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Flashcards in Copy of Neurology - Copy of Neurology Deck (52)
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1

Epinephrine (in Neurology)

1) Use: Glaucoma
2) Class/MOA: alpha agonist, decreases aqueous humor synthesis due to vasoconstriction
3) Side effects/ADEs: Mydriasis, stinging: do not use in closed angle glaucoma

2

Brimonidine (in neurology)

1) Use: Glaucoma
2) Class/MOA: Alpha 2 agonist, decreases aqueous humor synthesis
3) blurry vision, ocular redness, pruritus, foreign body sensation, allergic rxn

A2 agonist so you don't BRIM ON

3

Timolol, betaxolol, carteolol (in neurology)

1) Use: Glaucoma
2) Beta blockers, decreases aqueous humor secretion

4

Acetazolamide (in Neurology)

1) Use: Glaucoma
2) Class/MOA: Diuretic, decreases aqueous humor secretion by inhibiting carbonic anhydrase (NaHCO3 diuresis)

Same drug used for altitude sickness! when you climb a mtn you get glaucoma from pressure!!

5

Direct Cholinomimetics (Pilocarpine*, Carbachol) or Indirect Cholinomimetics (Physostigmine, Echhothiophate)

1) Use: Glaucoma
2) Class/MOA: Cholinomimetics, increases the outflow of the aqueous humor; contract ciliary muscle and open trabecular meshwork
3) Miosis, cyclospasm (from contraction of ciliary muscle)
4) use Pilocarpine** in emergencies, very effective at opening meshwork into canal of Schlemm

6

Latanoprost (PGF 2 alpha)

1) Use: Glaucoma
2) Class/MOA: Prostaglandin, increase the outflow of aqueous humor
3) Side effects/ADEs: darkens color of iris (browning)

"Latanoprost makes your eyes look more Latan."

7

Opiod Analgesics (morphine)

2) Class/MOA: Acts as agonists at opioid receptors (mu = morphine, delta = enkephalin, kappy = dynorphin) to modulate synaptic transmission - open K+ channels, close Ca2+ channels = decrease in synaptic transmission (hyperpolarization). Inhibit release of ACh, NE, 5-HT, glutamate, substance P.
3) Addiction, respiratory depression, constipation, miosis (pinpoint pupils), addictive CNS depression with other drugs. Tolerance does not develop with miosis and constipation. Toxicity treated with nalazone or naltrexone (opiod receptor antagonist).

8

Butorphanol

1) Pain; causes less respiratory depression than Full agonists
2) Partial agonist at opiod mu receptors, agonist at kappa receptors.
3) Causes withdrawal if on full opiod agonist (competition for opioid receptors)
4) OD not easily reversed w Naloxone

Bu/you TOR your PHANnie, and now you're in a lot of pain. Use Butorphanol to partially block your mu (~"Bu") and Kappa

9

Tramadol

1) Use: Chronic pain
2) Class/MOA: Very weak opiod agonist; also inhibits serotonin and NE reuptake (works on multiple neurotransmitters - "tram it all" in)
3) Similar to opiods. Decreases seizure threshold.

Implicated in Serotonin Syndrome*** when used concomitantly with Serotoninergic drugs

10

Phenytoin

1) 1st line Tonic-clonic. 1st line prophylax Status Epilepticus. Simple, Complex
2) Class/MOA: Increases Na+ channel inactivation, I.E. use-dependent blockade of Na+ channels: increase refractory period, inhibition of glutamate release from excitatory presynaptic neuron
3) Nystagmus*, diplopia, ataxia*, sedation, gingival hyperplasia, hirsutism, megaloblastic anemia, teratogen ("fetal hydantoin syndrome"), SLE-like sxs, induction of P450, LYMPHADENOPATHY ("pseudolymphoma"), SJS syndrome, osteopenia
4) Fosphentoin for parenteral use. Phenytoin metabolized by P450

-gingival hyperplasia bc Phenytoin incr expression of PDGF. Macrophages exposed to PDGF stimulate proliferation of gingival cells and alveolar bone

11

Carbamazepine

1) 1st line in: Tonic-clonic, Simple, and Complex
2) Class/MOA: Increases Na+ channel inactivation -->reduce ability of Na+ channels to recover from inactivation
3) Diplopia, ataxia, blood dyscrasias (agranulocytosis, aplastic anemia), liver toxicity, teratogenesis, induction of cytrochrome P-450, SIADH, SJS syndrome
4) 1st line for trigeminal neuralgia, also used as a Mood Stabilizer

12

Gabapentin

1) the big three (tonic-clonic, simple, complex)
2) Class/MOA: Designed as a GABA analog, but primarily inhibits HVA Ca2+ channels
3) Side effects/ADEs: sedation, ataxia
4) Fun Facts: also used for peripheral neuropathy and bipolar disorder

makes you feel gabaSPENTIN --> sedation, ataxia (walking crooked cause you're so tired)

13

Topiramate

1) big three seizures
2) Class/MOA: Blocks Na+ channels, increases GABA action
3) Sedation, mental dulling, kidney stones, weight loss.
4) Migraine prevention

Forgot to put your TOP on again bc your in pain (kidney stones) and crash dieting (wieght loss) so you can look sexy for your MATE who turns out to be your teacher but you didn't notice bc too much GABA was making you dull.

14

Phenobarbital

1) big three seizures
2) Class/MOA: increased GABAA action
3) Sedation, tolerance, dependence, induction of cytrochrome P-450
4) Fun Facts: 1st line in pregnant women, children

BARBIe is a toy for kids, EH?/"incr gabaA action. kids get tolerant and dependent on barbie for falling asleep (sedated) at night. Oh yeah, and induce P450

15

Valproic acid

1) 1st line in tonic-clonic. Absence, simple, complex, MYOCLONIC too.
2) Class/MOA: Increases Na+ channel inactivation, increases GABA concentration
3) GI distress, rare but fatal hepatotoxicity (measure LFT), neural tube defects in fetus (spinal bifida), tremor, weight gain. Contraindicated in pregnancy.

Val was a drinker and a fornicator! Gotta check her LFTs and make sure she doesn't get pregnant bc dead baby.

16

Ethosuximide

1) 1st line in Absence seizures
2) Class/MOA: Blocks thalamic T-type Ca2+ channels --> Hyperpolarization
3) GI distress, fatigue, headache, urticaria, Steven's-Johnson syndrome (Every Friday Go Home to Steven's house- Ethosuximide, Fatigue, GI, Headache, SJS)

Ethics SUX, I'm gonna be ABSENT next time we have that class.

17

Benzodiazepines (diazepam or lorazepam)

1) 1st line for acute Status Eplipepticus
2) Class/MOA: Increases GABAA action (incr affinity for receptor)
3) Side effects/ADEs: sedation, tolerance, dependence
4) also used for seizures of eclampsia (1st line is MgSO4) and alcohol withdrawa

18

Benzodiazepines for neurological problems (diazepam, lorazepam, triazolam, temazepam, oxzepam, midazolam, chlodiazepoxide, alprazolam))

1) Use: anxiety, spacticity, status epileptics (lorazepam and diazepam), detoxification (especially in alcohol DTs-DTs), night terrors, sleepwalking, general anesthetic (amnesia, muscle relaxation), hypnotic (insomnia)
2) Class/MOA: Facilitate GABAA action by increasing frequency of Cl- channel opening. Decr REM sleep. Most have long half-lives and active metabolites. FREnzodiazepines (Increase FREquency),
short acting = TOM thumb (Triazolam, Oxzepam, Midazolam ... also has the highest addictive potential).
Benzos, barbs, and EtOH all bind GABA(A)-R which is a ligand-gated chloride channel.

3) Side effects/ADEs: dependence, additive CNS depression effects with alcohol. Less risk of respiratory depression and coma than with barbiturates.

4) Fun Facts: treat overdose with FLUMAZENIL (competitive antagonist at GABA benxodiazepine receptor)

19

Tiagabine

1) Simple, Complex
2) Class/MOA: inhibits GABA reuptake

"Tia for Gabine!" i.e. inhibits GABA reuptake so it can be invited for tea for two

20

Vigabatrin

1) Simple, Complex
2) Class/MOA: Irreversibly inhibits GABA transaminase - increases GABA

VItalize GABA by inhibiting TRINsaminase

21

Levetiracetam

1) the big three
2) Class/MOA: Unknown, may modulate GABA and glutamate release

22

Barbiturates (Phenobarbital, Pentobartibal, thiopental, secobarbital)

1) Use: sedative for anxiety, seizures, insomnia, induction of anesthesia (thiopental)
2) Class/MOA: facilitate GABAA action by increasing duration of Cl- channel opening, thus decreasing neuron firing (barbiDURATe - increase DURATion).
3) Side effects/ADEs: dependence, additive CNS depression effects with alcohol, respiratory or cardiovascular depression (can lead to death), drug interactions owing to induction of liver microsomal enzymes (cytrochrome P-450)
4) Fun Facts: treat overdose with symptom management (assist respiration, increase blood pressure). Contraindicated in porphyria.

23

Nonbenzodiazepine hypnotics (zolpidem aka ambien, zaleplon, eszopiclone)

1) Use: Insomnia
2) Class/MOA: act via the BZI receptor subtype and are reversed by flumazenil
3) Side effects/ADEs: Atazia, headaches, confusion. Short duration because of rapid metabolism by liver enzymes. Unlike older sedative-hypnotics, cause only modest day-after psychomotor depression and few amnesic effects. Lower dependence risk than benzodiazepines.
4) Fun Facts

24

Inhaled anesthetics (halothane, enflurane, isoflurane, sevoflurane, methoxyflurane, NO)

1) Use & Effects: Anesthetic --> myocardial depression, respiratory distress, nausea/emesis, decr renal fxn*, incr cerebral blood flow by decr cerebral vasc. resistance (decr cerebral metabolic demand) but --> incr ICP

2) Class/MOA: mechanism unknown
3) Side effects/ADEs: Hepatotoxicity (Halothane), Nephrotoxicity (Methoxyflurane), Proconvulsant/~Epilepticy (Enflurane), malignant hyperthermia (rare), expansion of trapped gas (NO)

25

Intravenous anesthetic: Barbiturate (thiopental)

1) Use & Effects: intravenous anesthetic, used for induction of anesthesia and short surgical procedures. Effect terminated by rapid redistribution into skeletal muscle* and adipose tissue. Decrease in cerebral blood flow.
2) Class/MOA: high potency, high lipid solubility, rapid entry into the brain

26

Intravenous anesthetic: Benzodiazepines (Midazolam)

1) Use: intravenous anesthetic, used for endoscopy; used adjunctively with gaseous anesthetics and narcotics
2) Class/MOA:
3) Side effects/ADEs: may cause severe postoperative respiratory distress, decrease in blood pressure (treat overdose with flumazenil) and amnesia.
4) Fun Facts

27

Intravenous Anesthetic: Arylcyclohexylamines (Ketamine)

1) Use: intravenous anesthetic
2) Class/MOA: PCP analogs that act as dissociate anesthetics, blocks MNDA receptors.
3) Side effects/ADEs: cardiovascular stimulant, causes disorientation, hallucination and bad dreams, increases cerebral blood flow.
4) Fun Facts

28

Intravenous Anesthetic: Opiates (morphine, fentanyl)

1) Use: used with other CNS depressants during general anesthesia
2) Class/MOA:
3) Side effects/ADEs:
4) Fun Facts

29

Intravenous Anesthetics: Propofol

1) Use: rapid anesthesia induction and short procedures.
2) Class/MOA: Potentates GABAA receptors.
3) Side effects/ADEs: Less postoperative nausea than thiopental.
4) Fun Facts: Not recommended for home use by pop stars

30

Local Anesthetics (esters: procaine, cocaine, tetracain; amides-lidocaine, mepivaciane, bupicacaine - amides have 2 I's in each name)

1) Use: Minor surgical prodeedures, spinal anestheia. If allergic to esters, give amides.

2) Class/MOA: block Na+ channels by binding to specific receptors on inner portion of channel. Perferentially bind to activated Na+ channels, so most effective in rapidly firing neurons. tertiary amine local anesthetics penetrate membrnae in uncharged form, then bind to ion channel as charged form.
3) Side effects/ADEs:CNS excitation, severe cadiovascular toxifity (bupivacaine), hypertension, hypotension and arrhthmias (cocaine).

4) Principle: 1) in infected (acidic) tissue, alkaline anesthetics are charged and can't penetrate membranes effectivly. More anestetic is needed in these cases. 2) order of nerve blockage- small diamaeter fibers > large diameter. Myelinated fibers > unmyelinated fibers. Overall, size factor predominates over myelination such that small myelinated fibers >small unmyelinated fibers > large myelinated fibers > large unmyelinated fibers. Order of loss - pain (lose first) > temperature > touch > pressure (lose last).

Give w vasoconstrictor/EPI to enhance local action