eneuro Flashcards
(154 cards)
1
Q
DOC for absence seizures
A
ethoxsuximide
2
Q
mechanism for ethosuximide
A
blocks thalamic T type Ca 2+ channels that trigger and sustain rhytmical burst discharges in thalamic neurons
3
Q
SE of ethoSUXimide
A
EFGHIJ ethoxsuximide causes fatigue GI distress Headache itching (and urticaria) SJS
4
Q
epilepsy benzodiazepines
A
diazepam, lorazepam, midazolam
5
Q
DOC for status epilepticus
A
lorazepam
6
Q
SE of epilepsy benzodiazepines
A
sedation tolerance, dependdance, resp depression
7
Q
also for eclampsia seizures
A
benzodiazepines
8
Q
1st line for eclampsia seizures
A
mgso4
9
Q
phenobarbitol is 1st line in
A
neonates
10
Q
SE of phenobarbitol
A
sedation, tolerance, depdence, induction of p450, cardiresp depression
11
Q
phenobarbital treats which seizures
A
partial (focal), tonic-clonic
12
Q
phenotoin, fosphenytoin mechanism of action
A
blocks na+ channels; 0 order kinetics
13
Q
prophylaxis for status epilepticus
A
phenytoin
14
Q
1st line for acute status epilepticus
A
benzodiazepines
15
Q
Neurologic SE of phenytoin
A
nystagmus, diplopia, ataxia, sedation, peripheral neuropathy
16
Q
derm se of phenytoin
A
hirsuitism, SJS, gingival hyperplasia, DRESS syndrome
17
Q
MSK se of phenytoin
A
osteopenia, SLE-like syndrome
18
Q
hematologic se of phenytoin
A
megaloblastic anemia
19
Q
reproductive SE of phenytoin
A
teratogeniss (fetal hydantoin syndrome
20
Q
other SE of phentyoin
A
cytochrome p450 induction
21
Q
1st line for tonic clonic seizures
A
phenytoin , valproic acid
22
Q
carbamazepine first line for
A
partial seizures
23
Q
mechanism of action for carbamazzepin
A
blocks na+ channel (reduces aiblity of na channel to receover from inactivation)
24
Q
SE of carbamezipne
A
dipolopia, ataxia, blood dyscrasisas (agranulocytosis aplastic anemia), liver toxicity, teratogensis, induction of cytochrone p450, SIADH, SJS; bone marrow suppression
25
1st line for trigeminal neuralgia
carbamezepin
26
episodic severe unilateral eelctrical shock like pattern distrubiton of CN5; symptoms triggered by innocus stimuli: shaving/ washing face
trigeminal neuralgia
27
mechanism of action for valproic acid
na+ channel inactivation, increase Gaba concentration by inhibiting gaba transaminase
28
SE of valproic acid:
GI distress, rare but fatal hepatoocity, pancreatitis, neural tube defects, tremor, weight gain, CI in pregnancy
29
1st line for myoclonic seizures
valproic acid
30
used in bipolar disorder and migraine prophylaxis
valproic acid
31
vigabatrin mechanism
increaese gaba by irreversibly inhibitng gaba transaminase
32
se of vigabatrin
permanent visual loss (black box warning)
33
vigabatrin treats
partial seizure
34
gabapentin mechanism
primarily inhibits high voltage activated ca channels; designed as gaba analog
35
se of gabapentin
sedation, ataxia, confusion
36
also used for peripheral neuropathy, postherpetic neuralgia
gabapentin
37
use of gabapentin
focal seizure
38
topiramate mechanism
blocks na+ channels, increase gaba action
39
SE of topiramate
sedation , mental dulling, KIDNEY STONES, weight loss, glaucoma
40
topiramte also used for migraine prevention
true
41
topiramate treats
partial, tonic clonic seizures
42
lamotrigine mechanism
blocks voltage gated na channels; inhibits release of glutamate; also effective for BPD
43
SE of lamotrigine
SJS; also
44
lamotrigine use
partial, tonic clonic, absence
45
levetiracetam mechanism
binds to synaptic vesicel protein (SV2A)
46
SE of levetiracetam
fatigue, drowsiness, headache, neuropsychiatric symptoms (personality changes)
47
use of levetiracetam
partial, tonic clonic
48
tiagabine use
partial
49
tiagabine mechaism
increase gaba by inhibiting reuptake
50
Juvenile mycolonus epilepsy treated with
valproic acid
51
DRESS SYDNROME
phenytoin
52
2-8 weekks after use of anticonvulsants, allopurinol, sulfonamides, antiboitics. pt's get fever, generalized lymphadenopathy facial edema, diffuse morbiliform skin rash that progress to a confluent erythema w follicular accentaution; internal organ dysfucntion. lab studies: eosinophilia, atypical lymphocytes
dress sydnrome
53
thiopental is a
barbiturate
54
name the barbiturates
phenobarbital, pentobarbital, thiopental, secobarbital
55
mechanism of barbiturates
faciliate GABAa action by increasing duration of CL- channel opening, thus decrease neuron firing
56
contraindicated in porphyria
barbiturates
57
induction of anesthesia caused by which barbiutrate
thiopental
58
barbiturates use
sedative for anxiety, seizures, insomnia, induction of anesthesia
59
name the benzodiazepines
diazepam, lorazepam, traizolam, temazepam , oxazepam, midazolam, chlordiazepoxide, alprazolam
60
mechanism of benzodiazepines
facilitate GABAa action by increaseing frequency of CL- channel opening. Decreases rem sleep
61
benzodiazepines have short or long half lives
long half lives and active metabolites mostly
62
exceptiosn to long halv lives and active metabolites
```
ATOM
alprazolam
triazolam
oxazepam
midazolam
```
63
midazolam is a
benzodiazepine
64
ATOM have higher or lower addictive potential
higher; bc shorter acting : alprazolam, triazolam, oxazepam, midazolam
65
allosterically modulates binding of gaba
benzodiazpeines
66
which benzodiazepines are metabolized outside the liver
oxazepam temazepam, lorazepam
| OTL (outside the liver)
67
use of benzodiazepines
anxiety, spasticity, status epilepticus (lorazepam, diazepam), eclampsia, detoxification (esp alcohol withdrawll), night terrors, general anesthetic (amnesia, muscle relaxation), hypnotic (insomnia
68
seizures assoc w alcohol withdrawl treated with
diazepam and chlordiazepoxide
69
oxazepam, temazepan, and lorazepam have or dont have active metabolites
do not have active metabolites
70
treat benzo overdose with
flumazenil (competitive antagnoist at gaba benzo receptor)
71
SE of benzo
depedence, additive Cns depression effects w alcohol; less risk of resp depressoin and coma than barbiutrates
72
nonbenzodiazepine hypnotics
zolpidem, zaleplon, eszopiclone
73
zolpidem, zaleplon, eszopiclone mechanism
acts via bz1 subtype of gaba receptor; effects reversed by flumazenil. sleep cycle less affected as compared w benzodiazepines hypnoitcs
74
use of zolpidem, zaleplon, eszoplicone
insomnia
75
SE of zolpidem, zaleplon, eszoplicone
ataxia, headaches, confusion. short duration because of rapid metabolism by liver enzymes; only modest day after psychomotor depression and few amnestic effects
76
less dependence risk than benzodiazepines
zolpidem zalpelon, eszopiclone
77
SE in older adults: increase risk of falls and confusion
zolpidem, zaleplon, eszoplicone
78
phenytoin metabolis is dose dependdnet
yes
79
orexin (hypocretin) receptor antagnoist
suvorexant
80
suvorexant use
insomnia
81
se of suvorexant
cns depression, headache, dizziness, abnormal dreams, upper resp tract infection
82
CI of suvorexant
patients with narcolepsy, liver disease. strong cyp3a4 inhibirtors
83
suvorexant has low physical dependence
true
84
melatonin receptor agonist, binds MT1 and MT2 in suprachiasmatic nucelus
ramelteon
85
se of ramelteon
dizziness, fatigue, nausea, headache
86
5Ht 1b/1d agonist
sumatriptan
87
inhibit trigeminal nerve activation; prevent vasoactive peptide release; induce vasoconstriction
sumatriptan
88
use of sumatriptan
acute migraine, cluster headache attacks
89
se of sumatriptan
coronary vasopasm (CI in pt's with CAD or prinzmental angina), mild paraestheia, serotoni syndomre
90
PRopranolol can treat what
essentail tremor (bilateral rhytmic hand tremor that worsens during fine motor activity (intention tremor))
91
BB, antidepressentsa, and anticonvulsants for prophaylxis of
migraine
92
capsaicin mechaism
excessive activation of trpu1 (transmembrane cation channel) causes buildup of intracellular ca2+ resulting in long-lasting dysfunction of nociceptive nerve fibers (defunctionalization). also causes depletion of substanec P
93
capsaicin use
post herpetic neuralgia.
94
dopamine agonists include
bromocriptine, pramipexole, ropinirole
95
ergot derived
bromocriptine
96
increases dopamine release and decreases dopamine reuptake
amantidine
97
SE of amantadine
ataxia, livedo reticularis, dry mouth, blurring of vision, vissual changes
98
agents that prevent peripheral L dopa degradation; increases L dopa entering cns; increase central l dopa available for conversion to dopamine
Levodopa (L-dopa)/carbidopa, entacapone, tolcapone
99
blocks peripheral conversion of L-dopa to dopamine by inhibiting DOPA decarboxylase
carbidopa
100
Reduces side effects of peripheral L-DOPA conversion into dopamine
carbidopa
101
peirpheral se of dopamine
nausea vomiting
102
prevent periphreal L dopa degradation to 3-O-methyldopa (3-OMD) by inhibiting COMT
entecapone , tolcapone: treats wearing off periods
103
central COMT inhibtor
tolcapone
104
blocks conversion of dopamine into DOPAC by selectively inhibiting Mao-b
selegiline
105
blocks conversion of dopamine to 3-metoxytyramine (3-MT) by inhibiting central COMT
tolcapone
106
curb excess cholinergic activity in parkinson's
benztropine, trihexyphenidyl
107
benztropine, trihexyphenidyl are what type of drugs
antimuscarinic
108
they improve tremor and rigidty but little effect on bradykinesia
benztropine, triheyxphenydily
109
pergolide
dopamine agonist : D2 receptor
110
central effects of dopaine
anxiety, agitation, insomnia, confusion ,delusions, hallucinations.
111
SE of levodopa/carbidopa
arrythmias from increase periperal formation of catecholamines; long term use: on off period
112
drugs used in huntington disease
tetrabenazine, reserpine, haloperidol
113
MOA for tetrabenzine and reserpine
inhibit VMAT: decrease dopamine vesicle packaging and release
114
Haloperidol moa
d2 receptor antagnoist
115
For LOU gehrig disasese, give
riLOUzole
116
riluzole
treatment for ALS; modestly increase surivial by decrease glutamate excitotoxicity
117
alzheimer disease drugs
memantine, donepezil, galantamine, rivastigmine, tacrine
118
alzheimre drug that is an nmda receptor antagonist; helps prevent excitotoxicity (mediated by ca2+
memantine
119
SE of memantine
dizziness, confusion, hallucinations
120
alzheimer drug that is ache inhibtior
donepezil, galantamine, rivastigmine, tacrine
121
se of donepezil, galantamine, rivastigmine, tacrine
nausae, dizziness, insomina
122
anesttheics drugs with decreaes solubility will have
rapid induction and recovery times
123
Higher soluiblity in lipids (anesthetic drugs)
higher potency
124
MAC decreases with (increase or decrease age)
increased age
125
inhaled anesthetics include
desflurane, halothane, enflurane, isoflurane, sevolfurane, methoxyflurane, N20
126
inhaled anesthetics are metabolzied by
cytocrhone p450
127
effects of inhaled anesthteics
Myocardial depression, resp despression, nauea/emesis, increase cerebral blood flow (decrease cerebral demand), decrease renal funciton, decraesehepatic blood flow
128
which inhaled anestheic causes hepatotoxciity
halothane
129
which inhaled anestehtic causes nephrotoxcity
methoxyflurane
130
which inhalend anesthetic is a proconvuslant
enflurane, epileptogenic
131
expansion of trapped gas in a body cavity is caused by which anesthetic
n2o
132
INtravenous anestehtics
```
TMKPO: The mighty king proposes to opra
barbiturates (thiopental)
benzodiazepines (midazolam
arylcyclohexylamines (ketamine)
propofol
opioids
```
133
barbiturates IV anesthteic
thiopental
134
thiopential has high potency which means
high lipid soluiblity, rapid entry into brain
135
thiopental effect
use for induction of anestehsia and short surgical procedures. effect terminated by rapid redistribution into tissue and fat. decreases cerebral blood flow
136
beenzodiazepines drug iv anesthetic
midazolam
137
midazolam used for
endoscopy; used adjunctively w gaseous anestehtics and narcotics
138
se of midazolam
severe postop resp depression, decrease BP, anterograde amnesi
139
PCP analgo used as dissociative amnesia
ketamine: blocks nmda receptors; cv stimulants
140
ketamine se:
disorientation, hallucination, unplesant dreasm. increase cerebralblood flow : and ICP
141
propofol:
used for sedation for ICU, rapid anestheisa induction, short procedures. less postop nausea than thiopental. potentiates gabAa
142
SE of propfol
hypotension: vasodilation. rapidly cleared from plasma and prefernetially distrubted to organs receiving high blood flow (brain) = rapid onset. Redistrubted to organs receiving less blood flow. bc site of action in brain: redistribution accts for rapid termination of drug
143
local anesthetics esters
procaine, cocaine, tetracaine, benzocaine
144
local anesthetics amides
lidocaine, mepivacaine, bupivacaine
145
local anesthteics mechanism of action
block na+ channels by binding to specific receptors on inner portion of channel. most effective in rapidly firing neurons.
146
tertiray amine local anesthteics penetrate membrane in
uncharged form, then bind to ion channels as charged form
147
given with vasocnostnrictors to enahcne local action
local anestheics
148
why are local anesttheics given w vasocnostrictors
decrease bleeding, increases anesthesia by decreasing sysetmic concentration
149
in acidic tissue: what is effect of alkaline anesthetics
they are charged and cannot penetrate membrane effectively ; thus need more anesthetic
150
order of nerve blockade in local anesthteics
small diamter fibers > large diameter fibers; myelinated fibers> unmyelinated fibers. overall size predominates over myelinsation
small myelinated ifbers > small unmyelinated fibers
order of loss: pain temp touch pressure
151
SE of local anesttheics
CNS excitaiton, htn, hypotension
152
bupivacaine SE
cV toxicity
153
cocaine SE
arrhtymias
154
se of benzocaine
methemoglobinemia
