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Neuro Flashcards

1
Q

Bromocriptine

A

Parkinson

  • **Dopamine agonist **
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2
Q

Pramipexole

A

Parkinson

  • **Dopamine agonist **
  • ergot
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3
Q

Ropinirole

A

Parkinson

  • Dopamine agonist
  • non ergot
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4
Q

Amantadine

A

Parkinson

  • **Increase dopamine release **
  • Toxicity
    • ataxia
  • Also used as antiviral against influenza A and rubella
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5
Q

L- Dopa

+

Carbidopa

A

Parkinson

  • Increase dopamine
  • L-dopa: converted to dopamine in CNS
    • can cross BBB
    • converted by dopa decarboxylase in CNS to dopamine
  • Carbidopa: peripheral dopa decarboxylase inhibitor
    • increases bioavailabilty of L-dopa in brain
    • limits peripheral side effects
    • no effect on CNS isde effect
  • Toxicity
    • arrhythmia- increased peripheral formation of catecholamines
    • dyskinesia (following administration)
    • akinesia (between doses)
    • CNS
      • anxiety, agitation, insomnia, confusion, delusions, hallucinations
  • Do not give with vit B6
    • increase coversion of l-dopa to dopamine in periphery
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6
Q

Selegiline

A

Parkinson

  • **Selective MAO- B inhibitor **
    • preferentially metabolizes dopamine
    • increasing availability of dopamine
  • Clinical use
    • adjuctive agent to L-dopa
  • Toxicity
    • may enhance adverse effects of L-dopa
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7
Q

Entacapone

A

Parkinson

  • COMT inhibitor
    • prevent L-dopa degradation
    • increase dopamine availability
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8
Q

Tolcapone

A

Parkinson

  • COMT inhibitors
    • prevent L-dopa degradation
    • increase levaopa availability
    • hepatotoxicity
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9
Q

Benztropine

A

Parkinson

  • **Antimuscarinic **
    • improves tremor, rigidity
    • little effect on bradykinesia
  • Use with drug induced parkinsonism from first generation antipsychotic
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10
Q

Memantine

A

Alzheimer’s Disease

  • NMDA receptor antagonist
    • prevent excitotoxicity
    • mediated by Ca++
  • Toxicity
    • Dizziness
    • Confusion
    • Hallucinations
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11
Q

Donepezil

A

Alzheimer’s

  • **AChE Inhibitors **
  • Toxicity
    • nausea
    • dizziness
    • insomnia
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12
Q

Galantamine

A

Alzheimer’s

  • AChE inhibitors
  • Toxicity
    • nausea
    • dizziness
    • insomnia
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13
Q

Rivastigmine

A

Alzheimer’s

  • AChE inhibitors
  • Toxicity
    • nausea
    • dizziness
    • insomnia
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14
Q

Tetrabenazine

A

Huntington’s

  • Inhibit VMAT
    • limit dopamine vesicle packaging and release
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15
Q

Reserpine

A

Huntington

  • Inhibit VMAT
    • limit dopamine vesicle packaging and release
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16
Q

Haloperidol

A

Huntington

  • **dopamine receptor antagonist **
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17
Q

Sumatriptan

A

Migraine + Cluster Headaches

  • 5-HT agonist
    • inhibits trigeminal nerve activation
    • prevents vasosctive peptide release (substance P + CGPR)
    • induces vasoconstriction
    • half life 2 hours
  • Toxicity
    • coronary vasospasm
      • dont use in CAD or prinzmetal’s angina
    • mild tingling
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18
Q

Succinylcholine

A

Neuromuscular Blocking Drugs

  • Muscle paralysis in surgery or mechanical ventilation
    • Selective for motor nicotinic receptor
  • Depolarizing
    • Binds ACh receptor keeping it depolarized
    • prevents muscle contraction
  • Reversal of blockage
    • phase 1: no antidote, block potentiated by cholinesteraes inhibitors
    • phase 2: antidote = cholinesteraes inhibitors
      • neostigmine
  • Complications
    • hypercalcemia
    • hyperkalemia
      • can lead to arrhythmias in peopel predisposed to hyperkalemia (burns, myopathies, crush injury, denervating injuries or disease)
    • *malignant hyperthermia *
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19
Q

Tubocurarine

Atracurium

Mivacurium

Pancuronium

Vecuronium

Rocuronium

A

Neuromusclar blocking drugs

  • Muscle paralysis in surgery or mechanical ventilation
    • selective for motor and nicotinic receptor
  • Nondepolarizing
    • Competitive ACh receptor antagonist
  • Reversalof blockage
    • neostigmine
    • edrophonium
    • cholinesterase inhibitors
20
Q

Dantrolene

A

Malignant Hyperthermia

  • **Prevent Ca++ release from sarcoplasmic reticulum of skeletal muscle **
  • Malignant Hyperthermia
    • life threatening
    • inherited susceptibility
  • Neuroleptic malignany syndrome
    • toxicity of antipsychotic drugs
21
Q

Procaine

Cocaine

Tetracaine

A

Local anesthetic

  • Ester = “caine”
  • Mechanism
    • block activated Na+ channels
      • specifically inhibit rapidly firing neurons
  • Principle
    • give with vasoconstrictors (epi) to enhance local action
      • decrease bleeding
      • increase anesthesia
      • decrease systemic concentration
    • Infected tissue (acidic)
      • need more anesthetic
        • alkaline are charged adn can’t penetrate membrane
  • Clinical use
    • minor surgical procedures
    • spinal anesthesia
  • toxicity
    • CNS excitation
    • HTN
    • Hypotension
    • Arrhythmias = cocaine
22
Q

Local anesthetic

nerve blockade order

A
  • Small diameter > large diameter
  • Myelinated > unmyelinated
  • Size > Myelination
  • Small myelinated > small unmyelinated > large myelinated > large unmyelinated
  • Order of loss
    • pain > temp > touch > pressure
23
Q

Lidocaine

A

Local anesthetic

  • Amide = two i
  • Mechanism
    • block activated Na+ channels
      • penetrate membrane in uncharged form then bind channel in charged form
      • most effective in rapidly firing neurons
  • Principles
    • give with vasoconstrictors (epi) to enhance local action
      • decrease bleeding
      • increase anesthesia
      • decrease systemic concentration
    • Infected tissue (acidic)
      • need more anesthetic
        • alkaline anesthetics cant penetrate membrane
  • Clinical use
    • minor surgical procedures
    • spinal anesthesia
  • Toxicity
    • CNS excitation
    • HTN
    • Hypotension
24
Q

Mepivacaine

A

Local anesthetic

  • amide = 2 i
  • Mechanism
    • block activated Na+ channels
      • penetrate membrane in uncharged form and bind channel in charged form
      • most effective in rapidly firing neurons
  • Principle
    • give with vasoconstrictors (epi) to enhance local action
      • decrease bleeding
      • increase anesthesia
      • decrease systemic concentration
    • infected tissue (Acidic)
      • need more anesthetic
        • alkaline anesthetics are charged so cant pennetrate membrane
  • Use
    • minor surgical procedures
    • spinal anesthetica
  • Toxicity
    • CNS excitation
    • HTN
    • Hypotension
25
Q

Bupivacaine

A

local anesthetic

  • Amide = 2 i
  • Mechanism
    • Block active Na+ channels
      • penetrate membrane in uncharged form adn bind ion channel in charged form
    • most effective in rapidly firing neurons
  • Principle
    • give with vasoconstrictors (epi) to enhance local action
      • decrease bleeding
      • increase anesthesia
      • decrease systemic concentration
    • infected tissue (Acidic)
      • give more anesthetic
        • alkaline anesthetics charged and can’t penetrate membrane
  • Use
    • minor surgeries
    • spinal anesthesia
  • Toxicity
    • CNS excitation
    • severe CV toxicity
    • HTN
    • Hypotension
26
Q

Thiopental

A

IV anesthetic

  • Barbituate
    • high potency, high lipid solubility
    • rapid entry into brain
  • Use
    • Anesthesia induction
    • short surgical procedures
  • characteristics
    • rapid redistribution into tissue and fat
    • decreases cerebral flow
27
Q

Midazolam

A

IV anesthetic

  • Benzodiazapine
  • Use
    • endoscopy
      • use with gaseous anesthetics and narcotics
  • Toxicity
    • severe postop respiratory depression
    • decrease BP
      • give flumazenil
    • amnesia
28
Q

Ketamine

A

IV anesthetic

  • Aka: arylcyclohexamines
  • PCP analog
  • **Block NMDA receptor **
  • CV stimulant
  • *increase cerebral blood flow *
  • Toxicity
    • disorientation
    • hallucinations
    • bad dreams
29
Q

Morphine

A

IV anesthetics

  • opioid
  • Use
    • general anesthesia
      • use with other CNS depressants
30
Q

Fentanyl

A

IV anesthetics

  • Opioid
  • Use
    • general anesthesia
      • use with other CNS depressants
31
Q

Proprofol

A

IV anesthetic

  • Potentiation GABA
  • Less postop nausea than thiopental
  • Use
    • sedation in ICU
    • rapid anesthesia induction
    • short procedures
32
Q

Modafinil

A

Narcolepsy

  • Pyschostimulant
    • non amphetamine
  • first line
    • effective
    • well tolerated
    • drug abuse is rare
33
Q

Pentazocine

Class

MOA

Use

Toxicity

A
  • opioid analgesic
  • MOA: Partial agonist adn weak antagonist at mu receptors
  • Use:
    • effective analgesia with little abuse potential
  • Toxicity
    • Used in combo with full opioid agonists –> competitively inhibit mu receptors and produce antagonist effects reducing analgesic effect
    • Patient dependent on opioid (morphine) –> withdrawal symptoms
34
Q

Cyproheptadine

  • MOA
  • Use
A
  • MOA
    • 1st generation histamine antagonist
    • nonspecific 5-HT1 and 5-HT2 receptor antagonist properties
  • Use
    • Serotonin syndrome
  • Serotonin Syndrome
    • neuromuscular excitation
      • hyperreflexia
      • clonus
      • myoclonus
      • rigidity
      • flushing
      • diarrhea
      • seizures
    • autonomic stimulation
      • hyperthermia
      • tachycardia
      • CV collapse
      • diaphoresis
      • tremor
    • altered mental status
      • agitation
      • confusion
35
Q

Phentyoin

A
  • seizure
    • simple
    • complex
    • tonic clonic- first line
    • status epilepticus- first line
  • moa
    • increase Na+ channel inactivation
  • toxicity
    • nystagmus
    • diplopia
    • ataxia
    • sedation
    • gingival hyperplasia
    • hirsutism
    • megoblastic anemia
    • teratogen
      • fetal hydantoin syndrome
    • SLE like syndrome
    • CYP induce
    • lymphadenopathy
    • steven johnson syndrome
36
Q

Carbamazepine

A
  • seizures
    • simple- 1st line
    • complex- 1st line
    • tonic clonic- 1st line
  • trigeminal neuralgia
  • Bipolar - mood stabilizer
  • moa
    • increase Na+ channel ianctivation
  • toxicity
    • diplopia
    • ataxia
    • blood dyscarasias
      • agranulocytosis
      • aplastic anemia
    • liver toxicity
    • teratogen
    • Cyp inducer
    • SIADH
    • Steven johnson
37
Q

Lamotrigine

A
  • seizures
    • simple
    • complex
    • tonic-clonic
  • moa
    • blocks voltage gated Na+ channels
  • toxicity
    • steven johnson syndrome
38
Q

Gabapentin

A
  • seizures
    • simple
    • ecomplex
    • tonic clonic
    • peripheral neuropathy
    • postherpetic neuralgia
    • migraine prophylaxis
    • bipolar
  • moa
    • inhibit high voltage activated Ca++ channels
    • GABA analog
  • toxicity
    • sedation
    • atazia
39
Q

Topiramate

A
  • seizures
    • simple
    • complex
    • tonic clonic
    • migraine prevention
  • moa
    • block Na+ channels
    • increase GABA action
  • toxicity
    • sedation
    • mental dulling
    • kidney stones
    • weight loss
40
Q

Phenobarbital

A
  • seizures
    • simple
    • complex
    • tonic-clonic
  • 1st line kids
  • moa
    • increase GABA action
    • increase duration fo Cl- openning
  • toxicity
    • Respirator and CV depression
      • can be fatal
    • Sedation
      • CNS depression exacerbated by alcohol
    • tolerance
    • dependence
    • CYP inducer
41
Q

Valproic acid

A
  • seizues
    • simple
    • complex
    • tonic clonic- first line
    • absence
    • myoclonic seizures
  • Bipolar –> mood stabilizer
    • use if poor kidneys b/c can’t give lithum (renal excretion)
  • moa
    • increase Na+ channel inactivation
    • increase GABA concentration
  • toxicity
    • GI distress
    • rare but fatal hepatotoxicity (measure LFT)
    • teratogen- neural tube defects
      • spina bifida
    • tremor
    • weight gain
42
Q

ethosuximide

A
  • seizures
    • absence- 1st line
  • moa
    • block thalamic t type Ca+ channels
  • toxicity
    • GI distres
    • fatigue
    • headache
    • urticaria
    • steven johnson syndrome
43
Q

Benzodiazepines

diazepam

lorazepam

A
  • seizures
    • status epilepticus - 1st line
  • moa
    • increase GABA actio
    • increase frequency of Cl- channel openning
  • toxicity
    • sedation
      • do not give with alcohol, barbituatesm, neuroleptics, 1st generation antihistamines
    • tolerance
    • dependence
44
Q

Tiagabine

A
  • seizures
    • simple
    • complex
  • moa
    • inhibit GABA reputake
45
Q

Vigabatrin

A
  • seizures
    • simple
    • complex
  • moa
    • irreversible inhibit GABA transaminase
    • increase GABA
46
Q

Levetiracetam

A
  • seizures
    • simple
    • complex
    • tonic-clonic
  • mechanism
    • unknown
47
Q

Primidone

A
  • seizures
    • essential tremors
  • moa
    • metabolized into phenobarbital + phenylethylmalonamide (PEMA)

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