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83 Cards in this Set
- Front
- Back
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Parkinson's drugs that agonize dopamine receptors =
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bromocriptine, pramipexole, ropinirole
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Parkinson's drugs that increase dopamine availability to CNS =
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amantadine, L-dopa/carbidopa
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Parkinson's drugs that prevent dopamine breakdown =
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selegiline (MAO-B inhibitor), entacapone, tolcapone (COMT inhibitors)
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Parkinson's drug that curbs excess cholinergic activity =
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benztropine (antimuscarinic)
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Which Parkinson's drug, over long term use, can cause dyskinesia following dosage and akinesia between doses?
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L-dopa/carbidopa
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Which Parkinson's drug can make L-dopa side effects worse?
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Selegeline
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What do you give for cluster HA and acute migraine?
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Sumatriptan - 5HT 1D agonist, causes vasoconstriction {tox: coronary vasospasm and mild tingling}
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Which 3 epilepsy drugs are contraindicated in pregnant women?
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- phenytoin (teratogen)
- carbamazepine (teratogen) - valproic acid (spina bifida) *All 1st line for tonic-clonic |
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Which epilepsy drugs can cause Stevens-Johnson syndrome?
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- ethosuximide
- lamotrigine |
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Which epilepsy drug can also be used for night terrors and sleep walking because it shortens Stage 4 of the sleep cycle?
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Benzodiazepines
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Which epilepsy drug can also be used for seizures of eclampsia?
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Benzodiazepines
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Which epilepsy drug is safe for pregnant women and children?
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Phenobarbital
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How do you Tx a benzodiazepine overdose?
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Flumazenil - competitive GABA receptor antagonist!
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What are first-line for tonic-clonic generalized seizures? (3)
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- phenytoin
- carbamazepine - valproic acid |
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What is first-line for absence seizures?
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- ethosuximide
- valproic acid also used |
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What are 2 drugs for status epilepticus, a medical emergency?
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- phenytoin (prophylaxis)
- benzodiazepines (acute) |
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Which epilepsy drug is used to help alcohol withdrawal?
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Benzodiazepines
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Which epilepsy drug is least sedating and also appropriate for myoclonic seizures?
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Valproic acid
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Name 4 neuroleptic drugs commonly used for schizophrenia:
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- thioridazine
- haloperidol - fluphenazine - chlopromazine |
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How do the neuroleptics work?
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block D2 receptors (schizophrenia is too much dopamine)
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What is the evolution of side effects with long-term neuroleptics use?
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4 hrs - acute dystonia
4 day - akinesia 4 wks - akathisia 4 mon - tardive dyskinesia |
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What is Neuroleptic Malignant syndrome?
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- muscle rigidity
- hyperpyrexia - myoglobinuria - autonomic dysfunction |
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What are the bad side effects of neuroleptics? (6)
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- prolactinemia, gynecomastia
- hypotension (alpha blocker) - sedation (antihistamine) - dry mouth (anticholinergic) - EPS side effects - neuroleptic maligant synd. |
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What are the atypical anti-psychotics? (3)
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- olanzapine
- clozapine - risperidone |
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How do atypical antipsychotics work?
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block 5HT 2 and dopamine receptors - less EPS and anticholinergic toxicities than other antipsychotics
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What else can Olanzapine be used for, besides schizophrenia?
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OCD, anxiety, depression, mania, Tourette's
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What is a specific side effect of Clozapine?
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agranulocytosis - check WBCs every week
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What do you give for bipolar mood stabilization?
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Lithium
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What are side effects of Lithium?
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- tremor
- polyuria (ADH antagonist) - hypothyroidism - teratogen!! |
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What are the names of 4 SSRI's?
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- fluoxetine
- sertraline - paroxetine - citalopram |
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What are 3 side effects of SSRI's?
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- GI distress
- sexual dysfunction - if used in combo with MAOI, serotonin syndrome |
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What are the manifestations of Serotonin Syndrome?
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- hyperthermia
- muscle rigidity - cardiovascular collapse |
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How long does it take antidepressants to work?
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2-3 wks
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Name some TCA's: (6)
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- amitriptyline
- nortriptyline - imipramine - desipramine - clomipramine - doxepin |
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What do TCA's block?
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reuptake of NE and 5HT
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What can Imipramine also be used for besides major depression?
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bedwetting (dec. Stage 4 sleep)
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What can Clomipramine also be used for besides major depression?
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OCD
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What are 3 toxicities of TCAs?
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- convulsion
- coma - cardiotoxicity (arrhythmia) |
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Amitriptyline has worse ____ effects than Nortriptyline.
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anticholinergic! (recall QBank question where Amitriptyline exacerbated ACUTE ANGLE GLAUCOMA because it contracted pupillary constrictor to dilate pupil)
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Which TCA is least sedating?
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Desipramine
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Name 5 heterocyclic antidepressants:
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- bupropion
- venlafaxine - mirtazapine - maprotiline - trazodone |
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What else is Bupropion used for other than major depression?
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smoking cessation
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What are toxicities of Bupropion?
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- stimulant
- HA - seizures in bulimics *NO sexual side effects |
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What else is Venlafaxine used for besides major depression?
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GAD - inhibits NE/5HT/DA reuptake
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What are toxicities of Venlafaxine?
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- elevate BP
- nausea - sedation - constipation |
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What does Mirtazapine block?
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1) a2 antagonist - inc. release of more NE and 5HT
2) block 5HT 2 & 3 receptors |
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What are toxicities of Mirtazapine? (4)
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- inc. appetite
- wt. gain - dry mouth - sedation |
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What does Maprotiline block?
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NE reuptake
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What are 2 toxicities of Maprotiline?
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- sedation
- orthostatic hypotension |
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What does Trazodone inhibit?
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5HT reuptake
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What are side effects of Trazodone? (4)
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- sedation
- nausea - PRIAPISM - orthostatic hypotension |
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What are 2 MAOI's?
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- phenelzine
- tranylcypromine |
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What are 4 things you should NOT ingest when taking a MAOI?
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- tyramine foods (cheese, wine, beer)
- SSRI (serotonin syndrome) - beta agonist (serotonin syndrome) - meperidine (a narcotic) |
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Name 6 inhaled anesthetics:
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- halothane
- enflurane - isoflurane - sevoflurane - methoxyflurane - nitrous oxide (N2O) |
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The ___ the solubility in blood, the faster the inhaled anesthetic works.
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lower
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The ___ the lipid solubility, the less inhaled anesthetic you need, or the more potent it is.
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higher
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Which of the inhaled anesthetics has greatest solubility in blood, therefore takes longest to work?
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Halothane
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Which inhaled anesthetic has least blood solubility, therefore works fastest?
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N2O
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What are effects of inhaled anesthetics?
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- myocardial depression
- respiratory depression - nausea/emesis - inc. cerebral blood flow |
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What are specific toxities of halothane, methoxyflurane, enflurane?
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Halothane - hepatotoxicity
Methoxyflurane - nephro Enflurane - seizure |
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What is a rare but dangerous toxicity of inhaled anesthetics?
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Malignant hyperthermia!
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Which barbiturate is used IV to induce anesthesia and short surgical procedures?
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Thiopental - high potency, high lipid solubility, rapid entry into brain
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Which benzodiazepine is used as IV anesthetic for endoscopy?
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Midazolam - reverse effects with Flumazenil!
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Which IV anesthetic is a PCP analog?
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Ketamine - cardiovascular stimulant, cause bad stuff like hallucination, nightmares, disorientation
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Which 2 opiates are commonly used with other CNS depressants during general anesthesia?
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- morphine
- fentanyl |
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Which short-acting, rapid-inducing IV anesthetic has less postoperative nausea than Thiopental?
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Propofol
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What are the ester local anesthetics? (3)
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- cocaine
- procaine - tetracaine |
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What are the amide local anesthetics? (3)
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- lidocaine
- bupivacaine - mepivacaine |
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How do local anesthetics work?
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block Na channels by binding to inside of channel (amides enter membrane as uncharged form, but bind as charged form)
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If you want to locally anesthetize infected tissue, what is the rule?
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Give bigger dose. Infected tissue is acidic so drug will be protonated/charged and not easily enter membrane.
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Which nerve fiber will be blocked first: small unmyelinated pain fibers or small myelinated autonomic fibers?
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Small unmyelinated pain fibers - size more important than myelination
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When receiving a local anesthetic, what is the order in which you lose sensations?
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1) pain
2) temperature 3) touch 4) pressure |
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How do you enhance the action of a local anesthetic?
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Give epinephrine to vasoconstrict.
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When would you use local anesthetics?
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- minor procedures
- spinal anesthesia |
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Which local anesthetic has severe cardiovascular toxicity?
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Bupivacaine (amide)
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Which local anesthetic can cause arrhythmia?
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Cocaine
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What happens if someone is allergic to cocaine/procaine/tetracaine?
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Give an amide instead.
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How does Succinylcholine work?
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Depolarizing neuromuscular blocker. Binds selectively to motor nicotinic receptor on muscle cell.
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What is Phase 1 of succinylcholine action?
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Prolonged depolarization for which there is no antidote. Depolarization action potentiated if use cholinesterase inhibitors.
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What is Phase 2 of succinylcholine action?
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Repolarized muscle cell but still blocked. Here can use cholinesterase inhibitors to raise ACh concentration and overcome succinylcholine.
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What are the non-depolarizing neuromuscular blockers?
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- tubocurarine
- atracurium, mivacurium - pancuronium, vecuronium, rapacuronium |
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How does Vecuronium work? What can block it?
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Compete with ACh for receptors on muscle. Reverse effect with cholinesterase inhibitors.
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What do you give for malignant hyperthermia and neuroleptic malignant syndrome? What is its mechanism?
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Dantrolene - my favorite. Blocks release of Ca from SR of skeletal muscle so muscle can't contract and cause hyperthermia.
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