Neuro pharm

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Neuro pharm
2010-06-15 15:52:38
USMLE neurology pharmacology

USMLE neurology pharmacology
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  1. Glaucoma drugs which decrease aqueous humor synthesis
    • a-agonists
    • Epinephrine (don't use in closed-angle), brimonidine
  2. Glaucoma drugs which decrease aqueous secretion
    • B-blockers
    • Timolol, betaxolol, carteolol
    • Acetazolamide: decrease bicarb via inhibition of carbonic anhydrase
  3. Glaucoma drugs which increase outflow of aqueous humor
    • Direct cholinomimetics: pilocarpine (emergencies), carbachol
    • Indirect cholinomimetics: physostigmine, echothiophate
    • PGF2a: latanoprost (darkens iris)
  4. Opioid effects on membrane channels
    • Open K channels
    • Close Ca channels
    • Decreases synaptic transmission, inhibits NT release
  5. Butorphanol: MOA
    • Partial agonist at mu receptor, agonist at kappa
    • For pain
    • precipitates withdrawal
  6. Tramadol: MOA
    • Weak opioid, inhibits 5HT and NE reuptake
    • for chronic pain
  7. Tramadol: tox
    • like opioids
    • Decreases seizuer threshold
  8. Seizure drugs increasing Na channel inactivation
    • Phenytoin
    • carbamazepine
    • Valproate
  9. Seizure drugs blocking Na channels
    • Lamotrigine
    • Topiramate
  10. Gabapentin: MOA
    inhibits calcium channels
  11. Increase GABA action (seizure drugs)
    • Topiramate
    • Phenobarbital (duration of opening)
    • Valproate (increase GABA concentration)
    • Benzodiazepines (frequency of opening)
    • Tiagabine (inhibits reuptake)
    • Vigabatrin (inhibits GABA transaminase irreversibly)
  12. Ethosuxamide: MOA
    Blocks thalamic T-type Ca channels
  13. Seizure drugs that induce P450
    • Carbamazepine
    • Phenobarb
    • Phenytoin
  14. Seizure drugs causing Stevens-Johnson syndrome
    • Ethosuximide
    • Carbamazepine
    • Lamotrigine
  15. Carbamazepine: tox
    • Diplopia, ataxia
    • Blood issues
    • Liver
    • SIADH
    • teratogenesis
    • P450 induction, SJ
  16. Phenytoin: tox
    • Nystagmus, diplopia, ataxia, peripheral neuropathy
    • Sedation, hirsutism
    • SLE-like
    • megaloblastic anemia, gingival hyperplasia (kids)
    • Induction
  17. Valproate: tox
    • GI, fatal hepatotox
    • Spina bifida in fetus
    • Tremor, weight gain
  18. Topiramate: tox
    sedation, mental dulling, kidney stones, weight loss
  19. Phenytoin: specific MOA
    • Use-dependent Na block increases refractory period
    • Inhibits glutamate release from neuron
  20. Barbiturates contraindicated in
  21. Short-acting benzodiazepines
    • Are Triazolam, Oxazepam, Midazolam
    • have highest addictive potential
  22. Low blood solubility in anesthetics means:
    rapid induction and recovery
  23. High solubility in lipids for anesthetics means
    higher potency which = 1/MAC
  24. High blood/gas ratio means...
    • high solubility in blood
    • means slow induction and recovery
  25. Anesthetics effect on lungs
    increase rate and depth of ventilation increases gas tension
  26. Inhaled anesthetics effect on cerebral blood flow
  27. Halothane: tox
  28. Methoxyflurane: tox
  29. Enflurane: tox
  30. Barbiturate effect on cerebral blood flow
  31. Benzo effect on BP
  32. Ketamine/arylcyclohexylamines: MOA and heart/brain effects
    • PCP analogs block NMDA receptors
    • Stimulate cardio
    • Increase cerebral blood flow
  33. Propofol: MOA
    potentiates GABA
  34. Local anesthetics: MAO
    • Preferentially bind active Na channels
    • Need more in infected/acidic tissue
  35. Order of nerve blockade with local anesthetics
    • small myelinated > small unmyelinated > large myelinated > large unmyelinated
    • pain temp touch pressure
  36. Bupivacaine: tox
  37. NM blocking drugs are selective for
    motor nicotinic receptors
  38. Nondepolarizing NM blockers are competitve with ACh. Name suffix and how to reverse
    • -curium
    • Reverse with cholinesterase inhibitors
  39. Dantrolne treats
    • malignant hyperthermia (from succ + inhalational anesthetic)
    • NMS (antipsychotic tox)
  40. Dantrolene: MOA
    prevents release of Ca from the SR of skeletal muscle
  41. Dopamin receptor agonists for PD
    • bromocriptine, pergolide (ergot)
    • Pramipexole, ropinirole (non-ergot)
  42. Amantadine: MOA in PD
    Increase dopamine release
  43. Selegiline: MOA
    MAO-B inhibitor prevents DA breakdown
  44. Entacapone, tolcapone: MOA
    • COMT inhibitors prevent L-dopa degradation
    • entacapone works peripherally
    • tolcapone works centrally
  45. Cenztropine: MOA for PD
    • antimuscarinic to curb cholinergic activity
    • improves tremor/rigidity only
  46. Carbidopa: MOA
    peripheral decarboxylase inhibitor
  47. Memantine: MOA and use
    • Alzheimer's
    • NMDA receptor antagonist
    • Prevents excitotixicty mediated by Ca
  48. Acetylcholinesterase inhibitors for AD
    donepezil, galantamine, rivastigmine
  49. How to treat Huntington's
    • Reserpine (blocks NE transport)
    • tetrabenazine (blocks dopamine)
    • Haldol (antagonize dopamine receptor)
  50. Sumatriptan: MOA and tox
    • serotonin 1b/1d agonist cuasing vasoconstriction and CNV inhibition
    • tox: coronary vasospasm, tingling