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Flashcards in ANS, Neuro, and Psych Drugs Deck (102):
0

Pralidoxime

Ach esterase regenerator Used for AchE overdose (eg pesticides) Needs to be given immediately

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Succinylcholine

Depolarizing neuromuscular blocking agent. Keeps nACh channel opens. Giving ache during first phase (fasiculations) potentiates effect AChE during second phase (paralysis) attenuated effect

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Carbamates

AChE inhibitors (-stigmines)

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Ipatropine

Bronchi relaxation (IPA try to breathe now)

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Bethenchol

mAChR agonist Used for postoperative illeus (Beth needs to shit)

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Pilocarpine

mAChR agonist Used to induce myosis(pupillary contraction) and for glaucoma (allowing for movement if vit hum out canal of schlem)

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Carbachol

mAChR agonist Used for glaucoma ("need to squeeze the eye (constraction) to get rid of extra aqueous humor") Carborator on pipe to smoke weed another txt for glaucoma

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Scopolamine

mAChR antagonist Used as antiemetic (scope to clean out mouth after puking)

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Tolterodine

mAChR antagonist Used for urinary incontinence (toltery can hold it man)

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Tropicamide

Anticholinergic used to induce mydriasis Tropico is used topically

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Tubocurarine Pancuronium

Nondepolarizing paralytic (neuromuscular blocking agent) nAChR antagonist Look for cur as in curare in them

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Benzotropine

Anticholinergic fir Parkinson's Park the Benz (the Benz penetrates the cns)

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Atropine

Anticholinergic Antiparkinsonian

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Cholomimetic effects?

Cardiac slowing, decreased CO, vasodilation, decreased artery pressure GI peristalsis, contraction of bladder, contraction of bronchial smooth muscle Stim of glands: sweat, lacrimation, salivation and bronchial secretions

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Acetylcholinesterase inhibitor overdose?

Overdose= dumbbells Diarrhea urination mitosis bronchochonstriction bradycardia, excitation (of cns-Parkinson's like; skeletal muscle) lacrimation, salivation, sweating

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Anticholinergic effects?

Inhibition of sweat, secretions, tachycardia, mydriasis, cycloplegia, decrease gi motility, relaxation of bronchi biliary and uriniary smooth muscle With kids have to be careful of over activity with hyperthermia and no sweating

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Local anesthetics--two classes what are they and how do you know which one is which?

Esters--- take away Caine and there won't be another I in the name Degraded by PABA Amides---take the Caine out and there will be another i These are degraded by cyps

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Morphine

Opiate High first pass metabolism, why administered IV

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Methadone

Synthetic mu agonist, weaker than morphine and used to help with withdrawal symptoms Cross tolerance exhibited with heroin

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Hydromorphone (dilaudid)

Synthetic mu agonist, weaker than morphine and used as alternative Has antitussive effects

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Hydrocodone

Oral antitussive and analgesic

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Meperidine (Demerol)

Opiate Metabolized to convulsant (therefore renal and hepatic considerations) Tx in hospital until you start seeing fasiculations and then take ptn off of it

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Dextromethorphan

Antitussive opiate "Purple drank" robotussin

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Diphenoxylate

Antidiarhea formulated with atropine

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Loperamide

Antidiarrhea opiate

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Naloxone Naltrexone Nalmefene

Opiate antagonists (Tx for OD)

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Levodopa

Antiparkinsons DA precursor, passes thru BBB

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Carbidopa (sinemet)

Antiparkinsons Decarboxylase inhibitor, given in combo to prevent peripheral breakdown of L dopa. Does not pass into brain Side effects are less than with l dopa alone

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Bromocriptine

Antiparkinsons DA agonist Ergot- thus causes fibrosis

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Rotigone

Antiparkinsons DA agonist (non ergot) Hits DA R 1,2,3 "Roti does all three"

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Ropinirole

Antiparkinsons DA agonist Non ergot If it makes you uncontrollably sleepy then needs to be stopped

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Pramiplexole

Antiparkinsons non ergot DA agonist Also used for restless leg syndrome

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Apomorphine

Antiparkinsons D4 agonist Need to give antiemetic first

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Selegiline Resagiline

Antiparkinsons MAO B inhibitor (B specific for dopamine breakdown) Selegiline has side effects, htn crisis Resagiline does not have side effects

 

CAN BE USED TO INCREASE DA IN PD

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Tolcapone Entacapone

Antiparkinsons COMT inhibitors (Capone!!) Tolcapone has hepatotoxicity Entcapone does not--cuz ents are awesome

 

CAN BE USED TO INCREASE DA IN PD***** (only effect when used in combo with Levodopa/carbidopa) THESE WORK PERIPHERALLY INCREASING AMOUNT OF LEVODOPA AVAILIBLE FOR BRAIN

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Amantadine

Antiviral Antiparkinsons

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Antipsychotics

Both work similiarly, you pick drug based on SEs; long half lives; concerned with tardive dyskinesias as SEs---irreversible and immediate stoppage required. Toxicity---parkinsonian effects, SNS effects from muscarinic blockade; also an Alpha adrenergic blockade=postural hypotension and failure to ejaculate, cardiac=prolonged QT Typical (first generation)--D2 antagonists: most have "-zine" cuz the make you zzzzzz -SEs: Extrapyramidal neuro effects (neuroleptic drugs--tranquilizers, bradykinesia, mild rigidity, tremor, akathisia--subjective restlessness) -Also increased release of prolactin-->lacrimation; Dystonias caused by typcals can be relieved via diphenhydramine (benadril) or benzotropine -NB: Haloperidol (haldol), chlorpromazine (thorazine), thioridazine (mellarlil) Atypical (2nd generation): 5-Ht2 antagonists > D2 antagonists; most have "-pine" -SEs: less extrapyramidal symtoms. Do have hypotension, seizures, weight gain, increased risk of type II db, ad hyperlipidemia -NB: Clozapine (clozaril), risperidone (risperdal), paliperidone (invega), olanzapine (zyprexa), quetiapine (seroquel) short half life , ziprasidone short half life, aripiprazole (abilify) Neuroleptic Malignant syndrome: Bromocriptine (ergot DA agonist) and stop antipyshcotic

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Chlorpromazine

Typical Antipsychotics--D2 Antagonist; originally called neuroleptic drugs=tranquilizers SEs-Extrapyramidal effects: bradykinesia, mild rigidity, tremor, subjective restlessness (akathisia), reduced initiative and interest, emotional manifestations.

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Thioridazine

Typical Antipsychotics--D2 Antagonist; Also has mACh activity which might explain less extrapyramidal effects. Orthostatic hypotension and urinary retention originally called neuroleptic drugs=tranquilizers SEs-Extrapyramidal effects: bradykinesia, mild rigidity, tremor, subjective restlessness (akathisia), reduced initiative and interest, emotional manifestations.

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Haloperidol

Typical Antipsychotics--D2 Antagonist; Increased risk for extrapyramidal effect originally called neuroleptic drugs=tranquilizers SEs-Extrapyramidal effects: bradykinesia, mild rigidity, tremor, subjective restlessness (akathisia), reduced initiative and interest, emotional manifestations.

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Clozapine (as opposed with Clonidine)

Clozaril; Reduced risk of extrapyrmaidal effects, saved for tx resistant psychosis, works well but risk of agranulocytosis (monitor blood counts) Atypical Antipsychotic--5-ht2 antagonists and D2r antagonist SEs-Seizures, hypotension, weight gain, increased risk for type II db, and hyperlipidemia (clonidine: central alpha 2 agonist which decreases SNS tone in HTN)

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Clozapine (as opposed with Clonidine)

Clozaril; Reduced risk of extrapyrmaidal effects, saved for tx resistant psychosis, works well but risk of agranulocytosis (monitor blood counts) Atypical Antipsychotic--5-ht2 antagonists and D2r antagonist (WORKS ON D4 agonists as welL) SEs-Seizures, hypotension, weight gain, increased risk for type II db, and hyperlipidemia (clonidine: central alpha 2 agonist which decreases SNS tone in HTN)

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Paliperidone

Atypical Antipsychotic--5-ht2 antagonists and D2r antagonist SEs-Seizures, hypotension, weight gain, increased risk for type II db, and hyperlipidemia

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Olanzapine

Atypical Antipsychotic--5-ht2 antagonists and D2r antagonist SEs-Seizures, hypotension, weight gain, increased risk for type II db, and hyperlipidemia

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Quetiapine

Atypical Antipsychotic--5-ht2 antagonists and D2r antagonist SEs-Seizures, hypotension, weight gain, increased risk for type II db, and hyperlipidemia

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Ziprasidone

Atypical Antipsychotic--5-ht2 antagonists and D2r antagonist SEs-Seizures, hypotension, weight gain, increased risk for type II db, and hyperlipidemia

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Aripiprazole

Abilify Atypical Antipsychotic--5-ht2 antagonists and D2r antagonist SEs-Seizures, hypotension, weight gain, increased risk for type II db, and hyperlipidemia

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Anxiolytic Drugs

Sedative agent reducing anxiety and exerting a calming effect; can be hypnotic (sleep promoting); lipophillicity will determine CNS penetration; Cyp 3a4 then glucoronidation; many metabolites will have very long half lives therefore need to considerhepatic dysfunction and age (older ppl give less); instruction patients not to drive or drink or take anticholinergerics or antihistamines, HIGH RISK OF DEPENDENCE--don't write refills so they cannot horde them (suicide) and need to check up with you; can have anterograde amnesic affects. always short term use of sedatives (except things like Generalize anxiety disorder, panic disorder agroaphobia which can be longer use) Can have withdrawal where you need to wene them off and/or psychological dependence; FLUMZAENIL for BZ OD competitive inhibitor with SHORT half life Benzodiazepines--much safer as with large doses only cause anesthesia and not coma or respiratory depression; GABAa agonists (2 spots on channel) causing increased opening frq, not duration per opening; ANTICONVULSANTS (not barbs); muscle relaxation, slight resp depression only concerned with a pulmonary patient MOST END IN "AM" Barbituates--can causes coma with large doses, abuse and fatal potential; binding site inside of pore, therefore influences how long it stays open not freq of opening "-tal" NB Can give B-adrenergics to block peripheral effects of anxiety, will not remove subjective feeling however.

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Lorazepam

Benzo: Ativan Benzodiazepine Long half life, no active metabolites Instruct patient not to drive, use alchol, anticholinergics, or antihistamine. No refills Tx: Acute Anxiety states, panic attackes, generalized anxiety disorder, insomnia, skeletal muscle relazation, seizure disorders

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Clonazepam

Benzo--Kloniopin Benzodiazepine Long half life, no active metabolites Instruct patient not to drive, use alchol, anticholinergics, or antihistamine. No refills Tx: Acute Anxiety states, panic attackes, generalized anxiety disorder, insomnia, skeletal muscle relazation, seizure disorders

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Chlordiazepoxide

Benzo: Librium Benzodiazepine Long half life, no active metabolites Instruct patient not to drive, use alchol, anticholinergics, or antihistamine. No refills Tx: Acute Anxiety states, panic attackes, generalized anxiety disorder, insomnia, skeletal muscle relazation, seizure disorders

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Oxazepam

Generic Benzo Benzodiazepine Long half life, no active metabolites Instruct patient not to drive, use alchol, anticholinergics, or antihistamine. No refills Tx: Acute Anxiety states, panic attackes, generalized anxiety disorder, insomnia, skeletal muscle relazation, seizure disorders

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Clorazepate

Tranxene Benzodiazepine Long half life, no active metabolites Instruct patient not to drive, use alchol, anticholinergics, or antihistamine. No refills

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Diazepam

Benzo--Valium Benzodiazepine Long half life, no active metabolites Instruct patient not to drive, use alchol, anticholinergics, or antihistamine. No refills Tx: Acute Anxiety states, panic attackes, generalized anxiety disorder, insomnia, skeletal muscle relazation, seizure disorders

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Alprazolam

Benzo: Xanax Benzodiazepine Long half life, no active metabolites Instruct patient not to drive, use alchol, anticholinergics, or antihistamine. No refills Tx: Acute Anxiety states, panic attackes, generalized anxiety disorder, insomnia, skeletal muscle relazation, seizure disorders

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Midazolam

Benzo: Versed Benzodiazepine Long half life, no active metabolites Instruct patient not to drive, use alchol, anticholinergics, or antihistamine. No refills Tx: Acute Anxiety states, panic attackes, generalized anxiety disorder, insomnia, skeletal muscle relazation, seizure disorders

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Phenobarbital

Long acting Barbituate - Most commonly used drug for seizure disorders Binds inside of Gaba channel--increase duration of opening (as opposed to benzos increasing frequency) Induces Cyp450s--will stop birth control from working Depletes vit k, d and folate

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Pentobarbital

Barbituate Binds inside of channel

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Buspirone

NON BENZO Anxiolytic: BuSpar Longer onset, fewer side effects

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Flumazenil

Benzo ANTIDOTE with Short half life (will not work with Barbiutate overdose)**** Romazicon BZ binding site antagonist with VERY short half life. Used for BZ OD but need to give every few hours while you wait for person to clear system of BZ

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Reserpine

Anti-serotoninergic, originally used as an antihypertensive Prevents uptake of 5ht into vessicles

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Antidepressants

Need to tx for several weeks, monoamine neurotransmission hypothesis Reuptake blockers: -SSRI's -SNRI's--Blocks uptake of 5-ht and NE -TCA's--Non Selective reuptake inhibitors Metabolism inhibitors -MAOI's (A=nonspecific, NE and 5-HT, tyramine) (MAOs tend to be in presynaptic terminal, while COMTs tend to be on post-synaptic cleft); cause HTN particularly with Tyramine (fish, cheese)**** SARI's--(serotonin antagonist and reuptake inhibitor) --Not well understood since two effects seem counterproductive, explanation is that they selectively do this

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Trazodone

SARI--serotonin Antagonist and reuptake inhibitor Causes Sedation via histamine blockage 2nd Gen SARI's--(serotonin antagonist and reuptake inhibitor) --Not well understood since two effects seem counterproductive, explanation is that they selectively do this Prodrug,

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Nefazodone

SARI. Heptatoxicity 2nd Gen SARI's--(serotonin antagonist and reuptake inhibitor) --Not well understood since two effects seem counterproductive, explanation is that they selectively do this Structural anaolgo of 5-ht, antagonist for 5-ht2a/2c and 5-ht3

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Mirtazapine

SARI. Sedation. Weight gain (attractive for elderly) 2nd Gen SARI's--(serotonin antagonist and reuptake inhibitor) --Not well understood since two effects seem counterproductive, explanation is that they selectively do this Structural anaolgo of 5-ht, antagonist for 5-ht2a/2c and 5-ht3

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Bupropion

Antidepressant (in a class by itself), Smoking Cessation, Welbutrin; "Mom should be ON bupropriON" Enhances both NE and DA transmission while inhibiting reuptake of NE and DA Don't use with eating disorders (bulimia) due to seizure risk

 

MAJOR SIDE EFFECT IS SEIZURES

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SSRIs

Blocks 5ht transporters Tx for MDD, Anxeity disorder, ocd, pmdd, ptsd, bulimeia etc. Sexual dysfunction, sleep issues

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Fluoxetine

SSRIs--Prozac

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Paroxetine

SSRI---Paxil Teratogenic--No pregnancy (3 P's)

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Sertraline

SSRI Zoloft

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Citalopram

Celexa - SSRI

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SNRIs

Reuptake for NE and 5ht (little DA) Antidepressant (backup for SSRIs), Sympathetomemmitcs**** + Anticholinergic, sedation, hypertension (particularly Venlafaxine)

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Venlafaxine

SNRI - Effexor Hypertension

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Duloxetine

SNRIs - Cymbalta

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Tricyclic Antidepressants

Blocks NE and 5-ht less selective than SNRIs: Also blocks alpha adernergic receptors (HYPOTENSION**** compared with SNRIs=HTN), antihistamine (sedation) Overdose: arrhythmias/seizures

 

OD FROM ARRYTHMIAS from blocking fast Na channel in cardiomyocytes

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Impipramine

TCA

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Amitriptyline

TCA Antidepressant; amiTRItiptine=TRIcyclic

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Clomipramine

TCA antidepressant---Anafranil

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MOAI's

Tx for Major Depression unresponsive to other drugs HTN Crisis with TYRAMINE--(w/ meats and cheese) or Sympathomimetics Serotonin syndrome with SSRIs Tox: Hypotension and insomnia

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Phenelzine

MAOI-A Antidepressant Inhibits breakdown of NE, DA and tyramine HTN CRISIS with tyramine containing food (cheese, meat)

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Selegiline

MAOIBs

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Lithium

Mood stabilizing drug used as Bipolar Treatment Enters via Na+ channel, 6 to 8 hour half life, Low therapuetic index: 0.6 to 1.4 mEq/L target range; 2=toxicity Diuretics DECREASE clearance about ~25% SE is tremor which is controlled by propranolol or atenolol, decreases thyroid function, polydipsia and polyuria Not used in Dehydration, hyponatremia, significant CVD or renal impairment

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Doxepin (Silenor)

Insomnia Tx: Potent H1 Blocker

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General Anethestics

IV for Induction Inhaled for Maintence Benzos for amnesia Opioids for using less inhaled and for post op analgesia neuromusclular blocking drug to prevent patient moving during procedure Inhaled= MAC--minimum alveolar concentration (measure of potentcy). Less soluable has faster onset (it fills the well faster) Effect--decreases BP (vasodilation and negative inotropy), increased Resp Rate and lower tidal volumes (causing lower minute volume). Concerns with Malignant hyperthermia--decreased reuptake of Ca2+ from sarcoplasmic reticulum causing increased temp and muscle contractions. Tx with Dantrolene (inhibiting release from Sarcoplasmic reticulum) IV=method of induction (fast on/off), lipiphillic going first to highly perfused tissues and then washing out fast; context specific half life time

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Datrolene

Antidote for malignant hyperthermia. Inhibits release from sarcoplasmic reticulum

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NO

Inhaled Anesthetic Used as adjunct for amnesia and has analgesic actions

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Isoflurane, Sevoflurane, Desflurane

Volatile Inhaled Anesthetics Sevoflurane is the most pleasant to inhale and used for induction of kids Iso>Sevo>Des (least soluable thus better (Lower) MAC=minimum alveolar concnetration)

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Propofol

IV anesthetic "MJ Juice, Milk of amnesia" Used as induction agent Vasodilatory and negative inotropy, decreases tidal volume, RR and minute volume, decrease in upper airway reflexes antiemtic

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Etomidate

IV Anesthetic Use with Cardiovascualry comprimised patient (no hemodynamic effects: HR, BP, inotropy) Non-analgesic, Respiratory depressant, associated with PONV (post op nausea and vomitting)

89

Ketamine

IV Anesthetic Airway reflexes are preserved in most situations, secretions/lacrimations are increase, hallucinations and upleasant emergence might occur (suggested benzo co-administration) sub-analgesic doses might help in limiting or reversing opioid tolerance (effectively lowering the therapuetic doses necessary for opioids)

90

Dexmedetomidine

IV Anesthetic Used for sedation or adjunct to general anesthetic, and analgesic Significant deceases in BP/HR (to the point you need to give atropine sometimes) Mechanism of action: Alpha 2 agonist in LC and SC Good cuz preserve respiratory drive, context sensitive half life significantly increases after 8 hours of infusion

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Antiepileptics

3 Mechanisms of action: 1) Decrease Glutamate 2) Increase GABA 3) Modify Na/Ca Conductances Partial Seizures: Phenytoin, Carbamazepine, Valproate Generalized Tonic-Clonic (grand mal): Phenytoin, Carbamazepine, Valproate Absent (petit mal Seizures): Ethosuximide, Valproate (clonazepam) Myoclonic Seizures: Phenobarbital, Valproate (Clonazepam) Status Epilepticus: Phenobarbital, Diazepam (REALLY YOU WANT THEM UNDER GENERAL ANESTHESIA)

92

Phenytoin

Anti-Epileptic: Cyclic Ureide. Blocks Na channels, and thus decreasing glutamate. Phenoyt ion makes you face look funny Use for Generalized Tonic clonic and partial seizures SEs: Nystagmus diplopia, sedation, hirustims, anemisa peripheral neuropathy,osteoporiss, induction of hepatic drug metabolismo Important: Teratogenic (cleft lips/palates), induces Cyp450s thus birth ctl won’t work, hirutism, coarsening facial features and nystagmus associated, GINGIVAL HYPERPLASIA, Megaloblastic anemia, 

93

Ethosuximide

Anti-epileptic used for absence seizures; slows T-ca2+ channels in thalmus. Causes nausea Succinimide anticonvulsant, used over valproic acid (valproate) dt no hepatotoxic effects

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Valproate

Broad spectrum antiepileptic, most effective for myoclonic/atonic; Decreases T-caclium channel activity, hepatotoxic, increases gaba concentration in brain Used for generalized tonic-clonic, parital nd myoclonic siezures. Teratogenic and potential hepatotoxic (infants) SEs: Drowsiness nausea, tremor, hair loss ,weight gain, inhibition of heaptic drug metabolism

95

Carbamazepine

Anti-epileptic, and Mood stabilizer (BP) and antipsychotic agent for schizo. Also trigemneal neuralgia Inhibts votlage gated Na channels decreasing synaptic release of glutamate SEs: AGRANULOCYTOSIS AND APLASTIC CRISIS; Diplopia cog dysfunction, drowsiness, ataxia. Teratogenic potential and rare for steven johnson syndrome (life threatening skin condition causing the epidermis to separate from dermis---thought ot be a hypersensitivity Rxn)

96

Lamotrigene

Antiepileptic Toxic-epidermal necrosis (Stevens-Johnson syndrome) Prolongs inactivation of Na channels

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Dementia Txs

AChEI's and NMDA's Receptor Antagonists

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Donepazil, Rivastigmine, Galantamine

Dementia Txs: AChEI's

99

Mementine

Dementia Tx: NMDA receptor antagonists (protects against glutamate excitotoxicity)

100

Drug used to prevent cerebral vasospasm following stroke?

Nimodipine (Calcium channel blocker)

101

Most common cause of bacterial meningitis in adults? 

Lancet Gram positive Cocci in pairs (strep pneumonia)