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77 Cards in this Set
- Front
- Back
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Cheese Reaction
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S/E with MAO (-)--> phenelzine
-accumulation of TYRAMINE w/ ingestion of wine and cheese |
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MAO (-) S/E
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-hepatic toxicity
-orthostatic hypotension -cheese reaction |
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MAO (-) MOA
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-irreversible/ covalent inhibition of MAO in mitochondria
-lower cytoplasmic NE concentration -increase in jxn (transporters in reverse) |
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MAO (-) drugs
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-phenelzine ***
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TCA MOA
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-block reuptake of NE and 5-HT
-desipramine = NE only -imipramine = NE and 5-HT -clomipramine |
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TCA S/E due to muscarinic block
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-dry mouth
-memory problems -urinary and bowel retention -sexual dysfunction |
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TCA S/E due to H1 block
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-sedation
-weight gain |
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TCA S/E due to alpha-1 adrenergic block
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-orthostatic hypotension
-sexual dysfunction |
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TCA main S/E
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-tachycardia, T-wave inversion, PR elongation (Muscarinic block)
-dry mouth, urinary and GI retention, sexual dysfxn (musc. block) -orthostatic hypotension (alpha-1 block) -sedation + weight gain (H1 block) -fine tremor, manic episodes |
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Tx cardiovascular toxicity in TCA OD
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NaHCO3
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Tx Serotonin SYndrome
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cyproheptadine
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TCA for OCD
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-clomipramine
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TCA for bedwetting
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-imipramine
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Antidepressants causeing weight gain
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Miratazapine - block H1 rec
TCA due to H1 rec. block |
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Miratzapine
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alpha-2 autorec. antagonist---> increase NE, indirect 5-HT
-causes weight gain due to H1 block |
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Buproprion
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dopamine/ NE uptake inhibition
-smoking cessation -causes seizuresm tachycardia, stimulant -no sex effects |
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Carbidopa
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Tx: Parkinson w/ Levadopa
(-) peripheral decarboxylase--> lowers needed dose of L-DOPA--> lowers S/E cardiac arrythmias, n/v, anorexia -avoid use w/ Pyridixone/ Vit. B6 |
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Entacaptone
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COMT (-) for use w/ L-DOPA + Carbadopa (Parkinsons)
blocks L-DOPA----(COMT)--> alpha-mthyl-DOPA |
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Tolcapone
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COMT (-) for use w/ L-DOPA + Carbadopa (Parkinsons)
blocks L-DOPA----(COMT)--> alpha-mthyl-DOPA always get LFT prior to use |
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Bromocriptine
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Tx: Parkinsons, Neuroepilleptic Malignant syndrome, hyperprolactinemia
MOA- dopamine-2 rec. agonist Others: Pramipexola, Ropinarole, Apomorphine) S/E: orthostatic hypotension, N/V, constipation, psychosis, dyskinesias |
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Selegiline
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Tx: Parkinsons, MAO-B inhibitors
MOA- irreversible (-) of MAO-B, prevent degrade of Dopamine metabolized to amphetamine attenuate "on-off" of L-DOPA |
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Ach-Muscarinic Inhibitor Tx. Parkinsons
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-Tryhexaphenydil
-Benzotropine -Biperidines -Procyclidines |
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Dopamine rec. antagonist Tx. Huntintons
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Haloperidol
also: Tourettes syndrome |
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Active Isomeric form of Opiates
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L-(-)-isomeric form
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Absorption of narcotics
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-p.o. poor
-i.m. complete -transdermal may be effective |
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Meperidine
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-drug induced parkinsoniams, seizures, narcotic agent
-metabolized by esterases to normeperidine |
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Morphine-6-glucuronic acid
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-hepatic metabilization product of narcotics/ optiates--> ACTIVE METABOLITE
-due to hepatic conjugation w/ glucarionic acid -eliminated in bile |
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S/E Narcotic administration
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-analgesia: more dull pain, via mu and kappa rec.
-sedation -respiratory depression: due to central chemorec. -MIOSIS: increased PS tone -nausea/ vomitting (use propofol as adjunct) -cough supression -truncal rigidity -mu-rec mediate peripheral effects: ortho. hypoTN, histamine release, GI amotility |
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Naloxone HCl
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complete antagonist for all opiate rec
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Fentanyl
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-iv. narcotic analgesiac
-S/E- cardiac and resp. depression, MIOSIS, truncal rigidity -complete agonist to MU receptors |
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Dont give narcotics to:
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-head injury --> ICP/ CBF
-pancreatitis -MAO inhibitors--> convulsions, hypotension, resp. depression -pulmonary or hepatic dysfxn |
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Aspirin absorbed in:
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-upper small intestine
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ASA hydrolyzed by:
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plasma and tissue esterases
(most turned into acetate and salicylic acid) |
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Sx: Aspirin toxicity
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-tinnitus, hyperventilation (resk. alkalosis), metabolic acidosis
-headache, confusion, n/v Tx: alkalinize urine |
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non-narcotic safe w/ anti-coags
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acetominophen
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acute OD acetominophen
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hepatic necrosis
-exceed ability of liver to glucaronidate acetominophen--> move to microsomal N-hydroxylation (NABQ) -worsen w/ EtOH Tx: sulfahydryl grp. supplementation |
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chronic acetominophen OB
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-renal failure
-lower RBF/ GFR -esp. combo w/ aspirin -renal papillary necrosis |
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dont use ketoralac w/:
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-gastric problems
-renal problmes -more than 5d. |
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Baclophen
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-supraspinal muscle relaxant
-GABA-B agonist, decrease Glutamate -Tx: MS, flexor spasms |
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Acute effects of EtOH:
CNS |
-lower GABA
-increase Dopamine -lower RAS in medulla (high levels) |
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Acute effects of EtOH:
cardiovascular |
-cutaneous vasodilation
-myocardial depression |
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Acute effects of EtOH:
metabolism |
-ketoacidosis, uricemia, hyper/hypo-glycemia, lactic acidosis
-excess H+ -higher NADH: NAD+ -lipidemia |
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Acute effects of EtOH:
gi |
-pylorospasm (>40%)
-increase gastric acid |
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Acute effects of EtOH:
endocrine |
-(-) ADH release w/ diuresis
-lower testosterone, LH, and oxytocin |
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atypical antipsychotics
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-clozapine
risperidone olanzapine aripiprazole ziprasidone quietapine |
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Clonzapine uses
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Atypical ANtipsychotic
-Parkinsons disease- helps Tx EPS of levadopa -Tourettes in kids- prevents tardative dyskinesias |
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Problems with Typical Antispsychotics
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-no effect on (-) symptoms
-Extrapyramidal symptoms -hyperproactinemia -hit D2 as well as 5-HT |
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Typical Antipsychotics
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Chlorpromazine
Perphenazine Haloperidol |
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MOA Atypical ANtipsychotics
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-partial agonist D2-rec
-antagonist 5-HT rec |
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Cheese Reaction
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MAO-I--> tyramine build-up
-hypertensive crisis due to elevated NE Drugs: Phenylazine, Selegine, Rasagaline, Tranylcyclopromide |
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Tranylcyclopramide
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MOA-I
anti-depressant, PD? for wearing off of levadopa S/E- cheese reaction, orthostatic hypoTN, mania in BP patients, hepatic toxicity |
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Tx Social anxiety disorder
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SSRIs: fluoxetine, sertaline, Paroxitine, Citalopram, buproprion
S/E- othrostatic hypo TN, sexual dysfunction, weight loss, aesthenia |
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TCA S/E
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-prolonged PR interval, inverted T-wave
-tachycardia -BP pt. mania -tremors -seizures |
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SSRI w/ seizure risk
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Buproprion
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performance-related anxiety
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beta-blockers (propanolol)
also essential tremors |
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Fluoxetine
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SSRI
S/E- orthostatic hypotension, sex dysfxn, aesthenia, mania in BP Tx: depression, SAD, non-combat PTSD, panic disorder, OCD |
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Buproprion
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SSRI
S/E orthostatic hypotension, mania in BP, sexual problems, aesthenia |
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Propanolol in psychiatry
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-performance anxiety
-essential tremors |
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Citalopram
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SSRI
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Clomipramine
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TCA anti-depressant
-Tx: depression, OCD -MOA: serotonin reuptake inhibition |
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Imipramine
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TCA anti-depressant
S/E: tachycardia, T-wave inversion, PR-interval elongation, mania in BP, tremors, seizures |
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Mirtazepine
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anti-depressant--> blocks alpha2-receptos
S/E severe weight gain |
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Flumazil
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blocks BZ binding to GABA-A rec.
beware of short T50 |
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Zolpidem
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Ambien
Zaleplon and Exopidone |
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Zaleplon
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Sonata
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Exopiclone
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Lunestra
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Ramelton
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melatonin rec agonist
Tx: sleep onset disturbances |
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Haloperidol
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Typical AP
Tx: tourretes, SZ (beware EPS) |
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Lithium S/E
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-DI
-hypothyroidism -dysrythmias |
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Lamotrigine
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depressive Sx of BP
pair w/ valproate or Atypical AP |
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DOC abscence seizures
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succimides: lower Ca2+ conductance (T-waves)
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Trimethadone
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Tx; seizures
MOA= lower Ca2+ threshold |
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Ezogabine
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Tx: seizures
stablize open K+ channels |
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Lamotrigine
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wide spectum anti-epilleptic
inactivate Na+ channels 2' line Tx for abscence seizures |
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partial seizure tx
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carbazamine
phenytoin |
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DOC tonic-clonic
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phenytoin
ethotoin |
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DOC status epilepticus
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lorazepam or diazepam
2' = fosphenytoin |
