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138 Cards in this Set
- Front
- Back
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DX of seizures
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eeg-diff b/t tumor
PET-inj glucose into braind |
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TX of seizures
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1)dec firing -diazepam and phenobarb
2)dec the spread of elect activity-phenytoninand carbamazepam |
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phenytoin
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-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 |
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carbamazepine
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-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 |
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phenobarb
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-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 |
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diazepam
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-dec firing by activating gaba rec, open cl ch
-iv DOC for status epilepticus |
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ethosuximide
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-dec ca ions inhib seuzure initiation and spread
-DOC for absence seizures |
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valproic acid
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-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 |
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Lamotrigine
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-inhib of glutamate (NMDA antagonists)
side eff: steven johnson synd erythema multiforma->steve johnson->worst->toxic epidermal necrolysis or not bad immune disease |
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topiramate
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inhib glutamate rec
side eff kidney stones |
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felbamate
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inhib of glutamate
aplastic anememia |
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new seizure drugs
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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 |
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status epilepticus
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-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 |
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General anesthesia
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-absence of sensation and consciousness
-from inhaled anesthetics or iv |
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stages of anesthesia
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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 |
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administration of iv anesthetics
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iv->inhalational=rapid transition from concsciousness to anesthesia so early stages arent seen
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factors that affect induction and rcovery
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minimum alveolar conc
bld gas partition coef |
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MAC
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-measures potentcy
- the conc that 50% of pts dont respond to a noxious stim -not influenced by sex,o2 tension or acid base balance |
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Bld gas part coeff
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-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 |
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inhalational anesthetics
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-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 |
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Halothane
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inhal anesth
hepatotoxic not used |
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enflurane
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inhal anesth
occasional seuzures |
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isoflurane
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inhal anesth
bronchospasms |
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desflurane
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inhal anesth
airway irritaion |
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methoxyflurane
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inhal anesht
nephrotoxic |
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sevoflurane
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inhal anesth
brady and hypotension |
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nitric oxide
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gas
for dental and minor surgery side eff: diffusional hypoxia tx w. hyperbaric o2 |
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precaution w. inhal anesth
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caution w/ elderly b/c inc response = hypotn,inc resp dep,and longer rec
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Thiopental
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iv anesth
pn at inj site |
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Midazolam
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iv anesth
resp dep |
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diazepam
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iv anesth
paradoxical excitation |
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lorazepam
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iv anesth
dizzy |
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Alfentanil
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iv anesth
opioid resp dep |
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fentanyl
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iv anesth
opioid brady |
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remifentanil
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iv anesth
opioid paradoxical excitation |
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sufentanil
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iv anesth
oipoid conf |
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etomidate
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iv anesth used to induce
musc eye move pn at inj site |
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propofol
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iv anesth to induce
apnea |
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Dissociative anesthisia
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-amnesia,catatonia and analgesia
-ketamine side eff: cardiac stim hallucinations |
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Neuroleptanalgesia
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is an antipsychotic
-neuroleptics(tranquilizers)+ analgesic - |
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Droperidol+Fentanyl
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haloperidol+morphine deriv
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Neuroleptanesthesia
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Droperidol+Fentanyl+NO=loss of consc
-analgesics+cns deps need to be dec to 1/3 or 1/2 during recov |
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locals
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direct
no sensation at a part of body dec perm of na so dec nerve cond |
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esters
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metab by pseudocholinesterase
procaine tetracaine benzocaine |
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amides
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metab by liver
end in icaine lidocaine,class 1 antiarrythmic-xylocaine etidocaine mepivacaine |
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admin of locals
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topical=soln/oint
mm and dermis infiltration=inj sc/dermis block=inj,nerve trunk,dental surg spinal subarachnoid block=inj,abd surg,epidural |
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Antiparkinsons drugs
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dopamine agonists
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basal gang and subst nigra
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dopamine syst
-movement -dec dopamine=parkinsons |
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meso-limbic syst
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-drug abuse
-inc dopamine=euphoria -cocaine |
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meso-cortical
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-scizophrenia
-inc dopamine=psychosis -tx w/dopamine agonist |
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tubero-infundibular pthway
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-inc dopamine=inhib of prolactin made by ant pit
-dopamine is known as PIF |
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chemorec trigger zone
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-inc dopamine=emesis
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hypothalamus
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-endocrine
-ince dopamine=loss of appetite,hyperthermia, |
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Dopamine rec that inc camp
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D1A
D1B |
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dopamine rec that dec camp
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D2A=where typical antipsycho and antidopaminergics block
D2B D2C=where atypical antipsychos block |
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Parkinsonism
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less dopamine and more acetylcholine=needed for coordination
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levadopa
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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 |
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Dopamine reuptake inhib
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-inc dopamine
-post synaptic |
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Amantidine
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-dopamine reuptake inhib
-inc dopamine side eff: livedo reticularis=blue skin |
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bromocriptine
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-inc dopamine
-ergot dopamine agonist -tx for pit gland tumor to inhib prolactin w. hyperprolactino sec |
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pramipexole and ropinirole
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-inc dopamine
-non ergot dopamine agonist |
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slegiline
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-MAO inhib type B
-preserves dopamine in brain so its not metab |
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Entacapone and tolcapone
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-comt inhib
-hepatotoxic |
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Best combo tx for parkinsons
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carbidopa+leva+entacapone(stalevo)
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Benzatropine/biperiden/trhexphenidyl
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-anticholinergics used to tx --parkinsons
-inhib acetylcholine at M rec side eff: dry mouth blurred vision urinary reten confusion |
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Achcholinesterase inhibs to tx alzheimers
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-rivastagmine
-donepezil -gallantamine -tacrine |
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Glutamate rec inhib to tx alzheimers
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-memantine
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Opioid analgesics
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bind to opiod rec in cns
-indications: adjuncts to anesthesia cough cp from mi pn not relived by nonopioid analgesics |
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opioid NTs
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-u=beta endorphin
(precursor=preopiomelanocortin) -k=dynorphin(precursor=prodynomrphine) |
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u rec
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-morphine works on them
-supraspinal analgesia -sedation -resp dep -euphoria -miosis(pinpoint pupils) -dependence -constipation |
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k rec
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morphine works on them
spinal analgesia dysphoria |
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morphine
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-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 |
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morphine od
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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 |
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codeine
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-opioid agonist
-cough sup |
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hydrocodone and oxycontin
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-combo of tylenol and hydro/ocycontin
-cough supp |
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hydromorphone
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for renal failure
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alfentanil and fentanyl
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anesthetics
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merpidine
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for billiary collic
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methadone
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for morphine w/d
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prpoxyphene
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used w/asa and tylenol
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partial k and u antagonist
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-pentazocine/naloxone=blockers
hallucinations/depersonilization -nalbuphene= analgesia in labor -butorphanol |
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dec NE and 5Ht
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depression
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inc NEand 5HT
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bipolar
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inc dopamine
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psychosis
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dec gaba
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anxiety
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Antipsychotics
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block D2A
-called neuroleptics -antidopaminergics -only work on postive symps |
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chlorpromazine
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-is a phenothiazine
-not ptoent so less EPS and more anticholinergic -for antiemetic |
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fluphenazine
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-is a phenothiazine
-long acting available -potent so more EPS and less anticholinergic |
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mesoridazine and thioridazine
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-is a phenothiazine
-thior is not potent so less EPS and more anticholinergic -prolong QT int = torsades de pointes -retinal deposites |
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perphenazine
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-is a phenothiazine
-low cardiac risk |
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haloperidol
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-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 |
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loxapine and molindone
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-other typical antipsycotic
-low cardiac risk |
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pimozide
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-other typical antipsycotic
-prolonged QT |
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effects of all typical antipsychotics
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-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 |
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management of pts on antipsychotics
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-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 |
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atypical antipsychtics
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-no or less eps
-work on + and - symps |
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clozapine
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-clozaril
-check wbc ct -causes agranulocytosis |
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olanzapine
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-wt. gain and DM
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quetiapine
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-tx autism in kids
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risperidone
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-inc doses=eps
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ziprasidone
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-blocks dopamine and5HT
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aripiprazole
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-dopamine agonist/antagonist acitvity
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antideps
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-inc NE and 5HT
-tx mood disorders |
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exogenous dep
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-react to external cause
-loss of a loved one -tx w. therapy and antideps |
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endogenous dep
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-genetic
-chem imbalance -tx w/ antideps |
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unipolar major affective disorder
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major dep
dec NE and 5HT tx w/antideps |
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bipolar major effective disorder
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mania+dep
inc NE and 5HT tx w/ mood stabilizer ie lithium |
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amitriptyline and nortriptyline
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tricyc antidep
for chronic pn |
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clomipramine
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tricyc anitdep
for ocd |
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imipramine
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tricy anti
for enuresis bed wetter |
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trimipramine
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tricyc antidep
no gi upset |
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doxepin
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tricyc
anxiety |
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desipramine
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tricyc anti
sudden cardiac death in kids |
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amoxapine
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tetracylic anti
dopamine blocker |
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maprotiline
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tetracyc
seizures |
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mirtazapine
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tetra
seizures and agranulocytosis |
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nefazodone
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2nd gen
hepatotoxic |
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trazodone
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2nd gen
priapism=sustained erection |
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bupropion
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2nd gen
seizures smoking stop wellbutrin and zyban |
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venlafaxine
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2nd gen
nsri if 75mgs jst works on NE if over then ne and 5ht dose dep |
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phenelzine and tranylcypromine
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mao inhib
htn crisis w/ cheese and wine |
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fluoxetine
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ssri
prozac take in am |
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paroxetine
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ssri
paxil safe in preg |
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sertraline
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zoloft
less side eff |
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fluvoxamine
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flovox
ssri |
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citalopram
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ssri
celexa |
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management of antideps
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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 |
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lithium
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antimaniac
for bipolar dis pts will try to seduce md so restrain and give haldol narrow tx index nephrogenic diabeetes=hyponatrimea from v/d |
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carbamazepine
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antimaniac
causes agranulocytosis |
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valproic acid and levetiracetam
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antimaniacs
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management of lithium
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-tolerence is high in acute mania
-suicidal tendencies -toxcicty=tremors -drink h2o -cause hypothyroidism |
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alprazolam
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antianxiety
DOC tricyc anti beta blocker |
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ssri and benzos
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for phobias
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paroxetine and clomipramine and fluvoxamine
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for ocd
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ssris and atypical antideps
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for ptsd
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buspirone
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for gad
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zolpidine
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nonbenzo for gad
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hydroxyzine
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antihistamine for gad
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