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138 Cards in this Set

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DX of seizures
eeg-diff b/t tumor
PET-inj glucose into braind
TX of seizures
1)dec firing -diazepam and phenobarb
2)dec the spread of elect activity-phenytoninand carbamazepam
phenytoin
-dilantin
-dec spread of seuzure-blocks na ch.
side effects:
heypertrichosis(minoxadil)
hirsutism(spironolactone)
megaloblastic anemia(etoh)
granulocytopenia-do ANC for neut ct.
osteolmalacia
gingival hyperplasia
induces c p450
fetal hydantoin synd- cleft lip/palate
narrow tx index
carbamazepine
-tegratol
-dec spread of seizure by blocking Na ch
-DOC for trigem neuralgia
-2nd to lithium for bipolar
side eff:
agranulocytosis
aplastic anemia
inc ADH=hyponatremia
cranio facial abn
spina bifida
phenobarb
-dec firing by activating gaba rec
-keeps cl ch open
side eff:
sedation
dependence
osteomalacia
long term megaloblast anemia
induce c p450
contraind w/ intermit porphyria
diazepam
-dec firing by activating gaba rec, open cl ch
-iv DOC for status epilepticus
ethosuximide
-dec ca ions inhib seuzure initiation and spread
-DOC for absence seizures
valproic acid
-depakote for migraines or imitrex
-dec ca ions and inhib seizure spread initiation
-activates gaba and inhibs na ch
-2nd choice for migraines and bipolar
side eff:
pancreatitis
hepatoxicity
spina bifida
Lamotrigine
-inhib of glutamate (NMDA antagonists)
side eff:
steven johnson synd
erythema multiforma->steve johnson->worst->toxic epidermal necrolysis or not bad immune disease
topiramate
inhib glutamate rec
side eff
kidney stones
felbamate
inhib of glutamate
aplastic anememia
new seizure drugs
1.zonisamide-sulfonamide
2.gabapentin-stim gaba
3.primidone-barb->acute 4.psychotic rxn
5.vigabatrin-dep and psycosis
6.levetiracetam-used for bipolar disorder
7.oxcarbazepine-better tolerated than carbamazepine,causes SIADH=hyponatremia
8.tiagabine-stim gaba
status epilepticus
-ER
-seizure for >30 min=brain damage
-tx w/ iv phenytoin and daiazepam
-if they still seize then give iv phenobarb
-if still then call a neuroligist to put pt into a coma w. iv thiopental b/c theyll have inc glucose consumption=brain damage
General anesthesia
-absence of sensation and consciousness
-from inhaled anesthetics
or iv
stages of anesthesia
1. analgesia
2.excitment
3.surgical anesth:
phases of 3:
1-no eye movement
2-intercostal paralysis
3-complete intercostal paralysis
4.diaphragem paralysis
1-3 is where surgery is done
stage 4. medullary paralysis=toxic stage
administration of iv anesthetics
iv->inhalational=rapid transition from concsciousness to anesthesia so early stages arent seen
factors that affect induction and rcovery
minimum alveolar conc
bld gas partition coef
MAC
-measures potentcy
- the conc that 50% of pts dont respond to a noxious stim
-not influenced by sex,o2 tension or acid base balance
Bld gas part coeff
-measures sol
-more sol=longer induction and recovery
drug w/ dec sol will use bld as a carrier and gets to BBB faster than a norm drug
i.e. sevofluroane 0.5 is smaller and works faster than enflurane at 0.9
inhalational anesthetics
-inhaled by mixing w/ o2
-are volitile=malignant hyperthermia
-keep atropine around to stop brady ie athlete w/ dec hr
-hypothermia
-shivering w/ rec give pt warm w. blankets or heat
Halothane
inhal anesth
hepatotoxic
not used
enflurane
inhal anesth
occasional seuzures
isoflurane
inhal anesth
bronchospasms
desflurane
inhal anesth
airway irritaion
methoxyflurane
inhal anesht
nephrotoxic
sevoflurane
inhal anesth
brady and hypotension
nitric oxide
gas
for dental and minor surgery
side eff:
diffusional hypoxia
tx w. hyperbaric o2
precaution w. inhal anesth
caution w/ elderly b/c inc response = hypotn,inc resp dep,and longer rec
Thiopental
iv anesth
pn at inj site
Midazolam
iv anesth
resp dep
diazepam
iv anesth
paradoxical excitation
lorazepam
iv anesth
dizzy
Alfentanil
iv anesth
opioid
resp dep
fentanyl
iv anesth
opioid
brady
remifentanil
iv anesth
opioid
paradoxical excitation
sufentanil
iv anesth
oipoid
conf
etomidate
iv anesth used to induce
musc eye move
pn at inj site
propofol
iv anesth to induce
apnea
Dissociative anesthisia
-amnesia,catatonia and analgesia
-ketamine
side eff:
cardiac stim
hallucinations
Neuroleptanalgesia
is an antipsychotic
-neuroleptics(tranquilizers)+ analgesic
-
Droperidol+Fentanyl
haloperidol+morphine deriv
Neuroleptanesthesia
Droperidol+Fentanyl+NO=loss of consc
-analgesics+cns deps need to be dec to 1/3 or 1/2 during recov
locals
direct
no sensation at a part of body
dec perm of na so dec nerve cond
esters
metab by pseudocholinesterase
procaine
tetracaine
benzocaine
amides
metab by liver
end in icaine
lidocaine,class 1 antiarrythmic-xylocaine
etidocaine
mepivacaine
admin of locals
topical=soln/oint
mm and dermis
infiltration=inj
sc/dermis
block=inj,nerve trunk,dental surg
spinal subarachnoid block=inj,abd surg,epidural
Antiparkinsons drugs
dopamine agonists
basal gang and subst nigra
dopamine syst
-movement
-dec dopamine=parkinsons
meso-limbic syst
-drug abuse
-inc dopamine=euphoria
-cocaine
meso-cortical
-scizophrenia
-inc dopamine=psychosis
-tx w/dopamine agonist
tubero-infundibular pthway
-inc dopamine=inhib of prolactin made by ant pit
-dopamine is known as PIF
chemorec trigger zone
-inc dopamine=emesis
hypothalamus
-endocrine
-ince dopamine=loss of appetite,hyperthermia,
Dopamine rec that inc camp
D1A
D1B
dopamine rec that dec camp
D2A=where typical antipsycho and antidopaminergics block
D2B
D2C=where atypical antipsychos block
Parkinsonism
less dopamine and more acetylcholine=needed for coordination
levadopa
inc dopamine
-dopamine precursor
-metab too fast by aromatic amino acid decarboxylase b4 it gets to BBB so must give w/ carbidopa(sinimet)
-carbidopa binds to leva long enuf to get it to BBB then it cant cross but leva can and then be metab in brain to inc dopamine lvls
-B6(pyridoxine) inc metab of leva
Dopamine reuptake inhib
-inc dopamine
-post synaptic
Amantidine
-dopamine reuptake inhib
-inc dopamine
side eff:
livedo reticularis=blue skin
bromocriptine
-inc dopamine
-ergot dopamine agonist
-tx for pit gland tumor to inhib prolactin w. hyperprolactino sec
pramipexole and ropinirole
-inc dopamine
-non ergot dopamine agonist
slegiline
-MAO inhib type B
-preserves dopamine in brain
so its not metab
Entacapone and tolcapone
-comt inhib
-hepatotoxic
Best combo tx for parkinsons
carbidopa+leva+entacapone(stalevo)
Benzatropine/biperiden/trhexphenidyl
-anticholinergics used to tx --parkinsons
-inhib acetylcholine at M rec
side eff:
dry mouth
blurred vision
urinary reten
confusion
Achcholinesterase inhibs to tx alzheimers
-rivastagmine
-donepezil
-gallantamine
-tacrine
Glutamate rec inhib to tx alzheimers
-memantine
Opioid analgesics
bind to opiod rec in cns
-indications:
adjuncts to anesthesia
cough
cp from mi
pn not relived by nonopioid analgesics
opioid NTs
-u=beta endorphin
(precursor=preopiomelanocortin)
-k=dynorphin(precursor=prodynomrphine)
u rec
-morphine works on them
-supraspinal analgesia
-sedation
-resp dep
-euphoria
-miosis(pinpoint pupils)
-dependence
-constipation
k rec
morphine works on them
spinal analgesia
dysphoria
morphine
-cocaine and heroine in same grp
-analgesia
-sedation
-dec resp by dec sensitiviy to pco2 so dont give pts o2
-miosis activate M rec
-supress cough
-stim D2 rec in CTZ=n/v
-constipation
-inc billiary p and spams dont give for billiary colic but can give merpidine
-inc histamine release=urticaria=hypotn
-used for mi and pulm edema
morphine od
presents in er w/:
pinpoint pupils
resp dep
coma
tx w/ iv naloxone=has short duration of 1-1.5 hrs and rapid onset
if give po give after iv and must give q 1.5 hrs so pt wont get resp dep and die
codeine
-opioid agonist
-cough sup
hydrocodone and oxycontin
-combo of tylenol and hydro/ocycontin
-cough supp
hydromorphone
for renal failure
alfentanil and fentanyl
anesthetics
merpidine
for billiary collic
methadone
for morphine w/d
prpoxyphene
used w/asa and tylenol
partial k and u antagonist
-pentazocine/naloxone=blockers
hallucinations/depersonilization
-nalbuphene= analgesia in labor
-butorphanol
dec NE and 5Ht
depression
inc NEand 5HT
bipolar
inc dopamine
psychosis
dec gaba
anxiety
Antipsychotics
block D2A
-called neuroleptics
-antidopaminergics
-only work on postive symps
chlorpromazine
-is a phenothiazine
-not ptoent so less EPS and more anticholinergic
-for antiemetic
fluphenazine
-is a phenothiazine
-long acting available
-potent so more EPS and less anticholinergic
mesoridazine and thioridazine
-is a phenothiazine
-thior is not potent so less EPS and more anticholinergic
-prolong QT int = torsades de pointes
-retinal deposites
perphenazine
-is a phenothiazine
-low cardiac risk
haloperidol
-is a butyrophenone
-haldol
-most used
-potent so more EPS and less anticholinergic
-for psychosis,tourettes,hyperactive kids
-should be w/held 48hrs b4 and 24hrs after a myelogram b/c inc seizure
loxapine and molindone
-other typical antipsycotic
-low cardiac risk
pimozide
-other typical antipsycotic
-prolonged QT
effects of all typical antipsychotics
-extrapyramidal side effects b/c they dec the dopamine in the cns
-dry mouth
-constipation
-ortho hypotn from alpha blockade=reflex tachy
-no ejaculation
-photosensitivity
-inc appetite=wt gain b/c inc 5HT
management of pts on antipsychotics
-urine will be pink/red
-no otc or herbal meds
-monitor QT int
-no etoh or cns deps
-if get EPS give benzotropine or diphenhydramine b/c have an inc anticholinergic affect
atypical antipsychtics
-no or less eps
-work on + and - symps
clozapine
-clozaril
-check wbc ct
-causes agranulocytosis
olanzapine
-wt. gain and DM
quetiapine
-tx autism in kids
risperidone
-inc doses=eps
ziprasidone
-blocks dopamine and5HT
aripiprazole
-dopamine agonist/antagonist acitvity
antideps
-inc NE and 5HT
-tx mood disorders
exogenous dep
-react to external cause
-loss of a loved one
-tx w. therapy and antideps
endogenous dep
-genetic
-chem imbalance
-tx w/ antideps
unipolar major affective disorder
major dep
dec NE and 5HT
tx w/antideps
bipolar major effective disorder
mania+dep
inc NE and 5HT
tx w/ mood stabilizer ie lithium
amitriptyline and nortriptyline
tricyc antidep
for chronic pn
clomipramine
tricyc anitdep
for ocd
imipramine
tricy anti
for enuresis bed wetter
trimipramine
tricyc antidep
no gi upset
doxepin
tricyc
anxiety
desipramine
tricyc anti
sudden cardiac death in kids
amoxapine
tetracylic anti
dopamine blocker
maprotiline
tetracyc
seizures
mirtazapine
tetra
seizures and agranulocytosis
nefazodone
2nd gen
hepatotoxic
trazodone
2nd gen
priapism=sustained erection
bupropion
2nd gen
seizures
smoking stop
wellbutrin and zyban
venlafaxine
2nd gen
nsri
if 75mgs jst works on NE if over then ne and 5ht
dose dep
phenelzine and tranylcypromine
mao inhib
htn crisis w/ cheese and wine
fluoxetine
ssri
prozac
take in am
paroxetine
ssri
paxil
safe in preg
sertraline
zoloft
less side eff
fluvoxamine
flovox
ssri
citalopram
ssri
celexa
management of antideps
tricycs=dry mouth sedation
and take 30 days to work
ssri's take 1-4wks
dont mix maos w/ ssris = seratonin synd=fever,htn,hyperthermia
2wks to get ssris out of system
lithium
antimaniac
for bipolar dis
pts will try to seduce md so restrain and give haldol
narrow tx index
nephrogenic diabeetes=hyponatrimea from v/d
carbamazepine
antimaniac
causes agranulocytosis
valproic acid and levetiracetam
antimaniacs
management of lithium
-tolerence is high in acute mania
-suicidal tendencies
-toxcicty=tremors
-drink h2o
-cause hypothyroidism
alprazolam
antianxiety
DOC
tricyc anti
beta blocker
ssri and benzos
for phobias
paroxetine and clomipramine and fluvoxamine
for ocd
ssris and atypical antideps
for ptsd
buspirone
for gad
zolpidine
nonbenzo for gad
hydroxyzine
antihistamine for gad