Neuro - Pharmacology Flashcards
(149 cards)
1
Q
Which two alpha-agonists are used to treat glaucoma?
A
Epinephrine and brimonidine
2
Q
How do α1-agonists treat glaucoma?
A
They decrease aqueous humor synthesis
3
Q
Which alpha-agonist is contraindicated for closed-angle glaucoma?
A
Epinephrine
4
Q
Which beta-blockers are used to treat glaucoma?
A
Timolol, betaxolol, carteolol
5
Q
By what mechanism do beta-blockers treat glaucoma?
A
They decrease aqueous humor secretion
6
Q
How does acetazolamide treat glaucoma?
A
It decreases aqueous humor secretion by inhibiting carbonic anhydrase
7
Q
Which four cholinomimetics are used to treat glaucoma?
A
Pilocarpine, carbachol, physostigmine, echothiophate
8
Q
By what mechanism do cholinomimetics treat glaucoma?
A
They increase outflow of aqueous humor, contract the ciliary muscle, and open the trabecular meshwork
9
Q
Which drug is used for glaucoma in emergencies?
A
Pilocarpine
10
Q
Which prostaglandin increases the outflow of aqueous humor in glaucoma? Of which prostaglandin is it an analog?
A
Latanoprost; prostaglandin F2
11
Q
A patient’s new glaucoma drug is causing browning of the iris. What is she taking?
A
Latanoprost
12
Q
Morphine, fentanyl, codeine, heroin, methadone, meperidine, and dextromethorphan are in which category of drugs?
A
Opioid analgesics
13
Q
What is the mechanism of action of opioid analgesics?
A
They act as agonists at the mu, delta, and kappa opioid receptors to modulate synaptic transmission
14
Q
Match the following substances with the opioid receptor (mu/delta/kappa) that they bind most avidly: morphine, dynorphin, enkephalin.
A
Dynorphin is avidly bound to the kappa receptor, enkephalin is avidly bound to the delta receptor, and morphine is avidly bound to the mu receptor
15
Q
Which opioid agonist is used for cough suppression?
A
Dextromethorphan
16
Q
Which two opioid agonists are used to alleviate diarrhea?
A
Loperamide and diphenoxylate
17
Q
Which opioid analgesic is used for maintenance programs for heroin addicts?
A
Methadone
18
Q
What changes in neurotransmitter release result from opioid receptor agonists?
A
They inhibit release of acetylcholine, norepinephrine, serotonin, glutamate, and substance P
19
Q
A patient well-known to the emergency department presents with respiratory depression, constipation, and miosis. What is the most likely cause of her condition?
A
Opioid toxicity
20
Q
Despite requiring increasing doses for recreational use, which two adverse effects of opioid use will patients not develop tolerance to?
A
Miosis and constipation
21
Q
Which two drugs are used to treat opioid toxicity?
A
Naloxone or naltrexone (opioid receptor antagonists)
22
Q
Butorphanol acts a partial _____ (agonist/antagonist) at opioid _____ (mu/kappa) receptors, and an _____ (agonist/antagonist) at _____ (kappa/delta) receptors.
A
Agonist; mu; agonist; kappa
23
Q
What is the toxicity of butorphanol?
A
Withdrawal if a patient is on a full opioid agonist, due to its partial agonist activity
24
Q
What is the benefit of butorphanol over other opioid analgesics?
A
Butorphanol causes less respiratory depression than full agonists
25
Which analgesic drug is a weak opioid agonist and inhibitor of serotonin and norepinephrine uptake?
Tramadol
26
What is the toxic effect of tramadol?
Decreases seizure threshold
27
What is the clinical use of tramadol?
Chronic pain
28
Which types of seizures are treated with phenytoin? What is its mechanism of action?
Simple and complex partial seizures, tonic-clonic seizures, and status epilepticus; inactivates sodium channels
29
Which types of seizures are treated with carbamazepine? What is its mechanism of action?
Simple and complex partial seizures and tonic-clonic generalized seizures; inactivates sodium channels
30
Which types of seizures are treated with lamotrigine? What is its mechanism of action?
Simple and complex partial seizures and tonic-clonic generalized seizures; inactivates sodium channels
31
Which types of seizures are treated with gabapentin? What is its mechanism of action?
Simple and complex partial seizures and tonic-clonic generalized seizures; inactivates calcium channels
32
Which drug is used as a first-line agent for the treatment of trigeminal neuralgia?
Carbamazepine
33
Which types of seizures are treated with topiramate? What is its mechanism of action?
Simple and complex partial seizures and tonic-clonic generalized seizures; inactivates sodium channels and increases GABA action
34
Which epilepsy drug is the first-line agent used to treat pregnant patients?
Phenobarbital
35
Which types of seizures are treated with phenobarbital? What is its mechanism of action?
Simple and complex partial seizures and tonic-clonic generalized seizures; increases GABAA action
36
What is the first-line agent used to prevent seizures in patients with eclampsia?
Magnesium sulfate
37
Which types of seizures are treated with valproic acid? What is its mechanism of action?
Simple and complex partial seizures and tonic-clonic and absence generalized seizures; inactivates sodium channels, increases GABA concentration
38
If magnesium sulfate fails to prevent seizures in a patient with eclampsia, what class of drugs could also be used?
Benzodiazepines
39
Which types of seizures are treated with ethosuximide? What is its mechanism of action?
Absence generalized seizures; blocks thalamic T-type calcium channels
40
Which types of seizures are treated with benzodiazepines? What is the mechanism of action?
Status epilepticus; increase the action of GABAA
41
Which types of seizures are treated with tiagabine? What is its mechanism of action?
Simple and complex partial seizures; inhibits GABA reuptake
42
Which types of seizures are treated with vigabatrin? What is its mechanism of action?
Simple and complex partial seizures; it irreversibly inhibits GABA transaminase, thus increasing GABA concentration
43
Which types of seizures are treated with levetiracetam? What is its mechanism of action?
Simple and complex partial seizures and tonic-clonic generalized seizures; its mechanism is unknown, but it may modulate GABA and glutamate release
44
Which two blood dyscrasias are associated with carbamazepine toxicity?
Agranulocytosis and aplastic anemia
45
Which two epilepsy drugs may predispose individuals who are taking them to Stevens-Johnson syndrome?
Ethosuximide and lamotrigine
46
Which antiepileptic drug may cause sedation, tolerance, and dependence in addition to inducing cytochrome P450 enzymes?
Phenobarbital
47
What epilepsy drug may cause lupus-like syndrome and gingival hyperplasia?
Phenytoin
48
A patient with epilepsy presents with hirsutism, megaloblastic anemia, ataxia, and gingival hyperplasia. What drug may this person be taking to help treat the epilepsy?
Phenytoin
49
What are the adverse effects of carbamazepine use?
Diplopia, ataxia, blood dyscrasias, liver toxicity, teratogenesis, and the induction of cytochrome P450
50
Name the toxicities of ethosuximide; use the mnemonic, EFGH.
**E**thosuximide = **F**atigue, **G**I distress, **H**eadache
51
Acute hepatotoxicity is associated with which antiepileptic drug?
Valproic acid
52
Women of childbearing age who are using which two antiepileptic drugs should also be using birth control because of the teratogenic risks?
Valproic acid, which causes neural tube defects, and carbamazepine
53
Which antiepileptic drug is associated with kidney stones and weight loss?
Topiramate
54
Name two adverse effects of gabapentin.
Sedation and ataxia
55
What is Stevens-Johnson syndrome?
A disorder characterized by a prodrome of malaise and fever followed by rapid onset of erythematous and purpuric macules found on oral, ocular, and genital surfaces that eventually progress to epidermal necrosis and the sloughing of skin
56
What is the mechanism of action of phenytoin?
Phenytoin creates a use-dependent blockade of sodium channels and inhibits glutamate release from excitatory presynaptic neurons
57
What is the teratogenic effect of phenytoin use during pregnancy?
Fetal hydantoin syndrome
58
Which antiepileptic drug is primarily used to treat tonic-clonic seizures and is also a class IB antiarrhythmic agent?
Phenytoin
59
A patient presents with nystagmus, ataxia, diplopia, and sedation after starting an antiepileptic drug for tonic-clonic seizures. What medication was the patient most likely started on?
Phenytoin
60
Phenobarbital, pentobarbital, thiopental, and secobarbital are members of which class of drugs?
Barbiturates
61
True or False? Dependence is a major adverse effect of barbiturates.
TRUE
62
What is the mechanism of action of barbiturates?
Barbiturates facilitate GABAA action by increasing the duration of chloride channel opening, thereby decreasing neuron firing (remember: Barbi**DURAT**es increase duration)
63
What class of medications commonly used to treat anxiety is contraindicated for patients with porphyria?
Barbiturates
64
What is the treatment for barbiturate overdose?
Assisted respiration and maintenance of blood pressure until the drug is metabolized
65
What are the clinical uses of barbiturates?
Barbiturates are commonly used as sedatives for treating anxiety, seizures, and insomnia, and for the induction of anesthesia
66
What is the effect of combining barbiturates with alcohol?
Barbiturates have an additive central nervous system depression effect when combined with alcohol
67
What is the effect of barbiturates on cytochrome P450?
Barbiturates induce cytochrome P450 enzymes
68
Diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, and alprazolam are members of what class of drugs?
Benzodiazepines
69
Which class of drugs used for symptoms of alcohol withdrawal (delirium tremens) has an additive central nervous system depression effect with alcohol and may result in dependence?
Benzodiazepines
70
Compared with barbiturates, benzodiazepines carry a(n) _____ (decreased/increased) risk of respiratory depression and coma.
Decreased
71
What is the mechanism of action of benzodiazepines?
Benzodiazepines facilitate GABAA action by increasing the frequency of chloride channel opening (remember: FREnzodiazepines increase FREquency)
72
Most benzodiazepines have a _____ (short/long) half-life and ______ (active/inactive) metabolites.
Long; active
73
With which drug should benzodiazepine overdose be treated? What is its mechanism of action?
Flumazenil; it is a competitive antagonist of GABA receptors
74
What are the clinical uses of benzodiazepines?
Benzodiazepines are used to treat anxiety, spasticity, status epilepticus, night terrors, and sleepwalking
75
Which are the short-acting benzodiazepines?
**T**riazolam, **O**xazepam, **M**idazolam (remember: **TOM** Thumb is SHORT)
76
Which benzodiazepines have the higher addictive potential, short or long acting?
Short acting
77
General anesthetics that act on the central nervous system must be _____ (lipid/water) -soluble or actively transported across the blood-brain barrier.
Lipid
78
Nitrous oxide has _____ (high/low) blood and lipid solubility and thus _____ (fast/slow) induction.
Low; fast
79
Halothane has high lipid and blood solubility; thus, it has _____ (high/low) potency and _____ (fast/slow) induction.
High; slow
80
When discussing general anesthetics, the higher the lipid solubility, the _____ (higher/lower) the potency.
Higher
81
Anesthetic drugs with _____ (low/high) solubility in the blood have rapid induction and reduced recovery times.
Low
82
When discussing general anesthetics, what does the acronym MAC stand for and indicate? How does it relate to potency?
Minimal alveolar concentration at which 50% of the population is anesthetized; the lower the MAC, the more potent the anesthetic
83
Name four inhaled anesthetics.
Halothane, enflurane, isoflurane, and sevoflurane
84
What are four common adverse effects of inhaled anesthetics?
Myocardial depression, respiratory depression, emesis, and increased cerebral blood flow
85
Match the anesthetic to the type of toxicity: halothane, methoxyflurane, enflurane – nephrotoxicity, proconvulsant, hepatotoxicity.
Halothane causes hepatotoxicity; methoxyflurane causes nephrotoxicity; enflurane is a proconvulsant
86
Which class of drugs can cause malignant hyperthermia, myocardial depression, and a decrease in cerebral metabolic demand?
Inhaled anesthetics
87
Inhaled anesthetics may cause a(n) _____ (decrease/increase) in cerebral blood flow.
Increase
88
Which barbiturate is commonly used for the induction of anesthesia and short surgical procedures?
Thiopental
89
What is the most common drug used for anesthesia during endoscopy?
Midazolam
90
What are two common adverse effects of midazolam?
Amnesia and respiratory depression
91
\_\_\_\_\_, which is a phencyclidine (PCP) analog, acts as a dissociative anesthetic.
Ketamine
92
What are the effects of ketamine and thiopental on cerebral blood flow?
Ketamine increases cerebral blood flow whereas thiopental decreases it
93
What are three common adverse effects of ketamine?
Disorientation, hallucinations, and bad dreams
94
Which two opiates are commonly used with other agents during general anesthesia?
Morphine and fentanyl
95
Which intravenous lipid-based anesthetic, used for rapid anesthesia induction, results in less postoperative nausea than thiopental?
Propofol
96
What is the only commonly used anesthesia induction agent that does not lower blood pressure?
Ketamine
97
What is the mechanism of action of propofol?
Propofol potentiates GABAA
98
How does the mnemonic **B.B. K**ing on **OPIATES PROPO**ses **FOOL**ishly help you remember the classes and drugs involved in intravenous anesthesia?
**B**arbiturates, **B**enzodiazepines, **K**etamine, **OPIATES, Propofol**
99
What is the mechanism of action of ketamine?
It blocks NMDA receptors
100
Name three local anesthetics with an ester group.
Procaine, cocaine, and tetracaine
101
Local anesthetics block _____ channels by binding to specific receptors on the _____ (inner/outer) portion of the channel.
Sodium; inner
102
Local anesthetics penetrate infected tissue _____ (less/more) efficiently because of the ______ (decreased/increased) acidity in the tissue.
Less; increased
103
A nerve blockade has the greatest effect on nerves that are _____ (myelinated/unmyelinated) and _____ (large/small). _____ (Myelination/Size) predominates over _____ (myelination/size).
Myelinated; small; Size; myelination; therefore, small myelinated nerves are anesthetized first, followed by small unmyelinated fibers and then large fibers
104
List the order in which the following sensation is lost during nerve blockade from first to last: pressure, pain, touch, and temperature.
Pain, temperature, touch, and pressure
105
Name three local anesthetics with an amide group.
Lidocaine, mepivacaine, and bupivacaine (remember: am**I**des have 2 **I'**s in name)
106
Local anesthetics preferentially bind to ______ (activated/inactivated) sodium channels, so they are most effective in ______ (rapidly/slowly) firing neurons.
Activated; rapidly
107
Which drug is commonly mixed with local anesthesia (except for cocaine) to enhance the local anesthesia action, to decrease bleeding, and to decrease systemic concentration?
Epinephrine; it acts through local vasoconstriction, which leads to less dilution of the anesthetic agent
108
What amide, which is used in local anesthesia, may cause severe cardiovascular toxicity?
Bupivacaine
109
What uncommonly used local anesthetic is a commonly abused street drug that may cause cardiac arrhythmias?
Cocaine
110
Accidentally injecting local anesthetics such as lidocaine into a vein may cause what adverse event?
Cardiac arrhythmia
111
Succinylcholine is a _____ (depolarizing/nondepolarizing) neuromuscular blocking agent.
Depolarizing
112
Neuromuscular blocking drugs that are commonly used for muscle paralysis during surgery or mechanical ventilation are selective for motor _____ receptors.
Nicotinic
113
What is the antidote to phase I (prolonged depolarization) action of succinylcholine?
There is no antidote
114
Phase I depolarization in neuromuscular blockade is potentiated by _____ inhibitors.
Cholinesterase
115
Name six nondepolarizing neuromuscular blocking drugs.
Tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, and rocuronium
116
Nondepolarizing neuromuscular blocking drugs compete with _____ for receptors.
Acetylcholine
117
What is the antidote for a nondepolarizing neuromuscular blocking drug?
Neostigmine or edrophonium
118
Use of succinylcholine may cause what two electrolyte abnormalities?
Hyperkalemia and hypercalcemia
119
What is the antidote for phase II (repolarized but blocked) action of succinylcholine?
Neostigmine or other cholinesterase inhibitors
120
Which drug is used to treat malignant hyperthermia and neuroleptic malignant syndrome?
Dantrolene
121
Dantrolene can treat malignant hyperthermia via what mechanism of action?
By preventing the release of calcium from the sarcoplasmic reticulum of skeletal muscle
122
The use of which two drugs concomitantly may result in malignant hyperthermia in a patient who is genetically susceptible?
Inhalation anesthetics with succinylcholine
123
Bromocriptine is an agonist of which neurotransmitter?
Dopamine
124
Which selective monoamine oxidase type B inhibitor prevents the breakdown of dopamine in the central nervous system?
Selegiline
125
For which parkinsonian symptoms is benztropine effective?
Tremor and rigidity, but not bradykinesia (remember: decrease your tremor before you drive your Mercedes-BENZ)
126
Amantadine may _____ (decrease/increase) dopamine release.
Increase
127
Name two catechol-O-methyltransferase inhibitors that prevent the breakdown of L-dopa in the central nervous system.
Entacapone and tolcapone
128
Patients with parkinsonism have excess activity of what neurotransmitter?
Acetylcholine
129
What class of medication is used to treat an essential or familial tremor?
Beta-blockers
130
Which five drugs/classes are used to treat Parkinson's disease? Use the mnemonic, BALSA.
**B**romocriptine, **A**mantadine, **L**evodopa (with carbidopa), **S**elegiline (and catechol-O-methyltransferase inhibitors), **A**ntimuscarinics
131
What drug used to treat Parkinson's disease is also used as an antiviral agent against influenza A and rubella?
Amantadine
132
Amantadine toxicity is characterized by what symptom?
Ataxia
133
Which medication used to treat Parkinson's disease crosses the blood-brain barrier, where it is then converted into dopamine by dopa decarboxylase in the central nervous system?
L-dopa
134
What effect may L-dopa have on the heart?
Arrhythmias
135
Which medication is a peripheral decarboxylase inhibitor that is given with L-dopa to increase its effective concentration?
Carbidopa
136
Selegiline may _____ (increase/decrease) the adverse effects of L-dopa in patients with parkinsonian conditions.
Increase
137
Name two drugs that are approved to treat Alzheimer's disease.
Memantine and donepezil
138
To which class of drugs does donepezil belong?
Acetylcholinesterase inhibitors
139
What three side effects are associated with donepezil?
Nausea, dizziness, insomnia
140
Which drug, used for Alzheimer;s disease, acts as a NMDA receptor antagonist?
Memantine
141
What are the side effects of memantine?
Dizziness, confusion, hallucinations
142
Memantine helps prevent what calcium-mediated process in Alzheimer's disease?
Excitotoxicity of neurons
143
Huntington's disease is characterized by _____ (increased/decreased) dopamine, _____ (increased/decreased) GABA, and _____ (increased/decreased) acetylcholine activity.
Increased; decreased; decreased
144
Name two amine-depleting drugs used to treat Huntington's disease.
Reserpine and tetrabenazine
145
Which dopamine receptor antagonist can be used to treat Huntington's disease?
Haloperidol
146
What is the mechanism of action of sumatriptan?
It is a serotonin receptor 5-HT1B/1D agonist that inhibits the trigeminal nerve and reduces vasoactive peptide release
147
What adverse effects can result from sumatriptan use?
Coronary vasospasm and mild tingling
148
Sumatriptan is used to treat what conditions?
Migraines and cluster headaches
149
Sumatriptan is contraindicated in patients with what two conditions due to its effect of coronary vasospasm?
Coronary artery disease and Prinzmetal's angina
