Pharmacology Flashcards
(228 cards)
1
Q
What system that packages and store dopamine and make it ready to release?
A
VMAT2 (vesicular monoamine transporter 2)
2
Q
How do you get rid of dopamine in the synapses?
A
Dopamine transport (DAT) to reuptake/COMT and MAO-B to degrade
3
Q
Which dopamine pathway systems control movement? hyper function cause? hypo?
A
Nigrastriatal systems (between striatum and substantia nigra)/dyskinetic movement/Parkinsonism
4
Q
Which dopamine pathway systems control reward and perception?hyper function cause? hypo?
A
Mesolimbic system (between nucleus accumbens and tagmentum)/addiction/amotivation and apathy
5
Q
Which dopamine pathway systems make you alert, awake and focused? hyper function cause? hypo?
A
Mesocortical system (tagmentum and the front of your brain)/hypervigilance/inattention
6
Q
Which dopamine pathway systems control prolactin function? hyper function cause? hypo?
A
Tuberoinfundibular system (hypothalamus and pituitary)/hypoprolactinemia/hyperprolactinemia
7
Q
Loss of dopamine activity in what part of the brain causes ADHD?
A
Anterior cingulate
8
Q
Block dopamine can alleviate?
A
Nausea
9
Q
How does L-methylfolate increase the production of dopamine?
A
Folic acid—>MTHFR—>L-methylfolate—>cross BBB—>1 carbon cycle—>increase tyrosine—>increase dopamine
10
Q
What chemical also stimulate the 1 carbon cycle?
A
s-adenosyl methionine
11
Q
Which drug block DA and NE reuptake?
A
Bupropion
12
Q
2 mechanism of amphetamine?
A
Block DAT and might reverse it/promote VMAT2—>release more DA
13
Q
How does methylphenidate compare with amphetamine?
A
methylphenidate just blocks DAT
14
Q
Example of class I and II addictive drugs?
A
Cocaine (illegal)/amphetamine (allowed to prescribe)
15
Q
What does modafinil and armodafinil do? how does it work?
A
For ppl who are fatigue (class IV)/increase histamine activity in TMN/increase orexin (arousal)/might block DAT/might up NE receptor
16
Q
Should you prescribe class IV drugs to ppl who has addiction problems?
A
No
17
Q
Can modafinil and armodafinil make you loss weight?
A
Yes
18
Q
High dose of selegiline block?
A
MAO A and B
19
Q
What gives you HTN crisis (stroke/MI) when you are on MAOi?
A
NE and food with tyramine in it
20
Q
What is serotonin syndrome and what causes it?
A
high level of 5HT—>tremor/muscle spasm/hyerthermia/delirium/coma/death
takes 5HT when you are on MAOi
21
Q
What does entacapone and tolcapone treat?
A
Parkinson’s
22
Q
What is the side effect of entacapone?
A
Fatigue and nausea (unusual in stimulant drugs)
23
Q
Why don’t we want to use levodopa right away?
A
It stops working 10-20 years and give you dyskinesias
24
Q
Side effect of D2 agonists?
A
Mania (one of them)/too happy
25
What is D2 receptor?
Phasic DA--->release DA in short puff
26
What is D3 receptor?
Tonic DA--->goes up and down slowly in a day to keep you awake
27
What else can aripiprazole treat besides schizophrenia?
Depression
28
you want to __ DA in treating schizophrenia?
Lower
29
What are reserpine and tetrabenazine?
DA depleters--->reserpine: Psychosis (DA blocker--->shooting blank)
30
What is high potency first gen antipsychotic drugs (typical) and its side effect?
High affinity for D2/cause DA to be too low--->extrapyramidal syndromes
31
What is extrapyramidal syndromes?
Caused by FGA--->akathisia/dystonia (torticollis--->stiff neck)/Parkinsonism/neuroleptic malignant syndrome (all muscles contract--->hyperthermia/muscle rigidity/rhabdomyolysis
32
Why use anticholingeric drugs for Parkinson's?
Block cholingeric system--->release DA
33
What is diphenhydramine (Benadryl) used for?
Anticholinergic--->treat EPS caused by FGA/SGA
34
What happen if D2 receptor (high potency FGA) is blocked for years?
Highly sensitive D2 receptor emerge--->tardive dyskinesia (fast quirky movement usually on face)
35
What else does low potency FGA block besides D2 receptor?
They are also anticholinergic/anti H1/anti alpha 1--->more side effects
36
What are the 3 high potency FGAs?
Haloperidol/fluphenazine/thiothixine
37
What are the 2 low potency FGAs?
chlorpromazine/thioridazine
38
Difference of high and low potency FGAs regarding side effects?
High potency is more prone for EPS/low potency has more side effects
39
What is the difference between SGA (atypical) and FGA?
SGA is more specific--->it blocks D2 and 5HT2a--->blocking DA in mesolimbic system and allowing better transmission in other DA pathways
40
Do you get more or less EPS with SGA?
Way less/but SGA has more metabolic side effects--->also make younger people suicidal
41
What else does SGA treat?
depression
42
What are the side effects for pines (SGA)?
More antihistamine--->more sedative
| Make ppl eat more and gain more weight--->diabetes
43
What are the side effects for dones (SGA)?
More EPS
44
What is so special about clozapine?
Most effective SGA/risk of agranulocytosis/most metabolic risk/little to zero EPS
45
What is the most common type of headache?
episodic tension type
46
What gender is more prone to migraine?
Female (3 times more frequent than men)
47
What is the migraine phases?
Prodrome--->aura--->headache--->resolution
48
What is positive and negative visual phenomenon?
Positive--->see something
| Negative--->missing vision
49
What is aura regarding migraine?
Cortical spreading depression--->reduction of cerebral blood flow--->focal neurological problem (last about 20mins--->visual is most common (distortion) )
50
Would migraine headache relive by rest?
Yes
51
How long does migraine last?
4-72 hours
52
Symptoms of migraine headache?
osmo/photo/phonophobia (seek dark room)
53
Is migraine w/ aura more common than w/o?
No w/o is more common
54
What is familial hemiplegic migraine?
Mutation of Ca channel on chromosome 19--->cause one side of the body paralyzed
55
What is special about migraine pt's brain?
It is much more sensitive--->high response to stimuli
56
What is the pathophys of headache?
Activation of trigeminovascular system--->nerve fibers release vasodilating/permeability promoting peptides--->sterile inflammation--->increase mechanosensitivity and hyperalgesia to previous normal stimuli (blocked by triptans)--->pain perceived by the surface of the brain
57
Behavioral treatment for migraine involves?
healthy habits/stress/trigger avoidance
58
Mild to moderate migraine can be treated with?
Nonspecific med--->NSAIDs/analgesics and so on (overuse can cause headache)
59
What is the precaustion for barbiturates and opioids for acute treatment use?
Risk of overuse--->medication overuse headache
60
When to use corticosteroids for migraine?
Prolonged migraine
61
Why is dihydroergotamine (DHE) preferred over ergotamine?
Less side effects
62
How does triptans work?
Cross BBB--->agonize 5HT1b/d--->shut down trigeminovascular system (must take early take about 20mins to work)
63
What are some adjunctive treatments for acute migraines?
Antiemetics/neuroleptics (antipsychotic)
64
What to use for preventive treatment for migraine?
Antidepressants (TCA and SSRI)/antihypertensive (beta blocker and Ca channel blockers)/antiepiletpic
65
What are the 3 TCA that are used to prevent migraine?
Amitriptyline/protriptyline/nortiptyline
66
What is Ca channel blockers used for migraine prevention?
When pt has prolonged or disabling aura
67
What is the major side effect for topiramate (antiepileptic)?
Change in cognition
68
What is botox used for migraines?
Chronic migraine
69
What is tension type headache like?
Non-pulsating/dull/achy pain/not worsen by movement/not that severe
70
What defines chronic tension type headache?
More than 15 times per month
71
What do you treat acute TTH with? and prevent it from happening?
Analgesics/TCA like amitriptyline
72
What is cluster headache?
Happen at night and at the same time every year/mostly men--->heave facial features
73
How is the pain in cluster headache?
Unilateral/temporal/peaks quickly/really severe pain
74
What to use to treat acute cluster headache?
O2/triptan/DHE
75
What to use for short term preventive treatment for cluster headache?
Steroids
76
What to use for long term preventive treatment for cluster headache?
Verapamil (Ca channel blockers)/topiramate/valproic acid/lithium (avoid indomethacin and Ca depleting diuretics)
77
How is aqueous (eye) produced and traveled?
Made in ciliary body--->pass through between lens and iris--->anterior chamber--->drain out via trabecular meshwork
78
What is the angle in angle closure and open angle glaucoma? and how to tell if it is angle closure (prevent drainage of aqueous)?
The angle between iris and cornea/shine light from temporal side of the eye--->if both temporal and nasal iris are illuminated--->deep anterior chamber
79
At the age of 45, you start to loss the ability to ___?
Accommodate (thickening of the lens)
80
What does epi and dipivalyl do for glaucoma?
They lowered the intraocular pressure
81
Topical cocaine for the eye is testing for?
If pupil do not dilate---->symp dysfunction (Horner's)
82
If eyes do not respond to paredrine, what order of neuron is damaged?
3rd order neuron (postganglionic)
83
Parasymp paresis?
Loss of parasymp function--->pupillary dilation
| Parasymp runs with 3rd cranial nerve--->loss of eye movement and ptosis
84
Adie's symdrome?
Damage to ciliary ganglion--->parasymp synapse at ciliary ganglion--->parasymp damage--->large pupil--->don't respond to light but respond to accommodation
85
What happens with internal carotid aneurysm for the eyes?
Trauma to 3rd nerve--->pupillary dilation/loss of eye movement/ptosis
Aneurysm also comes with headache (medical emergency)
86
Distinguish Adis's from intracranial aneurysm?
Denervation hypersensitivity happens in Adi's--->small amount of ACh stimulates nerve (low dose of methacholine and pilocarpine will work)
87
1% pilocarpine constricts everybody's pupil but?
Not for pharmacologic blockade
88
Pilocarpine causes?
Bifrontal headache
89
What are the 3 light-near dissociation disorder?
Adie's/Parinaud's syndrome (mid brain tumor)/Argyll Robertson syndrome (tertiary syphilis)
90
Antidepressant is used for ?
Depression/anxiety (and its subtypes like OCD and PTSD/enuresis/neuropathic pain/bulimia
91
What are the major mechanisms for antidepression drugs?
Block amine reuptake/block MAO/block presynaptic amine autorecetpors
92
How long will you see the clinical improvement for antidepression drugs?
Not till weeks or months
93
___ antidepressants are very effective especially for children and teens?
Placebo
94
What is the difference between all the amine reuptake inhibitors?
Their selectivity against NE or 5HT reuptake transporter
95
What are the side effects of tricyclics?
Also block muscarinic/alpha/histamine/DA reuptake pump
96
Overdose of tricyclics causes?
Cardiac arrhythmias--->lethal
97
Why is SSRI used more than TCAs?
SSRI has less side effects (might not as good)---->more compliance
98
What is one of the major side effect of paroxetine and fluoxetine?
P450 inhibitor
99
What is ketamine?
Party drug that has a faster clinical effect than other antidepression drugs
100
Is resistant to depression meds common? and how do we deal with it?
It is common/switch, combine or augment different drugs
101
What are the 2 atypical antidepressant?
Mirtazapine and bupropion
102
What is the definition of local anesthetics?
Reversibly prevents nerve impulse transmission w/o affecting consciousness
103
The cell membrane of neuron is permeable to __ and not to ___?
Permeable to K but not Na
104
What is preemptive analgesia?
Nerve block before incision
105
Local anesthetic works on Na channels that are ___?
being activated (less in resting or inactivated states)
106
What are the 3 structural characteristics of local anesthetics?
Aromatic ring (lipophilic)/intermediate linkage either Ester or Amide/terminal amine
107
Intermediate linkage of local anesthetics determine the way of biodegradation, how does Ester and Amide degraded?
Ester--->hydrolyzed in the plasma by pseudocholinesterase (CSF does not have this enzyme)/Amide--->transformed by P450 in the liver
108
The terminal amine in local anesthetics can accept ___ and become ___?
Accept a proton and become a weak base---->thus hydrophilic and active
109
Only the ___ form of local anesthetics can cross the lipid membrane and only the ___ form can act on the Na channel
unionized/ionized
110
In physiologic pH, local anesthetics are ___?
Ionized
111
What do we do when we have to inject local anesthetics into an infected tissues (acidic environment)?
Add bicarb first and then LA
112
What kind of nerve would be blocked first by LA?
Smaller and myelinated nerves
113
What are the 4 types of nerve fibers and their diameter and conduction speed?
Diameter and conduction speed in descending order: A-alpha--->A-beta--->A-delta--->B--->C
114
Which 4 nerve fibers are myelinated and which 2 fibers conduct pain?
All the A fibers and B are myelinated and A-delta and C fiber conduct pain
115
Which nerve fiber gets blocked first and which ones recovers first?
B/C get blocked first and then A fibers/A fibers recover first and then B and C fibers
116
Pain and temp sensation can be blocked but ___ can not be blocked?
Pressure sensation
117
What is Cauda Equina Syndrome and what caused it?
High dose of intraspinal lidocaine--->complete motor weakness and sensory lost/lost of bladder and bowel function
118
Lidocaine and other LA can also cause ___?
Transient neurologic symptoms (transient pain)
119
How to treat LA toxicity?
Intralipid infusion with ventilation to maintain normal blood pH
120
Which LA causes allergy, esters or amide?
Esters (PABA metabolites)
121
What is the difference between toxicity and adverse effect?
Toxicity is predicted reaction, adverse effects are not
122
What kind of seizures do phenytoin treat?
Tonic-clonic and acute seizures
123
Lamotrigine competes with __ for excretion?
Valproate
124
What are the 2 drugs that bind to GABA A and for antiepileptic?
Phenobarbitol and benzodiazapines
125
What is status epilepticus and what drug is for that?
Seizures that start right after one another (medical emergency)/benzodiazepine
126
Which antiepileptic drug has cognitive toxicity (word finding)?
Topiramate
127
Li can be used for ___ headache?
cluster
128
What is MAC (minimal alveolar concentration)?
The concentration of anesthetic vapor in the lungs that 50% of pt would not response to noxious stimuli/additive
129
GABA and Glutamate bind to and open ___ channels?
ligand-gated ion channels
130
NMDA receptor conduct what ions?
Na/K/Ca
131
GABA receptor conduct what ion and result in?
Cl/hyperpolarization
132
Glycine is inhibitory or excitatory NT in CNS or spinal cord?
Inhibitory in spinal cord
133
Anesthetics bind to ___ pockets of ___ protein?
Hydrophobic pockets of water soluble protein
134
Volatile anesthetic (liquid) needs to be ___ before giving to pts?
Vaporized (specific drug goes with specific vaporizer)
135
What is partial pressure regarding inhaled anesthetics?
concentration of gas dissolved in liquid is proportionate to the partial pressure of the gas above the liquid--->equilibrium exists between 2 phases (e.g. alveoli and blood)
136
What is partition coefficient?
Ratio of solubilities of gas between 2 compartments/it describes how inhaled anesthetics distribute themselves
137
What propel the anesthetic gas to go from the machine to the brain?
Partial pressure of the alveoli PA
138
Partial pressure of alveoli PA/pulmonary papillary blood Pa/brain partial pressure Pbr are?
equal
139
How to maintain a good partial pressure of anesthetic gas in the alveoli by increase delivery to alveoli?
Increase amount of gas/increase alveoli ventilation/ and decrease functional residual capacity
140
How to maintain a good partial pressure of anesthetic gas in the alveoli by decreasing uptake of blood?
Decrease blood solubility/decrease CO/increase con. of gas in the blood--->so gas stay in the alveoli
141
You can start with ___ con. of gas since the gas will be mixed with other gas in the lungs and get diluted
Higher
142
What is concentration effect?
When the gas is rapidly absorbed into the blood stream in the lung, the remaining con. of gas in the alveoli increase because the volume shrinks
143
What is the 2nd gas effect?
Potent gas and N2O are in the alveoli--->N2O got absorbed a lot faster than the potent one--->potent gas con. goes up
144
Speed of anesthetic induction (speed of pt fall asleep) is determined by?
The rate of rise of alveolar concentration of anesthetic agent
145
What kind of anesthetic agents achieve high PA and thus faster induction?
Poorly soluble ones (tend to stay in alveoli)
146
MAC measures the response of ___?
spinal cord
147
MAC is increased in?
hyperthermia/red hair ppl/increase catecholamine and NTs/hypernatremia/cyclosporin
148
MAC is decreased in?
Increase age/pregnancy
149
Why is N2O used with other volatile anesthetics?
So we don't have to use too much of potent volatile anesthetics--->minimize side effects
150
What are the Guedel's 4 stages of CNS depression from anesthesia?
Analgesia--->excitement and delirium--->surgical anesthesia--->medullary depression (need ventilator)
151
Volatile agents increase?
Cerebral blood flow (counted by hyperventilation)/increase ICP/blood flow to brain muscle and skin
152
Volatile agents decrease?
systemic vascular resistance (vasodilate)/BP/ventilatory response to hypoxia
153
Volatile agents' effects on neuromuscular function?
Relax skeletal muscle/trigger malignant hyperthermia (genetic variant)
154
Barbiturates and propofol causes __ and results in ___?
Vasodilation and HoTN
155
For a elderly pt who can not tolerate drop in BP, use which general anesthesia?
Etomidate
156
What is ketamine's (general anesthesia) effect on cardiovascular system and respiratory system?
Stimulate sympathetic system/broncodilator
157
What generalized anesthesia do we use for children with developmental delay?
Ketamine
158
What is the difference between dexmedetomidine and other generalized anesthesia?
Pt on dexmedetomidine resembles natural sleep
159
All neuromuscular blockers have ___ structure?
Quarternary ammonium
160
Neuromuscular blockers can be countered with?
Anti cholinesterase
161
What is the difference of Train of Four for depolarizing and non depolarizing neuromuscular blockade?
every succeeding twitch is smaller for non-depolarizing/decrease the same degrees for all 4 twitches for polarizing
162
If a pt has renal failure and need non depolarizing NMB, which one you shouldn't give?
Pancuronium
163
Difference between sedative and hypnotic drugs?
Sedative--->calming/anti anxiety
| Hypnotic--->induce sleep
164
Does GABAa agonist bind directly to the binding site of GABA?
No, they bind onto the structure allosterically and then enhance the receptor (can't open them themselves)
165
GABA receptor has many subunits, resulting?
Different composition has different effect
166
What is BDZ1 receptor?
The receptor that zolpidem binds to (they made that receptor up just for zolpidem, aren't you special)
167
Benzo binds to BDZ1 or 2?
Both
168
Why is benzo safer than barb?
Benzo has ceiling effect---->they only enhance the receptor can't open them
Barb (and alcohol) in high dose act as agonist themselves--->can lead to much severe effect like coma and death
169
What determines the short and long acting benzo?
If they have active metabolites then they are long acting
170
Triazolam and zolpidem are used as a ___ pills
Sleeping (short half life)
171
___ is used for fear of flying (calm you down)
Alprazolam (Xanax)
172
GABA antagonist cause?
Seizure
173
Why Thiopental is rapid acting?
Lipid soluble--->access to brain fast--->redistribution out of the brain fast as well
174
What kind of drugs treat long term and short term anxiety?
Antidepressant/benzo
175
Alcohol is ___ in size therefore ___ absorbed
Small/rapidly
176
What determines the rate of absorption of alcohol?
Concentration of alcohol/stomach fullness
177
What happens to alcohol when there's food in the stomach?
Dilute alcohol/delay stomach emptying/increase effective metabolism of alcohol
178
Alcohol is distributed throughout the __ content of the body, and resulting women to have ___ alcohol
Water content/male has higher water fraction than females
179
Where is alcohol metabolism takes place?
Liver and stomach
180
What is the alcohol metabolism process in the liver?
Alcohol ---(alcohol dehydrogenase ADH)--->acetaldehyde---(acetaldehyde dehydrogenase--->ALDH1/2)--->acetate
181
Asians lack which enzyme that metabolize alcohol?
ALDH2--->higher ALD level--->higher alcohol sensitivity
182
When will the P450 metabolism of alcohol kick in?
When you drink too much or you are a seasoned drunk
183
What is the limiting factor for rate of alcohol oxidation, and how are other reactions involving this factor affected?
NAD+/all other NAD+ reaction are diverted to alcohol metabolism
184
When our system is fully saturated with alcohol (ya drunk), what is the order of kinetics regarding alcohol elimination?
Zero order (NAD+ is the limiting factor)--->turn to 1st order when the concentration is really low
185
Progression of alcohol intoxication?
Loss of inhibition--->impaired motor--->vision--->cerebellum--->medulla (respiration and temp)
186
Chronic alcohol usage causes ___? which can lead to ___?
Fatty liver--->cirrhosis
187
Moderate alcohol consumption can increase ___ and decrease ___?
HDL/coronary heart disease
188
Acute drug interaction of alcohol?
Metabolism of other drugs might be inhibited
189
Chronic drug interaction of alcohol?
Induce P-450--->enhance metabolism of other drugs
190
Alcohol has an ___ effect with other CNS depressant
Additive
191
What are methyl alcohol and ethylene glycol? and what is used for OD of these?
Their metabolites are toxic/use ethanol to compete with ADH (preferred substrate)--->pee out the toxic ones
192
Cocaine can be hydrolyzed via ___ or ___?
plasma cholinesterase or spontaneously
193
What is schedule I and II drugs?
Schedule I--->high potential for abuse and no medical use (hallucinogens/heroin/weeds and what not)
Schedule II--->high potential for abuse and some medical use (morphine/cocaine)
194
What are some examples of indole alkyl amines?
Serotonin like--->psilocybin and LSD
195
What is an example of phenylethylamines?
Mescaline
196
LSD's affects?
Distortion of perception and heightened sensory awareness
197
Why it is hypothesized that LSD share the same site of action with mescaline and psilocybin?
Because there's cross tolerance between LSD and mescaline and psilocybin
198
What is the mechanism of LSD?
agonists at inhibitory 5HT2a at raphe nucleus (raphe nucleus usually inhibit downstream 5HT)---->inhibit the inhibitor---->uncontrolled 5HT release
199
How is THC metabolized?
Highly lipid soluble/metabolized by P450
200
What are the 2 cannabinoid receptors and what do they do?
CB1--->euphoria
| CB2--->immune system
201
What is endogenous opioid?
Endorphin
202
Where does opioid receptor agonist act on?
decrease release of substance P/Ascending spinothalamic tract/descending pain modulatory system
203
What kind of receptor is opioid receptor?
G protein coupled
204
Opioid side effects include?
Miosis/lower seizure threshold/depressed respiration
205
What is bolus effect for opioid and what do we do to prevent it?
Analgesic effect from bolus of opioid injected but then pain comes back with rapid excretion/give extended release or IV
206
What should we worry about opioid with acetaminophen?
Pt might take too much acetaminophen
207
What to do when a pt who's on extended release opioid that is still in pain?
Use immediate release as a breakthrough, don't escalate the extended release (OD)
208
How do we administer opioid for pt who has renal or liver problems?
Decrease dose or interval/use as needed only for pt with no urine/opioid is conjugated in the liver and excreted in the urine
209
What is peudoaddiction of opioid?
Under treatment of pain
210
What is tolerance of opioid?
Decrease effectiveness w/ repeated dose/decrease side effects EXCEPT for constipation
211
What is physical dependence of opioid and how to avoid it?
Pt goes through withdraw/decrease the dose slowly
212
What is equianalgesic dosing?
Switch an opioid to another or from one route to another (has to change dose too)
213
How do we adjust for cross-tolerance when equianalgesic dosing?
(might be more sensitive to new drug) Decrease dosing for new drugs--->give more if pain
214
What to give pt for nausea vomiting caused by opioid side effect?
DA blocker
215
Is there a limited dose of opioid (ceiling) that you can give?
No, limited by side effect
216
Which opioid you shouldn't use for malnourished pt?
Fentanyl (patch form)
217
What are the 5 MS subtypes?
Clinically isolated syndrome (one location)
Relapsing-remitting (most common)
Primary progressive (slowly gets worse/no relapse)
Progressive relapse (has relapse, worse every time)
Secondary progressive (start like relapsing-remitting and then stop relapsing and just gets worse)
218
What does MS cause to the appearance of the brain?
White matter atrophy--->enlarged ventricles
219
Neutralizing antibodies interfere with ___ treatment?
IFN-beta for MS (antibodies neutralize IFN-beta)
220
Which IFN-beta drug has the highest neutralizing antibodies?
Betaseron (trade name)
221
Which MS drug slow disease progression?
IFN-beta-1a
222
The key for MS treatment is to treat?
Early
223
Which IFN-beta drug is preferably used over others?
Rebif (or glatiramer acetate)
224
How many years before the risk of getting PML from Natalizumab is increased and you should switch to other drugs?
About 2 years (JC antibody + pt has a higher chance of getting PML)
225
What are atypical antidepressants?
Mirtazapine and bupropion
226
What to give for alcohol withdraw
Benzo
227
What is Hoffman degradation
Spontaneous degradation
228
What causes Adie's syndrome and what is its eye presentation?
Bacterial or viral infection damage the ciliary ganglion of the postganglionic of parasymp/bilateral mydriasis--->react slowly to light but react normally to accommodation
