Neurology Pharm Flashcards by Carl Carlson

How do glaucoma drugs work

Dec. IOP via dec. amount of aqueous humor (inhibits synthesis/secretion or inc. drainage)

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alpha-agonists

Epinephrine, Brimonidine (alpha2)

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beta-blockers for glaucoma side effects

No pupillary or vision changes

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acetazolamide glaucoma side effects

no pupillary or vision changes

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What beta blockers are used in glaucoma

Timolol, betaxolol, carteolol

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What duretics used for glaucoma

Acetazolamide

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What alpha agonists used in glaucoma

epinephrine, brimonidine

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What cholinomimetics used in glaucoma

Direct: pilocarpine, carbachol
Indirect: Physostigmine, echothiophate

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What is latanoprost

Prostaglandin PGF2alpha, darkens color of iris

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How do the glaucoma drugs work

The alpha agonists, beta blockers, diuretics all decrease aqueous humor synthesis.
Cholinomimetics and prostaglandin increase aqueous humor outflow.

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Delta opioid receptor ligand

enkephalin

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Kappa opioid receptor ligand

dynorphin

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Opiates MOA on ion channels

open K+ channels, close Ca2+ channels, decerase synaptic transmission. inhibit ACh, NE, 5-HT, glutamate, substance P.

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Diarrhea opiates

loperamide and diphenoxyllate

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Opiate tolerance that doesn’t go away

No tolerance to miosis or constipation

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Butorphanol

Mu-opioid receptor partial agonist and kappa-opioid receptor agonist; produces analgesia. Less resp. depression than full agonists. Can’t reverse with naloxone very easily.

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Tramadol

Very weak opioid agonist; also a SNRI, [Tram It All]

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Tramadol use

Chronic pain, but decreases seizure threshold and can cause serotonin syndrome.

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What drugs can be used for absence seizures

Ethosuximide, valproate, and lamotrigine

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What drugs are used in status epilepticus?

Benzos and Phenytoin(PPx)

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What are the first line agents for tonic clonic seizures

Phenytoin, Carbamazepine, and Valproate.

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What is the first line agents for Simple and complex seizures

Carbamazepine only, Carbamazepine is best for all partial seizures and tonic clonic.

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What drugs can’t be used for partial seizures

Ethosuximide (Thalamic channels) and Benzos

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Ethosuximide side effects

EFGHIJ: Ethosuximide causes, Fatigue, GI distress, Headache, Itching, and Stevens-Johnson syndrome.

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Tx eclampsia seizures

1st line is MgSO4, benzos are second line.

ethosuximide MOA

Thalamic T-type Ca2+ channels

Topiramate non-seizure use

Migraine PPx

1st line for trigeminal neuralgia

Carbamazepine

Carbamazepine MOA

Inc. Na+ channel inactivation

Phenytoin MOA

Inc. Na channel inactiation; zero order kinetics

Valproate MOA

Inc. Na channel inactivation, inc. GABA conc. by inhibiting GABA transaminase

Gabapentin MOA

Blocks high voltage-activated Ca channels, GABA analog

Topiramate MOA

Blocks Na channels, inc. GABA action

Lamotrigine MOA

Blocks voltage-gated Na channels

Levetiracetam MOA

Unknown; may modulate GABA and glutamate release

Tiagabine

Inc. GABA by inhibiting re uptake

Vigabatrin MOA

Inc. GABA by irreversibly inhibiting GABA transaminase

Barbiturates MOA

Prolong GABAa opening duration.

Barbiturates contraindication

Porphyria

Barbiturates overdose tx

Assist respiration and maintain BP

Benzos MOA

Increase GABAa frequency of opening. Decrease REM.

Flumazenil MOA

competitive antagonist at GABA benzo receptor

Nonbenzodiazepine hypnotics

Zolpidem, Zaleplon, esZopiclone "All ZZZs put you to sleep."

Nonbenzo hypnotics MOA

Act via the BZ1 subtype of the GABA receptor. Effects reversed by flumazenil.

Anesthetic dec. solubility in blood leads to

rapid induction and recovery times

Anesthetic inc. solubility in blood leads to

inc. potency

Potency formula

1/MAC

Inhaled anesthetics Effects

Myocardial depression, resp. depr. N/V, INCREASED Cerebral blood flow (dec. cerebral metabolic demand)

Halothane tox

hepatotoxicity

Methoxyflurane tox

nephrotoxicity

Enflurane tox

proconvulsant

Nitrous oxide tox

Expansion of trapped gas in a body cavity

What drugs cause malignant hyperthermia

All inhaled anesthetics except nitrous oxide and succinyl choline. HEREDITARY CONDITION. Tx is dantrolene.

Thiopental drug class

Barbiturates

Thiopental pharmacokinetics

high potency, high lipid solubility, rapid entry into brain, rapidly redistributed. DECREASES CEREBRAL BLOOD FLOW.

Midazolam use

Most common drug for endoscopy

Midazolam toxicity

Severe postop resp. depressino, dec. BP, anterograde amnesia.

Arylcyclohexylamines

Ketamine, blocks NMDA receptors

Ketamine effects

CV stimulant, disorientation, hallucinations, bad dreams. Inc. cerebral blood flow.

Propofol

Potentiates GABAa

Amide local anesthetics

Have 2 I's in the name, bupivicaine, lidocaine, mepivacaine.

Local anesthetics MOA

binds Na+, especially when activated, so best in rapidly firing neurons.

Fact: tertiary amine local anesthetics penetrate membrane in uncharged form, then bind to ion channels as charged form.

Fact: in infected (acidic) tissue, alkaline anesthetics are charged and cannot penetrate membrane effectively, need more anesthetic.

What are the alkaline anesthetics?

Local anesthetics are all weak bases!!! So acidic tissue is bad for all local anesthetics. So sick tissue needs more anesthetic than happy tissue.

Order of nerve blockade for local anesthetics

Small diameter > large diameter. myelinated > unmyelinated

Order of loss with local anesthetics

1. Pain 2. Temp 3. Touch 4. Pressure

Which local anesthetic is toxic to the heart

Bupivicaine

Which local anesthetic causes arrhythmias:

Cocaine

Depolarizing neuromuscular blockers toxicity

HyperCa, hyperK, malignant hyperthermia

Nondepolarizing blockers

Tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, rocuronium

Nondepolarizing MOA

Competitive antagonists at NMJs, all are like curare

Nondepolarizing antidote

Neostigmine (msut be given with atropine to pervent muscarinic effects like bradycardia), edrophonium, and other AChEIs.

Phase I of succinylcholine

Prolonged depolarization, no antidote, AChEIs potentiate the effect.

Phase II of succinylcholine

Repolarized but blocked; ACh receptors available but desensitized: antidote of AChEIs

Non-ergot DA agonists

Pramipexole and ropinirole

parkinson drugs

BALSA | Bromocriptine, Amantadine, Levodopa (w/ carbidopa), Selegiline (and COMT inhibitors), Antimuscarinics

Amantadine MOA

May inc. DA release, antiviral for flu A and rubella; toxicity=ataxia

Selegiline MOA

selective MAO type B inhibitor

COMT inhibitors

Entacapone, tolcapone: prevent L-dopa degradation

Benztropine MOA

Antimuscarinic; improves tremor and rigidity but little effect on bradykinesia