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5drugsmental Flashcards

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1
Q

treatment of depression unresponsive to other
antidepressants (antidepressant)

what else is it used for

A

MAOI(selegine)

selegine also used for PD to selectively inhibit MAO-B that is selective to dopamine

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2
Q

uses for sellegine

A

-refractory depression
-early parkinsons disease
*can give intradermal which will avoid the cheese run

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3
Q

MAOI adverse effects

A

serotonin rxn(irreversible inhibitojn)
cheese rxn

NE inc causes drowsiness/ insomnia

SERT inc causes weight gain, dec sex

orthostatic hon

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4
Q

sx of serotonin rxn and tx

A

hyperthermia
sweating
monoclonus/jerking muscles

discontinue drug, sedate with benzodiazepines, and give serotonin agonist= cryptoheptidine

applicable to MAOI OD

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5
Q

sx of cheese rxn
what causes it
treatment

A

no degradation of tyramine by MAO causes release of catecholamines = tachy, htn, arrhythmia, seizures, stroke

-can be caused by cheese, wines with tyrosine. can also be causes by OTC cold meds(pseudoephedrine, and phenylpropanolamine)

tx with phentolamine or prazosin (for the HTN) or labetolol

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6
Q

TCA MOA

A

blocks NERT and SERT (reuptakers) which also causing block of a1, H1, M

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7
Q

TCA AE

A

inc serotonin effects(dec sex)
inc NE effects

anticholinergic (blurry, dry, delirium, glaucoma aggravation)

antihistaminic(sedation and weight gain/increases appetite)

blocks cardiac fast sodium channels(arrhythmia)

blocks alpha1 receptors(ortho hypo)

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8
Q

TCA arrhythmia antidote/ OD

A

sodium carbonate

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9
Q

SSRI AE and overdose

A

nausea from inc serotonin in the gut

weight gain

dec sex

NO: ortho hypo, dry, blurry

OD=seizure

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10
Q

which SSRIs have the lowest potential of other drug interactions

A

estatalopram
citalopram
sertraline

all can cause serotonin synd if paired with MAOI

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11
Q

SARI names, MOA

A

N/T-zodone

blocks SERT and NERT and antagonizes 5HT2 receptors to avoid unwanted effects of inc serotonin

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12
Q

AE of the SARIs

A

nefazodone causes hepatotoxiciity

trazodone ALSO BLOCKS a1 and H1…extremly sedating, ortho hypo, and PRIAPISM

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13
Q

SNRI MOA and time for use

A

blocks SERT and NERT
without the TCA side effects or the drug interactions with SSRIs

-try these is SSRIs dont work

venlafaxine will strongly inhibit SERT and in high doses can block NERT

Duoloxitine will inhibit both at any dose

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14
Q

Mirtazapine MOA and time for use

A

NaSSA
-Antagonist at serotonin Rs
-Antagonist at H1
-Antagonist of presynaptic alpha 2 receptors for serotonin and NE(normally when activated tells the neuron to stop releasing)

can be useful if there is also insomnia

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15
Q

ketamine MAO and time for use

A

noncompetitive antagonism at NMDA

refractory or suicidal depression

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16
Q

abnormal discontinuation syndrom sx and which drugs most likely cause this

A

flu like sx
electric shock sensation, insomnia

most likely caused by short half life drugs such as paroxetine and venlafaxitine…NOT from fluoxetine

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17
Q

tx chronic neuropathic pain

A

SNRI and TCA

ex.diabetic neuropathy

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18
Q

lithium use and MOA

A

tx bipolar

inhibits inositol synthesis(needed for the Gq, PLC, IP3/DAG) by uncompetitive inhibition of inositol phosphatase. no PIP2 so neuron cant fire.

alternatives are: valproate and carbamazepine, lamotrigine(anti epileptic), atypical antipsychotics(QORA)

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19
Q

lithium AE and OD

A

tremor, GI distress, seizures, hypothyroid, nephrogenic DI, alopecia

if used in pregnancy associated with congenital cardiac abnormalities

with OD: perfuse diahrea/vomitting, tremor, convulsions, coma

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20
Q

tx if lithium induces nephrogenic DI

A

discontinue lithium and give amiloride

if can discontinue, add thiazides or NSAIDs(reduces the renal clearance of lithium..also ACE)

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21
Q

what needs to be monitored with lithium

A

lithium serum levels
thyroid function
renal function

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22
Q

what needs to be monitored with valporate

A

liver function and CBC

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23
Q

what needs to be monitored with carbamazipine

A

CBC

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24
Q

dual antagonism of atypical antipsychotics

A

Dual antagonism at 5-HT2A and D2 receptors

less EPR, less prolactin inc

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25
atypical least likely to cause EPR
Clozapine and quetiapine in general atypical are less likely to cause EPR, prolacticemia, and can improve negative sx
26
partial agonist at D2 and 5HT1A receptors and an antagonist at 5HT2A receptors.
aripiprazole
27
an inverse agonist at the 5HT2A receptors with no significant affinity for dopamine receptors
Pimavanserin
28
high affinity for D1, D4, 5HT2, muscarinic and alpha-adrenergic receptor, but it is also a D2 blocker.
clozapine
29
blocks 5HT2 to a greater extent than it does D2
risperidone
30
which antipsychotics are not also antiemetics(blockade D2 receotrs in chemo center in medulla)
aripiprazole and thioridazole
31
why does thioridazine and chlorpromazine have the less likelihood of causing EPR
they have strong anticholinergic activity
32
what are the EPRs and how do you treat them
Parkinsonism: tx with antimuscarinics like trihexpheydil or benztropine. Can use diphenhydramine or amantidine Dystonia: tx with benztropine, trihexyphenidyl, or diphenhydramine Akathesia: clonazepam or propranolol tardative dyskinesia: discontinue any anticholinergics, add VMAT inhibitors(tetrabenzine or valbenzine) then switch them over to clozapine
33
May be due to dopamine receptor up-regulation
tardative dyskenesia
34
NEUROLEPTIC MALIGNANT SYNDROME sx and tx
possible side effect of antipsychotics sx- rigidity and hyperthermia, autonomic instability, elevated CK tx-dantrolene, bromocriptine
35
which antipsychotics have the biggest risk for seizures
Chlorpromazine and clozapine
36
which antipsychotic required monitoring and of what
need to monitor blood counts with clozapine bc it causes agranulocytosis
37
which antipsychotic has the cardiac problems what is the other side effect for this drug
thiordazine also causes retinal deposits
38
causes deposits in the cornea and lens
chlorpromazine classic antipsychotic
39
which antipsychotics have the highest and the lowest metabolic dysfunction
highest: clozapine and olanzipine lowest: aripiprazole, quietazole, haloperidol
40
antipsychotics black box warning
increased risk of death when given to elders for dementia related psychosis
41
tic tx
antipsychotic
42
approved for treatment of hallucinations and delusions associated with Parkinson's disease psychosis
Pimavanserin
43
antipsychotics for pregnancy
clozapine is safest, others are class C atypical have increased risk of weight gain and hyperglycemia in pregnancy
44
aspirin OD sx and tx
sailyic ACID OD = tinnitus, hyperventilation, vertigo, respiratory alkalosis/metabolic acidosis, impair renal, inc ketones and lactic acid(blocks oxidative phosphorylation and krebbs)...respiratory failure tx: sodium bicarbonate
45
acetometaphan OD sx and tx
hepatic necrosis**, renal necrosis, hypoglycemia coma inc NAPQI damage hepatocyte, depletes glutathione tx: n-acetylcystein
46
beta blocker OD sx and tx
Brady, heart block, QT prolongation, hypotension glucagon tx
46
CCB OD sx and tx
esp nifedipine causing dec SA and AV conduction tx: atropine, isoproterenol for Brady
46
anticholinergic od which drugs involved tx
antihistamines OD is seizure TCA OD is cardiac toxic overall anticholinergic effects: tachy and dilated pupils tx: physostigmine but not for TCA bc will agricvate cardio more..benzo good
47
amphetamine OD which drugs included tx
meth, cocaine, MDMA, pseudoepherdrine hyperventilation, htn, sweating tx: benzo or nitroprusside/ phentolamine. if arrythmias proposal
47
opioid OD sx and txx what drugs are in this category
heroin, morphin, codeine, oxycodone pinpoint pupils naloxone nalfemene
48
Nitrate od and tx
od: hemolytic anemia / methylglobinemia -inhibits ETC tx: methylene blue
49
theophylline OD tx
beta blockers proprolol or phenobarbital is seizing think caffeine
50
sulfa drug od sx and tx
hypoglycemia tx: octreotide and glucose infusion
51
what should be used in cases of QRS-interval prolongation after a massive diphenhydramine overdose
sodium bicarbonate
52
ethanol od tx
thiamine then glucose
53
NEUROLEPTIC MALIGNANT SYNDROME can be caused from and tx
can be caused from antipsychotic OD tx: Bromocriptine or dantrolene maybe benzo
54
methanol intoxo sx and tx
methanol"windshield wiper fluid", acidosis and blindness ethanol or Fomepizole may need to treat the metabolic acidosis with sodium bicarbonate
55
abdominal cramps, diarrhea, excessive salivation, sweating, urinary frequency, and increased bronchial secretions tx
organophosphate poisoning- anticholinesterase atropine
56
warfarin rodent bait od tx
Vit K1
57
cyanide od tx
sodium nitrate sodium thiosulfate hydroxocobalamin
58
ethylene glycol intoxo sx and tx
ethylene glycol "antifreeze" causes calcium crystal Fomepizole
59
binds to cytochrome c oxidase in mitochondria
cyanide
60
delta-ALA dehydratase and ferrochelatase are inactivated by
Lead
61
lead od sx and tx
PICA abdominal colic/ bloody diahrea, CNS problems, anemia! Chelation therapy: IV EDTA ± IM dimercaprol.
62
Severe gastrointestinal discomfort, vomiting, “ricewater” stools, capillary damage with dehydration and shock. anemia tx
arsenic poisoning Chelation with unithiol IV or succimer -can also give this in mercury poisoning
63
vomiting, bloody diarrhea, fever, lethargy and gray cyanosis tx
iron poisoning Deferoxamin
64
regenerates acetyl choline esterase
pralidoxime
64
heparin od tx
protamine
64
insulin OD
octreotide
65
all addictive drugs activate the what system
mesolimbic
66
which addiction drugs inc dopamine indirectly by blocking GABA
opioids, cannabis, benzes, alcohol
66
which addiction drugs directly stimulate dopamine which block ore reverse DAT
1. nic and alc 2. coc, amphetamines(coc actually blocks all of it SERT NET DAT) (amphetamines are MAOI and release catecholamines-mama is more specific for SERT)
66
CNS depressants
ethanol, barbs, benzes
66
ethanol withdrawal tx
Diazepam and chlordiazepoxide (benzos with long half life but if elderly give medium acting Lorazepam and oxazepam )
67
alcohol addition tx and MOA
-naltrexone- block Mu allowing inc in GABA and dec Dop -acamprostate- NMDA-R antag, blocking hyper glutamate -disulfiram- block alcohol dehydrogenase -topiramate- antagonizes glutamate
68
agonists at the GABAa receptor
Benzes -this will inhibit GABA and inc Dop
69
tremors, anxiety, perceptual disturbances, dysphoria, psychosis, and seizures
benzo withdrawal
70
management of benzo withdrawl
long acting benzo- diazepam
71
block presynaptic adenosine receptors which causes
Methylxanthines: caffeine, theophylline, theobromine what normally blocks NE is now blocked so there is an inc in NE
72
interfere with the VMAT, depleting synaptic vesicles
amphetamines
73
increased appetite, sleepiness, exhaustion, and mental depression
amphetamine withdrawal
74
VARENICLINE
Partial agonist at nicotinic receptors in the CNS. * Reduces the reward of smoking.
75
opioid withdrawal sx
dysphoria, lacrimation, rhinorrhea and yawning
76
opioid withdrawal tx
long acting opioid agonists: Methadone or buprenorphine. naltrexone is used AFTER withdrawal for abstinence compliance as it is a mu antagonist
77
what are the medical cannabis names what are they used for
Nabilone- chemo N/V Dronabinol- chemo N/V, anorexia * Cannabidiol (CBD)- seizures
78
MESCALINE MAO
psychedelics agonist effects at 5-HT2 receptors...no motor changes
79
PHENCYCLIDINE MAO
competitive antagonism at NMDA receptors and Blocks reuptake of norepinephrine and dopamine
80
natural remedies for cholesterol/htn
garlic, coenzyme Q
81
natural remedies for OA
condrotin sulfate glucosamine
82
natural remedies for 1.BPH 2.hepatits 3. performance enhancer 4. anxiety
saw palmetto mik thistle ma haung kava, ginseng
83
D2 conductance
dec adenyl cyclase dec Ca2+ inc K Parkinson drugs want to stimulate D2
84
what are the peripheral side effects of Levodopa how about CNS effects
nausea, vomiting, go bleeding, cardiac arrhythmias, tachy, hypotension cns: hallucination, depression, insomnia
85
For PD patients with severe off-periods who are unresponsive to other measures, what can you try. what are the other measures
apomorphine dopamine agents(non ergot) or COMT-I -usually first try capone
86
levodopa contraindications
dont give with B6 bc it will inc peripheral conversion with MAOI can induce hypertensive crisis dont give in close angle glaucoma dont give to psychotic patients or with antipsychotic drugs watch out for the cardiac patients and with GI ulcers
87
Used increasingly as initial treatment for PD, particularly for younger patients
the non ergot dopamine agonists Pramipexole & Ropinirole (patch) dont use the ergot bromocriptine anymore
87
trimethobenzamide when to use it
use it before giving apomorphine to minimize nausea
87
bromocriptine AEq
pulmonary infiltrates, pleural and retroperitoneal fibrosis, and erythromelalgia
87
Pramipexole AE
same as the Levodopa ones but also can cause 1. painless digital vasopasms 2. increased compulsive behaviors 3. severe solomnence-discontinue meds same applies for Ropinirole
88
88
apomorphine AE
nausea, QT prolongation, drowisness, swerating, hypotension
88
amantadine AE
toxic dose = psychosis as with any parkinsons drug Livedo reticularis -rash dry mouth ortho hypo urine retention, confusion, hallucinations
88
antimuscarinics used for parkinsons for what aspect
BENZTROPINE & TRIHEXYPHENIDYL for the rigidity and tremors, drooling
88
Metabolized to methamphetamine and amphetamine: may cause insomnia if taken late in the day
selegine/ rasagilline
88
89
BENZTROPINE & TRIHEXYPHENIDYL AE
mood changes, xerostomia, pupillary dilation, confusion, hallucinations, and urinary retention dont use in glaucoma, prostatic hypertrophy, or pyloric stenosis
90
receptor functions as a chloride channel what is the shape What bind
GABAa has a pentameric structure 2alpha 2beta 1gamma GABA binds between alpha and beta Benzos/NBBRA bind bw alpha and gamam(positive allosteric modulator of GABA) barbs bind at different alpha site
91
metabolites are then conjugated to form glucuronides that are excreted exceptions
benzos urine LOT- no P450 metabolism
92
93
benzos for: 1.muslcular disorders 2.sleep disorders
diazepam Temaz Triaz
94
Benzodiazepines may cause paradoxical effects
Anxiety, irritability, hostility and rage, paranoia, depression and suicidal ideation also can happen with barbs
95
5-HT1A PARTIAL AGONISTS
BUSPIRONE antianziety only with long onset of action
96
RAMELTEON MAO AE
agonist to melatonin receptor AE: endocrine changes, decreases in testosterone & increases in prolactin
97
blocks neuropeptides
SUVOREXANT & LEMBOREXANT blocks orexin A and B
98
SUVOREXANT & LEMBOREXANT AE and contraindication
Adverse effects include daytime somnolence and worsening of depression/suicidal ideation contraindicated in narcolepsy
99
effective in the management of nightmares and sleep disturbances associated with PTSD
PRAZOSIN
100
which antihistamines are used for sleep and which used for anxiety
sleep: doxepin anxiety: HYDROXYZINE
101
what is responsible for the optic nerve damage in alcoholics
formic acid which is a metabolite also applicable to methanol nerve damage
102
Motor dysfunction may involve chewing movements, diarrhea, urination and LOC
Focal Impaired Awareness Seizures usually in the temporal lobe
103
principle MOA for anti seizure drugs
Blockade of Voltage-Gated Ion Channels(Na T-type Ca) Modulation of Synaptic Transmission
104
which anti epileptics block voltage gated Na channels use?
phenytoin, carbamazepine, lamotrigine, zonisamide potentially valproate, phenobarbital, topiramate used for tonic clonic
105
antiepileptic: which drugs induce GABA presynaptically which postsynaptically which drugs block glutamate presynaptically, which postsynaptically
GABA post: barb, benzo, topi GABA pre: Tiagabine( by blocking reuptake), Vigabatrin (inhibits GABA aminotransferase/ degradation) glutamate post: phenobarbital, topimarate(blocks Na) glutamate pre: pregabalin and pregabalin(block Ca)
106
which antiepiletics block t type Ca channels what are they used for
used for absence seizures valporate(use for atypical absence or if also tonic clonics) ethansuxamide
107
binds to synaptic vesicle glycoprotein 2A (SV2A) function
Reduce Glutamatergic Neurotransmission Presynaptically- vesicle dont pop Levetiracetam
108
which ant epileptics induce P450
carbamazepine, phenytoin, phenobarbital
109
valproate AE
hepatotoxic inhibit metabolism of drugs/ inhibit P450
110
phenytoin AE
gingival, hirtuism, rash **zero order kinetics
111
carbamazepine AE
anemia, agranulocytosis rash
112
which anti epileptics have the highest SJS risk
carbamazepine, phenytoin, lamotrigine -back box warnings phenobarbital too but no black box also risk for toxic epidermal necrosis
113
vigabatrin AE
visual
114
anti epileptics while pregnant
valproate is the worst for malformations and can be combated with folic acid to decrease neural tube defects will also increase via K degradation causing newborn hemorrhagic disease and can be combated with vitamin K

term 4 (13 decks)

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