Pharm: CNS Drugs Flashcards
(117 cards)
1
Q
Long acting benzodiazepines preferred in treating alcohol withdrawal
A
Diazepam
Chlordiazepoxide
2
Q
Triad of Wernicke-Korsakoff syndrome
A
Ataxia
Confusion
Paralysis of extra ocular muscles
3
Q
Alcohol blood level associated with:
- Impairment of driving ability
- Gross drunkenness
- Loss of consciousness, coma
- Death
A
- 60-80 mg/dL
- 120-160
- 300
- 500
4
Q
Drinking antifreeze leads to severe acidosis and renal damage.
- What is in antifreeze?
- What is its toxic metabolite?
- Initial treatment?
A
- Ethylene glycol
- Oxalic acid
- Fomepizole, ethanol
5
Q
Inhibitors of aldehyde dehydrogenase
A
Disulfiram
Metronidazole
Oral hypoglycemics
Cephalosporins (some)
6
Q
What are the teratogenic effects caused by
Carbamazepine
Valproic acid
Phenytoin
A
Carbamazepine: cranio facial abnormalities
Valproic acid: NTD
Phenytoin: Fetal hydantoin syndrome
7
Q
Most anti seizure drugs are metabolized by hepatic enzymes except:
A
Gabapentin
Vigabatrin
Levetiracetam
Pregabalin
8
Q
What is the primary action of Gabapentin?
A
Blockade of T-type Ca channels.
It is a structural analog of GABA but does NOT act in receptors directly.
9
Q
Drugs of choice for generalized tonic-clonic seizures
A
Valproic acid
Carbamazepine
Phenytoin
10
Q
Drugs of choice for partial seizures
A
Phenytoin
Carbamazepine
Lamotrigine
11
Q
Drugs of choice for absence seizures
A
Ethosuximide
VPA
12
Q
This antiseizure drug is also a first line drug in the treatment of mania
A
VPA
13
Q
Drug of choice for trigeminal neuralgia; also an antiseizure drug
A
Carbamazepine
14
Q
What are the MOAs of inhaled anesthetics?
A
- Facilitate GABA-mediated inhibition
- Block brain NMDA receptors
- Block brain ACh-N receptors
15
Q
What sedative hypnotic may cause acute intermittent porphyria?
A
Barbiturates
16
Q
What NMDA glutamate receptor antagonist is used in the treatment of alcoholism?
A
Acamprosate
17
Q
What opioid receptor antagonist is used in the treatment of alcoholism?
A
Naltrexone
18
Q
Name two drugs used in the treatment of alcoholism
A
Naltrexone (opioid antagonist)
Acamprosate (NMDA antagonist)
19
Q
Name two drugs used in smoking cessation.
A
Varenicline (partial agonist at Nicotinic acetylcholine receptor)
Rimonabant (cannabinoid receptor agonist)
20
Q
Sedative with the highest lipid solubility.
A
Thiopental
21
Q
What are the drugs used for the treatment of methanol OR ethylene glycol poisoning?
A
Ethanol - competes for oxidation by alcohol dehydrogenase
Fomepizole: slows or prevents oxalic acid formation
22
Q
Benzodiazepine used in treating bipolar disorder
A
Clonazepam
23
Q
Hematologic complication of barbiturates (e.g. thiopental, pentobarbital, phenobarbital)
A
Acute intermittent porphyria
24
Q
Anxiolytic without anticonvulsant activities or muscle relaxant property that has minimal abuse liability and tolerance/withdrawal. Also it does not affect driving skills
A
Buspirone
25
Mechanism of ethanol tolerance
Primarily CNS adaptation but also...
Induction of cytochrome p450 enzyme synthesis and increased MEOS activity (MEOS is active at BAL > 100 mg/dl)
26
Most common neurologic effect of alcohol
Peripheral neuropathy
27
Chronic alcoholism predisposes to infectious pneumonia, what is the usual causative agent?
K. Pneumoniae
28
Scale used to monitor/assess delirium tremens?
CIWA scale
29
Antiseizure drug contraindicated in psychotics as it worsens psychosis.
Leviteracetam
30
Antiepileptic that blocks GABA reuptake by inhibiting the GAT-1 transporter?
Tiagabine
31
Antiseizure drug known to have cause fetal hydantoin syndrome. What are the features of this disease?
```
Phenytoin.
Fetal hydantoin syndrome:
Upturned nose
Mild facial hypoplasia
Long upper lip with thin vermillion border
```
32
Antiseizure drug that only affects calcium channels (T-type) in the thalamus
Ethosuximide
33
Drug that blocks glutamate NMDA receptors.
Felbamate
34
Worst side effects of felbamate
Aplastic anemia, hepatic failure
35
Long acting benzodiazepine commonly used as a date rape drug
Flunitrazepam
36
Benzodiazepines used in sleeping disorders
Estazolam, flurazepam, triazolam
37
MOA of ramelteon
Activates melatonin receptors in the suprachiasmatic nuclei of the CNS decreasing the latency of sleep onset.
38
Fixed capacity rate for ethanol metabolism
7-10 g / hour
39
BAL of this level is usually lethal
500mg/dL
40
What changes in the brain are seen in Wernicke-Korsakoff syndrome
hemorrhagic necrosis of the mamillary bodies
41
Inhibits alcohol dehydrogenase
fomepizole
42
Treatment of excessive CNS depression due to alcohol
Thiamine administration before IV dextrose
43
Treatment of Alcohol withdrawal syndrome if with compromised liver function
short acting benzodiazepines (e.g. lorazepam)
44
Water soluble form of Phenytoin
Fosphenytoin
45
Tricyclic antidepressant used in treating GTCS and tic doloreaux
Carbamazepine
46
What anti-seizure drugs are excreted by the kidney unchanged
Gabapentin, pregabalin, vigabatrin, leviteracetam
47
Anti-epileptic that irreversibly inhibits GABA-transaminase
Vigabatrin
48
What are the 4 stages of anesthesia?
A Dominatrix likes S & M (S is the stage we like)
1: Analgesia: decreased awareness of pain
2: Disinhibition: delirous, amnesia occurs, irregular respiration and enhanced reflexes
3: Surgical anesthesia: patient is unconscious, (-) pain reflexes
4: Medullary depression: severe respiratory and cardiovascular depression requiring mechanical and pharmacologic support
49
What makes Nitrous oxide an incomplete anesthetic?
no muscle relaxant component
50
Inhaled anesthetic with the lowest partition coefficient
Desflurane
51
Inhaled anesthetic that causes myocardial depression
Enflurane and halothan
52
Inhaled anesthetic that causes peripheral vasodilation
Isoflurane, desflurane, and sevoflurane
53
Inhaled anesthetics that sensitive myocardium to arrhythmogenic effects of myocardium
Halothane and isoflurane
54
Severe side effects of halothane that prompts its disuse in anesthesia
Postoperative hepatitis
Myocardial depression
Cathecolamine Arryhthmogenicity
Additive CNS depression
55
IV anesthetic that causes dissociative amnesia
Ketamine
Dissociative anesthesia: conscious but with marked catatonia, analgesia, and amnesia.
Also causes emergence delirium
56
What combination of anesthetics induce Neurolepthanesia?
fentanyl + droperidol and nitrous oxide
57
Local anesthetic with the shortest half life
Procaine
| 1-2 min
58
Local anesthetic with the longest half life
Ropivacaine
| 4.2 hours
59
All local anesthetics are vasodilators EXCEPT
Cocaine
60
Treatment of cardiotoxicity due to bupivacaine
Intralipid
61
What drug is known to cause severe post-operative respiratory depression?
Midazolam
62
Mnemonic to help distinguish made from ester LA.
Esters have one i: tetracaine, procaine, etc
| Amides have two i's: bupivacaine, lidocaine, etc
63
Expected BP in a patient given propofol during induction.
Marked hypotension via decreased peripheral resistance
64
Nondepolarizing drug with the most rapid onset
Rocuronium (60-120s)
65
Phases of Depolarizing blocks
Phase 1: depolarization
| Phase 2: desensitization
66
Pathophysiology of malignant hyperthermia
massive calcium release from the sarcoplasmic reticulum of skeletal muscles
Earliest clinical sign: trismus
Earliest finding: Inc. end tidal CO2 volume
67
Drugs used in lethal injection
Thiopental 5g
Pancuronium 100mg
KCl 100 mEq
68
Main drug used for acute muscle spasm
Cyclobenzaprine
69
```
Which of the following is not a spasmolytic?
Diazepam
Baclofen
Tizanidine
Dantrolene
Botulinum
Gabapentin
Pregabalin
```
All are spasmolytics
70
Why is carbidopa given with L-dopa?
To prevent peripheral (carbidopa does not cross BBB) conversion of L-dopa to Dopa by DOPA carboxylase.
71
COMT inhibitor in the CNS? Periphery?
CNS: Tolcapone
Periphery: Entecapone
72
Muscle relaxant that can be an antidote to strychnine poisoning
Pancuronium
73
Causes of drug-induced parkinsonism
Typical antipsychotics
Reserpine
MPTP (meperidine analog)
74
Parkinsonian phenomenon with alternating periods of improved mobility and akinesia occurring over a few days to weeks
On - Off Phenomenon
| Tx: apomorphine
75
Parkinsonian phenomenon with deterioration of drug effect in between doses
Wearing off Phenomenon
| Tx: Entecapone
76
MAOIs that inhibit MAO-B thereby preventing dopamine from being metabolized
Selegiline and rasagiline
77
What Antiparkinsonian drug causes livedo reticularis?
```
Amantadine
Others:
Hydroxyurea
Minocycline
Gemcitabine
Quinidine
```
78
Treatment for tremors caused by SABA, TCA, Lithium
propanolol
79
Treatment for essential tremors
Gabapentin, topiramate
| Botox
80
Treatment for movement disorder secondary to Huntington's Disease
Reserpine, haloperidol
81
Treatment for movement disorder due to tourette's syndrome
Haloperidol
82
Treatment for Movement disorder due to Wilson's disease
penicillamine
83
Treatment for restless leg syndrome
Ropinirole
84
Typical antipsychotics act on what receptor
D2 receptor
85
Atypical Antipsychotics act on what receptor
5-HT2 receptor
86
Blockade of D2 receptors frequently result in these symptoms
Extrapyramidal symptoms
| seen especially in fluphenazine
87
Only antipsychotic that significantly reduces the risk of suicide
Clozapine
| SE: Increased risk of agranulocytosis, and seizures
88
Only antipsychotic approved for use in young patients
Risperidone
89
Least sedating atypical antipsychotic
Also used for treating acute mania
Little or no tendency to cause weight gain
Aripiprazole
90
Compared to Typical antipsychotics, patients on atypical antipsychotics experience 2 symptoms less severely
Extrapyramidal symptoms and Hyperprolactinemia
91
Atypical antipsychotics that cause prolonged QT
Quetiapine and ziprasidone
92
Primary mood stabilizer in bi-polar disorder
Lithium
| SE: tremor, sedation, Nephrogenic DI, bradycardia, teratogen (Ebstein's anomaly)
93
Antidepressant also used to help in smoking cessation
Bupropion
94
Symptoms of Neuroleptic Malignant Syndrome
| Treatment?
```
FEVER
Fever
Encephalopathy
Vitals unstable
Elevated CPK
Rigidity
```
Tx: Dantrolene w/ or w/o diphenhydramine
95
Serotonin Syndrome = Serotonin + _________ (5 drugs in all)
| Treatment?
MAOIs, TCAs, Meperidine, MDMA, St. John's Wort
| Tx: Sedation, intubation, andminsitration of cyproheptadine
96
First line antidepressant
SSRI: fluoxetine
97
Antidepressants also used in patients with neuropathic pain and fibromyalgia
SNRIs: Venlafaxine, Duloxetine (for DM neuropathy)
98
Antidepressant class useful in patients with phobias, anxiety, and hypochondriasis
MAOIs: Phenelzine, Selegiline
99
Signs of Serotonin Syndrome
```
FAT CHD
Fever
Agitation
Tremor
Clonus
Hyperreflexia
Diaphoresis
```
100
5-HT2 antagonists that are used in depression
Trazodone, Nefazodone
SE: priapism (Tra), hepatotoxicity (Nef)
May cause arrhythmias in patients with cardiac disease
101
Key features in TCA Overdose
3 C's of TCA Overdose
Coma
Cardiotoxicity
Convulsions
TCA toxicity:
Excessive sedation, sympathomimetic effects, atropine like effects, orthostatic hypotension, tremor, weight gain
102
Opioid receptors and their prominent functions
mu: inhibition of respiration
delta: development of tolerance
kappa: sedation & with opioids slowed GI transit
103
What are the three endogenous opioids?
B-endorphin (mu), enkaphalin (delta), dynorphin (kappa)
104
Full agonists
morphine, methadone, meperidine, fentanyl, levorphanol, heroin
105
Systemic antidote for opioid toxicity (except nalbuphine)
Naloxone
106
Partial Agonists
Codeine, hydrocodone, oxycodone
107
MOA of tramadol
| In what subset of patients is tramadol contraindicated?
Weak agonist of the mu receptor, inhibits neuronal reuptake of serotonin and norepinephrine
CI: epileptics because tramadol decreases seizure threshold.
108
Triad of opioid overdose
Pupillary constriction, coma, respiratory depression
109
3 etiologies of tolerance
metabolic, behavioral, functional
110
Antidote for amphetamine overdose
No specific antidote. :p
| control body temp, prevent arrhythmias and seizures
111
Effects of chronic amphetamine abuse
Necrotizing arteritis, cerebral hemorrhage and renal failure
112
What is a "crack lung"
Hemorrhagic alveolitis
113
What is the teratogenic effect of cocaine?
cystic cortical lesions
114
What is angel dust?
PCP
| SE: horizontal and vertical nystagmus, seizures, marked hypertension
115
Side effects of MJs
impaired mental concentration, vasodilation, tachycardia, reddened conjunctiva, dry mouth
116
Hallucinogenic that does not cause dependence
LSD
117
Which canNOT be antagonized by flumazenil?
Barbiturates
Benzodiazepines
Zolpidem
Barbiturates
