Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
204 Cards in this Set
- Front
- Back
|
MOST IMPORTANT INHIBITORS OF P450
I.E. dec metabolism of other drugs |
CIMETIDINE, KETOCONAZOLE, ERYTHROMYCIN
|
|
|
MOST IMPORTANT INDUCERS OF P450 → ↑ METABOLISM OF DRUGS
|
BARBITUATES, PHENYTOIN, CARBAMAZAPINE
|
|
|
Drugs that increase the action of GABAa
|
Barbituates
BDZ EtOH Sedative Hypnotics |
|
|
what is the GABA channel and what ion does it work with
|
major inhibitory neuron of the brain
Cl- ion |
|
|
what is the mech of action for barbituates
|
INCREASE DURATION GABA KEEPS CHANNEL OPEN (CL-
|
|
|
side effects of barbituates
|
Major CNS depressant
Respiratory depression Porphyria paradoxical excitement dec REM |
|
|
what should you do if someone overdoses on phenobarbital and their BP severely drops
|
Alkalinize the urine
|
|
|
what is phenobarbital used for
|
a barbituate used as an anti- convulsant
|
|
|
what is thiopental good for
|
it is a barbituate that is used to induce anesthesia.
very short acting Midazolam is better for this (BDZ) |
|
|
what is the effect of BDZ at low doses?
High doses? |
Low - anxiolytic
High - sedative/ hypnotic |
|
|
what are the 3 main uses of BDZ
|
• anxiety, now standard Tx
• insomnia • EtOH, barbiturate withdrawal |
|
|
If you are taking someone off of a long term use of phenobarbital, what should you give them
|
a BDZ
|
|
|
why are BDZ good for withdrawls
|
they prevent seizures, hallucinations, delirium tremens
|
|
|
what do you NOT use BDZs for
|
OCD
Agoriphobia/ panic disorders PTSD kids or teens |
|
|
why are BDZs better than barbituates like phenobarbital
|
they have a ceiling effect and only facilitate the effect of GABAa, they cant do anything on their own
|
|
|
What type of patients would you avoid giving phenobarbital to
|
people with:
respiratory problems porphyria taking stimulants |
|
|
who would you not give a BDZ to
|
Pregnant mothers
Children/adolescents Elderly (except Triazolam (Halcion)) |
|
|
why dont you want to give BDZs to children
|
it impairs learning and memory
|
|
|
why dont you want to abruptly discontinue the use of BDZ
|
it can cause rebound Sx
|
|
|
Which BDZ have a long half life
|
Diazapam (Valium)
Chlordiazepoxide (Librium) Flurazepam (dalmane) |
|
|
which BDZ are short acting
|
* Midazolam (Versed)
* Temazepam (Restoril) * Triazolam (Halcion) |
|
|
which BDZs are given IV for status epilepticus
|
Diazapam (Valium)
Lorazepam (Ativan) |
|
|
what are the uses for Diazapam (Valium)
|
BDZ for:
* IV for status epilepticus * muscle relaxation * withdrawals |
|
|
what is Chlordiazepoxide (Librium) typically used for
|
BDZ for withdrawls
|
|
|
what is Flurazepam (dalmane) used for
|
BDZ good for a pt you want to keep asleep all night (long half life)
DO NOT use in elderly |
|
|
what is a good BDZ for an elderly insomniac
|
Triazolam (Halcion)
|
|
|
what is Temazepam (Restoril) used for
|
insomnia (intermediate half life)
|
|
|
what is the main use of Midazolam (Versed) and what are its side effects
|
IV anesthetic for short procedures
anterograde amnesia respiratory depression |
|
|
what is the DOC for a depressed pt c anxiety sx as well
|
Alprazolam (Xanax)
|
|
|
what are the uses for Lorazepam (Ativan)
|
IV for status epilepticus
And for alcohol withdrawl (delirium tremens) |
|
|
what is Clonazepam (Klonopin) used for
|
absence seizures
|
|
|
if you have a pt that has overdosed on a Benzo or some sleep medication, what can you give them to pull them our of their stupor
|
IV Flumazenil (romazicon)
|
|
|
what are the only drugs that Flumazenil is effective for
|
Benzo’s,
Zolpidem, Zalepon, Eszopiclone (sedative - hypnotics) |
|
|
what is the major SE with Flumazenil administration
|
can trigger withdrawal and seizures in those physically dependent on BDZs
|
|
|
which sedative - hypnotics are short acting?
|
* Zolpidem (Ambien)
* Zaleplon (Sonata) |
|
|
which sedative - hypnotics are long acting
|
Eszopiclone (Lunesta)
|
|
|
what are the side effects of the sedative - hypnotics (ambien, sonata, lunesta)
|
Sleep walking
blackouts can have withdrawal sx if pt is on them for a long time |
|
|
which medication specifically give a "sleep driving" warning
|
Zolpidem (ambien)
|
|
|
which sedative - hypnotic is the worst for withdrawal
|
Eszopiclone (Lunesta)
|
|
|
what is unique about Ramelteon (Rozerem) as a sleep medication
|
It is a melatonin agonist and resets your sleep clock
no effect on GABAa |
|
|
when should you avoid giving Ramelteon (Rozerem) to pts
|
in cases of liver disease
|
|
|
what should you remember about Chlorohydrate
|
bad drug, used as a cheep sedative in dentistry
|
|
|
when you are looking to relieve anxiety without producing sedative effects, the DOC is
|
Buspirone (Buspar)
|
|
|
other than the lack of sedation, what is another benifit for prescribing Buspirone (Buspar) for anxiety
|
it has a low addition potential
very useful in alcoholics, addicts, and the elderly (no sedation) |
|
|
how does Buspirone (Buspar) work
|
it is a partial agonist fo the 5-HT1a receptor
takes 2 weeks for full effect |
|
|
what are the SE and Contra for Buspirone (Buspar)
|
restlessness
do not take with MAOIs |
|
|
what receptors does alcohol work on
|
GABAa (stimulates, causing inhibition)
NMDA (inhibits glutamates effect) |
|
|
what enzymes metabolize alcohol
|
Alcohol dehydrogenase (GI and Liver)
aldehyde dehydrogenase (liver) CYP2E1 (alternate path in Liver) |
|
|
what receptor is upregulated in alcoholics and can cause hepatotoxicity if acetominophen is taken
|
CYP2E1
|
|
|
side effects of alcoholism
|
Liver cirrhosis
Cardiomyopathy, HTN, Stroke Gastritis, pancreatitis Korsakoff’s psychosis - memory loss Wernicke encephalopathy- (paralysis of eye muscles, ataxia, confusion) |
|
|
what drug is used after initial treatment of BDZ to reduce alcohol cravings
|
Naltrexone (ReVia)
|
|
|
who do you not want to give Naltrexone (ReVia) to?
|
anyone with liver issues, due to its hepatotoxic effects
|
|
|
what receptor does Naltrexone (ReVia) effect
|
its an opioid receptor agonist
|
|
|
what is a great drug to use for recovering alcoholics with liver issues
|
Acamprosate (Campral EC)
it is secreted by the kidneys I.E. no toxic effects or effects on duration |
|
|
what is the mech of action for Acamprosate (Campral EC)
|
restores the normal balance of GABA and glutamate transmission
|
|
|
what is Disulfiram (Antibuse) used for
|
severe headache, N/V, flushing, confusion
used to prevent people from drinking |
|
|
what is the mech of action for Disulfiram (Antibuse) and how long does it stay in your system
|
it blocks aldehyde dehydrogenase
lasts for 3 to 4 days |
|
|
what is the treatment for Methanol & Ethylene Glycol (anti-freeze) Poisoning
|
Fomezipole (Antizol)
|
|
|
what is the mech of action for Fomezipole (Antizol)
|
it inhibits alcohol dehydrogenase
|
|
|
what are tricyclic antidepressants typically used for now
|
Chronic pain
fibromyalgia (analgesic) |
|
|
why do TCAs have a lower abuse potential
|
they are not stimulants and do not cause euphoria
|
|
|
what is the mech of action for
Amitriptyline (elavil) Imipramine (Tofranil) Nortriptyline (pamelor) Desipramine (Norpramin) all TCAs |
inhibit uptake of NE & 5-HT
also block M, α-adrenergic, H receptors |
|
|
what are the BDZ's
|
anything with pam, lam, and also Chlordiazepoxide (Librium)
|
|
|
which TCAs are tertiary amines
|
Amitriptyline (elavil)
Imipramine (Tofranil) |
|
|
which TCAs are secondary amines
|
Nortriptyline (pamelor)
Desipramine (Norpramin) |
|
|
what is the diff btw tertiary and secondary amines?
|
tertiary amines are metabolized into secondary amines
tertiary amines are more sedating and have more anti-cholenergic effects than secondary (bad effects) |
|
|
how do you know if its a TCA?
|
-ine:
-amine or -line |
|
|
what are the side effects of TCAs
|
Torsades = classic
orthostatic hypotension sexual dysfunction SIADH tachycardia ↓ seizure threshold Drowseyness Memory impairment blurred vision constipation urinary retention dry mouth palpitations |
|
|
what are the contraindications for TCAs
|
Do not use c MAOIs- causes serotonin synd
Fluoxitine increases its toxicity by inhibiting its metabolism Hx of seizures |
|
|
what is the mech of action for MAOIs
|
inhibit MAO which breaks down catecholamines and tryamine
also blocks alpha and M receptors |
|
|
what foods should you avoid while taking MAOIs to prevent a hypertensive crisis
|
foods high in tryamine:
alcohol soy/bean curd aged cheese smoked, pickled, fermented, or aged meat and fish sausage and like products sauerkraut soups yeast extracts |
|
|
what foods should you use with caution while on MAOIs
|
avocados
• caffeine • chocolate • dairy products - cream, sour cream, cottage cheese, cream cheese, yogurt, or milk • nuts – peanuts, coconuts and brazil nuts • raspberries • soy sauce |
|
|
what are the contraindications while on MAOIs
|
OTC cold meds containing amphetamines. causes severe HTN
Meperidine (Demerol), dextromethorphan, TCAs, SSRIs → hyperpyrexia / serotonin syndrome |
|
|
what is serotonin synd
|
happens when MAOIs are mixed with certain drugs.
CNS toxicity, starting with restlessness, muscle twitches and myoclonus, hyperreflexia, sweating, tremor, proceeding to hyperpyrexia, convulsions, and coma |
|
|
what is special about the new MAOI's
|
they bind reversibly to MAOs
dec chance of hypertensive crisis and serotonin synd |
|
|
what type of drug is Phenelzine (nardil)
|
MAOI
|
|
|
what is the mech of action for Phenelzine (nardil)
|
irreversibly inhibits both MAO-A and MAO-B
|
|
|
what is the DOC for OCD
|
Clomipramine (anafranil)
|
|
|
what are SSRIs used for
|
* DOC for depression
* DOC for panic disorder * OCD * Social anxiety * Bulimia * alcoholism + depression * depression in kids and teens |
|
|
what is the mech of action for SSRIs
|
inhibit the reuptake of serotonin
takes 2 to 3 weeks to make its effect |
|
|
what are SSRI's metabolized by?
|
CYP450
|
|
|
what are the side effects of SSRIs
|
* GI: nausea, diarrhea, constipation, loss of appetite
* CNS stimulation: anxiety and insomnia * sexual dysfunction, ↓ libido SIADH is poss |
|
|
what are the contraindications for SSRIs
|
DO NOT use with MAOIs, St. Johns Wart, or amphetamines = serotonin synd
inc toxicity c: * TCAs * β-blockers * opioids * warfarin * phenytoin * carbamazepine |
|
|
What are the SSRI's
|
* Fluoxetine (prozac)
* Paroxetine (paxil) * Sertraline (zoloft) * Citalopram (celexa) * Escitalopram (lexapro) |
|
|
what SSRI is the DOC for OCD and is often used in the elderly
|
Paroxetine (paxil)
|
|
|
what is now the most commonly used SSRI
|
Escitalopram (lexapro)
|
|
|
what are the benifits and SE of Fluoxetine (prozac)
|
very long duration
SE- CNS stimulation: anxiety and insomnia - take it in the AM |
|
|
contraindications for Fluoxitine (prozac)
|
B-blockers = heart block and hypotension
Inhibits CYP2D6: can prevent some opioids from being converted to active form |
|
|
what is the major SE of Paroxetine (paxil)
|
sedation
|
|
|
which SSRIs have fewer drug interactions
|
* Sertraline (zoloft)
* Citalopram (celexa) * Escitalopram (lexapro) |
|
|
what is the mech of action for SNRIs and what are their uses
|
Serotonin and NE reuptake inhibitors
depression and chronic pain |
|
|
which SNRIs are only used for depression and may inc BP or cause SIADH
|
* Venlafaxine (effexor)
Desvenlafaxine (Pritiq®) |
|
|
which SNRI is used for chronic pain pts and depression, but should not be used for those with liver disease due to hepatotoxicity
|
Duloxetine (cymbalta)
|
|
|
what can be added to SSRIs to reduce sexual dysfunction side effects
|
Bupropion (wellbutrin)
|
|
|
what is Bupropion (wellbutrin) used for
|
ADHD
depression ER = zyban = stop smoking drug/alcohol recovery |
|
|
what is the mech of action for Bupropion (wellbutrin)
|
primarily inhibits the reuptake of DA, but also NE
|
|
|
what is Atomoxetine used for
|
ADHD
|
|
|
what is Trazodone used for and what side effect "sticks out"
|
insomnia and pain
Priapism |
|
|
what are the effects of Schizophrenia
|
Positive- hallucinations, delusions, agitation
Negative- loss of affect cognitive impairment |
|
|
what is the mech of action for anti-psychotic drugs
|
block the D2 receptor- positive sx
also block a, M, H receptors New drugs block D2 and 5-HT- positive and negative sx |
|
|
what are extrapyramidal effects
|
nigrostriatal system DA receptor blockade → akathisia (anxiety, pacing), dystonia (involuntary muscle spasms, sustained abnormal posture), Parkinsonian symptoms (tremor, rigidity, slow movement)
|
|
|
how do you treat extrapyramidal effects of anti-psychotic drugs
|
Tx w/ anticholinergics or use “atypical” antipsychotics
|
|
|
what are the side effects of anti-psychotics
|
extrapyramidal effects
tardive dyskinesia Weight gain seizures endocrine effects (prolactin) autonomic effects (a, M, H recep) neuroleptic malignant syndrome |
|
|
what are the endocrine effects of anti-psychotics
|
inc prolactin release:
- amenorrhea, lactation in women. - gynacomastia, impotence in men. - ↓ libido, infertility in both |
|
|
what is Neuroleptic Malignant syndrome, as seen in Anti-psychotic tx
|
life-threatening muscle rigidity, catatonia, marked increase in body temp, altered BP & heart rate
tx with dantrolene |
|
|
what do you treat neuroleptic Malignant synd with
|
dantrolene (muscle relaxant)
|
|
|
what are the autonomic effects seen in drugs that block a, M, H receptors (TCAs, anti-psychotics)
|
cholinergic (M): dry mouth, blurred vision, constipation, urinary retention, tachycardia
alpha - blockade: orthostatic hypotension H-blockade: sedation |
|
|
what are the SE of Bupropion (wellbutrin)
|
CNS stimulant → seizures, anxiousness, insomnia
|
|
|
what is a benifit to taking Bupropion (wellbutrin) as opposed to other SNRIs or even SSRIs
|
no weight gain and even possible weight loss
|
|
|
what are the traditional anti-psychotics (Phenothiazines)
|
Chlorpromazine (Thorazine®)
Thioridazine (Mellaril®) Fluphenazine (Prolixin®; Permitil®) |
|
|
what are the atypical anti-psychotics
|
* Clozapine (clozaril)
* Olanzapine (Zyprexa) * Risperidone (risperdal) * Ziprasidone (geodon) * Quetiapine (seroquel) * Aripiprazole (abilify) |
|
|
baord testable side effect of Chlorpromazine (thorazine)
|
jaundice
|
|
|
what is a board testable side effect of Thioridazine (mellaril)
|
retenal deposits
|
|
|
which of the typical anti-psychotic drugs are considered low potency and what does that mean
|
Thioridazine (mellaril)
chlorpromazine (thorazine) ↓ extra pyramidal effects + ↑ anticholinergic effects |
|
|
which of the typical anti-psychotic drugs are considered high potency and what does that mean
|
Fluphenazine
↑extra pyramidal effects + ↓ anticholinergics effects |
|
|
why is fluphenazine a high potency anti-psychotic
|
more effect on D2 and less on alpha, M, and H receptors
|
|
|
what are Thioridazine (mellaril)
chlorpromazine (thorazine) and Fluphenazine used fo |
* schizophrenia
* nausea, vomiting * pre-anesthetic sedation * psychotic episodes * EtOH, drug hallucinations |
|
|
what are the unique SE for Chlorpromazine(thorazine), Thioridazine (mellaril), and Fluphenazine
|
seizures and jaundice
|
|
|
which anti-psychotic is the most likely to cause extrapyramidal effects
|
Haloperidol (haldol) because of its D2 selectivity
|
|
|
what is Haloperidol (haldol) used for
|
acute psychotic situations (injected) DOC
Highly sedating |
|
|
what are SE for Haloperidol (haldol)
|
extrapyramidal effects
NO anticholinergic effects due to D2 selectivity |
|
|
what is different about the new generation, atypical anti-psychotic drugs
|
the block D4 and 5-HT2a receptors
they are better for negative symptoms ↓ tardive dyskinesia ↓ extrapyramidal symptoms |
|
|
which antipsychotic is associated with agranulocytosis (very low WBC count)
|
clozapine (clozaril)
|
|
|
Which drug requires weekly blood screening to check for its harmful SE
|
clozapine (clozaril)
agranulocytosis |
|
|
which anti-psychotic is The worst for
Hyperglycemia and weight gain!! (esp in type II diabetics) |
Olanzapine (Zyprexa)
|
|
|
what is Olanzapine (Zyprexa) used for
|
it is an anti-psychotic used for bipolar disease
|
|
|
which anti-psychotic lengthens the Q-T interval
|
Risperidone (risperdal)
|
|
|
which anti-psychotic should never be given to the elderly
|
Risperidone (risperdal)
inc Q-T killed alzheimers pts |
|
|
which anti-psychotic is known for hyperprolactinemia
|
Ziprasidone (geodon)
|
|
|
which anti-psychotic is very similar to clozapine, but does not contribute to agranulocytosis and does not in prolactin release
|
Quetiapine (seroquel)
|
|
|
which anti-psychotic is Extremely sedating, used as an adjunct for depresson, inc cholesterol, and causes weight gain
|
Quetiapine (seroquel)
|
|
|
which antipsychotic improves both + and - symptoms
|
Aripiprazole (abilify)
|
|
|
what is the mech of action for Aripiprazole (abilify)
|
* dopamine system stabilizer
* partial agonist of D2 & 5-HT1A, antagonist of 5-HT2A |
|
|
what are the SE of Aripiprazole (abilify)
|
* orthostatic hypotension
* ↑ blood glucose * seizures * esophageal motility(bad for this! |
|
|
which anti-psychotic should not be used in pts with esophageal defects
|
Aripiprazole (abilify)
|
|
|
what are some of the benifits to using Aripiprazole (abilify)
|
* improves both + and - symptoms
* NO effect on prolactin NO effect on weight gain |
|
|
what are the Bipolar drugs
|
Lithium (eskalith)
Topiramate (Topamax) Divalproex (Depakote®), Valproic acid (Depakene®) |
|
|
How does the body get rid of Lithium
|
excreted by the kidney
|
|
|
which drug competes with Na+ for reabsorption from the kidney?
|
Lithium
|
|
|
Which Bipolar drug has a very NARROW theraputic range
|
Lithium
|
|
|
what are the SE of lithium
|
* N/V, headache, tremor, ↓ thyroid function
* nephrogenic diabetes insipidus with polyuria & polydipsia (tx with amiloride) * weight gain, edema |
|
|
what are the contraindications for lithium
|
* NSAIDs, Thiazides(Diuretic) → lithium toxicity - arrhythmias, seizures, renal failure, coma or death
|
|
|
what is the DOC for people with multiple seizure disorders
|
Divalproex (Depakote®), Valproic acid (Depakene®)
|
|
|
what anticonvulsants Efficacy is equivalent to or greater than that of lithium as a bipolar medication
|
Divalproex (Depakote®), Valproic acid (Depakene®)
|
|
|
what are the SE for Divalproex (Depakote®), Valproic acid (Depakene®)
|
*Hepatotoxic
Nausea, vomiting, abdominal pain and heartburn, tremor, weight gain |
|
|
what are the contraindications for Depakote
|
Inhibits its own metabo at low doses
Inhib phenytoin & carbamazepine metabo |
|
|
what drug can be used as an anticonvulsant, withdrawl med, and also as a way to offset the weight gain caused by SSRIs
|
Topiramate (Topamax)
causes weight loss |
|
|
what are the anticonvulsant drugs
|
Phenytoin
Carbamazepine (Tegretol) Gabapentin (Neurontin) Ethosuximide (Zarontin) |
|
|
what causes seizures
|
dec in GABA activity, Inc in glutamate xmission
|
|
|
what is the DOC for partial seizures & gen tonic-clonic seizures
|
Phenytoin
|
|
|
what is the mech of action for Phenytoin
|
Inactivates Na+ channels
Dose dependant elimination |
|
|
what are the contraindications for Phenytoin
|
Increases the concentration of Warfarin
Inc metabolism of oral contraceptives |
|
|
what are the SE of Phenytoin
|
Gingival hyperplasia & hirsutism (hairyness)
|
|
|
which anticonvulsant causes anemia and agranulocytosis (dyscrasias)
|
Carbamazepine (Tegretol)
|
|
|
what is the DOC for partial seizures, gen tonic-clonic seizures & Trigeminal neuralgia
|
Carbamazepine (Tegretol)
|
|
|
what are the contraindications for Carbamazepine (Tegretol)
|
Induces CYP3A, inc oral contraceptive metabolism
|
|
|
what is Gabapentin (Neurontin) used for
|
*Pain
Bipolar, antianxiety Adjunct treatment for partial seizures and generalized tonic-clonic seizures |
|
|
what are the SE for Gabapentin (Neurontin)
|
dizziness, drowsiness, ataxia, headache, tremor, weight gain
|
|
|
what is the DOC absence seizures
|
Ethosuximide (Zarontin)
|
|
|
what is the mech of action for Ethosuximide (Zarontin)
|
T- Ca++ channels in thymus
|
|
|
what drug decreases the rate of clearance of Ethosuximide (Zarontin)
|
Valproic acid (depakote)
|
|
|
what are the drugs used in parkinson disease
|
L-Dopa
* L-Dopa / Carbidopa (sinemet) * Selegiline (deprenyl) * Bromocriptine (parlodel) * Pramipexole (mirapex) * Ropinirole (requip) |
|
|
why is carbidopa added to L-Dopa in the treatment of parkinsons
|
inhibits dopa-decarboxylase in the periphery, but does not cross the BBB
decreases N/V SE decreases the DA dose required |
|
|
what is Stevens-Johnson Syndrome
|
Hypersenstivity reaction consisting of erythema multiforme, arthritis, nephritis, CNS abnormalities and myocarditis
occurs with many drugs, but with most of the anticonvulsants |
|
|
what is the "On-Off phenomenon"
|
seen in parkinsons pts when L-dopa/carbidopa is administered
fluxuations in the clinical course of pt On= improved mobility c dyskinesia Off= akinesia |
|
|
how do you counteract the On-Off phenomenon in parkinsons treatment
|
add a DA agonist
Bromocriptine (Parlodel®) Pramipexole (Mirapex®) |
|
|
What are the contraindications for L-dopa/Carbidopa
|
MAOIs
psychosis malignant melanoma closed angle glaucoma |
|
|
is L-dopa/carbidopa a long term treatment
|
loses efficacy over time, does not slow the course of the disease
Not effective in drug induced parkinsons |
|
|
what is Selegiline (deprenyl)
|
a MAO-B inhibitor
added to L-dopa tx to slow the course of the disease and inhibit DA metabolism |
|
|
what is are major SE of Selegiline (deprenyl)
|
insomnia-take in the morning
serotonin synd if taken with TCAs or SSRIs |
|
|
what is Tolcapone (Tasmar®) used for and what are its side effects
|
it is a COMT inhibitor used for parkinsons
Inhibits DA metabolism; prolongs action of DA SE- Hepatotoxic |
|
|
what are Bromocriptine (Parlodel®) and Pramipexole (Mirapex®).
|
D2 agonists used in the treatment of parkinsons
|
|
|
what is the benifit in using Bromocriptine (Parlodel®)
Pramipexole (Mirapex®) |
they directly stimulate the D2 receptor, so they continue to be effective as the disease progresses
used with L-dopa during On Off periods |
|
|
what are the gen SE for * Bromocriptine (parlodel)
* Pramipexole (mirapex) * Ropinirole (requip) |
postural hypotension
N/V |
|
|
which DA agonist causes erythromyalgia (Red, swollen feet)
|
Bromocriptine (parlodel)
|
|
|
which DA agonist causes sudden sleep
|
* Pramipexole (mirapex)
* Ropinirole (requip) |
|
|
which DA agonists have D2 and some D3 activity
|
* Pramipexole (mirapex)
* Ropinirole (requip) |
|
|
what parkinson drug Increases DA neurotransmission
|
Amantadine (Symmetrel®)
antiviral for influenza |
|
|
when do you use Amantadine (Symmetrel®) and what are the SE
|
for Mild parkinsons (early on)
livedo reticularis (red spotting of skin) edema Toxic psychosis and convulsions |
|
|
why would you use Benztropine (Cogentin®) in the treatment of parkensons disease
|
it is an anticholinergic used to restore the Ach/DA balance
|
|
|
most effective treatment for tourettes
|
haldol
|
|
|
what causes alzheimers
|
the loss of cholenergic neurons
Ach is diminished up to 90% |
|
|
what are the AchE inhibitors used in alzheimers disease
|
Donepezil (Aricept®)
Tacrine (Cognex®) Rivastigmine (Exelon®) Galantamine (Reminyl®) |
|
|
what is the drawback to AchE inhibitors as a treatment of alzheimers
|
they help in the beginning and may even slow the progression of the disease, but as the neurons continue to degenerate over time the drugs lose their effectiveness
|
|
|
what is the mech of action for Memantine (Namenda®)
|
NMDA receptor agonist
|
|
|
what is Memantine (Namenda®) used for
|
alzheimers disease
May reduce neurotoxic effect of glutamate and slow degeneration of neurons |
|
|
what can you use with AchE inhibitors to help in the effectiveness of alzheimers treatment
|
Memantine (Namenda®)
|
|
|
what are the muscle relaxants
|
* Baclofen (Lioresal)
* Tizanidine (zanaflex) * Cyclobenzaprine (flexeril) * Carisoprodol (soma) * Dantrolene (dantrium) * Botulinum Toxin (botox) |
|
|
what the ONLY BDZ used as muscle relaxant
|
diazapam (valium)
|
|
|
which muscle relaxant is used in CHRONIC spastic muscle disorders
|
Baclofen (Lioresal)
Tizanidine (zanaflex) |
|
|
what muscle relaxant is used to treat * malignant hyperthermia
* Neuroleptic Malignant Syndrome (antipsychotics) |
* Dantrolene (dantrium)
|
|
|
which muscle relaxant is used to treat local muscle spasmsand is injected locally
|
botulinum toxin (botox)
|
|
|
what is the mech of action for Baclofen (Lioresal)
|
GABAb complex agonist
opens K+ channels and hyperpolarizes the presynaptic, excititory neuron via inhibition of Ca++ channels |
|
|
how do you administer Baclofen (Lioresal)
|
oral or intrathecal
|
|
|
what are the SE of Baclofen (Lioresal)
|
sedation and confusion, but not highly sedating
|
|
|
which muscle relaxant is an alpha2 receptor agonist and can be used for acute or chronic muscle spasms
|
Tizanidine (zanaflex)
|
|
|
what are the side effects of Tizanidine (zanaflex)
|
dec BP, dry mouth
sedation |
|
|
which muscle relaxant causes confusion and hallucinations
|
Cyclobenzaprine (flexeril)
|
|
|
what is the drawback to Carisoprodol (soma)
|
metabolized to meprobamate, acts like barbiturate → abuse (popular w/ HS kids)
|
|
|
what is the mech of action for Amphetamine or Amphetamine-like Drugs
|
release of NE and DA
|
|
|
what are amphetamines used for
|
narcolepsy
ADHD obesity abuse |
|
|
what are the CNS stimulants we need to know
|
Methylphenidate (Ritalin®)
Amphetamine (Adderall®) Atamoxetine (Strattera) caffeine |
|
|
what is the mech of action for Atamoxetine (Strattera)
|
inhibits the reuptake of NE
|
|
|
what is the mech of action for caffeine
|
blocks adenosine receptors
|
