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69 Cards in this Set

  • Front
  • Back
What is the underlying cause of Parkinson's?
loss of dopaminergic neurons and excess cholinergic activity
Mneumonic for Parkinson's Disease drugs?
BALSA: Bromocriptine, Amantiadine, Levodopa (+carbidopa), Selegiline (+COMT inhibitors), Antimuscarinics
MOA of Bromocriptine?
agonize dopamine receptors (ergot alkaloid and partial dopamine agonist)
Agents that increase dopamine?
Amantadine (increase dopamine release), L-dopa/carbidopa(converted to dopamine in CNS)
MOA of Selegiline and entacapone/tolcapone?
Prevent dopamine breakdown (Selegiline=selective MAO type B inhibitor)and (entacapone/tolcapone=COMT inhibitors)
MOA of Benztropine?
Curbs excess cholinergic activity (antimuscarinic)
Antimuscarinic that improves tremor and rigidity but has little effect on bradykinesia?
Clinical use of L-dopa/carbidopa?
MOA of L-dopa/carbidopa?
Increase dopamine levels in brain. Cross BBB and converted by dopa decarboxylase in CNS to dopamine.
Toxicity of L-dopa?
Arrhythmias from peripheral conversion to dopamine; dyskinesia after doses and akinesia between doses.
How can you avoid L-dopa induced arrhythmias?
Give with carbidopa = a peripheral decarboxylase inhibitor
Selegiline MOA?
Inhibits MAO-B; increase dopamine availability
Selegiline toxicity?
enhance adverse effects of L-dopa
Sumatriptin MOA?
5-HT1D agonist. Causes vasoconstriction.
Clinical use of Sumatriptin?
acute migraine, cluster headaches
Sumatriptin toxicity and contraindications?
coronary vasospasm; contraindicated in pts with CAD or angina
Clinical use of phenytoin?
1st line for generalized tonic-clonic seizures and status epilepticus prophylaxis. Also a class IB antiarrhythmic.
MOA of phenytoin?
increase Na+ channel inactivation. Inhibits glutamate (excitatory) release.
Clinical use of Carbamazepine?
1st line for generalized tonic-clonic seizures and trigeminal neuralgia. Also for simple and complex partial seizures.
MOA of Carbamazepine?
increase Na+ channel inactivation
Toxicity of Carbamazepine?
diplopia, atazia, agranulocytosis, aplastic anemia, liver toxicity, teratogenesis, induces cyto P-450
Toxicity of phenytoin?
nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hirsutism, megaloblastic anemia, teratogenesis, malignant hyperthermia, SLE-like syndrome, induces cyto P-450
Lamotrigine MOA?
blocks voltage-gaated Na+ channels
Clinical use Gabapentin?
simple and complex partial seizures; generalized tonic-clonic. Also peripheral neuropathy.
MOA of Gabapentin?
increase GABA release
Topiramate MOA?
blocks Na+ channels, increase GABA action
Gabapentin toxicity?
sedation, ataxia
Lamotrigine toxicity?
Stevens-Johnson syndrome.
Topiramete toxicity?
sedation, mental dulling, kidney stones, weight loss
Phenobarbital clinical use?
1st line in preggers and kids. Generalized tonic-clonic and simple and complex partial seizures.
Barbituate toxicity?
sedation, tolerance, dependence, cyto P-450 induction, resp/CV depression, additive with alcohol
Barbituate MOA?
increases GABA-A action by increase DURATION of Cl- channel opening, which decreases neuron firing. [barbiDURATe=increased DURATion]
Valproic acid clinical use?
1st line for generalized tonic-clonic seizures. Also for myoclonic and absence seizures.
Valproic acid MOA?
increase Na+ channel inactivation. Increase GABA concentration.
Valproic acid toxicity?
GI distress, fatal hepatotoxicity, neural tube defects, tremor, weight gain
Ethosuximide clinical use?
1st line for absence seizures.
MOA ethosuximide?
blocks thalamice T-type Calcium channels
Ethosuximide toxicity?
GI distress, lethargy, headache, urticaria, Stevens-Johnson syndrome
Benzodiazepine clinical uses?
1st line for acute status epilepticus; also for seizures of eclampsia
Name 4 barbituates.
Phenobarbital, pentobarbital, thiopental, secobarbital
Barbituate contraindication?
Name some Benzodiazepines. (8)
diazepam, lorazepam, triaxolam, temazepam, oxazepam, midazolam, chlordiazepoxide, alpraxolam
MOA of Benzos?
Facilitate GABA-A action by increse FREQUENCY of Cl- channel opening
What drug class do you use for alcohol withdrawal-DTs?
What are the 3 short-acting Benzos?
TOM thumb= Triazolam, Oxazepam, Midazolam
Do benzos or barbituates have a higher risk of resp depression and coma?
How do you treat a Benxo overdose?
Flumazenil (competitive antagonist at GABA receptor)
Name 6 inhaled anesthetics
halothane, enflurane, isoflurane, sevoflurane, methoxyflurane, nitrous oxide
Effects of inhaled anesthetics?
myocardial and resp depression, nausea/emesis, increase cerebral blood flow
Toxicity of halothane, methoxyflurane, and enflurane?
hepatotoxicity (halothane), nephrotoxicity (methoxyflurane), proconvulsant (enflurane)
Drug classes used as IV anesthetics? (5)
Barbiturates, Benzos, Ketamine, Opiates, Propofol
Name the local anesthetics that are esters
procaine, cocaine, tetracaine, amides
Name the local anesthetics that are amides
lidocaine, mepivacaine, bupivacaine
barbiturate used as IV anesthetic?
thiopental - used for short surgical procedures and induction of anesthesia
drug used for endoscopy?
Arrylcyclohexamine (ketamine) effects?
CV stimulant, disorientation, hallucination, bad dreams, increase cerebral blood flow
Opeates used during general anesthesia?
morphine, fentanyl
MOA of local anesthetics?
block Na+ channels. Tertiary amines penetrate membrane in uncharged form, then bind to ion channels as charged form.
Order of nerve block?
small diameter>large diameter. Myelinated>unmyelinated. Size predominates over myelination.
order of loss during nerve block?
how do you enhance local action?
give with vasoconstrictors (EPI)
What happens to local anesthetics in infected tissues?
tissue is acidic; anesthetics are charged and can't penetrate membrane. More anesthetic is needed.
What receptor do neuromuscular blocking drugs target and what are they used for clinically?
motor (vs. autonomic) nicotinic receptor. Used for muscle paralysis in surgery or mechanical ventilation.
Depolarizing neuromuscular blocking drug?
nondepolarizing neuromuscular blocking drugs?
tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, rapacuronium
What is dantrolene used for?
treatment of malignant hyperthermia and neuroleptic malignant syndrome
MOA of dantrolene?
prevents release of calcium from the SR of skeletal muscle
How do you reverse blockade of nondepolarizing neuromuscular blocking drugs?
neostigmine, edrophonium, and other cholinesterase inhibitors