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43 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What is a heterogenously enhancing lesion in the brain?
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Heterogenously enhancing lesion = GBM
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What different types of drugs are used to Tx glaucoma?
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Glaucoma Tx:
- a-agonists: epinephrine, brimonidine - B-blockers: timolol, betaxolol, carteolol - Diuretics: acetazolamide - Cholinomimetics: direct (pilocarpine, carbachol) and indirect (physostigmine, echotiophate - Prostaglandins: Latanoprost |
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How do a-agonists work as glaucoma drugs and which ones are used most frequently?
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a-agonists decrease aqueous humor syn due to vasoconstriction
- epinephrine (not for closed angle) - brimonidine |
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How do B-blockers work as glaucoma drugs and which ones are used most frequently?
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B-blockers decrease aqueous humor secretion.
- Timolol - Betaxolol - Carteolol |
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Which diuretics are used to Tx glaucoma? Why?
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Carbonic anhydrase inh: decrease aqueous humor secretion due to decreased HCO3-
- Acetazolamide |
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What are the different classes of cholinomimetics and how do they work for glaucoma Tx?
What side effects might cholinomimetics cause? |
Cholinomimetics:
- Direct: pilocarpine and carbachol - Indirect: physostigmine and echothiophate - Increase outflow of aqueous humor; contract ciliary muscle and open trabecular meshwork |
Cholinomimetics SEx:
miosis, cyclospasm |
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Patient has decreased vision and complains of acute onset of pain that started at same time. On physical exam, the eye is very hard. What drug should you give? What should you not give?
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Closed-angle glaucoma:
Tx with pilocarpine Do NOT Tx with epinephrine |
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Which prostaglandin is used to Tx glaucoma? What effect does this have and what side effects might it cause?
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Prostaglandin Tx of glaucoma:
Latanoprost - increase outflow of aqueous humor SEx: Darkens color of iris (browning) |
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Pilocarpine
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Direct cholinomimetic used to treat glaucoma. It is indicated for emergency (closed-angle) situations and increases outflow of aqueous humor. It can however, cause miosis and cyclospasm.
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A patient treated for glaucoma complains that his eyes have changed color. What drug was he given?
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Latanoprost, a prostoglandin, can be used to treat glaucoma (increased aqueous humor outflow) but it can cause browning or darkening of the iris.
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On what receptors and channels to opioids work?
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Opioids act mainly at the mu receptor (some effect at kappa and delta) and open K channels and close Ca channels. This decreases synaptic transmission.
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Which opioid is indicated for each of the following situations?
- Cough - Diarrhea - Addiction Tx |
Cough - dextromethorphan
Diarrhea - loperamide or diphenoxylate Addiction - methodone |
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What are the SEx of the opioids?
On which of these effects does tolerance not develop? |
Opioid SEx:
- Respiratory depression - Miosis (pinpoint pupules) - CNS depression (additive with other drugs) - Constipation |
Tolerance doesn't develop t omiosis or constipation.
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How do you Tx a opioid overdose or toxicity?
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Opioid toxicity --> naloxone, naltrexone (opioid receptor antagonists
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Butorphanol
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Butorphanol - partial agonist at opioid mu receptors and agonist at kappa receptors (dynorphin).
Used mostly for pain and causes less resp depression than full agonists. |
SEx: withdrawal if previously on full agonist
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Tramadol
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Weak opioid agonist that also decreased serotonin and NE reuptake.
Used for chronic pain. |
SEx of tramodol: similar to opioids but also decreases seizure threshold
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What drug is first line for absence seizures?
What other drug can also be used? |
Absence seizures: ethosuximide (blocks thalamic Ca channels)
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Absence seizure: valproic acid can also be used (Na channel inactivation and increased GABA concentration)
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What drug(s) are first line for status epilepticus?
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Status epilepticus --> benzo's (increase GABAa action) + pheytoin (Na channel inactivation) for prophylaxis
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What drugs are first line for generalized tonic-clonic seizures?
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Tonic-clonic seizures:
- Phenytoin - Carbamazepine - Valproic acid |
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Which anti-epileptic drug is also used for peripheral neuropathy or bipolar?
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Gabapentin (inh HVA calcium channels) used for partial seizures and peripheral neuropathy or bipolar.
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What is the first line Tx for seizures of eclampsia?
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Eclamptic seizure: MgSO4
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What anti-seizure medicine is first line for pregnant women and children?
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Pregnant or children: phenobarbital (increase GABAa action)
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Which anti-epileptic drug(s) can cause sedation, tolerance and dependence?
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Sedation, tolerance and dependence:
- Benzo's - Phenobarbital Gabapentin and topiramate can also cause some sedation |
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Which anti-epileptic drug(s) can cause blood dyscrasias?
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Carbamazepine can cause agranulocytosis and aplastic anemia.
Phenytoin can cause megaloblastic anemia. |
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Which anti-epileptic drugs can cause blistering skin disorders?
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Carbamazepine, lamotrigine and ethosuximide can all cause Steven-Johnson syndrome.
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What are the SEx of ethosuximide?
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Ethosuximide, an anti-epileptic drug (blocks thymic Ca channels) can cause EFGH + Stevens-Johnson
Ethosuximide Fatigue GI Headache |
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Which of the anti-epileptic drugs cause liver toxicity?
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(CVPP)
Cabamazepine can cause liver toxicity and induction of p450. Valproic acid can cause fatal hepatotoxicity. Phenobarbital and phenytoin can both cause induction of p450. |
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Which of the anti-epileptics can cause kidney stones, weight loss, and mental dulling.
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Topiramate can cause mental dulling (a dopey mate), kidney stones and weight loss.
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What is the mechanism of phenytoin and what are its uses?
What are the SEx of phenytoin? |
Phenytoin causes use-dependent blockade of Na channels and thus can be used for 1. tonic clonic seizures, 2. prophylaxis for status epilepticus and 3. IB antiarrhythmic
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Phenytoin SEx:
- Diplopia - SLE-like syndrome - p450 induction - Gingival hyperplasia - Hirsutism - Megaloblastic anemia - Fetal hydantoin syndrome |
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What are the demyelination disorders to remember?
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Demyelination:
MS, Guillain-Bare (AIDP),PMS (JC virus), Charcot-Marie tooth, metachromatic leukodystrophy |
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Temporal lobe encephalitis:
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HSV1 - temporal lobe encephalitis
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What are the barbiturates and how do they function?
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Barbiturates: phenobarbital, pentobarbital, thiopental, secobarbital
- Increase duration of Cl channel opening --> facilitates GABA a |
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What causes hypersegmented PMNs?
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Hypersegmented PMNs: megaloblastic anemias (B12 or folate def)
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How is the mechanism of benzo's and barbiturates similar / different?
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Benzo's - increase FREQUENCY of Cl- channel opening
Barbiturates - increase DURATION of Cl- channel opening Both lead to facilitation of GABAa effects |
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Which of the benzo's are short acting?
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Short acting benzo's are under TOM's thumb:
Triazolam Oxazepam Midazolam These have the highest addictive potential. |
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How do you treat benzodiazepine overdose?
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Benzo toxicity --> flumazenil (competitive antagonist at GABA benzodiazepine receptor)
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Which benzodiazepine doesn't in in "-am"
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Chlordiazepoxide - benzodiazapine
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How does blood solubility affect time to onset of action of an inhaled anesthetic?
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Increased blood solubility (increased blood/gas partition coefficient) --> slower onset of action and increased drug required to saturate blood
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Which of the inhaled anesthetics causes each of the following SEx?
- Hepatotoxicity - Nephrotoxicity - Proconvulsant - Expansion of trapped gas |
Inhaled anesthetic SEx
Hepatotoxicity = halothane Nephrotoxicity = methoxyflurane Proconvulsant = enflurane Gas trapping = nitrous oxide |
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What are the IV anesthetics?
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IV anesthetics:
- Barbiturates (thiopental) - Benzos (midazolam) - Ketamine - Opiates (morphine, fentanyl) - Propofol |
BB KOP
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Which IV anesthetic can cause severe postoperative respiratory depression and hypotension?
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Midazolam (a benzodiazapine)
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Which IV anesthetic is a PCP analog? How does this work?
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Ketamine is a PCP analog (dissocative) that works by blocking NMDA receptors.
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How does propofol work as an IV anesthetic?
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Propofol - potentiates GABAa and causes less post-operative nausea than thiopental.
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