MQW U3 > Pharm > Flashcards

Pharm Flashcards

(91 cards)

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1
Q

What DA pathway controls movement?

A

Nigrastriatal

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2
Q

What DA pathway controls reward and perception?

A

Mesolimbic

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3
Q

What DA pathway controls executive function?

A

Mesocortical

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4
Q

What DA pathway controls pituitary prolaction function?

A

Tuberoinfundibular

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5
Q

2 Post-synaptic enzymes that terminate DA action:

A

MAO A or B

COMT

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6
Q

Hyperfunctioning Migrostriatal pathway causes:

Hypofunctioning causes:

A

Hyper: dyskinetic movemnt
Hypo: dyskinetic movement, parkinsonism

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7
Q

Hyperfunctioning Mesolimbic pathway causes:

Hypofunctioning causes:

A

Hyper: Addiction, hallucinations
Hypo: amotivation, apathy

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8
Q

Hyperfunctioning Mesocortical pathway causes:

Hypofunctioning causes:

A

Hyper: hypervigilance
Hypo: inattention

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9
Q

Hyperfunctioning Tuberoinfundibular pathway causes:

Hypofunctioning causes:

A

Hyper: hypoprolactinemia
Hypo: hyperprolactinemia

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10
Q

What drugs to enhance DA synthesis?

A

Levodopa: DA precursor
Carbidopa: combined therapy to prevent peripheral DA activity –> lower side effects

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11
Q

Results of low and high DA activity:

A

Low: distractable
High: hypervigilant

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12
Q

ADHD: ___ DA activity at ___

A

low, anterior cingulate

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13
Q

Parkinson: ___ DA activity at ___

A

low, striatum

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14
Q

Why is MTHFR enzyme important?

Genetics?

A

Creates L-methylfolate, which is the form that can cross BBB

TT alleles bad –> less DA made

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15
Q

Bupropion:
Treats?
Class?
Affects what pathway?

A

Antidepressant
NDRI
Mesocortical

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16
Q

Amphetamines mechanism:

A
  • Block DAT

- Increase VMAT2 –>more DA release

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17
Q

Methylphenidate mechanism:

A

-Block DAT

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18
Q

2 wakefulness promoting stimulant drugs:
Treats?
Side effects?

A
  • Modafinil, Armodafinil
  • Narcolepsy
  • Off label: ADHD
  • P450-3A4 inducer
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19
Q

Selegiline:
low dose is used for for?
high dose is used for?

A

Low dose: MAO-B selective –> Parkinson

High dose: MAO A and B –> Depression

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20
Q

Rasagiline mechanism:

treats?

A
  • MAO-B inhibitor

- Parkinson’s

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21
Q

MAOIs for Depression:

A
  1. Isocarboxazid
  2. Phenelzine
  3. Tranylcypromine
  4. Selegiline
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22
Q

Serotonin Syndrome

A
  • MAOI decrease Serotonin breakdown
  • Adding Serotonin drug –> toxic levels in CNS
  • Tremor, muscle spasm, vital changes, hyperthermia, delirium, coma, death
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23
Q

COMTi drugs:
treats?
effect on neurotransmitters?

A
  • Entacapone, Tolcapone
  • Parkinson’s
  • elevate DA and NE
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24
Q

D2 receptor agonists:

treats?

A
  • Bromocriptine, pramipexole, ropinerole, Apomorphine injection
  • Parkinson’s or Restless leg Syndrome
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25
D3 receptor agonists: | treats?
- Aripiprazole - Antipsychotic for Schizo - Depression
26
Amantadine mechanism: | treats?
- Release DA, block DAT, stimulate D2 | - Parkinson's, Influenza
27
Reserpine treats:
HTN, Schizo psychosis, causes Depression
28
Tetrabenazine treats:
Huntington's Chorea by lowering DA availability
29
D2 receptor antagonist affects which pathways? treats? classification?
ALL; they are non-selective Schizophrenia FGAs (high, low potency), SGAs
30
What causes EPS? | Symptoms?
- High Potency FGA | - Akathisia, Dystonia, Parkinsonism, Neuroleptic Malignant Syndrome
31
Symptoms of Neuroleptic Malignant Syndrome:
1. Hyperthermia 2. Muscle rigidity 3. Vital sign instability 4. Rhabdomyolysis
32
What is Tardive Dyskinesia
- Chronic D2 receptor antagonism - Permanent movement disorder side effect - Choreic or Athetotic movements
33
High vs Low Potency FGA drugs: - Haloperidol - Thioridazine - Thiothixine - Fluphenazine - Chlorpromazine
High: Haloperidol Fluphenazine Thiothixine Low: Chlorpromazine Thioridazine
34
Blocking ___ receptor lowers EPS risk
Serotonin 2a (5HT2a)
35
Side effects of 'Dones' vs 'Pines'
Dones: more EPS Pines: more sedating, more metabolic syndrome
36
Clozapine risks and benefits
- Risk of agranulocytosis - Most metabolic risk of any agent - No neuromuscular effect --> no EPS/TD
37
Blocking what receptor stops psychosis?
D2
38
Mechanism of action for Beta blockers in Glaucoma?
Reduce aqueous production
39
Suffix for carbonic anhydrase inhibitors:
-zolamide
40
Mechanism of action for Carbonic Anhydrase Inhibitors in Glaucoma?
Reduce production of aqueous
41
Mechanism of action for Prostaglandin Analog in Glaucoma?
Increase uveoscleral outflow w/o effect on aqueous flow or trabecular outflow facility
42
Cocaine mechanism for diagnosing Horner's Syndrome
- Cocaine = reuptake inhibitor --> NE flood --> pupillary dilation - Horner's Syndrome = dysfunctional PANS --> no pupillary dilation
43
What drug is used to differentiate preganglionic from postganglionic lesions in Horner's Syndrome?
Hydroxyamphetamine: Releases NE
44
Hydroxyamphetamine mechanism for differentiating lesion location in Horner's Syndrome
- Topical application - No pupillary dilation = 3rd order neuron problem = Postganglionic = benign process - Dilation = Preganglionic lesion --> requires investigation
45
How do you differentiate Adie's syndrome from an intracranial aneurysm?
- Low dose muscarinic agonist (Methacholine or Pilocarpine) - Chronic denervated nerve in Adie's syndrom will be hypersensitive --> pupillary constriction - Acute trauma neurved from aneurysm will not respond
46
What is light-near dissociation?
No pupil response to light, but does have accomodation
47
Most common cause and population affected by Parinaud's Syndrome
- Midbrain tumor (pineal) | - Young children
48
Common presentation and population affected by Adie's Syndrome
- Loss of patellar reflex | - Young females
49
What characterizes Argyll-Robertson Syndrome:
- Miotic irregular pupils | - Does not respond to cycloplegics
50
Triptan's mechanism of action:
5HT1 B-D agonist --> vasoconstriction of intracranial EXTRACEREBRAL blood vessels (trigeminovascular system) --> block sterile inflammation reaction
51
In what patient population are triptans contraindicated?
Patients w/ vascular disease, uncontrolled HTN, and comlicated migraine syndromes
52
Migraine vs Tension vs Cluster Headache characteristics:
Migraine: unilateral, throbbing, moderate-severe, aggravated by activity, relieved by rest Tension: dull, achy, non-pulsatile, pressure-like, bilateral, mild-medium Cluster: severe, unilateral, in temporal, orbital or supraorbital areas
53
Most commonly used Beta blocker for Migraine?
Propranolol
54
Most commonly used Ca++ Channel Blocker for Migraine?
Verapamil | -useful for aura
55
For what patient population is Migraine prevantative therapy recommended?
- 3+ severe headaches/month or - 2+ mild-moderate headaches/week or - inability to use effective symptomatic therapy
56
2 Anti-epileptics used for migraine prevention
Valproic Acid, Topiramate
57
Cluster Headache characteristics:
- Clockwork daily and annual rhythm (same time) - Men:women 4:1 - Some patients have heavy facial features
58
Long-term Cluster Headache prevention drugs:
- Verapamil (Ca++ channel blocker) - Topiramate (antiepileptic) - Valproic Acid (antiepileptic) - Lithium (mood stabilizer)
59
Biogenic Amine Hypothesis of Depression:
Depression = too little CNS NE and/or 5HT
60
Scoring of Hamilton Depression Rating Scale (HDRS):
Mild= 8-13 Moderate= 14-18 Severe= 19-22 Very Severe= >23
61
What do MAO-A and -B mainly oxidize?
- A = NE, 5HT, Tyramine | - B = DA, phenyethylamine
62
What is the most used TCA for TTH prevention?
Amitriptyline
63
What is a common side effect of TCAs?
Cardiac arrhythmias
64
What 2 SSRIs have P450 Inhibition
Fluoxetine, Paroxetine
65
What is Ketamine's mechanism of action?
Glutamate NMDA receptor antagonist
66
What drug can quitting smokers use to maintain nicotine abstinence?
Bupropion - Atypical antidepressant
67
What is the important side effect of Buproprion?
Lowers seizure threshold
68
What can happen if you give a Bipolar person tricyclics?
Precipitate mania
69
What are the 3 structural parts of local anesthetics?
1. Aromatic ring 2. Intermediate Linkage 3. Terminal Amine
70
If there is a big difference between pKa of local anesthetic and physiologic pH, what form will be more common? (uncharged/charged)
Charged
71
The (charged/uncharged) form of a local anesthetic can penetrate membranes
Uncharged
72
Which structural part of a local anesthetic determines lipid solubility and potency?
Aromatic Ring
73
Metabolism of Ester vs Amide Local Anesthetics:
Esters: metabolized by plasma enzymes Amides: Metabolized by hepatic P450 enzymes
74
How and where do local anesthetics bind intracellularly?
- Reversibly | - Intracellular portion of Na channel
75
High risk for CNS toxicity from which 2 Local Anesthetics?
Bupivacaine, Ropivacaine
76
Which requires higher dose of Local Anesthetics: CNS or Cardio toxicity
Cardiotoxicity
77
What is Transient Neurological Syndrome and which local anesthetics can cause it?
- Severe transient pain from local anesthetic use in spinal anesthesia - Lidocaine, Procain, Mepivacaine
78
Which group (ester or amide) of local anesthetics have high allergic reaction rates?
Esters -- PABA metabolites = known allergen
79
Which nerve fibers are first to be blocked by local anesthetics?
- B and A delta | - Generally: smaller, myelinated nerves blocked first
80
What are toxic side effects of Na+ channel blockers? | What is a side effect?
Toxicity = Dizzy, drunk, double vision | Side effect = 15% have rash, rare Steven Johnson syndrome
81
What is a contraindication for Valproate? Why?
Pregnancy -- 4-8% Teratogenic
82
What drugs can be given for status epilepticus?
IV: Phenytoin, Lorazepam, Diazepam, Valproate
83
Absence seizure. | What drug? Mechanism?
Ethosuxamide | - T-type thalamus Ca++ channel blocker
84
Mechanisms for Anti-epileptics:
1. Voltage-gated Na+ channel blockers 2. Voltage-gated Ca++ channel blockers 3. Glutamate receptor blockers 4. GABA system agonists
85
Difference between Felbamate and Topiramate
``` Felbamate = NMDA blocker Topiramate = AMPA and Kainate receptor blocker ```
86
Difference between toxicity and side effect
Toxicity: Unwanted effect of drug Side effect: unexpected effect, not related to mechanism of action
87
Which anti-epileptic exhibits no metabolism?
Gabapentin
88
What drug has synergistic action/competes with valproic acid
Lamotrigine
89
Antiepileptic drug with "word finding" problem toxicity
Topiramate
90
What is the Meyer-Overton Rule?
Potency of anesthetic gases directly related to their solubility in olive oil
91
What is the gold standard drug for maintenance of general anesthesia?
Isoflurane
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