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87 Cards in this Set

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Alprazolam XANAX
anxiolytic BDZ, especially for panic disorder
BDZ pharmacokinetics
USE DEPENDENCE
lipid soluble
binds plasma proteins wo interactions
hepatic microsomal system wo interactions
contraindicated for sleep apnea
TRIAZOLAM (HALCION)
insomnia BDZ
ESTAZOLAM (PROSOM)
insomnia BDZ
TEMAZEPAM (RESTORIL)
insomnia BDZ
CLONAZEPAM (KLONOPIN)
anxiety BDZ
DIAZEPAM (VALIUM)
anxiety BDZ
insomnia v. anxiety for BDZ
fast acting - insomnia
slow - anxiety
Barbiturates general points
not only potentiate but activate, induce hepatic microsoaml system, high toxicity, rapid tolerance
THIOPENTAL
barbiturate - induces anesthesia
effects terminated by re-distribution
METHOHEXITAL
barbiturate - induces anesthesia
PHENOBARBITAL
barbiturate - anti-convulsant, especially useful for seizures in children, also used for epilepsy
elimination liver, 25% straight out kidney
can cause hyperalgesia
BUSPIRONE
partial 5HT Ag, for TX of GAD, LONG to work
ZALEPLON (SONATA)
very short t1/2 to induce sleep
ZOLPIDEM (AMBIEN)
acts specifically on BDZ1 to induce sleep
PROPRANOLOL
beta blocker, eases peripheral effects on anxiety
FLUMAZENIL
BDZ ANT, given for BDZ OD, can precipitate withdrawal in BDZ-dependent patients
BDZ effect on sleep
increase stage 2
decrease stage 3/4 (slow wave)
variable effect on REM
contraindications for BDZ
sleep apnea
CV?
teratogenic?
psychosis
set of sxs where ability to organize relaity is impaired
catalepsy
waxy flexibility
brief psychotic disorder
1 schizo episode in less than 1 month
shizophreniform
shizo for less than 6 months
shizoaffective
shizo and MDD with at least 1 episode of pure shizo
shizophrenia (DX)
at leasts 2: CONTINOUS FOR <6 months)
Positive SXs of shizo
delusions, hallucinations (usually auditory), disorganized speech, disorganized or catatonic behavior,
negative SXs of shizo
the As: avolition, alogia, anhedonia, asociality, flat affect
positive or negative sxs better prognosis in schizo
+
comorbidity of shizo
depression 25% SA 50% pot and EToH
Etiology of shizo
polygenic genetic, exposure to virus in uteor (2nd tri), excess DA - disorder of synaptic f(x) in prefrontal) - SYNAPSES NOT DELETED
The DA tracts
mesolimbic: VTA --> amygdala (hallucinations); Mesocortical: VTA--> olfactory bulb hippocampus and prefrontal (negative and cognitive SXs); Nigrostriatal: sub. N --> caudate/putamen (Motor SX); tuberoinfundibular arcuate n. of hypothalamus ---> med. eminence (inhibit release of prolactin, assoc. with SE of anti-pyshotics)
CHLORPROMAZINE
anti-psychotic worst TI, can lower seizure threshold
THIORIDAZINE
anti-psychotic, reduces EPS, may induce arrythmias
FLUPHENAZINE
anti-psychotic ok for CV pts
THIOTHIXENE
anti-psychotic (rarely used)
HALOPERIDOL (HALDOL)
anti-psychotic, best TI, can't OD, good for CV pts, most used
None
OLANZAPINE
anti-psychotic(atypical) - low EPS risk
RISPERIDONE
anti-psychotic(atypical) low EPS risk
CLOZAPINE
anti-psychotic(atypical) low EPS risk, risk of AGRANULOCYTOSIS
D2
activating D2 is inihibitory --> inihibits AC
Extrapyramidal Syndrome
SE of anti-pyscho: acute block of DA --> SE of Parkinsonism, dystonia (grimacing, torticollus), akathesia(motor restlessness), neuroleptic malignant syn
Tardive dyskinesia
SE of anti-pyscho: chronic block of DA --> SE of Huntingtons(oral twitching, lip smacking, may be caused by DA R supersensitivty in striatum, can be irreverisble
atypicals v. older generation
atypical acts on 5HT, old on DA2
neuroleptic malignnat syn
effect of extrapyramidal syn, parkin with catatonia, hyperthermia. TX: dantroline, bromocriptine (DA Ag)
Side effects of anti-pyschotics
anti-cholinergic, anti-alpha adrenergic, endocrine (bc of prolactin), weight gain
Drug interactions of anti-[yschotics
liver metabolism, interacts with TCAs
Kinetics and metabolism of anti-pyschotics
t1/2>24hrs, lipophilic, repository preps available for compliance
None
TCA
conduction abnormalities, induce p450, 5HT, NE>DA
MAO
hypertensive crisis with tyramine
Paroxetine (Paxil)
SSRI
Fluoxetine PROZAC
SSRI longer than 24 hr to stead state, 1 week
Sertraline ZOLOFT
SSRI longer than 24 hr to stead state, 1 week
Escitalopram LEXAPRO
SSRI
Citalopram CELEXA
SSRI
Venlafaxine EFFEXOR
SNRI
SE: upset stomach
Mirtrazapine REMERON
SNRI
SE: upset stomach
Duloxetine CYMBALTA
SNRI
peripheral neuropathy
SE: upset stomach
Buprionion WELLBUTRIN
atypical, no effect on 5HT, best AD for bipolar, CONTRADINDICATED in EATING DISORDERS
Lithium
Mood stabilizer, good for +/-Sxs of Bipolar, bad for mixed or rapid cyclers, easy to OD, exacerbated by kidney dysfunction, epstein's anaomly!
L-Dopa
TXs PD
Carbidopa
inhibits L-amino acid decarboxylase - keeps LDopa from getting digested
Tolcapone
inhibits COMT (PD)
Selegeline
inihibits MAOb
Amantadine
anti-viral, release DA
Pergolide
D1, D2 AG (PD)
Bromocriptine
D2 AG (PD)
Ropinirole
D2 Ag (PD)
MR ANT
promotes indirect
Haloperidol
Blocks D1, D2
Phenobarbital (LUMINAL)
 Seizure type: non-specific
 Very sedating, cheap, used for status epileptica to put them into coma
 Mechanism:
• Blocks Na, Ca, Glu, GABA increased, decreased repetitive firing of high frequency neurons
 Kinetics: metabolized in liver, can induce enzymes
o Phenytoin (DILANTIN)
 Seizure type: non-specific
 Mech: blocks sustained repetitive firing, prolongs inactivation of Na channels
 Kinetics:
• Highly protein bound
• Dose dependent metabolism
• Induces liver, stimulates its own metabolism
• Drug interactions relating to protein binding
o Important to look at albumin(low makes more sensitive to drug)
o Carbamazapine (TEGRETOL)
FROM BP: mania, rapid cycling, Stevens Johnson rash

 Seizure type: non-specific
 Mech: blocks high freq, blocks Na, blocks presynaptic transmission
 Kinetics:
• Induces hepatic enzymes
• Less protein bound
 SE: aplastic anemia, agranulocytosis, low Na, STEVEN JOHNSON

USED TO TREAT RC BP, Mixed, Mania side only
o Lamotrigine (LAMICTAL)
FROM BP:
good adjunct, delays next cycle, TXs MDD

 Seizure type: primary generalized, partial onset, lennox gastaut
WORKS ON BOTH POS AND NEG BP
 Mech: dec. high freq neurons, dec Glu, dec Na, Ca

 Kinetics: only 55% protein bound
 SE: Steven-Johnson, dizziness, diplopia, nausea, sleepiness, somnolence
o Topiramate (TOPAMAX)
FROM BP: adjunct SE: --> weight loss!
used to tx Binge Eating Disorder

USE: partial onset, PG T/C
Mech: Dec firing, dec Glu, block Ca, inc GABA
 Kinetics: most excreted through kidney, long t1/2, doesn’t induce enzymes
• IMP. Can increase metabolism of BIRTH CONTROL

also used for bullimia and binge eatting disorders

also used to tx bipolar as ADJUNCT for WEIGHTLOSS
o Levetricetam (KEPPRA)
SE: Aggressive behavior

Use; partial onset
 Designer drug
• Made as add-on med for seizure in children that were hard to control
• Now used in a variety of different ways
 Mech: affects synaptic vesicle f(x) dec Glu, inc, GABA
 Kinet: minimal drug interactions, low protein binding
o Gabapentin (NEURONTIN)
 USE: partial onset
 Mech: inc GABA, dec Glu
 Kinetics: GOOD, not metabolized, not protein bound, negligible interactions
o Valproic Acid (DEPAKOTE)
FROM BP: for rapid cycling, mixed, faciliate GABA SE: weight gain, teratogenic, liver)
 USE: partial onset, absence
• used also for mood stabilization
 Mech: multiple, blocks NMDA, inc GABA, blocks Na, blocks repetitive firing loop
 Kinetics:
• Highly protein bound, displaces phenytoin!
 INHIBITS METABOLISM OF OTHER DRUGS
 SE: (REQUIRES A LOT OF MONITORING)
• Steven-Johnson, hepatotoxicity, thrombocytopenia, tremors, teratogenic(NTD)
o Ethosuximide (ZARONTIN)
 PRIMARY CHOICE FOR ABSENCE SEIZURES
 Mech: decreased T type Ca in THALAMUS
 Kinetics: no protein binding, long t1/2, complete metabolism
• Valproic acid decreases clearance
o BDZ
 Used for status epilepticus (last 20-30 min or longer or pt doesn’t wake up between seizures)
 Diazepam and Lorazepam used
• For status epilepticus specifically, Lorazepam acts longer than Diazepam - Rapid onset, L longer t1/2, sedating and dev tolerance
Methadone
opioid, used to tx heroine addiction
buprenorphine
gamma part ag, lambda, kappa ant, used to tx heroine
varenicline CHANTIX
partial NR ag (tx. cigs)
rimonabanat ACOMPLA
Cannabinoid R ANT (tx all addictions?)
naltrexone, nalmefene
opioid ANT, decreases pleasure from drinking
SE: with opioids can cause withdrawal syn
disulfiram ANANTABUSE
makes you sick with you drink - acts on ALDH enz
acamprosate
normalezied NTs with ETOHmimics EtOH at GABAa
baclofen
GABAb Ag, anti-addiction