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CNS Flashcards

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1
Q

side effects of ethosuximide (4)

A 
Ethosuximide causes
Fatigue
GI distress
Headache
Itchiness
Stevens-Johnson syndrome
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2
Q

side effects of benzodiazepines (3)

A
  1. sedation
  2. dependence/tolerance
  3. respiratory depression (less than barbituates)
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3
Q

side effects of phenytoin (10)

A
  1. nystagmus, diplopia
  2. ataxia
  3. gingival hyperplasia
  4. hirsuitism
  5. megaloblastic anemia, peripheral neuropathy
  6. teratogen (fetal hydantoin syndrome)
  7. SLE-like syndrome
  8. cytochrome P-450 induction
  9. Stevens-Johnson syndrome
  10. osteopenia
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4
Q

side effects of carbamezapine (8)

A
  1. diplopia
  2. ataxia
  3. blood dyscrasia (agranulocytosis, aplastic anemia)
  4. liver toxicity
  5. teratogen
  6. cytochrome P-450 induction
  7. SIADH
  8. Stevens-Johnson syndrome
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5
Q

side effects of valproic acid (5)

A
  1. GI distress
  2. hepatotoxicity (measure LFTs)
  3. neural tube defects in fetus (DO NOT USE IN PREGNANCY)
  4. tremor
  5. weight gain
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6
Q

side effects of gabapentin (2)

A
  1. sedation

2. ataxia

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7
Q

side effects of phenobarbitol (4)

A
  1. sedation
  2. dependence/tolerance
  3. cytochrome P-450 induction
  4. cardiorespiratory depression
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8
Q

side effects of topiramate (4)

A
  1. sedation
  2. mental dulling
  3. kidney stones
  4. weight loss
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9
Q

side effects of lamotrigine (1)

A
  1. Stevens-Johnson syndrome
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10
Q

epilepsy drugs that cause Stevens-Johnson syndrome (4)

A
  1. ethosuximide
  2. phenytoin
  3. carbamezapine
  4. lamotrigine
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11
Q

epilepsy drugs that cause SIADH (1)

A
  1. carbamezapine
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12
Q

epilepsy drugs that cause kidney stones (1)

A
  1. topiramate
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13
Q

epilepsy drugs that cause SLE-like syndrome (1)

A
  1. phenytoin
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14
Q

first line tx absence seizures

A

ethosuximide

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15
Q

first line tx tonic-clonic seizures (3)

A
  1. phenytoin
  2. carbamezapine
  3. valproic acid
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16
Q

first line tx simple and complex seizures

A

carbamezapine

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17
Q

acute tx status epilepticus

A

benzodiazepines

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18
Q

prophylaxis of status epilepticus

A

phenytoin

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19
Q

first line tx seizure in neonate

A

phenobarbital

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20
Q

eclampsia seizures treatment

A

1st line: MgSO4

2nd line: benzodiazepines

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21
Q

treatment trigeminal neuralgia

A

carbamezapine

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22
Q

ethosuximide mechanism

A

blocks thalamic T-type Ca channels

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23
Q

benzodiazepines mechanism

A

increase GABA-A action

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24
Q

phenytoin mechanism

A

increase Na channel inactivation (zero-order kinetics)

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25
carbamezapine mechanism
increase Na channel inactivation
26
valproic acid mechanism
increase Na channel inactivation | increase GABA concentration by inhibiting GABA transaminase
27
gabapentin mechanism
inhibits high-voltage-activated Ca channels
28
phenobarbital mechanism
increase GABA-A action
29
topiramate mechanism
blocks Na channels | increase GABA action
30
lamotrigine mechanism
blocks voltage-gated Na channels
31
what is levetiracetam used for?
epilepsy
32
tigabine mechanism
increase GABA by inhibiting reuptake
33
vigabatrin mechanism
increase GABA by inhibiting GABA transaminase
34
what epilepsy drugs cause megaloblastic anemia (1)
1. phenytoin
35
what epilepsy drugs cause agranulocytosis and aplastic anemia (1)
1. carbamezapine
36
what epilepsy drugs cause hepatotoxicity (2)
1. carbamezapine | 2. valproic acid
37
drug class phenobarbital
barbituate
38
drug class pentobarbital
barbituate
39
drug class thiopental
barbituate
40
drug class secobarbital
barbituate
41
barbituate mechanism
facilitate GABA-A action by increase duration of Cl channel opening
42
can you use barbituates in porphyria?
NO!
43
side effects of barbituates (4)
1. respiratory/cardiovascular depression 2. CNS depression (worse with EtOH) 3. dependence 4. induces cytochrome P-450
44
overdose tx for barbituates
supportive (maintain breathing and BP)
45
drug class diazepam
benzodiazepine
46
drug class lorazepam
benzodiazepine
47
drug class triazolam
benzodiazepine
48
drug class temazepam
benzodiazepine
49
drug class oxazepam
benzodiazepine
50
drug class midazolam
benzodiazepine
51
drug class chlordiazepoxide
benzodiazepine
52
drug class alprazolam
benzodiazepine
53
mechanism benzodiazepine
facilitate GABA-A action by increase frequency of Cl channel opening
54
short-acting (more addictive) benzodiazepines
TOM (triazolam, oxazepam, midazolam)
55
effect of benzodiazepines on sleep
decrease REM sleep
56
drugs that bind the GABA-A receptor (3)
1. barbituates 2. benzodiazepines 3. EtOH
57
overdose tx of benzodiazepines
flumazenil (competitive antagonist GABA receptor)
58
drug class zolpidem
nonbenzodiazepine hypnotic
59
drug class zaleplon
nonbenzodiazepine hypnotic
60
drug class esopiclone
nonbenzodiazepine hypnotic
61
mechanism nonbenzodiazepine hypnotic
BZI subtype of GABA receptor
62
clinic use of nonbenzodiazepine hypnotic
insomnia
63
side effects of nonbenzodiazepine hypnotic (3)
1. ataxia 2. short duration b/c of liver metabolism 3. lower risk dependence
64
anesthetics with less solubility in blood
rapid induction, rapid recovery
65
anesthetics with greater solubility in lipids
higher potency (1/MAC)
66
MAC (minimal alveolar concentration)
amount of inhaled anesthetic required to prevent 50% from moving
67
drug class halothane
inhaled anesthetic
68
drug class enflurane
inhaled anesthetic
69
drug class isoflurane
inhaled anesthetic
70
drug class sevoflurane
inhaled anesthetic
71
drug class methoxyflurane
inhaled anesthetic
72
drug class nitrous oxide
inhaled anesthetic
73
effects of inhaled anesthetics (4)
1. myocardial depression 2. respiratory depression 3. nausea/vomiting 4. increased cerebral blood flow
74
side effect of halothane (1)
1. hepatotoxicity
75
side effect of methoxyflurane (1)
1. nephrotoxicity
76
side effect of enflurane (1)
1. seizures
77
what is malignant hyperthermia?
rare, hereditary. inhaled anesthetics and succinylcholine induce fever and muscle contractions
78
tx for malignant hyperthermia
dantrolene
79
what barbituate is used as IV anesthetic
thiopental (high potency, rapid entry and redistribution)
80
what benzodiazepine is used as an IV anesthetic
midazolam (for endoscopy)
81
side effects of midazolam anesthetic (3)
1. postoperative respiratory depression 2. decreased BP 3. anterograde amnesia
82
mechanism of arylcyclohexylamines
PCP analogs, block NMDA receptors
83
what are arylcyclohexylamines
IV anesthetic
84
what is ketamine another name for?
arylcyclohexylamines
85
what opiates are used as IV anesthetic
morphine, fentanyl
86
what is propofol's used in anesthesia
sedation in ICU, rapid induction | less postoperative nausea
87
propofol mechanism
potentiates GABA-A
88
what are the two groups of local anesthetics
1. esters (procaine, cocaine, tetracaine) | 2. amides (lidocaine, mepivacaine, bupivacaine)
89
mechanism local anesthetics
block Na channels (bind activated)
90
what happens to local anesthetics in infected tissue?
infected tissue = acidic --> alkaline anesthetics are charged, cannot penetrate --> need more
91
order of nerve blockade
small myelinated > small unmyelinated > large myelinated > large unmyelinated
92
order of loss of sensation
1. pain, 2. temperature, 3. touch, 4. pressure
93
side effect of bupivacaine
cardiovascular toxicity
94
side effects of local anesthetics (3)
1. CNS excitation 2. hypertension 3. hypotension
95
mechanism succinylcholine
ACh-receptor agonist --> prevents contraction
96
reversing succinylcholine blockade
``` Phase I (prolonged depolarization): none Phase II (repolarization but blocked): cholinesterase inhibitors ```
97
side effects of succinylcholine
1. hypercalcemia 2. hyperkalemia 3. malignant hyperthermia
98
what neuromuscular blocking drug is depolarizing?
succinylcholine
99
what neuromuscular blocking drugs are non-depolarizing?
1. tubocurarine 2. atracurium 3. mivacurium 4. pancuronium 5. vecuronium 6. rocuronium
100
mechanism of non-depolarizing neuromuscular blocking drugs
competitive ACh antagonist
101
drug class tubocurarine
non-depolarizing neuromuscular blocking drugs
102
drug class atracurium
non-depolarizing neuromuscular blocking drugs
103
drug class mivacurium
non-depolarizing neuromuscular blocking drugs
104
drug class pancuronium
non-depolarizing neuromuscular blocking drugs
105
drug class vecuronium
non-depolarizing neuromuscular blocking drugs
106
drug class rocuronium
non-depolarizing neuromuscular blocking drugs
107
reversal of blockade from non-depolarizing neuromuscular blocking drugs (3)
1. neostigmine (with atropine to prevent muscarinic effects like bradycardia) 2. edrophonium 3. other cholinesterase inhibitors
108
mechanism dantrolene
prevents release of Ca from sarcoplasmic reticulum
109
clinical use dantrolene
malignant hyperthermia and neuroleptic malignant syndrome
110
Parkinson's drugs
Bromocriptine (or pramipexole or ropinirole) Amantadine L-dopa/carbidopa Selegiline (or COMT inhibitors entacapone or tolcapone) Antimuscarinic (benztropine)
111
tx essential tremor
beta-blocker
112
carbidopa mechanism
blocks peripheral decarboxylase --> increases L-dopa to brain and decreases peripheral side effects
113
side effects of L-dopa (2)
1. arrhythmias | 2. on-off phenomenon
114
selegiline mechanism
inhibits MAO-B --> increases dopamine
115
what is donepezil
AChE inhibitor used in Alzheimer's
116
what is galantamine
AChE inhibitor used in Alzheimer's
117
what is rivastigmine
AChE inhibitor used in Alzheimer's
118
side effects of AChE inhibitors used in Alzheimer's (3)
1. nausea 2. dizziness 3. insomnia
119
what is memantine
NMDA receptor antagonist used in Alzheimer's (prevents excitotoxicity)
120
memantine side effects (3)
1. dizziness 2. confusion 3. hallucinations
121
what neurotransmitter changes are seen in Huntington's (GABA, ACh, and dopamine)
decreased GABA, decreased ACh, increased dopamine
122
what is tetrabenazine
inhibits vesicular monoamine transporter (VMAT), used in Huntington's
123
what is reserpine
inhibits vesicular monoamine transporter (VMAT), used in Huntington's
124
sumatriptan mechanism
serotonin agonist, inhibits trigeminal nerve activation, induces vasoconstriction
125
clinical use of sumatriptan
migraine, cluster headache
126
side effect of sumatriptan
coronary vasospasm
127
what is butorphanol
mu partial agonist, kappa agonist
128
clinical use butorphanol
opioid, less respiratory depression
129
tramadol mechanism
weak opioid agonist, inhibits serotonin and NE reuptake
130
clinical use tramadol
chronic pain
131
side effects tramadol
1. seizures | 2. serotonin syndrome
132
drug class morphine
opioid (mu)
133
drug class fentanyl
opioid
134
drug class codeine
opioid
135
drug class loperamide
opioid (and diarrhea)
136
drug class methadone
opioid
137
drug class meperidine
opioid
138
drug class dextromethorphan
opioid (and cough suppression)
139
drug class diphenoxylate
opioid (and diarrhea)
140
side effects opioids
1. respiratory depression 2. addiction 3. constipation 4. miosis
141
opioid overdose tx
naloxone or naltrexone (opioid receptor antagonists)
142
alpha agonists used for glaucoma (2)
1. epinephrine | 2. brimonidine (alpha-2)
143
beta blockers used for glaucoma (3)
1. timolol 2. betaxolol 3. carteolol
144
direct cholinomimetics used for glaucoma (2)
1. pilocarpine | 2. carbachol
145
indirect cholinomimetics used for glaucoma (2)
1. physostigmine | 2. echothiophate
146
cholinomimetics for glaucoma mechanism
constraction ciliary muscle --> increase outflow
147
which drugs should you not use in closed-angle glaucoma
alpha-agonists (epinephrine and brimonidine) --> cause mydriasis
148
prostaglandin used for glaucoma
latanoprost (PGF-2alpha)
149
latanoprost mechanism
increases outflow aqueous humor
150
which glaucoma treatment darkens the iris
latanoprost
151
what drug increases survival in ALS?
riluzole (decreases presynaptic glutamate release)

Pharmacology (8 decks)

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