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Flashcards in NEUROLOGY Deck (132):
1

If you wanted to give phenytoin parenterally, which drug would you give?

Fosphenytoin

2

Aside from its use as an anticonvulsant, topiramate is also used to _________

prevent migraine headaches

2

What is DOC for myoclonic seizures?

Valproic acid

2

What drugs should be used for essential or familial tremors?

beta blockers (propanolol)

3

Which IV anesthetic is an arylcyclohexamine?

ketamine (BAD DREAMS)

3

What is the MOA of tolcapone and entacapone?

COMT inhibitors that prevent the breakdown of dopamine

4

What is the AE of tramodol?

decreases seizure threshold

5

Name 2 alpha agonists used to treat glaucoma

Brimonidine and epinephrine

5

Which barbiturate is used to induce anesthesia?

thiopental

5

Which anticonvulsants are first line in children?

phenobarbital (ethosuximide for absence)

5

Name 3 short acting benzos. Significance?

triazolam, oxazepam, and midazolam? Higher addictive potential

5

Name the depolarizing neuromuscular blocker

succinylcholine

5

How is the reversal of depolarizing and nondepolarizing neuromuscular blockers different?

non-depolarizings can be reversed with anti-cholinesterases? depolarizing ones can only be reversed in phase II as in phase I there is no antidote

6

Which glaucoma drugs cause mydriasis?

Epinephrine and brimonidine (don?t give in closed angle glaucoma)

6

What is the MOA of ethosuximide?

Blocks thalamic T-type Ca channels

6

Why is haloperidol used in Huntington's chorea?

it is a dopamine receptor antagonist

7

What antiepileptic often cause fetal hydantoin syndrome? Which causes neural tube defects?

phenytoin; valproate

8

What are pramipexole and ropinirole?

non-ergot dopamine agonists (preferred)

9

Which antimuscarine agent is used in the treatment of Parkinsons disease?

Benztropine (Park your Benz)

10

How would you reverse the effects of the most common drug used in endoscopy?

The most common drug inducing anesthesia for this procedure is midazolam, reverse with flumazenil

12

Which drug irreversibly inhibits GABA transaminase?

Vigabatrin

13

What is the MOA of barbiturates?

facilitate GABAa action by increasing duration of chloride channel opening

14

Which glaucoma drug has the AE of darkening the pigment of the iris?

Latanoprost

14

What 2 drugs can be used to treat absence seizures?

Ethosuximide and valproic acid

14

Explain why the anticonvulsant that causes gingival hyperplasia can also result in megaloblastic anemia

This is phenytoin. Inhibition of intestinal conjugase impairs folic acid absorption leading to megaloblastic anemia

14

What is the MOA of propofol?

potentiates GABAa

15

What are the AE of halothane?

hepatotoxicity, malignant hyperthermia

16

What are the AE of cholinomimetics used to Tx glaucoma?

cyclospasm and miosis

17

What drug is DOC for prophylaxis of status epilepticus?

Phenytoin

17

Which inhaled anesthetic causes hepatotoxicity?

Halothane

19

Which drug is used in glaucoma that decreases the synthesis of aqueous humor by blocking carbonic anhydrase?

acetazolamide

19

What is fosphenytoin?

Parenteral version of phenytoin

20

What drug is DOC for acute status epilepticus?

Benzodiazepines (diazepam or lorazepam)

22

Which inhaled anesthetic is proconvulsant?

enflurane

23

What kind of drug is tubocurarine?

non-depolarizing neuromuscular blocker

23

What is the MOA of selegiline?

an MAO type B inhibitor that prevents dopamine degradation

23

What are the AE carbidopa/levodopa?

Arrhythmias from failure to breakdown peripheral catecholamines? Also long term use = dyskinesia after dose, akinesia in between

23

What is the MOA of tetrabenazine?

VMAT inhibitor for Huntington's, limits dopamine vesicle packaging and release

24

Which opioid analgesics are used to treat diarrhea?

loperamide and diphenoxylate

24

How would you treat an overdose of nonbenzodiazepine hypnotics?

Still flumazenil

24

Which parkinson drugs are COMT inhibitors (2)

tolcapone and entacapone

25

Name 3 beta blockers used in the treatment of gluacoma

betaxolol, carteolol, and timolol

27

What are the AE of methoxyflurane?

nephrotoxicity, malignant hyperthermia

28

MgSO4 is DOC for what neurologic disorder?

Seizures of eclampsia

29

What is a serious AE of all inhaled anesthetics except nitrous oxide?

malignant hyperthermia (tx with dantrolene)

30

Name 4 anticonvulsants that can cause Stevens-Johnson syndrome

phenytoin, lamotrigine, ethosuximide, and carbamazepine

31

Which drug was designed as a GABA analog but actually inhibits high voltage activated Ca channels?

Gabapentin

32

How do you know whether a local anesthetic is an ester or an amide?

esters only have one "I" in the name whereas amides have 2

33

What kind of drug is succinylcholine?

A depolarizing neuromuscular blocker

34

In which order are nerve fibers affected by local anesthetics?

small diameter > large diameter; myelinated > unmyelinated

35

What are galantamine, rivastigmine, and donepazil used for?

central acting anticholinesterases for Alzheimer's (since they lose Acetylcholine)

36

Which drug functions to increase dopamine RELEASE?

amantidine (an adamantane that is also used to treat influenza and rubella)

37

How do you treat barbiturate toxicity?

supportive care

38

What are the adverse ocular effects for acetazolamide and beta blockers when used to tx glaucoma?

none (but keep in mind that acetazolamide can cause a hyperchloremic metabolic acidosis)

38

What 3 drugs prevent dopamine degradation?

selegiline (MAO type B inhibitor) and Tolcapone and Entacapone (COMT inhibitors)

40

Which drugs are converted to dopamine in the CNS?

levodopa with carbidopa

42

What kind of drugs are eszopiclone, zalepon, and zolpidem?

nonbenzodiazepine hypnotics

43

What is the utility of phenytoin for cardiac arrhythmias?

it can also be used as a class Ib antiarrhythmic

44

What is the most common drug used for endoscopy?

midazolam

46

Name 3 dopamine agonists used for treating parkinsons

bromocriptine (ergot), pramipexole and ropinirole (non-ergots)

47

Which drug inhibits GABA reuptake?

Tiagabine

49

Which nucleus is most affected in Alzheimer's disease? Which drugs are used to counteract this (3)?

Nucleus Basalis of Meynert (an acetylcholine producing nucleus)? Central-acting anticholinesterases = rivastigmine, donepazil, galantamine

50

Which opioid analgesic is used for cough suppression?

Dextromethorphan

51

How do you treat opioid toxicity?

naltrexone (PO) and naloxone (IV)

53

Which anticonvulsant may cause kidney stones?

topiramate

55

Which parkinson drugs are MAO B inhibitors?

selegiline

57

What is the MOA of vigabatrin?

irreversibly inhibits GABA transaminase

59

How is the MOA of vigabatrin different from tiagabine?

vigabatrin irreversibly inhibits GABA transaminase and tiagabine prevents GABA reuptake

59

What is the MOA of ketamine?

blocks NMDA receptors

60

Which glaucoma drugs should not be given in closed angle glaucoma?

Alpha agonists (brimonidine and epinephrine)

60

What is benztropine used for?

An antimuscarinic used for Parkinson's tremor and rigidity but not for the bradykinesia

62

Which drug is a 5HT 1b/1d agonist?

sumatriptan

64

Which local anesthetic can have the AE of severe cardiotoxicity?

bupivicaine (although, cocaine can cause arrhythmias)

65

3 drugs for Huntington's

Haloperidol, Tetrabenazine, and Reserpine

66

In whom are barbiturates contraindicated?

porphyria

68

Name a mu-opioid partial agonist for analgesia

butorphanol

69

Which anticonvulsant can cause SIADH?

carbamazepine

70

What determines potency and induction time for inhaled anesthetics?

How soluble it is in the blood and lipids. A highly soluble drug (halothane) in lipids has high potency but long recovery time and induction time? A slightly soluble drug like N2O is quick but not highly potent

72

Which drug is a peripheral DOPA decarboxylase inhibitor?

carbidopa, co-administered with L-DOPA to prevent its peripheral conversion to dopamine

74

What kind of drugs are pancuronium, vecuronium, and rocuronium?

non-depolarizing neuromuscular blockers

75

Which parkinson drug is also an antiviral? Used for?

amantidine (influenza A and rubella)

76

Which IV anesthetic is a dissoicative anesthetic notorious for bad dreams?

ketamine

78

Which anticonvulsant inhibits folic acid absorption by inhibiting intestinal conjugase?

phenytoin

79

What is the MOA of local anesthetics?

Sodium channel blockers on activated nerves (mainly)

80

What 3 drugs are all considered first line for tonic clonic seizures?

Valproic acid, Carbamazepine, and Phenytoin

81

What kind of drugs are atracurium and mivacurium?

non-depolarizing neuromuscular blockers

82

What is cyclospasm?

Contraction of the ciliary muscle

83

What effect do inhaled anesthetics have on cerebral blood flow?

increase cerebral blood flow and decrease metabolic demand

84

What is the MOA of tiagabine?

Inhibits GABA reuptake

86

How do opiod analgesics work to slow synaptic transmission?

They open K channels and close Ca channels

87

What are diphenoxylate and loperimide used for?

opioids used in diarrhea (AE = constipation)

88

Which effects of opioids (2) can't you develop tolerance to?

constipation and miosis

89

What is the MOA of memantine? What Dz is it used for?

it is an NMDA receptor antagonist used to treat Alzheimer's? It prevents excitotoxicity

91

Which 3 anticonvulsants are inducers of CYP 450

carbamazepine, phenytoin, barbiturates

93

Which aspect of the sleep cycle is affected by benzos?

decreases REM sleep

94

What is DOC for seizures of pre-ecclampsia? What else can be used?

MgSO4 = 1st line but Benzo's = diazepam and lorazepam can also be used

95

Name 2 direct cholinomimetics used to treat glaucoma

Carbachol and Pilocarpine

96

What are the AE of enflurane?

proconvulsant, malignant hyperthermia

97

What receptor do non-benzodiazepine hypnotics work on?

GABA receptor BZ1 subtype

98

Which AE does succinylcholine share with inhaled anesthetics?

malignant hyperthermia

99

What is the MOA of gabapentin?

It is an anticonvulsant (with other indications) that is a GABA analog but actually inhibits high voltage gated Ca channels

100

What drug is DOC for Simple partial seizures and Complex Partial Siezures?

Carbamazepine

101

How is the MOA of phenytoin and carbamazepine different from lamotrigine?

Phenytoin and carbamazepine increase sodium channel INACTIVATION whereas lamotrigine blocks Na channels

103

Which inhaled anesthetic causes nephrotoxicity?

Methoxyflurane

105

How do cholinomimetics (direct and indirect) work to treat glaucoma?

They increase the outflow of aqueous humor by contracting the ciliary muscle and opening the trabecular meshwork

106

Name the non-depolarizing neuromuscular blockers (6)

Tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, rocuronium

107

What are the 2 indications for dantrolene?

malignant hyperthermia and neuroleptic malignant syndrome

108

Which anticonvulsant may cause a rare but fatal hepatotoxicity and requires that LFT's be checked?

valproic acid

109

Which Alzheimer's drug is targeted at preventing excitotoxicity?

memantine (an NMDA receptor antagonist)

110

How are epinephrine and brimonidine used to treat glaucoma?

They are alpha agonists used to decrease the synthesis of aqueous humor via vasoconstriction

111

Which opioid is used in maintenance programs for addicts?

methadone

112

Which drug is used for sedation in ICU and short procedures?

propofol

113

Which inhaled anesthetic does NOT cause malignant hyperthermia?

N2O

114

Name 2 indirect cholinomimetics used to treat glaucoma

physostigmine and echothiophate

115

What are the indications for sumatriptan?

ACUTE migraine and cluster headaches

116

What is the MOA of levetiracetam?

unknown but may modulate GABA and glutamate release (is an anticonvulsant)

117

What is DOC for absence seizure?

Ethosuximide

118

What is the MOA of latanoprost for treating glaucoma?

it is a PGF2alpha analog that increases the outflow of aqueous humor

119

In whom is sumatriptan contraindicated? Which cardiac drug is also contraindicated in this population?

CAD and Prinzmetal's (vasospasm); hydralazine is CI for angina and CAD because of the reflex tach

120

What is the MOA of topiramate?

Sodium channel blocker and increases GABA transmission

121

What is the MOA of carbidopa?

It is a peripheral DOPA decarboxylase inhibitor co-administered with L-dopa to prevent it from being converted to dopamine in the periphery

122

Which cholinomimetic is best for use in emergencies because it opens the meshwork into the canal of Schlemm?

pilocarpine

123

How is the MOA of benzodiazepines different from barbiturates?

barbiturates prolong chloride channel opening whereas benzos increase the frequency of them opening

124

What autoantibodies may develop in a patient taking phenytoin?

anti-histone (causes lupus like syndrome)

125

What are tetrabenazine and reserpine used to treat? MOA?

Huntington's chorea (VMAT inhibitors)

126

What kind of drug is chlordiazepoxide?

a benzo just a weird name

127

How do you treat overdose of benzo's vs. barbiturates?

Benzo's = flumazenil; Barbs = supportive care

128

How do beta blockers work to treat glaucoma?

Decrease the production of aqueous humor

129

What is butorphanol used for?

severe pain in labor or migraines (partial mu receptor agonist)

130

What is the MOA of tramodol?

Very weak opioid agonist that also inhibits NE and 5HT

131

Which receptor does sumatriptan work on?

5HT 1b/1d (a serotonin agonist)

132

What is the MOA of phenobarbital as an anticonvulsant? In whom is it first line?

increases GABAa activity; 1st line in children (unless absence seizure = ethosuximide)