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Flashcards in Pharm Deck (91):
1

What DA pathway controls movement?

Nigrastriatal

2

What DA pathway controls reward and perception?

Mesolimbic

3

What DA pathway controls executive function?

Mesocortical

4

What DA pathway controls pituitary prolaction function?

Tuberoinfundibular

5

2 Post-synaptic enzymes that terminate DA action:

MAO A or B
COMT

6

Hyperfunctioning Migrostriatal pathway causes:
Hypofunctioning causes:

Hyper: dyskinetic movemnt
Hypo: dyskinetic movement, parkinsonism

7

Hyperfunctioning Mesolimbic pathway causes:
Hypofunctioning causes:

Hyper: Addiction, hallucinations
Hypo: amotivation, apathy

8

Hyperfunctioning Mesocortical pathway causes:
Hypofunctioning causes:

Hyper: hypervigilance
Hypo: inattention

9

Hyperfunctioning Tuberoinfundibular pathway causes:
Hypofunctioning causes:

Hyper: hypoprolactinemia
Hypo: hyperprolactinemia

10

What drugs to enhance DA synthesis?

Levodopa: DA precursor
Carbidopa: combined therapy to prevent peripheral DA activity --> lower side effects

11

Results of low and high DA activity:

Low: distractable
High: hypervigilant

12

ADHD: ___ DA activity at ___

low, anterior cingulate

13

Parkinson: ___ DA activity at ___

low, striatum

14

Why is MTHFR enzyme important?
Genetics?

Creates L-methylfolate, which is the form that can cross BBB

TT alleles bad --> less DA made

15

Bupropion:
Treats?
Class?
Affects what pathway?

Antidepressant
NDRI
Mesocortical

16

Amphetamines mechanism:

-Block DAT
-Increase VMAT2 -->more DA release

17

Methylphenidate mechanism:

-Block DAT

18

2 wakefulness promoting stimulant drugs:
Treats?
Side effects?

-Modafinil, Armodafinil
-Narcolepsy
-Off label: ADHD
-P450-3A4 inducer

19

Selegiline:
low dose is used for for?
high dose is used for?

Low dose: MAO-B selective --> Parkinson

High dose: MAO A and B --> Depression

20

Rasagiline mechanism:
treats?

-MAO-B inhibitor
-Parkinson's

21

MAOIs for Depression:

1. Isocarboxazid
2. Phenelzine
3. Tranylcypromine
4. Selegiline

22

Serotonin Syndrome

-MAOI decrease Serotonin breakdown
-Adding Serotonin drug --> toxic levels in CNS
-Tremor, muscle spasm, vital changes, hyperthermia, delirium, coma, death

23

COMTi drugs:
treats?
effect on neurotransmitters?

-Entacapone, Tolcapone
-Parkinson's
-elevate DA and NE

24

D2 receptor agonists:
treats?

-Bromocriptine, pramipexole, ropinerole, Apomorphine injection
-Parkinson's or Restless leg Syndrome

25

D3 receptor agonists:
treats?

-Aripiprazole
-Antipsychotic for Schizo
-Depression

26

Amantadine mechanism:
treats?

-Release DA, block DAT, stimulate D2
-Parkinson's, Influenza

27

Reserpine treats:

HTN, Schizo psychosis, causes Depression

28

Tetrabenazine treats:

Huntington's Chorea by lowering DA availability

29

D2 receptor antagonist affects which pathways?
treats?
classification?

ALL; they are non-selective

Schizophrenia

FGAs (high, low potency), SGAs

30

What causes EPS?
Symptoms?

-High Potency FGA

-Akathisia, Dystonia, Parkinsonism, Neuroleptic Malignant Syndrome

31

Symptoms of Neuroleptic Malignant Syndrome:

1. Hyperthermia
2. Muscle rigidity
3. Vital sign instability
4. Rhabdomyolysis

32

What is Tardive Dyskinesia

-Chronic D2 receptor antagonism
-Permanent movement disorder side effect
-Choreic or Athetotic movements

33

High vs Low Potency FGA drugs:
-Haloperidol
-Thioridazine
-Thiothixine
-Fluphenazine
-Chlorpromazine

High:
Haloperidol
Fluphenazine
Thiothixine

Low:
Chlorpromazine
Thioridazine

34

Blocking ___ receptor lowers EPS risk

Serotonin 2a (5HT2a)

35

Side effects of 'Dones' vs 'Pines'

Dones: more EPS

Pines: more sedating, more metabolic syndrome

36

Clozapine risks and benefits

-Risk of agranulocytosis
-Most metabolic risk of any agent
-No neuromuscular effect --> no EPS/TD

37

Blocking what receptor stops psychosis?

D2

38

Mechanism of action for Beta blockers in Glaucoma?

Reduce aqueous production

39

Suffix for carbonic anhydrase inhibitors:

-zolamide

40

Mechanism of action for Carbonic Anhydrase Inhibitors in Glaucoma?

Reduce production of aqueous

41

Mechanism of action for Prostaglandin Analog in Glaucoma?

Increase uveoscleral outflow w/o effect on aqueous flow or trabecular outflow facility

42

Cocaine mechanism for diagnosing Horner's Syndrome

-Cocaine = reuptake inhibitor --> NE flood --> pupillary dilation
-Horner's Syndrome = dysfunctional PANS --> no pupillary dilation

43

What drug is used to differentiate preganglionic from postganglionic lesions in Horner's Syndrome?

Hydroxyamphetamine: Releases NE

44

Hydroxyamphetamine mechanism for differentiating lesion location in Horner's Syndrome

-Topical application
-No pupillary dilation = 3rd order neuron problem = Postganglionic = benign process
-Dilation = Preganglionic lesion --> requires investigation

45

How do you differentiate Adie's syndrome from an intracranial aneurysm?

-Low dose muscarinic agonist (Methacholine or Pilocarpine)
-Chronic denervated nerve in Adie's syndrom will be hypersensitive --> pupillary constriction
-Acute trauma neurved from aneurysm will not respond

46

What is light-near dissociation?

No pupil response to light, but does have accomodation

47

Most common cause and population affected by Parinaud's Syndrome

-Midbrain tumor (pineal)
-Young children

48

Common presentation and population affected by Adie's Syndrome

-Loss of patellar reflex
-Young females

49

What characterizes Argyll-Robertson Syndrome:

-Miotic irregular pupils
-Does not respond to cycloplegics

50

Triptan's mechanism of action:

5HT1 B-D agonist --> vasoconstriction of intracranial EXTRACEREBRAL blood vessels (trigeminovascular system) --> block sterile inflammation reaction

51

In what patient population are triptans contraindicated?

Patients w/ vascular disease, uncontrolled HTN, and comlicated migraine syndromes

52

Migraine vs Tension vs Cluster Headache characteristics:

Migraine: unilateral, throbbing, moderate-severe, aggravated by activity, relieved by rest

Tension: dull, achy, non-pulsatile, pressure-like, bilateral, mild-medium

Cluster: severe, unilateral, in temporal, orbital or supraorbital areas

53

Most commonly used Beta blocker for Migraine?

Propranolol

54

Most commonly used Ca++ Channel Blocker for Migraine?

Verapamil
-useful for aura

55

For what patient population is Migraine prevantative therapy recommended?

-3+ severe headaches/month or
-2+ mild-moderate headaches/week or
-inability to use effective symptomatic therapy

56

2 Anti-epileptics used for migraine prevention

Valproic Acid, Topiramate

57

Cluster Headache characteristics:

-Clockwork daily and annual rhythm (same time)
- Men:women 4:1
-Some patients have heavy facial features

58

Long-term Cluster Headache prevention drugs:

-Verapamil (Ca++ channel blocker)
-Topiramate (antiepileptic)
-Valproic Acid (antiepileptic)
-Lithium (mood stabilizer)

59

Biogenic Amine Hypothesis of Depression:

Depression = too little CNS NE and/or 5HT

60

Scoring of Hamilton Depression Rating Scale (HDRS):

Mild= 8-13
Moderate= 14-18
Severe= 19-22
Very Severe= >23

61

What do MAO-A and -B mainly oxidize?

-A = NE, 5HT, Tyramine
-B = DA, phenyethylamine

62

What is the most used TCA for TTH prevention?

Amitriptyline

63

What is a common side effect of TCAs?

Cardiac arrhythmias

64

What 2 SSRIs have P450 Inhibition

Fluoxetine, Paroxetine

65

What is Ketamine's mechanism of action?

Glutamate NMDA receptor antagonist

66

What drug can quitting smokers use to maintain nicotine abstinence?

Bupropion - Atypical antidepressant

67

What is the important side effect of Buproprion?

Lowers seizure threshold

68

What can happen if you give a Bipolar person tricyclics?

Precipitate mania

69

What are the 3 structural parts of local anesthetics?

1. Aromatic ring
2. Intermediate Linkage
3. Terminal Amine

70

If there is a big difference between pKa of local anesthetic and physiologic pH, what form will be more common? (uncharged/charged)

Charged

71

The (charged/uncharged) form of a local anesthetic can penetrate membranes

Uncharged

72

Which structural part of a local anesthetic determines lipid solubility and potency?

Aromatic Ring

73

Metabolism of Ester vs Amide Local Anesthetics:

Esters: metabolized by plasma enzymes

Amides: Metabolized by hepatic P450 enzymes

74

How and where do local anesthetics bind intracellularly?

-Reversibly
-Intracellular portion of Na channel

75

High risk for CNS toxicity from which 2 Local Anesthetics?

Bupivacaine, Ropivacaine

76

Which requires higher dose of Local Anesthetics: CNS or Cardio toxicity

Cardiotoxicity

77

What is Transient Neurological Syndrome and which local anesthetics can cause it?

-Severe transient pain from local anesthetic use in spinal anesthesia
-Lidocaine, Procain, Mepivacaine

78

Which group (ester or amide) of local anesthetics have high allergic reaction rates?

Esters -- PABA metabolites = known allergen

79

Which nerve fibers are first to be blocked by local anesthetics?

- B and A delta
-Generally: smaller, myelinated nerves blocked first

80

What are toxic side effects of Na+ channel blockers?
What is a side effect?

Toxicity = Dizzy, drunk, double vision
Side effect = 15% have rash, rare Steven Johnson syndrome

81

What is a contraindication for Valproate? Why?

Pregnancy -- 4-8% Teratogenic

82

What drugs can be given for status epilepticus?

IV: Phenytoin, Lorazepam, Diazepam, Valproate

83

Absence seizure.
What drug? Mechanism?

Ethosuxamide
- T-type thalamus Ca++ channel blocker

84

Mechanisms for Anti-epileptics:

1. Voltage-gated Na+ channel blockers
2. Voltage-gated Ca++ channel blockers
3. Glutamate receptor blockers
4. GABA system agonists

85

Difference between Felbamate and Topiramate

Felbamate = NMDA blocker
Topiramate = AMPA and Kainate receptor blocker

86

Difference between toxicity and side effect

Toxicity: Unwanted effect of drug

Side effect: unexpected effect, not related to mechanism of action

87

Which anti-epileptic exhibits no metabolism?

Gabapentin

88

What drug has synergistic action/competes with valproic acid

Lamotrigine

89

Antiepileptic drug with "word finding" problem toxicity

Topiramate

90

What is the Meyer-Overton Rule?

Potency of anesthetic gases directly related to their solubility in olive oil

91

What is the gold standard drug for maintenance of general anesthesia?

Isoflurane