Usmle Step 1 Fa Neurology-Pharmacology

Front 1

L dopa
(a) mechanism
(b) indications
(c) side effects

Back 1

(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

Front 2

Carbidopa
(a) mechanism
(b) indications

Back 2

(a) DOPA decarboxylase inhibitor in periphrey so Ldopa crosses BBB and is converted to dopamine in brain
(b) given w/Ldopa for Parkinson's

Front 3

Bromocriptine
(a) mechanism
(b) indications

Back 3

(a) stimulates D2 receptors in the striatum
(b) parkinson's disease

Front 4

Pergolide
(a) mechanism
(b) indications

Back 4

(a) stimulates D2 receptors in the striatum
(b) parkinson's disease

Front 5

Pramipexole
(a) mechanism
(b) indications

Back 5

(a) stimulates D2 receptors in the striatum
(b) considered first line drugs in initial management of parkinson's disease

Front 6

Ropinirole
(a) mechanism
(b) indications

Back 6

(a) stimulates D2 receptors in the striatum
(b) considered first line drugs in initial management of parkinson's disease

Front 7

Selegilline
(a) mechanism
(b) indications
(c) side effects

Back 7

(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

Front 8

Benztropine
(a) mechanism of action
(b) indications
(c) side effects

Back 8

(a) antimuscarinics (block muscarinic receptors in striatum)
(b) decr tremor and rigidity in parkinsons but have little effect on bradykinesia
(c) antimuscarinics

Front 9

Trihexyphenidyl
(a) mechanism of action
(b) indications
(c) side effects

Back 9

(a) antimuscarinics (block muscarinic receptors in striatum)
(b) decr tremor and rigidity in parkinsons but have little effect on bradykinesia
(c) antimuscarinics

Front 10

Entacapone/tolcapone
(a) mechanism
(b) indications

Back 10

(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"

Front 11

Amantadine
(a) mechanism
(b) indications
(c) side effects

Back 11

(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

Front 12

Memantine
(a) mechanism
(b) indications
(c) toxicity

Back 12

(a) NMDA receptor antagonist; prevent excitotoxicity (med by Ca2+)
(b) alzheimer's disease (moderate to severe)
(c) dizziness, confusion, hallucinations

Front 13

Donepezil
(a) mechanism
(b) indications
(c) toxicity

Back 13

(a) acetylcholinesterase inhibitor
(b) alzheimer's (mild to moderate)
(c) nausea, dizziness, insomnia

Front 14

Major classes used in treatment of glaucoma

Back 14

Alpha agonists
Beta blockers
Diuretics
Cholinomimetics
Prostaglandin

Front 15

Alpha agonists used in glaucoma treatment
(a) examples
(b) mechanism
(c) side effects

Back 15

(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)

Front 16

Beta blockers used in glaucoma treatment
(a) examples
(b) mechanism
(c) side effects

Back 16

(a) timolol, betaxolol, carteolol
(b) decr humor secretion
(c) no pupillary or vision changes

Front 17

Diuretics used in glaucoma treatment
(a) examples
(b) mechanism
(c) side effects

Back 17

(a) acetazolamide
(b) decr aqueoushumor secretion due to decr bicarb
(c) no pupillary or vision changes

Front 18

Cholinomimetics used in glaucoma treatment
(a) examples
(b) mechanism
(c) side effects

Back 18

(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

Front 19

Prostaglandin used in glaucoma treatment
(a) name
(b) mechanism
(c) side effect

Back 19

(a) latanoprost (PGF 2alpha)
(b) incr outflow of aqueous humor
(c) darkens color of iris (browning)

Front 20

Phenytoin mechanism

Back 20

Incr Na channel inactivation inhibiting glutamate release from excitatory presynaptic neurons

Front 21

Clinical use of phenytoin

Back 21

Partial seizures; simple and complex
Generalized seizures: 1st line for tonic clonic
Other: prophylaxis for status epilepticus; Class IB antiarrhythmic

Front 22

Carbamazepine mechanism

Back 22

Incr Na channel inactivation

Front 23

Clinical use of carbamazepine

Back 23

Partial: simple, cmoplex
Generalized: 1st line for tonic clonic
Other: 1st line for trigeminal neuralgia

Front 24

Lamotrigine mechanism

Back 24

Blocks voltage gated Na+ channels

Front 25

Clinical use of lamotrigine

Back 25

Partial: simple and coplex
Generalized: tonic clonic

Front 26

Gabapentin mechanism

Back 26

Incr GABA release

Front 27

Clinical use of gabapentin

Back 27

Partial: simple and complex
Generalized: tonic clonic
Other: also used for peripheral neuropathy

Front 28

Topiramate mechanism

Back 28

Blocks Na channels and also incr GABA action

Front 29

Clinical use of topiramate

Back 29

Partial: simple and complex
Generalized: tonic clonic

Front 30

Phenobarbital mechanism

Back 30

Incr GABA a action

Front 31

Clinical use of phenobarbital

Back 31

Partial: simple and complex
Generalized: tonic clonic
NOTE: first line in pregnant women and children

Front 32

Valproic acid mechanism

Back 32

Incr Na channel inactivation
Incr GABA concentration

Front 33

Clinical use of valproate

Back 33

Partial: simple and complex
Generalized: 1st line for tonic clonic; absence
Other: also used for myoclonic seizures

Front 34

Ethosuximide mechanism

Back 34

Blocks thalamic T type Ca2+ channels

Front 35

Clinical use for ethosuximide

Back 35

First line for absence seizures

Front 36

Benzodiaepines mechanism

Back 36

Incr GABAa action

Front 37

Clinical use for benzos

Back 37

1st line for acute status epilepticus
Other: used for sezirues of eclampsia

Front 38

1st line prevention
for seizures of eclampsia

Back 38

MgSo4

Front 39

Benzodiazepine toxicity

Back 39

Sedation, tolerance, dependence

Front 40

Carbamazepine toxicity

Back 40

Diploplia, ataxia, blood dyscrasias (agranulocytosis, aplastic anemia)
Liver toxicity, teratogenesis
Induction of P450

Front 41

Ethosuximide toxicity

Back 41

Gi distress, fatigue, HA, urticaria, SJ syndrome

Front 42

Phenytoin toxicity

Back 42

Nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hirsuitism, megaloblastic anemia (decr folate abs) , teratogenesis (fetal hydantoin syndrome, SLE like syndrome
Induction of P450

Front 43

Valproic acid toxicity

Back 43

Gi distress
Rare but fatal fetal hepatotoxicity (LFT's)
Neural tube defects in fetus (spina bifida)
Tremor, wt gain, contraindicated in pregnancy

Front 44

Lamotrigine toxicity

Back 44

Steven's Johnson syndrome

Front 45

Gabapentin toxicity

Back 45

Sedation, ataxia

Front 46

Topiramate toxicity

Back 46

Sedation, mental dulling, kidney stones, wt loss

Front 47

Name class: phenobarbital, pentobarbital, thiopental, secobarbital

Back 47

Barbituates

Front 48

Mechanism by which barbiturates work

Back 48

Facilitate GABAa action by incr duration of Cl- channel opening and decreasing neuronal firing

Front 49

Toxicty of barbiturates

Back 49

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)

Front 50

Mechanism of benzodiazepines

Back 50

Facilitate GABAa action by incr frequency of Cl- channel opening, decr REM sleep. Most have long half lives and active metabolites.

Front 51

Clinical use of benzodiazepines

Back 51

Anxiety, spasticity, status epilepticus (loraz and diaz), detox (esp alcohol withdrawal), night terrors sleep walking

Front 52

Toxicity of benzodiazepines

Back 52

Dependence, additive CNS depression effects w/alcohol. Less risk of respiratory depression and coma than with barbs.
Treat overdose w/flumazenil.