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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 |
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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 |
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Disorder: Seizure/post anesthesia
Drug Category: Drug: Mechanism: |
Disorder:Seizure/Post Anesthesia
Drug Category: Amphetamine Drug:Doxapram Mechanism: Respiratory stimulation |
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S/E of Amphetamine?
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Euphoria
Addiction Avoid Coffee Insomnia if taken w/i 6hrs of sleep |
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CNS stimulants
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Sedatives and Hypnotics
Barbituates--worst Coma Benzodiazepines--worst Anesthesia Non SH Alcohols |
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GABA
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GABA
GABAa receptors=ionotropic activated by B, B, G -Inc. Cl ions= hyperpolarization opposite of depol--relaxation |
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Which GABA receptor does Benzo bind? What reverses binding?
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Benzo binds to GABAy receptor, b/w gamma2 & alpha1 subunit
Binding reversed by Flumazenil |
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Which GABA receptor does Barb bind to?
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Barb binds to beta receptor GABAa
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Mechanism of Action of Baclofen
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Baclofen (muscle relaxer)
binds to GABAb receptor(g clpd receptor) GABAb dec. K+ =hyperpolarization & inhibition |
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BZ1
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BZ1 for sleep
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BZ2
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BZ2 for memory, sensory motor, cognitive functions
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What does benzo determine?
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Benzo determines frequency of channels open & binds on y site
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What does Barb determine?
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Barb increases the DURATION that the Cl channel stays open & binds to B site
At high dose Barb opens Cl & blks Na |
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Disorder: Seizures
Drug Category: Drug: Mechanism: |
Disorder: Seizures-Tourettes, Eclampsia
Drug Category:Barb Drug: Phenobarbital |
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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 |
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S/E of Barbs used for Seizures
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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 |
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Alprazolam
Used to Tx? Drug Cat: |
Alprazolam (Xanax)
Panic Attacks & short term insomnia Drug Cat: Benzo |
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Clonazepam
Used to tx? Drug Cat: |
Clonazepam
Anticonvulsants Drug Cat: Benzo |
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Diazepam
Used to tx? Drug Cat: |
Diazepam(Valium)
Statis epileptics longest acting anticonvulsant Drug Cat: Benzo |
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Flurazepam
Used to tx? Drug Cat |
Flurazepam
Insomnia, no REM suppression forms an active metabolite Drug Cat: Benzo |
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Flunitrazepam
used for? Drug Cat |
Date rape drug
Drug Cat: Benzo |
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Midazolam
Used to treat? Drug Cat |
Midazolam
IV only anesthetic Insomnia Drug Cat: Benzo |
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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 |
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S/E of Benzo
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S/E of Benzo
Sedation Anterograde Amnesia Tol & Depen less than barb Rebound withdrawal: Anxiety & Insomnia |
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Benzo OD in ER
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Benzo OD give
IV Flumezanil |
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New sleep disorder drugs & Mechanism
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Sleep disorder drugs:
Zolipidem Zaleplon Eszopiclone(lunesta) = insomnia Bind to BZ1 receptors to induce sleep only not like benzo |
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Buspirone
Used to tx? |
Buspirone
General Anxiety Disorder not panic attacks Takes 1-2wks to wk |
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Alcohols
Metabolized by? |
Ethylene Glycol-anti-freeze
Methanol Ethanol Metabolized by Alcohol Dehydrogenase |
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Process of ethylene glycol?
Toxicity? OD Rx? |
Ethylene Glycol-->Oxalic Acid:
CNS depression Metabolic Acidosis Renal Toxicity OD rx: Fomepizole |
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Process of Methanol?
Toxicity? OD rx? |
Methanol-->Formic Acid:
Toxicity: Blindness Resp. Depression Metabolic Acidosis w/ anion gap produced by Lamudpie OD rx: Ethanol |
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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 |
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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 |
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Types of seizures?
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Generalized=convulsive
Tonic clonic=Grand mal, petit mal Partial(focal)= simple=pt aware Complex= not aware of it, temp lobe |
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Grand mal seizure process
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Grand Mal
-Pt loses conscioness- bite the tongue- striking sound of air due to larynx contraction(epileptic cry) |
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Absent (petit mal seizure)
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Absent-
Kid is absent, starring, no motor manifestation |
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Partial seizure
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Partial sezure can feel it coming, has an aura
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What decreases firing during a seizure?
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DIazepam & Phenobarbital
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What stops the spread of the seizure, and how?
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Decrease the spread of electrical activity by increasing the threshold.
Phenytoin or Carbamazepine |
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What decreases the spread of seizure by blocking Na channels?
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Phenytoin & Carbamazepine by inactivating
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What dec firing by act GABA rec and how?
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Dec firing by act GABA rec. which open CL channels leading to hyperpolarization
Barb & Benzo |
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What decreases Ca ions which in hibit seizure initiation & spread?
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Ethozuximide & Valprpoic acid
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What inhibits Glutamate & how?
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Inhibit glutamate(excit nt) by NMDA receptor antagonists
Lamotrigine-Topiramate |
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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 |
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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 |
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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 |
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Diazepam
used to tx? |
IV Diazepam
Status Epilepticus & DT Longest acting anticonv. Stops Seiz @ focus |
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Ethosuximide
Mech? Used to tx? |
Ethosuximide
Dec. Ca++ ions Absence Seizure |
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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 |
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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 |
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Topiramate
Mech: Used to Tx: S/E: |
Topiramate
M:Inhibit Glutamate UTTx: stops craving in addicts S/E: Kidney stones |
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Felbamate
Mech: S/E: |
Felbamate
M: Inhibit glutamate S/E: Aplastic anemia |
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New drugs for Seizures & Mechanisms?
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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 |
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Status Epilepticus ER mgmt?
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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 |
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Guedels signs-Stages of Anesthesia
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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 |
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Stage III Surgical Anesthesia=Planes?
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Plane 1: Eye mvmt stops
Plane 2: Partial intercostal paralysis Plane 3 Complete intercostal paralysis Plane 4 Diaphragmatic paralysis |
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MAC?
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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) |
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Blood/Gas partition coefficient?
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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 |
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Inhalational Anesthetics
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IA=gases/liq admin by inhal
Halothane=Hepatotxic Enflurane=Occasional Seizures Isoflurane=Bronchospasm Desflurane=Airway irritation Methoxyflurane=Nephrotoxic Sevoflurane=bradycardia & hypotension |
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Nitrous Oxide
Used for? BW: Tx: |
NO
Used for: Dental & Minor surgery BW-S/E: Diffusional Hypoxia Rx: Hyperbaric Oxy for CO poisoning |
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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 |
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IV General Anesthetics w/ BW?
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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 |
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What is dissociative amnesia?
BW? S/E? |
Dissociative anethesia (catatonia, amnesia, analgesia)dissociation- seperation from reality
BW: Ketamine S/E: Cardiac stimulation Hallucinations |
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What is Neuroleptanalgesia?
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Neuroleptic +AnalgGESIC
BW: Droperidol + Fentanyl(opiod, Bradycardia, IV general anesth) Tranquilizing, CNS depress. |
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Neuroleptananesthesia use?
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NeuroleptanANESTHESIA
Droperiol + Fentanyl + NO |
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How does local anesthetic work?
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blocking the conduction of nerve impulses by decreasing the permeability to Na+
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