Cns Pharm Exam

Front 1

what is the effect of barbiturates?
mechanism?

Back 1

•generalized CNS depressant
•binds GABA-a receptor ⇒ ↑duration of GABA action
•also ↑Cl- influx to ⇒ inhibition *independent of GABA*

Front 2

what are the SEs of barbiturates?
how do you treat OD?

Back 2

•↓ respiratory drive
•↓ BP (w/ OD)
•porphyria
•tx OD w/ urine alkalinization

Front 3

what are the CIs for barbiturates?

Back 3

porphyria

Front 4

what are other uses for phenobarbital (besides CNS depression)?

Back 4

partial seizures, generalized tonic-clonic seizures

Front 5

how do the benzodiazepines act?
how does this compare to barbs?

Back 5

•facilitate GABA - bind specific receptor assoc. w/ GABA-a complex
•benzo acts ONLY when GABA is present; much safer than barbs

Front 6

what are the uses for benzos?

Back 6

•anxiolytic (DOC)
•acute mm relaxation at high dose (diazepam)
•alcohol & barb w/d
•status epilepticus
•DTs- diazepam, chloridiazepoxide, lorazepam

Front 7

what are the long & short acting benzos?

Back 7

long acting:
•diazepam
•chlordiazepoxide
•flurazepam

short acting:
•midazolam
•triazolam

Front 8

which benzo is given IV?

Back 8

midazolam

Front 9

what are the CIs of benzos?

Back 9

pregnancy (teratogenic), kids & elderly, sleep apnea, with alcohol, caution in recovering addicts

Front 10

what are the effects of flumazenil?
what drugs can cause seizures in combo w/ flumazenil?

Back 10

•benzo antagonist; also reverses effects of the "z drugs"
•seizures possible w/ benzo, barb, alcohol dependence, epilepsy, and TCA OD

Front 11

what are the pharmacokinetics of zolpidem & zaleplon?

what are the possible adverse effects?

Back 11

•very rapid action, very short half life

•may cause sleep behaviors - walking, driving, eating

Front 12

how is eszopiclone different from zolpidem & zaleplon?

Back 12

•eszopiclone has longer half life
•also can have w/d after chronic use

Front 13

what class is ramelteon?
how does it work?

Back 13

•melatonin analogue
•binds MT 1&2 receptors
•NO EFFECT on GABA-a

Front 14

what is buspirone?
what are its effects?

Back 14

•partial agonist at 5-HT1A
•acts as anxiolytic w/o sedation

Front 15

how does alcohol act?
how is it metabolized?

Back 15

•binds GABA-a receptor complex
•inhibits NMDA receptor

•metabolized by alcohol dehydrogenase first, followed by aldehyde DH
•zero order kinetics

Front 16

what happens w/ chronic alcohol use?

Back 16

•induce CYP2E1
•long term use down-regulates GABA & up-regulates NMDA
•pharmacodynamic & pharmacokinetic tolerance
•other effects: gastritis, hepatotoxicity, FAS, wernicke, korsakoff, cardiomyopathy

Front 17

what are the drug interactions for alcohol?

Back 17

tylenol ⇒ liver toxicity

(others: benzos, barbs, phenothiazines, TCAs)

Front 18

how do you treat alcohol w/d?

Back 18

•benzos
•also phenytoin, antipsychotics, ibuprofen

Front 19

what is naltrexone?
what is the bad SE?

Back 19

•opioid receptor antagonist
•reduces craving (block reward pathway)
•causes liver damage

Front 20

what is acamprosate?
what makes it a good choice?

Back 20

•restores GABA & glutamate balance in alcoholic
•good choice b/c NO liver toxicity

Front 21

how does disulfiram act?
how long do its effects last?

Back 21

•blocks aldehyde dehydrogenase
•must avoid all sources of alcohol
•3-4 day effects

Front 22

how does fomepizole act?
what are its uses?

Back 22

•blocks alcohol dehydrogenase
•used to treat methanol & ethylene glycol poisoning

Front 23

how does you treat methanol or ethylene glycol poisoning?

Back 23

•fomepizole - blocks alcohol DH
•or use alcohol to compete for the enzyme

Front 24

what class is imipramine?
how does it act?
uses?

Back 24

•TCA
•inhibits reuptake of NE & 5HT
•also blocks alpha1, histamine, and muscarinic receptors

•now used for chronic pain
•analgesia of spinal cord

Front 25

what are major SEs of TCAs?

Back 25

•weight gain
•↓seizure threshold
•SIADH
•sexual dysfunction
•sedation (antihistamine)
•anticholinergic, esp. impaired memory/cognition
•alpha1 postural hypotension

***torsades w/ OD

Front 26

what are the drug interactions for TCAs?

Back 26

•MAOIs ⇒ severe CNS toxicity, serotonin syndrome

Front 27

what class is desipramine?

Back 27

•TCA
•2° amine, so less sedation than imipramine

Front 28

what class is phenelzine?
what are the SEs?

Back 28

•MAOI
•HTN crisis when combined w/ tyramine from many foods - tx w/ alpha block
•also get muscarinic block

Front 29

what are the drug interactions of phenelzine?

Back 29

meperidone, dextomethorphan (OTC cold), TCAs, SSRIs (serotonin syndrome)

Front 30

what are the sx of serotonin syndrome?

Back 30

•CNS toxicity
•hyperpyrexia
•restlessness
•mm twitch
•can be fatal

Front 31

what class is fluoxetine?
long or short duration of action?
what are the SEs?

Back 31

•SSRI w/ a long duration of action
•GI - nausea, loss of appetite
•sexual disinterest
•SIADH

Front 32

what drugs inhibit CYP2D6?

Back 32

•fluoxetine
•duloxetine (moderate)

Front 33

what 3 drugs are SNRIs?

Back 33

venlafaxine
desvenlafaxine
duloxetine

Front 34

how does venlafaxine act?
SEs?

Back 34

•blocks uptake of both NE & 5HT
•similar to TCA w/o muscarinic or alpha block

•may ↑BP

Front 35

what are the uses and SEs for trazodone?

Back 35

•pain management
•significant sedation
•priapism**

Front 36

how does bupropion act?
SEs?

Back 36

•inhibits DA reuptake (no effect on 5HT, minor on NE)
•may cause wt loss
•few sexual SEs (can combine w/ SSRI)
•anxiety, insomnia, seizures

Front 37

st johns wort interactions?

Back 37

•used OTC for mild depression
•do not combine w/ other antidepressants
•reduced efficacy of protease inhibitors, OCP, digoxin, warfarin

Front 38

how does chlorpromazine act?
side effects?

Back 38

•inhibits D2 receptors to inhibit + sx of schizophrenia
•extrapyramidal sx- parkinson like
•tardive dyskinesia
•weight gain
•↑prolactin
•alpha, muscarinic, histamine block
•↓sz threshold
•jaundice
•neuroleptic malignant syndrome

Front 39

what drug causes neuroleptic malignant syndrome?
how do you treat?

Back 39

chlorpromazine
tx w/ dantrolene

Front 40

how to treat EPS?

Back 40

anticholinergic

Front 41

major SE of thioridazine?

Back 41

retinal deposits

Front 42

how does haloperidol act?
major SEs?

Back 42

•selective D2 receptor blockade
•no anticholinergic activity

•highest incidence of EPS
•highly sedating

Front 43

how does clozapine act?
what is its advantage?
major SE?

Back 43

•"atypical" antipsychotic
•block D4 & 5HT2A receptors
•advantage: very rare to get EPS or tardive dyskinesia
•major issue: agranulocytosis

Front 44

class and major SE of risperidone?

Back 44

•"atypical" antipsychotic
•prolongs QT interval
•may ↑ mortality in Alzheimer's

Front 45

class and major SEs of olanzapine?

Back 45

•"atypical" antipsychotic
•weight gain
***the WORST for hyperglycemia

Front 46

uses and SEs for quetiapine?

Back 46

•"atypical" antipsychotic
•used for sedation, antidepressant adjunct
•SEs: weight gain, extreme sedation
•little effect on prolactin, no agranulocytosis

Front 47

how does aripiprazole act?
major uses & SEs?

Back 47

•DA & 5HT-1A partial agonist
•used for schizophrenia & depression
***↓esophageal motility

also, no effect on prolactin, QT, weight, or EPS

Front 48

pharmacokinetics of lithium?
interactions?

Back 48

•excreted by kidneys
•narrow therapeutic range
•things that ↓Na will ↑Li -- thiazides
•NSAIDs will ↓Li clearance

•interactions: antidepressants, antipsychotics, thiazides, NSAIDs, sodium

Front 49

how to treat DI?
what drug can cause it?

Back 49

•amiloride
•caused by lithium

Front 50

signs for Li toxicity?
how to treat lithium OD?

Back 50

•N/V, tremor
•infuse Na

Front 51

what are the use & SEs for valproic acid?

Back 51

•good for multiple seizure disorders
•liver toxicity, weight gain

Front 52

how does topiramate act?

Back 52

•acts on Na channels
•not as teratogenic as the other anticonvulsants

Front 53

how does phenytoin act?
uses?
major SE?

Back 53

•prolongs inactivation of Na channels
•used for partial sz, generalized tonic-clonic sz
•narrow therapeutic range
***gingival hyperplasia

Front 54

what is the DOC for partial seizures?

Back 54

carbamazepine

Front 55

uses for carbamazepine?
SE?

Back 55

•DOC for parial sz
•tonic-clonic
•trigeminal neuralgia

**idiosyncratic blood dyscrasias

Front 56

use and SEs for gabapentin?

Back 56

•neuropathic pain
•drowsiness & weight gain
•pregnancy category C

Front 57

how does ethosuximide act?
use?
SE?

Back 57

•reduces low threshold Ca current in thalamic neurons
•DOC for absence sz
•can cause SJ syndrome (rare)

Front 58

how does levodopa act?
SEs?

Back 58

•↑DA levels by replacement
•readily crosses BBB and is converted to DA in neuron

•see peripheral effects in 80% - N/V, vasodilation

Front 59

how does carbidopa/levodopa act?
SEs?

Back 59

•carbidopa inhibits DA decarboxylase, but is unable to cross BBB
•prevents the peripheral conversion of l-dopa

•can still get some GI effects (N/V)
•dyskinesias develop w/ time
•may cause psychosis

Front 60

what class is selegiline?
how does it act?
use?
SE?

Back 60

•MAOI
•inhibits MAO-B, reducing striatal metabolism of DA
•can help w/ on/off phenomenon
•fewer food interactions than phenelzine
•may cause insomnia

Front 61

what is bromocriptine used for?
what is the SE?

Back 61

•on/off periods
•erythromelagia - red, swollen feet

Front 62

what drug class is pramipexole?
what is the major SE?

Back 62

•DA agonist
•may cause sudden sleep during the day

Front 63

what class is benzotropine?
how does it act?

Back 63

•anticholinergic
•restores DA/Ach balance to help improve rigidity in parkinsons

Front 64

what class is donepezil?
how does it act?
major SEs?

Back 64

•cholinesterase inhibitor
•increases the amount of Ach in nerve terminal
•this is indirect action, so it loses effectiveness as the neurons are lost w/ progression of Alzheimer's

•SEs: GI- N/V/D, stomach cramps

Front 65

what class is memantine?
how does it act?
use?
SE?

Back 65

•NMDA receptor antagonist
•may reduce neurotoxic effect of glutamate
•Alzheimer's disease
•incontinence

Front 66

how does baclofen work?

Back 66

•acts as agonist on GABAb receptor
•results in hyperpolarization and inhibition of release of excitatory NT (glutamate) from presynapse in both brain & SC

Front 67

which drug is administered intrathecally?

Back 67

baclofen

Front 68

what are the uses for baclofen?
SEs?

Back 68

•used for chronic spasticity
•SE- some drowsiness

Front 69

what class is cyclobenzaprine?
what major SE?

Back 69

•acts as a sedative at the level of the brain stem
•SE- confusion, transient visual hallucinations

Front 70

what is carisoprodol?

Back 70

•central sedative activity
•popular drug of abuse

Front 71

what is dantrolene used for?

Back 71

malignant hyperthermia
neuroleptic malignant syndrome

Front 72

how does botulinum toxin act?

Back 72

blocks release of Ach from presynaptic terminal

Front 73

how does methylphenidate act?
uses?

Back 73

•promote release of newly synthesized catecholamines
•DA neurons in brain mostly affected

•use for narcolepsy and ADHD

Front 74

what are the SEs of amphetamine?

Back 74

•NE effects in the periphery

Front 75

how does caffeine act?

Back 75

blocks adenosine receptors and ↑cAMP by inhibiting PDE