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USMLE Step 1 > Neurology--Pharmacology > Flashcards

Neurology--Pharmacology Flashcards

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USMLE® Step 1 flashcards
1
Q

Epinephrine in glaucoma moa, tox

A

alpha-agonist, decreases humor synthesis via vasoconstriction; Tox: mydriasis–do NOT use in closed angle glaucoma

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2
Q

brimonidine in glaucoma moa, tox

A

alpha2-agonist; decrease aqueous humor synthesis; Tox: blurry vision, ocular hyperemia, foreign body sensation, ocular allergic reactions/pruritus

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3
Q

Timolol, betaxolol, carteolol in glaucoma

A

B blockers; decrease aqueous humor synthesis

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4
Q

Acetazolamide in glaucoma

A

diuretic; decrease aqueous humor synthesis via inhibiton of carbonic anhydrase

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5
Q

pilocarpine, carbachol in glaucoma

A

direct cholinomimetic; increase outflow of humor via contraction of ciliary muscle and opening of trabecular meshwork

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6
Q

physostigmine, echothiophate in glaucoma

A

indirect cholinomimetics

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7
Q

use in emergencies glaucoma

A

pilocarpine

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8
Q

Tox of cholinomimetics in glaucoma?

A

miosis, cyclospasm

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9
Q

Latonoprost moa in glaucoma? Tox?

A

prostaglandin that increases outflow of humor; darkens color of iris (browning)

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10
Q

opioid MOA?

A

opioid receptors to modulate synaptic transmission; open K channels, close Ca channels–>decrease synaptic transmission; inhibit release of ACh, NE, 5HT, glutamate, substance P

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11
Q

opiate used for cough supression?

A

dextromethorphan

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12
Q

opiate used for diarrhea?

A

loperamide, diphenoxylate

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13
Q

butorphanol moa?

A

Mu opioid partial agonist and kappa-opiod receptor agonist–>analgesia; can cause withdrawal symptoms if used with full opioid agonist

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14
Q

tramadol moa? tox?

A

very weak opioid agonst, inhibits serotonin and NE uptake; used in chronic pain; decreases seizure threshold, serotonin syndrome

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15
Q

ethosuximide use? moa?

A

1st line for absence seizures; blocks thalamic T-type Ca channels

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16
Q

ethosuximide tox?

A

EFGHIJ: fatigue, GI distress, Headache, itching, Stevens johnson syndrome

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17
Q

benzodiazepines in epilepsy? moa?

A

1st line for acute status epilepticus; increase GABA action

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18
Q

1st line for eclampsia seizures?

A

MgSO4, then benzos

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19
Q

Phenytoin in seizures? moa?

A

first line in tonic clonic, first line for status epilepticus prophylaxis; increased Na channel inactivation; zero order kinetics;

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20
Q

phenytoin tox?

A

nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hisutism, peripheral neuropathy, megaloblastic anemia, teratogenesis, SLE like syndrome, induction of CYP450, LAD, SJ syndrome, osteopenia

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21
Q

drugs responsible for fetal dilantin syndrome?

A

phenytoin, carbamazepine; intrauterine growth restriction with microcephaly and develop minor dysmorphic craniofacial features and limb defects including hypoplastic nails and distal phalanges

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22
Q

carbamazepine in epilepsy? moa?

A

first line for simple, complex, tonic/clonic seizures; increases Na channel inactivation;

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23
Q

1st line for trigeminal neuralgia

A

carbamzepine

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24
Q

carbamazepine tox?

A

diplopia, ataxia, blood dyscrasias (agranulocytosis, aplastic anemia), liver toxic, teratogenesis, P450 induction, SIADH, SJ syndrome

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25
Q

valproic acid uses?

A

1st line for tonic/clonic seizures; myoclonic disorders, bipolar disorder

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26
Q

valproic acid moa?

A

increases Na channel inactivation, increases GABA concentration by inhibiting GABA transaminase;

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27
Q

valproic acid tox?

A

GI distress, rare but fatal liver tox, neural tube defects in fetus (spina bifida), tremor, weight gain, contraindicated pregnancy

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28
Q

measure before giving valproic acid?

A

LFTs (liver toxic

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29
Q

Gabapentin uses?

A

simple, complex, tonic clonic seizures but not first line; also used in peripheral neuropathies, postherpetic neuralgia, migraine prophylaxis, bipolar disorder

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30
Q

Gabapentin moa? tox?

A

inhibits high voltage Ca channels, designed as GABA analog; sedation, ataxia

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31
Q

Phenobarbital in epilepsy?

A

1st line in neonates for simple/complex/tonic-clonic; increases GABA action; sedation, tolerance, dependence, P450 induction, cardiorespiratory depression

32
Q

topiramate moa?

A

blocks Na channels, increases GABA action

33
Q

topiramate tx?

A

sedation, mental dulling, kidney stones, weight loss

34
Q

lamotrigine moa? tox?

A

blocks voltage gated Na channels, SJ syndrome (titrate slowly)

35
Q

levetiracetam moa?

A

unknown, may modulate GABA and glutamate release

36
Q

Tiagabine moa?

A

increases GABA by inhibiting reuptake

37
Q

vigabatrin moa?

A

increases GABA by irreversibly inhibiting GABA transaminase

38
Q

which epilepsy drugs increase GABA action?

A

benzos, barbituates, valproic acid (inhibit GABA transaminase), topiramate, levetiracetam, tiagabine, vigabatrin

39
Q

which epilepsy drugs increase Na channel inactivation?

A

phenytoin, carbamazepine, valproic acid, topiramate, lamotrigine

40
Q

which epilepsy drugs increase GABA action and increase Na channel inactivation?

A

valproic acid, topiramate

41
Q

which epilepsy drugs act on Ca channels?

A

ethosuximide (blocks thalamic T type); gabapentin (inhibits high voltage activated Ca 2+ channels)

42
Q

barbituate moa?

A

facilitates GABA-A action by increasing duration of Cl channel opening–>decr neuron firing

43
Q

barbituate contraindication?

A

porphyria; induces CYP450 and increases demand for heme metabolism–>toxic buildup of precursors

44
Q

benzos, barbs, EtoH all bind which receptor?

A

GABA-A receptor, ligand gated Cl channel

45
Q

moa of flumazenil

A

competitive antagonist at GABA benzo receptor

46
Q

zolpidem, zaleplon, eszopiclone

A

non-benzo hypnotics that act via BZ1 subtype of GABA receptor; reversed by flumazenil

47
Q

anesthetics with low blood solubility…

A

rapid induction and recovery times

48
Q

anesthetics with high solubility in lipids…

A

high potency = 1/MAC

49
Q

halothane SEs

A

liver tox, malignant hyperthermia

50
Q

methoxyflurane SEs

A

kidney tox; malignant hyperthermi

51
Q

what can cause malignant hyperthermia?

A

all inhaled anesthetics except N2O, succinylcholine

52
Q

IV anesthetic that is effect terminated by redistribution into tissue and fat

A

barbituates (thiopental); high potency, high solubility, rapid entry into brain

53
Q

IV anesthetic associated with anterograde amnesia, post-op respiratory depression, low BP

A

benzodiazepine

54
Q

IV anesthetic associated with hallucination and bad dreams

A

arylcyclohexylamines (ketamine) PCP analogs, block NMDA receptors

55
Q

propofol moa?

A

potentiates GABA-A receptor

56
Q

which anesthetics increase cerebral blood flow?

A

inhaled anesthetics, ketamine

57
Q

which anesthetics decrease cerebral blood flow?

A

barbiturates

58
Q

local anesthetics moa?

A

block Na channels by binding to specific receptors on inner portion of the channel; preferentially bind to activated Na channels–most effective in rapidly firing neurons

59
Q

infected tissues need more or less anesthetic?

A

more anesthetic if alkaline anesthetic cannot penetrate membrane effectively

60
Q

what is the order of nerve blockade with local anesthetics?

A

small diamter > large diameter. Myelinated > unmyelinated. smaller size predominates. Loss of pain, temp, touch, pressure in order.

61
Q

local anesthetic that is cardio toxic?

A

bupivicaine

62
Q

succinylcholine moa? tox?

A

strong Ach receptor agonist–>sustained depolarization, prevents muscle contraction; hypercalcemia/hyperkalemia, malignant hyperthermia

63
Q

nondepolarizing nmj blockers? moa?

A

competitive antagonists that compete with Ach for receptors; reverse with neostigmine (given with atropine to prevent muscarinic effects like bradycardia) and other AchE inhibitors

64
Q

dantrolene moa?

A

prevents release of Ca2+ from sarcoplasmic reticulum of skeletal muscle

65
Q

Parkinson drug families?

A

dopamine agonists; increase dopamine release; prevent dopamine breakdown; curb excess cholinergic activity

66
Q

bromocriptine, pramipexole, ropinirole

A

dopamine agonists

67
Q

amantadine, L-dopa/carbidopa

A

increase dopamine levels

68
Q

selegiline

A

selective MAO type B inhibitor; preferentially metabolizes dopamine over NE and 5-HT; increases dopamine availability

69
Q

entacapone, tolcapone

A

COMT inhibitors–prevent L-dopa degradation; increased dopamine

70
Q

benztropine

A

anti-muscarinic that improves tremor/rigidity, does not affect bradykinesia

71
Q

carbidopa

A

peripheral decarboxylase inhibitor

72
Q

Alzheimer drugs:

A

memantine, donepezil/galantoamine/rivastigmine

73
Q

memantine moa?

A

NMDA receptor antagonist; prevents excitotoxicity mediated by Ca; Tox: dizziness/confusion/hallucinations

74
Q

donepezil, galantamine, rivastigmine

A

AChE inhibitors; Tox: insomnia

75
Q

Huntington drugs:

A

Tetrabenzine + reserpine (limit VMAT; limit dopamine vesicle packaging and release); haloperidol: D receptor antagonist

76
Q

Sumatriptan moa?

A

5HT 1B/1D agonist; inhibits Trigeminal nerve activation; prevents vasoactive peptide release; induces vasoconstriction; 2 hr half-life; used in acute migraine, cluster headache attacks

77
Q

sumatriptan contraindication?

A

patients with CAD or prinzmetals angina because induces coronary vasospasm; mild tingling

USMLE Step 1 (36 decks)

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