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;
72 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
What are the preventative migraine drugs?
|
Beta Blockers (propanolol, timolol)
TCAs (amitriptyline) CCBs (verapamil) Anti-Epileptics (Topiramate, Valproic Acid) NSAIDs |
5 classes
|
|
|
Triptans MOA
|
5-HT1 receptor agonists
constrict cranial vessels and reduce sterile inflammation these receptors are on neurons and intracranial blood vessels (prevents albumin leakage) |
|
|
|
MOA difference between drugs for migraine prevention and acute attack
|
acute- 5-HT1 agonist
prevention - 5-HT2 antagonist |
|
|
|
Drawbacks/Contraindications to Ergots
|
less selective than triptans
ergotism (convulsive, gangrenous) rebound HA (not in DHE) CONTRA: vascular, renal, heptaic, pregnant |
|
|
|
Tx for migraine w/aura?
|
verapamil
|
|
|
|
mu opioid receptor
(where active? agonists? antagonists?) |
supraspinal action
agonists: b-endorphin, morphine, fentanyl antagonist: naloxone |
|
|
|
kappa opioid receptor (where active? agonist? antag?)
|
spinal action
agonist: dynorphins, pentazocine antag: naloxone |
|
|
|
delta opioid receptor (where? ag? antag?)
|
both spinal and supraspinal
agonist: enkephalins antag: naloxone |
|
|
|
which opioid side effects do not induce tolerance?
|
convulsant (meperidine, norcodeine)
miotic constipation |
|
|
|
Mixed opioid agonists/antagonists
How do they work? |
pentazocine, nalbuphine, butorphanol
agonists at kappa recpetors but partial agonists (fxnl antag in presence of full agonist) at mu receptors |
|
|
|
metabolites of
a. morphine b. meperidine c. codeine d. heroin |
a. active: 6-glucuronide
inactive: 3-glucuronide b. normeperidine c. morphine d. 6-acetylmorphine -> morphine |
|
|
|
CV ADR for opioids
|
hypotension
(supresses sympathetic outflow, psymp stimulation, morphine stimulates histamine release) |
|
|
|
Which opioid is used in renal impairment?
|
hydromorphone
|
water
|
|
|
methadone use?
|
treat opioid dependence
|
|
|
|
buprenorphine
|
partial agonist useful for opioid dependence management
prevents withdrawal sxs |
|
|
|
ADRs for SSRIs
|
SEXUAL DYSFXN (persistent...yikes)
SEROTONIN SYNDROME (confusion, fever, altered conc, myoclonus) nervousness/irritability/insomnia (transient) Nausea/diarrhea/dyspepsia (transient) |
|
|
|
SSRIs taken with what causes serotonin syndrome
|
MAO-Is
TCAs Li Carbamazepine |
|
|
|
SSRIs taken with warfarin, phenytoin et al causes what?
|
potentiation of toxicity
|
|
|
|
Advantage of sertraline over fluoxetine?
|
sertraline has a shorter half life (faster steady state and faster washout)
|
|
|
|
Paroxetine
(class, use, adr) |
SSRI with antichol action (sedating)
good for depression w/anxiety/insomnia Severe Discontinuation Syndrome |
|
|
|
Which class of antidepressants is good for eating disorders?
|
SSRIs
none for anorexia |
|
|
|
Which class of antidepressants is contraindicated in eating disorders?
|
NDRI (NE, DA, reuptake inhibit)
buproprion additive risk for SZ |
|
|
|
Which class of antidepressants treats chronic pain?
|
TCAs
|
|
|
|
Indications for buproprion?
|
Depression (fewer sexual adr)
smoking cess adhd |
|
|
|
What are phenelzine and tranylcypromine?
|
MAOIs (nonselective, irreversible)
|
|
|
|
When would you use TCAs?
|
resistant depression
enuresis chronic pain |
|
|
|
What is venlafaxine?
(adr?) |
SNRI (along w/duloxetine)
adr - dose dependent HTN, withdrawal syndrome w/abrupt discontinuation |
|
|
|
TCA poisoining Tx
|
Cardiac Monitoring
Gastric Lavage NaBicarb and KCl Lidocaine or Phenytoin |
|
|
|
what are the 3 main mood stabilizers?
|
Li
Valproate Carbamazepine |
|
|
|
What do you need to check before putting a pt on Li?
|
Renal Labs
TSH Preg test ECG |
|
|
|
What drugs increase blood Li levels?
|
NSAIDs
non loop diuretics (dehydration) ACE-Is |
|
|
|
Most common ADR of Li?
Others? |
*Hypothyroidism*
renal toxicity |
|
|
|
How does Li toxicity present?
|
tremor
fasiculations confusion/stupor/slurred speech seizure vomiting ataxia arrhythmia |
|
|
|
Why shouldn't preggers take Li?
Which trimester? |
Eb(p)stein's anomaly (tricuspid malformation)
1st trimester |
|
|
|
Indications for valproate in BP d/o?
|
rapid cycling bp
mixed cycles |
|
|
|
Pertinent ADRs for Valproate?
|
can induce hepatic failure but increased LFTs is usually transient and asymptomatic
PolyCystOvarSyndrome TERATOGENIC (neural tube defects) |
|
|
|
Indications for Carbamazepine in BP d/o?
|
refractory to Li and valproate
|
|
|
|
ADRs of Carbamazepine?
|
FATAL Agranulocytosis
Stevens Johnson teratogenic hepatitis |
|
|
|
Drug interactinos for carbamazepine?
|
induces cyt p450 system
|
|
|
|
Why give Lamotrigine for BP d/o?
|
not teratogenic
BUT...causes Stevens Johnsons |
|
|
|
When do heroin withrawal sxs begin (what are they)
|
8-10 hrs after last dose
(lots. no seizures) |
|
|
|
When do benzo withdrawal sxs begin? (which is dangerous?)
|
8th or 9th day (seizures)
|
|
|
|
When do mild EtOH withdrawal sxs begin? (what are they?)
|
6-8hrs
(tremor, anxiety, insomnia) |
|
|
|
Dangerous EtOH withdrawal sxs?
|
seizures, hallucinations, hyperthermia
|
|
|
|
Tx for Sed-Hyp withdrawal?
|
supportive (prevent sz, replace electrolytes, thiamine replacement)
ADMIT in severe cases |
|
|
|
Tx for Heroin Withdrawal?
|
methadone/clonidine
admit preggers |
|
|
|
Treatment for restless leg syndrome?
|
pramipexole or ropinorole
(DA agonists) |
|
|
|
Tx for Essential Tremor?
|
Primodone (barb) and propranolol (beta blocker)
|
|
|
|
Tx for debilitating Tourettes?
|
High potency 1st gen antipsychotics (fluphenazine, haloperidol, pimozide)
Tx OCD component w/ fluoxetine |
|
|
|
Tx for Huntington's Chorea?
|
antidepressants to prevent suicide
supportive nothing slows dz progression |
|
|
|
Tx for Tardive Dyskinesia?
|
Stop offending med (1st gen antispychotic)
Remove central anti-chol (TCAs, anti-PD) give diazepam if acute switch to atypical antipsychotic |
|
|
|
Tx for myoclonus?
|
Clonazepam, Valproate (GABAnergic)
|
|
|
|
Tx for dystonia (focal, general, acute)?
|
focal - Botox
general - anticholinergic or benzo acute - IV/IM diphenhydramine or benzatropine |
|
|
|
Tx for dementia w/Lewy Bodies?
|
L-Dopa/carbidopa AND AChE-Is
|
|
|
|
What drug classes are used to tx Parkinson's?
|
Anticholinergis (benzatropine, trihexiphenidyl)
MAOB-Is (rasagiline, selegiline) COMT-Is (Tolcapone, Entacapone) Amantadine DA agonist (bromocriptine, pergolide, pramipexole, ropinorole) |
|
|
|
Which antipsychotic is least likely to cause EPS?
|
clozapine
|
|
|
|
Dangers of non-selective MAO-Is
|
cheese effect (tyramine -> Hypertensive crisis)
|
|
|
|
Which parkinson's tx might be neuroprotective?
|
MAOB-Is (rasagiline)
|
|
|
|
BoTox is FDA approved for which 3 neurological conditions?
|
blepharospasm
hemifacial spasm cervical dystonia |
|
|
|
What is neuroleptic malignant syndrome? Tx?
|
life threatening reaction from antispychotics
muscle rigidity, altered mental status, autonomic dysfxn Tx w/Dantrolene, DA agonist |
|
|
|
what are the best drugs for drug-induced emesis?
|
5HT3 receptor antagonist (ondansetron, granisetron)
metoclopromide |
|
|
|
ADRs of 5HT3 receptor blockers?
|
HA, diarrhea, constipation, asthenia, phlebitis
|
|
|
|
What is aprepitant?
|
substance p/NK1 antagonist
anti-emetic |
|
|
|
Anti-emetics that you shouldn't use in kids?
|
anti-psychotics
trimethobenzamide (reye's syndrome) |
|
|
|
Difference in MOA btwn Benzos and Barbs?
|
Barbs - increased duration of channel opening (no ceiling effect)
Benzos - increased frequency channel opening (ceiling effect) |
|
|
|
Which benzos are not affected by cytP450?
|
lorazepam, oxazepam, temazepam
|
|
|
|
Time frame for withdrawal symptoms from BZDs?
|
6 wks unlikely
1yr - hard to discontinue |
|
|
|
AVOID BZDs in which populations?
|
preggers
BP alcoholics COPD/OSAS memory impairment elderly (dizzy/ataxia) |
|
|
|
ramelton MOA
|
melatonin receptor agonist (rozerem)
|
|
|
|
What are zolpidem, zaleplon and exzopiclone for? MOA?
|
insomnia
GABA-A receptor agonist |
|
|
|
Which insomnia drug has the shortest half life?
|
zaleplon (sonata)
|
|
|
|
generic names for:
a. ambien b. sonata c. lunesta |
a. zolpidem
b. zaleplon c. eszopiclone |
|
