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CNS Pharm Flashcards

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1
Q

Are BZs or Barbs safer?

A

BZs

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2
Q

What can Barbs or alcohol lead to that BZs can’t?

A

Coma

BZs can reach medullary depression and level out, Barbs and alcohol can pass that and lead to coma

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3
Q

Describe the GABA-A binding complex.

A

5 subunits – a, B, y, p, d

Alpha = GABA binding site
Gamma = BZ binding site
Beta = Barb binding site
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4
Q

GABA-A activation leads to the movement of what ion?

A

Increased Cl- influx

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5
Q

GABA-B activation leads to the movement of what ion?

A

Increased K+ efflux

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6
Q

This drug class potentiates GABA and increases the FREQUENCY of Cl- channel opening.

A

BZs

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7
Q

This drug class prolongs GABA activity by increasing DURATION of Cl- channel opening.

A

Barbs

“BarbiDURate”

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8
Q

This nonspecific BZ receptor antagonist is used for BZ overdose or anesthesia reversal.

A

Flumazenil

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9
Q

Which BZ receptor mediates sedation and is largely used for sleep disorders?

A

BZ-1

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10
Q

What are the suffixes used for BZs?

A
  • lam

- pam

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11
Q

This BZ is best for acute anxiety attacks, panic, or phobias.

A

Alprazolam

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12
Q

This BZ is long-acting and best for anxiety, preop sedation, muscle relaxation, and withdrawal states.

A

Diazepam

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13
Q

Which BZs are used for sleep disorders?

A

Temazepam

Oxazepam

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14
Q

This BZ is short-acting and used for preop sedation and anesthesia.

A

Midazolam

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15
Q

List the BZs (6).

A 
Alprazolam 
Diazepam
Lorazepam
Midazolam
Temazepam
Oxazepam
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16
Q

Which BZs are safe for use in pts with liver dysfunctions? Why?

A

Oxazepam
Temazepam
Lorazepam

They are conjugated extrahepatically, making use safer for pts with liver dysfunctions

“OTL” = “Outside The Liver”

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17
Q

Which Barb is used for seizures?

A

Phenobarbital

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18
Q

What are the withdrawal signs of Barbs and ethanol?

A

Anxiety
Agitation
Life-threatening seizures (Delirium tremens w/ alcohol)

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19
Q

What is the best way to treat withdrawal from Barbs and ethanol?

A

Long-acting BZs

Supportive care

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20
Q

What are the non-BZ drugs and their MOA?

A

Zolpidem - BZ-1 receptor agonist
Zaleplon - BZ-1 receptor agonist
Buspirone - 5HT1a partial agonist

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21
Q

What is the main use for Zolpidem and Zaleplon?

A

Sleep disorders

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22
Q

This drug is better for chronic anxiety because it takes 1-2 weeks to fully work.

A

Buspirone

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23
Q

Due to the end-product of alcohol metabolism being acids, what severe electrolyte disorder can occur?

A

Metabolic acidosis

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24
Q

Ethylene glycol (antifreeze) metabolizes into what acids?

A

Glycolic acid –> Oxalic acid

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25
What is the most worrisome side effect from ethylene glycol metabolism?
Nephrotoxicity
26
Methanol metabolizes into what?
Formaldehyde --> Formic acid
27
What is the most worrisome side effect from methanol metabolism?
Ocular damage
28
Ethanol metabolizes into what?
Acetaldehyde --> Acetic acid
29
What enzyme is inhibited by Disulfiram in ethanol metabolism?
Acetaldehyde dehydrogenase
30
What are the drugs that cause a Disulfiram-like effect when taken with alcohol?
Metronidazole Griseofulvin Cefoperazone
31
What is the best treatment for OD of ethylene glycol or methanol?
Ethanol -- b/c it's the best substrate for alcohol dehydrogenase (gonna have a hella hangover tho)
32
This is another antidote that can be used for methanol OD, it is a long-acting inhibitor of alcohol dehydrogenase.
Fomepizole
33
What are the characteristics of a child with fetal alcohol syndrome?
``` Growth restriction Midfacial hypoplasia Microcephaly CNS dysfunction Mental retardation ```
34
What are the main SSRIs used? (5)
``` Fluoxetine Paroxetine Sertraline Citalopram Fluvoxamine ```
35
What is the MOA of SSRIs?
Selective blockade of 5HT reuptake
36
What are the major uses for SSRIs?
``` Major depression OCD Bulimia PMDD PTSD ```
37
What is a major side effect of SSRIs that results in many pts discontinuing their use?
Sexual dysfunction (can't orgasm or have decreased libido)
38
If SSRIs are used in conjunction with other drugs that cause increased 5HT, what can result?
Serotonin syndrome
39
What are the characteristics of serotonin syndrome?
``` Sweating Rigidity Myoclonus Hyperthermia ANS instability Seizures ```
40
What are the main Tricyclic Antidepressants (TCAs)?
Amitriptyline Imipramine Clomipramine
41
What is the suffix most often used for TCAs?
-ipramine
42
What are major uses of TCAs? *Besides depression b/c mostly SSRIs are used now*
``` Neuropathic pain (diabetics or postherpetic neuralgia) Enuresis (bed-wetting) ```
43
What is the MOA of TCAs?
Nonspecific blockade of 5HT and NE reuptake
44
What the "3 C's" of toxicity that can occur with TCAs?
Coma Convulsions Cardiotoxicity (***Torsades de pointe***)
45
This class of drugs are like TCAs but without the ANS effects, and its use is for depression.
SNRIs
46
What are the main SNRIs?
Venlafaxine Desvenlafaxine Duloxetine
47
What is the MOA of SNRIs?
Inhibit reuptake of both serotonin and NE
48
Which drugs, if combined, can result in serotonin syndrome?
SSRIs TCAs MAOIs Meperidine
49
What are the MAOIs?
Phenelzine | Tranylcypromine
50
MAOIs are (IRREVERSIBLE/REVERSIBLE) inhibitors of MAO-A and MAO-B.
Irreversible
51
This antidepressant is associated with cardiac arrhythmias and priapism.
Trazodone
52
This antidepressant is a dopamine and NE reuptake blocker that has fewer sexual side effects, so pts often switch to this.
Bupropion
53
This drug is a dopamine and NE reuptake blocker used in smoking cessation.
Bupropion
54
This drug is a partial agonist of nicotinic receptors used in smoking cessation.
Varenicline
55
This is the DOC for bipolar disorders.
Lithium
56
What is the MOA of lithium?
Prevents recycling of inositol by blocking inositol monophosphatase (results in decreased cAMP)
57
What are the most worrisome side effects of lithium?
Tremor Hypothyroidism with goiter Nephrogenic diabetes insipidus
58
Lithium can be teratogenic. What abnormalities can it lead to in the fetus?
Ebstein anomaly (malformed tricuspid valve)
59
What other drugs can be used in bipolar disorders?
Valproic acid | Carbamazepine
60
What drugs are often used in ADHD?
Methylphenidate Amphetamine Atomoxetine (backup to methylphenidate)

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