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MSII Unit 3 > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What is the AED that binds to a synaptic vesicle protein SV2A, which is involved in pre-synaptic neurotransmitter release?

A

Levetiracetam (broad spectrum)

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2
Q

What is the AED that blocks low-threshold T-type Ca2+ channels?

A

Ethosuximide (only for generalized onset seizures)

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3
Q

Which AED is an AMPA antagonist?

A

Perampanel

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4
Q

Which AEDs are broad spectrum and work in both focal or generalized onset seizures? (5)

A
  1. Phenobarbital
  2. Valproic acid
  3. Lamotrigine
  4. Topiramate
  5. Levetiracetam
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5
Q

Which AED only works in generalized onset seizures?

A

Ethosuximide

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6
Q

Which AEDs work only in focal onset seizures? (2)

A
  1. Carbamazepine

2. Oxcarbamazepine

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7
Q

Which AED is associated with highest rate of teratogenicity among antiepileptic medications?

A 
Valproic acid (broad spectrum)
Increases synaptic GABA

Also associated with weight gain

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8
Q

Which AED is associated with a hypersensitivity causing mild maculopapular or erythematous rash? What is this rash called?

A

Lamotrigine is the most likely AED to cause Stevens-Johnson syndrome

Lamotrigine is broad specturm Na+ channel blocker

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9
Q

Which AED is most likely to cause renal stones due to inhibition of carbonic anhydrase?

A 
Topiramate (broad spectrum)
Several MOA:
Na+ channel blocker
Glutamate receptor blocker
Enhances GABA-A receptor activity
Reduces L-type, high voltage activated Ca2+ channel activity
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10
Q

Which AED is associated with adverse side effects of behavior and mood changes such as agitation, anxiety, depression, and acute psychosis?

A

Levetiracetam (broad spectrum)

Binds to SV2A (synaptic vesicle protein) which is involved in presynaptic neurotransmitter reslease

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11
Q

With what drug does Valproic acid have a significant reaction with? What is the reaction?

A

Valproic acid (broad specturm, GABA) interacts with Lamotrigine (broad spectrum, Na+ channel) by increasing its metabolism and therefore increasing the amount of Lamotrigine in the blood. If patient is on both, need to watch levels of Lamotrigine b/c you might need to lower thier dosage

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12
Q

Which two AEDs have no significant drug interactions? What are their MOA?

A

Lacosamide (focal, Na+ channel)

Levetiracetam (broad spectrum, SV2A)-excreted renally, no hepatic metabolism

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13
Q

What is the MOA of ethosuximide?

A

blocks T-type Ca2+ channels in thalamo-cortical circuits

ONLY GENERALIZED ONSET AED

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14
Q

Which AED follows zero order kinetics, and why is that important?

A

Phenytoin (focal, prolongs inactivation of Na+ channels)
Zero order kinetics- non-linear pharmacokinetics meaning that at certain doses, a very small increase in dose may cause a very large increase in drug concentration in the blood, must be careful

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15
Q

What are the 4 direct acting muscarinic cholinomimetic drugs and the 1 direct acting nicotinic drug ?

A

Muscarinic

  1. Bethanechol
  2. Muscarine
  3. Pilocarpine
  4. Cevimeline

Nicotinic
1. Nicotine

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16
Q

Which direct acting muscarinic cholinomimetic drug is used for post-operative and neurogenic ileus and urinary retention?

A

Bethanechol-muscarinic
Recall that bowel and bladder smooth muscle is ACh-innervated

Remember that neostigmine is the indirect acting AChE inhibitor used for post op and neurogenic ileus and urinary retention

Side effects: SLUDGE

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17
Q

Which direct acting muscarinic cholinomimetic drug is used for glaucoma? Side effects?

A

Pilocarpine (muscarinic)
ACh activates sphincter and ciliary muscles of eye
Remember that physistigmine is the short acting and echothiophate is the long acting indirect acting AChE inhibitor used for glaucoma

Side effects: SLUDGE

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18
Q

Which direct acting muscarinic cholinomimetic drug is used for dry mouth (e.g. Sjogren’s) via increased salivation? Side effects?

A

Cevimeline (muscarinic)

Side effects: SLUDGE

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19
Q

Which direct acting nicotinic cholinomimetic drug is used for smoking cessation to reduce cravings?

A

Nicotine (nicotinic)

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20
Q

What side effects are included in SLUDGE?

A 
S: salivation
L: lacrimation
U: Urination
D: Defecation
G: GI distress
E: Emesis

All of these effects can be blocked by atropine

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21
Q

What are the 7 indirect acting AChE inhihbitors and 1 AChE regenerator?

A

AChE inhibitors

  1. Neostigmine
  2. Physostigmine
  3. Donepezil
  4. Edrophonium
  5. Echothiophate
  6. Sarin
  7. Parathion

AChE regenerator:
1. Pralidoxime

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22
Q

Which indirect acting AChE inhibitor is used for post operative and neurogenic ileus, urinary retention, myasthenia gravis, and reversal of neuromuscular blockade?
Side effects?

A

Neostigmine
Remember that bethanechol is the direct acting muscarinic cholinomimetic used for post op and neurogenic ileus and urinary retention

SE: SLUDGE and general increase in cholinergic neurotransmission; paralysis

23
Q

Which indirect acting AChE inhibitor is used for Glaucoma?
Short acting?
Long acting?
Side effects?

A

Physostigmine (short acting)
Echothiophate (long acting)
Remember that pilocarpine is the direct acting muscarinic cholinomimetic used for glaucoma

SE: SLUDGE and general increase in cholinergic neurotransmission; paralysis

24
Q

Which indirect acting AChE inhibitor is used for Alzheimers? Side effects?

A

Donepezil
Amplifies endogenous ACh in brain

SE: SLUDGE and general increase in cholinergic neurotransmission; paralysis

25
Q

Which indirect acting AChE inhibitor is used for differentiating Myasthenia Gravis?
Side effects?

A

Edrophonium

SE: SLUDGE and general increase in cholinergic neurotransmission; paralysis

26
Q

Which strong nucleophile that regenerates phosphorylated AChE is used to reverse poisoning by nerve gas?

A

Pralidoxime

also found in insecticide

27
Q

What is the name of the very volatile nerve gas that functions as an AChE inhibitor?

A

Sarin
to treat someone with sarin gas poisoning, administer pralidoxime

SE: SLUDGE and general increase in cholinergic neurotransmission; paralysis

28
Q

Which indirect acting AChE inhibitor is used as an insecticide and may cause death?

A

parathoin

SE: SLUDGE and general increase in cholinergic neurotransmission; paralysis

29
Q

Which 2 muscarinic antagonist drugs (blocks muscarinic receptors), affect the eye, causing mydriasis and cycloplegia?

A

Atropine and tropicamide (rapidly metabolizes)

30
Q

Which muscarinic antagonist drug (blocks muscarinic receptors) is used to prevent or reduce motion sickness?

A

Scopolamine

31
Q

Which muscarinic antagonist drug (blocks muscarinic receptors) is used to treat transient cystitis; post operative bladder spasms and incontinence (overactive bladder)?

A

Tolterodine

32
Q

Which muscarinic antagonist drug (blocks muscarinic receptors) is used to treat gastric hypermotility?

A

Glycopyrrolate

33
Q

Which 2 muscarinic antagonist drugs (blocks muscarinic receptors) causes bronchodilation in asthma or COPD? Which are longer acting?

A

Ipratropium (short acting)

Tiotropium (longer acting)

34
Q

Which 2 ganglionic receptor blocking (Nn) drugs are used for hypertensive crisis and bloodless field surgery?

A

Hexamethonium

Mecamylamine

35
Q

What depolarizing blocker causes overstimulation of the nicotinic receptor, leading to desensitization of the muscle unit to further ACh stimulation?

A

Succinylcholine

This is used for brief procedures like tracheal intubation and resetting dislocated joints

36
Q

Which two non-depolarizing blockers work by blocking nicotinic (Nm) receptors and is used as a muscle relaxant for surgery w/o deep anesthesia?

A

Tubocurarine (longer acting)

Mivacurium (short acting)

37
Q

What environmental toxin is a local paralytic that blocks vesicle fusion and ACh release on presynaptic terminal by degrading SNAP-25 that can also be used to reduce frown lines and wrinkles

A

Botulinum toxin A (botox)

used to reduce frown lines and wrinkles; achalasia; strabismus; oromandibular dystonia

38
Q

What weight loss medication acts as a glucagon-like peptide-1 (GLP-1) agonist to hormonally lower appetite and caloric intake?

A

Liraglutide

*may promote thyroid cancer

39
Q

What weight loss medication or combination is anti-endorphin/appetite suppressant (antidepressant) via its antagonism on opioid receptors?

A

Naltrexone/Bupropion combo

May induce acute opiod withdrawl

40
Q

What weight loss medication is anti-serotonergic via its 5HT2c receptor agonism, to increase leptin sensitivity and metabolism

A

Lorcaserin

41
Q

What weight loss medication or combination improves insulin sensitivity and is an appetite suppressant?

A

Topiramate/Phentermine combo
topiramate is an epilepsy drug that has antidiabetic properties
Renal stones, glaucoma, acidosis, oligohydrosis risks

42
Q

What weight loss medication inhibits gastric lipases causing fat malabsorption?

A

Orlistat

43
Q

What weight loss medication increases NE tone via NRI which suppresses appetite?

A

Phentermine, used in combo with topiramate (epilepsy drug that has antidiabetic properties)

44
Q 
A 26 year-old female medical student comes to your office for a complete eye exam. Which one of the following is the best medication that allows you to perform a complete fundus exam, and allows the patient to resume studying as soon as possible?
A. Tropicamide
B. Cyclopentolate
C. Pilocarpine
D. Atropine
E. Carbachol
A

A. Tropicamide
Tropicamide, cyclopentolate and atropine would all produce the desired effect; significant pupillary dilation. But, tropicamide has the shortest onset and duration of action. Carbachol and pilocarpine would produce pupillary constriction.

45
Q 
A 35 year-old female has miosis and ptosis from Horner’s syndrome. It is thought to be caused by a third order neuron, although there could be a lesion at the level of the first or second order neuron. Which one of the following drugs is the most appropriate to use to prove a third order neuron deficit?
A. Levobunolol
B. Pilocarpine
C. Apraclonidine
D. Hydroxyamphetamine (Paredrine)
E. Cocaine
A

D. Hydroxyamphetamine (Paredrine)
Hydroxyamphetamine works by causing the release of pre-synaptic norepinephrine. Thus, a dilation response to hydroxyamphetamine will only occur if the third order neuron is functional and releases norepinephrine. If no response to hydroxyamphetamine is seen, then the third order neuron is not functioning.

46
Q 
A 72-year-old male with chronic obstructive pulmonary disease is diagnosed with glaucoma and requires topical therapy to reduce the eye pressure. Which one of the following drug classes would you prescribe?
(A) Sympathetic antagonist.
(B) Alpha-agonist.
(C) Direct parasympathetic agonist.
(D) Carbonic anhydrase inhibitor.
(E) Prostaglandin analogs.
(F) Parasympathetic antagonist.
(G) Sympathetic agonist.
A

E. Prostaglandin analogs
The number one choice to treat glaucoma is the use of Xalatan, Lumigan or other prostaglandin analogs if the patient cannot use a beta-blocker due to lung disease.

47
Q 
A 23-year-old medical student complains of flashing lights, floaters and loss of side vision. A drug from which class would best aid in your eye examination?
(A) Sympathetic antagonist.
(B) Parasympathetic agonist.
(C) Carbonic anhydrase inhibitor.
(D) Prostaglandin analog.
(E) Parasympathetic antagonist
A

E. Parasympathetic antagonist

Tropicamide is used to dilate the pupil and facilitate fundus examination

48
Q

Muscarinic receptors are the major receptor type in all of the following ocular areas except which one?
(A) Lacrimal glands
(B) Superior palpebral muscle of Muller
(C) Iris sphincter
(D) Circular fibers of the ciliary muscle
(E) Longitudinal fibers of the ciliary muscle

A

B. Superior palpebral muscle of Muller

The superior palpebral muscle of Muller is innervated by the sympathetic system causing ptosis in Horner’s syndrome.

49
Q

What kind of ocular drugs cause pupillary constriction?

What are 2 examples?

A

Muscarinic agonists like pilocarpine (direct) and echothiophate (indirect-AChE inhibitors) cause pupillary constriction

50
Q

What kinda of ocular drugs cause pupillary dilation?

What are some examples?

A

Muscarinic antagonist like tropicamide, atropine, or scopolamine
alpha1 agonist like phenylephrine

51
Q

Edrophonium’s only application in ophthalmology is operating as an indirect nicotinic agonist used to diagnose what condition?

A

Myasthenia gravis

52
Q

_____ prevents the reuptake of NE, causing pupillary dilation in a normal/healthy patient, but you will see a failure or dilation in a patient with Horners syndrome, confirming a diagnosis

A

Cocaine (10%)
This is the first step and confirms the Horners dx, after you will need to find out if it is pre/post ganglionic using paredrine (Hydroxyamphetamine)

53
Q

In someone with Adie’s syndrome, they have a parasympathetic dysfunction leading to one dilated pupil and a hypersensitivity to a very small amount of neurotransmitter. To make sure that this is not an affected nerve from an aneurysm, what two drugs can be given at a very low dose (one that would not produce an effect in a normal patient), to check for a response?

A

Methacholine or pilicarpine can be given. It will be given at such a low dose that it will not cause the pupil to constrict in a healthy person but will cause constriction in a patient with hypersensitivity.

MSII Unit 3 (9 decks)

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