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Dr. Omar's Deck of Secret Knowledge > Pharm: CNS Drugs > Flashcards

Pharm: CNS Drugs Flashcards

1
Q

Long acting benzodiazepines preferred in treating alcohol withdrawal

A

Diazepam

Chlordiazepoxide

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2
Q

Triad of Wernicke-Korsakoff syndrome

A

Ataxia
Confusion
Paralysis of extra ocular muscles

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3
Q

Alcohol blood level associated with:

  1. Impairment of driving ability
  2. Gross drunkenness
  3. Loss of consciousness, coma
  4. Death
A
  1. 60-80 mg/dL
  2. 120-160
  3. 300
  4. 500
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4
Q

Drinking antifreeze leads to severe acidosis and renal damage.

  1. What is in antifreeze?
  2. What is its toxic metabolite?
  3. Initial treatment?
A
  1. Ethylene glycol
  2. Oxalic acid
  3. Fomepizole, ethanol
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5
Q

Inhibitors of aldehyde dehydrogenase

A

Disulfiram
Metronidazole
Oral hypoglycemics
Cephalosporins (some)

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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

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7
Q

Most anti seizure drugs are metabolized by hepatic enzymes except:

A

Gabapentin
Vigabatrin
Levetiracetam
Pregabalin

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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.

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9
Q

Drugs of choice for generalized tonic-clonic seizures

A

Valproic acid
Carbamazepine
Phenytoin

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10
Q

Drugs of choice for partial seizures

A

Phenytoin
Carbamazepine
Lamotrigine

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11
Q

Drugs of choice for absence seizures

A

Ethosuximide

VPA

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12
Q

This antiseizure drug is also a first line drug in the treatment of mania

A

VPA

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13
Q

Drug of choice for trigeminal neuralgia; also an antiseizure drug

A

Carbamazepine

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14
Q

What are the MOAs of inhaled anesthetics?

A
  1. Facilitate GABA-mediated inhibition
  2. Block brain NMDA receptors
  3. Block brain ACh-N receptors
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15
Q

What sedative hypnotic may cause acute intermittent porphyria?

A

Barbiturates

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16
Q

What NMDA glutamate receptor antagonist is used in the treatment of alcoholism?

A

Acamprosate

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17
Q

What opioid receptor antagonist is used in the treatment of alcoholism?

A

Naltrexone

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18
Q

Name two drugs used in the treatment of alcoholism

A

Naltrexone (opioid antagonist)

Acamprosate (NMDA antagonist)

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19
Q

Name two drugs used in smoking cessation.

A

Varenicline (partial agonist at Nicotinic acetylcholine receptor)
Rimonabant (cannabinoid receptor agonist)

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20
Q

Sedative with the highest lipid solubility.

A

Thiopental

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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

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22
Q

Benzodiazepine used in treating bipolar disorder

A

Clonazepam

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23
Q

Hematologic complication of barbiturates (e.g. thiopental, pentobarbital, phenobarbital)

A

Acute intermittent porphyria

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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

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25
Q

Mechanism of ethanol tolerance

A

Primarily CNS adaptation but also…

Induction of cytochrome p450 enzyme synthesis and increased MEOS activity (MEOS is active at BAL > 100 mg/dl)

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26
Q

Most common neurologic effect of alcohol

A

Peripheral neuropathy

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27
Q

Chronic alcoholism predisposes to infectious pneumonia, what is the usual causative agent?

A

K. Pneumoniae

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28
Q

Scale used to monitor/assess delirium tremens?

A

CIWA scale

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29
Q

Antiseizure drug contraindicated in psychotics as it worsens psychosis.

A

Leviteracetam

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30
Q

Antiepileptic that blocks GABA reuptake by inhibiting the GAT-1 transporter?

A

Tiagabine

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31
Q

Antiseizure drug known to have cause fetal hydantoin syndrome. What are the features of this disease?

A 
Phenytoin.
Fetal hydantoin syndrome:
Upturned nose
Mild facial hypoplasia
Long upper lip with thin vermillion border
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32
Q

Antiseizure drug that only affects calcium channels (T-type) in the thalamus

A

Ethosuximide

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33
Q

Drug that blocks glutamate NMDA receptors.

A

Felbamate

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34
Q

Worst side effects of felbamate

A

Aplastic anemia, hepatic failure

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35
Q

Long acting benzodiazepine commonly used as a date rape drug

A

Flunitrazepam

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36
Q

Benzodiazepines used in sleeping disorders

A

Estazolam, flurazepam, triazolam

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37
Q

MOA of ramelteon

A

Activates melatonin receptors in the suprachiasmatic nuclei of the CNS decreasing the latency of sleep onset.

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38
Q

Fixed capacity rate for ethanol metabolism

A

7-10 g / hour

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39
Q

BAL of this level is usually lethal

A

500mg/dL

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40
Q

What changes in the brain are seen in Wernicke-Korsakoff syndrome

A

hemorrhagic necrosis of the mamillary bodies

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41
Q

Inhibits alcohol dehydrogenase

A

fomepizole

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42
Q

Treatment of excessive CNS depression due to alcohol

A

Thiamine administration before IV dextrose

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43
Q

Treatment of Alcohol withdrawal syndrome if with compromised liver function

A

short acting benzodiazepines (e.g. lorazepam)

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44
Q

Water soluble form of Phenytoin

A

Fosphenytoin

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45
Q

Tricyclic antidepressant used in treating GTCS and tic doloreaux

A

Carbamazepine

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46
Q

What anti-seizure drugs are excreted by the kidney unchanged

A

Gabapentin, pregabalin, vigabatrin, leviteracetam

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47
Q

Anti-epileptic that irreversibly inhibits GABA-transaminase

A

Vigabatrin

48
Q

What are the 4 stages of anesthesia?

A

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
Q

What makes Nitrous oxide an incomplete anesthetic?

A

no muscle relaxant component

50
Q

Inhaled anesthetic with the lowest partition coefficient

A

Desflurane

51
Q

Inhaled anesthetic that causes myocardial depression

A

Enflurane and halothan

52
Q

Inhaled anesthetic that causes peripheral vasodilation

A

Isoflurane, desflurane, and sevoflurane

53
Q

Inhaled anesthetics that sensitive myocardium to arrhythmogenic effects of myocardium

A

Halothane and isoflurane

54
Q

Severe side effects of halothane that prompts its disuse in anesthesia

A

Postoperative hepatitis
Myocardial depression
Cathecolamine Arryhthmogenicity
Additive CNS depression

55
Q

IV anesthetic that causes dissociative amnesia

A

Ketamine

Dissociative anesthesia: conscious but with marked catatonia, analgesia, and amnesia.
Also causes emergence delirium

56
Q

What combination of anesthetics induce Neurolepthanesia?

A

fentanyl + droperidol and nitrous oxide

57
Q

Local anesthetic with the shortest half life

A

Procaine

1-2 min

58
Q

Local anesthetic with the longest half life

A

Ropivacaine

4.2 hours

59
Q

All local anesthetics are vasodilators EXCEPT

60
Q

Treatment of cardiotoxicity due to bupivacaine

A

Intralipid

61
Q

What drug is known to cause severe post-operative respiratory depression?

62
Q

Mnemonic to help distinguish made from ester LA.

A

Esters have one i: tetracaine, procaine, etc

Amides have two i’s: bupivacaine, lidocaine, etc

63
Q

Expected BP in a patient given propofol during induction.

A

Marked hypotension via decreased peripheral resistance

64
Q

Nondepolarizing drug with the most rapid onset

A

Rocuronium (60-120s)

65
Q

Phases of Depolarizing blocks

A

Phase 1: depolarization

Phase 2: desensitization

66
Q

Pathophysiology of malignant hyperthermia

A

massive calcium release from the sarcoplasmic reticulum of skeletal muscles

Earliest clinical sign: trismus
Earliest finding: Inc. end tidal CO2 volume

67
Q

Drugs used in lethal injection

A

Thiopental 5g
Pancuronium 100mg
KCl 100 mEq

68
Q

Main drug used for acute muscle spasm

A

Cyclobenzaprine

69
Q 
Which of the following is not a spasmolytic?
Diazepam
Baclofen
Tizanidine
Dantrolene
Botulinum
Gabapentin
Pregabalin
A

All are spasmolytics

70
Q

Why is carbidopa given with L-dopa?

A

To prevent peripheral (carbidopa does not cross BBB) conversion of L-dopa to Dopa by DOPA carboxylase.

71
Q

COMT inhibitor in the CNS? Periphery?

A

CNS: Tolcapone
Periphery: Entecapone

72
Q

Muscle relaxant that can be an antidote to strychnine poisoning

A

Pancuronium

73
Q

Causes of drug-induced parkinsonism

A

Typical antipsychotics
Reserpine
MPTP (meperidine analog)

74
Q

Parkinsonian phenomenon with alternating periods of improved mobility and akinesia occurring over a few days to weeks

A

On - Off Phenomenon

Tx: apomorphine

75
Q

Parkinsonian phenomenon with deterioration of drug effect in between doses

A

Wearing off Phenomenon

Tx: Entecapone

76
Q

MAOIs that inhibit MAO-B thereby preventing dopamine from being metabolized

A

Selegiline and rasagiline

77
Q

What Antiparkinsonian drug causes livedo reticularis?

A 
Amantadine
Others:
Hydroxyurea
Minocycline
Gemcitabine
Quinidine
78
Q

Treatment for tremors caused by SABA, TCA, Lithium

A

propanolol

79
Q

Treatment for essential tremors

A

Gabapentin, topiramate

Botox

80
Q

Treatment for movement disorder secondary to Huntington’s Disease

A

Reserpine, haloperidol

81
Q

Treatment for movement disorder due to tourette’s syndrome

A

Haloperidol

82
Q

Treatment for Movement disorder due to Wilson’s disease

A

penicillamine

83
Q

Treatment for restless leg syndrome

A

Ropinirole

84
Q

Typical antipsychotics act on what receptor

A

D2 receptor

85
Q

Atypical Antipsychotics act on what receptor

A

5-HT2 receptor

86
Q

Blockade of D2 receptors frequently result in these symptoms

A

Extrapyramidal symptoms

seen especially in fluphenazine

87
Q

Only antipsychotic that significantly reduces the risk of suicide

A

Clozapine

SE: Increased risk of agranulocytosis, and seizures

88
Q

Only antipsychotic approved for use in young patients

A

Risperidone

89
Q

Least sedating atypical antipsychotic
Also used for treating acute mania
Little or no tendency to cause weight gain

A

Aripiprazole

90
Q

Compared to Typical antipsychotics, patients on atypical antipsychotics experience 2 symptoms less severely

A

Extrapyramidal symptoms and Hyperprolactinemia

91
Q

Atypical antipsychotics that cause prolonged QT

A

Quetiapine and ziprasidone

92
Q

Primary mood stabilizer in bi-polar disorder

A

Lithium

SE: tremor, sedation, Nephrogenic DI, bradycardia, teratogen (Ebstein’s anomaly)

93
Q

Antidepressant also used to help in smoking cessation

94
Q

Symptoms of Neuroleptic Malignant Syndrome

Treatment?

A 
FEVER
Fever
Encephalopathy
Vitals unstable
Elevated CPK
Rigidity

Tx: Dantrolene w/ or w/o diphenhydramine

95
Q

Serotonin Syndrome = Serotonin + _________ (5 drugs in all)

Treatment?

A

MAOIs, TCAs, Meperidine, MDMA, St. John’s Wort

Tx: Sedation, intubation, andminsitration of cyproheptadine

96
Q

First line antidepressant

A

SSRI: fluoxetine

97
Q

Antidepressants also used in patients with neuropathic pain and fibromyalgia

A

SNRIs: Venlafaxine, Duloxetine (for DM neuropathy)

98
Q

Antidepressant class useful in patients with phobias, anxiety, and hypochondriasis

A

MAOIs: Phenelzine, Selegiline

99
Q

Signs of Serotonin Syndrome

A 
FAT CHD
Fever
Agitation
Tremor
Clonus
Hyperreflexia
Diaphoresis
100
Q

5-HT2 antagonists that are used in depression

A

Trazodone, Nefazodone
SE: priapism (Tra), hepatotoxicity (Nef)
May cause arrhythmias in patients with cardiac disease

101
Q

Key features in TCA Overdose

A

3 C’s of TCA Overdose
Coma
Cardiotoxicity
Convulsions

TCA toxicity:
Excessive sedation, sympathomimetic effects, atropine like effects, orthostatic hypotension, tremor, weight gain

102
Q

Opioid receptors and their prominent functions

A

mu: inhibition of respiration
delta: development of tolerance
kappa: sedation & with opioids slowed GI transit

103
Q

What are the three endogenous opioids?

A

B-endorphin (mu), enkaphalin (delta), dynorphin (kappa)

104
Q

Full agonists

A

morphine, methadone, meperidine, fentanyl, levorphanol, heroin

105
Q

Systemic antidote for opioid toxicity (except nalbuphine)

106
Q

Partial Agonists

A

Codeine, hydrocodone, oxycodone

107
Q

MOA of tramadol

In what subset of patients is tramadol contraindicated?

A

Weak agonist of the mu receptor, inhibits neuronal reuptake of serotonin and norepinephrine

CI: epileptics because tramadol decreases seizure threshold.

108
Q

Triad of opioid overdose

A

Pupillary constriction, coma, respiratory depression

109
Q

3 etiologies of tolerance

A

metabolic, behavioral, functional

110
Q

Antidote for amphetamine overdose

A

No specific antidote. :p

control body temp, prevent arrhythmias and seizures

111
Q

Effects of chronic amphetamine abuse

A

Necrotizing arteritis, cerebral hemorrhage and renal failure

112
Q

What is a “crack lung”

A

Hemorrhagic alveolitis

113
Q

What is the teratogenic effect of cocaine?

A

cystic cortical lesions

114
Q

What is angel dust?

A

PCP

SE: horizontal and vertical nystagmus, seizures, marked hypertension

115
Q

Side effects of MJs

A

impaired mental concentration, vasodilation, tachycardia, reddened conjunctiva, dry mouth

116
Q

Hallucinogenic that does not cause dependence

117
Q

Which canNOT be antagonized by flumazenil?
Barbiturates
Benzodiazepines
Zolpidem

A

Barbiturates

Dr. Omar's Deck of Secret Knowledge (57 decks)

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