Central Nervous System Flashcards
1
Q
[Sedative Hypnotics]
acute anxiety attacks, anesthesia induction, preoperative sedation, decrease REM sleep
A
midazolam
2
Q
[Sedative Hypnotics] seizure disorders (status epilepticus), alcohol withdrawal, tranquilizer
A
diazepam
3
Q
[Sedative Hypnotics]
date-rape drug
A
flunitrazepam
4
Q
[Sedative Hypnotics]
antidote to benzodiazepine overdose
A
flumazenil
5
Q
[Sedative Hypnotics]
anesthesia induction, lethal injection, truth serum
A
thiopental
6
Q
[Sedative Hypnotics]
seizure disorders in children
SE: precipitates porphyria, potent inducer of CYP450
A
phenobarbital
7
Q
GABA receptor effects
FREnzodiazepines: FREquency
BarbiDURATes: DURATion
A
GABA receptor effects
FREnzodiazepines: FREquency
BarbiDURATes: DURATion
8
Q
[preferred benzodiazepine]
anticonvulsant maintenance
A
clonazepam
9
Q
[preferred benzodiazepine]
status epilepticus
A
lorazepam, diazepam
10
Q
[preferred benzodiazepine]
skeletal muscle relaxation (eg, cerebral palsy)
A
diazepam
11
Q
[preferred benzodiazepine]
panic disorders, phobias
A
alprazolam, clonazepam
12
Q
[preferred benzodiazepine]
insomnia
A
estazolam, flurazepam, triazolam
13
Q
[preferred benzodiazepine]
anesthesia induction
A
midazolam, diazepam
14
Q
[preferred benzodiazepine]
bipolar disorder
A
clonazepam
15
Q
[preferred benzodiazepine]
alcohol withdrawal
A
chlordiazepoxide, diazepam
16
Q
what abnormal sleep pattern results from the use of benzodiazepines?
A
decreased REM sleep
17
Q
which benzodiazepine has the longest half-life?
A
Chlordiazepoxide
half life: 36-200 hours
18
Q
which drugs are considered date-rape drugs?
A
“AFG”
Alcohol (most common)
Flunitrazepam (rohypnol)
Gamma-hydroxybutyrate
19
Q
shortest acting
A
Thiopental
“TAYOpental= TAYO agad”
20
Q
what is the most catastrophic symptom of sedative-hypnotic withdrawal?
A
rebound suicide
21
Q
mnemonic:
“zzzzzzzzzzzz (sleep)”
zolpidem, zaleplon = zleep disorders
A
mnemonic:
“zzzzzzzzzzzz (sleep)”
zolpidem, zaleplon = zleep disorders
22
Q
mnemonic:
“Busiperone for Busy people”
(always anxious)
BuSPirone like your BenzodiaSePine
A
mnemonic:
“Busiperone for Busy people”
(always anxious)
BuSPirone like your BenzodiaSePine
23
Q
SEDATIVE-HYPONOTIC POISONING "Hot Hot Hot DeCisioN!" Hypothermia Hypotension Hypoactive BS Disinhibition Coma Nystagmus
A
SEDATIVE-HYPONOTIC POISONING "Hot Hot Hot DeCisioN!" Hypothermia Hypotension Hypoactive BS Disinhibition Coma Nystagmus
24
Q
[alcohols]
most frequently abused drug,
Wernicke-Korsakoff syndrome in overdose,
Delirium tremens in withdrawal
A
ethanol
25
[alcohols]
| prevention of Wernicke-Korsakoff syndrome
thiamine
26
[alcohols]
| treatment of alcohol withdrawal
diazepam
27
[alcohols]
wood alcohol
SE: visual dysfunction due to formaldehyde accumulation
methanol
28
[alcohols]
antifreeze
SE: nephrotoxicity due to oxalic acid accumulation
ethylene glycol
29
[alcohols]
| alcohol dehydrogenase inhibitor
fomepizole
30
[alcohols]
| aldehyde dehydrogenase inhibitor
disulfiram
31
```
DISULFIRAM
"Clara took the Pre-Medical Test in the PM"
Chlorpropamide
cefoPerazone
cefoMandole
cefoTetan
cefoProcarbazine
cefoMetronidazole
```
```
DISULFIRAM
"Clara took the Pre-Medical Test in the PM"
Chlorpropamide
cefoPerazone
cefoMandole
cefoTetan
cefoProcarbazine
cefoMetronidazole
```
32
```
[antiseizure drugs]
status epilepticus,
potent CYP450 inducer,
antiarrhythmic class 1b
SE: gingival hyperplasia, hirsutism, fetal hydantoin syndrome (long upper lip, thin vermillion border)
```
phenytoin
33
[antiseizure drugs]
potent CYP450 inducer,
DOC for partial seizures and trigeminal neuralgia
SE: blood dyscrasias
carbamazepines
34
[antiseizure drugs]
potent CYP450 inhibitor,
DOC for GTC and myoclonic seizures
SE: teratogen (spina bifida)
valproic acid
35
[antiseizure drugs]
potent CYP450 inducer,
DOC for seizures in children and pregnant women
SE: porphyria
phenobarbital
36
[antiseizure drugs]
DOC for absence seizures
SE: behavioral changes
ethosuximide (Ca channels)
37
[antiseizure drugs]
DOC for status epilepticus
SE: anterograde amnesia
diazepam
38
[antiseizure drugs]
treatment of neuropathic pain
SE: nystagmus, tremor
gabapentin
39
[antiseizure drugs]
anti-seizure for pregnant women
SE: Stevens Johnson Syndrome
lamotrigine
40
DOC for generalized tonic clonic seizures
DOC:
valproic acid
phenytoin
carbamazepine
alternative drugs:
phenobarbital
lamotrigine
topiramate
41
DOC for partial seizures
DOC:
carbamazepine
lamotrigine
phenytoin
```
alternative drugs:
felbamate
phenobarbital
topiramate
valproic acid
```
42
DOC for absence seizures
DOC:
ethosuzimide
valproic acid
```
alternative drugs:
lamotrigine
levetiracetam
zonisamide
clonazepam
```
43
DOC for myoclonic and atypical absence syndromes
DOC:
valproic acid
```
alternative drugs:
clonazepam
levetiracetam
topiramate
zonisamide
felbamate
```
44
DOC for status epilepticus
lorazepam
diazepam
phenytoin
phenobarbital
45
DOC for bipolar affective disorders
valproic acid (first-line for mania)
carbamazepine
lamotrigine
46
DOC for trigeminal neuralgia
carbamazepine (DOC)
| oxcarbazepine
47
DOC for neuropathic pain (postherpetic neuralgia)
gabapentin
| pregabalin
48
DOC for migraine
gabapentin
phenytoin
topiramate
49
[general anesthetics]
highest MAC (lowest potency)
SE: euphoria
nitrous oxide (least cardiotoxic)
50
[general anesthetics]
facilitated GABA-mediated inhibition, block NMDA and ACh-N receptor
SE: pulmonary irritant
desflurane
| does not cause bronchodilation
51
[general anesthetics]
facilitated GABA-mediated inhibition, block NMDA and ACh-N receptor
SE: postoperative hepatitis, malignant hyperthermia
halothane (if given with succinylcholine)
52
[general anesthetics]
lowest MAC (highest potency),
slowest induction and recovery
SE: renal insufficiency
methoxyflurane
53
[general anesthetics]
dissociative anesthesia, NMDA receptor blocker
SE: emergence delirium
ketamine
54
[general anesthetics]
anesthesia for patients with limited cardiopulmonary reserve
SE: adrenal suppression
etomidate
55
[general anesthetics]
prolonged sedation,
"milk of amnesia"
SE: hypotension
propofol
56
[local anesthesia]
| how will you distinguish whether local anesthetics are esters or amides?
ESTERS have only 1 i in their names.
tetracaine
procaine
benzocaine
AMIDES have 2 i's in their names.
bupivacaine
ropivacaine
lidocaine
57
[local anesthesia]
| which local anesthetics have the shortest and longest half-lives?
PROCAINE = shortest half-life (1-2 mins)
A PRO finishes the race fastest.
ROPIVACAINE = longest half-life (4.2 hrs)
at the end of the long ROPe.
58
[local anesthesia]
| why should we not inject LIDOCAINE into abscesses?
*don't inject lidocaine into abscess
*won't work due to acidic environment
(below pKa = protonated form predominates, so it can't penetrate tissues)
59
[local anesthesia]
| what is the toxic dose of lidocaine?
5mg/kg for any drug or solution, 1%=10mg/mL
60
[skeletal muscle relaxants]
prototype nondepolarizing neuromuscular blocker
SE: orthostatic hypotension
tubocurarine
61
[skeletal muscle relaxants]
undergoes Hoffman elimination
SE: bronchospasm, most frequently used non-depolarizing neuromuscular blocker
atracurium
62
[skeletal muscle relaxants]
lethal injection, strychnine poisoning
SE: hypertension
pancuronium
| KCl, thiopental, pancuronium
63
[skeletal muscle relaxants]
reversal agent for nondepolarizing neuromuscular blockade
SE: miosis, salivation, diarrhea
neostigmine
64
[skeletal muscle relaxants]
depolarizing neuromuscular blocker
SE: malignant hyperthermia, affected by pseudocholinesterase activity
succinylcholine
65
[anti-parkinsonism drugs]
| DOC for Parkinson disease
levodopa + carbidopa
66
[anti-parkinsonism drugs]
treatment of hyperprolactinemia
SE: erythromelalgia, pulmonary fibrosis
bromocriptine
67
[anti-parkinsonism drugs]
adjunctive drug for wearing-off phenomena
SE: red-orange urine
entocarpine
68
[anti-parkinsonism drugs]
| cause fulminant hepatitis
tolcarpone
69
[anti-parkinsonism drugs]
anti-parkinsonism drug with antiviral properties
SE: livedo reticularis, cerebellar ataxia
amantadine
70
[anti-parkinsonism drugs]
| improves tremor and rigidity but has no effect of bradykinesia, atropine-like side effects
benztropine, biperiden
71
what are the primary signs of Parkinson disease?
```
Parkinson Disease
"It's a TRAP!"
tremor
rigidity
akinesia
postural instability
```
72
What drugs ca cause livedo reticularis?
```
livedo reticularis
"A man reads FHM and GQ!"
amantadine
hydroxyurea
minocycline
gemcitabine
quinidine
```
73
[anti-psychotic drugs]
prototype typical antipsychotic; may also block alpha and histamine receptor
SE: corneal/lens deposits, failure of ejaculation
chlorpromazine, promethazine
74
[anti-psychotic drugs]
treatment of floridly psychotic patients
SE: major EPS (neuroleptic malignant syndrome)
haloperidol
75
[anti-psychotic drugs]
DOC for suicidal and refractory schizophrenics
SE: agranulocytosis
clozapine
76
[anti-psychotic drugs]
2nd generation (5HT>>>D2)
SE: obesity, hyperglycemia
Olanzapine
77
[anti-psychotic drugs]
2nd generation (5HT>>>D2)
SEL priapism, hypnagogic hallucinations
quetiapine
78
[anti-psychotic drugs]
for schizophrenia in the youth and elderly
SE: marked hyperprolactinemia, insomnia, gynecomastia
risperidone
79
[anti-psychotic drugs]
for mania and SIADH
SE: nephrogenic diabetes insipidus, teratogen (Ebstein's anomaly)
lithium
80
what are the features of neuroleptic malignant syndrome?
```
neuroleptic malignant syndrome
"fever"
fever
encephalopathy
vitals unstable
elevated CPK
rigidity
```
81
[anti-depressants]
tricyclic antidepressant,
treatment of eneuresis
SE: atropine-like effects, cardiotoxicity
imipramine
82
[anti-depressants]
selective serotonin reuptake inhibitor (SSRI),
first lime drug for major depressive disorder
SE: erectile dysfunction, serotonin syndrome, CYP450 inhibitor
fluoxetine
83
[anti-depressants]
serotonin-norepinephrine reuptake inhibitor (SNRI)
SE: hypertension, CYP450 inhibitor
venlafaxine
84
[anti-depressants]
serotonin antagonist
SE: priapism
trazodone
85
[anti-depressants]
tetracyclic antidepressant, smoking cessation
SE: weight loss, priapism, seizures
bupropion
86
[anti-depressants]
monoamine oxidase inhibitor
SE: hypertensive crisis when taken with tyramine (cheese, wine), serotonine syndrome
phenelzine
87
what are the features of tricyclic antidepressant overdose?
3Cs of TCA overdose
coma
convulsions
cardiotoxicity
88
what drugs can cause erectile dysfunction?
```
erectile dysfunction
"SOREE, Sore Penis Fucked Hard!"
SSRIs
Opiates
Risperidone
Ethanol
Estrogens
Spironolactone
Propranolol
Finasteride
Hydrochlorothiazide
```
89
what drugs can cause priapism?
```
PRIAPISM
"Tig-a Si Pitoy Qu, BAW!"
trazodone
sildenafil
papaverine
quetiapine
bupropion
alprostadil
warfarin
```
90
symptoms of serotonin syndrome
```
serotonin syndrome
"FAT CHD"
fever
agitation
tremor
clonus
hyperreflexia
diaphoresis
```
91
symptoms of malignant hyperthermia
```
malignant hyperthermia
"FCHART"
fever
clonus
hypertension
acidosis
rhabdomyolysis
trismus
```
92
first line treatment for malignant hyperthermia (life threatening condition characterized by massive Ca release)
dantrolene
93
first line treatment for neuroleptic malignant syndrome
diphenhydramine
94
first line treatment for serotonin syndrome
sedation, paralysis, intubation and ventilation
95
```
[opioids]
prototype opioid (full agonist)
SSE: miosis, respiratory depression, constipation
```
morphine
96
[opioids]
| severe pain, breakthrough cancer pain, available in lollipop form or transdermal patch
fentanyl
97
[opioids]
opioid of choice for acute pancreatitis and biliary colic, does not cause miosis
SE: seizures
Can cause HYPERTENSIVE CRISIS when used with Tyramine
meperidine
98
[opioids]
| replacement therapy for opioid dependence
methadone
99
[opioids]
| cough suppression
dextromethorpan, codeine
100
[opioids]
| balanced anesthesia, frequently abused by healthcare professionals
nalbuphine
101
[opioids]
| antidote to opioid overdose
nalOxone
102
[opioids]
| treatment of opioid and alcohol dependence
naltrexone
103
which opioids have the shortest and longest half-lives?
```
REMIFENTANIL= shortest half-life (3-4 mins)
BUPRENORPHINE = longest half-life (4-8 hrs)
```
104
what is the triad of opioid overdose?
```
Opioid overdose
"PCR"
pupillary constriction
comatose state
respiratory depression
```
105
[drugs of abuse]
| euphoria, sleeplessness, self-confidence
amphetamine
106
[drugs of abuse]
| sexual enhancement, hyponatremia
MDMA (ecstasy)
107
[drugs of abuse]
| mydriasis, crack lung, teratogen (cystic cortical lesions)
cocaine
108
[drugs of abuse]
| most dangerous hallucinogen, psychotomimetic effects, nystagmus
phencyclidine
109
```
[drugs of abuse]
psychedelic effects (out of body experience), mind raveling effects, bad trips
```
LSD
110
[drugs of abuse]
| dream-like state, red conjunctiva, tachycardia, dry mouth
marijuana
111
[sedative hypnotics]
| Longest acting benzodiazepines (t1/2: 36-200 hrs)
Chlordiazepixide
112
[sedative hypnotics]
| Most catastrophic symptom of sedative-hypnotic withdrawal
Rebound suicide
113
Drugs used in lethal injection
“PaPaTay”
Pancuronium (100mg)
Potassium Chloride (100mEq)
Thiopental (5g)
114
Early sign of malignant hyperthermia
Trismus (contraction of jaw muscles)
115
Drugs for Huntington Disease
Tetrabenzamine/Reserpine
116
MOA: deplete amine transmitters esp Dopa from nerve endings by reversibly inhibiting VMAT2, resulting in decreased uptake of monoamines
Uses: reduces chorea severity
SE: hypotension, sedation, depression, diarrhea
Tetrabenzamine/Reserpine
| Drugs for Huntington disease
117
Drugs for Tourette Syndrome
Haloperidol/ Pimozide
118
MOA: blocks central D2 receptor
Uses: reduces vocal and motor tic frequency and severity
SE: Parkinsonism, dyakinesia, sedation, blurred vision, dry mouth, visual disturbance, arrhythmia
Haloperidol/Pilozide
119
Drugs that cause Livedo Reticularis
```
“HAM GQ”
Hydroxyurea
Amantadine
Minocycline
Gemcitabine
Quinidine
```
120
[anti-psychotics]
Only anti-paychotic with Fatal Overdose;
Has strongest autonomic effects
SE: retinal deposits
Thioridazine
121
[anti-psychotics]
Least sedating atypical
Uses: MDD, cocaine dependence, autism, schizophrenia, BPD manic phase
Arpiprazole
122
Morphine Side Effects
```
Miosis
Increase ICP
Constipation
Urinary retention
Pruritus
Restlessness
Respiratory depression
Postural hypotension
Addiction liability
```
123
Anticonvulsant that should not be given intramuscularly because of unpredictable absorption and precipitation of the drug in the muscle
Phenytoin
124
Anticonvulsant that act by inhibiting neurotransmission through NMDA receptor antagonism
Felbamate
