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248 Cards in this Set
- Front
- Back
LDL: Friedwald equation
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LDL = TC - [HDL +(TG/5)].....not valid if TG > 400
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2ary hyperlipidemia: endocrine causes
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diabetes mellitus, hypothyroidism
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2ary hyperlipidemia: drug induced
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HIV protease inhibitors
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2ary hyperlipidemia: renal
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nephrotic syndrome
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2ary hyperlipidemia: hepatic
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cholestatic liver disease
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cholestyramine: class
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bile acid sequestrant
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cholestyramine: mechanism
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bind bile acids
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cholestyramine: dosing
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given with meals
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cholestyramine: side effects
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GI, absorption of other drugs
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cholestyramine: indications
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kids; moderate LDL 2nd line; combo therapy for bad LDL
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cholestyramine: interactions
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bind other drugs
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cholestyramine: effect on total cholesterol
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decrese
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cholestyramine: effect on LDL
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decrease
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cholestyramine: effect on HDL
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increase
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cholestyramine: effect on serum triglycerides
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no effect
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colestipol: class
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bile acid sequestrant
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colestipol: mechanism
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bind bile acids
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colestipol: dosing
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given with meals
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colestipol: side effects
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GI, absorption of other drugs
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colestipol: indications
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kids; moderate LDL 2nd line; combo therapy for bad LDL
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colestipol: interactions
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bind other drugs
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colestipol: effect on LDL
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decrease
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colestipol: effect on HDL
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increase
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colestipol: effect on serum triglycerides
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no effect
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bile acid sequestrants: mechanism
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bind bile acids
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bile acid sequestrants: 1st line which pts
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children
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bile acid sequestrants: dosing
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given with meals
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bile acid sequestrants: side effects
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GI, absorption of other drugs
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bile acid sequestrants: indications
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kids; moderate LDL 2nd line; combo therapy for bad LDL
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bile acid sequestrants: interactions
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bind other drugs
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bile acid sequestrants: effect on LDL
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decrease
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bile acid sequestrants: effect on HDL
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increase
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bile acid sequestrants: effect on serum triglycerides
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no effect
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ezetimibe: class
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cholesterol absorption inhibitors
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ezetimibe: mechanism
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inhibit cholesterol absorption at brush border of small intestine
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ezetimibe: indications
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adjunct to statins
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ezetimibe: pharmacokinetics
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prodrug absorbed and converted to active glucuronide and excreted into gut where it is active
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ezetimibe: interactions
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bound by bile acid resins
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ezetimibe: effect on LDL
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decrease (biggest effect)
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ezetimibe: effect on HDL
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no effect
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ezetimibe: effect on serum triglycerides
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decrease
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ezetimibe: predominiant serum lipid effect
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decrease LDL
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cholesterol absorption inhibitors: mechanism
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inhibit cholesterol absorption at brush border of small intestine
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cholesterol absorption inhibitors: indications
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adjunct to statins
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cholesterol absorption inhibitors: interactions
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bound by bile acid resins
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cholesterol absorption inhibitors: effect on LDL
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decrease (biggest effect)
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cholesterol absorption inhibitors: effect on HDL
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no effect
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cholesterol absorption inhibitors: effect on serum triglycerides
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decrease
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cholesterol absorption inhibitors: predominiant serum lipid effect
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decrease LDL
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gemfibrozil: class
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fibric acid derivative
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gemfibrozil: mechanism
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PPAR receptor agonist, induce TG metabolism and clearance
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gemfibrozil: indications
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high triglyceride hyperlipidemia
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gemfibrozil: interactions
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statins and gemfibrozil--risk of skeletal muscle dysfunx
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gemfibrozil: effect on total cholesterol
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decrease
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gemfibrozil: effect on LDL
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decrease (usually)
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gemfibrozil: effect on HDL
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increase
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gemfibrozil: effect on serum triglycerides
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decrease
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gemfibrozil: predominiant serum lipid effect
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reduce triglyceride containing lipoproteins
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fibric acid derivatives: mechanism
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PPAR receptor agonist, induce TG metabolism and clearance
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fibric acid derivatives: indications
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high triglyceride hyperlipidemia
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fibric acid derivatives: effect on total cholesterol
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decrease
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fibric acid derivatives: effect on LDL
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decrease (usually)
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fibric acid derivatives: effect on HDL
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increase
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fibric acid derivatives: effect on serum triglycerides
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decrease
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fibric acid derivatives: predominiant serum lipid effect
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reduce triglyceride containing lipoproteins
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Statins: mechanism
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competitive inhibition of HMG CoA reductase; upregulation of LDL receptors; decreased de novo cholesterol and VLDL
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Statins: 1st line which pts
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hypercholesterolemia w/ increased LDL
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Statins: excretion
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metabolized by liver and excreted in bile
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Statins: metabolism
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metabolized in liver, big 1st pass effect
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Statins: adverse effx
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skeletal muscle dysfnx--risk increased with gemfibrozil or CYP 3A inhibitors
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lovastatin: class
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statin
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lovastatin: mechanism
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competitive inhibition of HMG CoA reductase; upregulation of LDL receptors; decreased de novo cholesterol and VLDL
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lovastatin: dosing
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given with food to enhance absorption
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lovastatin: excretion
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metabolized by liver and excreted in bile
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lovastatin: metabolism
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metabolized in liver, big 1st pass effect
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HMG CoA reductase: fnx
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regulatory enzyme in cholesterol biosynthesis
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Niacin: chemistry
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nicotinic acid
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Niacin: mechanism
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complex: affects synthesis and metabolism of cholesterol and triglycerides
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Niacin: adverse effx
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flushing from PGD2 release (aspirin alleviates)
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niaspan: class
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controlled release niacin
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niaspan: 1st line which pts
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familial hyperlipidemia w/ inc VLDL and LDL, and in hyperlipoprotenemias with elevated VLDL
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Strychnine : class
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analeptic/conglusant
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Strychnine : mechanism
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inhibits GABA in CNS
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Strychnine : adverse effx
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tonic extensino of body and limbs
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Strychnine : tx of poisoning
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diazepam
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picrotoxin: class
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analeptic/conglusant
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picrotoxin: mechanism
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inhibits Glycine in spine
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picrotoxin: adverse effx
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generalized tonic clonic
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picrotoxin: tx of poisoning
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diazepam
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caffeine: class
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methylxanthines stimulatant
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caffeine: mechanism
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action at adenosine receptors (A1 and A2)
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theophylline: class
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methylxanthines stimulatant
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theophylline: mechanism
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action at adenosine receptors (A1 and A2)
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theobromine: class
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methylxanthines stimulatant
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theobromine: mechanism
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action at adenosine receptors (A1 and A2)
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amphetamine: mechanism
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promotes release of NE and DA; inhibits reuptake
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amphetamine: indications
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narcolepsy, ADD, weight loss
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amphetamine: route
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oral
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amphetamine: time to peak plasma conc
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1 to 3 hours
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amphetamine: urine pH and clearance
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high pH, metabolic; low pH, urine
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cocaine: mechanism
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blocks reuptake of NE, DA, and 5HT
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cocaine: half life
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~ half hour
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cocaine: Spanish
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la cocaína
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cocaine: French
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la cocaïne
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cocaine: Arabic
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الكوكائين
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cocaine: Chinese
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可卡因(kěkǎyīn)
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nonamphetimine: narcolepsy
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modafinil
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nonamphetimine: ADD
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methylphenidate
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nonamphetimine: weight loss
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fenfluaramine, phentermine
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ergot compounds (LSD): class
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indolalkylamine, chemically related to 5HT
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indolamines: class
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indolalkylamine, chemically related to 5HT
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beta carboines: class
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indolalkylamine, chemically related to 5HT
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mescaline: class
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phenylethylamine, chemically related to dopamine
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amphetamine derivatives: class
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phenylethylamine, chemically related to dopamine
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LSD: half life
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3 hours
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psylocybin: class
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indolalkylamine resembling serotonin. Tryptamine derivative
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hallucinagens: mechanism
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agonists of 5HT(2A) subtype
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hallucinagens: tolerance
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yup
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hallucinagens: physical dependence
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nope
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Phencyclidine : mechanism
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blocks NMDA receptors (subset of glutamate receptors)
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benzodiazepine: mechanism
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enhance GABA-ergic transmission, self limiting effect
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benzodiazepine: side effects
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decreased alertness, ataxia (problem for elderly, hp fx)
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benzodiazepine: tolerance
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yeah
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benzodiazepine: physical dependence
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yeah
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benzodiazepine: effect on dose resonse curve of GABA
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increased potency, unaffected efficacy
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benzodiazepine: antidote
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Flumazenil
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diazepam: class
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benzodiazepine
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diazepam: trade name
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valium
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chordiazepoxide: class
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benzodiazepine
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chordiazepoxide: trade name
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librium
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lorazepam: class
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benzodiazepine
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lorazepam: excretion
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glucoronidation
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lorazepam: trade name
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ativan
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lorazepam: duration
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short
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midazolam: class
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benzodiazepine
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midazolam: excretion
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hydroxylation and glucoronidation
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midazolam: trade name
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versed
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midazolam: duration
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short
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buspirone: mechanism
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erotonergic agonists acting at the 5HT1A
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buspirone: clinical effect
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anti anxiety
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Zolpidem : clinical effect
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sleep aid
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ethanol: cytochrome intx
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augments metabolism of CYP 450
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methanol: antidote
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4-methylpyrazole, and ethanol
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methanol: toxicity
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anion gap acidosis, blindness
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ethelyne glycol: toxicity
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oxalate crystals in urine, anion gap acidosis
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delirium tremens: tx
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diazepine, (watch out diazepam if liver disease)
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Chlorpromazine : class
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phenothiazine and related antipsychotic
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reserpine: class
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rauwolfia alkaloids antipsycotic
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reserpine: mechanism
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blockade of D2 receptors
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neuroleptics: effect at reticular activating system
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depression
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neuroleptics: effect at mesolimbic dopamine system
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reduction in psychosis
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neuroleptics: effect at mesocortical system
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increased negative sx of schizo
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neuroleptics: effect at nigrostriatal system
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parkinsonian like sx
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neuroleptics: effect at hypothalamus
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poikilothermia, increase prolactin
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neuroleptics: time till effect
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3-6 weeks
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neuroleptics: neuroleptic malignant syndrome characteristics
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muscular rigidity; fever; elevated CPK
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haloperidol: class
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depot antipsychotic
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risperidone microspheres: class
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depot antipsychotic
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depot antipsychotic: advantages
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compliance not problem
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depot antipsychotic: disadvantages
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increased risk of side effx
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neuroleptic malignant sydrome: tx
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datrolene, fever reduction, keep 'em alive
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typical antipsychotics: lipid solubility
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highly protein bound
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typical antipsychotics: protein binding
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0.9
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clozapine: class
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atypical antipsychotic
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clozapine: mechanism
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blockade of 5HT2a/2c, which stimulates dopamine release in mesolimbic area
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clozapine: side effects
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agranulocytosis
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Risperidone : class
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atypical antipsychotic
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Risperidone : 1st line which pts
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Mixed D2 - 5HT2a effects (most prominent D2 of atypical class)
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Olanzapine : class
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atypical antipsychotic
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Olanzapine : 1st line which pts
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Receptor binding affinity almost identical to clozapine (5HT2a, weak D2)
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Aripiprazole : class
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atypical antipsychotic
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Aripiprazole : 1st line which pts
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D2 partial agonist
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phenelzine : class
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Hydrazines MAO inhibitor
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phenelzine : side effects
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hypotension, antisymp sx; tyramine induced hypertension
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tranylcypromine : class
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nonhydrazine MAO inhibitor
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tranylcypromine : side effects
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hypotension, antisymp sx; tyramine induced hypertension
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MAO inhibitor: side effects
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hypotension, antisymp sx; tyramine induced hypertension; fat, can't fuck
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MAO inhibitor: indications
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depresssion and anxiety disorders
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MAO inhibitor: interactions
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central serotonin syndrome, central symp sydrome, reduced metabolism some drugs
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MAO inhibitor: inhibit metabolism of
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pseudoephedrine, phenylpropanolamine; meperidine
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amitryptyline: class
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tricyclic
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amitryptyline: mechanism
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block monoamine reuptake
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amitryptyline: side effects
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cholinergic blockade; a1 receptor inhibition (orthostatic hypo); histamine blockade (drowsy, weight gain), extra symp (cant fuck
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amitryptyline: indications
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depresssion and anxiety disorders
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nefadazone: class
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heterocyclic
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nefadazone: mechanism
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block monoamine reuptake
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nefadazone: side effects
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cholinergic blockade; a1 receptor inhibition (orthostatic hypo); histamine blockade (drowsy, weight gain), extra symp (cant fuck
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nefadazone: indications
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depresssion and anxiety disorders
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nefadazone: cytochrome metabolism
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CYP P450 3A4 (cyclosporine)
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fluoxetine: class
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SSRI
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fluoxetine: mechanism
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block serotonin reuptake
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fluoxetine: side effects
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cholinergic blockade; a1 receptor inhibition (orthostatic hypo); histamine blockade (drowsy, weight gain), extra symp (cant fuck
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fluoxetine: indications
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OCD
|
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fluoxetine: cytochrome metabolism
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CYP P450, competitively inhibit (inc beta blockers)
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sertaline: class
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SSRI
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sertaline: mechanism
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block serotonin reuptake
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sertaline: side effects
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cholinergic blockade; a1 receptor inhibition (orthostatic hypo); histamine blockade (drowsy, weight gain), extra symp (cant fuck
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sertaline: indications
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depression, panic
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sertaline: cytochrome metabolism
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CYP P450, competitively inhibit (inc beta blockers)
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paroxetine: class
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SSRI
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paroxetine: mechanism
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block serotonin reuptake
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paroxetine: side effects
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cholinergic blockade; a1 receptor inhibition (orthostatic hypo); histamine blockade (drowsy, weight gain), extra symp (cant fuck
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paroxetine: indications
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OCD
|
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paroxetine: cytochrome metabolism
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CYP P450, competitively inhibit (inc beta blockers)
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tricyclic & related with dopamine blockade: side effects
|
more psychosis
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tricyclics: heart side efx
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Ia antiarrhythmics, AV block
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SSRIs: cytochrome metabolism
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CYP P450, competitively inhibit (inc beta blockers)
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Lithium: class
|
mood stabalizer
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Lithium: mechanism
|
inhibit Gs proteins and antagonize phospholipase C (probably)
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Lithium: side effects
|
hypothyroidism (weight gain); polydypsia, interstitial nephritis; heart conduction problems; birth defects
|
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Lithium: indications
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typical bipolar I
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Lithium: interactions
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diuretics decrease clearance; NSAIDS increase plasma level (not aspoirin); neuromuscular drugs potentiated
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Lithium: contraindx
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sick sinus synd; pregnancy
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Lithium: alternatives in biopolar
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Carbamazepine; divalproex; olanzapine
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carbamazepine: class
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mood stabalizer
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carbamazepine: mechanism
|
inhibit Gs proteins and antagonize phospholipase C (probably)
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divalproex: chemistry
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valproic acid
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divalproex: class
|
mood stabalizer
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divalproex: mechanism
|
inhibit Gs proteins and antagonize phospholipase C (probably)
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divalproex: indications
|
bipolar i and ii
|
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Olanzapine : class
|
mood stabalizer
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Olanzapine : mechanism
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inhibit Gs proteins and antagonize phospholipase C (probably)
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fast pain: fiber type
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A delta (myelinated)
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slow pain: fiber type
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C (unmyelinated)
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hyperalgesia/allodynia: involved nerurecepter type in dorsal horn neurons
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substance P receptor (NMDA(
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analgesia: involved nerurecepter type in dorsal horn neurons
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mu opiate receptor; alpha 2 adrenergic
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endomorphins: involved nerurecepter type in dorsal horn neurons
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mu opiate receptor
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morphine: class
|
opiate
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morphine: mechanism
|
binds mu opiate receptor
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morphine: side effects
|
itcing (histamine release); puking
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morphine: involved nerurecepter type in dorsal horn neurons
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mu opiate receptor
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morphine: effect at D2 receptors
|
agonist
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morphine: first pass effect
|
stupid big
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morphine: bioavailability
|
under 50%
|
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codeine: class
|
opiate
|
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codeine: bioavailability
|
0.7
|
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meperidine: class
|
opiate
|
|
meperidine: side effects
|
neurotoxicity; only short term
|
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meperidine: indications
|
p
|
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meperidine: contraindx
|
end stage renal failure
|
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fentanyl: class
|
opiate
|
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methadone: class
|
opiate
|
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naloxone: class
|
opiate antagonist
|
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naloxone: indications
|
opiate toxicity
|
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naloxone: duration
|
under hour
|
|
opiate overdose: signs
|
miosis (small pupils); slow, shallow resp; coma
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opiate overdose: tx
|
naloxone
|
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status epilepticus: best tx
|
lorazepam followed by fosphenytoin
|