Pharmacology- Neurology

Front 1

Phenytoin
-Mechanism

Back 1

Use-dependent blockade of Na+ channels; inhibition of glutamate release from excitatory presynaptic nuerons

Front 2

Phenytoin
-Clinical use

Back 2

Tonic-clonic seizure; also class 1B antiarrhythmic

Front 3

Phenytoin
-Toxicity

Back 3

*Chronic use produces gingival hyperplaisa in children
-Peripheral neuropathy,
-megaloblastic anemia (decreases folate absorption)
-Teratogenic (fetal hydanton syndrome)
Nystagmus, ataxia, diplopia sedation, SLE-like symptoms; induction of cytochrome p-450.

Front 4

Barbiturate
-Mechanism

Back 4

Facilitate GABAa action by increasing duration of Cl- channel opening, thus decreasing neuron firing
(Ending with barbital)

Front 5

Barbiturate
-Clinical use

Back 5

Sedative for anxiety, seizures, insomnia, induction of anesthesia (thiopental)

Front 6

Barbiturate
-Toxicity

Back 6

Dependence, additive CNS depression effects with Alcohol, respiratory or cardiovascular depression (can lead to death), drug interactions owing to induction of liver microsomal enzymes (cytochrome p450)

Front 7

How do you treat Barbiturate overdose?

Back 7

Symptom management (Assist respiration, increase BP)

Front 8

Benzodiazepine
-Mechanism

Back 8

Facilitate GabaA action by increasing frequency of Cl- channel opening. MOst havne long half-lifes and active metabolites (most examples end with zepam (Lorazepam))

Front 9

Which drug has an effect on sleep cycle?

Back 9

Benzodiazepine decreases REM sleep

Front 10

Benzodiazepine
-Clinical use

Back 10

Anxiety, spasticity, status epilepticus (lorazepam and diazepam), detoxification especially alcohol withdrawl-DT's), night terrors, sleep walking

Front 11

Benzodiazepines
-Toxicity

Back 11

Dependence, additive CNS depression effect with alcohol. Less risk of respiratory depression and coma than with barbiturates

Front 12

Which Benzodiazepine have the highest addictive potential?

Back 12

Short acting- TOM traizolam, oxazepam, Midazolam

Front 13

What do you treat Benzodiazepine with?

Back 13

Flumazenil (Competitive antagonist at GABA receptors

Front 14

What are the requirements of CNS drugs?

Back 14

Lipid-Soluble--> Go through CNS (blood-brain barrier)

Front 15

CNS drugs with decrease blood solubility has what effect

Back 15

Decrease solubility in blood causes rapid induction and recovery

Front 16

Drugs with increase solubility in lipids have what effect

Back 16

Increase potency= 1/MAC
MAC=Minimal alveolar concentration at which 50% of the popoulation is anesthesized decrease with age

Front 17

N20 low blood and lipid solublitiy means

Back 17

fast induction and low potency

Front 18

Inhaled anesthetics
-Examples

Back 18

Halothane, -flurane, Nitrous oxide

Front 19

Inhaled anesthetics
-Effects
-Brain
-Body

Back 19

Myocardial depression, respiratory depression, nausea/emesis, increase cerebral blood flow (decrease cerebral metabolic demand)

Front 20

Halothane and methyoxyflurane
-Toxicity

Back 20

*Hepatotoxicity (halothane), nephrotoxicity (methyoxyflurane)
Proconvulsant (enflurane)

Front 21

Thiopental
-Potency and lipid solubility

Back 21

Benzodiazepin High potency and high lipid solublity used for short surgical procedures

Front 22

Midazolam
-Uses of and what type of drug

Back 22

Benzodiazepines, most common drug for endoscopy used with gasesous anesthestics and narcotics.
Can cause respiratory depression, decrease BP and Amnesia

Front 23

Ketamine
-Use

Back 23

PCP analog acts as a dissociative anesthetics. Blocks NMDA receptors. Cardiovascular stimulants. Increase cerebral blood flow

Front 24

Ketamine
-Side effects

Back 24

Disorientaion, hallucination, and bad dreams

Front 25

Morphine
-Use

Back 25

Opiate during general anesthesia (fentanyl as well)

Front 26

Propofol
-Use

Back 26

Used for rapid anesthesia induction and short procedures. Potentiates GABAa

Front 27

Why would propofol be used instead of thiopental?

Back 27

Less post-op nausea

Front 28

Esters vs. Amides idenitifying

Back 28

Esters one I and Amides hae two I's

Front 29

Esters and Amides
-Mechanisms

Back 29

Blocks Na+ channels by binding to specific receptors on inner portion of channel. Preferentially binds to activated Na+ channels so most effective in rapidly firing neurons. third degree amine local anesthetics penetrate membrane in uncharged form then bind to ion channels as charged form

Front 30

Procaine
-Category

Back 30

Ester

Front 31

Thiopental
-Type

Back 31

Barbiturate

Front 32

Lidocaine
-Type

Back 32

Amide

Front 33

Esters and amides
-Allergic

Back 33

If your allergic to one give the other

Front 34

Esters and amides
-Infected tissues

Back 34

In infected tissue its acidic so the alkaline anesthetic are charged and cannot penetrate membrane effectively (Give more anesthetic)

Front 35

Esters and amides
-Order of nerve blockade

Back 35

small diameter myelinated fiber> small unmyelinated fiber> large myelinated fiber> large unmyelinated fiber
Size predominates over myelination

Front 36

Esters and amides
-Order of losses of temp, pain, pressurem touch

Back 36

Pain (lose first) > temp> touch> pressure (lose last)

Front 37

Esters and amides
-How do you enhance local action

Back 37

Give with vasoconstrictors (usually epi) to decrease bleeding, Increase anesthesia by decreasing systemic concentration

Front 38

Succinylcholine
-Complications

Back 38

Hyperkalemia and hypercalcemia

Front 39

Succinylcholine
-stages and reversibility

Back 39

Considered a depolarizing drug
Nicotinic
Phase I (prolonged depolarization): no anitdote block potentiated by cholinesterase inhibitors
Phase II: (repolarized by blocked)- antidote consist of cholinesterase inhibitors (eg. Neostigmine)

Front 40

Tubocurarine
-Mechanism

Back 40

Non-depolarizing compete with Ach for receptors (nicotinic)

Front 41

Tubucurarine
-Agents for Reversal of blockade

Back 41

neostigmine, edrophonium, and other cholinesterease inhibitors

Front 42

Dantrolene
-Used in treatment of

Back 42

Malignant hyperthermia (causesd by concominant use of inhalation anesthetics (halothane, not n20) and succinyl choline
Also used to treat neuroleptic malignant syndrome

Front 43

Dantrolene
-Mechanism

Back 43

prevents release of Ca2+ from the sarcoplasmic reticulum of skeletal muscles (muscle relaxer)

Front 44

Drugs used in parkinsons

Back 44

Bromocriptine
Amatadine
Levdopa
Selegline
Anticholinergic

Front 45

Bromocriptine
-Function

Back 45

Agonize dopamine receptors

Front 46

Amatidine
-Function

Back 46

Increase dopamine release (also antiviral against influenza and rubella)

Front 47

Levdopa
-Mechanism

Back 47

Converted to dopamine in CNS given with Carbidopa. Can cross blood-brain barrier and converted to Dopa-decarboxylase in the CNS to dopamine

Front 48

Selegline
-Function

Back 48

Prevent dopamine breakdown (selective MAO type B inhibitor)

Front 49

Benztropine
-Function

Back 49

Curb excess cholinergic activity (antimuscarininc- improves tremor and rigidity but little effect on bradykinesia)

Front 50

For essential or familial tremor use

Back 50

Beta-Blockers

Front 51

Levdopa
-Toxicity

Back 51

Arrhythmias from peripheral conversion to dopamine
Long-term use--> dyskinesia following administration, akinesia between doses

Front 52

Why is Carbidopa given with L-Dopa?

Back 52

Carbidopa (peripheral decarboxylase inhibitor) to increase the bioavailability of L-dopa in the brain and limit peripheral side effects

Front 53

Sumatriptan
-Mechanism

Back 53

5-HT (1b/1d) agonist causes vasoconstriction, inhibition of trigeminal activation and vasoactive peptide release:

Front 54

Sumatriptan
-Clinical use

Back 54

Acute Migraine, cluster headache attacks

Front 55

Sumatriptan
-Toxicity

Back 55

Coronary vasospasm (contraindicatied in patients with CAD or Prinzmental's angina), mild tingling

Front 56

Memantine
-Mechanism

Back 56

NMDA receptor antagonist; (prevents too much glutamate which can hurt the brain) helps prevent excitotoxicity (mediated by Ca2+)

Front 57

Memantine
-Toxicity

Back 57

Dizziness, confusion, hallucinations

Front 58

Donepezil
-Mechanism

Back 58

Acetylcholinesterase inhibitor
Alzheimers

Front 59

Donepezil
-Toxicity

Back 59

Nausea, dizziness, insomnia