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65 Cards in this Set

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Attention Deficit Hyperactivity Disorder
Drug Category:
Drug:
Mechanism:
Attention Deficit Hyperactivity Disorder
Drug Category:Amphetamine
Drug:Methylphenidate, Pemoline, Atomexitine
Mechanism:Stimulates brain to calm the brain
Disorder: Narcolepsy
Drug Category:
Drug:
Mechanism:
Disorder:Narcolepsy w/ cataplex also Modafini Shift work sleep disorder

Drug Category:Amphetamine

Drug: Dextroamphetamine

Mechanism: Tx stimulates brain
Disorder: Seizure/post anesthesia
Drug Category:
Drug:
Mechanism:
Disorder:Seizure/Post Anesthesia
Drug Category: Amphetamine
Drug:Doxapram
Mechanism: Respiratory stimulation
S/E of Amphetamine?
Euphoria
Addiction
Avoid Coffee
Insomnia if taken w/i 6hrs of sleep
CNS stimulants
Sedatives and Hypnotics
Barbituates--worst Coma
Benzodiazepines--worst Anesthesia

Non SH
Alcohols
GABA
GABA
GABAa receptors=ionotropic activated by B, B, G
-Inc. Cl ions= hyperpolarization opposite of depol--relaxation
Which GABA receptor does Benzo bind? What reverses binding?
Benzo binds to GABAy receptor, b/w gamma2 & alpha1 subunit

Binding reversed by Flumazenil
Which GABA receptor does Barb bind to?
Barb binds to beta receptor GABAa
Mechanism of Action of Baclofen
Baclofen (muscle relaxer)
binds to GABAb receptor(g clpd receptor)

GABAb dec. K+ =hyperpolarization & inhibition
BZ1
BZ1 for sleep
BZ2
BZ2 for memory, sensory motor, cognitive functions
What does benzo determine?
Benzo determines frequency of channels open & binds on y site
What does Barb determine?
Barb increases the DURATION that the Cl channel stays open & binds to B site

At high dose Barb opens Cl & blks Na
Disorder: Seizures
Drug Category:
Drug:
Mechanism:
Disorder: Seizures-Tourettes, Eclampsia
Drug Category:Barb
Drug: Phenobarbital
Disorder: Pre-Anesthetic
Drug Category:
Drug:
Mechanism:
Disorder: Pre-Anesthetic, Granmal epilepsy
Drug Category: Barb
Drug:Thiopental
Mechanism: IV b/c extremely fast & lipid soluble
S/E of Barbs used for Seizures
S/E for barbs used for GTC seizures

Tolerance & Dependence

Intermittent Porphyria-cant make heme dx w/ abd pain

W/ OC pills can cause convulsion
Alprazolam
Used to Tx?
Drug Cat:
Alprazolam (Xanax)
Panic Attacks & short term insomnia

Drug Cat: Benzo
Clonazepam
Used to tx?
Drug Cat:
Clonazepam
Anticonvulsants

Drug Cat: Benzo
Diazepam
Used to tx?
Drug Cat:
Diazepam(Valium)
Statis epileptics

longest acting anticonvulsant

Drug Cat: Benzo
Flurazepam
Used to tx?
Drug Cat
Flurazepam
Insomnia, no REM suppression

forms an active metabolite

Drug Cat: Benzo
Flunitrazepam
used for?
Drug Cat
Date rape drug

Drug Cat: Benzo
Midazolam
Used to treat?

Drug Cat
Midazolam
IV only anesthetic
Insomnia

Drug Cat: Benzo
LOT stands for
used to treat?

Drug Cat
Lorazepam
Oxazepam
Temazepam

not metabolized in liver so safe for ppl w/ hepatic impairment

Drug Cat: Benzo
S/E of Benzo
S/E of Benzo
Sedation
Anterograde Amnesia
Tol & Depen less than barb
Rebound withdrawal: Anxiety & Insomnia
Benzo OD in ER
Benzo OD give
IV Flumezanil
New sleep disorder drugs & Mechanism
Sleep disorder drugs:
Zolipidem
Zaleplon
Eszopiclone(lunesta)
= insomnia
Bind to BZ1 receptors to induce sleep only not like benzo
Buspirone
Used to tx?
Buspirone
General Anxiety Disorder not panic attacks

Takes 1-2wks to wk
Alcohols
Metabolized by?
Ethylene Glycol-anti-freeze
Methanol
Ethanol

Metabolized by Alcohol Dehydrogenase
Process of ethylene glycol?
Toxicity?
OD Rx?
Ethylene Glycol-->Oxalic Acid:
CNS depression
Metabolic Acidosis
Renal Toxicity

OD rx: Fomepizole
Process of Methanol?
Toxicity?
OD rx?
Methanol-->Formic Acid:
Toxicity: Blindness
Resp. Depression
Metabolic Acidosis w/ anion gap produced by Lamudpie

OD rx: Ethanol
Process of Ethanol?
S/E?
Mechanism?
Ethanol-->Acetic Acid
S/E: Throb headach, Hypotension, confusion, w/ typical

Disful. inhibt acetyl dehy to accum of acetyl
Alcohol withdrawal?
S/S
ER mgmt?
Alcohol withdrawal
S/S: Delirium tremors (DT)
Seizures, Arrythmia, Hallucination

ER mgmt:
IV diazepem/chlordiazepoxide
IV thiamine

if pt has liver damage give?? LOT
Types of seizures?
Generalized=convulsive
Tonic clonic=Grand mal, petit mal
Partial(focal)= simple=pt aware
Complex= not aware of it, temp lobe
Grand mal seizure process
Grand Mal
-Pt loses conscioness- bite the tongue- striking sound of air due to larynx contraction(epileptic cry)
Absent (petit mal seizure)
Absent-
Kid is absent, starring, no motor manifestation
Partial seizure
Partial sezure can feel it coming, has an aura
What decreases firing during a seizure?
DIazepam & Phenobarbital
What stops the spread of the seizure, and how?
Decrease the spread of electrical activity by increasing the threshold.

Phenytoin or Carbamazepine
What decreases the spread of seizure by blocking Na channels?
Phenytoin & Carbamazepine by inactivating
What dec firing by act GABA rec and how?
Dec firing by act GABA rec. which open CL channels leading to hyperpolarization

Barb & Benzo
What decreases Ca ions which in hibit seizure initiation & spread?
Ethozuximide & Valprpoic acid
What inhibits Glutamate & how?
Inhibit glutamate(excit nt) by NMDA receptor antagonists

Lamotrigine-Topiramate
Phenytoin
Mechanism?
S/E?
Teratogenic Effect?
TI?
Phenytoin
Na+ channel blocker
S/E: Hypertrichosis, Hirsutism, Megaloblastic Anemia, Granulocytopenia, Gingivival Hyperplasia, Osteomalacia, Induce cytP450

Teratogenic: Fetal hydantoin syndrome (cleft palate & lip)

Narrow TI- cant inc dose
Carbamazepine
Mechanism?
S/E
Teratogenic
Carbamazepine
Blks Na+ inact. channels dec spread
---Drug of choice for Trigem Neuralgia
---2nd to Lithium in Bipolar dis.,
3rd is Valproic Acid
4th is Levetiracetam(seizure)

S/E: Agranulocytosis, Aplastic Anemia
Enhance ADH secretion leading to hyponatremia(SIADH--Carb--Trigem Neuro)

Terato: Craniofacial abn. & Spina bifida
Phenobarbital
Mech?
S/E
Phenobarbital(Barb)
M: Dec firing of seizures, supp seizure focus(diaz)
Rx: of insom, & long act seiz

S/E:
Osteomalacia, Megaloblas Anemia, Induce cyt P450,

CONTRAindicated in Intermittent Porphyria
Diazepam
used to tx?
IV Diazepam
Status Epilepticus & DT
Longest acting anticonv.
Stops Seiz @ focus
Ethosuximide
Mech?
Used to tx?
Ethosuximide
Dec. Ca++ ions
Absence Seizure
Valproic Acid
Mech?
Used to tx?
S/E
Valproic Acid
M: Act. GABA & inhibits Na channels
Used as 2nd opt to tx Migraine & Bipolar

S/E: Pancreatitis (elev. Amylase)
Hepatotoxicity

Terat: Spina Bifida
Lamotrigine
Mech?
Used to tx?
S/E
Lamotrigine
M: Inhibits Glutamate(NMDA antag)
UTtx: Migraines, GrandMal 2+

S/E: Steven Johnson Synd.(severe skin problem), Spina bifida
Topiramate
Mech:
Used to Tx:
S/E:
Topiramate
M:Inhibit Glutamate
UTTx: stops craving in addicts
S/E: Kidney stones
Felbamate
Mech:
S/E:
Felbamate
M: Inhibit glutamate
S/E: Aplastic anemia
New drugs for Seizures & Mechanisms?
Zonisamide=Sulfonamide

GABAPENTIN (STIMULATES GABA)

PRIMIDONE=BARB, GETS ACUTE PSYCHOTIC RXN

VIGABATRIN= WORKS ON GABA RECEPTOR=watch for depression and psychosis

TIAGABINE= GABA, diplopia

LEVETIRACETAM= used for BPolar

OXCARBAZEPINE=SIADH= WITH HYPONATREMIA
Status Epilepticus ER mgmt?
STATUS EPILEPTICUS
Seizing gonna give IV diazepam, not responding for more 20 mins, seizure is eating glucose gonna get brain damage
-need to be careful with management
-give IV diazepam 10mg first, + load of IV phenytoin not with regular seizure (this is for Hx of status epileptics)
-if this is not effective, need to give IV Phenobarbiturate, if this doesn’t work
YOU NEED TO CALL A NUEROLOGIST
 need to induce coma, to stop eating glucose, till the glucose is normal, then wake him up
-we’re not sure with thiopental and the dose dealing with brain damage let the nuerologist handle it
Guedels signs-Stages of Anesthesia
Stage I: less pain or no pain
Stage II: excitement, vomitting, irregular respiration
Stage III: surgical anesthesia (want to keep Pt in this stage)
-most surgery is plane 2 or upper 3, want the pt to breathe on his own
Stage IV: Medullary Paralysis: TOXIC
Stage III Surgical Anesthesia=Planes?
Plane 1: Eye mvmt stops
Plane 2: Partial intercostal paralysis
Plane 3 Complete intercostal paralysis
Plane 4 Diaphragmatic paralysis
MAC?
MAC=Min Alveolar Conc.
MAC-> measure of potency-> how potent is the anesthetic

50% of the patients do not feel noxious (not responding to pain)
Blood/Gas partition coefficient?
BW: It is a measure of solubility

The more soluble the gas the longer it takes to induce & to recover from anesthesia=longer its in the blood
Inhalational Anesthetics
IA=gases/liq admin by inhal

Halothane=Hepatotxic
Enflurane=Occasional Seizures
Isoflurane=Bronchospasm
Desflurane=Airway irritation
Methoxyflurane=Nephrotoxic
Sevoflurane=bradycardia & hypotension
Nitrous Oxide
Used for?
BW:
Tx:
NO
Used for: Dental & Minor surgery
BW-S/E: Diffusional Hypoxia
Rx: Hyperbaric Oxy for CO poisoning
Halothane & Succinylcholine can cause?
How do u treat?
Halothane can cause Malignant Hyperthermia

Mech: Succinylcholine can also cause, b/c nicotini agonist

Rx: Dantrolene=blocks Ca from sarcoplasm reticulum
IV General Anesthetics w/ BW?
Thiopental ultrashort acting, put pt into coma, pain at injection site
Midazolam insomnia, resp depression
Lorazepam dizziness, long acting
Sufentanil Confusion
Diazepam paradoxical excitation with remifentanil

Used w/ other agents in Cardio
Alfentanil=Resp depression
Fentanyl=Bradycardia
Remifentanil=Paradxical Exc.

Etomidate=Muscle/Eyemvmt-pain @ inj site

Propofol=Apnea, used for day surgeries
What is dissociative amnesia?
BW?
S/E?
Dissociative anethesia (catatonia, amnesia, analgesia)dissociation- seperation from reality

BW: Ketamine

S/E: Cardiac stimulation
Hallucinations
What is Neuroleptanalgesia?
Neuroleptic +AnalgGESIC
BW: Droperidol + Fentanyl(opiod, Bradycardia, IV general anesth)

Tranquilizing, CNS depress.
Neuroleptananesthesia use?
NeuroleptanANESTHESIA
Droperiol + Fentanyl + NO
How does local anesthetic work?
blocking the conduction of nerve impulses by decreasing the permeability to Na+