Flashcards in Neurology druuggz Deck (209):
1
list the strategies for treating glaucoma
alpha agonists - decrease synthesis (hurts my brain bc on dilator muscles and that's it)
beta blockers - decrease synthesis
diuretics - to decreased IOP
cholinomimetics - to increase outflow fo aqueous humor
prostaglandins - to increase outflow of aqueous humor
2
what durg is not to be used in closed angle galucoma
epinephrine bc causes mydriasis - bad news bears
3
how does epinephrine decreased aqueous humor
alpha 1 agonist - decreases aqeous humor production by vasoconstriction
4
how does brimonidine work for glaucoma
alpha two agonist - decreases aqueous humor production
5
what are the side effects of epinephrine and brominidine for glaucoma treatment
blurry vision
ocular hyperemia
doreign body sensation
ovcular allergic reactions
ocular pruritis
6
which drug?
blurry vision
ocular hyperemia
foreing body sensation
ocular allergic reactions
ocular pruritus
epinephrine - alpha 1 agonist
brimodine - alpha 2 agonist
7
what beat blockers are used to treat glaucoma
timolol
betaxolol
carteolol
8
what are betaxolol and carteolol used for
glaucoma with timolol
9
how to timolol betaxolol and carteolol treat glaucoma
beta blockers - decreasd aqueous humor production
10
what are the s/e of betaxolol and carteolol and timolol when used for glaucoma treatment?
no pupillary or vision chances
11
what diuretic is used for glaucoma treatment
acetazoloamide
12
how does acetazolamide help in glaucoma
decreases aqueoue humor synthesis via inhibition of carbonic anhydrase
13
a/se relevated to acetazolamide treatment for glaucoma
no pupillary or vision changes
14
what are the direct cholinomimetics used to treat gluacoma
pilocarpine and carbachol
15
how do pilocarpine and carbachol help with galucoma
increased outflow by constricting the ciliary muscle and opening the trabecular meshwork
16
what are the indirect cholinomimetics used to treat gluacoma
physostigmine and echothiophate
17
how do physostigmine and echothiophate work to help with glaucoma
increased outflow of aqueous humor via contraction of ciliary muscle
open trabecular meshwork
18
what are a/se of cholinomimetics when used for gluacoma
miosis and cyclospam - contraction of ciliary msucle
19
what drugs to choose if done want any pupillary of vision a/se for glaucoma
beta blockers: timolol, betaxolol, carteolol
diuretics: acetazolamide
20
what durgs to choose for glaucoma if don't mind pupillary or vision a/se
alpha agonists: epinephrine and brimonidine
cholinomimetis: carbachol, pilocarpine, physostigmine, echothiophate
21
what drug to use in glaucoma emergencies and why please
pilocarpine - bc especially good at opening meschwork into the canal of schlemm
22
what pg is used for glaucoma treatment
latanoprost PGF2a analog
23
what does latanoprost/PGF2a do for help in glaucoma
increases outflow of aqueous humor
24
what are a/se of latanoprost
browns up the iris
25
list the opioid analgesics please
morphine
fentanyl
codeine
loperamide
methadone
meperidine
destromethrophan
diphenoxylate
pentazocine
26
what is the MOA of opioid analgesics
agonists at opiod recetors, m, d, k to modulate synaptic transmission - increase K and decreased Ca - decreases synaptic transmission - inhibits the release of a) Ach b( NE c) 5Ht, d) flutamate and e) substance P
27
what neurotransmitters do opiod analgesics decrease release of
NE, Ach, glutamate, substance P, 5Ht
28
again what neurotransmitters do opioid analgesics decrease
Ach, NE, glutamate, 5 Ht, substance P
29
what is destromethrophan used for
opioid
cough suppression
30
what is loperamide and diphenoxylate used for
diarrhoea
31
what is methadone used for
maintaince program for heroin addicts
32
what is buprenorphine and naloxone combo used for
maintenance program for heroin addicts
33
what are all opioids used for
pain
acute pulmonary oedema
34
opiod used for cough suppression
dextromethorphan
35
opioid used for diarrhoea
loperamide and diphenoxylate
36
opioid used for maintenance of heroin addiction
methadone
OR
buprenorphine with naloxone
37
what are the toxo risks of opioids
addiction
respiratory depression
constipation
miosis
additive CNS depression with other drugs
38
how to treat opioid toxicity
naloxone or naltrexone - opioid receptor antagoinsts
39
what a/se do not build up tolerance in opioid tox
miosis
constipation
40
MOA of butorphanol
k opoiod receptor agonist
mew opioid receptor partial agonist
produces ANALGESIA
41
clinical use of butorphanol
severe pain - migraine and labour
42
who cares about butorphanol
k opioid agonist and mew opioid receptor agonist
less respiratory depresion
43
toxo of butorphanol
can cause opioid withdrawal symptoms if patient is also taking full opiod agonist due to competition for recptors
44
how to treat o/d of butrophanol
NOT Easily with naloxone
45
what is tramadol
very weak opioid agonist
also inhibits 5HT reuptake and NE reuptake
TRAM IT ALL with TRAMADOL
46
what is tramadol used for
chronic pain
47
toxo of tramadol
similar to opioids
DECREASED SEIZURE THRESHOLD
SEROTONIN SYNDROME
48
whath opioid causes decrease seizure threshold
tramadol
49
what opioid causes less resp depression
butorphanol
50
what opioid can cause serotonin syndrome
tramadol - increases 5ht reuptake
51
list the barbituates please
phenobarbital
pentobarbital
thiopental
secobarbital
BARBITAL and pental
52
what is the moa of barbituates
favilirate GABAa by increasing DURATION Cl channels are open - decreases neuronal firing
53
what are barbituates used for
sedative for anxiety
seizures
insomnia
induction of anesthesia = thipental
54
use of thiopental
induction of anesthesia
55
what can cause increased CNS depression fo barbituates
alcohol
56
what are the a/se of barbituates
resp and cardiovascular depression CAN BE FATAL
CNS depression - can be made worse with alcohol
dependence
induces P450
57
how to treat overdose of barbituates
supportive
assist respiration and maintain blood pressure
58
list the benzodiazepines
diazepam, lorazepam, trazolam, temazepam, oxazepam, midazolam, chlordiazepoxide ,alprazolam
OLAM and chlordiazepoxides
59
moa of benzodiazepines
facilitate GABAa action by increasing FREQUENCY of Cl channel opening
60
effect of benzos on sleep
decreases REM - treat night terrors and sleep waling whih makes no sense to me bc night terros and sleep walking happen in NON REM STAGE III but anywho
61
list the short acting benzodiazepines
ATOM: alprazolam, triazolam, oxazepam, midazolam
62
whats different between benzos with a long or a short half life
short half life - more addictive potential
ie alprazolam, triazolam, oxazepam and midazolam are more addictive tha diazepam, lrazepma, temazepam, chlordiazepxoide that have long half lifes
63
list the benzodiazepines with longer hald lifes
diazepam
lorazepam
temazepam
chlordiazepoxide
64
clinical use of benzos please
anxiety
spasticicty
status epilepticus
detox from alcohol withdrawal/delirium tremens
night terros
sleepwalking
cneral anesthetics - amnesia and muscle relaxants
hypnotics - insomnia
65
which benzs are used for status epilepticus
lorazepam and diazepam
66
what are the toxos of benzos
dependence
addictive CNS depression effects with alcohol
less risk of respi depression an d coma that barbituatesa
67
how to treat o/d of benzos
FLUMAZENIL
68
what is flumazenil
treatment of o/d benzos (and nonbenzo hypnotics the zzzs)- acuts by competitive antag at GABA benzo receptor
69
which has more risk of resp depression and coma, barbs or benzos
barbs.
70
list the nonbenzodiazepine hypnotics
zolpidem
zaleplon
eszopiclone
71
what are zolpidem, zaleplon, eszopiclone
nonbenzodiazepine hypnotics
72
what is the MOA of zolpidem, zalephlon, eszopiclone
act via the BZ1 subtype of the GABA receptor
73
how to reverse effects of zolpidem, zaleplon, eszopiclone
flumazenil
74
what are zolpidem, zaleplon and eszopiclone used fro
insomnia
75
toxo risks of zolpidem, zalephlon, eszopiclone
ataxia
headache
confusion
only modest day after psychomotor depression and fefw amniestic effects
decreased risk of dependency
76
what are the benefits of zolpidem, zaleplon and eszopiclone over benzos
less day after amniestic effects and less psychomotor depression
less risk of dependency
77
why do zolpidem, zaleplon and eszopiclone have a short durcation of action
rapid metabolism by liver enzymes
78
how do anesthetis reach the BBB
either are lipid soluble or are actively transported
79
what does it mean if an anesthetic has decreased blood solubility
faster onset and faster recovery
80
what does it mean if an anesthetic has increased lipid solubility
increased potency
81
what does potency equal
1/MAC
82
what is the MAC
MAC: minimal alveolar concentraction of inhaled anesthetic required to prevent 50% of subjects from moving in response to noxious stimulus ie skin incision
the higher the MAC the less potent (less lipid soluble)
83
N2O is low blood soluble and low lipid soluble.... describe it as an anesthetic
fast induction and fast recovery - low blod osolubility
low potency - low lipid solbulity
84
halothane has high blood solubility and high lipid solubility ...describe it as an anesthetic
high blood solubility - longer to induce and longer to recovery
high lipid solubility - more potent. lower MAC
85
list the inhaled anesthetics
halothane
enflurane
isoflurane
sevofulrane
methoxyflurane
N2O
FLURANEs or THANEs or N2O
86
describe the MOA of inhaled anesthetics
we don't know :)
87
what are the effects of inhaled anesthetics
myocardial depression
respiratory depression
nausea/emesis
increased cerebral blood flow - decreased metabolic demand
88
a/se of halothane
hepatoxicity
89
a/se of methoxyflurane
nephrotoxicity
90
a/se of enflurane
proconvulsant
91
a/se of N2O
expansion of trapped gas I a body cavity
92
a/se of which inhaled anesthetic? hepatoxicity
halothane
93
a/se of which inhaled anesthetic? nephrotoxivity
methoxyflurane
94
a/se of which inhaled anesthetic? proconvulsant
enflurane
95
a/se of which inhaled anesthetic? expansion of trapped gas in body cavities
N2O
96
what is the major concern of inhaled anesthetics
MALIGNANT HYPERTHERMIA doesn't happen with N2O
97
what is malignant hyperthermia
rare
life threatening
heritable
inhaled anetsthics (NOT N2O) and succinylcholine induce FEVER and SEVERE MUSCLE CONTRACTIONS
98
how to treat malignangy hyperthermia
dantrolene
99
what is dantrolene MOA
blocks Ca release from the SR of skeletal muscle
100
what is dantrolene used for
malignant hyperthermia from inhaled anesthetics and succinhylcholine ;use
101
please list the IV anesthetics and their families
thiopental/barbiturate
midazolam/benzo
ketamine/arylcyclohexylamine
morphine + fentanyl/opioid
propofol/not listed :)
102
describe the pharmacokinetics of thiopental
highly lipid soluble - high potency - rapidly gets in the braine
103
what is thiopental used for
induction into anesthesia
short surgical procedures
104
how does effect of thiopental get terminated
rapid redistribution into skeletal muscle and fat
105
effect of thiopental on CNS blood flow
decreases
106
how is midazolam used
endoscopy
and in conjunction with narcotis and gaseous anesthetics
107
what are a/se of midazolam
may cause severe postop respiratoyr depression
decreased bp
anterograde amnesia
108
how to treat severe post op resp depression, decreasd bp and anterograde amnesina of midazolam
flumazenil
109
what is ketamine
a pcp analog that acts as a dissociative anesthetic
blocks NMDA receptors
cardiovascular stimulatin
110
what are effects of ketamine
cardiovascular stiulate
hallucionat
sdisorientation
bad dreams
111
effet of ketamine on cerebral blood flow
increases vrs thiopental that decreases it
112
what opiodis are use with other CNS depressnats during general anesthesia?
morphine and fentanyl
113
what is propofol used for
sedation int eICU
rapid anetsthesia induction
short procedures
114
what is MOA of propofol
potentiates GABAa receptor
115
what is benefit of propofol over thiopental
less postop nausea than thiopental
116
name the IV anesthetic used for endoscopy
midazolam
117
name the IV anesthetic used for induction to anesthesia
thiopental
118
name the IV anesthetic used for short procedures
propafol > thiopental, because less nauceas
119
name the IV anesthetic used for sedation in the ICU
propafol
120
name the IV anesthetic used for dissociation
ketamine
121
list the IV anesthetics that make you forget
ketamine - dissociative desired s/e
midazolam - anteriograde amnesia a/se
122
list the local anesthetic esters
procaine
cocaine
tetracaine
ONLY ONE I
123
list the local anesthetic amides
lidocaine
mepivacaine
bupivavaine
AMIDES have TWO Is
124
what is uslaly given with local anesthetics
a vasoconstrictor like epinephrine -- enhances local action - decreases bleeding and increases local anesthetics by decreases systemic concentation
125
what is the moa of local anesthetics
block na channels by binding to inner portion of channel
preferentially bind to active channgels - so most effective in rapidly firing nerutions
enter as non charged and bind as charged
126
how does infected tissue affect local anesthetics
infected tissue is acidic - traps alkaline anethetics in charged form so can t enter tissues. - need more of it bc effectiveness is decreased
127
which fibres are blocked first
matters less - myelinated
matters more - small
128
list the order of fibres that are blocked
small myelinated > small unmyelinated > large myelinated > large unmyelinated
129
list the modalities sequentially blocked with local anesthetics
pain > temp > touch > pressure
130
what are local anesthetics used for
minor surgical procedures and spinal anesthesia
131
what if someone is allergic to procaine
give an amide with two is
132
what are neuromuscular blocking drugs used for
muscle paralysis in surgery or mechanical ventilation
133
what receptors do neuromuscular blockers act on
Nm not Nn
134
what are the depol NMJ blockers
succinylcholine
135
how does succinylcholine work
strong Ach receptor agonist - produces sustained depol and prevents muscle contraction
136
what are the phases of reversal of blockade in succinylcholine
phase 1 - prolonged depol: no antidote
phase 2 - repol but blocked; ach receptors available but desensitized; antidote is cholinesterase inhibitors
137
how do you reverse the blockade of succinylcholine
during phase 1, prolonged depol no antidote, achase inhibitors will make worse
during phase2, repol but blocked aka ach receptors are available but are desensicity;es used achase inhibitors
138
what are the complications of succinychloine
hypercalcemia
hyperkalemia
malignant hyperthermia
139
what are the nondepolarizating NMJ blockers
tubocurarine
atracurirum
mivacurium
pancuronium
vecuronium
rocuronium
140
how do non depol NMJ blockers work
competitive antagoinsts - cometep with ACh for receptors
141
how to reverse blockage of nondepol NMJ blockers
with neostigmine - have o give with atropine to prevent muscarinic effects - bradycardia
edrophonium
other cholinesterase inhibitors
142
what is baclofen
inhibits GABA b receptors at spinal cord - induces skeletal muscle relaxation
143
uses of baclofen
muscle spasms ie lower back pain
144
what is cyclobenzaprine
centrally acting skeletal muscle relaxant; structurally similar to TCAs with anticholi a/se too
145
what is cyclobenzaprine used for
muscle spams
146
list treatment for muscle spasms please
baclofen - gaba b agonist
cyclobenzaprine - central like a tca
147
list the strategies for treating Parkinson disease
want to increased DA and dereased ACh
- DA agonists
- increase DA availaibility central
- increased Ldopa availability peripheral
- prevent DA breakdown- central
- stop excess cholinergic activity
148
list the drugs that act as DA agonists
bromocriptin - ergot
pramipexole and ropinirole
Ro-PIN- ROLLING (resting tremor)
149
list the drugs that increase DA availability centrally
amantadine - increases release and decrease DA uptake
150
list the drugs that increase ldopa availability
levodopa and carbidopa
entacapnoe and tolcapone - inhibit COMT
151
list the durgs that precent DA breakdown centrally
seleglitine - inihibts MAOB
tolcapone - inhibits COMT peri and centrally
152
list the drugs that curb excess ach activity
benztropine
153
MOA of bromocriptine pelase
DA agonist, ergot. not preferred to pramipexole and ropinirole
154
MOA of ropinirole pelase
DA agonist, non ergot preferred over bromocriptine
155
MOA of pramipexole pelase
DA agonist, non ergot preferred over bromocription
PRAMIPEXOLE
156
moa of amantadine please
increase DA release and prevents uptake of DA
antiviral vrs influenze A and rubella
157
toxo of amantadine pelase
livedo reticularis
ataxia
158
anti Parkinson used as an antiviral
amantadine - anit influenza A and rubella
159
what is the MOA of levodopa/carbidopa combo
caridopa blocks peripheral DOPA decarboxylase and reduces a/se of increase da in peripherly
160
oa of entacapone
peripheral block of COMT - no breakdown of L DOPA to 3- O methyldopa
161
MOA of talcapone
peripheral and central block of COMT - no breakdown of LDOPA to 3-o methyl dopa in periphery nor DA to DOPAC centrally
162
MOA of selefiline
blocks conversion of dopamine into 3MT by inhibiting MAOB
163
effects of benztropine
park your benz
antimuscarinic - has effects on tremor and rigidity but not bradykinesia
164
which can cross the bbb da or ldopa
ldopa waddup
tis why we need carbidopa to inhibit dopa decarboxylase in the periphery
165
toxo of lecodopa/carbidopa
arrthymias deom increased peripheral formation of catecholamines
166
what can long term use of levodopa/carbidopa cause
dyskinesia after administration and akinesia between doses
167
what is selsgiline
MAO b inhibitor - increases DA degradation more than norephinephirine
168
use od selegiline
adjunctive agent to l dopa for parkinson
169
toxo of selegiline
may enhacen arrhythmias, od dyskinesia and akinesia with use of levo and carbidopa
170
list drugs used to treat Alzheimer disease
memantine
donepezilgalantamine
rivastigmine
tacrine
171
what is the moa of memantine
NMDA receptor antagonist
helps prevent excitatoxicity mediated by Ca++
172
what is memantine used for
alzhemier
173
what are toxos of memantine
dizziness, confusion, hallucinations
174
alxhemier disease is associated with low Ach levels. therapeutically how can this be corrected
can use AChase inhibitors
175
what are donepezil
galantamine
rivastigmine
tacrine
achase inhibitors
used in alxehmier
donepezil, galantamine, rivastigmine, tacrine
176
what are the toxos fo donepezil, galantamine, rivastigine tacrine
nausea, dizziness, insomnia
177
what are the nt changes inhuntingtons
decreased gaba
decreasd ach
increasd da
178
how do you treat Huntington disease
tetrabenazine and reserpine: inhibit VMAT - limit DA vesicle packaging and release
haloperidol - D2 receptor antagonist
179
tetrabenazine and reserpine?
Huntington treatment
inhibit VMAT - limit DA vesicle packaging and release
180
haloperidol use?
Huntington disease
D2 receptor antagonist (indirect pathway )
181
sumatriptan moa pelase
5ht1b/1d agonist
inhibit trigeminal nerve activation
prevent vasoactive pepride relase
iduce vasocsotnrtion
182
why are tripasn effective treatment for acute migrains and cluster headaches
agonist and 5HT1/d/b
inhibit trigeminal nerve actiation
prevent vasoactive peptide release
induce vasoconstriction
183
as/e of triptans
coronary vasospasm
mild parethesias
184
where are triptans contraindicated
coronary artery disease
praziqnautel disease
185
doc at absent seizures
ethosuximide
sucs to have silent seizures
186
doc at acute status epilepticus
benzodiazepines - diazepam and lorazepam
187
doc at prophylaxis for status epilepticus
phenytoin
188
doc for tonic clonics
phenytoin
valproid acid
carbamaezepine
189
doc at simple seizures
carbamazepine
190
doc at complex seizures
carbamazepine
191
which seizure drugs act by blocking ca channels t type at thalamus
ethosuximide
doc at absence seizures
192
which seizure drugs act by increase action at GABA a receptors
benzodiazepines
phenobarbital
topiramate
levetiracetma
tigabine
vigabatrin
193
which seizure drugs act by increase na channel inactivation
phenytoin
carbamazepine
valproid acid
topiramate
lamotrigine
194
which seizure drugs act by inhibiting GABA transaminase
valproid acid
vigabatrin
195
which seizure drugs are teratogens
phenytoin
carbamazepine
valproic acid
196
which seizure drugs can cause steven Johnson syndrome
ethosuximide
phenytoin
carbamazepine
lamotrigine
197
what seizure drugs can induce P450
phenytoin
carbamazepine
phenobarbital
198
what seizure drug casues kidney stones
topiramate
199
what seizure drugs can cause ataxia
phenytoin
gabapentin
200
which seizure drugs can mess with blood
phenytoin- megaloblastic
carbamazepine - agranulocytosis and aplastic anemia
201
which seizure drug causes gingiaval hyeprplasi
phenytoin
202
what seizure drug causes DSIADH
carbamazepine
203
what seizure drug causes SLE like syndrome
phenytoin
204
what seizure drug casues neural tube defects
valproic acid
205
what is DOC for trigeminal neuralgia
carbamazepine
206
what is DOC for exlampsia
MgSO4 first and then benzodiazepines
207
what drug used for myoclonic seizures
valproid caid
208
what seizure drug used for migraine prophylaxis
topiramte
209