Pharmacology for Neuro Flashcards
What classes of drugs can be used to treat glaucoma? (5)
a-agonists b-blockers diuretics cholinomimetics prostaglandin
When is epinephrine contraindicated for treating glaucoma?
Do not use for closed-angle glaucoma
What med should be used emergently to treat glaucoma?
Pilocarpine- very effective at opening meshwork into canal of schlemm
What drug used to treat glaucoma can cause darkening of the iris?
latanoprost (FGF2a- prostaglandin)
Morphine
Opioid analgesic
mu opioid receptor
Enkephalin
Opioid analgesic
delta opioid receptor
Dynorphin
Opioid analgesic
kappa opioid receptor
What opioid analgesics are used to treat diarrhea?
Loperamide, diphenoxylate
What opioid analgesics are used as a cough suppressant?
dextromethorphan
What is the mechanism of action of opioid analgesics?
modulate synaptic transmission (decr K+ channels, close Ca2+ channels)
inhibit release of ACh, norepinephrine, 5-HT, gultamate, substance P
What treats toxicity of opioid analgesics?
naloxone or naltrexone
What are two side effects of opioid analgesics that do not result in tolerance?
miosis and costipation
Butorphanol
mu-opioid receptor partial agonist and kappa-opioid receptor agonist
What is the advantage of butorphanol over full opioid agonists?
causes less respiratory depression
Tramodol
very weak opioid agonist; also inhibits serotonin and norepinephrine reuptake
What is an important side effect of tramodol
decreases seizure threshold
Mechanism of ethoxusimide
blocks thalamic T-type Ca2+ channels
What drugs are used to treat absence seizures
ethosuximide, valproic acid, lamotigrine
What drugs are used to treat status epilepticus?
diazepam, lorazepam, phenytoin
What is the first line treatment for simple seizures?
Carbamazepine
What is the first line treatment for complex seizures?
Carbamazepine
What is the first line treatment for tonic-clonic treatment?
Carbamazepine, phenytoin, valproic acid
What is the mechanism of phenytoin?
incr Na+ channel inactivation
What is the mechanism of carbamazepine?
Incr Na+ channel inactivation
What is the mechanism of valproic acid?
Incr Na+ channel inactivation, incr GABA conc by inhibiting GABA transaminase
What is the mechanism of benzodiazepines?
incr GABAA action by incr frequency of Cl- channel opening
What is the mechanism of barbiturates?
facilitate GABAa action by incr duration of Cl- channel opening, decr neuron firing
With what disease are barbiturates contraindicated?
porphyria
What is used to treat overdose of benzodiazepines?
flumazenil
Zolpidem
nonbenziodiazepine hypnotic
used to treat insomnia
Zaleplon
nonbenziodiazepine hypnotic
used to treat insomnia
eszopiclone
nonbenziodiazepine hypnotic
used to treat insomnia
What are is the mechanism of nonbenziodiazepine hypnotics?
act via BZ1 subtype of GABA receptor
Compare the induction and potency of N20 and halothane and how these relate to blood and lipid solubility
N20- decr blood and lipid solubility; fast induction, low potency
Halothane- incr lipid and blood solubility; high potency, slow induction
What is an important side effect of halothane?
hepatotoxicity
What is an important side effect of methoxyflurane?
nephrotoxicity
What is an important side effect of enflurane?
proconvlusant
What is an important side effect of nitrous oxide?
expansion of trapped gas in a body cavity
What is a life threatening complication of inhaled anesthetics? How is this treated?
malignant hyperthermia
dantrolene
What IV anesthetic is commonly used for induction of anesthesia and for short surgical procedures?
thiopental (barbiturate)
What is the mechanism of propofol?
potentiates GABAa
What is the mechanism of ketamine as an IV anesthetic?
Blocks NMDA receptors
What IV anesthetic causes isorientation, hallucination, bad dreams?
propofol
What IV anesthetic is commonly used for endoscopy?
midazolam (benzo)
Give examples of ester vs amide local anesthetics
Ester- procaine, cocaine, tetracaine
amide- lidocaine, mepivacaine, bupivacaine (amide= 2 I’s)
What local anesthetic causes severe cardiovascular toxicity?
bupivacaine
In what order are nerve fibers lost by local anesthetics?
pain
temp
touch
pressure
What is the mechanism of local anesthetics?
block Na+ channels by binding specific receptors in inner portion of channel. Preferentially bind activated Na+ channels (most effective in rapidly firing neurons)
Succinylcholine
depolarizing neuromusc blocking drug
What are the side effects of succinylcholine?
hypercalcemia, hyperkalemia, malignant hyperthermia
What are the two phases of blockade for succinycholine?
Phase I: prolonged depolarization
Phase II: repolarized but blocked; ACh receptors are available but desnsitized
Dantrolene
used to treat malignant hyperthermia and neuroleptic malignant syndrome
prevents release of Ca2+ from sarcoplasmic reticulum of skeletal muscle
Tubocuranine, atrocurium…
nondepolarizing neuromusc blocking drugs
What is the mechanism of nondepolarizing neuromuscular blocking drugs
competitive antagonist, compete with ACh for receptors
Bromocriptine
ergot dopamine agonist
used to treat parkinsons
Pramipexole
non-ergot dopamine agonist
used to treat parkinsons
ropinirole
non-ergot dopamine agonist
used to treat parkinsons
Amatadine
increases dopamine release, used to treat parkinson (also works against influenza A and rubella)
What is the toxicity of amatadine?
ataxia
levodopa/caribidopa
dopamine analog
passes BBB and converted to dopamine in CNS
selegiline
prevents dopamine breakdown (selective MAO type B inhib) treat parkinson
benzotropine
antimuscarinic, improves tremor and rigidity but little effect on bradykinesia
used to treat Parkinson’s
Memantine
NMDA receptor antagonist
used to treat Alzheimers
Donepezil
AChE inhibitor
used to treat Alzheimer
Galantamine
AChE inhibitor
used to treat Alzheimer
Rivastigmine
AChE inhibitor
used to treat Alzheimer
Sumatriptan
5-HT1B/1D agonist; inhibits tigeminal nerve activation
treats acute migraine and cluster headache attacks
