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Flashcards in Neuro Deck (95):
1

Name 3 drugs which:
decrease REM/delta sleep

1. Alcohol
2. Benzos
3. Barbs

2

Name 1 drug which:
decreases REM only

Norepinephrine

3

2 drugs for treating Bedwetting (sleep enuresis).
Which is preferred? Why?

1. oral desmopressin (ADH analog)
2. imipramine

Desmopressin > Imipramine (too many side effects)

4

Drug for treating Night terrors/ Sleepwalking

Benzos

5

Name the 4 dopaminergic pathways in the brain

1. mesocortical
2. mesolimbic
3. Nigrostriatal
4. tuberoinfudibular

6

Which dopaminergic pathway...
1. is affected little by antipsychotic drugs?
2. is the therapeutic target for positive symptoms?
3. is the major dopaminergic pathway in the brain?
4. is affected significantly by Movement disorders?
5. is affected significantly by antipsychotic drugs?

1. Mesocortical
2. Mesolimbic
3. Nigrostriatal
4. Nigrostriatal
5. Nigrostriatal

7

effects of prolactin (5)

1. decrease libido/ sex dysfunction
2. galactorrhea
3. gynecomastia
4. amenorrhea
5. infertility

8

Antipsychotic drugs help treat which better- + or - symptoms

+ (mesolimbic)> - (mesocortical)

9

treatment for essential tremor (2)

1. nonselective BB (propranolol)
2. primidone

10

Treatment of Subarachnoid Hemorrhage(2)

1.stabilize
2. start on Ca+2 blocker to decrease cerebral ischemia

11

Treatment of TIA(2)

1. full work up
2. prescribe low-dose aspirin

12

Treatment of Ischemic Stroke (4)

1. tPA (within 3-4.5hrs)
2. aspirin/clopidogrel
3. BP control/ BS control/ lipids
4. treat condition (like A.fib)

13

Treatment of Pseudotumor Cerebri

1. weight loss
2. acetazolamide
3. topiramate
4. invasive procedures (repeat LP, CSF shunt, optic nerve fenestration surgery)

14

ALS treatment

Riluzole (increase survival by 6mos)

15

Treatment of Facial nerve palsy (Bell's palsy)
(2)

1. Corticosteroids
2. Acyclovir

16

Sensorineural hearing loss due to otoxoic drug presents as:

1. Tinnitus
2. Vertigo

17

Lens for correcting Hyperopia

"Far-sighted"
Convex

18

Lens for correcting Myopia

"Nearsighted"
Concave

19

Lens for correcting Presbyopia

Reading glasses

20

What medicine should be avoided with acute closed angle glaucoma?
When can this drug be used?

Epinephrine (b/c of its mydriatic effect)

- useful in chronic glaucoma to decrease aqueous humor production

21

Treatment for Uveitis

Steroids

22

Treatment for Conjunctivits:
Bacterial
Viral

Bacterial= abx
Viral (commonly adenovirus) self-resolving

23

Treatment of Wet Age-related macular degeneration

anti-VEGF injections (like RANibizumab)

(remember "BEVerly RAN for her VEGtables" Bev=bevacizumab"

24

Prevention of Dry Age-related macular degeneration

multivitamin/ antioxidant supplement

25

Treatment of Nonprolif. Diabetic Retinopathy

blood sugar control

26

Treatment of Prolif. Diabetic Retinopathy

1. peripheral retinal photocoagulation
2. surgery
3. anti-VEGF(like ranibizumab)

27

Treat Multiple Sclerosis:
Slow progression of disease-modifying therapies (3)

1. IFN-B
2. glatiramer (polymer of 4a.a. in Myelin Basic Protein)
3. natalizumab (alpha4-integrin, check for JC virus)

28

Treat Multiple Sclerosis:
acute flares (1)

1. IV steroids

29

Treat Multiple Sclerosis:
symptomatic treatment for
Neurogenic bladder(2)
spacticity(2)
pain(1)

Neurogenic bladder:
1. catheterization
2. muscarinic antagonists("On The Darn Toilet, Sorry")

Spacticity:
1. Baclofen
2. GABA-b-R agonists

Pain:
1. opioids

30

Treatment of Acute Inflammatory Demyelinating Polyradiculopathy(3)

(subtype of Guillain-Barre)
1. Respiratory support
2. Plasmapheresis
3. IVIG

* NO STEROIDS

31

Treatment of Cluster HA: (2)
Prophylaxis of Cluster HA: (1)

Tx: 1. Sumatriptan
2. 100% O2

Px: Verapamil

32

Treatment of Tension HA (3)
Chronic tension HA (1)

Tx: 1. Analgesics
2. NSAIDs
3. Acetaminophen

Chronic: Amitriptyline

33

Treatment of Acute Migraines (3)

1. NSAIDs
2. Triptans
3. Dihydroergotamine

34

Prophylaxis of Migraines(6)

1. lifestyle changes (sleep, exercise, diet)
2. BB
3. Ca+2 Channel blocker
4. amitriptyline
5. topiramate
6. valproate

35

2 uses for Triptan

1. Migraines
2. Cluster HA

36

Treatment of Trigeminal Neuralgia
Symptoms (3)

Tx: Carbamazepine

1. repetitive
2. unilateral
3. shooting pain in distribution of CN V that lasts typically less than 1 min

37

Epinephrine, Brimonidine:
Use/drug class
MOA
Adverse(6)
Contra

Glaucoma
Epi (a1 agonist)= decrease Aqueous production via Vasoconstriction
Brimonidine (a2 agonist)= decrease Aqueous production

1. Mydriasis (a1)
2. Blurry vision
3. Ocular hyperemia
4. foreign body sensation
5. ocular allergic rxn
6. ocular pruritus

Contra: CLOSED-ANGLE GLAUCOMA

38

Timolol, Betaxolol, Carteolol:
Use/drug class
MOA
Adverse
Which has the most systemic effects?

Glaucoma/ BB ('-olol')
decrease Aqueous production

-No pupillary or vision changes
- Timolol most likely to have systemic effects if drained into lacrimal system

39

Acetazolamide:
Use/drug class
MOA
Adverse

Glaucoma/ CA inhib (diuretic)
-decrease aqueous humor synthesis via CA inhib
-No pupillary or vision changes

40

Pilocarpine, Carbachol:
Use/drug class
MOA
Adverse
Which is used in an emergency? Why?

Glaucoma/ Direct M3 cholinomimetic
1. increase outflow of aqueous via contraction of ciliary muscle
2. open trabecular meshwork

Adverse: Miosis & cyclospasm

Emergency: Pilocarpine is very effective at opening meshwork into canal of Schlemm

41

Physostigmine, Echothiophate:
Use/drug class
MOA
Adverse

Glaucoma/ Indirect M3 cholinomimetic
1. increase outflow of aqueous via contraction of ciliary muscle
2. open trabecular meshwork

Adverse: Miosis & cyclospasm

42

Which muscle controls miosis?
Which muscle controls cyclospasm?

miosis=contraction of pupillary sphincter m.
cyclospasm= contraction of ciliary m.

43

Bimatoprost, Iatanoprost:
Use/drug class
MOA
Adverse

1st line treatment of Glaucoma/ Prostaglandins (Iatanoprost= PGF-2a)
- increase aqueous outflow through canal of Schlem

Adverse: 1. Darkens color of iris (Browning) 2. Eyelash growth

44

Opioid Analgesics:
Name (9)

1. Morphine
2. Fentanyl
3. Codeine
4. Loperamide
5. Methadone
6. Meperidine
7. Dextromethrophan
8. Diphenoxylate
9. pentazocine

45

Opioid Analgesics:
Name 3 opioid-R
MOA
Release modulation(all decrease)(5)

mu-R: B-endorphin
delta-R: enkephalin
kappa-R: dynorphin

open K+ channels, close Ca+2 channels--> decrease pain transmission.
1. Ach
2. NE
3. 5-HT
4. Glu
5. Substance P

46

Opioid Analgesics:
to treat pain/cough suppression

dextromethorphan

47

Opioid Analgesics:
to treat diarrhea

1. loperamide
2. diphenoxylate

48

Opioid Analgesics:
Acute pulmonary edema

Methadone, buprenorphine + naloxone

49

Opioid Analgesics:
Maintenance programs for heroin addicts

Methadone, buprenorphine + naloxone

50

Opioid Analgesics:
Adverse(5)

1. Addiction
2. respiratory depression
3. constipation
4. miosis
5. additive CNS depression with other drugs

51

Opioid Analgesics:
which opioid doesn't cause miosis?

meperidine (causes mydriasis)

52

Opioid Analgesics:
Tolerance does not develop to what symptoms of opioid use?

No tolerance to miosis and constipation

53

Opioid Analgesics:
treatment of opioid toxicity

Naloxone or Naltrexone (opioid-R antagonist)

54

Pentazocine:
MOA
Clinical Use

1. Kappa-R agonist
2. Mu-R antagonist

Moderate-Severe Pain

55

Pentazocine:
What happens when co-admin with full opioid ANTAGONIST (like Naloxone)?
Why?

Opioid withdrawal symptoms
(muscle aches, sweating, D/N/V, dilated pupils)

-competition for opioid-R

56

Butorphanol:
MOA
Clinical Use
Benefit to use over other opioids?

1. Kappa-R agonist
2. Mu-R partial agonist

-Severe Pain (migraine/labor)
- Less respiratory depression than full opioid agonist

57

Butorphanol:
What happens when co-admin with full opioid AGONIST?
Why?
Effect of Naloxone on Butorphanol?

Opioid withdrawal symptoms
(muscle aches, sweating, D/N/V, dilated pupils)

-competition for opioid-R

-Overdose not easily reversed with Naloxone

58

Tramadol:
MOA
Clinical Use

"'Tram it all' in with Tramadol" (meaning it works on many NTs)
- very weak opioid agonist
-inhib 5-HT & NE reuptake

-Chronic Pain (people beat up their dog to get their hands on this medication)

59

Tramadol:
Adverse

1. similar to Opioids
2. increase seizure risk (decreases threshold)
3. Serotonin Syndrome

60

Whats the difference btw Tolerance, Dependence, and Withdrawal?

Tolerance-must increase drug amount-->decrease effect
Dependence- drug needed for normal function
Withdrawal- ill effects of drug use

61

Ethosuximide:
First line treatment for...
MOA

Absence Seizures
"Sucks to have Silent Seizures"

- Block T-type Ca+2 channels (thalamus)

62

Ethosuximide:
Adverse(5*)

"EFGHIJ"
Ethosuximide causes
1.Fatigue
2.GI upset
3.HA
4. Itching
5. Steven-Johnsons

63

Benzodiazepines:
Name 3 seizure drug examples
MOA
First line for acute treatment for...
Additional Use

1. Diazepam 2. Lorazepam 3. Midazolam

-increase GABA-A action via increase frequency of Cl- channel opening

-Status Epilepticus
-Eclampsia Seizures

64

First line treatment for Eclampsia seizures?

MgSO4

65

Benzodiazepines:
Adverse (3)

1. Sedation --> Respiratory Depression
2. Tolerance
3. Dependence

66

Phenobarbital:
MOA
First line of treatment for...
other seizure uses (3)

-increase GABA-A action via increase duration of Cl- channel opening

-First line in Neonates
1. Simple
2. Complex
3. Tonic-clonic

67

Phenobarbital:
Adverse(4)

1. Sedation--> cardiovascular depression
2. Tolerance
3. Dependence
4. induction of P450 ("Chronic Alcoholics Steal Phen-Phen & Never Refuses Greasy Carbs")

68

Phenytoin & Fosphenytoin(oral):
MOA & important metabolism note
First line prophylaxis for ...
First line treatment for...
Other seizure uses (2)

Block Na+ channels (ZERO-ORDER: "PEA")

-1st px: Status epilepticus
-1st tx: Tonic-Clonic
1. Simple
2. Complex

69

Phenytoin & Fosphenytoin(oral):
Adverse
-Neuro(4)
-Derm (4)

Neuro:
1. Nystagmus/Diplopia
2. Ataxia
3. Peripheral Neuropathy
4. Sedation

Derm:
1. Hirsutism
2. Steven-Johnson's rash
3. Gingival Hyperplasia
4. DRESS-syndrome (drug rash w/ eosinophils and systemic symptoms)

70

Phenytoin & Fosphenytoin(oral):
Adverse
-MSK (2)
-Hematologic (1)
-Reproductive (1)
-Other (1)

MSK: 1. osteoporosis 2. SLE-like syndrome

Hematologic: Megaloblastic anemia

Reproductive: Teratogenesis (Fetal hydantoin Synd)

Other: P450 induction

71

Drugs causing Megaloblastic Anemia (3)

"having a BLAST with PMS"
1. Phenytoin
2. Methotrexate
3. Sulfa drugs

72

Drugs causing Gingival Hyperplasia (3)

1. Phenytoin
2. Ca+2 channel blockers (rare)
3. cyclosporine

73

Drugs causing Steven-Johnsons

"CLAPPPERS"
1. Carbamazepine
2. Lamotrigine
3. Allopurinol
4. Phenytoin
5. Phenobarbital
6. Penicillin
7. Ethosuximide
8. Rash
9. Sulfa drugs

74

Drugs causing SLE-like syndrome

"having lupus is SHIPP-E"
1. Sulfa drugs
2. Hydralazine
3. Isoniazid
4. Procainamide
5. Phenytoin
6. Etanercept

75

Carbamazepine:
MOA
First line treatment for (2, 1)
other seizure use (1)

Blocks Na+ channel

1. Simple
2. Complex
3. Trigeminal neuralgia

-Tonic-Clonic Seizures

76

Carbamazepine:
Adverse (7)

1. Diplopia
2. Ataxia
3. Agranulocytosis/ Aplastic Anemia (Monitor 'C'BC)
4. Hepatotox & P450 induction
5. Teratogenesis
6. SIADH
7. Steven-Johnson

77

Valproic Acid:
MOA (2)

1. Na+ channel inactivation
2. increase GABA concentration by inhibiting GABA-transaminase

78

Valproic Acid:
First line treatment for...
Other seizure uses (4)
Additional uses (2)

First line: Tonic Clonic
1. Simple
2. Complex
3. Absence
4. Myoclonic Seizures

1. Bipolar DO
2. Migrane prophylaxis

79

Valproic Acid:
Adverse (5)
Contra-Why?

1. GI distress
2. Fatal Hepatotox (rare but must monitor LFTs)
3. Pancreatitis
4. Trmeor
5. Weight gain

Contra: Pregnancy- Neural Tube defects

80

Vigabatrin:
MOA
Clinical uses (2)

increase GABA concentration by IRREVERSIBLY inhibiting GABA-transaminase

1. Simple
2. Complex

81

Gabapentin:
MOA
Seizure uses (2)
Additional uses (2)

- inhib VG-Ca+2 channels (designed as GABA analog)

1. Simple 2. Complex

1. Peripheral Neuropathy
2. Post-herpetic Neuralgia

82

Gabapentin:
Adverse(2)

1. Sedation
2. ataxia

83

Topiramate:
MOA
Seizure uses (3)
Additional use (1)

- Blocks Na+ channels -->increase GABA action

1. Simple
2. Complex
3. Tonic-Clonic

1. Migrane prevention

84

Topiramate:
Adverse (3)

1. Sedation/Mental dulling ("topey makes you dopey")
2. Kidney Stones (Topey makes it hard TO pee)
3. weight loss

85

Lamotrigine:
MOA
Clinical uses (4)
Benefit over Carbamazepine/Phenytoin
Adverse (1)

-Block VG-Na+ channel
1. Simple
2. Complex
3. Tonic-clonic
4. Absence
-fewer side effects when compared to Carbamazepine/Phenytoin

-Adverse: Steven-Johnsons (must titrate slowly)

86

3 drugs to treat Absence seizures?
Whats the first line?

1. Ethosuximide
2. Valproic acid
3. Lamotrigine

87

Treatment of Myoclonic seizures

Vlaproic acid

88

Levetiracetam:
MOA
Clinical uses (3)

- Unknown modulation of GABA&Glutamate release

1. simple
2. complex
3. tonic-clonic

89

Tiagabine:
MOA
Clinical uses (2)

-increase GABA concentration by inhibiting GABA-REUPTAKE

1. Simple
2. Complex

90

Seizure drugs which induce P450 (3)

1. phenobarbital
2. Phenytoin/ Fosphenytoin
3. Carbamazepine

91

1 drugs which increase Na+ Channel inactivation
4 drugs which block Na+ channels

1. Valproic Acid


1. Phenytoin/Fosphenytoin
2. Lamotrigine
3. Topirimate
4. Carbamazipine

92

3 drugs which increase GABA action

3 drugs which increase GABA level

1. Topirimate
2. Phenobarbital
3. Benzodiazepines

1. Valproic Acid
2. Tiagabine
3. Vigabatrin

93

2 drugs which block Ca+2 channel

1. Gabapentin
2. Ethosuximide

94

1 drug which modulates GABA & Glutamate release

1. Levetiracetam

95

What is dressler syndrome?

autoimmune phenomenon resulting in fibrous pericarditis several weeks post MI (associated with Phenytoin)