrome

A

phenytoin

204
Q

what seizure drug casues neural tube defects

A

valproic acid

205
Q

what is DOC for trigeminal neuralgia

A

carbamazepine

206
Q

what is DOC for exlampsia

A

MgSO4 first and then benzodiazepines

207
Q

what drug used for myoclonic seizures

A

valproid caid

208
Q

what seizure drug used for migraine prophylaxis

A

topiramte

209
Q

what drug also used for peripheral neuropathy

A

gapapentin

Pharmocology - step (16 decks)

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