Name the muscular derivatives of the first pharyngeal arch.
Four muscles of mastication:
3) Lateral pterygoid
4) Medial pterygoid
Anterior belly of the digastric muscle
Tensor veli palantini
Name the skeletal derivatives of the first pharyngeal arch.
The derivatives of the first pharyngeal arch are innervated by what nerve?
V3 of the trigeminal nerve
Name the muscular derivatives of the second pharyngeal arch.
Muscles of facial expression:
2) Orbicularis oris
Posterior belly of the digastric
Name the skeletal derivatives of the second pharyngeal arch.
Superior part of the hyoid, sttyloid process, stapes
What nerve innervates the derivatives of the second pharyngeal arch?
What nerve innervates the third arch?
What is the muscular derivative of the third arch?
What is the skeletal derivative of the third arch?
Inferior part of the hyoid
What is the muscular derivative of the fourth arch?
Cricothyroid, innervated by the superior laryngeal (external branch) of the vagus nerve
Levator veli palatini
All innervated by the pharyngeal branches of the Vagus
What is the skeletal derivative of the fourth arch?
What drug do we avoid in closed-angle glaucoma?
What is the MOA of epinephrine in glaucoma treatment?
Decreases aqueous humor synthesis due to vasoconstriction, causes mydriasis and stinging, contraindicated in closed-angle glaucoma
What is Brimonidine used for?
Alpha-agonist used in the treatment of glaucoma, decreases aqueous humor synthesis
What beta-blockers are used in glaucoma treatment?
Timolol, betaxolol, cartelol
How does acetazolamide treat glaucoma?
carbonic anhydrase inhibitor which will decrease aqueous humor secretion due to decreased HCO3-
What direct cholinomimetics are used in the treatment of glaucoma?
pilocarpine and carbachol: increase the OUTFLOW of aqueous humor, contract ciliary muscle and open the trabecular meshwork.
What drug do we use in glaucoma EMERGENCIES?
Pilocarpine. Very effective in opening meshwork into canal of schlemm.
What are the side-effects of the cholinomimetic glaucoma drugs?
miosis, and cyclospasm (contraction of the ciliary muscle in the eye, in the accommodation of focus for near vision)
How does Latanoprost treat glaucoma?
increases outflow of aqueous humor, a prostaglandin PGF2alpha
Which glaucoma drug causes browning of the iris?
What are the indirect cholinomimetics used to treat glaucoma?
physostigmine, echothiophate:increase the OUTFLOW of aqueous humor, contract ciliary muscle and open the trabecular meshwork.
Meperidine, dextromethorphan, diphenoxylate are examples of what class of drug?
MOA of opioid analgesics?
agonists at opioid receptrs, modulate synaptic transmission, open potassium channels, close calcium channals --> decreases synaptic transmission --> inhibit release of ACh, NE, 5-HT, glutamate, substance P
What drug do we use to suppress cough?
What opioid drug do we use to treat diarrhea?
What drug is used as a maintenance program for opioid addicts?
What neurotransmitter acts at kappa opioid receptors?
Respiratory depression, constipation, miosis (pinpoint pupils). What symptoms of opioid overdose do NOT develop tolerance?
miosis and constipation
How do you treat opioid OD?
naloxone or naltrexone
What is the MOA of butorphanol?
Partial agonist at mu receptors, agonist at kappa. Withdrawal symptoms if on FULL opioid agonist
MOA of tramadol?
weak opioid agonist that inhibits serotonin and NE reuptake for chronic pain. DECREASES SEIZURE THRESHOLD
What drug is first line for simple partial seizures?
What drug is first line for complex partial seizures?
What drug is first line for trigeminal neuralgia?
What drug is first line for generalized tonic-clonic seizures?
What drug is first line for status epilepticus PROPHYLAXIS?
What drug is first line for ACUTE status epilepticus?
Benzodiazepines (lorazepam or diazepam)
How do you treat seizures of eclampsia?
1st MgSO4, then benzodiazepines
Three drugs are listed as first line for generalized tonic clonic seizures. List them.
Phenytoin, carbamezapinem, valproic acid
Which antiseizure drug can be used for both peripheral neuropathy and bipolar disorder?
What is first line for generalized absence seizures?
What is the MOA of Ethosuximide?
Blocks thalamic T-type calcium channels
What is the MOA of benzos?
increased GABAa action
What is the MOA of topiramate?
blocks sodium channels and increases GABA action
What drug is used for myoclonic seizures?
Which antiepileptic causes dose-related thrombocytopenia?
What is the MOA of gabapentin?
inhibits HVA calcium channels
What is the MOA of phenytoin?
increase sodium channel inactivation
What is the MOA of carbamezapine?
increased sodium channel inactivation
What is the MOA of lamotrigine?
blocks voltage gated sodium channels
Patient with excess orotic acid in urine and megaloblastic anemia. What is the defect?
Orotic aciduria, can be either orotic acid phosphoribosyltransferase or orotidine 5'-phosphate decarboxylase (AR)
Hydrocephalus will present with what signs in a neonatal?
UMN from stretching of the periventricular corticospinal tracts
AA patient with Inferior wall MI now has right sided eye pain. What happened?
inferior wall MI --> bradycardia from involvement of the AV node --> treat with atropine --> atropine causes mydriasis which can narrow the anterior chamber and rick glaucoma in patients with increased intraocular pressure. AAs are at a higher risk for Open/wide angle glaucoma (silent)
What side effect is cause for discontinuation of lamotrigine?
What drug causes hypothyroidism in mood disorder patients?
What drug can be given as a mood stabilizer and for SIADH?
What are the side effects of benzodiazepines?
Sedation, tolerance, dependence
What are the side effects of carbamazepine?
Diplopia, ataxia, blood dyscrasias (agranulocytosis, aplastic anemia), liver toxicity, teratogenesis, induction of cytochrome p450, SIADH, stevens-johnson syndrome
What are the side effects of ethosuximide?
GI distress, fatigue, headache, urticaria, Steven-Johnson syndrome (EFGH - Ethosyximide, Fatigue, Gi, Headache)
What are the side effects of Phenobarbital?
Sedation, tolerance, dependence, induction of cytochrome P-450
What are the side effects of Phenytoin?
Nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hirsutism, megaloblastic anemia (prevents folate absorption), fetal hydantoin syndrome, SLE-like syndrome, induction of p450, peripheral neuropahty, hirsutism
What are the side effects of Valproic acid?
GI distress, rare but fatal hepatotoxicity (measure LFTs), neural tube defects in fetus (spina bifida), tremor, weight gain. Contraindicated in pregnancy. Alopecia, pancreatitis, thrombocytopenia.
What are the side effects of Lamotrigine?
What are the side effects of Topiramate?
Sedation, mental dulling, kidney stones, weight loss
What are the side effects of Primidone?
Metabolized to phenobarbital and phenyethylmalonamide (both active anticonvulsants, increased levels of phenobarbital in blood.. look for the phenobarb side effects like sedation, tolerance, dependence, induction of cytochrome p450
What is the MOA of phenytoin?
use-dependent blockade of Na+ channels; increased refractory period, inhibition of glutamate release from excitatory presynaptic neuron
What are the side effects of phenobarbital, pentobarbital, thiopental, secobarbital?
De[endence, additive CNS depression with alcohol, respiratory or CV depression, drug interaction from induction of p450.
How do you treat an overdose of phenobarbital?
Symptom management, assist respiration and increase BP
35 y.o. hospitalized with headaches and vomiting. She's known for her eccentric eating habits. Physical exam shows dry skin, papilledema, and hepatosplenomegally. Dx?
Vitamin A toxicity.
Patient with low self-esteem since high school. Does not have any problems with others. Took her 3 weeks to schedule an appointment for the doctor because she was afraid the receptionist wouldn't like her. What personality disorder?
Avoidant: hypersensitive to rejection, socially inhibited, timid feelings of inadequacy, desires relationships with others
Patient previously hospitalized with psychosis now has parkinson-like symptoms. What do you give?
Give Benztropine, an anticholinergic to help with the tremor. Dopamine agonists should be avoided as they cause precipitation of symptoms