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CNS Flashcards

1
Q

Fluoxetine mechanism of action

A

SSRI

Selective blockade of 5HT reuptake

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2
Q

Amitriptyline mechanism of action

A

TCA

Nonspecific blockade of 5HT and NE reuptake

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3
Q

Phenelzine mechanism of action

A

Inhibits MAOA and MAOB

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4
Q

Carbamazapine adverse affects

A
  1. CNS depression
  2. Osteomalacia
  3. Megaloblastic anemia
  4. Aplastic anemia
  5. Exfoliative dermatitis
  6. Increase ADH secretion causing dilutional hyponatremia
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5
Q

Gabapentin mechanism of action and use

A
  • Increase GABA effect
  • Used in seizure states, neuopathic pain (postherpetic neuralgia)
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6
Q

Nigrostriatal tract

A
  • Cell bodies in the substantia Nigra project to the stritum where they release DA which inhiits GABA-ergic neurons
  • In Parkinsons, loss of DA neurons leads to excessive ACh activity
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7
Q

Amides and esters (local anesthetics) co-adminstered with? And why?

A

Alpha 1 agonist

  1. Decreas local anesthetic absorption into the system circulation
  2. Prolong effect and decrease toxicity
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8
Q

D2 second messenger

A

Gi

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9
Q

SSRI’s are used for

A
  1. Major depression
  2. OCD
  3. Bulimia
  4. Anxiety disorders
  5. Premenstrual dysphoric disorder (PMDD)
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10
Q

Phenytoin pharmacokinetics

A
  1. Variable absorption
  2. Nonlinear kinetics
  3. Induction of Cytochrome P450
  4. Zero-order kinetic of elimination
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11
Q

Lithium teratogenicity

A

Causes Ebstein’s anomaly (Malformed tricuspid valve)

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12
Q

Withdrawl signs of BZ

A
  1. Anxiety
  2. Rebound insomnia
  3. Seizure when BZ are used as antiepileptic or in High doses
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13
Q

Meperidine chx:

A
  • Full opiod agonist
  • Also antimuscarinic so causes no miosis, tachycardia and no GI/GU/GB spasms
  • Metabolized by P450 to normeperidine, a serotonin reuptake inhibitor. May cause serotonin syndrome and seizures
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14
Q

Selegiline mechanism of action

A

MAOB Selective inhibitor preventing DA breakdown to metabolites

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15
Q

Lithium adverse affects

A
  • Tremor, flu-like symptoms, seizures
  • Hypothyroidism with goiter (due to inhibition of 5’-deiodinase)
  • Nephrogenic DI (Decrease ADH) [manage with AMILORIDE]
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16
Q

Withdrawl signs of Barbs

A
  1. Anxiety
  2. Agitation
  3. Life-threatening seizures
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17
Q

Buprenorphine CHX:

A
  • Partial opiod agonist
  • Used for precipation of withdrawl
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18
Q

Lithium mechanism of action

A
  • Prevents recycling of Inositol (Decrease in PIP2) by blocking Inositol monophosphatase
  • Decrease cAMP
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19
Q

Alcohol in pregnancy causes

A
  1. Growth restriction
  2. Midfacial hypoplasia
  3. microcephaly
  4. CNS dysfunction
  5. frequent occurrence of mental retardation
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20
Q

Methadone CHX:

A
  • Full opiod agonist
  • Used in maintenance of opiate addiction
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21
Q

Amides and esters (Local anesthetics) mechanism of action

A
  • Ionized form blocks internal inactivated Na channel in axon
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22
Q

Clozapine CHX:

A

Atypical antipsycotic

Blocks D2c and 5HT2 receptors

NO TD

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23
Q

Benzodiazepine mechanism of action

A

Potentiates GABA causing increased frequency of Cl channel opening

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24
Q

Alprazolam indication

A

BZ

  1. Anxiety
  2. Panic
  3. Phobias
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25
Barbiturate mechanism of action
Prolong GABA activity by increaing **duration** of Cl channel opening Also inhibits Complex 1 of ETC
26
TCA toxicity
**3 C's** 1. Coma 2. Convulsions 3. Cardiotoxicity
27
Nalbuphine CHX:
* Mixed opiod agonist - antagnoist * **Kapa** Agonist: Spinal analgesia and dysphoria * **Mu** antagonist: Precipitation of withdrawl
28
D2A found in
Nicrostriatal
29
Mirtazapine CHX:
Antidepressant that is an **ALPHA 2 antagonist** associated with **weight** **gain**
30
SSRI adver affects
1. Anxiety 2. Agitation 3. Bruxism 4. Sexual dysfuntion 5. Weight loss
31
Olanzapine EPS, M Block, Sedation and Alpha Block:
**Atypical Antipsycotic** EPS: -/+ M Block: + Sedatoin: + Alpha Block: ++
32
Risperidone EPS, M Block, Sedation and Alpha Block:
**Atypical Antipsycotic** EPS: + M Block: +/- Sedation: ++ Alpha Block: ++
33
Acute adverse affects of opiods
1. Pinpoint pupils 2. Respiratory depression 3. Coma
34
When to caution with Morphine
1. Head trauma due to vasodilation 2. Renal dysfuntion due to morphine metabolite is active
35
Disulfiram-like drugs
1. Metronidazole 2. Chlorpropamide 3. Griseofulvin
36
Carbamazepine mechanism of action
Blocks axonal Na channels in their inactivated state decreasing axonal conduction preventing seizure propagation
37
Phenelzine and Tranylcypromine used for
MOA inhibitors used for atypical depression
38
Pharmocologic goal in Parkinsons
Increase DA and decrease ACh
39
Buspirone mechanism of action
5-HT1A Partial agonist that has no effect on GABA therefore it is NON sedative but takes 1 to 2 wks for effect
40
Nondepolarizing skeletal mucle blockers Mechanism and CHX
* Nicotinic antagonists * Reversible with AChEI * No effects on cardiac and smooth muscle * No CNS effects
41
Diazepam indicaiton
BZ 1. Anxiety 2. Peop sedation 3. Muscle relaxation 4. Withdrawal state
42
Oxazepam indication
BZ 1. Sleep disorder 2. Anxiety
43
Tolcapone Mechanism of action
Inhibits COMT from converting L-Dopa to 3-O-methyldopa (a partial agonist at DA receptor)
44
Felbamate is
Same as lamotrigine by blocking Na channels and glutamate receptors
45
In partial seizures (simple or complex) give
1. Valproic acid 2. Phenytoin 3. Carbamazepine 4. Lamotrigine
46
Aripiprazole CHX:
**Atypical Antipsycotic** Partial agonist of **D2** receptors Blocks **5HT2** receptors
47
Lamotrigine adverse affects
Steven-Johnson syndrome (skin rash)
48
Levodopa adverse affects
1. Dyskinesias 2. "on-off" effect 3. Psychosis 4. Hypotension 5. Vomiting
49
Antipsycotics adverse affects from DA block
1. Dyskinesias (extrapyramidal symptoms) 2. Dysphoria 3. Endocrine dysfunction: Tem regulation problems, Increase Prolactin, Increase eating
50
Ethosuximide mechanism of action
Blocks T-type Ca channels in thalamic neurons
51
Lorazepam indication
BZ 1. Anxiety 2. Preop sedation 3. Status epilepticus (IV)
52
Ketamine adverse affects
1. Cardiovascular stimulation 2. Increase intracranial pressure
53
Zolpidem and Zaleplon overdose reversed by
Flumazenil
54
Valproic acid adverse affects
1. Hepatotoxicity from metabolites 2. **Thrombocytopenia** 3. **Pancreatitis** 4. **Alopecia**
55
Phenytoin adverse affects
1. CNS depression 2. **Gingival hyperplasia** 3. **Hirsutism** 4. Osteomalacia (decreas Vit D) 5. **Megaloblastic anemia** (decrease Folate) 6. **Aplastic Anemia** (check hematology)
56
Atracurium mechanism of action
* Nondepolarizing (competative) skeletal muscle relaxant * Nicotinic antagonist * Rapid in recovery * Safe in hepatic or renal impairment * Spontaneous inactivation to **Laudanosine** (can cause **Seizures**)
57
Fluvoxamine mechanism of action
**SSRI** Selective blockade of 5HT reuptake
58
Olanzapine and Risperidone CHX:
**Atypical** **antipsycotic** Blocks **5HT2** receptors improves **negative** **symptoms**
59
Venlafaxine CHX:
Antidepressant that is a nonselective reuptake blocker devoid of ANS side effects
60
Ketamine as anesthetics mechanism of action
Glutamate antagonist NMDA receptor antagonist
61
Temazepam indication
BZ 1. Sleep disorder
62
Lamotrigine mechanism of action
Blocks Na channels and Glutamate receptors
63
Midazolam indication
BZ 1. Preop sedation 2. Anesthesia via IV
64
Thioridazine EPS, M Block, Sedation and Alpha Block:
**Typical Antipsycotic** EPS: + M Block: +++ Sedation: +++ Alpha block: +++
65
Entacapone
Same as Tolcapone without hepatotoxicity
66
Sedating drug list
1. BZ (**-zolam or -zepam**) 2. Barb (**Phenobarbital or Thiopental**) 3. Z drugs (**Zolpidem and Zaleplon**) 4. Buspirone
67
DA receptor agonists
1. Bromocriptine 2. Pramipexole 3. Ropinirole
68
MOLTAD of BZ
Duration of action for Short to long * M: Midazolam * O: Oxazepam (No active metabolite) * L: Lorazepam (No active metabolite) * T: Temazepam (No active metabolite) * A: Alprazolam * D: Diazepam
69
In status epilepticus give
1. Lorazepam 2. Diazepam 3. Phenytoin 4. Fosphenytoin
70
Full opiod agonists
1. Meperidine 2. Methadone 3. Codeine
71
Haloperidol EPS, M Block, Sedation and Alpha Block:
**Typical antipsycotic** EPS: +++ M Block: + Sedation: + Alpha block: +
72
Inhaled anesthetics have barying potency in proportion to:
Their lipid soluability
73
Atomoxetine CHX:
Durg used in ADHD Selective NE reuptke inhibitor
74
Phenytoin mechanism of action
Blocks axonal Na channels in their inactvated states decreasing axonal conduction and preventing seizure propagation
75
Levodopa converted to DA by
Aromatic amino acid decarboxylas (AAAD)
76
Codeine CHX
* Full opiod agonist * Cough suppressant * Analgesia * Used in combination with NSAIDS
77
Methylphenidate adverse affects
1. Agitation 2. Restlessness 3. Insomnia 4. Cardiovascular toxicity
78
Two phase system of Depolarizing Skeletal Muscle relaxants
**Phase 1** * Depolarization, fasciculation, prlong depolarization, flaccid paralysis **Phase 2** * Desensitization
79
Valproic acid teratogenicity
Spina bifida
80
Naltrexone CHX:
* Opiod antagonist * Oral, decrease craving for alcohol and used in opiate addiction
81
D1 second messenger
Gs
82
Phenytoin teratogenicity
Causes **Cleft lip and palate**
83
Carbamazepine DOC
Trigeminal neuralgia
84
Pentazocine chx:
* Mixed opiod agonist - antagnoist * **Kapa** Agonist: Spinal analgesia and dysphoria * **Mu** antagonist: Precipitation of withdrawl
85
Selegiline adverse affects
Dyskinesias, psychosis, insomnia (because it is metabolized to **AMPHETAMINE**)
86
Midazolam as anesthetic uses
1. Pre op sedation 2. Anterograde amnesia 3. Induction 4. Outpatient surgery
87
Carbamazepine teratogenicity
1. Cleft lip and palate 2. Spina bifida
88
Paroxetine mechanism of action
**SSRI** Selective blockade of 5HT reuptake
89
**Carbidopa** given with Levodopa for
Carbidopa inhibits conversion of LDopa to DA in periphery allowing MORE LDopa to enter CNS
90
Trazadone CHX:
**Antidepressent** associated with Cardiac arrhythmias and **PRIAPISM**
91
Methylnaltrexone chx:
* Opiod antagonist * Treatment of opiod-induced consitbation because it doesn't not cross BBB and wont precipitate withdrawal
92
TCA used for
1. Major depression 2. Phobic and panic anziety states 3. OCD 4. Neuropathic pain 5. Enuresis
93
Lamotrigine and Felbamate used for
Seizure states as an adjunct therapy
94
Imipramine mechanism of action
**TCA** Nonspecific blockade of 5HT and NE reuptake
95
Morphone in CVS
Causes Vasoldilation (avoid in head trauma)
96
Tranylcypromine mechanism of action
Inhibits MAOA and MAOB
97
Drugs the decrease ACh activity in Parkinsons
1. Benztropine 2. Trihexyphenidyl 3. Diphenhydramine
98
Amantadine mechanism of action in parkisons
Antiviral that block M receptora dn increase DA release
99
Amantadine adverse affects
Livedo reticularis
100
Signs of opiod withdrawl
1. Yawning 2. Lacrimation, rhinorrhea, salivation 3. Anxiety, sweating, goose bumps 4. Muscle cramps, spasm, CNS-originating pain
101
Valproic acid mechanism of action
* Blocks axonal Na channels in their inactivated state decreasing axonal conduction and preventing seizure propagation * Inhibition of **GABA transaminase** * Blocks **T-type Ca channels**
102
Antipsycotics used for
1. Schizophrenia 2. Schizoaffective states 3. Bipolar 4. Tourette syndrome 5. Huntington 6. Drug or radiation emesis
103
Zolpidem and Zaleplon mechanism of action
BZ1 Receptor agonist and have a less effect on cognitive function
104
Fluphenazine EPS, M Block, Sedation and Alpha Block:
**Typical antipsycotic** EPS: +++ M Block: + Sedation: + Alpha Block: +
105
Thioridazine adverse affects
* Cardiotoxic causing quinidine like **Torsades** * Retinal deposits
106
Valproic acid used for
1. Seizures 2. Mania of bipolar disorders 3. Migraine prophylaxis
107
BZ receptors
BZ1: sedation BZ2: Antianxiety and impairment of cognitive funtion
108
Felbamate adverse affects
Hepatotoxicity and Aplastic anemia
109
Thipopental (Barb) use as anethetic
IV for induction Highly lipid soluable: Rapid onset Short acting due to redistribution
110
Citalopram mechanism of action
**SSRI** Selective blockade of 5HT reuptake
111
Clozapine EPS, M Block, Sedation and Alpha Block:
**Atypical Antipsycotic** EPS: -/+ M Block: ++ Sedation: + Alpha Block: +++
112
Endogenous opiate peptides:
1. Endorphins 2. Enkephalins 3. Dynorphins
113
Amides and esters (local anesthetics) adverse affects
1. Neurotoxicity 2. Cardio toxicity 3. Allergies (Esters via **PABA formation**)
114
Antipsycotic adverse affects from M blockade
Tachycardia and decrease seizure threshold
115
Clomipramine mechanism of action
**TCA** Nonspecific blockade of 5HT and NE reuptake
116
Midazolam as anesthetics adverse affects
Depresses respiratory functions
117
MAC and potency
The more lipd soluble the anethetic, the lower the MAC and the greater the potency
118
Morphine receptor
Mu agonist
119
D2C found in
Mesolimbic
120
Depolarizing (noncompetative) skeletal muscle relaxants Mechanism and CHX
* Nicotinc antagonist * Two phase system * AChEI increase phase 1 and **may reverse phase 2** * Rapidly hydrolyzed by **pseudocholinesterase**
121
Clozapine adverse affects
**Agranulocytosis** (requires weakly WBC count) Increased salivation ("wet pillow" Seizures
122
Haloperidol adverse affects
Most likely cause of Neuoleptic malignant syndrome (NMS) and TD
123
Morphine on Respiratory
Respiratory depression: Decrease response to increase pCO2 (do not give O2 in crisis, give **Naloxone**)
124
In general (absence) seizures give
1. Ethoxuzimide 2. Valproic acid
125
Sertraline mechanism of action
**SSRI** Selective blockade of 5HT reuptake
126
Morphine on Smooth muscle
* Relaxes Longitudinal muscles * Constics Circular muscles
127
Mesolimbic-mesocortical tract
Cell bodies in **midbrain** project to **cerebrocortical** and **limbic** structures
128
Chlorpromazine EPS, M Block, Sedation and Alpha Block:
**Typical Antipsycotic** EPS: ++ M Block: ++ Sedation: +++ Alpha block: +++
129
Methylphenidate CHX:
Used in ADHD Amphetamine lik
130
Tolcapone adverse affects
Hepatotoxic
131
Buspirone used for
Generalized anxiety disorder
132
In general (tonic clonic) seziures give
1. Valproic acid 2. Phenytoin 3. Carbamazepine 4. Lamotrigine
133
IV anesthetic drugs
1. Thiopental (barb) 2. Midazolam (BZ) 3. Propofol 4. Fentanyl (opiate) 5. Ketamine (Glutamate antagonist)
134
Morphine in Analgesia
* Increase pian tolerance and decrease perception and reacto to pain * Sedation
135
Aripiprazole EPS, M Block, Sedation and Alpha Block:
**Atypical Antiypsycotic** EPS: + M Block: +/- Sedation: +/- Alpha Block: +/-a
136
Mivacurium mechanism of action
* Nondepolarizing (competative) Skeletal muscle relaxant * Very short duration * Metabolized by **Plasma cholinesterases**
137
Naloxone chx:
* Opiod antagonist * IV reversal for respiratory depression
138
TCA adverse affects
Muscarinic and alpha blockade

Pharmacology (12 decks)

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