Pharm: Neuro/psych

Front 1

What are the 4 other receptors that are involved with imipramine's side effects?

Back 1

1. Cardiac fast channels = arrhythmias, cardiotoxicity, wide QRS complex
2. muscarinic Ach receptors = flushing, hyperthermia, dilated pupils, ileus, urinary retention, sinus tachy, confusion, hallucination
3. alpha 1 receptors = hypotension, vasodilation
4. H1 receptors = sedation

Front 2

mechanism of methadone, meperidine, dextromethorphan, codeine

Back 2

opioids open K+ channels, close Ca2+ channels --> hyperpolarization and inhibition, causing decrease synaptic transmission of ACh, NE, 5-HT, glutmate, substance P/

Front 3

opiod rx for diarrhea

Back 3

loperamide, diphenoxylate

Front 4

how do you treat a person who comes in ODing on a substance that causes:
-respiratory/CNS depresion
-constipation
-PINPOINT pupils

Back 4

Opioid toxicity treated with naloxone, naltrexone

Front 5

In chronic opioid use, what 3 things do you build tolerance to, what 2 things can you not develop tolerance to?

Back 5

Build tolerance to:
-CNS depression
-Resp depression
-cough

Do NOT develop tolerance to:
-miosis (pinpoint pupils)
-constipation

Front 6

Partial agonist at opioid mu receptor, agonist at kappa receptor

Back 6

Butrophanol

*used for pain- has less resp. depression than full mu agonists.

Front 7

Tramadol
-mechanism
-uses

Back 7

very weak opioid agonist- also inhibits serotonin and NE reuptake.

Used for chronic pain, has similar opioid side effects, also has decreased seizure threshold.

Front 8

3 drugs that are 1st line for tonic clonic

Back 8

phenytoin, carbamazepine, valproic acid

Front 9

5 indications for carbamazepine

Back 9

1. tonic clonic seizures
2. partial (simple or complex) seizures
3. trigeminal neuralgia
4. diabetic neuropathy
5. mood stabilizer

Front 10

5 classes of side effects for phenytoin

Back 10

1. neuro: nystagmus*, diplopia, ataxia, sedation, peripheral neuropathy*

2. cosemtic: gingival hyperplasia*, hirsutism*, acne

3. megaloblastic anemia

4. teratogen "fetal hydantoin syndrome"

5. SLE like syndrome*

*also induces CYP450

Front 11

we all know agranulocytosis, aplastic anemia, liver toxicity are the 3 feared side effects of carbamazepine.

what are 5 other, less famous, side effects?

Back 11

1. diplopia, ataxia
2. teratogen (like phenytoin)
3. induces CYP450 (like phenytoin)
4. SIADH
stevens-johnson syndrome

Front 12

This drug blocks voltage gated Na+ channels and has the dreaded side effect of Stevens-Johnson syndrome

Back 12

Lamotrigine (used 2nd line for partial and tonic clonic)

Front 13

Mechanism and 3 uses of Gabapentin

Back 13

mechanism: designed as GABA analog, but ironically inhibits HVA Ca2+ channels.

Uses =
-partial, tonic clonic.
-peripheral neuropathy (post herpetic neuralgia)
-bipolar disease.

Front 14

Blocks Na+ and GABA

Causes mental dulling, kidney stones, weight loss

Back 14

Topiramate

Front 15

4 uses of barbituates (which increase duration of Cl- channel opening)

Back 15

1. anxiety
2. seizures partial or generalized - phenobarbital
3. insomnia
4. induction of anestheia - thiopental

Front 16

3 epilepsy drugs that induce CYP450

Back 16

PCP induce (thus would make heparin subtherapeutic)

phenytoin, carbamazepine, phenobarbital (barbituates)

Front 17

Use for patient with absence seizure AND has tonic clonic.

Inactivates Na+ channels, and increases GABA concentration.

Back 17

Valproic acid

*also 1st line for MYOclonic seizures

Front 18

1st line for absence seizures

what are 5 main side effects?

Back 18

ethosuximide - blocks thalamic T-type Ca2+ channels

fatigue
GI symptoms
headache
urticaria
stevens johnson syndrome

Front 19

rare side effect of valproic acid

Back 19

rare but fatal hepatotoxicity
also, tremor, weight gain

*teratogen = neural tube defects in fetus

Front 20

Inhibits GABA reuptake

Back 20

tiagabine

Front 21

irreversibly iinhibits GABA transaminase --> increased GABA

Back 21

vigabatrin

Front 22

4 short acting benzos

Back 22

triazolam
oxazepam
midazolam
alprazolam

Front 23

3 intermediate acting benzos

Back 23

lorazepam
estazolam
temazepam

Front 24

4 long acting benzos

Back 24

diazepam
chloridazepoxide
clorazepate
flurazepam

Front 25

4 clinical uses of benzos

Back 25

1. anxiolytic
2. sedative - night terrors, sleepwalking, insomnia
3. anticonvulsant (used acutely and for alcoholic DTs)
4. muscle relaxant - spasticity

Front 26

OD of benzo rx

Back 26

flumazenil (competitive antagonist at GABA benzodiazepine receptor)

Front 27

Which are more likely for withdrwal, oxazepam or flurazepam?

Back 27

oxazepam = short acting (along with triazolam, midazolam, alprazolam)

short acting are more likely to cause withdrawl

flurazepam = long acting along with diazepam, chlordiazepoxide, clorazepate

Front 28

act via BZ1 receptor and treats insomnia with less addictive potential because it is rapidly metabolized and has less psychomotor depression.

Back 28

zolpidem (ambien), zaleplon, eszopiclone

*side effects = ataxia, headache, confusion

Front 29

what determines rapid induction and recovery times in anesthetics?

Back 29

less solubility in blood = rapid induction and recovery times

*high blood solubility = high blood/gas partition coefficient = increased gas to saturate blood = slower onset of action

Front 30

what determines potency in anesthestics?

Back 30

drugs with more lipid solubility = increased potency = 1/MAC (minimum alveolar conc.)

Front 31

inhaled anesthetic side effects = CV/resp depression, nausea/emesis, increased cerebral blood flow, rarely malignant hyperthermia

what are specific side effects for:
-halothane
-methoxyflurane
-enflurane

Back 31

-halothane: fulminant hepatoxicity
-methoxyflurane: nephrotoxicity
-enflurane: proconvulsant

Front 32

thiopental has one weird side effect

Back 32

decreases cerebral blood flow

*high potency, rapid entry. effect terminated by redistribution in to tissue/fats.

Front 33

anesthetic commonly used for endoscopy with inhaled anesthetics, can cause severe postoperative resp depression

Back 33

midazolam (short acting benzo)

Front 34

ketamine mechanism and side effects

Back 34

block NMDA receptors- cardiovascular stimulants.

cause disorientation, hallucination, bad dreams.

increase cerebral blood flow.

Front 35

order of nerve blockade with local anesthetics (esters-procaine, amides-lidocaine)

Back 35

small myelinated > small unmyelinated > large myelinated > large unmyelinated

Front 36

order of pain loss with local anesthestics (esters-procaine, amides-lidocaine)

Back 36

pain > temperature > touch > presure

Front 37

side effects of bupivicaine (amide local anesthetic) and cocaine (ester local anesthetic)

Back 37

bupivicaine = severe CV tox

cocaine = arrhythmias

*all local anesthetics cause CNS excitation

Front 38

reversal of succinylcholine phase 1 and phase 2

what happens when given cholinesterase inhibitors (neostigmine)

Back 38

phase 1 = prolonged depolarization, no antidote, block POTENTIATED by cholinesterase inhibitors

phase 2 = repolarized but blocked, neostigmine works.

*general side effects of succinylcholine = hypercalcemia, hyperkalemia

Front 39

neuromuscular blocking drugs that block ACh receptors

Back 39

tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, rocuronium

*can reverse with neostigmine

Front 40

Rx for neuroleptic malignant syndrome

Back 40

dantrolene

Front 41

3 parkinson's drugs that are dopamine agonists

Back 41

bromocriptine
pramipexole
ropinirole

Front 42

3 drugs that prevent dopamine breakdown

Back 42

selegiline = selectively inhibits MAO-B, which preferentially metabolizes dopamine ofver NE/5-HT

COMT inhibitors, prevent L-dopa degradation
entacapone
tolcapone

Front 43

What side effects will NOT be prevented by carbidopa

Back 43

Carbidopa is administereed with L-Dopa to prevent peripheral conversion to dopamine, which can cause arrhythmias, vomiting, nausea.

However, it will NOT prevent axiety/agitation of parkinson's disease as these are CNS symptoms and carbidopa only works peripherally.

Front 44

NMDA receptor antagonist for Alzheimers

Back 44

memantine

remember alzheimers = low ACh, high NE, high glutamate

by blocking NMDA you can decrease the effect of the increased glutamate (which works on NMDA receptors) and help prevent excitotoxicity.

side effects can include hallucinations

Front 45

acetylcholinesterase inhibitors that treat alzheimers

Back 45

donepezil, galantamine, rivastigmine

side effects can include insomnia

Front 46

two treatment options for huntingtons

Back 46

disease = high dopamine, low ACh, low GABA

1. reserpine + tetrabenazine - prevent neurotranmitter entry to presynpatic vesicles, amine depleting

2. haloperidol - dopamine receptor antagonist

Front 47

major side effect of sumatriptan

Back 47

sumatriptan = 5HT IB/ID agonist which causes vasoconstruction, inhibition of trigeminal activationa and vasoactive peptide release.

used for acute migrane, cluster headaches.

tox = coronary vasospasm - contraindicated in patients with CAD or prinzmetal's angina.

Front 48

ADHD treatment

Back 48

methylphenidate (ritaline), dextroamphetamine

*can also be used for narcolepsy

Front 49

Evolution of EPS side effects with typical antipsychotics:
4h
4d
4wk
4mo

Back 49

4h: acute dystonia (muscle spasm, stiffness, oculogyric crisis)
4d: akinesia (parkinsonian symptoms)
4wk: akathasia (restlesness)
4mo: tardative dyskinesia (lock smaking, tongue chewing)

*occurs from upregulation or hypersensitivity of dopamine receptors and a decrease in cholinergic tone.

Front 50

4 main symptoms of neuroleptic malignant syndrome

Back 50

hyperthermia (dopamine is involved in temp regulation)
rigidity
autonomic instability/encephalopathy
myoglobinuria

Front 51

Other than EPS side effects and NMS, what are 4 other side effects (things blocked) by typical antipsychotics (haloperidol + -azines)

Back 51

1. endocrine side effects --> hyperprolactinemia
2. blocking muscarinic (dry mouth, constipation)
3. blocking alpha (hypotension)
4. blocking histamine (sedation)

*also remember that typical antipsychotics are highly lipid soluble and are very slow to be removed by the body.

Front 52

Which are the high potency and which are the low potency typical psychotics?

Back 52

High potency: haloperidol, trifluoperazine, fluphenazine *have more neurologic side effects (EPS)

Low potency: thioridazine, chloropromazine (non neuro side effects- anticholinergic, antihistamine, alpha blocker)

Front 53

special side effects of chloropromazine and thirodazine (both low potency)

Back 53

chloropromazine - corneal deposits

thioridazine - retinal deposits

Front 54

mechanism of olanzapine

Back 54

block 5-HT2, dopamine, alpha, H1 receptor

*used to treat pos + neg symptoms of schizophrenia.
-Olanzapine is also used for OCD, anxiety, depression, mania, Tourette's

*has less EPS/anticholinergic symptoms than typicals.

Front 55

side effects of olanzapine and clozapine

Back 55

both olanzapine and clozapine cause weight gain.

clozapine also can cause agranulocytosis.

Front 56

mood stabilizer for bipolar disorder and can treat SIADH

Back 56

lithium

Front 57

What are the 5 side effects of lithium

Back 57

Movement (tremor)
Nephrogenic diabetes inspidus- hypernatremia, polyuria, polydispia
hypOthyroidism
Pregnancy problems
Fetal cardiac defects- ebstein abomaly (fucked up tricsupid valve), malformation of the great vessels

Front 58

What is the mechanism of TCAs?

what are the names of 5 common TCAs

Back 58

imipramine (bed wetting), amitriptyline (very anticholinergic), nortryptiline (not so anticholinergic), desipramine, clomopramine (OCD), doxapine, amoxapine

block reuptake of NE + Serotonin

Front 59

what are the 4 other things that TCA can accidentally block?

Back 59

1. Cardiac fast channels = arrhythmias, cardiotoxicity, wide QRS complex

2. muscarinic ACh receptor = flushing, hyperthermia, dilated pupils, ileus, urinary retention, sinus tachy, confusion, hallucination

3. alpha 1 block = hypotension

4. H1 block = sedation

Front 60

which drug TCA has the least anticholinergic effects?

what about least sedating?

Back 60

amitriptyline has more anticholinergic side effects than nortriptyline

desipramine is the least sedating and has lower seizure threshold (desis keep you awake)

Front 61

rescue for TCA cardiotoxicity (wide QRS from blocking Na+ fast channels)

Back 61

NaHCO3

Front 62

patient presents with hyperthermia, muscle rigidity, CV collapse, flushing, diarrhea, seizures. what is the treatment?

Back 62

serotonin syndrome - occurs when you comine MAOi + SSRI

treat with cyproheptadine (5-HT2 receptor antagonist)

*differentiate from NMS because it has flushing, diarrhea, seizures

Front 63

2 SNRIs and their main toxicity

Back 63

venlafaxine (depression + GAD), duloxetine (depression + diabetic peripheral neuropathy)

main tox: high BP

Front 64

name the 4 SSRIs

Back 64

fluoxetine, paroxetine, sertraline, citaprolam

rx for depression, OCD, bulimia, social phobias, PTSD, panic disorder

Front 65

4 common MAOi's

what is the mechanism

Back 65

phenezline, tranylcypromine, isocarboxazid, selegiline (selective for dopamine)

*mechanism: inhibit breakdown of NE, serotonin, dopamine