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72 Cards in this Set
- Front
- Back
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What is the effects of initial use of drug versus prolong use of drug?
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Initial use of drug have different effect to drug is taken chronically/ prolong use of drug.
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What increase the therapeutic effects of CNS?
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Antipressants and onset of action
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What decrease the side effect in using drug for seizure?
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Phenobarbital and sedative side effects.
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What happen to drug tolerance of CNS adaption?
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Decreased response when prolong drug use
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What happen to physical dependence of CNS adaption?
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Precipitate withdrawal reaction if discontinuation of drug use.
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What CNS drug act on?
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Brain and spinal cord
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What does CNS drug treat?
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Medical use:
Psychiatric Disorder Suppress seizure Pain relief Production of anesthesia Non-medical Use: Stimulant Depressant Euphoriant |
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What are the 3 neurotransmitter for the peripheral NS?
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Acetylcholine
norepinephrine epinephrine CNS have at least 21 compound that act on neurotransmitter |
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What are the CNS Neurotransmitter of Monoamines?
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Dopamine
Epinephrine Nonepinephrine Serotonin |
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What are the CNS Neurotransmitter of Amino acids?
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Aspartate
GABA Glutamate Glycine |
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What is the CNS transmitter of Opioid Peptides?
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Dynorphins
Endorphins Enkephalins |
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What is the CNS transmitter of Purines?
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Adenosine
Adenosine monophosphate Adenosine triphosphate |
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What is the CNS transmitter of Nonopioid peptides?
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Vasopressin
Oxytocin Neurotensin Somatostatin Substance P |
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What other CNS transmitter?
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Acetylcholine
Histamine |
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What are the limitation of BBB?
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Lipid soluble drug
Protein bound Ionized drug |
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What is the function of BBB?
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Protect from toxic substance
BBB not fully develop at birth or infant |
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Define Epilepsy.
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Recurrent seizure
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Define seizure?
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Abnormal, disorderly discharge of the brain's nerve cell.
Lead to temporary disturbance of motor, sensory, or mental function |
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When happening during seizure?
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Electrical discharge from a focus spread to other areas of the brain.
Type of seizure depend on the location of neuronal connection to the focus. Found in infancy, childhood, adolescence, and old age |
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What can increase the risk of epilepsy?
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Biochemical/ transmitter disorder of the brain.
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What may also result of seizure?
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Birth trauma
Perinatal injuries Congenital malformations Hypoxia at birth Accidents Head injuries Encephalitis Brain tumors Abcesses or infections Nutritional disorders Alcohol withdrawal, Circulatory disturbances Drug interaction |
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Define Primary Idiopathic Epilepsy.
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Seizure activity where there is no known cerebral
50% Seizure is Idiopathic |
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What happen if the first seizure occur after age 21?
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Seizure being secondary to an organic or metabolic significantly high
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Define Partial Seizures?
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Neuronal firing to a limited part of the brain
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What are the three type of Partial Seizure?
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Simple partial seizures
- 1-2 mins; no impair consiousness; start w/ left arm go to Left Leg then go to Right arm. Complex partial seizures - Start simple partial sz and loss of consciousness at onset Secondary generalized seizure - can be Simple and Complex + generalized tonic - clonic sz |
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Absence sz (Petit Mal)
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Mild clonic movement
Brief LOC 10-20sec 4-8 age |
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Atypical Absence Sz
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Lennox-Gastaut syndrome
5-30 second before 6 yrs |
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Myoclonic SZ
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Single/ Multiple short contraction
1-5 second Late childhood |
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Tonic-Clonic SZ
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Vague aura, LOC, amnesia
10-30sec, fall on the ground Any age |
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Status Epilepticus
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2 or more Seizure w/o full recovery of consciousness
30-60 min Any age |
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Atonic Sz
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Loss of Muscle tone; drop attack
10-30 sec Infants and children |
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Tonic SZ
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Altered LOC
Ocular phenomena 30sec - 1 mins Any age |
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Clonic SZ
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Repetitive clonic jerk, symmetical/asymmetrical
Early childhood |
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Unclassified seizure
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neonatal sz rhythmic eyes movement, chewing, swimming
10-30sec |
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How Antiepileptic Drugs work?
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Suppress discharge of neuron w/in sz focus
Suppress propagation of SZ activity from focus to other area of the brain |
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What is the mechanism of Antiepileptic Drug work?
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Suppression of Na influx
Suppression of Ca influx Antagonism of glutamate - primary excitatory transmitter Potentiation of GABA -inhibitory transmitter |
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What are the treatment goal and treatment?
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Treatment:
Neurosurgery Vagal Nerve stimulation Ketogenic diet - high fat, low CHO Diagnosis and drug selection Drug evaluation |
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What are therapeutic consideration of epilepsy?
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Monitoring plasma drug levels
Promoting patient adherence w/drawing antiepileptic drug Suicide risk |
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What are the classification of Antiepileptic drugs (AED)?
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Traditional AED's:
Phenytoin, Carbamazepine, Valportic Acid Newer AED's: Oxcarbazepine, Gabapentin, Zonisamide |
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Phenytoin (Dilantin)
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Treat: Partial sz & Tonic-Clonic sz
Routes: ORAL, IV, IM (Rare) Action: Stablilizes Na channel Half life: 8-60 hours SE: Nystagmus (Eyes twigging) Sedation; Ataxia; Diplopia (double vision); Cognitive impairment; Gingival hyperplasia - over growth of gum); Skin Rash; Pregnancy category D drug Drug Interaction: Decrease effect w/ oral contraceptives, warfarin, glucocrticoids Increase effect w/ diazepam, isoniazid, cimetidine, alcohal, and valporic acid |
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Carbamazepine/ Tegretol
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Treat: Epilepsy, Bipolar disorderand trigeminal neuralgia
SE: nystagmus, ataxia, leukopenia, anemia, thrombocytopenia, birth defect, rash, photosensitivity |
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Valporic Acid (Depakene, Depakote, Depacon)
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Use: Seizure disorder, Bipolar disorders, migraines
SE: GI effect, hepatoxicity, Liver failure, Pancreatitis, and teratogenic effect |
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Zarontin (Ethosuximide)
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Use: Absence seizures
SE: drowsiness, dizziness and lethary |
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Phenobarbital
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Use: Partial sz and Tonic-clonic sz
SE: sleep and sedation (occur only initial; will goes away after long term use); Neuropsychologic effect; porphyria; w/ drawal siezures. |
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What would you give in Terminate sz?
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IV benzodiazepine
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What is the goal of treatment of epilepticus?
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Maintain ventilation
Correct hypglycemia (low blood sugar - give 50% dextrode to bring up the sugar level) |
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When will you use antipsychotic Agent in Schizophrenia?
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Schizophrenic
Delusional disorder Bipolar disorders Depressive psychoses Drug induces Psychoses Supress emesis, Tourette's syndrome and Huntington's Chorea |
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What are function of the first generation antipscychotic or conventional antipsychotic?
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Block receptor for dopamine in CNS
Serious movement disorder - SE still occur even when stop use medication. S/S like Parkinson symptom |
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What are function of the secondary generation antipscychotic?
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Produce moderate blockade of dopamine receptor, stronger blockade for serotonin
Fewer extrapyramidal symptom - motor movement is less |
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What are the three types of symptoms in Antipsychotics?
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Postive - hallucination, delusion, agitation
Negative - blunted effect, lack of motivation, poor self care Cognitive - disorder thinking, reduced ability to concentrate |
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Conventional Antipsychotic
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Use: Schizophrenia, bipolar disorder, Tourette's syndrome and emesis
Action: Block dopamine receptors in mesolimibic area of the brain SE: Extrapyramidal symptom, acute dystonia, parkinsonism, tardive dyskinesia, anticholinergic effect and orthostatic Hypotension, sedation, seizures, agranulocytosis, severe dysrhythmias OVERDOSE: HTN, CNS depression, Treatment for Overdose: IV fluid, alpha-adrenergic agonist, gastric lavage |
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Low potency agents
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Thorzine, Mellaril
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Medium potency agents
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Loxitane, Moban, Trilafon
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High potency agent
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Haldol, Prolixin, Stelazine
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Atypical Antipsychotics
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Clozapine, Risperdal, Zyprexa, Seroquel (PO)
Risk of weight gain, diabete, dyslipidemia |
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What are the function of Schizophrenia Drug Therapy?
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Suppression of acute episodes,
Prevention of acute exacerbation Maintenance of the highest possible level of function |
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What drug for Antidepressants?
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Tricyclic
Selective serotonin reuptake inhibitor (SSRI) Serotonin/ norepinephrine reuptake inhibitor (S/NRI) Monoamine oxidase inhibitors (MAOI) Atypical Antidepressants |
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What is the characteristic of Depression?
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Risk of suicide is high in depression
Common psychiatric disorder |
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Depression clinical features
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Depressed mood
loss of pleasure or interest insomnia/ hypersomnia anorexia/ hyperphagia mental slowing/ loss of concentration feeling of guilt, worthlessness, helplessness Thougt of death and suicide overt suicidal behavior |
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What is the cause of depression?
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Genetic
Difficult childhood Chronic low self esteem |
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What is the treatment of depression?
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ECT - rapid response needed, severely depressed patient, suicidal patient
Vagus nerve stimulation = when treatment w/ at least four drug and FAIL |
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How would you present suicide risk while patient taking antidepressant?
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Observed closed for suicidal, worsening mood, change in behavior
Give small doses |
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What is the first choice of drug for antidepressants?
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Tricyclis
Use: Add, bipolar, depression, insomnia, neuropathic pain, panic disorder Act: Block reuptake NE and Serotonin SE: Anticholinergic effect, Arrhythm, diaphoresis, hypomania, orthostatic hypotension, sedation, seizures Toxicity: anticholinergic and cardiatoxic action Treatment: Gastric lavage, charcoal, physostigmine, inderal, lidocaine, phenytoin |
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What is the most common drug prescribed in US?
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SSRI (Prozac and Amitriptyline)
Use: Bulemia, OCD, premenstrual dysphoric disorder Act: inhibition of serotonin reuptake SE: Weight gain, emesis, Bruxism, Sexual dysfunction, serotonin syndrom, teratogen DI: MAOI, TCA, warfarin, lithium |
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What drug can cause serious action with MAOI?
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S/NRI Cymbalta
Use: depression, relieve pain of diabetic peripheral neurophathy Act: Inhibit reuptake of NE and serotonin Admin: NOT w/ food; highly bound to protein in the blood Half life: 12 hours |
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Why do SSRI and TCA better than MAOI?
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MAOI - NADRIL
Use: depression, OCD, panic attack AE: CNS stimulation, orthostatic hypotension, hypertensive crisis, DI: antidepression, antihypertensive, meperidine Atypical depression |
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What drug are atypical antidepressant?
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WELLBUTRIN
Use: stimulant and suppress appetite AE: agitation, tremor, tachycardia, blurred vision, dizziness, HA, insomnia, dry mouth, GI upset, constipation Increase effect if use with MAOI |
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What is the characteristic of BPD?
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Euphoric mania
Hypomania Depression Mixed |
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What is the drug therapy treatment for BPD?
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Stabilizer mood
Antipsychotic Antidepressant |
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What is the nondrug therapy treatment for BPD?
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Psychotherapy
Education ECT |
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What is the definition of BPD?
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Cyclic disorder
Recurrent fluctuation in mood Episode of mania and depression |
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What drug is use for stabilizer mood?
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Lithium
SE: GI, tremors, polyuria, hypothyroid, teratogenesis DI: diuretic, NSAIDS, anticholinergic drug Plasma level: 0.8-1.4 Lithium excreted when sodium level are low Short half-life Action: synthesis and release NE, serotonin, dopamine Alter distribution of certain Ion. |
