Kaplan

Question 1

DA antagonist and agonist causes what in nigrostriatal pathway?

Answer 1

bradykinesia (Parkinson like)/hyperkinesia

Question 2

Drug that increase DA in mesolimbic and mesocortical tract would?

Answer 2

Increase reinforcement/psychosis (side effect of DA drugs)

Question 3

DA antagonist in tuberoinfundibular pathway causes?

Answer 3

gynecomastia/amenorrhea and galactorrhea

Question 4

DA antagonist can be used for ___ during chemo and radio therapy

Answer 4

antiemetic

Question 5

DA agonist can also causes weight gain or lost?

Answer 5

Weight lost

Question 6

D1/D2 receptor are __ coupled receptors?

Answer 6

Gs/Gi

Question 7

Where are D2A and D2C found in the brain?

Answer 7

nigrostriatal and mesolimbic

Question 8

What is the reason behind cogwheel rigidity and resting tremor in Parkinson’s pts?

Answer 8

Increase ACh on muscarinic receptors

Question 9

What is the transmitter imbalance in Parkinson’s?

Answer 9

Decrease DA and increase ACh

Question 10

In nigrostriatal pathway, DA binds to __ receptor on the GABA neuron to inhibit GABA and start movement?

Answer 10

D2A receptor

Question 11

In nigrostriatal pathway, ___ bind to GABA neuron to promote GABA and inhibit movement?

Answer 11

ACh binds to muscarinic receptor

Question 12

What are the 4 ways to treat Parkinson’s at the nigrostriatal level?

Answer 12

L-DOPA (increase DA)/D2 agonist/inhibit MAO-B (selegiline)/Muscarinic blocker

Question 13

Levodopa is converted to DA by?

Answer 13

AAAD

Question 14

Is carbidopa a competitive or noncompetitive inhibitor of AAAD in periphery?

Answer 14

Non-competitive

Question 15

Why do we use levodopa with other drugs?

Answer 15

Levodopa causes on and off dyskinesia—>use with other drugs to reduce the fluctuation of DA in CNS

Question 16

Tolcapone is highly?

Answer 16

Hepatotoxic

Question 17

COMT metabolizes DA and L-DOPA to partial agonists which ___ during ___? and why tolcapone and entacapone are used?

Answer 17

Blocks DA from binding to receptor when there are high level of DA/these drugs block COMT therefore prevent partial agonists from forming

Question 18

Selegiline is metabolized into ___ and causes ___?

Answer 18

Amphetamine (stimulant) and causes insomnia

Question 19

Pramipexole and ropinerole are also ___?

Answer 19

Antioxidant (key in Parkinson’s disease)

Question 20

What drug causes livedo recticularis (lace like rash)?

Answer 20

Amantidine

Question 21

What kind of drugs do you use to treat EPS?

Answer 21

Antimuscarinic

Question 22

What is acute and chronic EPS?

Answer 22

acute: pesudoparkinsonism/dystonia/dyskinesia/akathisia (I like to move it move it, I like to move it move it…)
chronic: tardive dyskinesia

Question 23

How does tardive dyskinesia happen?

Answer 23

Chronic using of D2 blocking antipsychotic drugs—->upregulation of D2 receptor—>hyperkientic (similar to Hungtinton’s)

Question 24

DA antagonist would worsen ___ symptoms of schizo pt and also cause increase ___ that cause ___ in male and ___ in female?

Answer 24

worsen - symptoms (decrease DA)/increase prolactin/gynecomastia in male and amenorrhea and galactorrhea in female

Question 25

Antipsychotic drugs (both 1st and 2nd gen) besides block D2, what else do they block?

Answer 25

Muscarinic and alpha

Question 26

What cause neuroleptic malignant syndrome? and what do you give pt for that?

Answer 26

Caused by antipsychotic drugs such as haloperidol/give pt bromocriptine

Question 27

What caused neuroleptic malignant syndrome?

Answer 27

DA antagonist of antipsychotic drugs interrupt temp control in the brain cause fever and muscle rigidity (from antimuscarinic affect)

Question 28

Clozapine (SGA) blocks D2_ and __ that results in___?

Answer 28

D2C (in mesolimbic system)--->no tardive dyskinesia/5HT--->improve negative symptoms

Question 29

All antipsychotic drugs causes weight __?

Answer 29

gain

Question 30

90% of 5HT is in ___ system and block 5HT results in __?

Answer 30

digestion system/increase salivation (side effect of clozapine)

Question 31

SGA has __ EPS symptoms only ___ gives agranulocytosis?

Answer 31

little EPS symptoms/clozapine

Question 32

Aripiprazole is a ___ blocker but also a partial ___ agonis results in?

Answer 32

DA blocker and also a partial D2/3 agonist--->not as potent as DA blocker

Question 33

The goal of antidepressant is to increase ___ and ___?

Answer 33

NE and 5HT

Question 34

Antidepressant can causes high NE and 5HT which are called?

Answer 34

HTN crisis/serotonin syndrome

Question 35

Do we still use MAOi and TCA?

Answer 35

Not really due to their side effects, mainly SSRI now

Question 36

What else do we use amitriptyline for besides depression?

Answer 36

Neuropathic pain

Question 37

What do we use for enuresis that also treats depression?

Answer 37

Imipramine

Question 38

What are 2 side effect of TCA?

Answer 38

Antimuscarinic and alpha blockade

Question 39

What to give with SSRI in the beginning to prevent anxiety and further suicide?

Answer 39

Alprazolam (a benzodiazepine)

Question 40

SSRI has the side effect of ?

Answer 40

Serotonin syndrome/bruxism and anorgasmia/weight loss

Question 41

Venlafaxine is like TCA but?

Answer 41

It does not have antimuscarinic and alpha blockade

Question 42

What is the only antidepressant that causes weight gain and often used for anorexia?

Answer 42

Mirtazapine

Question 43

Diuretics would ___ Li clearance hence ___ Li level

Answer 43

decrease clearance and increase Li level

Question 44

What congenital defect can Li cause?

Answer 44

Ebstein's anomaly (downward displacement of tricuspid valve)

Question 45

Stimulant drugs like methylphenidate and amphetamine for ADHD should not be stopped abruptly because?

Answer 45

It may produce severe depression--->suicide

Question 46

Cocaine block reuptake of ? and __ channel blocker as well?

Answer 46

NE/5HT/DA and Ca channel blocker (local anesthetic)

Question 47

Increase 5HT in cocaine abuser might cause?

Answer 47

Aggressiveness

Question 48

Difference between benzodiazepine and barbiturate?

Answer 48

Benzo is GABA agonist/barb prolong GABA

Question 49

benzodiazepine and barbiturate both are CNS ___?

Answer 49

depressant

Question 50

What does BZ1 and BZ2 of benzodiazepine mediate?

Answer 50

BZ1: sedation/BZ2: cognitive impairment

Question 51

Benzodiazepine toxicity can be reversed by?

Answer 51

Flumazenil

Question 52

What are the 3 opioid receptors and which one is the most potent?

Answer 52

mu/kappa/delta--->mu is the most potent one

Question 53

Which area within the limbic system that is associated with DA and addition?

Answer 53

Nucleus accumbens

Question 54

Which two drugs are life threatening if withdrawal?

Answer 54

Barbiturate and ethanol

Question 55

What is MDMA?

Answer 55

Amphetamine like/hallucinogenic/ppl died of dehydration during RAVE parties

Question 56

Only __ form of inhaled anesthetics (gas inhalation) is active and they go to ___ first rapidly and redistribute to __ that can go back to the blood and ___?

Answer 56

Free form/CNS/fat/CNS

Question 57

The more ___ the anesthetic, the ___ MAC and the greater the potency

Answer 57

Lipid soluble/lower

Question 58

MAC is lower in ___ population and with ___ kind of drug?

Answer 58

Elderly/opiate

Question 59

___ blood gas ratio drugs has fast onset and recovery

Answer 59

Lower

Question 60

What are the 2 side effects of N2O?

Answer 60

Diffusional hypoxia/spontaneous abortion

Question 61

Halothane and the newer agents (-flurane) also succinylcholine can cause

Answer 61

Malignant hyperthermia

Question 62

Sensitivity of nerve fibers to local anesthetics in descending order

Answer 62

(smaller diameter fiber response first) B and C >A delta

Question 63

What to give with local anesthetics to prevent systemic effect?

Answer 63

Alpha 1 agonist--->prolonged effects

Question 64

What does tetradotoxin TTX work on?

Answer 64

It blocks Na channel (from puffer fish)

Question 65

How many molecule of NMB is needed to block Nm?

Answer 65

Just 1

Question 66

What is the progression for NMB?

Answer 66

Face--->limbs-->respiratory muscles

Question 67

What is the angle in open and closed angle glaucoma?

Answer 67

Angle between iris and cornea

Question 68

Is open angle glaucoma chronic or acute?is it painful or painless? and what does it caused by?

Answer 68

Chronic/painless/decrease reabsorption of aqueous humor

Question 69

Where is the aqueous humor produced and drained?

Answer 69

Ciliary body (beta 1 receptor)/through the tribecular meshwork in the angle

Question 70

What does closed angle glaucoma lead to?and it is chronic or acute?

Answer 70

It leads to the obstruction of canal of Schlemm/it can be both chronic and acute

Question 71

What is use dependence of anesthetics?

Answer 71

Use-dependence relates to the fact that more drug binds to the sodium channel protein when the fiber fires at a faster rate.

Question 72

All local anesthetics are ___ molecule

Answer 72

Amphipathic

Question 73

Gabapentin undergoes ___ clearance unlike all the other anti seizure drugs?

Answer 73

Renal

Question 74

Gabapentin can also treat ___?

Answer 74

Neuropathic pain

Question 75

Opioid causes broncho__?

Answer 75

Constriction

Question 76

Which alcohol compound form crystal?

Answer 76

Ethylene glycol

Question 77

SSRI and TCA takes how long to work?

Answer 77

8 weeks

Question 78

Benzo has a slow or fast onset?

Answer 78

Fast

Question 79

Which benzo does not have active metabolites?

Answer 79

Lorazepam

Question 80

What therapy works the fastest for antidepressant?

Answer 80

ECT

Question 81

High LI causes what dysfunction?

Answer 81

Renal

Question 82

Major side effect of SSRI?

Answer 82

Sexual dysfunction?

Question 83

Only injectable drug for migraine? IV?

Answer 83

Sumotriptan/DHE

Question 84

What is Baclofen?

Answer 84

GABAb agonist--->antispaticity

Question 85

What is the Henry's law equation?

Answer 85

Partial pressure = concentration/solubility

Question 86

What drug do you give before giving general anesthesia?

Answer 86

Benzo

Question 87

What brain part does general anesthesia target to cause LOS?

Answer 87

Thalamus

Question 88

MAC means to prevent ___?

Answer 88

Movement--->immobility

Question 89

Which anesthesia causes dissociative anesthesia?

Answer 89

Ketamine

Question 90

What brain part does general anesthesia target to cause immobility?

Answer 90

Spinal cord

Question 91

ACh comes from what part of the brain?

Answer 91

Nucleus of maynert

Question 92

What drug to give if the Parkinson's pt is young and has mild disease? what about mild and older pt?

Answer 92

Anticholinergic/amantidine

Question 93

What is the concern of L-dopa drug for Parkinson?

Answer 93

Delay it as long as possible, only use it for severe disease under 65

Question 94

Most important of determining the type of headache is ?

Answer 94

Time course

Question 95

Jaw pain and visual symptoms with headache indicate?

Answer 95

Temporal arteritis

Question 96

Concern regarding treating migraine?

Answer 96

Only use NSAIDs first

Question 97

What is the proprolaxysis guidline for migrain headache?

Answer 97

more than 2 headaches per month and less than 8