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52 Cards in this Set

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L dopa
(a) mechanism
(b) indications
(c) side effects
(a) dopamine precursor that crosses BBB; converted to DA by DOPA decarboxylase
(b) parkinson's disease
(c) on/off phenomena; long term use can dyskinesia after dose akinesia b/w
Postural hypotension
Nausea/vomiting
Carbidopa
(a) mechanism
(b) indications
(a) DOPA decarboxylase inhibitor in periphrey so Ldopa crosses BBB and is converted to dopamine in brain
(b) given w/Ldopa for Parkinson's
Bromocriptine
(a) mechanism
(b) indications
(a) stimulates D2 receptors in the striatum
(b) parkinson's disease
Pergolide
(a) mechanism
(b) indications
(a) stimulates D2 receptors in the striatum
(b) parkinson's disease
Pramipexole
(a) mechanism
(b) indications
(a) stimulates D2 receptors in the striatum
(b) considered first line drugs in initial management of parkinson's disease
Ropinirole
(a) mechanism
(b) indications
(a) stimulates D2 receptors in the striatum
(b) considered first line drugs in initial management of parkinson's disease
Selegilline
(a) mechanism
(b) indications
(c) side effects
(a) inhibits MAO type B which preferentially metabolizes dopamine
(b) parkinson's disease
(c) not to be taken with SSRI's (serotonin syndrome) or meperidine; may enhance adverse effects of L dopa
Benztropine
(a) mechanism of action
(b) indications
(c) side effects
(a) antimuscarinics (block muscarinic receptors in striatum)
(b) decr tremor and rigidity in parkinsons but have little effect on bradykinesia
(c) antimuscarinics
Trihexyphenidyl
(a) mechanism of action
(b) indications
(c) side effects
(a) antimuscarinics (block muscarinic receptors in striatum)
(b) decr tremor and rigidity in parkinsons but have little effect on bradykinesia
(c) antimuscarinics
Entacapone/tolcapone
(a) mechanism
(b) indications
(a) COMT inhibitor which incr efficacy of L dopa. COMT metabolizes L dopa to 30MD which competes w/L dopa for active transport into CNS
(b) used as an adjunct to Ldopa/carbidopa therapy; incr "on time"
Amantadine
(a) mechanism
(b) indications
(c) side effects
(a) incr dopaminergic neurotransmission; antimuscarinic
(b) parkinson's disease; also used as an antiviral against influenza A and rubella
(c) antimuscarinic effects; livedo reticularis; ataxia
Memantine
(a) mechanism
(b) indications
(c) toxicity
(a) NMDA receptor antagonist; prevent excitotoxicity (med by Ca2+)
(b) alzheimer's disease (moderate to severe)
(c) dizziness, confusion, hallucinations
Donepezil
(a) mechanism
(b) indications
(c) toxicity
(a) acetylcholinesterase inhibitor
(b) alzheimer's (mild to moderate)
(c) nausea, dizziness, insomnia
Major classes used in treatment of glaucoma
Alpha agonists
Beta blockers
Diuretics
Cholinomimetics
Prostaglandin
Alpha agonists used in glaucoma treatment
(a) examples
(b) mechanism
(c) side effects
(a) epinephrine, brimonidine
(b) decr aqueous humor synth (in case of epi-due to vasoconstriction)
(c) mydriasis; stinging; do not used in closed angle glaucoma (epi)
Brimo (no pupillary or vision changes)
Beta blockers used in glaucoma treatment
(a) examples
(b) mechanism
(c) side effects
(a) timolol, betaxolol, carteolol
(b) decr humor secretion
(c) no pupillary or vision changes
Diuretics used in glaucoma treatment
(a) examples
(b) mechanism
(c) side effects
(a) acetazolamide
(b) decr aqueoushumor secretion due to decr bicarb
(c) no pupillary or vision changes
Cholinomimetics used in glaucoma treatment
(a) examples
(b) mechanism
(c) side effects
(a) pilocarpine, carbachol, physostigmine, echothiophate
(b) incr outflow of aqueous humor; contract ciliary muscle and open trabecular meshwork; use pilocarpine in emergencies; very effective at opening canal of Schlemm
(c) miosis, cycloplasm
Prostaglandin used in glaucoma treatment
(a) name
(b) mechanism
(c) side effect
(a) latanoprost (PGF 2alpha)
(b) incr outflow of aqueous humor
(c) darkens color of iris (browning)
Phenytoin mechanism
Incr Na channel inactivation inhibiting glutamate release from excitatory presynaptic neurons
Clinical use of phenytoin
Partial seizures; simple and complex
Generalized seizures: 1st line for tonic clonic
Other: prophylaxis for status epilepticus; Class IB antiarrhythmic
Carbamazepine mechanism
Incr Na channel inactivation
Clinical use of carbamazepine
Partial: simple, cmoplex
Generalized: 1st line for tonic clonic
Other: 1st line for trigeminal neuralgia
Lamotrigine mechanism
Blocks voltage gated Na+ channels
Clinical use of lamotrigine
Partial: simple and coplex
Generalized: tonic clonic
Gabapentin mechanism
Incr GABA release
Clinical use of gabapentin
Partial: simple and complex
Generalized: tonic clonic
Other: also used for peripheral neuropathy
Topiramate mechanism
Blocks Na channels and also incr GABA action
Clinical use of topiramate
Partial: simple and complex
Generalized: tonic clonic
Phenobarbital mechanism
Incr GABA a action
Clinical use of phenobarbital
Partial: simple and complex
Generalized: tonic clonic
NOTE: first line in pregnant women and children
Valproic acid mechanism
Incr Na channel inactivation
Incr GABA concentration
Clinical use of valproate
Partial: simple and complex
Generalized: 1st line for tonic clonic; absence
Other: also used for myoclonic seizures
Ethosuximide mechanism
Blocks thalamic T type Ca2+ channels
Clinical use for ethosuximide
First line for absence seizures
Benzodiaepines mechanism
Incr GABAa action
Clinical use for benzos
1st line for acute status epilepticus
Other: used for sezirues of eclampsia
1st line prevention
for seizures of eclampsia
MgSo4
Benzodiazepine toxicity
Sedation, tolerance, dependence
Carbamazepine toxicity
Diploplia, ataxia, blood dyscrasias (agranulocytosis, aplastic anemia)
Liver toxicity, teratogenesis
Induction of P450
Ethosuximide toxicity
Gi distress, fatigue, HA, urticaria, SJ syndrome
Phenytoin toxicity
Nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hirsuitism, megaloblastic anemia (decr folate abs) , teratogenesis (fetal hydantoin syndrome, SLE like syndrome
Induction of P450
Valproic acid toxicity
Gi distress
Rare but fatal fetal hepatotoxicity (LFT's)
Neural tube defects in fetus (spina bifida)
Tremor, wt gain, contraindicated in pregnancy
Lamotrigine toxicity
Steven's Johnson syndrome
Gabapentin toxicity
Sedation, ataxia
Topiramate toxicity
Sedation, mental dulling, kidney stones, wt loss
Name class: phenobarbital, pentobarbital, thiopental, secobarbital
Barbituates
Mechanism by which barbiturates work
Facilitate GABAa action by incr duration of Cl- channel opening and decreasing neuronal firing
Toxicty of barbiturates
Dependence, additive CNS depression effects w/alcohol, respiratory or CV system depression (can lead to death); drug interactions owing to induction of liver microsomal enzymes (cytP450)
Mechanism of benzodiazepines
Facilitate GABAa action by incr frequency of Cl- channel opening, decr REM sleep. Most have long half lives and active metabolites.
Clinical use of benzodiazepines
Anxiety, spasticity, status epilepticus (loraz and diaz), detox (esp alcohol withdrawal), night terrors sleep walking
Toxicity of benzodiazepines
Dependence, additive CNS depression effects w/alcohol. Less risk of respiratory depression and coma than with barbs.
Treat overdose w/flumazenil.