USMLE neuro drugs

Question 1

opioid analgesics MOA

Answer 1

mu agonists (open K, close Ca) to decrease transmission- inhibit release of ACh, NE, 5-HT, substance P, glutamate

Question 2

opioid analgesics ADR

Answer 2

addiction, respiratory depression, miosis, additive CNS depression with other drugs- tx with naloxone

Question 3

butorphanol

Answer 3

MOA: partial mu agonist, produces analgesia
USES: extreme pain (migraine, labor, etc.)
ADR: less respiratory depression than full agonist, overdose not easily reversed with naloxone

Question 4

tramadol

Answer 4

MOA: weak opioid agonist, works on lots of NTs (“tram it all”)
USE: chronic pain
ADR: decrease sz threshold, serotonin sydrome

Question 5

2 non opioids for neuropathic pain

Answer 5

duloxetine, gabapentin

Question 6

ethosuximide

Answer 6

MOA: blocks T-type Ca channels
USE: absence
ADR: SJS

Question 7

benzos for sz

Answer 7

MOA: increase freq Cl channel opening to increase GABA
USE: status elipticus

Question 8

phenytoin

Answer 8

MOA: increase Na channel inactivation
USE: status elipticus, tonic-clonic
ADR: SJS

Question 9

carbamazepine

Answer 9

MOA: Na channel inactivation
USE: partial/generalized sz
ADR: SJS, agranulocytosis, aplastic anemia, SIADH, teratogenesis (neural tube)

Question 10

valproic acid

Answer 10

MOA: Na channel inactivation and increase GABA
USE: tonic clonic (also all others), bipolar
ADR: hepatotoxicity, contra in pregnancy (neural tube)

Question 11

gabapentin

Answer 11

MOA: GABA analog, inhibits Ca channels
USE: partial/generalized sz, peripheral neuropathic pain

Question 12

phenobarbital

Answer 12

MOA: increase GABA
USE: partial/generalized sz, great in neonates

Question 13

topiramate

Answer 13

MOA: blocks Na channels, increase GABA
USE: partial/generalized sz, migraine prevention, EtOH and cocaine addiction
ADR: mental dulling

Question 14

lamotrigine

Answer 14

MOA: blocks Na channels
USE: all sz
ADR: SJS

Question 15

3 meds for absence sz

Answer 15

ethosuximide, valproic acid, lamotrigine

Question 16

barbituates

Answer 16

“-barbital”
MOA: increase duration of Cl channel opening to decrease neuron firing and increase GABA
USE: sedative, anesthesia
ADR: resp/CV depression, CYP-450, dependence

Question 17

benzos

Answer 17

MOA: increase freq of Cl channel opening to increase GABA
USE: anxiety, status epileptics, EtOH detox, anesthesia
ADR: additive CNS effects, dependence- tx overdose with flumazenil

Question 18

insomnia agents

Answer 18

zolpidem, zaleplon, eszopiclone, temazepam, trazodone

MOA: BZ1 GABA receptor

Question 19

Parkinson drugs

Answer 19

DA agonists: bromocriptine
increase DA: amantadine, L-DOPA/carbidopa
prevent breakdown: selegiline
curb excess cholinergic activity: benztropine

Question 20

Alzheimer drugs

Answer 20

memantine: NMDA antagonist donepezil, rivastigmine: AChE inhibitors

Question 21

sumatriptan

Answer 21

MOA: 5-HT agonist (inhibits trigeminal nerve activation, prevents vasoactive peptide release, vasoconstriction)
USE: migrane, cluster
ADR: coronary vasospasm (contra in CAD, angina)

Question 22

ADHD drugs

Answer 22

CNS stimulants: amphetamine salts, methylphenidate, phentermine
MOA: increase NE and DA
USE: ADHD, appetite control, narcolepsy
ADR: growth restriction

Question 23

high potency antipsychotics

Answer 23

haloperidol, trifluoperazine, fluphenazine
MOA: block D2
USE: schizophrenia positive symptoms, tourettes
ADR: EPS symptoms

Question 24

low potency antipsychotics

Answer 24

chlorpromazine, thioridazine
MOA: block D2
ADR: anticholinergic, antihistamine effects, sedation- chlorpromazine: corneal deposits- thioridazine: retinal deposits

Question 25

2 serious ADR of typical antipsychotics

Answer 25

tardive dyskinesia, neuroleptic malignant syndrome

Question 26

atypical antipsychotics

Answer 26

clozapine, risperidone, olanzapine, quetiapine
MOA: ?
USE: schizo (positive and negative symptoms), bipolar, OCD, Tourettes
ADR: fewer than typicals- clozapine: agranulocytosis

Question 27

lithium

Answer 27

MOA: ?
USE: mood stabilizer for bipolar, SIADH
ADR: HORNET

Question 28

buspirone

Answer 28

MOA: stimulates 5-HT receptors
USE: anxiety
PROS: less abuse potential, minimal hypnotic effects, doesn’t interact with alcohol

Question 29

SSRIs

Answer 29

fluoxetine, paroxetine, sertraline, citalopram
USE: depression, anxiety, panic, OCD, bulemia, PTSD
ADR: serotonin syndrome, sexual dysfunction- tx with cyproheptadine

Question 30

SNRI

Answer 30

venlafaxine, duloxetine

Question 31

TCAs

Answer 31

“-ipramine”, “-iptyline”
MOA: block reuptake of NE and 5-HT
ADR: convulsions, coma, cardiotoxicity (arrhythmias), resp depression, anticholinergic- NaHCO3 for cardio toxicity

Question 32

wide QRS and overdose

Answer 32

TCA overdose

Question 33

MAOIs

Answer 33

PITS: phenelzine, isocarboxazid, tranylcypromine, selegiline
USE: atypical depression
ADR: hypertensive crisis, contra with SSRI, TCA, St. John’s

Question 34

mood stabilizers

Answer 34

lithium, valproic acid, carbamazepine, lamotrigine

MOA: Na inhibition (anticonvulsant), GABA agonist (mood stabilizer)

Question 35

bupropion

Answer 35

MOA: NE, DA uptake inhibitor
USE: smoking, depression
ADR: sz in bulemia pts
PRO: no sexual side effects

Question 36

mirtazapine

Answer 36

MOA: alpha 2 antagonist (increase NE, 5-HT release)
USE: depression
ADR: weight gain, sedation

Question 37

trazodone

Answer 37

MOA: blocks 5-HT2 and alpha 1
USE: insomnia
ADR: priapism (“trazobone”)