Pharm 3 - Neuro

gsafsaf's version from 2015-05-22 19:36

Seizure Meds

Question Answer
PhenytoinBlock sodium channels
CarbamazepineBlock sodium channels
LamotrigineBlock sodium channels
Valproic acidBlock sodium channels
Blocking sodium channelsDecreases action potential generation in neurons
Increasing GABA activityDecreases neuronal excitability + seizure activity
GabapentinIncreases GABA activity
PhenobarbitalIncreases GABA activity
Valproic acidIncreases GABA activity
BenzodiazepinesIncreases GABA activity
TigabineIncreases GABA activity
VigabatrinIncreases GABA activity
LevetiracetamIncreases GABA activity
Blocking T-type calcium channels Decrease neuronal action potentials
GabapentinBlock T-type calcium channels
EthosuximideBlock T-type calcium channels
Phenytoin (high doses)Block T-type calcium channels
EthosuximideDrug of choice for absence seizures
Valproic Acid2nd line for absence seizures
BenzodiazepinesDrug of choice for status epilepticus
Magnesium sulfateEclampsia seizure
PhenytoinGingival hyperplasia
PhenytoinFetal hydantoin syndrome
Fetal hydantoin syndromecleft lip/palate, congenital heart disease, mental/dvlpmtl delay
PhenytoinMegaloblastic anemia
PhenytoinPeripheral neuropathy
PhenytoinDrug-induced lupus
PhenytoinSteven-Johnson's syndrome
Valproic acidTeratogenic
Carbamazepine Teratogenic
Valproic acidCan cause spina bifida in fetus
EthosuximideSteven-Johnson's syndrome
LamotrigineSteven-Johnson's syndrome
CarbamazepineSteven-Johnson's syndrome
Phenobarbital Steven-Johnson's syndrome
Valproic acidHepatic toxicity
CarbamazepineHepatic toxicity
PhenytoinP450 inducer
PhenobarbitalP450 inducer
Topiramate Block sodium channels
CarbamazepineTreats trigeminal neuralgia
PhenytoinRx for tonic-clonic seizure
Valproic acidRx for tonic-clonic seizure
Carbamazepine Rx for tonic-clonic seizure

Inhaled anesthetics

Question Answer
The more potent the anesthetic, the _____ its lipid solubilityhigher
The more rapid the anesthetic's onset, the _____ its blood solubility lower
Nitrous oxideLow blood solubility (more rapid onset)
Nitrous oxideLow lipid solubility (less potent)
HalothaneHigh blood solubility (slower onset)
SevofluraneLow blood solubility (more rapid onset)
DesfluraneLow blood solubility (more rapid onset)
SevofluraneHigh lipid solubility (more potent)
DesfluraneHigh lipid solubility (more potent)
IsofluraneHigh blood solubility (slower onset)
Halothane Liver toxicity - not used much anymore
HalothaneHigh lipid solubility (more potent)
Nitrous oxideInhaled Anesthetic
HalothaneInhaled Anesthetic
DesfluraneInhaled Anesthetic
SevofluraneInhaled Anesthetic
IsofluraneInhaled Anesthetic

IV anesthetics

Question Answer
Sedative, but not much analgesia (not including opiods)IV anesthetic
PropofolIV anesthetic
KetamineIV anesthetic
BarbituatesIV anesthetic
BenzodiazepinesIV anesthetic
OpiodsIV anesthetic
PropofolRapid onset (15 to 20 seconds)
PropofolIV drip can be used to maintain anesthesisia
PropofolHigh tryglyceride content - don't want pt on it for days - risk of pancreatitis
KetaminePCP analog
KetamineDissociative anesthetic (pt seems aware but is not)
KetamineIncreases cerebral blood flow
KetamineMay cause hallucinations at high doses
Barbituates Decrease cerebral blood flow (good for brain surgery)
Barbituates Keep GABA receptor CL- channels open LONGER - facilitates inhibitory effects of GABA
BarbituatesNo great antidote - need overdose to treat symptomatically
BenzodiazepinesDecrease Stage N3 sleep
BenzodiazepinesIncrease FREQUENCY of GABA receptor CL- channel opening - facilitates inhibitory effects of GABA
MidazolamBenzodiazepine often used for conscious sedation for short procedures
Mixing Opiods + Benzodiazepines Synergistic effect
Opiod receptor for ß-endorphin Mu receptor
Opiod receptor for Enkephalin Delta receptor
Opiod receptor for DynorphinKappa receptor
ButorphanolCauses less respiratory depression
DextromethorphanCough suppressant
Tramadol "Non-addictive" opiod analgesic
LoperimideAntidiarrheal opiod
DiphenoxylateAntidiarrheal opiod

Nerve blockers

Question Answer
SuccinylcholineOnly depolarizing neuromuscular blocker - nicotinic agonist so muscle does polarize initially - can see fasciculations
Tubocurarine, Atracurium, RocuroniumNondepolarizing neuromuscular blockers
Competitive inhibitors of post synaptic nicotinic ACh receptors on NMJ Nondepolarizing neuromuscular blockers
Phase I block of SuccinylcholineNormal dose, lasts about 10 minutes, cannot be antagonized
Phase II block of SuccinylcholineLarger dose, last longer, effects look like non depolarizing neuromuscular blocker, can be antagonized by cholinesterase inhibitors
SuccinylcholinePotential for malignant hyperthermia
Lidocaine, Procaine, CocaineLocal anesthetics - block Na+ channels - blocks neuronal action potential - do NOT work well in acidic tissue - give w local vasoconstrictor in tissues w collateral blood flow
Small diameter + myelinated nerve fibersMore susceptible to local anesthetics
Large diameter + un-myelinated nerve fibersLess susceptible to local anesthetics
Minimal alveolar concentrationcorrelates with the potency of an inhaled anesthetic

Movement Disorder Rx

Question Answer
LevadopaDopamine precursor that crosses BBB; Parkinson's
What effect does the conversion of L-dopa in the periphery (before it reaches CNS) have?HTN, Arrhythmias, Hallucinations, Psychosis
CarbidopaInhibits dopamine decarboxylase enzyme in perihphery, so that L-dopa can make it to CNS; Parkinson's
BromocriptineDopamine receptor agonist; Ergot - HTN
Pramipexole + RopiniroleNon-ergot dopamine receptor agonists, Parkinson's
AmantadineIncreases Dopamine release and inhibits Dopamine reuptake; once used as antiviral, Parkinson's
SelegilineMAO-B inhibitor - blocks Dopamine breakdown, Parkinson's
RasagilineMAO-B inhibitor - blocks Dopamine breakdown, Parkinson's
EntacaponeCOMT inhibitor - blocks Dopamine breakdown, Parkinson's
Tolcapone COMT inhibitor - blocks Dopamine breakdown, Parkinson's
BenztropineAnti-muscarinic; Parkinson's assctd w increased ACh; anti-muscarinics will treat tremor bot not bradykinesia
Deep Brain Stimulationoverstimulate subthalamic nucleus to combat hypokinesis, Parkinson's
TetrabenazineBlocks Dopamine release for Huntington's