Neurology Pharmacology

Question 1

What is the use of neuromuscular blocking drugs?

Answer 1

Used for muscle paralysis in surgery or mechanical ventilation

Selective for motor nicotinic receptor

Question 2

What are the two classes of NMB drugs?

Answer 2

Depolarizing and Nondepolarizing

Question 3

What is the mechanism of dantrolene?

Answer 3

Prevents the release of Ca²⁺ from the sarcoplasmic reticulum of skeletal muscle

Question 4

Clinical use of dantrolene

Answer 4

Used in the treatment of malignant hyperthermia, a rare but life-threatening side effect of inhalation anesthetics and succinylcholine

Also used to treat neuroleptic malignant syndrome

Question 5

What 5 majore drugs are used to treat Parkinson’s?

Answer 5

BALSA

Bromocriptine

Amantadine

Levodopa (with carbidopa)

Selegiline (and COMT inhibitors)

Antimuscarinics

Question 6

What is the strategy of bromocriptine in treating Parkinson’s?

Answer 6

Dopamine agonist

Question 7

What is hte strategy of amantadine in treating Parkinson’s?

Answer 7

Increase dopamine

Question 8

What is the toxicity of amantadine?

Answer 8

Tremor

Question 9

Whatis the strategy of L-dop/carbidopa in treating Parkinson’s?

Answer 9

Increase dopamine

Question 10

What is the strategy of selegiline in treating Parkinson’s?

Answer 10

Prevent dopamine breakdown

Question 11

What enzyme does selegiline inhibit to prevent dopamine breakdown?

Answer 11

Selective MAO type B inhibitor

Question 12

What is the strategy of entacapone and tolcapone in treating Parkinson’s?

Answer 12

Prevent dopamine breakdown

Question 13

What enzyme does entacapone and tolcapone inhibit to prevent dopamine breakdown?

Answer 13

COMT

Question 14

What specific antimuscarinic is used to treat Parkinson’s?

Answer 14

Benztropine

Question 15

What is the strategy of benztropine in treating Parkinson’s?

Answer 15

Curb excess cholinergic activity

Question 16

Why is L-dopa used rather than dopamine to increase level of dopamine in brain?

Answer 16

Unlike dopamine, L-dopa can cross the BBB and is converted by dopa carboxylate in the CNS to dopamine

Question 17

Why is carbidopa used along with L-dopa?

Answer 17

It is a peripheral decarboxylase inhibitor to increase the bioavailability of L-dopa in the brain and to limit peripheral side effects

Question 18

Toxicity of L-dopa

Answer 18

Arrhythmias from increased peripheral formation fo catecholamines

Long-term use can lead to dyskinesia following administration, akinesia between doses

Question 19

Mechanism of selegiline

Answer 19

Selectively inhibits MAO-B which preferentially metabolizes dopamine over NE and 5-HT, thereby increasing the availability of dopamine

Question 20

Clinical use of selegiline

Answer 20

Adjunctive agent to L-dopa in treatment of Parkinson’s

Question 21

Toxicity of selegiline

Answer 21

May enhance adverse effects of L-dopa

Question 22

Clinical use of memantine

Answer 22

Alzheimer’s

Question 23

Mechanism of memantine

Answer 23

NMDA receptor antagonist; helps prevent excitotoxicity (mediated by Ca2+)

Question 24

Toxicity of memantine

Answer 24

Dizziness

Confusion

Hallucinations

Question 25

Clinical use of donepezil

Answer 25

Alzheimer's

Question 26

Clinical use of galantamine

Answer 26

Alzheimer's

Question 27

Clinical use of rivastigmine

Answer 27

Alzheimer's

Question 28

Mechanism of donepezil, galantamine and rivastigmine?

Answer 28

AchE inhibitor

Question 29

Toxicity of donepezil, galantamine and rivastigmine

Answer 29

Nausea Dizziness Insomnia

Question 30

What neurotransmitter changes occur in Huntington's?

Answer 30

Decreased GABA Decreased Ach Increased dopamine

Question 31

Clinical use of tetrabenazine

Answer 31

Huntington's

Question 32

Mechanism of tetrabenazine

Answer 32

Inhibit VMAT to limit dopamine vesicle packaging and release

Question 33

Clinical use of reserpine

Answer 33

Huntington's

Question 34

Mechanism of reserpine

Answer 34

Inhibit VMAT to limite dopamine vesicle packaging and release

Question 35

Clinical use of haloperidol

Answer 35

Huntington's

Question 36

Mechanism of haloperidol

Answer 36

Dopamine receptor antagonist

Question 37

Mechanism Sumatriptan

Answer 37

5-HT_1B/1D agonist Inhibits trigeminal nerve activation Prevents vasoactive peptide release Induces vasoconstriction Half-life \< 2 hours

Question 38

Clinical use of sumatriptan

Answer 38

Acute migraine, cluster headache attacks

Question 39

Toxicity of sumatriptan

Answer 39

Coronary vasospasm Mild tingling

Question 40

Contraindication of sumatriptan

Answer 40

Contraindicated in patients with CAD or Prinzmetal's angine (due to coronary vasospasm side effect)