CNS Drugs: Unique Features

Question 1

inhibits aldehyde dehydrogenase…

Answer 1

disulfiram

Question 2

inhibits alcohol dehydrogenase…

Answer 2

fomepizole

Question 3

Which has a ceiling effect? BZs or Barbs?

Answer 3

BZs

Question 4

Describe the dose response curve of barbiturates and what this means…

Answer 4

steep, low margin of safety

Question 5

Duration of action?

Diazepam
flurazepam
temazepam
chlordiazepoxide

Answer 5

Long acting

Question 6

Duration of action?

alprazolam
lorazepam
oxazepam

Answer 6

Intermediate acting

Question 7

Duration of Action?

midazolam
triazolam

Answer 7

very short acting

Question 8

do BZs depend on GABA binding the receptor?

Answer 8

yes

Question 9

Flumazenil has what C/I?

Answer 9

hx of seizure

Question 10

Describe the margin of safety for Z drugs…

Answer 10

high margin of safety

Question 11

Which Z drug is unique in that it has a long half-life and is used in long-term treatment?

Answer 11

eszopiclone

Question 12

What type of psychotic sxs?

hallucination, delusion
catatonic behavior
disorganized speech/thoughts

Answer 12

positive sxs

Question 13

overactive limbic system DA pathways describes…

Answer 13

positive mesolimbic symptoms

Question 14

underactive DA pathway in PFC describes

Answer 14

Negative mesocortical sxs

Question 15

What type of psychotic sxs?

Affective behavior
Apathy
Withdrawal
Anti-social
Lack of motivation
depression

Answer 15

negative sxs

Question 16

How long for antipsychotic onset?

Answer 16

6 weeks

Question 17

The below mechanism describes what type of psychotic sxs?

DA receptor blockade in nigrostriatal pathway

Imbalance of striatal DA and ACh → Parkinson’s like sxs

Answer 17

extrapyramidal sxs

Question 18

Choreic, uncontrolled jerky movements of face and limbs

S/E of long-term tx, often irreversible

Answer 18

tardive dyskinesia

Question 19

which two antipsychotics are least likely to cause tardive dyskinesia

Answer 19

clozapine

olanzapine

Question 20

what is the tx for EPS?

Answer 20

benztropine (anticholinergic)

Question 21

which antipsychotic class is more likely to cause EPS?

Answer 21

classic antipsychotics

Question 22

** LIFE THREATENING **

Block of Striatal and Hypothalamic DA D2 receptors → Muscle Rigidity, Hyperpyrexia

Answer 22

neuroleptic malignant syndrome

Question 23

neuroleptic malignant syndrome can be treated with what two drugs?

Answer 23

1st line: dantrolene (muscle relaxant for hyperthermia, rigidity)
2nd line: bromocriptine (DA agonist)

Question 24

The below antipsychotics have increased risk of…

Lurasidone
clozapine

Answer 24

agranulocytosis

Question 25

describe the metabolism of lithium

Answer 25

no metabolism

Question 26

The below have what major S/E? ``` Carbamazepine phenytoin phenobarbital lamotrigine valproate ```

Answer 26

SJS

Question 27

What type of seizure? Begin in focused cortical area, then may spread

Answer 27

partial

Question 28

What type of seizure? No LOC, 20-90s Grimacing Focal clonic jerking of extremity

Answer 28

simple partial

Question 29

what type of seizure? AMS or LOC, Hallucination, < 120s Temporal lobe Automatic movements

Answer 29

Simple complex

Question 30

What type of seizure? LOC Muscle contractions alternating w. relaxation

Answer 30

Partial w. Secondary Generalized Tonic-Clonic

Question 31

What type of seizure? 15-30s tonic rigidity → tremor → clonic jerking LOC, AMS (stupor, confusion) Arise from reciprocal firing of thalamus and cortex

Answer 31

Generalized tonic-clonic

Question 32

What type of seizure? sudden onset, 15-30s, no LOC Loss of Awareness

Answer 32

Generalized absence

Question 33

What type of seizure brief spasm/rigidity, seconds long secondary to other seizure d/o

Answer 33

Generalized myoclonic

Question 34

What type of seizure? sudden loss of postural tone patient falls down

Answer 34

Generalized atonic

Question 35

The below drugs have what benefit? ``` ethosuximide vigabatrin levetiracetam topiramate TCAs ```

Answer 35

safe in pregnancy/non-teratogenic

Question 36

Describe the kinetics of phenytoin at therapeutic doses?

Answer 36

zero order

Question 37

topiramate can increase the metabolism of what other meds?

Answer 37

OCPs

Question 38

what prolongs the absorption of valproate?

Answer 38

food

Question 39

seizures and sedation are more common in what class of TCAs?

Answer 39

Tertiary Amines (amitriptyline, imipramine)

Question 40

What increases the metabolism of... OCPs digoxin protease inhibitor warfarin

Answer 40

st. john's wort

Question 41

schizophrenia occurs with progressive loss of...

Answer 41

grey matter

Question 42

sxs of parkinson's occur due to...

Answer 42

loss of DA in substantia nigra

Question 43

This is an aggregation of alpha-synuclein/proteins in the nigrostriatal system

Answer 43

lewy body

Question 44

sxs of parkinson's appear when there is ___% of DA neurons

Answer 44

70-80%

Question 45

The decreased DA production from substantia nigra in parkinson's leads to a change in the ratio of...

Answer 45

DA:ACh

Question 46

Alzheimer's is a function of accumulating...

Answer 46

beta amyloid plaques tau protein tangles

Question 47

What causes the decreased memory/cognition in alzheimers?

Answer 47

degeneratio of cholinergic neurons in the nucleus of meynert

Question 48

Alcohol is metabolized by and induces CYP ____

Answer 48

CYP2E1

Question 49

The primary pathway for alcohol metabolism is thru...

Answer 49

EtOH to acetaldehyde via ADH and acetaldehyde to acetate via ALDH

Question 50

the ADH pathway of alcohol metabolism via oxidation requires which cofactor, which can be diminished in chronic users?

Answer 50

NAD+

Question 51

The minor metabolic pathway of alcohol is _____

Answer 51

Microsomal-ethanol oxidizing system via CYP2E1

Question 52

CYP2E1 increases toxicity of...

Answer 52

acetaminophen

Question 53

these BZs are useful for the person who has trouble staying asleep

Answer 53

flurazepam, temazepam