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162 Cards in this Set
- Front
- Back
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What imaging results help diagnose alzheimers?
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MRI, PET
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What makes up neurofibrillary filaments? are they specific for alzheimers?
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hyperphosphorylated tau
no |
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What are the senile plaques in alzhiemers made up of?
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amyloid beta protein
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What chromosome is APP gene found on? what disease is it associated with?
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21
AD |
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What chromosome is APOE e4 found on? what disease is it associated with?
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19
AD |
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What chromosome is PSEN1 found on? what disease is it associated with?
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14
AD |
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What chromosome is PSEN2 found on? what disease is it associated with?
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1
AD |
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How is alzheimers caused in familial AD?
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mutation causes lifelong increase of Amyloid beta 42 production
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How is alzheimers caused in sporadic AD?
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aging, environmental factors, and APOE e4 causes failure of amyloid beta clearance
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What type of genetic inheritence is huntingtons disease?
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autosomal dominant
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What type of cells does huntingtons strike?
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GABAergic neurons of the caudate nucleus of the basal ganglia (also called medium spiny neurons)
fyi: gaba is a inhibitory neurotransmitter |
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What chromosome is the huntington gene found on?
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4p
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What is chorea?
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disorder of mvmt characterized by sudden frequent, involuntary, purposeless, and quick jerks of the trunk, extremities and head associated with facial grimaces.
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What parts of the brain atrophy first in huntingtons?
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caudate and putamen
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What is the most common form of progressive motor neuron disease?
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ALS
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Does ALS effect upper motor neurons or lower motor neurons?
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trick question. its both. i know you guys hate me.
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What part of the brain does AD affect?
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hippocampus and cortex
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What specific parts of the CNS does ALS affect?
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spinal cord and precentral gyrus
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what parts of the brain does parkinsons affect?
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substantia nigra
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In huntingtons, what trinucleotide repeat is there?
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CAG
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What type of generation to generation pattern does huntingtons display?
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anticipation
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How do you diagnose ALS, what test do you run?
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you dont run any tests, there arent really any. its a diagnosis of exclusion
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What is the main excitatory neurotransmitter in the brain?
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glutumate
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What is taus role in the body? In AD, what happens with tau?
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its a microtubule associated protein that has a role in neuronal plasticity and axonal transport
it aggregates to form tangles which perturbs function |
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How do you treat mild cognitive impairment?
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donepezil
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How does donepezil work?
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acetylcholinesterase inhibitor
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How does riluzole work?
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potassium channel activator, which decreases glutumate release
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What does riluzole treat and what kind of outcome does treatment have?
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ALS, 2-3 months extension to survival
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How does galantamine work?
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ACE inhibitor; has neuroprotective action by upregulating neurotrophic factors
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How does memantine work? whats its treat?
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NMDA glutamate receptor antagonist
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How does baclofen work?
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antispastic; GABAb receptor antagonist
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How does tizanidine work?
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antispastic; alpha 2 adrenergic (sympathetic) receptor
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How does Clonazepam work?
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potentiates GABAA channels, not for advanced ALS
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What anti-depressants would you prescribe for a woman with huntingtons disease?
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fluozetine (SSRI), carbamazepine
NOT tricyclics |
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How do you treat large amplitude chorea? How do the drugs work?
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reserpine, tetrabenazine
depletes cerebral dopamine from the storage sites |
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What are the two hypothesis for cause of schizophrenia?
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increased dopamine and glutumate deficiency
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T/F antipsychotics will work in 90% of schizophrenic cases.
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false. only 2/3 show improvement on antipsychotics
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What is the main mechanism for typical antipsychotics?
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D2 blockade
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What kinds of problems are seen with typical antipsychotics?
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extrapyramidal symptoms, parkinson like symptoms, dystonia, tardive dyskinesia
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activating which dopamine pathway can cause hyperprolactemia?
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tubuloinfundibular
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Which dopamine pathway is only slightly inhibited by serotonin? which is significantly affected by serotonin? which are moderately affected?
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mesolimbic
mesocortical tubuloinfundibular and nigrostriatal |
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Whats the biggest reasons people stop taking atypical antipsychotics?
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WEIGHT GAIN and they are expensive as hell
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Lithium can cause hepatic or renal problems?
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renal, its metabolized by the kidney
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What endocrine problem can you see with long term lithium use?
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hypothyroidism
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You see a lion and get scared, what was activated your amygdala or hippocampus?
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amygdala
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You see the man who shot your best friend and get scared. what was activated (first) your amygdala or hippocampus?
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hippocampus
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What types of disorders would you prescribe benzos for?
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panic disorder, generalized anxiety, acute stress disorder, PTSD, agitation alcohol withdrawal.
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80 year old woman comes in with confusion and agitation, her urine is turbid and her leukocyte esterase test is positive. you gave her a benzo to calm her down and your attending splashes hot coffee in your face. why was he so upset?
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benzos can worsen delirium, and you should try not to prescribe them in the elderly. 22
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24 year old medical student comes in and has tried to kill herself using benzos. what do you give her?
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flumazenil
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Whats the worse thing you can have happen with benzo withdrawal?
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seizures
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If you have someone with no previous exposure to benzos and general anxiety disorder, whats a good drug of choice?
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buspirone
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Which is not a gaba-ergic soporific
A) flurazepam B) ramelteon C) temazepam D) zalepelon E) zolpidem |
ramelteon-activates melatonin receptors
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name the three most commonly used high potency benzodiazepines
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alprazolam, clonazepam, lorazepam
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name the four most commonly used low potency benzodiazepines
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chlordiazepoxide, diazepam, oxazepam, temazepam
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How do tricyclic antidepressants work?
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block serotonin and norepinephrine reuptake transporters.
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Whats the most dangerous side effect of TCAs?
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quinidine like side effects, atrioventricular and bundle branch blocks
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What are the symptoms of serotonin syndrome?
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hyperthermia, muscle rigidity, myoclonus, and rapid fluctuations in mental status and vital signs
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What does MAO-A degrade? MAO-B?
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serotonin, norepinephrine, tyramin and dopamine
dopamine mainly |
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What is the MOA of selegiline and whats it used for?
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inhibits MAO-B
parkinsons |
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Whats the most dangerous possible side effect of MAOs? How will it present? How do you prevent it?
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tyramine toxcicity
hypertensive crisis: headache, tachycardia, nausea, cardiac arrythmia, stroke dont go to wine and cheese tasting parties |
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Whats the antidepressants of choice to treat OCD and hows it work?
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clomipramine-TCA
fluvoxamine-SSRI |
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T/F you have to start SSRIs at small doses and increase to a predetermined daily dose.
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false, TCAs and MAOIs you have to do that
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What antidepressants would you use to treat chronic pain and how do they work?
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duloxetine at standard dose-SNRI
venlafaxine at higher dose-SNRI |
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What antidepressants would you use to treat premenstral dysphoric disorder and how do they work?
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fluoxetine-SSRI
sertralineSSRI |
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What antidepressant would you use to treat bulemia and how do they work?
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fluoxetine
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What antidepressants would you use to treat PTSD and how do they work?
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SSRIs
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What should you warn your pt about TCAs before he leaves for his friday night activities?
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dont drink because TCA+EtOH=really really drunk driving
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A large λ(oil/gas) means a more or less potent anesthetic?
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more
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a large λ(blood/gas) means a faster or slower induction of an anesthetic?
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slower.
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What is MAC?
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minimum alveolar concentration: alveolar partial pressure of anesthetic at which 50% of patients do not respond to a skin incision
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What is the definition of the time constant in anesthetics? the formula?
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the time required for equilibration to be 63% complete in 2 compartments
=λ(brain/blood) x Vol brain/(Q brain) |
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You are bringing a patient out of anesthesia and just take off their gas mask. why did you possibly just kill them?
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N2O diffuses faster than other gases and will rapidly move from blood to lungs, expanding expiratory pressure. this restricts oxygen levels and causes hypoxia. you have to give them 100% oxygen for a while first.
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What are the perfusion limited anesthetics? large or small λ(blood/gas)? influenced by cardiac output?
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nitrous oxide, desflurane, sevoflurane
small not really |
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Which type of anesthetics, ventilation limied or perfusion limited, are preferred in hemorrhagic shock?
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perfusion
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What are the ventilation limited anesthetics? large or small λ(blood/gas)? influenced by cardiac output?
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diethyl ether, enflurane, isoflurane, halothane
large yes, increased CO means slower induction |
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What receptors do halogenated inhalation anesthetics work on and do they inhibit/potentiate each?
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potentiate GABA A receptor chloride channels and glycine erceptor chloride channels, inhibit nicotinic Ach receptor channels
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What is the only inhaled anesthetic that doesnt decrease cardiac output?
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nitrous oxide
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What are the two barbituates that are used as anesthetics?
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thiopental and methohexital
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Whats the only anesthetic that increases cardiac output?
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ketamine
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What anesthetic causes dissociative anesthesia and whats its MOA?
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ketamine
blocks NMDA receptor subtype |
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What fibers transmit first pain and are they myeliniated?
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Aδ
yes |
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What fibers transmit proprioception and are they myeliniated?
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Aα and Aβ
yes |
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What fibers transmit second pain and are they myeliniated?
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C (dorsal root)
no-deep pain |
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What neurotransmitter mediates fast excitatory transmission between primary and secondary sensory neurons?
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glutamate
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How do you get slow synaptic effects in nerve terminals and what are they in response to?
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co-release of neuropeptides like tachykinins substance P and calcitonin gene related peptide (CGRP) with glutumate
high intensity stimuli |
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define allodynia
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when normally innocuous stimuli are perceived as painful
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define hyperalgesia
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high intensity stimuli are perceived as more painful than usual at the site of injury
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What sodium channels are down regulated in injured primary sensory neurons and which is upregulated, possibly leading to neuropathic pain?
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Nav1.8 and Nav1.9
Nav1.3 |
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Differentiate between nociceptive pain and neuropathic pain
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nociceptive pain is derived firectly from pain receptors, is due to tissue damage, and has a biological 'purpose"
neuropathic pain is caused my damage or malfunction of the nervous system and can be peripheral or central |
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What are the three mechanisms of central sensitization?
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glutumate/NMDA receptor mediated sensitization
disinhibition microglial activation |
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How do opioids control pain?
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in the presynaptic terminal, receptor activation decreases calcium influx. in the post synaptic terminal receptor activation increase potassium conductance. both of these inhibit relaying of pain messages.
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How do NSAIDS help chronic pain patients? (MOA)
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reduce prostaglandin synthesis and decrease recruitment of leukocytes, which prevents the generation of prostaglandins that act as pain producing neuromodulators in the dorsal horn
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How does acetaminophen differ from NSAIDS?
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it reduces CENTRAL prostaglandin synthesis, so has little anti-inflammatory efficacy
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Why are TCAs often part of pain management therapy?
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they produce analgesia by blocking sodium channels and increasing the activity of anti-nociceptive noradrenergic and serotonergic projections.
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What four anticonvulsants are commonly used in the treatment of chronic pain?
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gabapentin, pregabalin, lamotrigine, and carbamazepine
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How does gabapentin work? what are its side effects?
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binds to teh α2δ subunit of voltage dependent calcium channels
AE: dizziness, somnolence, confusion, ataxia |
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How does carbamazepine work? What pain condition is it commonly used for? what are its side effects?
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blocks sodium channels
trigeminal neuralgia lots and lots o side effects |
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What alpha2 agonist is used as a adjuvant in pain treatment?
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clonidine
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What are the 5 phases of pain physiology?
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transduction: fire to nerve ending
conduction: action potential from nerve ending to dorsal dorn transmission: neurotransmitter release at central axon terminal in dorsal horn perception: dorsal horn to brain modulation: inhibition of ascending transmission by descending control |
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pt comes into the ER for a heroine overdose, what do you give him?
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naloxone
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Pt comes in with pain after an MI. do you give him nalbuphine, pentazocine, or butorphanol?
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nalbuphine
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What receptors does nalbuphine affect?
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strong kappa agonist and mu receptor antagonist
similar potency to morphine |
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What receptors does buprenorphine affect?
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partial mu agonist and kappa antagonistm
25-50 x more potent than morphine |
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What are the two main opiod antagonists and what are they used for?
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naloxone and naltrexone
negatively encourage drug abuse, help wean addicts, overdose |
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T/F Opioids work better on neuropathic pain than nociceptive pain
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F, other way around
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Kid comes in after a skittle party with CNS depression and seizure, a friend says the only thing he took were OTC cough medicine pills. what is he ODing on?
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dextromethorphan
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T/F In elderly patients you want to give increased amounts of morphine because opioid receptors lose affinity with age.
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100% false. decreased doses
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T/F Patient comes in complaining the codeine you gave them isnt working and they need something stronger. this is obvious drug seeking behavior and you should refuse to prescribe a stronger opioid
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F. about 10% of caucasians cannot convert codeine to morphin and will have no analgesia from codeine
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What is the MOA of heroin?
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strong μ agonist
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What drug is ten times less potent than morphine, is used in post anesthetic shivering, and isnt used in chronic pain because of metabolite toxicity?
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meperidine
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Patient is on an MAOI and has a history of arrhythmia. what opioid is highly contraindicated?
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meperidine, could cause serotonin syndrome and has antimuscarinic effects which could lead to tachycardia.
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Fentanyl has a longer/shorter peak to analgesia than morphine and is more/less potent than morphine.
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shorter, more
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What is the half life of morphine? methadone?
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2 hr
20-46 hr |
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What is the most common drug used in the treatment of opioid abuse?
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methadone
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If you dont wnat to give your patient an opioid as strong as morphine and are worried about the addictability of codeine, whats another option?
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D-propoxyphene
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What is the MOA of ergotamine in the treatment of migraine?
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activates % HT1 receptors on presynaptic trigeminal nerve endings, inhibiting release of neuropeptides.
vasoconstriction of cerebral vasculature |
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Which 5 HT agonist is most likely to trigger the medullary vomitting center?
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ergotamine
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A patient you have been seeing who has a family Hx of hypertension and borderline HTN develops migraines. whats a good pharmaceutical option?
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propranolol
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What is currently being used to treat cluster headaches and whats its MOA?
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verapamil
calcium channel blocker |
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What are two peptides that show potential for future migriane treatments?
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capsazepine and calcitonin gene related peptide (CGRP)
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A patient of yours with untreated dysthymia starts getting migraines. whats a good treatment option?
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TCAs
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Whats the most extreme treatment for migraine headaches and how long do its effects last? (even better if the patient really could use a facelift)
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botulinum toxin type A
6 months |
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What is echinacea most often used for? what patients is it contraindicated with?
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enhance immune function in individuals with colds
AIDS, cancer, MS, RA, TB, organ transplant |
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What do people think garlic helps with? does it? what pts shouldnt use it?
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lower LDL and triglycerides
no it doesnt pts on anticlotting medications because of reported antiplatlet effects |
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What is ginkgo used for? whats its efficacy for these diseases? what pts shouldnt use it?
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significant improvements in pain free wlaking distance in pts with mild to moderate occlusive peripheral arterial disease. shows no clinically significant improvment in dementia and Alzheimers though
pts on antiplatelet or anticoagulants or individuals with preexisting seizure disorders |
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What has ginseng been shown to help? what are its adverse effects? what pts shouldnt it be used in?
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lowers postprandial glucose, can be used in DM
vaginal bleeding mastalga (breast pain) and CNS stimulation (insomnia, nervousness) and HTN in high doses pts on antipsychotics, estrogenics, or hypoglycemic medicaitons. not to be used in pts on warfarin |
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What is milk thistle used for? does it work?
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improving liver function
probably not |
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What is st johns wort used for? does it work? what are things to watch out for with its use?
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mild to moderate depression
ya it actually does serotonin syndrome with concurrent antidepressant use, can also affect therapeutic effects of lots of drugs like birth control, HIV meds, warfarin and anticonvulsants |
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What is saw palmetto used for? does it work?
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BPH
for mild cases ya it does |
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What is Coenzyme Q10 used for? how well tolerated is it?
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Significantly lowers BP, improves lots of crap for post MI pts, and reduces pain in pts with statin induced myopathy
its really well tolerated |
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What is glucosamine used for? does it work/ what pts shouldnt take it?
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OA
nope pts on warfarin |
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Whats melatonin used for? Who shouldnt use it?
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sleep distrubances
pregnant or nursing women and pts on anti HTN medications |
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Which has two i's in their name, esters or amides?
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amides
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If your patient is allergic to everything under the sun, do you want to give her an amide or an ester?
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amide
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What is the MOA of local anesthetics?
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conduction blockade of neural impulses by preventing inward passage of sodium ions through ion-selective sodium channels in nerve membrane
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T/F Moderately hydrophobic local anesthetics are more effective than extremely hydrophobic local anesthetics
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true
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local anesthetics with a high/low pKa tend to have a more rapid onset
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low
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Why are vasoconstrictors added to local anesthetics?
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delays absorption of the anesthetic from its injection site, can reduce systemic toxicity and prolongs duration of action
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What is the culminating symptom in local anesthetic CNS toxicity?
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tonic clonic seizure
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How do you treat CNS toxicity by local anesthetic?
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short acting barbituate like thiopental sodium and/or benzodiazepine like diazepam
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T/F Tolerance is decreased effect of a drug with continued use
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True
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T/F Patient requires large dose of opioid for chronic pain relief in whom analgesia was successfully
achieved is addictive |
False
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T/F Innate tolerance: due to individual variations in sensitivity from polymorphisms
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true
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T/F An addict feeling like he needs the drug in order to be productive at work is a sign of physical dependence
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F, physical dependence are the adverse physical symptoms and signs that result, not psychological
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What are the 3 categories of acquired tolerance
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pharmacokinetic, pharmacodynamic, learned
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T/F Overdose of cocaine is often fatal, overdose of amphetamines is rarely fatal
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true
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T/F Withdrawal symptoms of barbs is rarely life threatening
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false
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T/F Withdrawal symptoms of opiods is rarely life threatening
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true
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T/F DA plays little role in cocaine induced CV toxicity
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true
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T/F Cocaine is a mu receptor agonist
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false
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T/F Cocaine is almost always well-tolerated by young individuals
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false
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Which treatment of psychostimulant overdose is most effective?
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Administration of neuroleptic antipsychotic to control seizures, psychosis, and hallucinations
(halloperidol) |
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T/F PCP is life threatening, LSD is not
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true
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T/F Pharmacokinetic tolerance results from the changes in drug receptor interaction, changes in the
number of receptor binding |
false
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whats the most common example of xanthines and methylxanthines?
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caffiene
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T/F The effects of cocaine are significantly heightened compared to the effects of amphetamines.
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False, they are pretty much the same
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T/F The effects of amphetamines last longer than the effects of cocaine
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true
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T/F Intranasal is the route of cocaine usage that provides the most intense experience
|
nope, so why is that always the way they do it in the movies?
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What is the MOA of cocaine?
|
blocks the dopamine transporter which doesnt allow it to be reuptooken (not sure of the tense im going for here...) therefore flooding the synapse
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What is the MOA of amphetamine?
|
displaces dopamine from its vesicles by altering their pH and inhibits dopamine metabolism by MAO
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A chick and her boyfriend come in, she has dilated eyes, he has constricted pupils. what illegal substances are they on?
|
girls probably on coke, boys on morphine (
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How would you treat a cocaine overdose?
|
labetalol
diazepam haloperidol |
