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83 Cards in this Set
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- Back
- 3rd side (hint)
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Barbiturates |
-sedative/hypnotic of choice -many unwanted side effects (habit forming) -Narrow therapeutic range (harder to dose) -long term control of seizures -imprtnt part of anesthesia -do not stop abruptly -controlled sub |
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What is the prototype for barbiturates? |
phenobarbital |
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What to barbiturates end in? |
BARBITAL |
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MOA FOR BARBS |
work in the brain stem and the cerebral cortex -decreased respirations. -CNS depressant |
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What is GABA? |
a inhibitory neurotransmitter |
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How do barbs depress the CNS? |
they potentiate GABA, (raise seizure threshold) |
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What are the therapeutic Effects of Barbs? |
sedation anticonvulsant (not common) surgery(induction of anesthesia) ****RISK FOR RESP DEPRESSION*** |
Barbs S A S |
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What are the Drug/Drug interactions of Barbs? |
-highly metabolized in liver -drug/drug interactions high -can affect drug dosages |
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Side effects barbs CNS |
drowsiness |
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Side effects Barbs RESP *** |
resp. depression |
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Side effects barbs Sleep |
decreased REM sleep and inability to deal with normal sleep |
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Side effects barbs GI |
NVDC |
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What happens if a pt overdoeses on barbs? Treatment? |
-lethargic (can't wake up/coma) - very shallow resp, ineffective -pin point pupils
treatment is supportive There is no antidote |
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Why would we purposely overdose a pt on barbs? |
-Anesthesia induction -cannot stop seizures, phenobarb coma to control seizures. |
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Benzodiazepines characteristics |
Favorable side effect profile -safety-OD: little more than hard sleep -doesn't affect resp to the extent that barbs do |
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What is the MOA of Benzo's |
-similar action of barb but doesn't affect the brain stem. -No resp. Depression. -Location of MOA is what is different |
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Use for Benzo's |
(BAASSI) -(zanax) anxiety -insomnia -seizures -alcohol withdrawl -balanced anesthesia -skeletal muscle relax |
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What is the antidote for Benzo's?*** |
Flumazenil |
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What do benzo's end in? |
pam/lam |
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Side effects of benzos? |
drowsiness/lethargy fall risk for elderly hangover effect benzos do not induce hepatic enzymes -help bathroom
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help them ambulate to bathroom |
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Benzodiazepine overdose |
Tx is supportive. -somnolence, confusion, coma, diminished reflexes
benzo and alcohol: death
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What benzos are used for antianxiety? |
Xanax and Valuium, diazepam |
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antiseizure/alcohol withdrawl benzo |
valium ativan |
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Benzo- conscious sedation |
versed |
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Benzo-like drugs (sonata) |
wake up and have trouble falling back asleep. Short half life. 4 hrs left |
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Ambien (benzo like) |
for insomnia. Sleepwalking reporting approvd for long term use |
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Lunesta |
approved for long term used for sleep/ insomnia |
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roze rem* |
does not depress CNS -melatonin receptor agonist -liver disease contraindicated |
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Muscle Relaxants |
work through the CNS -effect most likely comes from sedation.
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dantrium is a? |
direct acting on skeletal muscles, closely resembles GABA
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why do we give muscle relaxants? |
muscle spams ms cerebral palsy
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baclofen: be used with bump
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CNS Stimulant |
-all can cause seizures if dose is high enough - associated with weight loss and growth retardation (check childrens weight and height) -therapeutic uses are limited: ADHD, narcolepsy, neonatal apnea |
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amphetamines |
schedule II -increased wakefullness/alertness -improve self confidence and initative -suppress appetite (baseline wt) -stimulate respiration (ADHD, narcolepsy) |
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amphetamines adverse effects |
growth retardation, insomnia, restlessness, tachycardia....increased HR |
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Drugs for amphetamines |
adderall, vyvanse, desoxyn,
riddlin, concerta
give in the morning |
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Strattera |
suicidal ideation with children Not a CNS stimulant
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Antiepileptic drugs |
-used to control or prevent seizures -minimize adverse effects -mood stabilizers/ neuropathic pain -thereapeutic drug monitor import.
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phenytoin therapeutic level |
10-20 |
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Carbamazepine therapeutic level |
4-12 |
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phenytoin |
highly protein bound, induces hepatic drug metabolizing,
Vitamin D= osteoporosis Dilantin facies- zitty face, swollen
Brush teeth reg. hyperplasia large vein, large gauge, normal saline diluted.
fosphenytoin= less hurt
give more fos then phen
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crabamezepine |
an autoinductor, induces hepatic enzymes, specifically those that metabolize itself. -marrow depression
anemia lab workup important |
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Stevens-Johnson syndrome |
rare, serious disorder of your skin and mucous membranes. It's usually a reaction to a medication or an infection.
liver and kidneys stop meds right away
carb and pheno
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Neurontin |
other AED, neuro pain |
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zarontin |
absence seizures |
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lyrica |
neuro pain and postherapetic neuralgia |
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lamictal |
risk for stephens-johnsons _RASH |
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gabitril |
avoid off label uses |
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Parkinson's Disease |
T=tremor R=rigidity A=akinesia (really bradykinesia) P=postural instability |
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Parkinson's is caused by the imbalance of which two neurotransmitters? |
DOP (inhibitory) ACH (excitatory) |
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why can they not give dopamine to help Parkinsons? |
it is a catecholamine, levodopa can be given orally/iv. But it can only cross the bbb if it is converted after it has crossed. Carbidopa is given to inhibit the action of decarboxylase. |
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Unisom and diphenhydramine (benedryl) |
otc sleep aids approved |
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muscle relaxers implications |
side rails up, use bed alarms assist with ambulation monitor for adverse effects |
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provigil |
made for shift workers. |
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implications for CNS stimulant |
tachycardia, insomnia, take at least 6 hrs before bedtime, dry mouth |
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Drugs for weight loss |
majority done in first six months.
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orlistat/ALLI |
oily spat....supresses appetitie, but greasy foods= oily diarehea. gassy.
metamucil= help side effects |
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phenermine |
appetite supression |
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phenobarbital |
drowsiness inducer drug/drug interactions epilepsy febrile seizures |
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Valproic acid |
pancreatitis hepatotoxicity (check liver enzymes) |
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carbidopa/levodopa (sinemet) |
on/off phenomenon urine/sweat will darken cannot take B6(pyridoxine) at the same time. |
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MAO-B |
slows progression of parkisons no cheese effect unless greater than 10 mg. giline end in |
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amantadine (symmetrel) |
most effective in earlier stages effective for 6-12 months -antiviral drug |
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COMT Inhibitors |
inhibits the enzyme that breaks down levodopa -hepatotoxicity -darken urine -check liver enzymes 40 (ALT, AST) -orthostatic hypotension -1 hr before or 2 hr after meals -capone |
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mirapex |
restless leg syndrome |
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benadryl (diphenhydramine) |
anti parkinsons |
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Psychotherapeutics |
dopamine, norepi, serotonin
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Drugs for anxiety |
benzodiazepines-1st line
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BuSpar (buspirone |
not cns depressant not prn |
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Lithium |
narrow therapeutic range 6-12 Stable sodium |
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Valproate |
hepatoxicity drug of choice for bipolar |
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Drugs for bipolar |
tegretol lamictal valproate ALT AST 30-40 |
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Antidepressants for bipolar |
always given a mood stabilizers otherwise their manic episodes may increase |
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MAOIs |
No tyramine ingested Cheese effect hypertensive crisis: headache, tachycardia, confusion,
Know what OTC meds they are on |
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TCA's |
life threatening toxic effects amitripytyline
8x daily dose
bed wetting(aneuresis) |
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Drugs for depression |
black box warning for suicide 4-6 weeks to work |
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SSRIs |
inhibits serotonin reuptake sexual dysfunction weight gain highly protein bound |
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Serotonin syndrome |
HARM -hyperthermia -autonomic instability -rigidity -mental status changes/myoclonus |
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SNRIs |
inhibits serotonin and norepi |
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wellbutrin |
smoking cessation |
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Antipsychotics |
all block dopamine |
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First gen antipys |
more extrapyramidal symptoms |
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second gen antipys |
check platelets, wbc, weekly blood draws
less EPS
zyprexa-highest risk for metabolic syndrome |
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neuroleptic malignant syndrome |
rare lead pipe rigidity high fever sweating
pt on 2nd gen for schiz, sweating, pipe rigidity=nms. on serequil 103 temp= call 911
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