Neuropharm

Question 1

Brimonidine

Answer 1

Alpha 2 agonist. Decreases aqueous humor synthesis

Question 2

Acetazolamide for the eye?

Answer 2

Decreases aqueous humor synthesis via inhibition of carbonic anhydrase.

Question 3

What do you use in emergency glaucoma?

Answer 3

Pilocarpine. Muscarinic, very effective at opening canal of Schlemm via ciliary contraction.

Question 4

Epinephrine for glaucoma?

Answer 4

Decreases aqueous humor synthesis via vasoconstriction but causes mydraisis, so don’t use in closed angle glaucoma

Question 5

Latanoprost. Use and AE

Answer 5

PGFalpha. Increases outflow of aqueous humor for glaucoma, but darkens color of iris

Question 6

Meperidine

Answer 6

Think of meeper with his pinpoint pupils. This is an opioid

Question 7

Diphenoxylate uses

Answer 7

Opioid used to treat diarrhea

Question 8

Butorphanol

Answer 8

Mu opioid receptor partial agonist and kappa opioid receptor agonist, analgesia and less resp depression than full opioid agonists.

Question 9

Tramadol vs trazadone

Answer 9

Tram it all to hell. My back hurts all the time but I don’t want opioids! Tram it, now I’m having seizures. Tramadol = weak opioid agonist and also inhibits serotonin and NE reuptake.
Trazadone = atypical antidepressant for insomnia –> trazabone

Question 10

What do you do for status epilepticus?

Answer 10

1. IV lorazepam. 2. Phenytoin to prevent recurrence. If still seizing, start phenobarbital. If still seizing, intubate and give genearl anesthesia.

Question 11

First line for myoclonic seizures?

Answer 11

Valproic acid

Question 12

Primidone

Answer 12

Prodrug for phenobarbital.

Question 13

AE’s of phenobarbital

Answer 13

Inducer of P450 and contraindicated in porphyria

Question 14

Big AE of valproic acid

Answer 14

Hepatotoxicity

Question 15

Big AE of lamotrigine

Answer 15

Steven Johnson

Question 16

Big AE of topiramate

Answer 16

Induces metabolism of estrogen– makes OCPs not work

Question 17

Benzos MOA vs barbiturates

Answer 17

Benzos increase frequency of channel opening, barbs increase duration

Question 18

Diazepam, lorazepam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, flurazepam, alprazolam, clorazepate, estazolam. Duration of actions?

Answer 18

Diazepam: long
Lorazepam: Medium
Triazolam: short
Temazepam: Medium
Oxazepam: short
Midazolam: short
Chlordiazepoxide: long
Flurazepam: long
Alprazolam: short
Clorazepate: long
Estazolam: medium

Question 19

Zolpidem

Answer 19

Ambien. Nonbenzo but acts at benzo site. Lower dependence risk and lower hangover. Others - zaleplon, eszopiclone

Question 20

2 days to 4 weeks after had anesthesia patient had centrilobular hepatic necrosis with increased LFTs. 80% mortality. What was the anesthetic?

Answer 20

Halothane -> hepatotoxicity. H!

Question 21

AE of methyoxyflurane

Answer 21

Nephrotoxicity (M –> N)

Question 22

AE of enflurane

Answer 22

Seizures. E–> epilepsy

Question 23

How is the barbiturate effect terminated?

Answer 23

Rapid redistribution into tissue and fat.

Question 24

Propofol

Answer 24

Used for ICU sedation, rapid anesthesia induction, short procedures. Potentiates GABA-A, but not barb

Question 25

Succinylcholine: MOA and AE's

Answer 25

Phase I: Depolarization --> inactivation --> flaccid paralysis Phase II: Desensitized --> acts like nondepolarizing block AEs: hypercalcemia, hyperkalemia, malignant hyperthermia

Question 26

Dantrolene MOA

Answer 26

Blocks RyR to treat malignant hyperthermia and neuroleptic malignant syndrome

Question 27

Pramipexole

Answer 27

DA agonist for PD

Question 28

"capone" drugs

Answer 28

LIke Mafia taking care of L-dopa, "taking care of" COMT to increased DA entering brain. Still need carbidopa or ineffective. Tolcapone does peripheral and central and has hepatotoxicity. Entacapone just does peripheral.

Question 29

What do you use to treat tremor predominant parkinsons?

Answer 29

Benztropine

Question 30

B6 effect on L dopa?

Answer 30

Increases peripheral metabolism so less enters brain

Question 31

Memantine vs amantadine

Answer 31

Memantine = NMDA antagonist to prevent excitotoxicity in Alzheimer's, amantadine = influenza drug that increases DA release for PD.

Question 32

Donepezil

Answer 32

AChEi. NOT ACEi. Used to treat Alzheimer's

Question 33

Sumatriptan

Answer 33

Not tricyclic... headache drug! 5HT1B/1D agonist. Inhibits trigeminal nerve activation, prevents vasoactive peptide release, induces vasoconstriction. 5 HT blocks pain pathway, blocks cGRP and substance P release.