"High Yield" Stuff that I think is important but Hoppe and Esper probably think otherwise Flashcards Preview

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Flashcards in "High Yield" Stuff that I think is important but Hoppe and Esper probably think otherwise Deck (143):
1

Focal seizures with altered mental status sx

Usually frontal or temporal lobe involvement with automatism and impaired memory

2

Phenytoin MOA and use

Na+ channel blocker, for tonic-clonic seizures, high drug-drug interaction (oral contraceptives)

3

Side effects of phenytoin

gingival hyperplasia, hirsutism and others

4

Carbamazepine MOA and use

Na+ channel blocker, for focal seizure tx, induces own metabolism (increase dose over time to compensate

5

Lamotrigine MOA and use

Na+ channel blocker, 3rd choice for absence seizures, can cause Steven Johnsons syndrome, rash and other side effects

6

Lacosamide MOA and use

Na+ channel blocker, modulates NMDA receptor, adjunct for focal seizures

7

Ethosuximid MOA and use

decreases threshold for Ca2+ T-type currents (closer to depolarized state), used for 1st line absence seizures

8

Valproic acid MOA and use

Na+ and Ca+2 T-type channel blockers, increases GABA an d for both absence and focal seizures

9

Gabapentin MOA and use

increases GABA in synaptic cleft, not as potent/not 1st line

10

Pregabalin MOA and use

decreases excitatory NT's, affects calcitonin, more potent than gabapentin, METABOLIZED by KIDNEYS (not liver)

11

Benzodiazepine use

chronic inhibition of seizures

12

Clonazepam MOA and use

is a BZ, indirectly inhibits Ca2+ T-type so used for tx of absence seizuires, lots of side effects=4th choice for tx

13

Phenobarbital use

focal, tonic-clonic, and resistant seizures. CAN MAKE ABSENCE SEIZURES WORSE

14

Vigabatrin MOA and use

increases GABA by GABA transaminase inhibition, for infantile seizures and focal epilepsy. Side effect=VISION LOSS

15

Tiagabine MOA

GABA inhibitor for reuptake (increases synaptic GABA)

16

Felbamate MOA and use

Inhibits NMDA receptors, tx for refractory epilepsy, CAN CAUSE APLASTIC ANEMIA AND LIVER FAILURE

17

Rufinamide MOA and use

inhibits mGluR5 in high doses/prolongs Na+ channels, tx for focal seizures, Lennox-Gastaut, and refractory seizures

18

Drug hierarchy for tx of status epilepticus

lorazepam/diazepam, fosphenytoin, phenobarbital, general anesthesia (propofol/midazolam)

19

Sign of absence seizure on EEG

3Hz spike and wave

20

Atonic vs myoclonic seizure

Atonic has brief impaired consciousness, myoclonic does not

21

Simple vs complex partial seizure

comples has LOC, simple does not, complex also has aura and amnesia

22

Sign of partial seizure with 2nd generalization

eye deviation

23

Benign febrile convulsions sx/age

4mo to 4 years, from rapid increase in temp

24

Tx for absence seizure (1st and 2nd line)

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

32

Assc with Chiari malformation

meningomyelocele anchoring spinal cord, increased intracranial pressure

33

Pachygyria

broad gyri with decreased number

34

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

86

Nondepolarizing NMJ blocker to use with liver/renal failure

cisatracurium

87

Atracurium side effect/cause

cardio/respiratory involvement from histamine release

88

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