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Flashcards in Neuro Deck (57)
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1

Epinephrine (alpha1), Brimonidine (alpha 2)
[Effect in Glaucoma]

>Epinephrine: vasoconstriction -- dec. aqueous humor synth; can cause mydriasis via alpha1 (not for closed-angle glaucoma).
>Brimonidine: dec. aqueous humor synth

2

Timolol, Betaxolol, Carteolol (B-blockers)
[Effect in Glaucoma]

Dec. aqueous humor synth by the ciliary epithelium.

3

Acetazolamide (diuretic)
[Effect in Glaucoma]

Inhibit carbonic anhydrase -- dec. aqueous humor synth.

4

Pilocarpine, Carbachol (direct cholinomimetics).
Physostigmine, Echothiophate (indirect).
[Effect in Glaucoma, SE]

Contracts ciliary muscle (M3) and opening of trabecular meshwork -- Inc. aqueous humor outflow.
*Pilocarpine for emergencies: effective in opening canal of Schlemm.
SE: mitosis, cyclospasm.

5

Latanoprost (PGF2a)
[Effect in Glaucoma, SE]

Inc. outflow of aqueous humor (by inc. uveoscleral outflow).
SE: darkens iris color (browning)

6

Opioid analgesics
Drug names (4)

Morphine, Fentanyl, Codeine
Loperamide, Methadone, Meperidine
Dextromethorphan, Diphenoxylate Pentazocine

7

Opioid analgesics
MOA

>Agonists at opioid receptors -- open K channels, close Ca channels -- dec. synaptic transmission.
>Inhibits release of neurotransmitters (ACh, NE, 5HT, glutamate, substance P).
[Mu - morphine, Delta - enkephalin, Kappa - dynorphin]

8

Opioid analgesics
Use

Pain.
Cough suppression (dextromethorphan).
Diarrhea (loperamide, diphenoxylate).
Acute pulmo edema.
Maintenance for heroin addicts.(methadone, buprenorphine + naloxone)

9

Opioid analgesics
Toxicity

Addiction, Respi depression, constipation.
Pinpoint pupils (miosis).
Tx: Naloxone, Naltrexone (opioid receptor antagonist).

10

Butorphanol
[use]

Kappa receptor agonist; partial agonist to Mu-receptor.
For severe pain (migraine, labor).
*Don't give w/ full opioid agonist -- withdrawal sx due to competition for receptors; overdose not easily reversed w/ naloxone

11

Tramadol
[use, SE]

Weak opioid agonist; also inhibits 5HT and NE reuptake.
For chronic pain.
SE: Serotonin syndrome.

12

Ethosuxamide
[Seizure type, MOA, SE]

Absence seizures.
>MOA: Blocks thalamic T-type Ca channels -- inhibits the transient depolarizations necessary to make spike-wave patterns seen in Absence (maintains rhythmic discharge in thalamic neurons).
>SE: Fatigue, GI distress, Headache, Itching, SJS.

13

Diazepam, Lorazepam
[Seizure type, MOA]

Status epilepticus; Eclampsia seizures.
MOA: Inc. GABA-A action by inc. frequency of Cl- channel opening.

14

Phenytoin
[Seizure types, MOA, SE]

Tonic-clonic (1st line), Status epilepticus (prophylaxis); partial seizures.
>MOA: Inc. Na channel inactivation (dec. propagation)
>SE: gingival hyperplasia, megaloblastic anemia, teratogenesis, SJS, osteopenia

15

Carbamazepine
[Seizure types, MOA, SE]

1st line: Partial seizures, Tonic-clonic.
1st line: trigeminal neuralgia.
>MOA: Inc. Na channel inactivation.
>SE: blood dyscrasias (agranulocytosis, aplastic anemia), teratogenesis, liver toxicity

16

Valproic acid
[Seizure types, MOA, SE]

Tonic-clonic (1st line), absence, Partial seizures.
>MOA: Inc. Na channel inactivation; Inhibits GABA transaminase (inc. GABA conc.).
>SE: Neural tube defects, CI in preg

17

Gabapentin
[Seizure types, MOA]

Partial seizures.
>MOA: inhibits voltage-activated Ca channels (GABA analog).
*Also for peripheral neuropathy, postherpetic neuralgia

18

Phenobarbital
[Seizure types, MOA]

Partial seizures, Tonic-clonic.
MOA: inc. GABA-A action by inc. duration of Cl- channel opening.
*1st line in neonates

19

Lamotrigine
[Seizure types, MOA, SE]

Partial seizures; Tonic-clonic, Absence.
MOA: Blocks voltage-gated Na channels.
SE: SJS (titrate slowly).

20

Topiramate
[Seizure types, MOA]

Partial seizures, Tonic-clonic.
MOA: Blocks Na channels, Inc. GABA action.
*Also for migraine prevention

21

Tiagabine
[Seizure types, MOA]

Partial seizures.
MOA: Inhibits GABA reuptake.

22

Barbiturates
[Drug names, use]

Phenobarbital, Pentobarbital, Thiopental, Secobarbital.
Sedative for anxiety, seizures, insomnia.
Induction of anesthesia (thiopental).

23

Barbiturates
[MOA, toxicity]

>MOA: Inc. duration of Cl channel opening -- inc. GABA-A action -- dec. neuron firing.
>SE: respi and cardiovascular depression; CNS depression, dependence.

24

Benzodiazepines
[Drug names, use]

>Diazepam, Lorazepam, Triazolam, Temazepam, Oxazepam, Midazolam, Chlordiazepoxide, Alprazolam.
>For anxiety, Status epilepticus (lorazepam, diazepam), detoxification (alcohol-w/d DT), general anesthetic, night terrors, hypnotic.

25

Benzodiazepines
[MOA, toxicity]

>MOA: GABA-A receptor; Inc. frequency of Cl channel opening -- inc. GABA-A action.
>SE: dependence, additive CNS depression w/ alcohol; less risk of respi depression vs barbiturates.
*Tx overdose: flumazenil (competetive antagonist)

26

Non-BZ hypnotics
[Drugs, MOA, use]

Zolpidem, Zaleplon, Eszopiclone.
Acts on BZ1 subtype of GABA receptor.
For insomnia (short-term tx).
*Effects reversed by flumazenil

27

Inhaled anesthetics
[Drug, effects]

Halothane, enflurane, isoflurane, sevoflurane, methoxyflurane; N2O.
>Effects: myocardial depression, respi depression, inc. cerebral blood flow (dec. cerebral metabolic demand).

28

Inhaled anesthetics
Toxicity

Hepatotoxic (halothane); Nephrotoxic (methoxyflurane); Proconvulsant (enflurane).
Expansion of trapped gas in body cavity (N2O).
*Malignant hyperthermia: life-threatening, hereditary; inhaled anesthetics (except N2O) and succinylcholine induce fever, muscle contractions; Tx is Dantrolene.

29

Why is thiopental (as an IV barbiturate) most commonly used for induction of anesthesia and short surgical procedures?

Has high potency, high lipid solubility, and rapid entry into brain.
Rapid redistribution into tissues terminates effects.

30

Which benzodiazepine is most commonly used for endoscopy? What are possible side effects?

Midazolam, used adjunctively w/ gas anesthetics and narcotics.
May cause severe post-op respi depression and dec. BP (tx overdose w/ flumazenil).
Possible anterograde amnesia