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Neuro Flashcards

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1
Q

Sumatriptan

A

Analgesic, HA abortive

MOA:

  • Serotonergic -> vasoconstricion
  • t1/2 = 2hrs

SE’s

  • Chest/neck tightness
  • flushing, sedation
  • Serotonin syndrome in SSRI/SNRI/MAOI/other triptans
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2
Q

Ergotamine Tartrate

A

Analgesic, HA abortive

MOA:

  • Sertonergic, adrenergic, dopaminergic - suppress neurogenic inflammation]
  • vasoconstriction

SE’s

  • Narrow therapeutic window
  • vasoconstriction
  • hallucinations
  • No Pregnancy
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3
Q

Dihydroergotamine

A

Analgesic, HA abortive

MOA:

  • Sertonergic, adrenergic, dopaminergic - suppress neurogenic inflammation]
  • vasoconstriction

SE’s

  • Narrow therapeutic window
  • vasoconstriction
  • hallucinations
  • No Pregnancy
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4
Q

Propranaolol

A

HA prophylaxis, Anyihypertensive, Beta-blocker

MOA:

  • Inhibits CSD
  • good for MVP, HTN, anxiety, tremor

SE’s

  • Bad w. depression, fibromyalgia, Raynaud’s, asthma
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5
Q

Amitriptyline

A

HA prophylaxis, Antidepressant

MOA

  • Tricyclic antidepressant

ClinUse:

  • good in sleep disturbance, neck pain, T-T headache
  • Inhibits CSD

SE’s

  • Weight gain, sedation, dry-mouth, orthostatic hypotension
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6
Q

Valproic acid

A

HA prophylaxis, Anticonvulsant, mood stabilizer

MOA:

  • not well understood
  • ?Na channel blocker, GABA, Ca, K effects?
  • Enhances GABA activity,
  • reduces excittory NT,
  • reduces serotonergic activity

Metabolism:

  • Hepatic metabolism
  • NOT inducer
  • T1/2 15h

Clin Use

  • PO/IV
  • All seizure types
  • Migraine
  • BPD

SE’s:

  • +++ Weight Gain; occasional
  • GI upset
  • menstrual problems,
  • Hair loss
  • thrombocytopenia
  • hepatic encephalopathy w/out elevated enzymes (elevated NH4+) Tx. carnatine
  • Birth defects (spina bifida)
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7
Q

Topiramate

A

HA prophylaxis, Anticonvulsant

MOA:

  • Multiple - Na channel blockade
  • GABA agonist
  • Glu antagonist
  • Reduces neuron firing in TNC & inhibits CSD

Met:

  • Renal excretion unchanged
  • t1/2 = 24h

Clin Use:

  • Broas specturm; no good vs absence
  • chronic migraine prophylaxis
  • neuropathic pain
  • weight loss

SE’s:

  • sedation
  • aphasias
  • parasthesias
  • nephroliths
  • glaucoma
  • weight loss
  • cognitive difficulty
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8
Q

Verapamil

A

HA prophylaxis, antihypertensive Ca entry blocker

MOA:

ClinUse:

SEs:

  • constipation
  • heart block
  • depression
  • weight gain
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9
Q

Lithium

A

HA prophylaxis, mood stabilizer

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10
Q

BoTox

A

HA prophylaxis

MOA:

  • Prevents synaptic vesicle fusion w/ nerve terminal;
  • prevenst ACh/Glu/CGRP release

ClinUse:

  • Best for chronic migraine

​SE’s:

  • Neck pain
  • weakness
  • ptosis, diplopia
  • Spock eyebrow
  • flu-like illness
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11
Q

Phenobarbital

A

Anticonvulsant, sedative-hypnotic

MOA

  • GABA agonist -> opens Cl channels -> hyperpolerization

Metabolism

  • 100 hr T1/2
  • Loading dose required
  • Hepatic metabolism and enzyme inducer

Clinical use

  • All seizure types except absence
  • PO/IV for status epilepticus

Side Effects

  • Hyperactivity in peds
  • Sedation in adults
  • Joint/CT problems
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12
Q

Phenytoin

A

Anticonvulsant

MOA

  • Blocks voltage gated Na channels

Metabolism

  • Hepatic met and Enzyme inducer
  • Zero order Kinetics at high doses; OD with small changes
  • T1/2 variable (6-24h)
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13
Q

Ethosuximide

A

Anticonvulsant

MOA:

  • Blocks T-type Ca channels

Metabolism;

  • hepatic metabolism
  • Mild hepatic induction

Clin Use

  • Absence Seizures
  • PO
  • 1st line by PCP

SE’s

  • Sedation
  • GI distress
  • behavior change
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14
Q

Benzodiazepines

A

Anxiolytic, sedative, amnestic, anticonvulsant, skeletal muscle relaxant

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15
Q

Carbamazepine

A

anticonvulsant, mood stabilizer

MOA:

  • Na channel blocker

Metabolism

  • hepatic met, enzyme inducer
  • short t1/2 = 12h
  • Levels increased by Ca channel blockers & macrolides

Clin Use:

  • Focal and 2nd generalized seizures
  • cheap
  • PO only
  • mood stabilizer for BPD, neuropathic pain, trigeminal neuralgia

SEs

  • Blurred vision
  • sedation
  • neutropenia
  • hyponatremia
  • weight gain
    *
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16
Q

Gabapentin

A

Anticonvulsant

MOA:

  • Increases GABA levels in brain
  • blocks Na post synaptically

Metabolism:

  • v. short T1/2
  • not metabolized/inducer/inhibitor
  • urinary excretion unchanged

Clin Use

  • peripheral neuropathy
  • partial & secondarily generalized seizures
  • PO only

SE’s

  • sedation (esp in elderly)
  • GI distress
  • pedal edema
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17
Q

Lamotrigine

A

Anticonvulsant, mood stabilizer

MOA:

  • blocks pre-synaptic Glu release
  • Blocks Na channel post synaptically

Metabolism:

  • Hepatic metabolism
  • Renal Excretion
  • t1/2 = 24h

Clin Use:

  • Broad specturm vs all seizure types
  • neuropathic pain
  • BPdisorder
  • PO only

SE’s:

  • Allergic rash
  • insomnia
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18
Q

Levetiracetam

A

Anticonvulsant

MOA:

  • Ca channel blocker
  • blocks vesicle exocytosis

Met:

  • Urinary excretion, unchanged
  • Not enzyme inducer
  • Not protein bound

ClinUse:

  • Broad spectrum, focal & generalized
  • equivelent PO/IV dosing
  • Favorite of hospitals

SE’s

  • Cognitive and Behavioral sx
    *
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19
Q

Aspirin

A

Analgesic, antipyretic, anti-inflammatory

MOA:

  • irreversibly inhibits COX
  • lasts 10-14 days in platelets
  • analgesia via COX-2
  • Side effects by COX-1

ClinUse

  • Very goor for inflammatory & somatic pain
  • NO 3rd trimester pregnant women
    • Close DA of fetus
    • APAP instead
  • Kids = APAP
  • Elderly
    • hypoalbuminemia -> toxicity, longer t1/2

ADR:

  • Reyes Syndrome in kids
  • Hepatotox

DDI:

  • Lithium
  • Warfarin
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20
Q

ibuprofen

A

Analgesic, antipyretic, anti-inflammatory

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21
Q

Naproxen

A

analgesic, antipyretic, anti-inflammatory

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22
Q

Oxaprozin

A

analgesic, antipyretic, anti-inflammatory

MOA:

  • concentrates in synovial fluid
  • Non-selective COX inhibitor
  • NFkB metalloprotease inhibitor
  • t1/2 = 40-60h

ClinUse:

  • Orthopedic pain
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23
Q

Meloxicam

A

analgesic, antipyretic, anti-inflammatory

Enolic Acid

MOA:

  • COX2 preferential
  • t1/2 =20h

Clinical Use

  • good for hepatic/renal fail; no need to adjust

AE:

  • Fewer GI effects than piroxicam, diclofenac, naproxen
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24
Q

Celecoxib

A

Analgesic, anti-inflammatory

MOA:

  • COX-2 selective inhibitor

ClinUse

  • Mild - Moderate Pain

AE’s:

  • GI bleed (less than non-selectives)
  • interacts w/ hepatic enzyme inducers
  • decreases ACE-I and diuretic effects
  • Increases Lithium levels
  • Contranidicate w/ sulfa allergy
  • No platelet effects
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25
Ketorolac
Analgesic, anti-inflammatory MOA: * Non-selective COX inhibitor ClinUse: * Use for \< 5 days * shrot term pain management * IV/PO * Good post op; very strong AE: * Allergic rxns * GI effects * Hepatotox w/ APAP * renal failure *
26
Indomethacin
NSAID MOA: * Non-selective COX inhibitor * concentrates in joints ClinUse: * Gout - couple of weeks * Osteoarthritis * PDA closure in neonates AEs: * High side effects * short term only
27
Diclofenac
NSAID MOA: * COX-2 Selective * Concentrates in joints ClinUse: * Post-op pain relief * Topical AE: * monitor for hepatotox
28
Acetaminophen
Analgesic, antiypyretic APAP MOA: * unclear mech * central prostaglandin synthesis * no-antiplatelet activity * active 4-6hrs ClinUse: * **Not Anti-Inflammatory** * chronic pain, used w/ NSAIDS AE's: * **Narrow therapeutic window** * **fatal hepatotox via glutathione depletion** * depression, chronic pain, EtOH/drug use, multiple NSAID use * Hepatotox * **No EtOH**
29
Morphine
Analgesic, drug of abuse MOA: * mu opioid receptor agonist ClinUse: * can be used w/ hepatic failure * prolonged t1/2 * ​Avoid w/ GFR \< 30ml/min * toxic metabolite accumulation AEs: * Sedation confusion, constipation * resp depression, sexxual dysfunction * fracture, physical dependence * infection, tumor * Additeve w/ CNS depressants * MAOIs - severe/fatal rxn
30
Meperidine
Analgesic MOA: * mu opiod receptor agonist ClinUse: * 10x as powerful as morphine * Not for routine use; severe pain AEs: * **Mydriasis** (all others cause miosis * MAOI = fatal/severe rxn * ADRS of morphine + increased HR
31
oxycodone
Analgesic MOA: * mu opioid receptor agonist * equianalgesic to morphine * t1/2 = 2-3h * To oxymorphone 2D6 * To noroxycodone 3A4 ClinUse: * acute pain AE: * Additive w/ CNS depressants * abuse deterent formula * ADRS of morphine *
32
Oxymorphone
Analgesic MOA: * 2x morphine strength * metabolic end product of morphine ClinUse: * Acute pain AR: * high abuse potential * morphine like ARs
33
Hydromorphone
Analgesic MOA: * mu opiod agonist ClinUse: * **7.5x potent as morphine** * avoid sustained release w/ hepatic disease * not for renal disease; ARs: * Morphine like
34
Methadone
Opioid abuse MOA: * mu opioid agonist (levo) * **NMDA receptor antagonist (dextro)** * SRI * t1/2 = 8- 47h ClinUse: * Severe pain (chronic) * **addiction** * caution in **elderly** * dont increase more than q14day * **variable potency - dose dependent** AR: * morphine ADRs * **long QTc** * **arrhythmia** * baseline EKG
35
Fentanyl
analgesic MOA: * mu opioid agonist ClinUse: * 80x strong as morphine * patch for severe pain * liver disease decreases absorption * Ok renal disease AE: * additive w/ CNS depressants *
36
tramadol
analgesic MOA: * modulation of nociception * inhibits NE/5HT reuptake ClinUse: * Chronic pain AE: * don't combine w/ SRI's (eg methadone or ADDs)
37
Tapentadol
Analgesic MOA: * modulation phase * inhibits NE/5HT reuptake ClinUse: * severe pain * neuropathic pain (v.strong) AE: * Morphine ADR * dont combine w/ SRIs (eg methadone ADDs)
38
Naloxone
Opioide overdose MOA: * competitivly blocks mu, kappa, delta opioid receptors ClinUse: * rapidly reverse opiod agonists * opiod OD, dependence AE: * can precipitate withdrawal in dependent persons
39
Codeine
Analgesic
40
Buprenorphine
Opiod
41
Marijuana
Pain, chronic pain, weight loss, Cancer, MS, HIV
42
Bupivicaine
Long acting local anesthetic MOA: * amide - binds Na channel of inner nerve membrane * closes Na channel -\> no AP * Better in non-ionized form (not acidic places) * Best on **narrow, heavily myelinated, rapid firing neurons** * partial liver metabolism ​ClinUse: * Inj - long acting local anesthetic * w/ Epi for prolonged duration AE: * Most toxic of the 'caines * **Cardiac arrest if IV** * light headed, tinnitus, metallic taste * blurred vision, numbness, twitching * **convulsions** * **Resuscitative equipment available** * delay in mgmt =\> **acidosis, cardiac arrest, death** * longest acting 12-18h *
43
Ketamine
Sedative hypnotic
44
Nitrous oxide
dissocidative anesthetic
45
Sevoflurane
General anesthetic
46
Isoflurane
General anesthetic
47
Propofol
General anesthetic MOA: * lipid soluble IV agent * **GABAa potentiation** * blocks Na channels * impacts endocannabinoid system ClinUse: * IV short acting anesthetic * anti-emetic * euphoria * **Aseptic technique** - susceptible to bacterial contamination * single use parenteral AE: * injection site pain * apnea * decreased CO * hypotension
48
Midazolam
Conscious sedation MOA: * **GABAa** potentiation; enhances effects ClinUse: * IV bzd - for hospital sedation * General anesthetic adjuvant * 15-20min duration AE: * resp depression * addiction, tolerence (error risk) * CV depression * caution with ER formulation
49
Etomidate
sedative-hypnotic MOA: * **GABAa** modulator at B3 subunits * Hepatic metabolism ClinUse: * IV general anesthetic * non-analgesia * t1/2= 75min AE: * CV and resp depression * skeletal muscle movements * laryngospasm * shock
50
Remifentanil
Analgesic MOA: * Opioid receptor agonist ClinUse: * IV - opioid * analgesic and sedative * **short acting** - t1/2 = 4min * immdiate emmergence
51
Lidocaine
Local anesthetic MOA: * medium-acting * amide - binds Na channel of inner nerve membrane * closes Na channel -\> no AP * Better in non-ionized form (not acidic places) * Best on narrow, heavily myelinated, rapid firing neurons ClinUse: * local anesthesia * Epi to prolong action AEs: * seizures
52
Phenobarbital
Anticonvulsant, sedative-hypnotic MOA * GABA agonist -\> opens Cl channels -\> hyperpolerization Metabolism * 100 hr T1/2 * Loading dose required * Hepatic metabolism and enzyme inducer Clinical use * All seizure types except absence * PO/IV for status epilepticus Side Effects * Hyperactivity in peds * Sedation in adults * Joint/CT problems
53
Tetracaine
Local Anesthetic MOA: * amide - binds Na channel of inner nerve membrane * closes Na channel -\> no AP * Better in non-ionized form (not acidic places) * Best on narrow, heavily myelinated, rapid firing neurons * AChE metabolism ​ClinUse: * Inj - long acting local anesthetic * w/ Epi for prolonged duration
54
Chloroprocaine
Local Anesthetic Short-acting MOA: * amide - binds Na channel of inner nerve membrane * closes Na channel -\> no AP * Better in non-ionized form (not acidic places) * Best on narrow, heavily myelinated, rapid firing neurons * metabolized by **AChE** ​ClinUse: * Inj - short acting local anesthetic * w/ Epi for prolonged duration * short acting; 30-60mins AE: * safest 'caine *
55
Sucinylcholine
Depolarizing neuromuscular blockade MOA: ClinUse: * Induction agent * facilitate paralysis for intubation AEs: * Disassociate them first
56
Rocuronium
Non-depolarizing neuromuscular blockade MOA ClinUse: * Intubation * surgical paralysis AEs: * disassociate first
57
Desflurane
General anesthetic MOA: * inhaled hydrocarbon ClinUse: * surgical anesthetic AEs: * delayed emergence * delirium * N/V
58
Dexmetomidine
Anesthetic adjunct MOA: * a2 agonist * dose dependent analgesia and sedation ClinUse: * Reduce side effects from high-dose inhalation agents * can be used alone for minor procedures AEs: *
59
Isoflurane
General anesthetic MOA: * inhaled hydrocarbon ClinUse: * surgical anesthetic AEs: * delayed emergence * delirium * N/V
60
Sevoflurane
General anesthetic MOA: * inhaled hydrocarbon ClinUse: * surgical anesthetic AEs: * delayed emergence * delirium * N/V
61
Neostigmine
Paralytic reversal MOA: ClinUse: * Reverses muscle relaxants AEs:

Pharm II (3 decks)

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