Pharm - Required Reading Oneliners

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Common side effect of hypnotic agents

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Sedation

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Occurs when sedative hypnotics are used chronically or at high doses

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Tolerance

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The most common type of drug interaction of sedative hypnotics w/ other depressant medications

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Additive CNS Depression

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Benzodiazepines used to promote sleep

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Temazapam, trizolam, flurazepam

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Benzodiazepine used for anxiety

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Alprazolam

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non-benzodiazepine used as an anxiolytic

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Buspirone

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non-benzodiazepine used for sleep

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Zolpidem

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Major effect of benzodiazepines on sleep at high doses

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DECREASES REM

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Neurologic SE of benzodiazepines

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Anterograde amnesia

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Reason benzos are used cautiously in pregnancy

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Ability to cross placenta

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Main route of metabolism for benzo's

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Hepatic

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Benzo that undergoes extrahepatic conjugation (which are useful in older ppl or hepatically impaired)

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Lorazepam, oxazepam, temazepam

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MOA for benzo's

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Increase the FREQUENCY of GABA - mediated chloride ion channel opening

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Antidote to benzo overdose (antagonist that reverses the CNS effects)

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Flumazenil

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Benzo with useful relaxant effects in skeletal muscle spasticityof central origin

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Diazepam

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Benzo that has efficacy against absence seizures and in anxiety states, such as AGORAPHOBIA

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Clonazepam

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Benzo's that are the moes effect in the treatment of PANIC disorder

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Alprazolam & Clonazepam

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Benzo used for anesthesia

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Midazolam

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DOC for status epilepticus

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Diazepam

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Longer acting benzo used in the management of withdrawal states if alcohol and other drugs

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Chlordiazepoxide and Diazepam

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Agents having active metabolites, long half-lives and a high incidence of adverse effects

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Diazepam, flurazepam, chlordiazepoxide and clorazepate

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Baebiturates may precipitate this hematologic condition

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Acute intermittent Porphyria

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Baebiturates decrease the effectiveness of many other drugs viz this pharmacokinetics property

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Liver enzyme INDUCTION

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Baebiturates MOA

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Increase the DURATION of GABA-mediated chloride ion channels

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Baebiturate used for the induction of anesthesia

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Thiopental

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Site of action of zaleplon & zolpidem

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Bezodiazepine receptor BZ1
(although mdo not have a benzodiazepine ring structure)

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Good hypnotic activity with less CNS SE than most benzo's

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Zolpidem, zaleplon

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Agent that is a partial agonist for the 5-HT1A receptor

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Buspirone

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DOC for generalized anxiety disorder, NOT effective in acute anxiety

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Buspirone

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Agent that is metabolized to acetaldehyde by alcohol dehydrogenase and microsomal ethanol-oxidizing system (MEOS)

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Ethanol

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Agent with zero-order kinetics

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Ethanol

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Rate limiting step of alcohol metabolism

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Aldehyde dehydrogenase

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System that increases in activity with chronic EtOH exposure and may contribute to tolerance

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MEOS

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Enzyme that metabolizes acetaldehyde to acetate

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Aldehyde dehydrogenase

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Agents that inhibit Alchohol dehydrogenase

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Disulfirm, metronidazole, certain sulfonylureas, and cephalosporins

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Agent used in the tx of ALCOHOLISM, if alcohol is consumed concurrently, adetaldehyde builds up and results in nausea, HA, flushing and hypotension

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Disulfiram

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The most common neurologic abnormality in chronic alcoholics

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Peripheral neuropathy (also excessive alcohol use is assoc. with HTN, anemia, and MI)

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Agent that is a teratogen and causes a Fetal syndrome

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Ethanol

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Agent that is the antidote for methanol overdose

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Ethanol, fomepizole

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Drug that inhibits alcohol dehydrogenase and is used in ethylene glycol exposure

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Fomepizole

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MOA of general anesthetics

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Most are thought to act at GABA-A receptor - chlorida channel

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Inhaled anesthetic with low blood/gas partition coefficient

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Nitrous oxide

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Inversely related to potency of anesthetics

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MAC - Minimum alveolar anesthetic concentration

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Inhaled anesthetics metabolized by liver enzymes which has a major role in the toxicity of these agents

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Halothane and methoxyflurane

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Most inhaled anesthetics SE

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Decrease arterial BP

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Inhaled anesthetics that are myocardial

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Enflurane and Halothane

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Inhaled anesthetic that causes periphera vasodilation

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Isoflurane

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Inhaled anesthetic that may sensitize the myocardium to arrhythogenic effects of catecholamines and has produced Hepatitis

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Halothane - Hepatitis

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Inhaled anesthetic less liekly to lower BP than other agents and has smallest effect on respiration

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Nitrous oxide

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Fluoride released by metabolism of this inhaled anesthetic may cause renal insufficiency

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Methoxyflurane

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Prolonged exposure to this inhaled anesthetic may lead to MEGALOBLASTIC ANEMIA

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Nitrous oxide

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PUNGENT inhaled anesthetic which leads to high incidence of coughing and vasospasm

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Desflurane

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DOC for MALIGNANT HYPERTHERMIA that may be caused by used of halogenated adesthetics

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Dantolene

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IV barbiturate used as a pre-op anesthetic

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Thiopental

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Benzo used adjunctively in anesthesia

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Midazolam

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Benzo receptor antagonist, it accelerates recovery from benzo overdose

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Flumazenil

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This produces "dissociative anesthesia" is a cardiovascular stimulant which may increase intracranial pressure, and hallucinations occur during recovery

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Ketamine

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Opioid associated with respiratory depression, but is used in high risk patients who may not survive full general anesthetic

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Fentanyl

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State of analgesia and amnesia produced when fentanyl is used with droperidol with NO

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Neuroleptanestheia

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Produces both rapid anesthesia and recovery, has antiemetic activity and commonly used for outpatient surgery, may cause marker hypotension

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Propofol

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Structurally related to acetylcholine, used to produce muscle paralysis in order to facilitate surgery or artificial ventilation. Full doses lead to respiratory paralysis and require ventilation

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Neuromuscular blocking agents

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These drugs strongly potentiate and prolong the effect of neuromuscular blockade (NMB)

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Inhaled anesthetics, especially isoflurane, aminoglycosides, and antiarrhythmic

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These prevent the action of ACh at the skeletal m. endplate to produce "surmountable blockade" effect is reversed by cholinesterase inhibitors (ex. neostigmine or pyridostigmine)

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Nondepolarizing type antagonists

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Agenst with long duration of action and is most likely to cause histamine release

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Tubocurarine

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Non-depolarizing skeletal muscle antagonist that has short duration

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Mivacurium

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Skeletal m. agent that can block muscarinic receptors

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Pancuronium

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Skeletal m. agent that undergoes Hofmann elimination ( breaks down spontaneously )

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Atracurium

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One depolarizing blocker that causes continuous depolarization and results in muscle relaxation and paralysis, causes muscle pain postoperatively and myoglobinuria may occur

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Succinylcholine

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During Phase I these agents worsen muscle paralysis by succinylcholine, but during phase II they reverse the blockade produced by succ.

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Cholinesterase Inhibitors