Drugs Flashcards by E *

Sedative is?

Anxiolytic- exerts a calming effect - w/ no efx on motor/mental fix

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Hypnotic is?

Produces drowsiness for sleep

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2 Major classes of sedatives?

Benzodiazepines and barbiturates

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Benzodiazepines are used for? Barbiturates used for historically?

Short term sedation, insomnia, epilepsy, anesthesia

Insomnia/epilepsy/anesthesia

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MOA of sedatives/hypnotics?

Binds to GABA receptors; increases Cl- influx

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Which dose curve is more dangerous? Barbs or Benzo?

Barbiturates - coma, death faster

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Barbiturates are metabolized where?

Liver

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Most severe adverse SEs of barbiturates?

CNS depression
Hangover effect
Withdrawal (more severe than opiates)

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What pregnancy category is barbiturates?

Cat D

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Treatment of Barbiturate overdose?

Ventilation
Stomach purge
+- hemodialysis

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Specific SEs of phenobarbital?

Sex dysfx
HOTN, Brady-C
Hyperactivity w/ cognitive impairment

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Short acting (t1/2) BZDs?

Midazolam
Oxazepam
Triazolam

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Intermediate t1/2 BZDs?

Alprazolam
Estazolam
Lorazepam
Temazepam

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Long acting t1/2 BZDs?

Chloridazepoxide
Clonazepam
Diazepam
Flurazepam
Quazepam

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Short vs Long t1/2 BZDs SEs?

Long -
last all day,
less withdrawal, breakthrough s/s
more hangover s/s

Short -
Better/quicker control for acute mgmt
Tolerance is rapid
Withdrawal/breakthrough s/s is common

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BZDs will not have what effects/actions?

No analgesic
No antipsychotic
No efx on ANS

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Best BZDs for Etoh Withdrawal?

Oxazepam (liver disease)
Lorazepam (liver disease
Chlordiazepoxide (Long acting coverage)
Diazepam (Long acting coverage)

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Best long acting/fast onset BZD?

Diazepam

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BZDs used for Anxiety?

Lorazepam
Diazepam
Clonazepam (Not FDA approved)

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Short term BZDs have more of a risk of?

Withdrawal

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BZDs used for Panic attack?

Clonzepam
Alprazolam
Oxazepam

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Short acting BZDs for insomnia

Triamzolam

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Intermediate acting BZDs for sleep maintenance?

Temazepam

Estazolam

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Which BZDs has the fastest onset?

Lorazepam 2-3m

Diazepam 4-5m

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Common adverse SEs of BZDs?

Residual daytime sedation Rebound insomnia Antegrade amnesia

What is max TXT period for BZDs?

3-4mo

BZD pregnancy category?

Cat D to X

BZDs for geriatrics?

Lorazepam Oxazepam Temazepam

Rescue/reversal agent for BZDs? How is it administered?

Flumazenil (IV) possible to have multiple doses due to quick onset/duration

NON-Benzodiazepines

``` Buspirone (buspar) Zolpidem (Ambien) Eszopiclone (Lunesta) Zaleplon (Sonata) Ra-melteon Tasi-melteon ```

Name drugs w/ MOA - melatonin receptor agonist?

Ra-melteon | Tasi-melteon (blindness)

Busprione MOA?

Sero/D2 receptors action

Buspirone vs BZDs?

Buspirone has no abuse potential, sedation, or euphoric effects.

Buspirone is typically used for?

Mgmt of anxiety disorders

Non-BZDs, Non melatonin agonist that are used for insomnia?

Zolpidem (Ambien) Eszopiclone (Lunesta) Zaleplon (sonata)

Insomnia Rx similar SE's

``` SI, ABNL behavior change Fx dependence(Not physical dependence) ```

Unique SE of Eszopiclone (Lunesta)?

Metallic taste

Sedating antidepressants?

Mirtazapine Trazadone Doxepin

Sedating AH?

Diphenhydramine | Doxylamine

SEs of sedating AHs?

Anticholinergic effects (Bad BPH/Dementia)

Non-BZDs Rx for sleep onset insomnia?

``` Zolpidem (Ambien) Eszopiclone (Lunesta) Zaleplon (sonata) or Ra-melteon ```

Non-BZDs Rx for sleep maintenance insomnia?

Eszopiclone (Lunesta) | Zolpidem (Ambien)

Acute mgmt of anxiety d/o or panic attack?

BZDs (as adjunct w/ antidepressants)

GAD Rx mgmt? 1L and others

SSRI > SNRI > TCAs | Adjuncts - Buspirone and pregabalin

Refractory GAD txt?

Antipsychotic (Quetiapine)

Panic d/o Rx mgmt? 1L and others

SSRI > SNRI > TCAs > MAOI | Adjuncts - 1L Clonazepam or Alprazolam

Social anxiety d/o Rx mgmt? 1L group and others (2L, performance anxiety)

SSRI > SNRI > TCAs > MAOI (Adjuncts - 1L Clonazepam or Alprazolam) 2L agents - gabapentin or pregbalin Performance anxiety - propanolol

OCD Rx mgmt? 1L and others

SSRI > SNRI > TCAs | Adjunct antipsychotics

Rx used for nightmares?

Prazosin

PTSD Rx mgmt? 1L and others

``` SSRI or SNRIs (Adjunct or mono-T antipsychotics) - Quetiapine - Olanzapine - Risperidone (Nightmares - prazosin alpha-blk) (Uncontrolled anxiety - BZDs) (Impulsive behavior - anticonvulsants) ```

Anticonvulsants used for impurlsive behavior w/ PTSD?

Tiagabine Topiramate Divalproex

Binge drinking is?

0.08g/dL <2hrs

Mild symptoms of ETOH Withdrawal begin when?

w/in 6hrs after last drink

Delirium Tremens may occur when?

1-5d after last drink

1L seizure prevention in ETOH withdrawal?

BZDs 1. Lorazepam (best for liver) 2. Diazepam 3. Chlordiazepoxide

Chronic ETOH abuse is associated w/ what neurologic condition?

Wernickes encephalopathy

Wernickes encephalopathy triad?

Confusion, ataxia, ophthalmoplegia

TXT of malnutrition in ETOH abuse?

Thiamine/folic acid/b12 (Vitamins) + lytes + fluid

TXT of etoh dependence?

1L - Naltrexone or Acamprosate

Naltrexone MOA?

Competitive agonist at opioid receptors reducing alcohol dependence

Acamprosate MOA?

GABA action and Antagonism of glutamate

Acamprosate use?

Maintain ETOH abstinence (x3D)

Main Difference between Naltrexone and Acamprosate

Naltrexone is metabolized by Liver (x5) | Acamprosate is excreted by kidneys

Requirments before initiating ADHD medications?

Vitals (BP, HR, ht/wgt)

Stimulant medications used for ADHD?

Amphetamines Dextroamphetamine (Dex) Methylphenidate Lisdexamfetamine

Non-stimulant medication for ADHD?

Atomoxetine Clonidine Guanfacine

MOA is amphetamine stimulants?

Release NEPI/DOPA

Amphetamine stimulant uses?

ADHD Narcolepsy Obesity

Amphetamine stimulants are CI in what pts?

HTN, CV disease, Hyperthyoridism, Glaucoma

Two main types of stimulants for ADHD?

Amphetamines | Methylphenidate (Dexmethylphenidate)

Methylphenidate brand names?

Ritalin or Concerta

Dexmethylphenidate brand name?

Focalin

Non-stimulants Rx for ADHD are perferred if?

Concern for abuse Pt preference CI medical conditions

MOA of atomoxetine?

Blocks reuptake of NEPI (non-stimulant)

MOA of clonidine XR?

Central alpha2 agonist

Clonidine/Guanfacine uses?

PEDs - intolerant to stimulants/TICs

Clonidine SEs?

HOTN, Brady-C | Arrythmias - QTC-Prolongation

MOA of Guanfacine XR?

Central alpha2 agonist

Central alpha2 agonist RXs?

Clonidine | Guanfacine

Are SSRIs useful in ADHD?

TCAs used in ADHD?

Imipramine | Desipramine

Other stimulant Rx (separate from ADHD Dx)?

Modafinil | Armodafinil

Uses of Modafinil and Armodafinil?

OSA - excess sleepiness Narcolepsy Shift work disorder

Caffeine is AKA?

Methylxanthine

Which Antidepressants suppress appetite?

SSRI - Fluoxetine, Sertraline | Buproprion (wellbutrin)

Drugs Flashcards

(85 cards)