Neuropharm Flashcards
Brimonidine
Alpha 2 agonist. Decreases aqueous humor synthesis
Acetazolamide for the eye?
Decreases aqueous humor synthesis via inhibition of carbonic anhydrase.
What do you use in emergency glaucoma?
Pilocarpine. Muscarinic, very effective at opening canal of Schlemm via ciliary contraction.
Epinephrine for glaucoma?
Decreases aqueous humor synthesis via vasoconstriction but causes mydraisis, so don’t use in closed angle glaucoma
Latanoprost. Use and AE
PGFalpha. Increases outflow of aqueous humor for glaucoma, but darkens color of iris
Meperidine
Think of meeper with his pinpoint pupils. This is an opioid
Diphenoxylate uses
Opioid used to treat diarrhea
Butorphanol
Mu opioid receptor partial agonist and kappa opioid receptor agonist, analgesia and less resp depression than full opioid agonists.
Tramadol vs trazadone
Tram it all to hell. My back hurts all the time but I don’t want opioids! Tram it, now I’m having seizures. Tramadol = weak opioid agonist and also inhibits serotonin and NE reuptake.
Trazadone = atypical antidepressant for insomnia –> trazabone
What do you do for status epilepticus?
- IV lorazepam. 2. Phenytoin to prevent recurrence. If still seizing, start phenobarbital. If still seizing, intubate and give genearl anesthesia.
First line for myoclonic seizures?
Valproic acid
Primidone
Prodrug for phenobarbital.
AE’s of phenobarbital
Inducer of P450 and contraindicated in porphyria
Big AE of valproic acid
Hepatotoxicity
Big AE of lamotrigine
Steven Johnson
Big AE of topiramate
Induces metabolism of estrogen– makes OCPs not work
Benzos MOA vs barbiturates
Benzos increase frequency of channel opening, barbs increase duration
Diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, flurazepam, alprazolam, clorazepate, estazolam. Duration of actions?
Diazepam: long Lorazepam: Medium Triazolam: short Temazepam: Medium Oxazepam: short Midazolam: short Chlordiazepoxide: long Flurazepam: long Alprazolam: short Clorazepate: long Estazolam: medium
Zolpidem
Ambien. Nonbenzo but acts at benzo site. Lower dependence risk and lower hangover. Others - zaleplon, eszopiclone
2 days to 4 weeks after had anesthesia patient had centrilobular hepatic necrosis with increased LFTs. 80% mortality. What was the anesthetic?
Halothane -> hepatotoxicity. H!
AE of methyoxyflurane
Nephrotoxicity (M –> N)
AE of enflurane
Seizures. E–> epilepsy
How is the barbiturate effect terminated?
Rapid redistribution into tissue and fat.
Propofol
Used for ICU sedation, rapid anesthesia induction, short procedures. Potentiates GABA-A, but not barb
Succinylcholine: MOA and AE’s
Phase I: Depolarization –> inactivation –> flaccid paralysis
Phase II: Desensitized –> acts like nondepolarizing block
AEs: hypercalcemia, hyperkalemia, malignant hyperthermia
Dantrolene MOA
Blocks RyR to treat malignant hyperthermia and neuroleptic malignant syndrome
Pramipexole
DA agonist for PD
“capone” drugs
LIke Mafia taking care of L-dopa, “taking care of” COMT to increased DA entering brain. Still need carbidopa or ineffective. Tolcapone does peripheral and central and has hepatotoxicity. Entacapone just does peripheral.
What do you use to treat tremor predominant parkinsons?
Benztropine
B6 effect on L dopa?
Increases peripheral metabolism so less enters brain
Memantine vs amantadine
Memantine = NMDA antagonist to prevent excitotoxicity in Alzheimer’s, amantadine = influenza drug that increases DA release for PD.
Donepezil
AChEi. NOT ACEi. Used to treat Alzheimer’s
Sumatriptan
Not tricyclic… headache drug! 5HT1B/1D agonist. Inhibits trigeminal nerve activation, prevents vasoactive peptide release, induces vasoconstriction. 5 HT blocks pain pathway, blocks cGRP and substance P release.
