USMLE (Subject) / Pharmacology - Neurology (Lesson)

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  • Capsaicin Irritant found in the chili pepper family.- Causes excessive activation of TRPV1 (a transmembrane cation channel), causing a buildup of intracellular calcium that results in long-lasting dysfunction of nociceptive nerve fibers (defunctionalization).- Causes release and subsequent depletion of substance P, a polypeptide neurotransmitter involved in transmission of pain signals. - On initial application, topical capsaicin causes burning, stinging, and erythema, but persistent exposure leads to a moderate reduction in pain over time. Indication: Neuropathic pain, eg, postherpetic shingles
  • Duration of action of benzodiazepines Short (half-life <6 hours):- Trizolam- Oxazepam- Midazolam Intermediate (half-life 6-24 hours):- Alprazolam- Lorazepam- Temazepam Long (half-life >24 hours)- Diazepam- Chlordiazepoxide- Flurazepam
  • Diphenoxylate Opioid structurally related to meperidine.- Binds to mu opiate receptors in the GI tract and slows motility. Use: Diarrhea
  • Memantine NMDA receptor antagonist. Helps prevent excitotoxicity (mediated by Ca2+) Use: Alzheimer Adverse effects: Dizziness, confusion, hallucinations.
  • Donepezil AChE inhibitor Use: Alzheimer Adverse effects: Nausea, dizziness, insomnia
  • Rivastigmine AChE inhibitor Use: Alzheimer Adverse effects: Nausea, dizziness, insomnia
  • Galantamine AChE inhibitor Use: Alzheimer Adverse effects: Nausea, dizziness, insomnia
  • Echothiophate Glaucoma drug Indirect cholinomimetic (M3). Inhibits AChE. ↑ outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork
  • Physostigmine Glaucoma drug Indirect cholinomimetic (M3). Inhibits AChE. ↑ outflow of aqueous humor via contraction of ciliary muscle and opening of trabecular meshwork
  • Apraclonidine Glaucoma drug α2-agonist ↓ aqueous humor synthesis Adverse effects: Blurry vision, ocular hyperemia, foreign body sensation, ocular allergic reactions, ocular pruritus.
  • Brimonidine Glaucoma drug α2-agonist ↓ aqueous humor synthesis Adverse effects: Blurry vision, ocular hyperemia, foreign body sensation, ocular allergic reactions, ocular pruritus.
  • Preferred anticonvulsants Narrow spectrum:- Carbamazepine- Gabapentin- Phenobarbital- Phenytoin→ used for focal seizures Broad spectrum:- Lamotrigine- Levetiracetam- Topiramate- Valproic acid→ used for generalized seizures
  • Lidocaine Local anesthetic (amide type)Class IB antiarrhythmic agent Adverse effects:- Slurred speech- Confusion- Tremor- Personality and mood changes- Hallucinations
  • Butorphanol Narcotic agonist-analgesic of the κ-opiate (kappa) receptor and partial agonist of the μ-opioid (mu) receptor. Pathophysiology: It inhibits the ascending pain pathways, which leads to altered sensation in response to pain, producing analgesia, respiratory depression, and sedation. Indication: - Management of moderate to severe acute pain- Balanced anesthesia, preanesthesia, preoperativ- Labor pain Side effects: sedation, nausea and vomiting, nasal congestion, dizziness, and insomnia. Absolute contraindications: Respiratory depression, opioid dependence, respiratory failure, cardiac arrhythmias
  • Meperidine Opioid analgesic Indications:- Renal colic patients, with high potency and rapid onset of action. Contraindications: Patients taking monoamine oxidase inhibitors
  • Prochlorperazine Intravenous antiemetic that blocks dopaine (D2) receptors and serotonin receptors at higher doses. Indications:- Acute migraine associated with nausea/vomiting Intravenous diphenhydramine is usually coadministered to prevent the occurence of extrampyramidal effects (eg, akathisia, dystonia)

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