First Aid - Neurology - Pharmacology

Front 1

what can be used to decrease aqueous humor synthesis in glaucoma?

Back 1

alpha-agonists (due to vasoconstriction)
-eipnephrine - mydriasis, stinging; do NOT used for closed-angle
-brimonidine - no pupillary/vision changes

beta-blockers (timolol, betaxolol, carteolol) - no pupillary/vision changes

Acetazolamide - due to decreased HCO3 - no pupillary/vision changes

Front 2

what can be used to increase outflow of aqueous humor in glaucoma?

Back 2

cholinomimetics - contracts ciliar mm which opens trabecular meshwork; can cause miosis & cyclospasm
*direct - pilocarpine, carbachol
*indirect - physostigmine, echothiophate

Latanoprost (PGF [2-alpha] is a prostaglandin) - darkens color of iris (browning)

**give pilocarpine for emergency

Front 3

what to give for glaucoma emergency?

Back 3

pilocarpine (cholinomimetic) - very good at opening meshwork in canal of schlemm

Front 4

what opioid effects do not develop tolerance?

Back 4

miosis & constipation

Front 5

how do opioids modulate synaptic transmission?

-channels?
-change in neutotransmitters?
-receptors?

Back 5

modulate synaptic transmission

-open K+ channels, close Ca2+ channels --> decreased synaptic transmission
-inhibit release of: ACh, NE, 5-HT, glutamate, substance P

-mu receptor = morphine; delta receptor = enkephalin; kappa receptor = dynorphin

Front 6

clinical use or opioid analgesics?

Back 6

pain
cough suppression (dextromethorphan)
diarrhea (loperamide & diphenoxylate)
acute pulmonary edema
maintenance programs (methadone)

Front 7

toxicity of opioids?

Back 7

addiciton
respiratory depression
constipation
miosis (pinpoint pupils)
additive CNS depression w/other drugs

Front 8

what opioids can be used for cough? for diarrhea?

Back 8

cough - dextromethorphan
diarrhea - loperamide, diphenoxylate

Front 9

what is butorphanol?

Back 9

partial agonist of mu opioid receptor
agonist at kappa receptor

used for pain, less resp depression than full agonists
can precipitate withdrawl if accustomed to a full agonist

Front 10

what is tramadol?

Back 10

very weak opioid agonist
-inhibits serotonin & NE reuptake

used for: chronic pain
toxicity: similar to opoids; decreased SEIZURE threshold

"tram it all" in - works on multiple neurotransmitters (5HT & NE reuptake inhibiton)

Front 11

1st line tx for partial seizures?

Back 11

Carbamazepine
(both simple & complex)
(also 1st line for trigeminal neuralgia)

Front 12

1st line tx for tonic-clonic (generalized) seizures?

Back 12

Phenytoin, Carbamazepine, Valproic acid

Front 13

1st line tx for absent (generalized) seizures?

Back 13

ethosuximide

Front 14

1st line therapy for status epilepticus?

Back 14

acute - benzodiazepines (diazepam or lorazepam)
prophylaxis - phenytoin

Front 15

Phenytoin?

-MOA:
-Partial:
-Generalized:
-Notes:

Back 15

-MOA: increase Na+ channel inactivation
-Partial: simple, complex
-Generalized: 1st line for tonic-clonic & status epilepticus (prophylaxis)
-Notes: fosphenytoin for parenteral use

Front 16

Carbamazepine?

-MOA:
-Partial:
-Generalized:
-Notes:

Back 16

-MOA: increase Na+ channel inactivation
-Partial: 1st line for simple & complex
-Generalized: 1st line for tonic-clonic
-Notes: 1st line for trigeminal neuralgia

Front 17

Lamotrigine?

-MOA:
-Partial:
-Generalized:
-Notes:

Back 17

-MOA: blocks voltage-gated Na+ channels
-Partial: simple, complex
-Generalized: tonic-clonic
-Notes:

Front 18

Gabapentin?

-MOA:
-Partial:
-Generalized:
-Notes:

Back 18

-MOA: primarily inhibits HVA Ca2+ channels (tho designed as GABA analog)
-Partial: simple, complex
-Generalized: tonic-clonic
-Notes: also used for peripheral neuropathy, bipolar disorder

*HVA = high voltage activation Ca channels

Front 19

Topiramate?

-MOA:
-Partial:
-Generalized:
-Notes:

Back 19

-MOA: blocks Na+ channels, increases GABA action
-Partial: simple, complex
-Generalized: tonic-clonic
-Notes: -

Front 20

Phenobarbital?

-MOA:
-Partial:
-Generalized:
-Notes:

Back 20

-MOA: increase GABA-A action
-Partial: simple, complex
-Generalized: tonic-clonic
-Notes: 1st line in pregnant women & children

Front 21

Valproic acid?

-MOA:
-Partial:
-Generalized:
-Notes:

Back 21

-MOA: increase Na+ channel inactivation; increase GABA concentration
-Partial: simple, complex
-Generalized: 1st line for tonic-clonic; works for absence
-Notes: also used for myoclonic seizures

Front 22

Ethosuximide?

-MOA:
-Partial:
-Generalized:
-Notes:

Back 22

-MOA: blocks thalamic T-type Ca2+ channels
-Partial: -
-Generalized: 1st line for absence
-Notes: -

Front 23

Benzodiazepines (lorazepam, diazepam) for seizures?

Back 23

first line for acute status epilepticus
also used for seizures of eclampsia

increases GABA-A action

Front 24

1st line for seizures of eclampsia?

Back 24

MgSO4
also use benzodiazepines (lorazepam, diazepam)

Front 25

Tigabine?

-MOA:
-Partial:
-Generalized:
-Notes:

Back 25

-MOA: inhibits GABA reuptake
-Partial: simple, complex
-Generalized: -
-Notes: -

Front 26

Vigabatrin?

-MOA:
-Partial:
-Generalized:
-Notes:

Back 26

-MOA: irreversibly inhibits GABA transaminase --> increased GABA
-Partial: simple, complex
-Generalized: -
-Notes:

Front 27

Levetiracetam?

-MOA:
-Partial:
-Generalized:
-Notes:

Back 27

-MOA: unknown, may modulate GABA & glutamate release
-Partial: simple, complex
-Generalized: tonic-clonic
-Notes:

Front 28

epilepsy drug toxicity - siADH?

Back 28

Carbamazepine

Front 29

epilepsy drug toxicity - Steven-Johnson syndrome?

Back 29

Carbamazepine
Ethosuximide
Lamotrigine

Front 30

epilepsy drug toxicity - teratogenesis?

Back 30

Carbamazepine
Phenytoin (fetal hydantoin syndrome)
Valproic Acid (neural tube defects)

Front 31

epilepsy drug toxicity - hepatotoxicity?

Back 31

Carbamazepine
Valproic Acid - rare but fatal; check LFTs

Front 32

epilepsy drug toxicity - agranulocytosis?

Back 32

Carbamazepine

Front 33

epilepsy drug toxicity - aplastic anemia?

Back 33

Carbamazepine

Front 34

epilepsy drug toxicity - inductin of cytochrome P-450?

Back 34

Carbamazepine
Phenobarbital
Phenytoin

Front 35

epilepsy drug toxicity -
sedation, tolerance, dependence

Back 35

Benzodiazepines

Front 36

epilepsy drug toxicity - ?

Diplopia, ataxia, blood dyscrasias, liver toxicity, teratogenesis, induction of cytochrome P-450, Stevens-Johnson syndrome

Back 36

Carbamazepine

also - agranulocytosis, aplastic anemia, siADH

Front 37

epilepsy drug toxicity - ?

GI distress, fatigue, headache, urticaria, Stevens-Johnson syndrome

Back 37

Ethosuximide

EFGH - Ethosuximide, Fatigue, GI, Headache

Front 38

epilepsy drug toxicity - ?

Sedation, tolerance, dependence, induction of P450

Back 38

Phenobarbital

Front 39

epilepsy drug toxicity - gingival hyperplasia?

Back 39

Phenytoin

Front 40

epilepsy drug toxicity - ?

Nystagmus, diplopia, ataxia, sedation, hirsutism, megaloblastic anemia, teratogenesis, SLE-like syndrome, induction of P450

Back 40

Phenytoin

also gingival hyperplasia

Front 41

epilepsy drug toxicity - hirsutism?

Back 41

Phenytoin

Front 42

epilepsy drug toxicity - ?

GI distress, tremor, weight gain, neural tube defects

Back 42

Valproic acid

also rare but fatal hepatotoxicity, check LFTs

Front 43

epilepsy drug toxicity - ?

Steven's Johnson syndrome

Back 43

Lamotrigine

Front 44

epilepsy drug toxicity - ?

Sedation, ataxia

Back 44

Gabapentin

Front 45

epilepsy drug toxicity - ?

sedation, mental dulling, kidney stones, weight loss

Back 45

Topiramate

Front 46

short acting benzodiazepines?

Back 46

TOM

Triazolam
Oxaxepam
Midazolam

-highest addictive potential

Front 47

what binds the GABA-A receptor? mechanism?

Back 47

GABA-A is a ligand-gated chloride channel

Benzodiazepines - increases GABA binding freq
Barbituates - increase durationof binding; at high doses directly agonizes
Ethanol

Front 48

how to tx benzodiazepine OD?

Back 48

flumazenil (competitive antagonist)

Front 49

Nonbenzodiazepine hypnotics?

Back 49

Zolpidem (Ambien), zaleplon, eszopiclone

short duration; act via BZ1 receptor; reversed by flumazenil

Front 50

what is MAC? formula?

Back 50

minimum alveolar concentration = conc at which 50% of population is anesthetized

increased lipid solubility = increased potency = 1/MAC

Front 51

anesthetics - effect of increased blood solubility?

Back 51

slower onset of action; more gas required to saturate blood

Front 52

anesthetics - what does an increased arterio-venous concentration gradient indicate?

Back 52

slower onset of action
-increased solubility w/increased gas required to saturate tissues

Front 53

anesthetics - effect of increased lipid solubility?

Back 53

increased potency, decreased MAC

Front 54

anesthetics - which have rapid induction & recovery times?

Back 54

drugs w/decreased solubility in blood

Front 55

anesthetics - effects of inhaled anesthetics?

Back 55

myocardial & respiratory depression
nausea/emesis
increased cerebral blood flow
decreased cerebral metabolic demand

Front 56

inhaled anesthetics toxicity - hepatotoxicity?

Back 56

Halothane

Front 57

inhaled anesthetics toxicity - nephrotoxicity?

Back 57

methoxyflurane

Front 58

inhaled anesthetics toxicity - proconvulsant?

Back 58

enflurane

Front 59

inhaled anesthetics toxicity - expansion of trapped gas?

Back 59

nitrous oxide

Front 60

IV anesthetics - used for rapid induction & short procedures?

Back 60

Propofol
potentiates GABA-A
less postoperative nausea than thiopental

Thiopental (barbituates)
-high potentcy
-high lipid solubility
-rapid entry into brain, effect terminated by rapid redistribution into tissue & fat
-decreased cerebral blood flow

Front 61

IV anesthetics - used for endoscopy; adjunctively w/gaseous anestheics & narcotics?

Back 61

Midazolam (benzodiazepines)

may cause severe postoperative respiratory depression
decreased BP
amnesia

Front 62

IV anesthetics - PCP analog that acts as dissociative stimulant?

Back 62

Ketamine (arylcyclohexylamines)
-block NMDA receptors
CV stimulant
cause: disorientation, hallucination, bad dreams
increase cerebral blood flow

Front 63

Local anesthetics - names? mechanism?

Back 63

Lidocain
Mepivocain
Bupivicaine

block Na channels by binding to specific receptors on INNER portion (preferentially bind active, so most effective in rapid firing)

tertiary amine local anesthetics penetrate membrane in uncharged form, bind to ion channels as charged form

Front 64

Local anesthetics - what needs to be considered in infected tissue?

Back 64

infected tissue is acidic
alkaline anesthetics become charged, can't pennetrate membrane
more anesthetic needed in this case

Front 65

Local anesthetics - order of nerve blockade? sensation?

Back 65

small-diameter > large diamter
myelinated > unmyelinated

pain (first) > temp > touch > pressure (last)

size factor predominates

small myelinated > small unmyelinated > large myelinated > large unmyelinated

Front 66

Local anesthetics - why give w/epinephrine (vasoconstrictor)?

Back 66

decrease bleeding
increase anesthesia by decreasing systemic concentration

don't do this with cocain; in digits, penis, (eye?), other areas w/single blood supply

Front 67

Local anesthetics toxicity - severe cardiovascular toxicity?

Back 67

bupivicaine

Front 68

Local anesthetics toxicity - general?

Back 68

CNS excitation
severe cardiovascular toxicity (bupivicaine)
HTN
Hypotension
Arrythmias (cocaine)

Front 69

Local anesthetics toxicity - arrhythmias?

Back 69

Cocaine

Front 70

depolarizing blockade of NMJ?

complications, phases, antidotes?

Back 70

Succinylcholine - hypercalcemia & kyperkalemia are complications

Phase I (prolonged depolarization) - no antidote; potentiated by cholinesterase inhibitors
Phase II (repolarized but blocked) - antidote consits of cholinesterase inhibitors (neostigmine)

Front 71

nondepolarizing blockade of NMJ?

Back 71

tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, rocuronium

compete w/ACh for receptors
reversal - neostigmine, edrophonium, other cholinesterase inhibitors

Front 72

how to tx malignant hyperthermia? MOA?

Back 72

Dantrolene
prevents Ca2+ release from sarcoplasmic reticulum of skeletal mm

also used to tx neuroleptic malignant syndrome

Front 73

Parkinson's tx - agonize dopamine receptors?

Back 73

Bromocriptine (ergot)
Pramipexole
Ropinirole (non-ergot)

*non ergots are preferred

Front 74

Parkinson's tx - increase dopamine?

Back 74

Amantadine (may increase dopamine release)
toxicity = ataxia

L-dopa/carbidopa - converted to dopamine in CNS

Front 75

Parkinson's tx - prevent breakdown of dopamine?

Back 75

Selegiline - selective MAO type B inhibitor
Entacopone, tolcapone (COMT inhibitors - prevent L-dopa degradation)

Front 76

Parkinson's tx - curb excess cholinergic activity?

Back 76

Benztropine
-antimuscarinic, improves tremor & rigidity but has little effect on bradykinesia

"Park your mercedes-Benz"

Front 77

Parkinson's tx - mneumonic?

Back 77

BALSA

Bromocriptine
Amantadine
Levodopa (w/carbidopa)
Selegiline (& COMT inhibitors)
Antimuscarinics

Front 78

How to tx essential or familial tremors?

Back 78

beta-blocker

Front 79

how to tx Alzheimer's?

Back 79

Memantine - NMDA receptor antagonist; prevents excitotoxicity (mediated by Ca2+)

Donepezil, galantamine, rivastigmine - Acetylcholinesterase inhibitors

Front 80

treating Huntington's - do what to neurotransmitters? drugs?

Back 80

Huntington's has increased dopamine w/decreased GABA & ACh, need to fix this

Reserpine + tetrabenazine - amine depleting
Haloperidol - dopamine receptor antagonist

Front 81

how to tx acute migraines, cluster headache attacks?

Back 81

Sumatriptan
-5HT (1B/1D) agonist
-vasoconstriction, inhibition of trigeminal activation, & vasoactive peptide release
-half life < 2 hours

toxicity: coronary vasospasm, mild tingling
-contraindicated in pts w/CAD or prinzmetal's angina

Front 82

what pts is sumatriptan contraindicated in?

Back 82

Coronary Artery Dz
Prinzmetal's angina

sumatriptan causes vasoconstriction (via 5HT agonism)