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Flashcards in CNS Pharm EC Deck (53):
1

Phenytoin (MOA, Use)

Inactivate Na channels

1st line for tonic clonic seizures
1st line for status epilepticus prophylaxis
Simple partial seizures
Complex partial seizures

2

Phenytoin toxicity

Nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hirsutism, megaloblastic anemia, teratogen, SLE-like syndrome, induction of P450s, lymphadenopathy, Steven's Johnson syndrome, osteopenia

3

Carbamazepine (MOA, Use)

Inactivate Na channels

1st line for simple partial seizures
1st line for complex partial seizures
1st line for tonic clonic seizures
1st line for trigeminal neuralgia

4

Carbamazepine toxicity

Diplopia, ataxia, blood dyscrasias, liver toxicity, induce P450s, teratogen, SIADH, Stevens-Johnson syndrome

5

Lamotrigine (MOA, Use)

Blocks voltage gated Na channels

Simple partial seizures
Complex partial seizures
Tonic clonic seizures

6

Lamotrigine toxicity

Stevens-Johnson syndrome

7

Gabapentin (MOA, Use)

Inhibits voltage activated Ca channels

Simple partial seizures
Complex partial seizures
Tonic clonic seizures
Peripheral neuropathy
Migraine prophylaxis
Bipolar disorder

8

Gabapentin toxicity

Sedation, ataxia

9

Topiramate (MOA, Use)

Blocks Na channels
Potentiates GABA

Simple partial seizures
Complex partial seizures
Tonic clonic seizures
Migraine prevention

10

Topiramate toxicity

Sedation, mental dulling, kidney stones, weight loss

11

Phenobarbital (MOA, Use)

Potentiate GABAa

1st line in children
Simple partial seizures
Complex partial seizures
Tonic clonic seizures

12

Phenobarbital toxicity

Sedation
Tolerance
Dependence
Induction of P450s

13

Valproic acid (MOA, Use)

Inactivate Na channels
Increase GABA concentration

1st line for tonic clonic seizures
Simple partial seizures
Complex partial seizures
Absence seizures
Myoclonic seizures

14

Valproic acid toxicity

GI distress
Fatal hepatotoxicity
Neural tube defects (contraindicated in pregnancy)
Tremor
Weight gain

15

Ethosuximide (MOA, Use)

Blocks thalamic T-type Ca channels

1st line for absence seizures

16

Ethosuximide toxicity

GI distress
Fatigue
Headache
Urticaria
Stevens-Johnson syndrome

17

Diazepam or Lorazepam (MOA, Use in seizures)

Potentiate GABAa

1st line for acute status epilepticus
Seizures of eclampsia

18

Tiagabine (MOA, Use)

Inhibits GABA reuptake

Simple partial seizures
Complex partial seizures

19

Vigabatrin (MOA, Use)

Irreversibly inhibits GABA transaminase (increases [GABA])

Simple partial seizures
Complex partial seizures

20

Levetiracetam (MOA, Use)

Modulate GABA and glutamate release

Simple partial seizures
Complex partial seizures
Tonic clonic seizures

21

Zolpidem, Zaleplon, Eszopiclone (MOA, Use, Tox)

Act on BDZ1 GABA receptor (effects reversed by flumazenil)

Treats insomnia

Can cause ataxia, headaches, confusion.

22

Halothane, enflurane, isoflurane, sevoflurane, methoxyflurane, nitrous oxide (Use, Effects, Tox)

Inhaled anesthetics

Myocardial depression, respiratory depression, N/V, Increase cerebral blood flow

Malignant hyperthermia (all but NO)

23

Halothane toxicity

Hepatotoxicity

24

Methoxyflurane toxicity

Nephrotoxicity

25

Enflurane toxicity

Proconvulsant

26

NO toxicity

Expansion of trapped gas in a body cavity

27

Thiopental (Class, Use, Effects)

High potency barbiturates used as IV anesthetic

Induction of anesthesia

Rapid redistribution
Decrease cerebral blood flow

28

Midazolam (Class, Use, Effects)

Benzodiazepine used as IV anesthetic

Choice for endoscopy
Adjunct with gaseous anesthetics and narcotics

Severe postoperative respiratory depression
Decrease in BP
Amnesia

29

Ketamine (MOA, Use, Effects)

Block NMDA receptor (PCP analog) used as IV anesthetic

Cardiovascular stimulant
Disorientation
Hallucination/bad dreams
Increase cerebral blood flow

30

Morphine and Fentanyl as IV anesthetics

Adjunct in general anesthesia

31

Propofol (MOA, Use, Effects)

Potentiates GABAa

IV anesthetic

Used for sedation in ICU
Rapid anesthesia, induction and short procedures
Little postoperative nausea

32

Procaine, Cocaine, Tetracaine (Class, MOA, Use, Tox)

Ester local anesthetic

Block activated Na channels (most effective in rapidly firing neurons)

Minor surgical procedures, spinal anesthesia

Causes CNS excitation, Hypertension/Hypotension

33

Lidocaine, Mepivacaine, Bupivacaine (Class, MOA, Use, Tox)

Amide local anesthetic (2 I's in name)

Block activated Na channels (most effective in rapidly firing neurons)

Minor surgical procedures, spinal anesthesia

Causes CNS excitation, Hypertension/Hypotension
CV toxicity (Bupivacaine)
Arrhythmias (Cocaine)

34

Succinylcholine (MOA, Use, Tox, Reversal of blockade)

Depolarizing neuromuscular blocker
ACh receptor agonist (sustained depolarization and prevents muscle contraction)

Muscle paralysis in surgery or mechanical ventilation

Hypercalcemia, Hyperkalemia, malignant hyperthermia

Phase I (prolonged depolarization) - no antidote
Phase II (repolarization, ACh desensitized) - Cholinesterase inhibitors (Neostigmine)

35

Tubocurarine, Atracurium, Mivacurium, Pancuronium, Vecuronium, Rocuronium (MOA, Use, Reversal of blockade)

Competitive antagonists at ACh receptors

Nondepolarizing neuromuscular blocker

Cholinesterase inhibitors (Neostigmine, edrophonium)

36

Dantrolene (MOA, Use)

Prevents Ca release from SR of skeletal muscle

Treatment of MALIGNANT HYPERTHERMIA
Treats neuroleptic malignant syndrome (antipsychotic toxicity)

37

Bromocriptine, Pramipexole, Ropinirole (MOA, Use)

Dopamine agonists

Used to treat Parkinson's

38

Amantadine (MOA, Use, Tox)

Increases dopamine levels

Used in Parkinson's
Used as antiviral against Influenza A and Rubella

Can cause ataxia

39

L-DOPA/Carbidopa (MOA, Use, Tox)

L-DOPA can cross BBB and is converted to dopamine
*given with Carbidopa which inhibits PERIPHERAL dopa decarboxylase to isolate effect to CNS

Used in Parkinson's

Arrhythmias
Dyskinesia with long term use

40

Selegiline (MOA, Use)

MOA-B blocker (prevent dopamine breakdown)

Adjunct to L-DOPA in Parkinson's

41

Entacapone, Tolcapone (MOA, Use)

COMT inhibitors (prevent L-DOPA breakdown)

Used in parkinson

42

Benztropine (MOA, Use)

Antimuscarinic

Improves tremor and rigidity in Parkinson's

43

Memantine (MOA, Use, Tox)

NMDA antagonist (prevents Ca-mediated excitotoxicity)

Used in Alzheimer's

Dizziness, confusion, hallucinations

44

Donepezil, Galantamine, Rivastigmine (MOA, Use, Tox)

Acetylcholinesterase inhibitors

Used in Alzheimer's

Nausea, dizziness, insomnia

45

Tetrabenazine, Reserpine (MOA, Use)

Inhibit VMAT (limiting dopamine vesicle packaging and release)

Used in Huntington's

46

Haloperidol (MOA, Use in Huntington's)

Dopamine receptor antagonist

47

Sumatriptan (MOA, Use, Tox)

5-HT1B/1D agonist
(inhibits trigeminal nerve activation, prevents vasoactive peptide release, induces vasoconstriction)

Used in acute migraines and cluster headache

Coronary vasospasm (contraindicated in CAD or Prinzmetal's angina)

48

Epinephrine, Brimonidine (MOA, Use, Tox)

alpha-agonists -decrease aqueous humor synthesis

Open angle glaucoma

Mydriasis, blurry, vision, ocular hyperemia, foreign body sensation, allergic reaction/pruritus

49

Timolol, Betaxolol, Carteolol (MOA, Use, Tox)

Beta-blockers - decrease aqueous humor synthesis

Glaucoma

No pupillary or vision changes

50

Acetazolamide in eye (MOA, Use, Tox)

Decrease aqueous humor synthesis via inhibition of carbonic anhydrase

Glaucoma

No pupillary or vision changes

51

Pilocarpine, Carbachol (MOA, Use Tox)

Direct Cholinomimetics - Increase aqueous humor outflow via contraction of ciliary muscle and opening of trabecular meshwork

Glaucoma (USE PILOCARPINE FOR EMERGENCIES)

Miosis and cyclospasm (contraction of ciliary muscle)

52

Physostigmine, Echothiophate (MOA, Use, Tox)

Indirect Cholinomimetics - Increase aqueous humor outflow via contraction of ciliary muscle and opening of trabecular meshwork

Glaucoma

Miosis and cyclospasm (contraction of ciliary muscle)

53

Latanoprost (MOA, Use, Tox)

Prostaglandin - PGF2a (increase aqueous humor outflow)

Glaucoma

Darkens color of iris