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92 Cards in this Set
- Front
- Back
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Sensitive indicator of alcohol use:
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GGT
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Sign of alcohol withdrawal
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Delirium tremens - DTs
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What is Delirium tremens? When does it occur?
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A life-threatening alcohol withdrawal syndrome; peaks 2-5 days after last drink
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What are the first symptoms to appear in delirium tremens?
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Autonomic hyperactivity
-Tachycardia -Tremors -Anxiety |
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What are the later symptoms to appear in delirium tremens?
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Psychotic symptoms
-Hallucinations -Delusions -Confusion |
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What drug treat DT's?
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Benzodiazepines
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Pinpoint pupils:
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Opioid toxicity
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Why is Opioid toxicity especially concerning?
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It is life threatening
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3 signs in addition to pinpoint pupils that point to Opioid toxicity:
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-CNS DEPRESSION
-N/v -Constipation |
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What are signs of opioid withdrawal?
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DIlATED pupils
Gooseflesh - cold turkey Runny nose/diarrhea yawning - on the nod |
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3 drug overdoses that can cause pupil DILATION
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-Amphetamines (meth)
-Cocaine -LSD |
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What do Amphetamine, Cocaine, Marijuana overdoses produce psychologically?
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Euphoria
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What does Meth/amphetamine withdrawal cause?
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Post-use CRASH - severe depression and suicidality
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What else causes a similar post-use crash?
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Cocaine withdrawal
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How is Cocaine withdrawal different from Meth withdrawal?
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More psychological CRAVING with cocaine withdrawal
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What is a hallmark sign of Cocaine OVERDOSE?
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Tactile hallucinations - bugs crawling on skin
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What other intoxication is associated with tactile hallucinations? What are these called?
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DTs - delirium tremens - Formications; ants crawling on skin
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What drug overdose can cause homicidality and belligerence?
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PCP - angel dust
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What is unique about PCP withdrawal?
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Symptoms can be RECURRENCE of INTOXICATION symptoms
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Why does PCP withdrawal result in the same symptoms as overdose?
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Because of reabsorption from the GI tract
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What are signs of PCP withdrawal then?
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SEVERE, Random HOMOCIDAL violence
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What therapeutic drugs have a low safety margin? Why?
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Barbiturates - Respiratory depression
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What anti-anxiety drugs have a higher margin of safety?
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Benzodiazepines
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What does withdrawal of benzos and barbiturates result in?
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REbound anxiety and insomnia
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How many people in the US are heroine addicts?
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500,000
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What 2 drugs competitively inhibit Heroin?
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-Naloxone
-Naltrexone |
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What is used for long-term maintenance or heroin detox? Why?
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Methadone - it has a long half life
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Drug to make alcoholics not want to drink:
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Disulfiram
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How is Ethanol itself toxic to the body?
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It interpolates into membranes, increases fluidity, and causes toxicity in the brain.
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What are 2 bad things that Acetaldehyde does in the body?
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-Protein/DNA adducts
-Makes AcCoA |
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What does increased AcCoA cause?
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Fatty liver!
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What does the increased NADH:NAD ratio from all the ALD and Cyp2E1 reactions lead to?
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Inhibits gluconeogenesis and fatty acid oxidation
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What is the treatment for Wernicke Korsakoff syndrome?
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Vit B1 - IV thiamine!
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How are Mallory-Weiss tears symptoms different from Esophageal varices?
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They cause pain; varices is nonpainful
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Txmt for Alcohol withdrawal:
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Benzodiazepines
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Txmt for Anorexia/bulimia
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SSRIs
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Txmt for Anxiety
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-Benzos/barbiturates
-Buspirone -MAO inhibitor |
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Txmt for ATYPICAL DEPRESSION
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MAO inhibitors
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Txmt for normal Depression
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-SSRIs
-TCAs |
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Txmt for Depression with INSOMNIA
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-Trazodone
-Mirtazapine |
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Txmt for OCD:
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SSRIs
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Txmt for Panic disorder
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-TCAs
-Buspirone |
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So 2 uses for Buspirone:
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Anxiety and Panic
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Txmt for Schizophrenia:
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Antipsychotics
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Txmt for Bipolar:
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Mood stabilizers
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3 mood stabilizers:
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Lithium
Valproic acid Carbamazepine |
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What are the 4 'typical' antipsychotics?
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-Chlorpromazine
-Thioridazine -Fluphenazine -Haloperidol |
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Mechanism of the typical antipsychotics:
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D2 receptor blockade
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Motor side effects of Fluphenazine and Haloperidol:
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EPS
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What is the order of onset of extrapyramidal side effects?
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4 hours - acute dystonia
4 days - akinesia 4 weeks - akathisia 4 mo - tardive dyskinesia |
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Endocrine side effect of typical antipsychotics:
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GALACTORRHEA - due to Dopamine blockade which disinhibits Prolactin release
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Side effects of Chlorpromazine and Thioridazine
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-M blockade - drymouth/constipn
-a blockade - hypotension -Histamine blockade - sedation |
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Rigidity, Myoglobinuria, Autonomic instability, Hyperpyrexia:
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Neuroleptic Malignant Syndrome!
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Txmt for Neuroleptic malignant syndrome:
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-Dantrolene
-Dopamine AGONIST |
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Hallmark side effect of long term typical D2 blockade:
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Tardive dyskinesia
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What are the 3 ATYPICAL antipsychotics?
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-Clozapine
-Olanzapine -Risperidone (old closets risper) |
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Mechanism of atypicals:
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Block D2 AND 5-HT2 receptors
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Atypicals are especially useful for:
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Block both the positive and negative symptoms of Schizophrenia!
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What is Olanzapine used for? 4
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-Tourettes
-OCD -Mania -Anxiety disorder -Depression |
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What do you HAVE to do if giving Clozapine and why?
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WEEKLY CBC - it causes AGRANULOCYTOSIS
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Lithium mechanism related to?
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Phosphoinositol recycling
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Lithium's use:
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Mood stabilizer - Bipolar
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Side effects of LITHIUM:
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LMNOP
-Movement - tremor -Nephrogenic Diabetes insipidus -HypOthyroidism -Pregnancy problems-Teratogenic! |
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Mechanism of Buspirone:
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5HT1A AGONIST
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Buspirone' uses:
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-GAD generalized anxiety disorder
-Panic |
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Buspirone does NOT:
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Cross react with BDZ's, barbiturates, or alcohol - no risk of addiction or resp depression
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Fluoxetine, Sertraline, Paroxetine, Citalopram:
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SSRI's
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Mechanism of SSRI's:
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Specific block of Serotonin reuptake
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3 uses of SSRI's:
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-Depression
-Bulimia/anorexia -OCD |
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SSRI's should NOT be given with _____ because:
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MAOI's - Serotonin Syndrome results
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Signs of Serotonin syndrome:
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-Hyperthermia
-Muscle RIGIDITY -CV collapse |
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Imipramine
Amitryptiline Nortriptyline Doxepin, Clomipramine, Desipramine: |
TCAs
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Mechanism of TCA's:
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Block reuptake of BOTH NE and Serotonin
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Imipramine is used for:
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Bedwetting
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Clomipramine is used for:
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OCD
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Side effects of the TCAs:
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-Atropine like - cholinergic blockade symptoms
-Alpha blockade -Sedation |
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Anticholinergic symptosm:
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Hot as a hare
Dry as bone Red as beet Mad as hatter |
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Which TCAs have the worst anticholinergic symptoms?
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Tertiary - Amitriptyline
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Least sedating TCA:
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Desipramine
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3 symptoms of TCA TOXICITY:
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-Convulsions
-Coma -Cardiac arrythmia |
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What do TCAs cause in ELDERLY? Why? How do we counteract it?
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Confusion and hallucinations from Anticholinergic effects; give Nortriptyline - secondary
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Atypical Antidepressant also for Smoking cessation:
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Bupropion - Zyban
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Atypical Antidepressant that inhibits Serotonin, NE, and DA reuptake - all 3:
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Venlafaxine
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a2-antagonist for depression:
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Mirtazepine
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Side effects of Mirtazapine:
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Increased appetite - weight gain
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NE reuptake blocker
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Maprotiline
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Trazodone:
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Inhibits serotonin reuptake
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Side effect of Trazodone
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Priapism
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Phenelzine/tranylcypromine:
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MAO inhibitors
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When are MAOi's contraindicated?
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In conjunction with Tyramine ingestion and B-blockers
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2 other drugs that should NOT be given with MAOi's:
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-SSRIs
-Meperidine |
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Why shouldn't SSRI's or Meperidine be given with Phenelzine/Tranylcypromine?
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Cause SEROTONIN syndrome
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