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199 Cards in this Set

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Phenytoin:
- class
- antiepileptic (antiarrhythmic 1b)
Phenytoin:
- mechanism of action
- blocks Na+ channels, increases GABA inhibition, decreases Ca++ influx
Phenytoin:
- indications
- generalized tonic-clonic seizures (grand mal) and partial seizures
Phenytoin:
- major side effects/ considerations
- nystagmus, diplopia, ataxia, sedation
- gingival hyperplasia, hirsutism
- status epilepticus with sudden withdrawal
Carbamazepine:
- class?
- antiepileptic
Carbamazepine:
- mechanism of action?
- blocks Na+ channels
Carbamazepine:
- indications?
- partial seizures and tonic-clonic seizures
Carbamazepine:
- side effects
- diplopia, ataxia
- blood dyscrasias
Abrupt withdrawal of phenytoin in epileptic patients may lead to ...?
status epilepticus
Phenobarbital:
- class
- antiepileptic/ sedative
Phenobarbital:
- mechanism of action
- potentiates GAVAnergic stimulus by increasing the duration of Cl-channel openings
- more generalized action than benzodiazepines
Phenobarbital:
- indications
- sedation, hypnosis, anesthesia, epilepsy
Phenobarbital:
- side effects
- cardiopulmonary depression, DDIs, addiction
Ethosuximide:
- class
antiepileptic
Ethosuximide:
blocks Ca++ channels
Ethosuximide:
absence (petit mal) seizures
Ethosuximide:
- headache, dizziness
- GI distress, Parkinsonism, bone marrow depression
Valproate:
- class
antiepileptic
Valproate:
enhances GABA-mediated inhibition, blocks Na+ channels, increases K+ current, blocks Ca++ channels
Valproate:
all seizure types
Valproate:
hair loss
Gabapentin
- class
antiepileptic
Gabapentin
- mechanism of action
unknown
Gabapentin
- indications
partial seizures
Gabapentin
-side effects
sedation, dizziness, unsteadiness, relatively benign
Diazepam (valium)
- class
benzodiazepine, anxiolytic, antiepileptic
Diazepam (valium)
- mechanism of action
enhances GABA, especially in limbic system, hypothalamus, thalamus
Diazepam
- indications
continuous seizure activity, especially tonic-clonic status epilepticus
Diazepam
- side effects
tolerance
drowsiness, fatigue, ataxia
thrombosis/phlebitis at injection site
Lorazepam (Ativan)
- class
benzodiazepine, antiepileptic, anxiolytic-sedative
Lorazepam (Ativan)
- mechanism of action
facilitates GABA
Lorazepam (Ativan)
- indications
status epilepticus (more long-acting than Diazepam)
Lorazepam (Ativan)
- side effects
drowsiness
contraindicated with myasthenia gravis and acute narrow angle glaucoma
Lamotrigine
- side effects
skin rashes (SJS), toxic epidermal necrosis (Lyell's syndrome)
Lamotrigine
- class
antiepileptic
Lamotrigine
- mechanism of action
blocks Na+ channels
Lamotrigine
- indications
partial seizures and absence seizures
Caffeine
- class
stimulant, methylxanthine
Caffeine
- mechanism of action
adenosine receptor antagonist --> increased intracellular cAMP
Caffeine
- indications
sleep retardant, migraine, apnea of prematurity
Caffeine
- side effects
mild delirium, insomnia, diuresis, tachcardia, arrythmia
Nicotine
- class
stimulant
Nicotine
- mechanism of action
nicotinic agonist
low doses: mainly stimulant (locus ceruleus)
high doses: reward effects (limbic)
Nicotine
- indications
aid to smoking cessation, nicotine withdrawal
Nicotine
- side effects
overdose: pallor, cold sweat, nausea, sailvation, vomiting, abd pain, diarrhea, HA, dizziness, confusion, tremor, weakness, disturbed hearing and vision
Cocaine
- class
stimulant
Cocaine
- mechanism of action
blocks monoamine reuptake transport; Na channel blocker
Cocaine
- side effects
tachycardia, HTN, hyperthermia, mydriasis, cardiac arrythmia, seizure
ADDICTION
Methylphenidate (Ritalin)
- class
stimulant
Methylphenidate (Ritalin)
- mechanism of action
blocks reuptake of dopamine
Methylphenidate (Ritalin)
- indications
ADHD, narcolepsy
Methylphenidate (Ritalin)
- side effects
nervousness, insomnia, HA, dizziness, drowsiness, chorea, nausea, anorexia, wt loss
Dextroamphetamine, methamphetamine
- class
stimulant
Dextroamphetamine, methamphetamine
- mechanism of action
increases release of monoamines (norepi, 5-HT, dopamine) from storage sites in nerve terminals
Dextroamphetamine, methamphetamine
- indications
ADHD, narcolepsy
Dextroamphetamine, methamphetamine
- side effects
nervousness, insomnia, palpitations, HTN, HA, dizziness, anorexia, dryness of mouth
MDMA (ecstasy)
- mechanism of action
increases release of monoamines (5-HT, norepi, dopamine), distorted sense of time/ perception, sexual enhancer, facilitates interpersonal communication
MDMA (ecstasy)
- class
stimulant, hallucinogen
MDMA (ecstasy)
- side effects
long term neurotoxicity, tachycardia, HTN, mydriasis
LSD
- class
hallucinogen
LSD
- mechanism of action
agonist and/or antagonist of 5-HT receptors
LSD
- side effects
sense of time and self may change, delusions, visual hallucinations, mydriasis, tachycardia, panic attacks
PCP
- class
hallucinogen
PCP
- mechanism of action
blocks NMDA-type glutamate receptors
PCP
- side effects
acute psychosis, dissociation, disorientation, loss of proprioception, catatonic posturing, aggression
THC
- class
hallucinogen, antiemetic, analgesic
THC
- mechanism of action
cannabinoid receptor agonist at CB1 and CB2
THC
- indications
cancer-related N/V, appetite stimulation among AIDS pts, chronic pain
THC
- side effects
antimotivational syndrome with chronic use
Ethanol
- class
depressant
Ethanol
- mechanism of action
enhancement of GABA, inhibition of glutamate at NMDA receptors
Ethanol
- symptoms of abuse/poisoning
ataxia, slurred speech, slow breathing, vomiting, stupor, coma, cirrhosis
Ethanol
- DDIs
induction of cytP450 --> acetaminophen toxicity, inhibited metabolism of other drugs
physical and psychological dependence
Disulfirim
- indication
treatment of alcoholism
Disulfirim
- mechanism of action
blocks acetaldehyde dehdrogenase (converts acetaldehyde to acetic acid) --> unpleasant effects (flushing, SOB, N/V, HA, postural fainting, etc)
Naltrexone
- class
narcotic antagonist
Naltrexone
- mechanism of action
blocks or reverses action of narcotic analgesics
Naltrexone
- indications
alcohol dependence,
longer duration of action than Naloxone --> long-term treatment of opioid addiction
Naltrexone
- side effects
hepatocellular injury
Morphine
- class
narcotic analgesic
Morphine
- mechanism of action
opioid receptor agonist
Morphine
- mechanism of action
pain relief
Morphine
- side effects
constipation, N/V, dizziness, sedation, respiratory depression, circulatory depression, apnea, shock
addiction/ abuse
Codeine
- class
narcotic analgesic
Codeine
- mechanism of action
opioid receptor agonist in CNS, bowel
Codeine
- indications
mild to moderate pain relief
Codeine
- side effects
constipation, N/V, sedation, sweating, dry mouth, respiratory depression
Dextromethorphan
- class
nonnarcotic antitussive
Dextromethorphan
- mechanism of action
cough suppression via medulla
Dextromethorphan
- indications
nonproductive cough relief
Dextrmethorphan
- side effects
dizziness, drowsiness
N/V, stomach pain
Hydrocodone
- combined with acetaminophen = ?
Vicodin
Hydrocodone
- class
semisynthetic narcotic analgesic, antitussive
Hydrocodone
- mechanism of action
opioid agonist, similar to codeine
Hydrocodone
- indications
mild to moderate pain
Hydrocodone
- side effects
lightheadedness, dizziness, sedation, N/V, additive w/ other depressants
Oxycodone
- combined with ASA = ?
Percodan
Oxycodone
- class
narcotic analgesic
Oxycodone
- mechanism of action
semi-synthetic narcotic, similar to morphine
Oxycodone
- indications
moderate to severe pain, mild sedation, MSK injury, cancer pain
Oxycodone
- side effects
light headedness, dizziness, sedation, N/V
Tramadol
- class
centrally acting analgesic (not chemically related to opioids)
Tramadol
- mechanism of action
unknown:
- opioid receptor agonist?
- inhibition of norepi and 5-HT reuptake?
Tramadol
- indications
moderate to moderately severe pain
Tramadol
- side effects
dizziness, vertigo, HA, somnolence, CNS stimulation, anxiety, confusion, seizures
Tramadol
- increased risk of seizures with what drug?
Naloxone (does not work to treat Tramadol overdose)
Meperidine (Demerol)
- class
narcotic analgesic (synthetic)
Meperidine (Demerol)
- mechanism of action
opiate receptor agonist
Meperidine (Demerol)
- indications
analgesic for moderate to severe pain, especially minor surgeries and diagnostic procedures
Meperidine (Demerol)
- side effects
transient hallucinations, transient hypotension, visual disturbances
Methadone
- class
narcotic analgesic, morphine type (synthetic)
Methadone
- mechanism of action
similar to morphine
only mild euphoria (less addictive)
Methadone
- indications
detox and maintenance of narcotic dependence
Methadone
- side effects
constipation, sweating, pulmonary edema, chorea
Heroin
- class
hallucinogen, opiate
Heroin
- mechanism of action
- CNS depressant --> dreamlike state of warmth and well-being
Heroin
- intoxication Sx
- withdrawal Sx
intoxication: myosis, nausea, respiratory depression, euphoria

withdrawal: panic, nausea, muscle cramps, chills, insomnia, miscarriage, stillbirth
Chlorpromazine
- Class
typical antipsychotic
Chlorpromazine
- mechanism of action
blocks alpha 1 & 5-Ht2 < D2 < D1 receptors
Chrlorpromazine
- side effects
drowsiness, seizures, agranulocytosis, aplastic anemia, thrombocytopenia, tardive dyskinesia, neuroleptic malignant syndrome
Haloperidol
- class
typical antipsychotic
Haloperidol
- mechanism of action
blocks D2 > D1 predominantly
Haloperidol
- indications
psychosis, Tourette's
Haloperidol
- side effects
EPS, elevated serum prolactin, tardive dyskinesia
Risperidone
- class
atypical antipsychotic
Risperidone
- mechanism of action
blocks D2 & 5-HT2 receptors
Risperidone
- side effects
minimal EPS, minimal prolactin elevation, less propensity to induce tardive dyskinesia
Clonazapine
- class
atypical antipsychotic
Clonazapine
- mechanism of action
blocks D4 & alpha 1 receptors
Clonazapine
- side effects
minimal EPS, minimal prolactin elevation, less propensity to induce tardive dyskinesia
Olanzapine
- class
atypical antipsychotic
Olanzapine
- mechanism of action
blocks 5-HT2 > D1
Olanzapine
- side effects
minimal EPS, minimal prolactin elevation, less propensity to induce tardive dyskinesia
Olanzapine
- indications
psychosis, bipolar disorder
Amitryptiline, imipramine
- class
tricyclic antidepressants (tertiary amines)
Amitryptiline, imipramine
- mechanism of action
block reuptake of serotonin and norepinephrine
Amitryptiline, imipramine, desipramine, nortryptiline
- side effects
arrythmia, orthostatic hypotension, fatal overdose, dizziness, dry mouth, urinary retention, conduction defects, sedation, weight gain, constipation
Desipramine, nortryptiline
- class
tricyclic antidepressants (secondary amines)
desipramine, nortryptiline
- mechanism of action
block reuptake of norepinephrine
Selegiline, phenelzine, isocarboxazid, tranylcypromine
- class
MAOIs
Selegiline, phenelzine, isocarboxazid, tranylcypromine
- mechanism of action
inhibit MAO-A and -B from deactivating monoamine NTs (epi, norepi, dopamine, serotonin)
Dietary consideration with MAOIs?
low tyramine (MAO-A metabolizes tyramine foods)
too much tyramine --> hypertensive crisis
Selegiline, phenelzine, isocarboxazid, tranylcypromine
-side effects
dizziness, dry mouth, weight gain, sexual dysfunction, headache, insomnia, constipation, blurred vision, urinary retention, LFT elevation, fainting, nausea, peripheral edema, myoclonic jerks
Fluoxetine, sertraline, paroxetine, citalopram
- class
SSRIs
Fluoxetine, sertraline, paroxetine, citalopram
- side effects
altered GI motility, nausea, agitation, anxiety, sleep disturbance, sexual dysfunction
Venlaxafine, duloxetine, buproprion
- class
Norepinephrine and serotonin reuptake inhibitor (NSRI)
Venlaxafine, duloxetine, buproprion
- side effects
idiopathic htn
Mirtazapine
-class
NSRI
Mirtazapine
- mechanism of action
increased release of norepi and serotonin, 5-HT2 and 3 antagonist, H1 antagonist --> net effect to upregulate 5-HT1
Mirtazapine
- side effects
weight gain, sexual dysfunction
Trazodone
- class
antidepressant
Trazodone
- mechanism of action
mixed serotonin antagonist/ agonist
Trazadone
- side effects
othostatic hypotension, sedation, priapism
Nefazodone
- class
antidepressant
Nefadozone
- mechanism of action
5-HT2 antagonist
Nefadozone
- side effects
liver necrosis
Aripiprazole
- class
antidepressant
Apriprazole
- mechanism of action
D2 partial agonist (atypical antipsychotic)
Which antidepressants are used to treat depression and OCD in children?
Depression - Fluoxetine
OCD - Fluoxetine, fluvoxamine, sertaline, clomipramine
Lithium
- indications
mania, mood stabilizer
Lithium
- mechanism of action
enhances serotonin neurotransmission, decreases neostriatal dopaminergic activity, facilitates norepi release
Lithium
- side effects
narrow therapeutic index; tremor, diarrhea, weight gain, polyuria, excessive thirst, memory problems,
Valproate
- class
anticonvulsant
Valproate
- indications
acute mania in bipolar disorder
Valproate
- mechanism of action
potentiates GABA
Valproate
- side effects
hepatic failure, pancreatitis, thrombocytopenia
Lamotrigine
- indications
maintenance of bipolar depression
Carbamazepine
- indications
bipolar depression, tonic-clonic seizures, trigeminal neuralgia
DDI:
Lamotrigine and depakote
Stevens-johnson syndrome
SSRI + St Johns Wort OR sumatriptan OR zolmitriptan -->
serotonin syndrome
SSRI +tricyclic -->
TCA excess, monitor anticholinergic excess
SSRI + MAOI -->
hypertensive crisis
What effects do benzodiazapine hypnotics have on various stages of sleep?
Induces sleep in alert and quiet wakefullness
Stage 1 & 2 - longer
Stage 3 & 4 - shorter
Barbituate hypnotics (Pentobarbital, secobarbital, amobarbital)
- mechanism of action
enhance GABA-A receptor/chloride channel via prolonging duration of opening
Barbituate hypnotics (Pentobarbital, secobarbital, amobarbital)
- indication
short-term basis for frequent awakenings/nightmares
Barbituate hypnotics (Pentobarbital, secobarbital, amobarbital)
- side effects
drug hangover, respiratory depression, induction of CytP450, dependence
Benzodiazepine hypnotics (lorazepam, alprazolam, temazepam)
- mechanism of action
enhance GABA-A receptor/chloride channel via allosteric site --> increases frequency of channel opening
Use SHORT ACTING benzo's for sleep
In whom should doses of benzodiazepines be reduced
- elderly
- liver failure/ dysfunction (e.g. cirrhosis)
Benzodiazepine hypnotics (lorazepam, alprazolam, temazepam)
- side effects
decreased alertness, habituation, dependence, withdrawal (clonazepam lower), can cross placenta and breast milk, DDI with depressants
Flumazenil
- mechanism of action/ indication
displaces benzodiazepines at binding site on GABA-A --> benzo antagonist for overdose
Zolpidem, Zalepon, Eszopiclone
- class
short-acting hypnotics
Zolpidem, Zalepon, Eszoplicone
- mechanism of action/ advantages over benzodiazepines
- bind to subset of GABA-A receptors allosterically in the CNS
- fast onset, short duration --> do not affect sleep architecture, minimal hangover, lower risk of dependence
- Eszoplicone (Lunesta) is for longer use - little rebound insomnia, lower dependence
Other treatments (non-barb, non-benzo) used for insomnia?
- chloral hydrate
- anti-histamines
- antidepressants (Trazodone)
- kava kava, valerian root, melatonin
Ramelteon
- mechanism of action
- selective melatonin MT1 & MT-2 receptor agonist in suprachiasmatic nucleus (SCN)
- no GABA-A action --> non-scheduled drug
Ropinirole, Pramipexole
- mechanism of action
- indication
- non-ergot D2-receptor agonist
- RLS
Which benzodiazepines are used for anxiety?
- long-acting: Diazepam (valium), alprazolam (xanax), lorazepam (ativan)
Which benzodiazepines are used for panic disorder?
alprazolam (xanax)
Aspirin (O-acetyl salicylic acid)
- mechanism of action
irreversible nonspecific COX inhibitor
Aspirin (O-acetyl salicylic acid)
- side effects
GI ulcers, platelet blockage, inhibition of PG-mediated renal fxn, hypersensitivity, HA, dizziness
Reye's syndrome in children w/ chicken pox or flu
Ibuprofen (2-arylpropionic acids)
- indications
arthritis, bursitis, tendonitis, dysmennorhea
Ibuprofen (2-arylpropionic acids)
- side effects
GI ulcers, platelet blockage, inhibition of PG-mediated renal fxn, hypersensitivity, HA, dizziness
Ibuprofen (2-arylpropionic acids)
- mechanism of action
nonspecific COX inhibitor
Celecoxib
- mechanism of action
selective COX-2 inhibitor
Celecoxib
- side effects
renal toxicity, increased thrombosis
Acetaminophen
- actions
analgesic, antipyretic, NOT anti-inflammatory
Acetaminophen
-toxicity mechanism
-exacerbated by...
depletion of glutathione --> accumulation of toxic metabolite --> necrosis of liver and kidney tubules

exacerbated by phenobarbital or ethanol (P450 inducers)
Triptans
- mechanism of action
serotonin agonist selective for cranial vasculature receptors
Triptans
- side effects
elevation of blood pressure, cardiac events
Dihydroergotamine
- indication
- side effect
- migraine
- nauseachart