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Pharm Flashcards

1
Q

What DA pathway controls movement?

A

Nigrastriatal

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2
Q

What DA pathway controls reward and perception?

A

Mesolimbic

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3
Q

What DA pathway controls executive function?

A

Mesocortical

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4
Q

What DA pathway controls pituitary prolaction function?

A

Tuberoinfundibular

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5
Q

2 Post-synaptic enzymes that terminate DA action:

A

MAO A or B

COMT

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6
Q

Hyperfunctioning Migrostriatal pathway causes:

Hypofunctioning causes:

A

Hyper: dyskinetic movemnt
Hypo: dyskinetic movement, parkinsonism

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7
Q

Hyperfunctioning Mesolimbic pathway causes:

Hypofunctioning causes:

A

Hyper: Addiction, hallucinations
Hypo: amotivation, apathy

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8
Q

Hyperfunctioning Mesocortical pathway causes:

Hypofunctioning causes:

A

Hyper: hypervigilance
Hypo: inattention

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9
Q

Hyperfunctioning Tuberoinfundibular pathway causes:

Hypofunctioning causes:

A

Hyper: hypoprolactinemia
Hypo: hyperprolactinemia

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10
Q

What drugs to enhance DA synthesis?

A

Levodopa: DA precursor
Carbidopa: combined therapy to prevent peripheral DA activity –> lower side effects

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11
Q

Results of low and high DA activity:

A

Low: distractable
High: hypervigilant

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12
Q

ADHD: ___ DA activity at ___

A

low, anterior cingulate

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13
Q

Parkinson: ___ DA activity at ___

A

low, striatum

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14
Q

Why is MTHFR enzyme important?

Genetics?

A

Creates L-methylfolate, which is the form that can cross BBB

TT alleles bad –> less DA made

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15
Q

Bupropion:
Treats?
Class?
Affects what pathway?

A

Antidepressant
NDRI
Mesocortical

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16
Q

Amphetamines mechanism:

A
  • Block DAT

- Increase VMAT2 –>more DA release

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17
Q

Methylphenidate mechanism:

A

-Block DAT

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18
Q

2 wakefulness promoting stimulant drugs:
Treats?
Side effects?

A
  • Modafinil, Armodafinil
  • Narcolepsy
  • Off label: ADHD
  • P450-3A4 inducer
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19
Q

Selegiline:
low dose is used for for?
high dose is used for?

A

Low dose: MAO-B selective –> Parkinson

High dose: MAO A and B –> Depression

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20
Q

Rasagiline mechanism:

treats?

A
  • MAO-B inhibitor

- Parkinson’s

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21
Q

MAOIs for Depression:

A
  1. Isocarboxazid
  2. Phenelzine
  3. Tranylcypromine
  4. Selegiline
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22
Q

Serotonin Syndrome

A
  • MAOI decrease Serotonin breakdown
  • Adding Serotonin drug –> toxic levels in CNS
  • Tremor, muscle spasm, vital changes, hyperthermia, delirium, coma, death
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23
Q

COMTi drugs:
treats?
effect on neurotransmitters?

A
  • Entacapone, Tolcapone
  • Parkinson’s
  • elevate DA and NE
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24
Q

D2 receptor agonists:

treats?

A
  • Bromocriptine, pramipexole, ropinerole, Apomorphine injection
  • Parkinson’s or Restless leg Syndrome
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25
D3 receptor agonists: | treats?
- Aripiprazole - Antipsychotic for Schizo - Depression
26
Amantadine mechanism: | treats?
- Release DA, block DAT, stimulate D2 | - Parkinson's, Influenza
27
Reserpine treats:
HTN, Schizo psychosis, causes Depression
28
Tetrabenazine treats:
Huntington's Chorea by lowering DA availability
29
D2 receptor antagonist affects which pathways? treats? classification?
ALL; they are non-selective Schizophrenia FGAs (high, low potency), SGAs
30
What causes EPS? | Symptoms?
- High Potency FGA | - Akathisia, Dystonia, Parkinsonism, Neuroleptic Malignant Syndrome
31
Symptoms of Neuroleptic Malignant Syndrome:
1. Hyperthermia 2. Muscle rigidity 3. Vital sign instability 4. Rhabdomyolysis
32
What is Tardive Dyskinesia
- Chronic D2 receptor antagonism - Permanent movement disorder side effect - Choreic or Athetotic movements
33
High vs Low Potency FGA drugs: - Haloperidol - Thioridazine - Thiothixine - Fluphenazine - Chlorpromazine
High: Haloperidol Fluphenazine Thiothixine Low: Chlorpromazine Thioridazine
34
Blocking ___ receptor lowers EPS risk
Serotonin 2a (5HT2a)
35
Side effects of 'Dones' vs 'Pines'
Dones: more EPS Pines: more sedating, more metabolic syndrome
36
Clozapine risks and benefits
- Risk of agranulocytosis - Most metabolic risk of any agent - No neuromuscular effect --> no EPS/TD
37
Blocking what receptor stops psychosis?
D2
38
Mechanism of action for Beta blockers in Glaucoma?
Reduce aqueous production
39
Suffix for carbonic anhydrase inhibitors:
-zolamide
40
Mechanism of action for Carbonic Anhydrase Inhibitors in Glaucoma?
Reduce production of aqueous
41
Mechanism of action for Prostaglandin Analog in Glaucoma?
Increase uveoscleral outflow w/o effect on aqueous flow or trabecular outflow facility
42
Cocaine mechanism for diagnosing Horner's Syndrome
- Cocaine = reuptake inhibitor --> NE flood --> pupillary dilation - Horner's Syndrome = dysfunctional PANS --> no pupillary dilation
43
What drug is used to differentiate preganglionic from postganglionic lesions in Horner's Syndrome?
Hydroxyamphetamine: Releases NE
44
Hydroxyamphetamine mechanism for differentiating lesion location in Horner's Syndrome
- Topical application - No pupillary dilation = 3rd order neuron problem = Postganglionic = benign process - Dilation = Preganglionic lesion --> requires investigation
45
How do you differentiate Adie's syndrome from an intracranial aneurysm?
- Low dose muscarinic agonist (Methacholine or Pilocarpine) - Chronic denervated nerve in Adie's syndrom will be hypersensitive --> pupillary constriction - Acute trauma neurved from aneurysm will not respond
46
What is light-near dissociation?
No pupil response to light, but does have accomodation
47
Most common cause and population affected by Parinaud's Syndrome
- Midbrain tumor (pineal) | - Young children
48
Common presentation and population affected by Adie's Syndrome
- Loss of patellar reflex | - Young females
49
What characterizes Argyll-Robertson Syndrome:
- Miotic irregular pupils | - Does not respond to cycloplegics
50
Triptan's mechanism of action:
5HT1 B-D agonist --> vasoconstriction of intracranial EXTRACEREBRAL blood vessels (trigeminovascular system) --> block sterile inflammation reaction
51
In what patient population are triptans contraindicated?
Patients w/ vascular disease, uncontrolled HTN, and comlicated migraine syndromes
52
Migraine vs Tension vs Cluster Headache characteristics:
Migraine: unilateral, throbbing, moderate-severe, aggravated by activity, relieved by rest Tension: dull, achy, non-pulsatile, pressure-like, bilateral, mild-medium Cluster: severe, unilateral, in temporal, orbital or supraorbital areas
53
Most commonly used Beta blocker for Migraine?
Propranolol
54
Most commonly used Ca++ Channel Blocker for Migraine?
Verapamil | -useful for aura
55
For what patient population is Migraine prevantative therapy recommended?
- 3+ severe headaches/month or - 2+ mild-moderate headaches/week or - inability to use effective symptomatic therapy
56
2 Anti-epileptics used for migraine prevention
Valproic Acid, Topiramate
57
Cluster Headache characteristics:
- Clockwork daily and annual rhythm (same time) - Men:women 4:1 - Some patients have heavy facial features
58
Long-term Cluster Headache prevention drugs:
- Verapamil (Ca++ channel blocker) - Topiramate (antiepileptic) - Valproic Acid (antiepileptic) - Lithium (mood stabilizer)
59
Biogenic Amine Hypothesis of Depression:
Depression = too little CNS NE and/or 5HT
60
Scoring of Hamilton Depression Rating Scale (HDRS):
Mild= 8-13 Moderate= 14-18 Severe= 19-22 Very Severe= >23
61
What do MAO-A and -B mainly oxidize?
- A = NE, 5HT, Tyramine | - B = DA, phenyethylamine
62
What is the most used TCA for TTH prevention?
Amitriptyline
63
What is a common side effect of TCAs?
Cardiac arrhythmias
64
What 2 SSRIs have P450 Inhibition
Fluoxetine, Paroxetine
65
What is Ketamine's mechanism of action?
Glutamate NMDA receptor antagonist
66
What drug can quitting smokers use to maintain nicotine abstinence?
Bupropion - Atypical antidepressant
67
What is the important side effect of Buproprion?
Lowers seizure threshold
68
What can happen if you give a Bipolar person tricyclics?
Precipitate mania
69
What are the 3 structural parts of local anesthetics?
1. Aromatic ring 2. Intermediate Linkage 3. Terminal Amine
70
If there is a big difference between pKa of local anesthetic and physiologic pH, what form will be more common? (uncharged/charged)
Charged
71
The (charged/uncharged) form of a local anesthetic can penetrate membranes
Uncharged
72
Which structural part of a local anesthetic determines lipid solubility and potency?
Aromatic Ring
73
Metabolism of Ester vs Amide Local Anesthetics:
Esters: metabolized by plasma enzymes Amides: Metabolized by hepatic P450 enzymes
74
How and where do local anesthetics bind intracellularly?
- Reversibly | - Intracellular portion of Na channel
75
High risk for CNS toxicity from which 2 Local Anesthetics?
Bupivacaine, Ropivacaine
76
Which requires higher dose of Local Anesthetics: CNS or Cardio toxicity
Cardiotoxicity
77
What is Transient Neurological Syndrome and which local anesthetics can cause it?
- Severe transient pain from local anesthetic use in spinal anesthesia - Lidocaine, Procain, Mepivacaine
78
Which group (ester or amide) of local anesthetics have high allergic reaction rates?
Esters -- PABA metabolites = known allergen
79
Which nerve fibers are first to be blocked by local anesthetics?
- B and A delta | - Generally: smaller, myelinated nerves blocked first
80
What are toxic side effects of Na+ channel blockers? | What is a side effect?
Toxicity = Dizzy, drunk, double vision | Side effect = 15% have rash, rare Steven Johnson syndrome
81
What is a contraindication for Valproate? Why?
Pregnancy -- 4-8% Teratogenic
82
What drugs can be given for status epilepticus?
IV: Phenytoin, Lorazepam, Diazepam, Valproate
83
Absence seizure. | What drug? Mechanism?
Ethosuxamide | - T-type thalamus Ca++ channel blocker
84
Mechanisms for Anti-epileptics:
1. Voltage-gated Na+ channel blockers 2. Voltage-gated Ca++ channel blockers 3. Glutamate receptor blockers 4. GABA system agonists
85
Difference between Felbamate and Topiramate
``` Felbamate = NMDA blocker Topiramate = AMPA and Kainate receptor blocker ```
86
Difference between toxicity and side effect
Toxicity: Unwanted effect of drug Side effect: unexpected effect, not related to mechanism of action
87
Which anti-epileptic exhibits no metabolism?
Gabapentin
88
What drug has synergistic action/competes with valproic acid
Lamotrigine
89
Antiepileptic drug with "word finding" problem toxicity
Topiramate
90
What is the Meyer-Overton Rule?
Potency of anesthetic gases directly related to their solubility in olive oil
91
What is the gold standard drug for maintenance of general anesthesia?
Isoflurane

MQW U3 (11 decks)

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