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Clinical Neuro General > Pharm Exam 1 > Flashcards

Pharm Exam 1 Flashcards

1
Q

What is the function of Cholinergic agents in dealing with Glaucoma?

A
  • Open-angle glaucoma: contraction of ciliary muscles leading to increase flow through the intertribecular spaces
  • Closed Angle Glaucoma: contraction of the sphincter muscles increases the angle between the sclera and the iris
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2
Q

What are some example of cholinergic agents?

A

-Carbachol,, pilocarpine, echothiophate

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3
Q

What are some adverse reactions of carbachol, pilocarpine, physostigmine, and ecothiophate?

A
  • Carbachol- over stimulation of nicotinic receptors
  • Pilocarpine - HTN and tachycardia
  • Physostigmine- (can cross the BBB) seizures and abnormal defecation
  • Ecothiophate- night blindness and frontal headache
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4
Q

What are the action of Beta adrenergic blockers in glaucoma?

A
  • They interact with ciliary epithelium to decrease production of aqueous humor. No effect on outflow.
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5
Q

What are some examples of beta blockers used in chronic open-angle gluacoma?

A

Timolol, carteolol, betaxolol

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6
Q

What are the adverse effects of Timolol, Carteolol, Betaxolol?

A
  • Timolol: blurred vision, dry eyes, hallucination
  • Carteolol: insomnia, bronchospasm
  • Betaxolol: MI, AV block
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7
Q

What is the mechanism of action of Prostaglandin analogs in open-angle glaucoma and intraocular hypertension?

A
  • increase the outflow of the uveoscleral aqueous humor (latanoprost) as well as the outflow through the trabecular meshwork (bimatoprost)
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8
Q

Name the Prostaglandin analogs used in intraocular hypertension and open-angle glaucoma?

A
  • Latanoprost, bimatoprost, travoprost

“-prost”

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9
Q

What are some adverse effects of prostaglandin analogs?

A
  • darkens color of the iris
  • macular retinal edema
  • conjunctival hyperemia (bimatoprost, travoprost)
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10
Q

What is the mechanism of action of carbonic anhydrase inhibitors in the treatment of intraocular hypertension and open-angle glaucoma?

A
  • Decrease aqueous humor production

- No effect on pupils or vision

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11
Q

What are carbonic anhydrase inhibitors?

A
  • Acetazolamide, brinzolamide, dorzolamide

“-amide”

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12
Q

What are the adverse effects of carbonic anhydrase inhibitors?

A
  • Metabolic acidosis **
  • Urolithiasis - high pH in urine
  • electrolyte imbalance (acetazolamide)
  • Agranulocytosis and thrombocytopenia (acetazolamide)
  • Immune hypersensitivity reactions (dorzolamide)
  • Burning sensation in the eye (dorzolamide)
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13
Q

What is the mechanism of action of Alpha-2 selective agonists in treating open-angle glaucoma?

A
  • decrease production and increase outflow of aqueous humor

- Brimonidine - decreases aqueous humor production increase uveoscleral outflow

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14
Q

What drugs are alpha-2 selective agonists?

A
  • Apraclonidine and brimonidine
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15
Q

What are the adverse effects that might result from use of alpha-2 selective agonists?

A
  • irregular heart rate, fatigue, dry mouth, red, itchy, or swollen eyes
  • Depression, dizziness, and chest pain with apreaclonidine
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16
Q

What is the mechanism of action of epinephrine?

A
  • decreases aqueous humor production due to vasoconstriction and decrease blood flow to ciliary bodies.
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17
Q

What is the mechanism of action of dipivefrin?

A

a prodrug that is hydrolyzed to epinephrine within the eye.

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18
Q

What are adverse effects of dipivefrin and epinephrine?

A
  • dipivefrin - burning sensation in the eye, follicular conjunctiva
  • epinephrine- mydriasis, stinging, not to be used in closed-angle glaucoma
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19
Q

What is the serotonin theory?

A

Increases in urine 5-IAA levels and decrease in plasma serotonin levels–> most anti-migraine drugs are either serotonin agonist or antagonist.
- reserpine or fenfluramine causes an increase risk of attack

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20
Q

What is the mechanism of action of NSAIDS?

A
  • Decrease the pain threshold secondary to decreasing prostaglandin synthesis.
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21
Q

What types of NSAIDS are used for migraine treatment?

A
  • indomethacin,ibuprogen, aspirin, naproxen
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22
Q

What are some side effects of NSAIDS?

A
  • ulcers, GI bleeding, and rebound headaches
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23
Q

What type of migraine and what is the mechanism of action of triptans?

A
  • acute migraine treatment
  • Block the release of pro-inflammatory neurotransmitters within the perivascular space in the vicinity of the trigeminal nerve.
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24
Q

What are the triptans that we need to know.

A
  • anything with “-triptan”

- Sumatriptan, rizatriptan, naratriptan, almotriptan, frovatriptan, electriptan, and zolmitriptan.

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25
Q

What is contraindicated with Triptan use?

A
  • concurrent ergot alkaloids use,
  • coronary artery disease, ischemic disease
  • MAO inhibitors use
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26
Q

What are the side effects of Triptan use?

A
  • asthenia, fatigue, pain in neck, chest of jaw
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27
Q

What is different about second generation triptans and what are they?

A
  • low adverse effect profile and faster onset of actions

- natratriptan, zolmitriptan, electriptan, almotriptan, rizatriptan, and frovatriptan

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28
Q

What is the mechanism of action of Opoids?

A
  • decrease pain sensation secondary to agonist effects at U, K, and delta receptors
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29
Q

What is a type of opoid used for migrane?

A
  • codeine
30
Q

What type of migrane is acetaminophen used on and what can be done to make it stronger?

A
  • headache - especially when aspirin is contraindicated. Only viable action during pregnancy.
  • for moderate headache combine with isometheptene and dichlorophenazone
  • for severe headaches combine with butalbital
31
Q

When is butorphanol used and what is it’s MOA and adverse effect?

A
  • intranasal spray for migraines
  • MOA: partial agonist u and k
  • AE: sedation confusion, and dizziness
32
Q

When and how is meperidine used?

A
  • Meperidine is used for SEVERE migraine pain and it is administered via IV
33
Q

What is oxycodone and hydrocondone used and what is the main concern?

A
  • used for severe pain, but addiction liability is worrisome
34
Q

What is Metoclopramide used, what is its AE?

A
  • Used in combination for migraines

- AE: galactorrhea, constipation, extrapyramidal effects, tardive dykinesia.

35
Q

What are the uses and what are the adverse effects of Chlopromazine and prochlorperazine?

A
  • Clinical uses: anti-emetic, schizophrenia, tourettes’s syndrome, huntington’s chorea and dementia
  • AE: poikilthermic, blurred vision, constipation, agranulocytosis, phototoxicity
36
Q

What is Amidrine?

A

A combo of acetaminophen, dichloralphenazone (analgesic and anti-pyretic), and isometheptene (vasoconstrictor)

37
Q

What drugs are considered for migraine prophylaxis?

A
  • Propranolol, pizotifen, tricyclic anti-depressants ( amitriptyline, dothiepin, and nortriptyline), Topiramate, Valproic acid, Gabapentin, Methysergide.
38
Q

What is propranolol used for, what is its MOA, what are the Adverse effects, and what are the contraindication?

A
  • Migraine prophylaxis, hypertension,
  • MOA: B-blocker
  • AE: bronchospasm, AT block, postural sym, sedation
  • Contraindicated: asthmatic patients
39
Q

What is the clinical uses of Pizotifen, AE, Contraindication?

A
  • Clinical uses: RECURRENT migraine headaches, or when beta blockers are contraindicated
  • Adverse effects: weight gain, antidepressants, anti-muscarinic effects
  • Contra: MAO inhibitors use
40
Q

What are the clinical uses of tricyclic anti-depressants (amitriptyline, dothiepin, and nortriptyline), what are the adverse effects, contraindication?

A
  • uses: migrain prophylaxis
  • AE: AV bundle branch block
  • may precipitate mania in patients with bipolar
41
Q

What is the clinical uses of Topiramate, what are its adverse effects?

A
  • migraine prophylaxis, generalized tonic clonic, and partial seizures
  • AE: p450 inducer therefore metabolism is induced by carbamazepine and phenytoin
  • MOA: blocks Na+ channels and enhances GABA transmission
42
Q

What is clinical uses of Valproic acid, MOA, AE?

A
  • uses migraine prophylaxis, and generalized and absence seizures
  • MOA: stabilizes Na+ channels in the inactive state and inhibits low-threshold T-type Ca2+ thereby increasing GABA transmission.
  • AE: Drowsiness, weight gain, bone marrow depression
43
Q

What is the clinical uses of Gabapentin, MOA, and AE?

A
  • Uses: migraine prophylaxis, partial seizures
  • MOA: analoge of GABA
  • AE: dizziness, sedations, and peripheral edema
44
Q

What is the clinical uses of Methysergide, MOA, AE?

A
  • Uses: highly effective migraine prophylaxis, used for severe refractory migraines or cluster headaches
  • MOA: Serotonin antagonists
  • AE: retroperitoneal fibrosis, fibrosis of heart valves, and pleura
45
Q

What are the functions of the mu receptor?

A
  • Supraspinal and spinal analgesia

- Sedation and inhibition

46
Q

What are the function of the delta receptor?

A
  • Supraspinal and spinal analgesia, modulation of hormones and neurotransmitter release
47
Q

What are the functions of the kappa receptor?

A
  • Psychomimetic effects, supraspinal and spinal analgesia
48
Q

Where and what does Codeine get metabolized into?

What is a more potent widely used derivative of morphine?

A
  • Codein hepatic de-amination to morphine

- Hydromorphone

49
Q

When is morphine used and what is a possible AE of methadone?

A
  • Long plasma half-life used mostly for chronic pain in terminally ill cancer patients.
  • AE: respiratory depression
50
Q

What are the uses and possible AE of Meperidine?

A
  • uses: analgesic efficacy - less potent though.
  • AE: seizures,
  • causes mydriasis (dilation) rather then miosis (constriction) as seen in opiods
51
Q

What is the uses of butorphanol?

A
  • agonist at K and partial agonist at u
  • analgesia with milder euphoria
  • treat opioid addiction, maintenance of anesthesia, labor pain
52
Q

What is the uses of Buprenorphine?

A
  • Pain, chronic
53
Q

What is the use of Nalbuphine? What is the AE?

A
  • effective analgesic, pre-op, post-op, obstetrical analgesia,
    AE- Depression
54
Q

What is an antidote for opioid intoxication due to its antagonist effects at mu receptors and K receptors?

A

-Naloxone

55
Q

What is naltrexone used for?

A

A pure competitive antagonist that is used for opioid dependence and specifically alcohol withdrawal.

56
Q

What type of signaling is partially mediated when achieving tolerance with opioids?

A

-NMDA signaling

57
Q

What effects can occur with the increased opioid usage?

A
  • REspiratory depression (decreased sensitivity of chemo-sensitive neurons to pCO2)
  • GI disturbances: inc tone of pyloric sphincter and decreased peristaltic movement
  • Miosis
  • Nausea and vomiting
  • Hypotension and bradycardia- impairment of sympathetic compensatory responses
58
Q

What are 3 drugs that you can give for treatment of chronic pain not responsive to opioids?

A
  • Amitriptyline, nortriptyline, and imipramine
59
Q

What are 2 NMDA receptor antagonists that you can give for pain?

A

-Ketamine (acute severe pain) and dexamethorphan (chronic pain and post-op)

60
Q

What are adrenergic agonists?

A
  • Clonidine, Gabapentin, pregabalin, lamotrigine, carbamazepine
61
Q

What types of pain does clonidine treat?

A
  • Acute and chronic pain
62
Q

What type of pain does Gabapentin treat?

A

Chronic and post-op pain.

63
Q

What are the uses of pregabalin and what is the MOA?

A
  • neuropathic pain, fibromyalgia, and spinal cord injury

- GABA analog, more potent, faster, and predictable than gabapentin

64
Q

What is Lamotrigine used for?

A
  • Trigeminal neuralgia and neuropathic pain.

- AE: skin reaction

65
Q

What is carbamazepine used for and what is its MOA?

A
  • trigeminal neuralgia

- Na+ channel blocker

66
Q

What are the different types of dementia?

A
  • Alzheimer’s dementia
  • Vascular dementia
  • Lewy body dementia
  • Frontal temporal dementia
  • HIV- associated dementia
67
Q

What drugs class would you use for depression associated with Alzheimer’s Disease?

A
  • SSRI’s (sertraline, fluoxetine)

- Tricyclic antidepressants (caution)

68
Q

What medications would you use to treat hallucinations associated with Alzheimer’s Disease?

A
  • Quetiapine, olanzepine, risperidone
69
Q

What drug is the most popular to treat delusions associated with alzheimer’s disease?

A
  • Haloperidol
70
Q

What 3 Cholinesterase inhibitors would you use to treat Alzheimer’s Dementia?

A
  • Donepezil, Rivastigmine, Galatamine
71
Q

What are some characteristics of Donepezil?

What AE might appear?

A
  • long plasma half-life, lower affinity for peripheral cholinesterase (less secondary side effect)
    AE: cholinergic side effects (diarrhea, nausea, and vomiting)
72
Q

What must you administer Rivastigmine with?

What are possible AE?

A
  • Must be administered with food

- significant nausea vomiting, headaches, anorexia.

Clinical Neuro General (3 decks)

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