Neurology--Pharmacology Flashcards Preview

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Flashcards in Neurology--Pharmacology Deck (77):
1

Epinephrine in glaucoma moa, tox

alpha-agonist, decreases humor synthesis via vasoconstriction; Tox: mydriasis--do NOT use in closed angle glaucoma

2

brimonidine in glaucoma moa, tox

alpha2-agonist; decrease aqueous humor synthesis; Tox: blurry vision, ocular hyperemia, foreign body sensation, ocular allergic reactions/pruritus

3

Timolol, betaxolol, carteolol in glaucoma

B blockers; decrease aqueous humor synthesis

4

Acetazolamide in glaucoma

diuretic; decrease aqueous humor synthesis via inhibiton of carbonic anhydrase

5

pilocarpine, carbachol in glaucoma

direct cholinomimetic; increase outflow of humor via contraction of ciliary muscle and opening of trabecular meshwork

6

physostigmine, echothiophate in glaucoma

indirect cholinomimetics

7

use in emergencies glaucoma

pilocarpine

8

Tox of cholinomimetics in glaucoma?

miosis, cyclospasm

9

Latonoprost moa in glaucoma? Tox?

prostaglandin that increases outflow of humor; darkens color of iris (browning)

10

opioid MOA?

opioid receptors to modulate synaptic transmission; open K channels, close Ca channels-->decrease synaptic transmission; inhibit release of ACh, NE, 5HT, glutamate, substance P

11

opiate used for cough supression?

dextromethorphan

12

opiate used for diarrhea?

loperamide, diphenoxylate

13

butorphanol moa?

Mu opioid partial agonist and kappa-opiod receptor agonist-->analgesia; can cause withdrawal symptoms if used with full opioid agonist

14

tramadol moa? tox?

very weak opioid agonst, inhibits serotonin and NE uptake; used in chronic pain; decreases seizure threshold, serotonin syndrome

15

ethosuximide use? moa?

1st line for absence seizures; blocks thalamic T-type Ca channels

16

ethosuximide tox?

EFGHIJ: fatigue, GI distress, Headache, itching, Stevens johnson syndrome

17

benzodiazepines in epilepsy? moa?

1st line for acute status epilepticus; increase GABA action

18

1st line for eclampsia seizures?

MgSO4, then benzos

19

Phenytoin in seizures? moa?

first line in tonic clonic, first line for status epilepticus prophylaxis; increased Na channel inactivation; zero order kinetics;

20

phenytoin tox?

nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hisutism, peripheral neuropathy, megaloblastic anemia, teratogenesis, SLE like syndrome, induction of CYP450, LAD, SJ syndrome, osteopenia

21

drugs responsible for fetal dilantin syndrome?

phenytoin, carbamazepine; intrauterine growth restriction with microcephaly and develop minor dysmorphic craniofacial features and limb defects including hypoplastic nails and distal phalanges

22

carbamazepine in epilepsy? moa?

first line for simple, complex, tonic/clonic seizures; increases Na channel inactivation;

23

1st line for trigeminal neuralgia

carbamzepine

24

carbamazepine tox?

diplopia, ataxia, blood dyscrasias (agranulocytosis, aplastic anemia), liver toxic, teratogenesis, P450 induction, SIADH, SJ syndrome

25

valproic acid uses?

1st line for tonic/clonic seizures; myoclonic disorders, bipolar disorder

26

valproic acid moa?

increases Na channel inactivation, increases GABA concentration by inhibiting GABA transaminase;

27

valproic acid tox?

GI distress, rare but fatal liver tox, neural tube defects in fetus (spina bifida), tremor, weight gain, contraindicated pregnancy

28

measure before giving valproic acid?

LFTs (liver toxic

29

Gabapentin uses?

simple, complex, tonic clonic seizures but not first line; also used in peripheral neuropathies, postherpetic neuralgia, migraine prophylaxis, bipolar disorder

30

Gabapentin moa? tox?

inhibits high voltage Ca channels, designed as GABA analog; sedation, ataxia

31

Phenobarbital in epilepsy?

1st line in neonates for simple/complex/tonic-clonic; increases GABA action; sedation, tolerance, dependence, P450 induction, cardiorespiratory depression

32

topiramate moa?

blocks Na channels, increases GABA action

33

topiramate tx?

sedation, mental dulling, kidney stones, weight loss

34

lamotrigine moa? tox?

blocks voltage gated Na channels, SJ syndrome (titrate slowly)

35

levetiracetam moa?

unknown, may modulate GABA and glutamate release

36

Tiagabine moa?

increases GABA by inhibiting reuptake

37

vigabatrin moa?

increases GABA by irreversibly inhibiting GABA transaminase

38

which epilepsy drugs increase GABA action?

benzos, barbituates, valproic acid (inhibit GABA transaminase), topiramate, levetiracetam, tiagabine, vigabatrin

39

which epilepsy drugs increase Na channel inactivation?

phenytoin, carbamazepine, valproic acid, topiramate, lamotrigine

40

which epilepsy drugs increase GABA action and increase Na channel inactivation?

valproic acid, topiramate

41

which epilepsy drugs act on Ca channels?

ethosuximide (blocks thalamic T type); gabapentin (inhibits high voltage activated Ca 2+ channels)

42

barbituate moa?

facilitates GABA-A action by increasing duration of Cl channel opening-->decr neuron firing

43

barbituate contraindication?

porphyria; induces CYP450 and increases demand for heme metabolism-->toxic buildup of precursors

44

benzos, barbs, EtoH all bind which receptor?

GABA-A receptor, ligand gated Cl channel

45

moa of flumazenil

competitive antagonist at GABA benzo receptor

46

zolpidem, zaleplon, eszopiclone

non-benzo hypnotics that act via BZ1 subtype of GABA receptor; reversed by flumazenil

47

anesthetics with low blood solubility...

rapid induction and recovery times

48

anesthetics with high solubility in lipids...

high potency = 1/MAC

49

halothane SEs

liver tox, malignant hyperthermia

50

methoxyflurane SEs

kidney tox; malignant hyperthermi

51

what can cause malignant hyperthermia?

all inhaled anesthetics except N2O, succinylcholine

52

IV anesthetic that is effect terminated by redistribution into tissue and fat

barbituates (thiopental); high potency, high solubility, rapid entry into brain

53

IV anesthetic associated with anterograde amnesia, post-op respiratory depression, low BP

benzodiazepine

54

IV anesthetic associated with hallucination and bad dreams

arylcyclohexylamines (ketamine) PCP analogs, block NMDA receptors

55

propofol moa?

potentiates GABA-A receptor

56

which anesthetics increase cerebral blood flow?

inhaled anesthetics, ketamine

57

which anesthetics decrease cerebral blood flow?

barbiturates

58

local anesthetics moa?

block Na channels by binding to specific receptors on inner portion of the channel; preferentially bind to activated Na channels--most effective in rapidly firing neurons

59

infected tissues need more or less anesthetic?

more anesthetic if alkaline anesthetic cannot penetrate membrane effectively

60

what is the order of nerve blockade with local anesthetics?

small diamter > large diameter. Myelinated > unmyelinated. smaller size predominates. Loss of pain, temp, touch, pressure in order.

61

local anesthetic that is cardio toxic?

bupivicaine

62

succinylcholine moa? tox?

strong Ach receptor agonist-->sustained depolarization, prevents muscle contraction; hypercalcemia/hyperkalemia, malignant hyperthermia

63

nondepolarizing nmj blockers? moa?

competitive antagonists that compete with Ach for receptors; reverse with neostigmine (given with atropine to prevent muscarinic effects like bradycardia) and other AchE inhibitors

64

dantrolene moa?

prevents release of Ca2+ from sarcoplasmic reticulum of skeletal muscle

65

Parkinson drug families?

dopamine agonists; increase dopamine release; prevent dopamine breakdown; curb excess cholinergic activity

66

bromocriptine, pramipexole, ropinirole

dopamine agonists

67

amantadine, L-dopa/carbidopa

increase dopamine levels

68

selegiline

selective MAO type B inhibitor; preferentially metabolizes dopamine over NE and 5-HT; increases dopamine availability

69

entacapone, tolcapone

COMT inhibitors--prevent L-dopa degradation; increased dopamine

70

benztropine

anti-muscarinic that improves tremor/rigidity, does not affect bradykinesia

71

carbidopa

peripheral decarboxylase inhibitor

72

Alzheimer drugs:

memantine, donepezil/galantoamine/rivastigmine

73

memantine moa?

NMDA receptor antagonist; prevents excitotoxicity mediated by Ca; Tox: dizziness/confusion/hallucinations

74

donepezil, galantamine, rivastigmine

AChE inhibitors; Tox: insomnia

75

Huntington drugs:

Tetrabenzine + reserpine (limit VMAT; limit dopamine vesicle packaging and release); haloperidol: D receptor antagonist

76

Sumatriptan moa?

5HT 1B/1D agonist; inhibits Trigeminal nerve activation; prevents vasoactive peptide release; induces vasoconstriction; 2 hr half-life; used in acute migraine, cluster headache attacks

77

sumatriptan contraindication?

patients with CAD or prinzmetals angina because induces coronary vasospasm; mild tingling