Drugs- Basic High Yield Stuff for Boards > Neuro > Flashcards

Neuro Flashcards

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1
Q

Name 3 drugs which:

decrease REM/delta sleep

A
  1. Alcohol
  2. Benzos
  3. Barbs
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2
Q

Name 1 drug which:

decreases REM only

A

Norepinephrine

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3
Q

2 drugs for treating Bedwetting (sleep enuresis).

Which is preferred? Why?

A
  1. oral desmopressin (ADH analog)
  2. imipramine

Desmopressin > Imipramine (too many side effects)

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4
Q

Drug for treating Night terrors/ Sleepwalking

A

Benzos

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5
Q

Name the 4 dopaminergic pathways in the brain

A
  1. mesocortical
  2. mesolimbic
  3. Nigrostriatal
  4. tuberoinfudibular
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6
Q

Which dopaminergic pathway…

  1. is affected little by antipsychotic drugs?
  2. is the therapeutic target for positive symptoms?
  3. is the major dopaminergic pathway in the brain?
  4. is affected significantly by Movement disorders?
  5. is affected significantly by antipsychotic drugs?
A
  1. Mesocortical
  2. Mesolimbic
  3. Nigrostriatal
  4. Nigrostriatal
  5. Nigrostriatal
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7
Q

effects of prolactin (5)

A
  1. decrease libido/ sex dysfunction
  2. galactorrhea
  3. gynecomastia
  4. amenorrhea
  5. infertility
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8
Q

Antipsychotic drugs help treat which better- + or - symptoms

A

+ (mesolimbic)> - (mesocortical)

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9
Q

treatment for essential tremor (2)

A
  1. nonselective BB (propranolol)

2. primidone

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10
Q

Treatment of Subarachnoid Hemorrhage(2)

A
  1. stabilize

2. start on Ca+2 blocker to decrease cerebral ischemia

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11
Q

Treatment of TIA(2)

A
  1. full work up

2. prescribe low-dose aspirin

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12
Q

Treatment of Ischemic Stroke (4)

A
  1. tPA (within 3-4.5hrs)
  2. aspirin/clopidogrel
  3. BP control/ BS control/ lipids
  4. treat condition (like A.fib)
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13
Q

Treatment of Pseudotumor Cerebri

A
  1. weight loss
  2. acetazolamide
  3. topiramate
  4. invasive procedures (repeat LP, CSF shunt, optic nerve fenestration surgery)
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14
Q

ALS treatment

A

Riluzole (increase survival by 6mos)

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15
Q

Treatment of Facial nerve palsy (Bell’s palsy)

2

A
  1. Corticosteroids

2. Acyclovir

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16
Q

Sensorineural hearing loss due to otoxoic drug presents as:

A
  1. Tinnitus

2. Vertigo

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17
Q

Lens for correcting Hyperopia

A

“Far-sighted”

Convex

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18
Q

Lens for correcting Myopia

A

“Nearsighted”

Concave

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19
Q

Lens for correcting Presbyopia

A

Reading glasses

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20
Q

What medicine should be avoided with acute closed angle glaucoma?
When can this drug be used?

A

Epinephrine (b/c of its mydriatic effect)

  • useful in chronic glaucoma to decrease aqueous humor production
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21
Q

Treatment for Uveitis

A

Steroids

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22
Q

Treatment for Conjunctivits:
Bacterial
Viral

A

Bacterial= abx

Viral (commonly adenovirus) self-resolving

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23
Q

Treatment of Wet Age-related macular degeneration

A

anti-VEGF injections (like RANibizumab)

(remember “BEVerly RAN for her VEGtables” Bev=bevacizumab”

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24
Q

Prevention of Dry Age-related macular degeneration

A

multivitamin/ antioxidant supplement

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25
Treatment of Nonprolif. Diabetic Retinopathy
blood sugar control
26
Treatment of Prolif. Diabetic Retinopathy
1. peripheral retinal photocoagulation 2. surgery 3. anti-VEGF(like ranibizumab)
27
Treat Multiple Sclerosis: | Slow progression of disease-modifying therapies (3)
1. IFN-B 2. glatiramer (polymer of 4a.a. in Myelin Basic Protein) 3. natalizumab (alpha4-integrin, check for JC virus)
28
``` Treat Multiple Sclerosis: acute flares (1) ```
1. IV steroids
29
``` Treat Multiple Sclerosis: symptomatic treatment for Neurogenic bladder(2) spacticity(2) pain(1) ```
Neurogenic bladder: 1. catheterization 2. muscarinic antagonists("On The Darn Toilet, Sorry") Spacticity: 1. Baclofen 2. GABA-b-R agonists Pain: 1. opioids
30
Treatment of Acute Inflammatory Demyelinating Polyradiculopathy(3)
(subtype of Guillain-Barre) 1. Respiratory support 2. Plasmapheresis 3. IVIG * NO STEROIDS
31
Treatment of Cluster HA: (2) | Prophylaxis of Cluster HA: (1)
Tx: 1. Sumatriptan 2. 100% O2 Px: Verapamil
32
Treatment of Tension HA (3) | Chronic tension HA (1)
Tx: 1. Analgesics 2. NSAIDs 3. Acetaminophen Chronic: Amitriptyline
33
Treatment of Acute Migraines (3)
1. NSAIDs 2. Triptans 3. Dihydroergotamine
34
Prophylaxis of Migraines(6)
1. lifestyle changes (sleep, exercise, diet) 2. BB 3. Ca+2 Channel blocker 4. amitriptyline 5. topiramate 6. valproate
35
2 uses for Triptan
1. Migraines | 2. Cluster HA
36
Treatment of Trigeminal Neuralgia | Symptoms (3)
Tx: Carbamazepine 1. repetitive 2. unilateral 3. shooting pain in distribution of CN V that lasts typically less than 1 min
37
``` Epinephrine, Brimonidine: Use/drug class MOA Adverse(6) Contra ```
Glaucoma Epi (a1 agonist)= decrease Aqueous production via Vasoconstriction Brimonidine (a2 agonist)= decrease Aqueous production 1. Mydriasis (a1) 2. Blurry vision 3. Ocular hyperemia 4. foreign body sensation 5. ocular allergic rxn 6. ocular pruritus Contra: CLOSED-ANGLE GLAUCOMA
38
``` Timolol, Betaxolol, Carteolol: Use/drug class MOA Adverse Which has the most systemic effects? ```
Glaucoma/ BB ('-olol') decrease Aqueous production - No pupillary or vision changes - Timolol most likely to have systemic effects if drained into lacrimal system
39
Acetazolamide: Use/drug class MOA Adverse
Glaucoma/ CA inhib (diuretic) - decrease aqueous humor synthesis via CA inhib - No pupillary or vision changes
40
``` Pilocarpine, Carbachol: Use/drug class MOA Adverse Which is used in an emergency? Why? ```
Glaucoma/ Direct M3 cholinomimetic 1. increase outflow of aqueous via contraction of ciliary muscle 2. open trabecular meshwork Adverse: Miosis & cyclospasm Emergency: Pilocarpine is very effective at opening meshwork into canal of Schlemm
41
Physostigmine, Echothiophate: Use/drug class MOA Adverse
Glaucoma/ Indirect M3 cholinomimetic 1. increase outflow of aqueous via contraction of ciliary muscle 2. open trabecular meshwork Adverse: Miosis & cyclospasm
42
Which muscle controls miosis? | Which muscle controls cyclospasm?
miosis=contraction of pupillary sphincter m. | cyclospasm= contraction of ciliary m.
43
Bimatoprost, Iatanoprost: Use/drug class MOA Adverse
1st line treatment of Glaucoma/ Prostaglandins (Iatanoprost= PGF-2a) - increase aqueous outflow through canal of Schlem Adverse: 1. Darkens color of iris (Browning) 2. Eyelash growth
44
Opioid Analgesics: | Name (9)
1. Morphine 2. Fentanyl 3. Codeine 4. Loperamide 5. Methadone 6. Meperidine 7. Dextromethrophan 8. Diphenoxylate 9. pentazocine
45
Opioid Analgesics: Name 3 opioid-R MOA Release modulation(all decrease)(5)
mu-R: B-endorphin delta-R: enkephalin kappa-R: dynorphin open K+ channels, close Ca+2 channels--> decrease pain transmission. 1. Ach 2. NE 3. 5-HT 4. Glu 5. Substance P
46
Opioid Analgesics: | to treat pain/cough suppression
dextromethorphan
47
Opioid Analgesics: | to treat diarrhea
1. loperamide | 2. diphenoxylate
48
Opioid Analgesics: | Acute pulmonary edema
Methadone, buprenorphine + naloxone
49
Opioid Analgesics: | Maintenance programs for heroin addicts
Methadone, buprenorphine + naloxone
50
Opioid Analgesics: | Adverse(5)
1. Addiction 2. respiratory depression 3. constipation 4. miosis 5. additive CNS depression with other drugs
51
Opioid Analgesics: | which opioid doesn't cause miosis?
meperidine (causes mydriasis)
52
Opioid Analgesics: | Tolerance does not develop to what symptoms of opioid use?
No tolerance to miosis and constipation
53
Opioid Analgesics: | treatment of opioid toxicity
Naloxone or Naltrexone (opioid-R antagonist)
54
Pentazocine: MOA Clinical Use
1. Kappa-R agonist 2. Mu-R antagonist Moderate-Severe Pain
55
Pentazocine: What happens when co-admin with full opioid ANTAGONIST (like Naloxone)? Why?
Opioid withdrawal symptoms (muscle aches, sweating, D/N/V, dilated pupils) -competition for opioid-R
56
Butorphanol: MOA Clinical Use Benefit to use over other opioids?
1. Kappa-R agonist 2. Mu-R partial agonist - Severe Pain (migraine/labor) - Less respiratory depression than full opioid agonist
57
Butorphanol: What happens when co-admin with full opioid AGONIST? Why? Effect of Naloxone on Butorphanol?
Opioid withdrawal symptoms (muscle aches, sweating, D/N/V, dilated pupils) - competition for opioid-R - Overdose not easily reversed with Naloxone
58
Tramadol: MOA Clinical Use
"'Tram it all' in with Tramadol" (meaning it works on many NTs) - very weak opioid agonist - inhib 5-HT & NE reuptake -Chronic Pain (people beat up their dog to get their hands on this medication)
59
Tramadol: | Adverse
1. similar to Opioids 2. increase seizure risk (decreases threshold) 3. Serotonin Syndrome
60
Whats the difference btw Tolerance, Dependence, and Withdrawal?
Tolerance-must increase drug amount-->decrease effect Dependence- drug needed for normal function Withdrawal- ill effects of drug use
61
Ethosuximide: First line treatment for... MOA
Absence Seizures "Sucks to have Silent Seizures" - Block T-type Ca+2 channels (thalamus)
62
Ethosuximide: | Adverse(5*)
``` "EFGHIJ" Ethosuximide causes 1.Fatigue 2.GI upset 3.HA 4. Itching 5. Steven-Johnsons ```
63
``` Benzodiazepines: Name 3 seizure drug examples MOA First line for acute treatment for... Additional Use ```
1. Diazepam 2. Lorazepam 3. Midazolam - increase GABA-A action via increase frequency of Cl- channel opening - Status Epilepticus - Eclampsia Seizures
64
First line treatment for Eclampsia seizures?
MgSO4
65
Benzodiazepines: | Adverse (3)
1. Sedation --> Respiratory Depression 2. Tolerance 3. Dependence
66
Phenobarbital: MOA First line of treatment for... other seizure uses (3)
-increase GABA-A action via increase duration of Cl- channel opening - First line in Neonates 1. Simple 2. Complex 3. Tonic-clonic
67
Phenobarbital: | Adverse(4)
1. Sedation--> cardiovascular depression 2. Tolerance 3. Dependence 4. induction of P450 ("Chronic Alcoholics Steal Phen-Phen & Never Refuses Greasy Carbs")
68
``` Phenytoin & Fosphenytoin(oral): MOA & important metabolism note First line prophylaxis for ... First line treatment for... Other seizure uses (2) ```
Block Na+ channels (ZERO-ORDER: "PEA") - 1st px: Status epilepticus - 1st tx: Tonic-Clonic 1. Simple 2. Complex
69
Phenytoin & Fosphenytoin(oral): Adverse -Neuro(4) -Derm (4)
Neuro: 1. Nystagmus/Diplopia 2. Ataxia 3. Peripheral Neuropathy 4. Sedation Derm: 1. Hirsutism 2. Steven-Johnson's rash 3. Gingival Hyperplasia 4. DRESS-syndrome (drug rash w/ eosinophils and systemic symptoms)
70
``` Phenytoin & Fosphenytoin(oral): Adverse -MSK (2) -Hematologic (1) -Reproductive (1) -Other (1) ```
MSK: 1. osteoporosis 2. SLE-like syndrome Hematologic: Megaloblastic anemia Reproductive: Teratogenesis (Fetal hydantoin Synd) Other: P450 induction
71
Drugs causing Megaloblastic Anemia (3)
"having a BLAST with PMS" 1. Phenytoin 2. Methotrexate 3. Sulfa drugs
72
Drugs causing Gingival Hyperplasia (3)
1. Phenytoin 2. Ca+2 channel blockers (rare) 3. cyclosporine
73
Drugs causing Steven-Johnsons
"CLAPPPERS" 1. Carbamazepine 2. Lamotrigine 3. Allopurinol 4. Phenytoin 5. Phenobarbital 6. Penicillin 7. Ethosuximide 8. Rash 9. Sulfa drugs
74
Drugs causing SLE-like syndrome
"having lupus is SHIPP-E" 1. Sulfa drugs 2. Hydralazine 3. Isoniazid 4. Procainamide 5. Phenytoin 6. Etanercept
75
Carbamazepine: MOA First line treatment for (2, 1) other seizure use (1)
Blocks Na+ channel 1. Simple 2. Complex 3. Trigeminal neuralgia -Tonic-Clonic Seizures
76
Carbamazepine: | Adverse (7)
1. Diplopia 2. Ataxia 3. Agranulocytosis/ Aplastic Anemia (Monitor 'C'BC) 4. Hepatotox & P450 induction 5. Teratogenesis 6. SIADH 7. Steven-Johnson
77
Valproic Acid: | MOA (2)
1. Na+ channel inactivation | 2. increase GABA concentration by inhibiting GABA-transaminase
78
Valproic Acid: First line treatment for... Other seizure uses (4) Additional uses (2)
First line: Tonic Clonic 1. Simple 2. Complex 3. Absence 4. Myoclonic Seizures 1. Bipolar DO 2. Migrane prophylaxis
79
Valproic Acid: Adverse (5) Contra-Why?
1. GI distress 2. Fatal Hepatotox (rare but must monitor LFTs) 3. Pancreatitis 4. Trmeor 5. Weight gain Contra: Pregnancy- Neural Tube defects
80
Vigabatrin: MOA Clinical uses (2)
increase GABA concentration by IRREVERSIBLY inhibiting GABA-transaminase 1. Simple 2. Complex
81
Gabapentin: MOA Seizure uses (2) Additional uses (2)
- inhib VG-Ca+2 channels (designed as GABA analog) 1. Simple 2. Complex 1. Peripheral Neuropathy 2. Post-herpetic Neuralgia
82
Gabapentin: | Adverse(2)
1. Sedation | 2. ataxia
83
Topiramate: MOA Seizure uses (3) Additional use (1)
- Blocks Na+ channels -->increase GABA action 1. Simple 2. Complex 3. Tonic-Clonic 1. Migrane prevention
84
Topiramate: | Adverse (3)
1. Sedation/Mental dulling ("topey makes you dopey") 2. Kidney Stones (Topey makes it hard TO pee) 3. weight loss
85
``` Lamotrigine: MOA Clinical uses (4) Benefit over Carbamazepine/Phenytoin Adverse (1) ```
- Block VG-Na+ channel 1. Simple 2. Complex 3. Tonic-clonic 4. Absence - fewer side effects when compared to Carbamazepine/Phenytoin -Adverse: Steven-Johnsons (must titrate slowly)
86
3 drugs to treat Absence seizures? | Whats the first line?
1. Ethosuximide 2. Valproic acid 3. Lamotrigine
87
Treatment of Myoclonic seizures
Vlaproic acid
88
Levetiracetam: MOA Clinical uses (3)
- Unknown modulation of GABA&Glutamate release 1. simple 2. complex 3. tonic-clonic
89
Tiagabine: MOA Clinical uses (2)
-increase GABA concentration by inhibiting GABA-REUPTAKE 1. Simple 2. Complex
90
Seizure drugs which induce P450 (3)
1. phenobarbital 2. Phenytoin/ Fosphenytoin 3. Carbamazepine
91
1 drugs which increase Na+ Channel inactivation | 4 drugs which block Na+ channels
1. Valproic Acid 1. Phenytoin/Fosphenytoin 2. Lamotrigine 3. Topirimate 4. Carbamazipine
92
3 drugs which increase GABA action 3 drugs which increase GABA level
1. Topirimate 2. Phenobarbital 3. Benzodiazepines 1. Valproic Acid 2. Tiagabine 3. Vigabatrin
93
2 drugs which block Ca+2 channel
1. Gabapentin | 2. Ethosuximide
94
1 drug which modulates GABA & Glutamate release
1. Levetiracetam
95
What is dressler syndrome?
autoimmune phenomenon resulting in fibrous pericarditis several weeks post MI (associated with Phenytoin)
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