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159 Cards in this Set
- Front
- Back
agonize dopamine receptors
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bromocriptine, pramipexole, ropinirole
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increase dopamina
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amantadine, l-dopa/carbidopa
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prevent dopamine breakdown
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selegiline, entacapone, tolcapone
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prevent dopa methylation in periphary that leads to competitive antagonism of BBB uptake
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entacapone, tolcapone
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MAO type B inhibitor
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selegiline
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curb excess cholinergic activity
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benztropine
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what is benztropine good for?
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tremors and rigidity
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what is benzotropine not good for
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bradykinesia
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what is the overall effect of benzotropine
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antimuscarinic
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toxicities of l-dopa/carbidopa
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arrythmias, dyskinesia following administration, akinesia between administraitons
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5-HT1D agonist
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sumatriptan
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migraines, cluster headaches
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sumpatriptan
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toxicity of sumatriptan
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hypertensive crises
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why does sumatriptan contraindicated in CAD patients?
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it's a vasoconstrictor
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1st line for tonic-clonic
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phenytoin
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1st line for prophylaxis of status epiplepticus
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phenytoin
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1st line for trigeminal neuralgia
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carbamazepine
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1st line in pregnant women and children
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phenobarbital
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myoclonic seizures
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valproic acid
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1st line absence seizures
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ethosuximide
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1st line acute status epilepticus
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diazepam/lorazapem
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first line seizures of preeclampsia
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magnesium sulfate
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how does ethosuximide work?
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blocks thalamic T-type calcium channels
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what is an antiepileptic that works for seizures of preeclampsia?
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diazepam/lorazepam
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toxicity: kidney stones, weight loss
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topoiramate
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how does topiramate work?
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blocks sodium channels, increase GABA action
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induce p-450, teratogen, liver toxicity, agranulocytosis, aplastic anemia
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carbamazepine
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urticaria, stevens johnson
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ethosuximide
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sedation, tolerance, induce p-450
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phenobarbital
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gingivial hyperplasia
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phenytoin
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hirsutism
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phenytoin
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megaloblastic anemia
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phenytoin
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SLE-like snydrome
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phenytoin
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what two anti-epileptics are teratogens?
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phenytoin, carbamazzapine
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what 3 anti-epileptics induce p-450
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phenytoin, carbamazepine, barbituates
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neural tube defects
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valproic acid
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weight gain, tremors
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valproic acid
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rare but fatal hepatotoxicity (need to measure LFTs)
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valproic acid
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two drugs that cause stevens johnson
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lamotrigine and ethosuximide
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how does phenytoin work?
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increase sodium channel inactivation
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how does carbamazepine work
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increase sodium channel inactivation
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how does lamotrigine work?
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blocks voltage-gated sodium channels
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how does gabapentin work?
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increases GABA release
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how does phenobarbital work?
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incrases GABA action
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what drug can be used for peripheral neuropathy
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gabapentin
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used for alcohol withdrawal (DTs)
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benzodiazepens
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used for anxiety and spasticity (anti-epileptic)
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benzodiazepene
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less risk of respiratory depression than barbituates
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benzodiazpenes
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treatment for benzo overdose
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flumaeznil
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name 4 antipsychotics
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thioridazine, haloperidol, fluphenazine, chlorpromazine
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mechanism for neuroleptics
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blocks D2 receptors
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describe evolution of EPS side effects in neuroleptics?
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4 hours acute dystonia, 4 days akinesia, 4 weeks akathisia, 4 months tardive dyskinesia (irreversible)
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clinical uses for neuroleptics (4)
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schizophrenia (only positive syndromes), psychosis, acute mania, Tourette's
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how do you treat neuroleptic malignant syndrome?
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dantrolene, dopamine agonists
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what are 4 factors in neuroleptic malignant syndrome?
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rigidity, myoglobinuria, hyperpyrexia, autonomic instability
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what drug causes hyperprolactinemia and gynecomastia?
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neuroleptics
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3 general side effects for neuroleptics
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muscarinic blocker (dry mouth, constipation), alpha blocker (hypotension), histamine blocker (sedation)
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define tardive dyskinesia
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sterotypic oral-facial movements
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what is the mechanism for tardive dyskinesia?
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dopamine receptor sensitziation due to upregulation (long-term antipsychotic use)
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name 3 atypical antipsychotics
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clozapine, olanzapine, risperidone
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what is the mechanism of atypical antipsychotics
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blocks 5-HT2 and dopamine receptors
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what 5 disorders is olanzapine useful for?
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OCD, anxiety disorder, depression, mania, tourette's
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what are atypical antipsychotics used for?
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good for negative and positive symptoms of schizophrenia
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what is a side effect of clozapine
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agranulocytosis
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mechanism of lithium
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blocks phosphoinositol cascade
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what is lithium used for?
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mood stabilizer for bipolar disorder
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causes nephrogenic diabetes insipidus
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lithium
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causes polyuria
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lithium
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ADH antagonist
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lithium
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hypothyroidism
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lithium
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is lithium a teratogen?
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yes
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why do you need to closely monitor lithium levels?
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narrow therapeutic window
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name 4 SSRIs
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fluoxetine, sertraline, paroxetine, citalopram
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how long does it take for antidepressants to work?
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2-3 weeks
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how do SSRI's work?
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seratonin-specific reuptake inhibitor
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what 2 things can SSRI treat?
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OCD, endogenous depression
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side effect: anorgasmia
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SSRIs
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side effect: seratonin syndrome
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SSRIs
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define seratonin syndrome
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hyperhtermia, msucular rigidity, cardiovascular collapse
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what two combos cause seratonin syndrome?
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SSRI + MAO inhibitors, beta-agonists + MAO inhibitors
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name 6 tricyclic antidepressants
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imipramine, desipramine, clomipramine, amitriptyline, nortriptyline, doxepin
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mechanism of tricyclics
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block NE and seratonin
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general use for TCAs
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major depression
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specific use for imipramine
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bedwettin
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specific use for clomipramine
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OCD
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what drug causes atropine-like (anticholinergic side effects)
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TCAs
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what are some atropine-like side effects?
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tachycardia, urinary retention
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what has more anticholinergic effects, amitriptyline or nortriptylne?
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amitriptyline
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what is the least sedating TCA
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desipramine
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name the 5 main side effects of TCAs
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convulsions, coma, convulsions (arrythamias ) 3 C's + respiratory depression and hyperpyrexia
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what side effects are found in elderly with TCAs
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confusions and hallucinations
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what TCA do you switch to when you see elderly side effects?
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nortriptyline
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alternative function for bupropion
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smoking cessation
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mechanism for bupropion
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not known
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major toxicity of bupropion
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seizures in bulemic patients
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what heterocyclic can you use that does not cause sexual side effects?
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bupropion
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heterocylic also used for generalized anxiety disorder
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venlafaxine
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mechanism: inhibts seratonin, norepinephrine, dopamine reuptake
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venlafaxine
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major venlafaxine side effect
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stimulant side effects
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mechanism of mirtazapine
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alpha2 anatagonist (increases relaease of NE and seratonin) + 5-HT2 and 5-HT3 antagonist
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3 side effects of mirtazapine
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increased appetite, weight gain, dry mouth
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mechanism of maprotiline
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blocks NE reuptake
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major side effect of maproptiline
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orthostatic hypotension
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2 major side effects of trazadone
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priapism, orthostatic hypotension
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primary mechanism of trazadone
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inhibits seratonin reuptake
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name the 5 heterocyclics
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buproprion, venlafaxine, mirtazapine, maprotiline, trazadone
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name 2 MAO inhibitors
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phenelzine, tranylcypromine
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3 uses for mao inhibitors
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atypical depression (w/ psychosis or phobia), anxiety, hypochondriacs
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what drug is used for hypochondriacs?
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mao inhibitors
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what 2 substances causes hypertensive crises in mao inhibitors
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tyramine ingestion, meperidine (opioid)
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what characteristic is required in anesthetics for rapid induction and recovery
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decreased solbulity in blood
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what characteristic in necssary for anesthetics to be potent
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incresaed solbulity in lipids
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what does MAC stand for
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minimal anesthetic concentratoin
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what is a mathematical expression for anesthetic potency
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1/MAC
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name 6 inhaled anesthetics?
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halothane, enflurane, isoflurane, sevoflurane, methoxyflurane, nitrous oxide
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4 major side effects of inhaled anesthetics
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myocardial depression, respiratory deprssion, nausea/emsis, incresaed cerebral blood flow
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anesthetic that causes hepatotoxicity
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halothane
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anesthetic that causes nephrotoxicity
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methoxyflurane
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proconvulsant anesthetic
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enflurane
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what is the main purpose of using inhaled anesthetics?
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maintenance after induction w/ IV anesthetics
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what is the major barbituate anesthetic
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thiopental
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which anesthetic leads to decreased cerebral blood flow
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thiopental
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is thiopental potent or not potent?
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potent
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what is the major use of IV anesthetics?
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rapid induction of anesthesia, maintained though with inhalation agents
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what is the most common anesthetic used for endoscopy
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midazolam
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what is a dissociative anesthetic (appear to be awake but unconscious and feel no pain)
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ketamine
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side effects: disorientaiton, hallucination, nightmares
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ketamine
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which anesthetic is a cardiovascular stimulant and cannot be used in those w/ hypertension/ stroke
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ketamine
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what anesthetic is best for those who are hypovolemic or in shock
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ketamine
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name 2 opiates used for anesthesia
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moprhine, fentanyl
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what is the major benefit of using propofol?
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less postoperative nausea than tiopental
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name 3 ester anesthetics
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procaine, cocaine, tetracaine
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name 3 amide anesthetics
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lidocaine, bupivacaine, mepivacaine
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how do local anesthetics work?
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blocks sodium channel by bidning to specific receptors in inner portion of channel
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in what form (charged or uncharged) do local anesthetics bind to ion channels?
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charged
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why do you need to use more anesthetic in infected tissue?
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it's acidic so anesthetics become charged and can't penetrate as well
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what is the general order of nerve blockade for local anesthetics?
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small>large, myelinated>unmyelinated
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what is the order of sensation loss for local anesthetics
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pain first then temprature then touch then pressure
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what do you give with local anesthetics to enhance local actoin?
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vasoconstrictors (epinephrine)
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how do vasoconstrictors + local anesthetics work?
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decrease bleeding and systemic concentratoin so increase local action
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what do you use for spinal anesthesia?
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local anesthetics
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if you are allergic to ester anesthetics, what do you do?
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give amide anesthetics
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anesthetic that causes severe cardiovascular toxicity
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bupivacaine
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anesthetic that causes arryhtmias
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cocaine
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what is the use for neuromuscular blockade drugs (2)
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muscle paralyis in surgery or mechanical venitilatoin
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what is the selectivity of neuromusclar blocking drugs?
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selective for motor vs autonomic nicotinic receptor
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what is a depolarizing neuromusclar blocking drug
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succinylcholine
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what are the 2 phases in succinylcholine action?
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phase I (prolonged depolarizatoin), phase II (repolarized but blocked)
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which phase of succinylcholine is potentiated by cholinesterase inhibitors
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phase I
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what phase of succinylcholine can you use neostigmine as an antidote?
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phase II
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name 2 nondepolarizing neuromusuclar blockers
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atracurium, mivacurium
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what is the mechanism of nondepolarizing neuromuscular blocing drugs
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competitive inhibitor with ACh for ACh receptors
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how do you reverse atracurium blockade?
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give neostigmine or edrophonium
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drug used to treat malignant hyperthemia
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dantrolene
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what 2 anesthetic drugs in combination cause malignant hyperthemia
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inhalation anesthetics (Except nitric oxide) + succinylcholine
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what is the drug used to treat neuroleptic malignant syndrome
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dantrolene
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what is the mechanism of dantrolene
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prevents release of caclium fromsarcoplasmic reticulum of skeletal muscle
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what drugs are good for OCD?
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olanzapine, SSRIs, clomipramine
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what drugs are good for generalized anxiety disorder? (5)
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barbituates, benzodiazepens, olanzapine, venlafaxine, MAO inhibitors
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