"High Yield" Stuff that I think is important but Hoppe and Esper probably think otherwise Flashcards
(143 cards)
1
Q
Focal seizures with altered mental status sx
A
Usually frontal or temporal lobe involvement with automatism and impaired memory
2
Q
Phenytoin MOA and use
A
Na+ channel blocker, for tonic-clonic seizures, high drug-drug interaction (oral contraceptives)
3
Q
Side effects of phenytoin
A
gingival hyperplasia, hirsutism and others
4
Q
Carbamazepine MOA and use
A
Na+ channel blocker, for focal seizure tx, induces own metabolism (increase dose over time to compensate
5
Q
Lamotrigine MOA and use
A
Na+ channel blocker, 3rd choice for absence seizures, can cause Steven Johnsons syndrome, rash and other side effects
6
Q
Lacosamide MOA and use
A
Na+ channel blocker, modulates NMDA receptor, adjunct for focal seizures
7
Q
Ethosuximid MOA and use
A
decreases threshold for Ca2+ T-type currents (closer to depolarized state), used for 1st line absence seizures
8
Q
Valproic acid MOA and use
A
Na+ and Ca+2 T-type channel blockers, increases GABA an d for both absence and focal seizures
9
Q
Gabapentin MOA and use
A
increases GABA in synaptic cleft, not as potent/not 1st line
10
Q
Pregabalin MOA and use
A
decreases excitatory NT’s, affects calcitonin, more potent than gabapentin, METABOLIZED by KIDNEYS (not liver)
11
Q
Benzodiazepine use
A
chronic inhibition of seizures
12
Q
Clonazepam MOA and use
A
is a BZ, indirectly inhibits Ca2+ T-type so used for tx of absence seizuires, lots of side effects=4th choice for tx
13
Q
Phenobarbital use
A
focal, tonic-clonic, and resistant seizures. CAN MAKE ABSENCE SEIZURES WORSE
14
Q
Vigabatrin MOA and use
A
increases GABA by GABA transaminase inhibition, for infantile seizures and focal epilepsy. Side effect=VISION LOSS
15
Q
Tiagabine MOA
A
GABA inhibitor for reuptake (increases synaptic GABA)
16
Q
Felbamate MOA and use
A
Inhibits NMDA receptors, tx for refractory epilepsy, CAN CAUSE APLASTIC ANEMIA AND LIVER FAILURE
17
Q
Rufinamide MOA and use
A
inhibits mGluR5 in high doses/prolongs Na+ channels, tx for focal seizures, Lennox-Gastaut, and refractory seizures
18
Q
Drug hierarchy for tx of status epilepticus
A
lorazepam/diazepam, fosphenytoin, phenobarbital, general anesthesia (propofol/midazolam)
19
Q
Sign of absence seizure on EEG
A
3Hz spike and wave
20
Q
Atonic vs myoclonic seizure
A
Atonic has brief impaired consciousness, myoclonic does not
21
Q
Simple vs complex partial seizure
A
comples has LOC, simple does not, complex also has aura and amnesia
22
Q
Sign of partial seizure with 2nd generalization
A
eye deviation
23
Q
Benign febrile convulsions sx/age
A
4mo to 4 years, from rapid increase in temp
24
Q
Tx for absence seizure (1st and 2nd line)
A
ethosuxamide and valproic acid
25
Tx for juvenile myoclonic epilepsy
depakote
26
West syndrome sx
infantile spasms, severe developmental delay
27
Lennox-Gastout syndrome sx
multiple seizure types (intractable), developmental delay
28
Diet for tx of seizures
ketogenic diet
29
Cause of cerebral palsy generally
nonprogressive injury to the brain
30
Specific causes of cerebral palsy (3)
intraparenchymal hemorrhages (thalamus/caudate), periventricular leukomalacia (infarcts), multicystic encephalopathy
31
Sx of Chiari Malformation type I
loss of pain/temp/m. strength of upper extremities
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Assc with Chiari malformation
meningomyelocele anchoring spinal cord, increased intracranial pressure
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Pachygyria
broad gyri with decreased number
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Lissencephaly
smooth gyri surface, failure of cell migration
35
Assc with Down's syndrome
Alzheimer's by 4th decade
36
Trisomy of chromosomes 13-15 sx
midline defects/holoproencephaly
37
Developmental Reflexes/disappearance (8 of them)
stepping at 1-2m, galant at 1-2m, grasp at 3m, moro at 3-6m, tonic neck at 3-6m, root/suck at 4-7m, babinski at 1-2 yr, parachute starts at 8-9m and stays
38
Developmental milestones/appearance (7)
smile/recognize parents at 2m, roll back to front at 4m, roll front to back 5m, sit/recognize stranges at 6m, walk alone/use 2 words at 12 m
39
Only neuroprotective tx for neonates
hypothermia
40
Tx to prevent neonatal hemorrhages
antenatal corticosteroids
41
Assc of cerebral palsy (common cause)
periventricular leukomalacia
42
Aicardi syndrome causes/sx
absence of corpus callosum, more in females (X chromosome defect), seen infantile spasms
43
Possible cause of ADHD
prenatal tobacco exposure
44
Dx of ADHD
in more than 1 setting, longer than 6 months, before 7 yrs, some type of impaired function
45
Tx for ADHD
methylphenidate/dextroamphetamine (stimulants), atomoxetine (NE reuptake inhibitor)
46
Autism sx
enlarged head, regression/no attainment of language
47
Rett syndrome cause (genetically) and sx
MECP 2 gene mutation on Xq28. See smaller head, stereotypic hand movements and dementia. More in females
48
Sx of Neurofibromatosis-1 and cause
scoliosis, epilepsy, eye problems. From chromosome 17
49
Cause of NF-2
merlin/NF2 proteins on chromosome 22
50
Sx of NF
cafe au lait spots, axillary freckling, neurofribromas in 2nd/3rd decade
51
Sturge Weber sx
port wine stain on face, cerebral calcification, seizures. Can see trolley track lines in occipital lobe
52
Tuberous sclerosis triad
mental retardation, adenoma sebaceum, and epilepsy
53
Cause of tuberous sclerosis
hamartin and tuberin genes on chromosomes 9 and 16
54
Sx of maple syrup urine disease
seizures, hypoglycemia, hypertonia, delicious urine
55
Sx of homocystinuria
multiple thromboembolic events, ectopia lentis, seizures
56
Dx of Niemann Pick Disease
bone marrow x with decreased sphingomyelinase in leukocytes
57
Wilson disease sx
degeneration of basal nuclei, cirrohosis of liver, Kaysier Fleischer rings, onset 11-25 yrs
58
Aminoesters and their metabolism
Cocaine, procaine, tetracaine. Via pseudocholinesterase in plasma/tissues
59
Aminoamides and their metabolism
lidocaine, bupivacaine, prilocaine, articaine, ropivacaine, levobupivacaine. Via CYP450 in liver, excreted via urine
60
When to use mepivacaine
with kids, causes little vasodilation so no epi needed
61
When to use bupivacaine
long procedures
62
What can epi cause with local anesthetics?
epi-indued hypoxia from vasoconstriction
63
Serious side effect of bupivacaine
cardiotoxicity
64
Risk of procaine (and aminoesters)
allergic rxn from PABA (metabolite)
65
Extra effect of lidocaine
1b anti-arrhythmi drug for atrial fibrillation
66
Use of prilocaine
for pts who cannot use epi (cardio pts), because it causes vasoconstriction
67
Atricaine metabolism uniqueness
metabolized in liver and plasma
68
Major toxicity of local anesthetics
decreased cardio conduction velocity and contractility
69
Propofol use and side effects
For inducing anesthesia, but causes cardio/respiratory depression
70
Contraindication for barbiturates and metabolism
porphyria. metabolized in liver
71
Antidote for benzodiazepines
flumazenil
72
Ketamine MOA, use and perk
NMDA inhibitor used for profound analgesia (only) with sympathetic stimulation. Causes minimal respiratory depression
73
Etomidate use and perk
for anesthesia (no analgesia), alternate to propofol cause it causes not cardio contraction problems
74
Dexmedetomidate MOA, use and side effects
alpha2 agonist, for short term sedation (intubation), and causes heart block/bradycardia
75
N2O use and side effects
For analgesia/sedation, causes pneumothorax and B12 deficiency sx
76
Halothane use and side effects (has lots)
For induction of children and maintenance of adult anesthesia. Causes malignant hyperthermia, hepatotoxicity, sensitization of catecholamines (arrhythmias)
77
Enflurane use and side effects
for anesthesia maintenance and causes increased isoniazid metabolism, m. relaxation, seizures
78
Isoflurane perk, side effects, and contraindication
Has no proconvulsive properties, causes airway irritation, cannot use with coronary artery disease
79
Desflurane use and side effects
for maintenace of anesthesia, caueses airway irritation and bronchospasm
80
Sevoflurane use and perk
For outpt anesthesia, causes no airway irritation
81
Thiopental + inhaled anesthetics perk
skip stage 1 and 2 of anesthesia
82
Use of trimethaphan
dissecting aortic aneurysm/HTN emergency
83
Use of mecamylamine
adjunct to nicotine patch or electroconvulsive therapy
84
Drugs interacting with NMJ nondepolarizing blockers
inhaled anesthetics, aminoglycosides, tetracyclins, Ca2+ channel blockers
85
Metabolism of NMJ nondepolarizing blockers (+2 special cases)
Excreted via urine/bile. Atracurium via plasma esterase, and cisatracurium via Hoffmann degradation
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Nondepolarizing NMJ blocker to use with liver/renal failure
cisatracurium
87
Atracurium side effect/cause
cardio/respiratory involvement from histamine release
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Long acting NMJ nondepolarizing blockers
doxacurium and pancuronium
89
Contraindication of succinylcholine
Muscle injury
90
Anticholinesterase effects on NMJ blockers
nondepolarizing effects are reversed, depolarizing effects are enhanced
91
Drug addiction pathway
Mesolimbic (ventral tegmental area to nucleus accumbens)
92
MOA of reward system for opioids
disinhibition (resulting in excitation at nucleus accumbens with DA release)
93
Tx for alcohol addiction
Benzodiazepine taper for withdrawal
94
Areas involved in cocaine/amhpetamine addiction
Nucleus accumbens and locus ceruleus
95
Marijuana addiction MOA
feed forward enhances VTA stimulation
96
Phencyclidine MOA
blocks NMDA Glut receptors
97
MDMA MOA
increases 5HT release and blocks reuptake and synthesis
98
Tx for opioid withdrawal
methadone/buprenorphine taper
99
Tx for barbiturate withdrawal
phenobarbital
100
What is common among all drug withdrawals?
Sympathetic hyperactivity
101
MOA of disulfiram
accumulates acetylaldehyde (from EtOH), causes aversion
102
Naltroxane MOA
opioid antagonist, only prevents "high"
103
Methadone MOA
long acting opioid agonist, no "high" spike when taken orally
104
Buprenorphine MOA
u-opioid partial agonist, decreases withdrawal sx and cravings
105
Suboxane characteristic
buprenorphine and naloxone, if injected naloxone prevents high, but if taken orally get buprenorphine effect
106
Varenicline MOA
nicotine partial agonist, contraindicated with psych pts
107
Acamprosate use
Modulation of Glu hyperactivity in EtOH dependence
108
Bupropion use and side effect
tx for smoking cessation but lowers seizure threshold (is an antidepressant)
109
Tx for cocaine/amphetamine addiction
antidepressants (desipramine/fluoxetine)
110
Triad of spasmus nutans
ocular oscillations, head nodding and torticollis
111
Signs of central vertigo
no habituation, nystagmus may change direction, immediate or delayed nystagmus
112
Signs of peripheral vertigo
habituation, no vertical nystagmus, delayed nystagmus
113
Dix-Hillpike with peripheral disorder
onset 2-20s, lasts less than 1 min, fatiguability, one direction
114
Dix-Hillpike with central disorder
no latent onset, lasts over 1 min, nonfatiguing, may change direction
115
Sx of benign paroxysmal positional vertigo
rotatory, fatigable, transient nystagmus. from otoliths being displaced
116
Vertigo sx with Meniere's disease
severe and spontaneous lasting min to hrs, nausea and vomiting seen
117
Vestibular neuritis vertigo sx
sudden and severe, lasts days to months
118
Meds causing vertigo
antihistamines (meclizine, promethazine, dimenhydrinate), anticholinergics (scopolamine), benzo's (diazepam)
119
Sx of cardiac syncope
rapid onset, little posture relation, exertion causes it
120
What causes convulsive syncope?
seizure triggered by decrease in BP
121
DM mononeuropathy cause
occlusion of vasa nervorum or compressive injury from lack of sensation
122
EEG seen with Creutzfeldt Jacob
bi or triphasic spike wave complexes
123
Most common roots affected in DM radiculopathy
Thoracic roots due to sheer number. Resembles herpes zosters without the vesicles
124
Sx of poylmyositis
elevated serium creatinine and creatine kinase, inflammation of muscles on MRI/ultrasound, ANA + in 1/3
125
Sx of Lambert-Eaton syndrome
is paraneoplastic. proximal m. weakness that improves with use, no improvement with anticholinesterase, autonomic findings
126
Sx of pseudotumor cerebri
elevated intracranial pressure (CSF tap over 250 mmH20)
127
EtOH abuse disorders (4)
subacute combined degeneration (B12 deficiency), Alcoholic polyneuropathy (symmetric and distal), Marchiafava Bignami (demyelination of cc with seizures, dementia), Wernicke Korsakoff (thiamine deficiency impacting memory)
128
Tx for Wernicke Encephalitis
thiamine before glucose
129
Stages of Lyme disease
Bull's eye rash (local), meningitis/carditis/neuropathy (early disseminated), persistent arthritis (late disseminated)
130
Sx of Myasthenia Gravis
fluctuating m. weakness that is better in the morning, assc with thymoma. Pyridostigmine used to tx
131
Location of cluster headaches
Supraorbital/temporal region. often occurs at night. Tx with sumatriptan, verapamil, Li+, methylsergide
132
Tx for MS
solumedrol (steroid) or interferon drugs
133
Side effect of all drug withdrawals (and tx)
all will cause hyperactivity of sympathetics. use clonidine which is an alpha2 agonist
134
Contraindication of varenicline
It is for nicotine craving reduction, but cannot be used with psychiatric pts
135
Side effect of buproprion
It is for smoking cessation but can cause seizures by lowering threshold
136
Weak side of Lipid Theory
enantiomers of barbiturates, etomidate and steroids do not almost membranes/do not cause anesthesia (stereochemistry is involved somehow)
137
Preoperative drugs to control emesis
droperidol/ dexamethasone and metoclopramide
138
Adverse effect of barbiturates (thiopental/methohexital)
extreme vasoconstriction -> gangrene
139
Use of ketamine
analgesia w/ sympathetic stimulation
140
Side effect of etomidate
adrenocortical depression
141
EEG of West syndrome
high amplitude abnormal spikes (hypsarrhythmia)
142
EEG of Lennox Gastaut Syndrome
slow spike and wave, paroxysmal fast activity
143
EEG of atonic seizure
low voltage, polyspike wave, electrodecrement
