Melatonin is just cheap acid
A 45‑year‑old man abruptly stops taking alprazolam after 4 months of daily use. Two days later he presents with tremors, anxiety, photophobia, and severe insomnia. Which property of alprazolam explains the severity of his withdrawal?
A. It has active metabolites with long half‑lives
B. It is short‑acting
C. It is metabolized outside the liver
D. It has no effect on sleep architecture
E. It is a partial agonist at GABAA receptors
B. It is short‑acting
Slide 11
This vitamin is very important for regenerating reduced vitamin E after it has been oxidized
Bonus: This other enzyme can also assist in recycling Vitamin E
What is vitamin C?
Slide 19
Bonus: CoQ10
This is the most common viral causative agent of encephalitis
What is HSV-1?
Slide 23
Involves the temporal and frontal lobes -> psychiatric features, memory deficits, aphasia
Carbamazepine has this effect on CYP3A4, leading to things like oral contraceptives not working
What is induce?
Slide 13
Highest risk of DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms)
What is expansion?
Slide 15
A 76‑year‑old woman takes an over‑the‑counter medication for insomnia. She becomes confused, has difficulty urinating, and complains of blurry vision. Which mechanism best explains these adverse effects?
A. Blockade of H1 receptors
B. Blockade of α2 receptors
C. Blockade of muscarinic receptors
D. Activation of MT1 and MT2 receptors
E. Blockade of orexin receptors
C. Blockade of muscarinic receptors
Remember that diphenhydramine and doxylamine have anticholinergic effects
Slide 25
This enzyme protects neurons by using glutathione to detoxify hydrogen peroxide
What is Glutathione peroxidase?
Slide 16
An MRI of a patient presenting with Eastern equine or Japanese encephalitis virus will show focal lesions in these locations (name 1 of the 3)
What are the basal ganglia, thalamus, and brainstem?
Slides 4 and 10
This is the first-line treatment for absence seizures
What is Ethosuximide?
Slide 24
Succinylcholine can't be broken down by AchE and is instead inactivated by this
What is pseudocholinesterase?
Slide 21
Mutations here lead to prolonged succinylcholine duration of action
A 33‑year‑old woman is prescribed a medication for sleep‑onset insomnia. She reports improved sleep but says she occasionally wakes up to find food missing from her kitchen with no memory of eating. Which drug most likely caused this effect?
A. Zaleplon
B. Temazepam
C. Ramelteon
D. Trazodone
E. Suvorexant
A. Zaleplon
Z-hypnotics can have side effects associated with complex sleep behaviors (e.g. sleep eating)
Slide 23
SOD2 is present in this part of the cell
Bonus: What are the two co-factors for SOD2
What is the mitochondria?
Slide 14
Bonus: Fe and Mn
SOD1: Cytoplasm; Cu and Zn
SOD3: Extracellular
This is the only arbovirus with clear sexual transmission
What is Zika virus?
Slide 16
Can lead to Guillain-Barre syndrome; microcephaly in neonates (first trimester infection = highest risk)
Exam clue: Ascending paralysis after viral illness + travel history
This antiseizure drug carries the highest risk out of any antiseizure drug of causing Stevens-Johnson syndrome
What is Lamotrigine?
Slide 20
Lamotrigine and Levetiracetam carry the lowest teratogenic risk
Along than sugammadex, this class of drugs is used to reverse non-depolarizing blockades of the NMJ
What are acetylcholinesterase inhibitors?
Neostigmine, pyridostigmine
Slide 20 answer to blank
A 54‑year‑old woman is brought to the ED after being found minimally responsive next to several empty pill bottles. Her pupils are normal, respirations are shallow, and she withdraws to pain. Her husband reports she takes diazepam for anxiety and amitriptyline for depression. The team considers giving a medication to reverse benzodiazepine effects, but the toxicologist warns that administering it could precipitate life‑threatening seizures. Which medication is being discussed?
A. Naloxone
B. Suvorexant
C. Physostigmine
D. Buspirone
E. Flumazenil
E. Flumazenil
Slide 16
Elevated levels of this, along with MDA, indicate that free radicals are stripping electrons from cell membrane fats
What is 4-HNE?
Slide 20
This is the classical triad of congenital toxoplasmosis
What are chorioretinitis, hydrocephalus, and cerebral calcifications?
Slide 34
Long-term use of this drug can lead to gingival hyperplasia
What is phenytoin?
Slide 10
Zero-order kinetics; induces P450 enzymes
This general anesthetic has minimal impact on blood pressure and is thus used in hemodynamically unstable patients
What is Etomidate?
Slide 8
Can lead to adrenal insufficiency with long-term use
A 42‑year‑old woman with generalized anxiety disorder is switched from clonazepam to a medication that her psychiatrist describes as “non‑sedating, non‑addictive, and safe to use while driving.” After three weeks, she reports only minimal improvement in her symptoms. She denies drowsiness, memory impairment, or any change in sleep quality. Which receptor is the primary target of this drug?
A. GABAA receptor
B. GABAB receptor
C. 5‑HT1A receptor
D. α2 adrenergic receptor
E. MT1 receptor
C. 5‑HT1A receptor
Buspirone is a partial agonist; slow onset of action
Slide 17
Tocopherols enter the brain through this receptor
What are SR-B1 receptors?
Slide 22
A clinical feature of this congenital infection is a "blueberry muffin" rash
What is CMV?
Slide 44
Valproate inhibits these two metabolic processes?
What are CYP2C9 and glucuronidation?
Slide 15
Most teratogenic antiseizure drug
Ketamine is used in patients with these two conditions
What are cardiovascular issues and asthma?
Slide 9
Used in children