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Flashcards in Copy of Neurology - Copy of Neurology Deck (52)
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31

Neuromuscular Blocking Drugs, Depolarizing (Succynlcholine)

1) Use: for muscle paralysis in surgery or mechanical ventilation. Selective for motor (vs. autonomic) nicotinic receptor.
2) strong Ach receptor agonist --> sustained depolarization/prevent m contraction.
3) hypercalcemia, hyperkalemia, Hyperthermia*
4) for reversal of blockage: Phase I) prolonged depolarization: no antidote. Block potential by cholinesterase inhibitors. Phase II) repolarized by blocked: antidote consists of cholinesterase inhibitors (e.g. neostigmine).

32

Neuromuscular blocking drugs, Nondepolarizing (tubocuraine, atracurium, mivacurium, pancuronium, verocuronium, rocuronium).

1) Use: for muscle paralysis in surgery or mechanical ventilation. Selective for motor (vs. autonomic) nicotinic receptor.
2) Competitive antagonist for Ach Nicotinic receptors
4) reversal of blockage (incr Ach): neostigmine, edrophonium and other cholinesterase inhibitors.

33

Dantrolene

1) Use: used in the treatment of malignant hyperthermia, which is caused by inhalation anesthetics (except N2)) and succinylcholine. Also used to treat neuropleptic malignant syndrome (a toxicity of antipsychotic drugs)

2) Class/MOA: Prevents release of Ca2+ from sarcoplasmic reticulum of skeletal muscle

34

Bromocriptine (ergot), pramipexole, ropinirole (non ergot, preferred)

1) Use: Parkinson's
2) Class/MOA: agonize dopamine receptors

BROs do DOPe (agonizes receptors)

35

Amantadine

1) Use: Parkinson's, also used as a antiviral against influenza A and rubella; toxicity = ataxia
2) Class/MOA: Increase dopamine release

36

L-dopa/carbidopa

1) Use: Parkinson's
2) Class/MOA: increase dopamine, converted to dopamine in the CNS. Unlike dopamine, L-dopa can cross the blood brain barrier and is converted by dopa decarboxylase in the CNS to dopamine.
3) Side effects/ADEs: Arrhythmias from peripheral conversion to dopamine. Long term use can cause dysskinesia following administration, akinesia between doses.

Carbidopa, a peripheral decarboxylase inhibitor, is given with L-dopa to increase the bioavailability of L-dopa in the brain and to limit peripheral side effects.

37

Selegiline

1) Use: Adjunctive agent to L-dopa in treatment of Parkinson's disease.
2) Class/MOA: prevent dopamine breakdown, selective MAO type B inhibitor, which preferentially metabolizes dopamine over NE and 5-HT, thereby increasing the availability of dopamine.
3) Side effects/ADEs: may enhance adverse effects of L-dopa

38

Entacapone, tolcapone

1) Use: Parkinson's
2) Class/MOA: prevent dopamine breakdown, COMT inhibitor - prevent peripheral L-dopa degradation, thereby increasing dopamine availability/incr quantity of dopamine entry into brain
3) Tolcapone: hepatotoxicity

al -CAPONE had L-Dopa's back, prevented its degradation by blocking COMT

39

Benztropine

1) Use: Parkinsons
2) antimuscarinic; improves tremor and rigidity but has little effect on bradykinesia

4) Fun Facts: Park your Mercedes-Benz

40

Memantine

1) Use: Alzheimer's drug
2) NMDA receptor antagonist, helps prevent excitotocity (mediated by Ca2+)
3) Side effects/ADEs: Dizziness, confusion, hallucinations

Memantine is a meme of Ketamine --> blocks NMDA receptors, causes hallucinations

41

Donepezil, falantamine, rivastigmine

1) Use: Alzheimer's
2) Class/MOA: acetylcholinesterase inhibitor
3) Side effects/ADEs: Nausea, dizziness, insomnia

42

Reserpine + tetrabenazine

1) Use: Huntington's drug
2) Inhibit VMAT; limit dopamine vesicle packaging and release

43

Haloperidol

1) Use: Huntington's drug
2) Class/MOA: dopamine receptor antagonist

44

Sumatriptan

1) Use: Acute migraine, cluster headache attacks.
2) Class/MOA: 5-HT 1B/1D agonist. Causes vasoconstriction, inhibition of trigeminal activation and vasoactive peptide release. Half life <2 hrs
3) Coronary vasospasm, mild tingling.
4) Fun Facts: A SUMo wrestler TRIPs ANd falls on your head! Sumo wrestlers are fat and have coronary vasospasm

45

Fentanyl

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).

46

Codeine

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).

47

Heroin

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).

48

Methadone

1) Maintenance programs for addicts
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).

49

Meperidine

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).

50

Dextromethorphan

1) Pain, cough suppression
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).

51

Diphenoxylate

1) Diarrhea (+ loperamide =immodium)
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).

52

Lamotrigine

1) the big three seizures
2) blocks voltage-gated Na+ channels
3) SJS