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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

what drug also used for peripheral neuropathy

gapapentin