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72 Cards in this Set

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What are the preventative migraine drugs?
Beta Blockers (propanolol, timolol)
TCAs (amitriptyline)
CCBs (verapamil)
Anti-Epileptics (Topiramate, Valproic Acid)
NSAIDs
5 classes
Triptans MOA
5-HT1 receptor agonists
constrict cranial vessels and reduce sterile inflammation
these receptors are on neurons and intracranial blood vessels
(prevents albumin leakage)
MOA difference between drugs for migraine prevention and acute attack
acute- 5-HT1 agonist
prevention - 5-HT2 antagonist
Drawbacks/Contraindications to Ergots
less selective than triptans
ergotism (convulsive, gangrenous)
rebound HA (not in DHE)
CONTRA: vascular, renal, heptaic, pregnant
Tx for migraine w/aura?
verapamil
mu opioid receptor
(where active? agonists? antagonists?)
supraspinal action
agonists: b-endorphin, morphine, fentanyl
antagonist: naloxone
kappa opioid receptor (where active? agonist? antag?)
spinal action
agonist: dynorphins, pentazocine
antag: naloxone
delta opioid receptor (where? ag? antag?)
both spinal and supraspinal
agonist: enkephalins
antag: naloxone
which opioid side effects do not induce tolerance?
convulsant (meperidine, norcodeine)
miotic
constipation
Mixed opioid agonists/antagonists
How do they work?
pentazocine, nalbuphine, butorphanol
agonists at kappa recpetors but partial agonists (fxnl antag in presence of full agonist) at mu receptors
metabolites of
a. morphine
b. meperidine
c. codeine
d. heroin
a. active: 6-glucuronide
inactive: 3-glucuronide
b. normeperidine
c. morphine
d. 6-acetylmorphine -> morphine
CV ADR for opioids
hypotension
(supresses sympathetic outflow, psymp stimulation, morphine stimulates histamine release)
Which opioid is used in renal impairment?
hydromorphone
water
methadone use?
treat opioid dependence
buprenorphine
partial agonist useful for opioid dependence management
prevents withdrawal sxs
ADRs for SSRIs
SEXUAL DYSFXN (persistent...yikes)
SEROTONIN SYNDROME (confusion, fever, altered conc, myoclonus)
nervousness/irritability/insomnia (transient)
Nausea/diarrhea/dyspepsia (transient)
SSRIs taken with what causes serotonin syndrome
MAO-Is
TCAs
Li
Carbamazepine
SSRIs taken with warfarin, phenytoin et al causes what?
potentiation of toxicity
Advantage of sertraline over fluoxetine?
sertraline has a shorter half life (faster steady state and faster washout)
Paroxetine
(class, use, adr)
SSRI with antichol action (sedating)
good for depression w/anxiety/insomnia
Severe Discontinuation Syndrome
Which class of antidepressants is good for eating disorders?
SSRIs
none for anorexia
Which class of antidepressants is contraindicated in eating disorders?
NDRI (NE, DA, reuptake inhibit)
buproprion
additive risk for SZ
Which class of antidepressants treats chronic pain?
TCAs
Indications for buproprion?
Depression (fewer sexual adr)
smoking cess
adhd
What are phenelzine and tranylcypromine?
MAOIs (nonselective, irreversible)
When would you use TCAs?
resistant depression
enuresis
chronic pain
What is venlafaxine?
(adr?)
SNRI (along w/duloxetine)
adr - dose dependent HTN, withdrawal syndrome w/abrupt discontinuation
TCA poisoining Tx
Cardiac Monitoring
Gastric Lavage
NaBicarb and KCl
Lidocaine or Phenytoin
what are the 3 main mood stabilizers?
Li
Valproate
Carbamazepine
What do you need to check before putting a pt on Li?
Renal Labs
TSH
Preg test
ECG
What drugs increase blood Li levels?
NSAIDs
non loop diuretics
(dehydration)
ACE-Is
Most common ADR of Li?
Others?
*Hypothyroidism*
renal toxicity
How does Li toxicity present?
tremor
fasiculations
confusion/stupor/slurred speech
seizure
vomiting
ataxia
arrhythmia
Why shouldn't preggers take Li?
Which trimester?
Eb(p)stein's anomaly (tricuspid malformation)
1st trimester
Indications for valproate in BP d/o?
rapid cycling bp
mixed cycles
Pertinent ADRs for Valproate?
can induce hepatic failure but increased LFTs is usually transient and asymptomatic
PolyCystOvarSyndrome
TERATOGENIC (neural tube defects)
Indications for Carbamazepine in BP d/o?
refractory to Li and valproate
ADRs of Carbamazepine?
FATAL Agranulocytosis
Stevens Johnson
teratogenic
hepatitis
Drug interactinos for carbamazepine?
induces cyt p450 system
Why give Lamotrigine for BP d/o?
not teratogenic
BUT...causes Stevens Johnsons
When do heroin withrawal sxs begin (what are they)
8-10 hrs after last dose
(lots. no seizures)
When do benzo withdrawal sxs begin? (which is dangerous?)
8th or 9th day (seizures)
When do mild EtOH withdrawal sxs begin? (what are they?)
6-8hrs
(tremor, anxiety, insomnia)
Dangerous EtOH withdrawal sxs?
seizures, hallucinations, hyperthermia
Tx for Sed-Hyp withdrawal?
supportive (prevent sz, replace electrolytes, thiamine replacement)
ADMIT in severe cases
Tx for Heroin Withdrawal?
methadone/clonidine
admit preggers
Treatment for restless leg syndrome?
pramipexole or ropinorole
(DA agonists)
Tx for Essential Tremor?
Primodone (barb) and propranolol (beta blocker)
Tx for debilitating Tourettes?
High potency 1st gen antipsychotics (fluphenazine, haloperidol, pimozide)
Tx OCD component w/ fluoxetine
Tx for Huntington's Chorea?
antidepressants to prevent suicide
supportive
nothing slows dz progression
Tx for Tardive Dyskinesia?
Stop offending med (1st gen antispychotic)
Remove central anti-chol (TCAs, anti-PD)
give diazepam if acute
switch to atypical antipsychotic
Tx for myoclonus?
Clonazepam, Valproate (GABAnergic)
Tx for dystonia (focal, general, acute)?
focal - Botox
general - anticholinergic or benzo
acute - IV/IM diphenhydramine or benzatropine
Tx for dementia w/Lewy Bodies?
L-Dopa/carbidopa AND AChE-Is
What drug classes are used to tx Parkinson's?
Anticholinergis (benzatropine, trihexiphenidyl)
MAOB-Is (rasagiline, selegiline)
COMT-Is (Tolcapone, Entacapone)
Amantadine
DA agonist (bromocriptine, pergolide, pramipexole, ropinorole)
Which antipsychotic is least likely to cause EPS?
clozapine
Dangers of non-selective MAO-Is
cheese effect (tyramine -> Hypertensive crisis)
Which parkinson's tx might be neuroprotective?
MAOB-Is (rasagiline)
BoTox is FDA approved for which 3 neurological conditions?
blepharospasm
hemifacial spasm
cervical dystonia
What is neuroleptic malignant syndrome? Tx?
life threatening reaction from antispychotics
muscle rigidity, altered mental status, autonomic dysfxn
Tx w/Dantrolene, DA agonist
what are the best drugs for drug-induced emesis?
5HT3 receptor antagonist (ondansetron, granisetron)
metoclopromide
ADRs of 5HT3 receptor blockers?
HA, diarrhea, constipation, asthenia, phlebitis
What is aprepitant?
substance p/NK1 antagonist
anti-emetic
Anti-emetics that you shouldn't use in kids?
anti-psychotics
trimethobenzamide (reye's syndrome)
Difference in MOA btwn Benzos and Barbs?
Barbs - increased duration of channel opening (no ceiling effect)
Benzos - increased frequency channel opening (ceiling effect)
Which benzos are not affected by cytP450?
lorazepam, oxazepam, temazepam
Time frame for withdrawal symptoms from BZDs?
6 wks unlikely
1yr - hard to discontinue
AVOID BZDs in which populations?
preggers
BP
alcoholics
COPD/OSAS
memory impairment
elderly (dizzy/ataxia)
ramelton MOA
melatonin receptor agonist (rozerem)
What are zolpidem, zaleplon and exzopiclone for? MOA?
insomnia
GABA-A receptor agonist
Which insomnia drug has the shortest half life?
zaleplon (sonata)
generic names for:
a. ambien
b. sonata
c. lunesta
a. zolpidem
b. zaleplon
c. eszopiclone