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1
Q

Diazepam

A

Long acting benzo

Use: SZ: alcohol withdrawal, sz status epilepticus SLEEP: insomnia, sleep walking, night terrors, muscle relaxant, PSYCH: GAD, panic disorder

MOA: Facilitate GABA-A action, increase opening frequency

SE: Dependence, tolerance, central ataxia, confusion, somnolence, anterograde amnesia

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2
Q

Lorazepam

A

Long acting benzo

Use: SZ: alcohol withdrawal, sz status epilepticus SLEEP: insomnia, sleep walking, night terrors, muscle relaxant, PSYCH: GAD, panic disorder

MOA: Facilitate GABA-A action, increase opening frequency

SE: Dependence, tolerance, central ataxia, confusion, somnolence, anterograde amnesia

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3
Q

Triazolam

A

Short acting benzo

Use: SZ: alcohol withdrawal, sz status epilepticus SLEEP: insomnia, sleep walking, night terrors, muscle relaxant, PSYCH: GAD, panic disorder

MOA: Facilitate GABA-A action, increase opening frequency

SE: Dependence, tolerance, central ataxia, confusion, somnolence, anterograde amnesia

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4
Q

Temazepam

A

Short acting benzo

Use: SZ: alcohol withdrawal, sz status epilepticus SLEEP: insomnia, sleep walking, night terrors, muscle relaxant, PSYCH: GAD, panic disorder

MOA: Facilitate GABA-A action, increase opening frequency

SE: Dependence, tolerance, central ataxia, confusion, somnolence, anterograde amnesia

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5
Q

Oxazepam

A

Short acting benzo

Use: SZ: alcohol withdrawal, sz status epilepticus SLEEP: insomnia, sleep walking, night terrors, muscle relaxant, PSYCH: GAD, panic disorder

MOA: Facilitate GABA-A action, increase opening frequency

SE: Dependence, tolerance, central ataxia, confusion, somnolence, anterograde amnesia

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6
Q

Midazolam

A

Short acting benzo

Use: SZ: alcohol withdrawal, sz status epilepticus SLEEP: insomnia, sleep walking, night terrors, muscle relaxant, PSYCH: GAD, panic disorder

MOA: Facilitate GABA-A action, increase opening frequency

SE: Dependence, tolerance, central ataxia, confusion, somnolence, anterograde amnesia

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7
Q

chlordiazepoxide

A

Long acting benzo

Use: SZ: alcohol withdrawal, sz status epilepticus SLEEP: insomnia, sleep walking, night terrors, muscle relaxant, PSYCH: GAD, panic disorder

MOA: Facilitate GABA-A action, increase opening frequency

SE: Dependence, tolerance, central ataxia, confusion, somnolence, anterograde amnesia

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8
Q

Alprazolam

A

Short acting benzo

Use: SZ: alcohol withdrawal, sz status epilepticus SLEEP: insomnia, sleep walking, night terrors, muscle relaxant, PSYCH: GAD, panic disorder

MOA: Facilitate GABA-A action, increase opening frequency

SE: Dependence, tolerance, central ataxia, confusion, somnolence, anterograde amnesia

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9
Q

Short vs long acting benzo

A

Short acting: ATOM (alprazolam, triazolam, oxazepam, midazolam). Inactivated by liver

Long acting: active metabolites formed by liver

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10
Q

Phenobarbital

A

Barb

Use: Anxiety, sz, insomnia

MOA: Facilitate GABA-A by increasing opening duration. Long half live relative to bzd (hangover effect)

SE: Respiratory, cardiovascular depression, CNS depression, Dependence, INDUCE CYP450

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11
Q

Pentobarbital

A

Barb

Use: Anxiety, sz, insomnia

MOA: Facilitate GABA-A by increasing opening duration. Long half live relative to bzd (hangover effect)

SE: Respiratory, cardiovascular depression, CNS depression, Dependence, INDUCE CYP450

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12
Q

Thiopental

A

Barb

Use: Anesthesia induction, anxiety, sz, insomnia

MOA: Facilitate GABA-A by increasing opening duration. Long half live relative to bzd (hangover effect)

SE: Respiratory, cardiovascular depression, CNS depression, Dependence, INDUCE CYP450

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13
Q

Primidone

A

Barb

Use: essential tremor (with propanolol) sz (1 active metabolite is phenobarbital)

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14
Q

Bzd metabolism not in liver

A

OLT

Oxazepam, temazepam, and lorazepam are metabolized Outside The Liver

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15
Q

Zolpidem

A

Z drug, short acting

Use: Insomnia (initiation)

MOA: Bind GABA-A receptor (same spot as benzo). More specificity, less anxiolytic/antisz

SE: Cognitive impairment, delirium, central ataxia (less likely to cause dependence or tolerance)

DDI: alcohol, bzd, barbs, antihistamines

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16
Q

Zaleplon

A

Z drug, short acting

Use: Insomnia (initiation)

MOA: Bind GABA-A receptor (same spot as benzo). More specificity, less anxiolytic/antisz

SE: Cognitive impairment, delirium, central ataxia (less likely to cause dependence or tolerance)

DDI: alcohol, bzd, barbs, antihistamines

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17
Q

Eszopiclone

A

Z drug, long acting

Use: Insomnia (initiation and maintenance)

MOA: Bind GABA-A receptor (same spot as benzo). More specificity, less anxiolytic/antisz

SE: Cognitive impairment, delirium, central ataxia (less likely to cause dependence or tolerance)

DDI: alcohol, bzd, barbs, antihistamines

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18
Q

Flumazenil

A

Use: bzd/z drug od

MOA: GABA-A receptor antagonist at bzd site

SE: withdrawal induction

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19
Q

Ramelteon

A

Use: insomnia

MOA: Melatonin receptor MT1/MT2 agonist in SCN

SE: Dizziness, nausea, fatigue, HA (mild)

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20
Q

Desflurane

A

Inhaled Anesthetic

MOA: unknown, GABA potenitation

SE: cardiac depression, respiratory depression, n/v, Increased ICP, malignant hyperthermia

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21
Q

Halothane

A

Inhaled Anesthetic

MOA: unknown, GABA potenitation

SE: cardiac depression, respiratory depression, n/v, Increased ICP, HEPATOTOXIC, malignant hyperthermia

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22
Q

enflurane

A

Inhaled Anesthetic

MOA: unknown, GABA potenitation

SE: cardiac depression, respiratory depression, n/v, Increased ICP, NEPHROTOXIC, SZ, malignant hyperthermia

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23
Q

Isoflurane

A

Inhaled Anesthetic

MOA: unknown, GABA potenitation

SE: cardiac depression, respiratory depression, n/v, Increased ICP, malignant hyperthermia

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24
Q

Sevoflurane

A

Inhaled Anesthetic

MOA: unknown, GABA potenitation

SE: cardiac depression, respiratory depression, n/v, Increased ICP, malignant hyperthermia

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25
Methoxyflurane
Inhaled Anesthetic MOA: unknown, GABA potenitation SE: cardiac depression, respiratory depression, n/v, Increased ICP, malignant hyperthermia, NEPHROTOXIC
26
Inhaled Anesthetics Solubility
Less Soluble: faster onset, faster recovery Blood gas partition coefficient = solubility
27
MAC definition and relation to potency
Alveolar concentration when 50% pt's unresponsive Potency=1/MAC
28
Dantrolene
Use: Malignant hyperthermia and NMS MOA: RYR block
29
Opioid General Use, MOA, SE
Use: Pain, cough suppression, diarrhea, acute pulm edema, maintenance programs MOA: Mew agonist --> post synaptic K open/ presynaptic Ca channel block SE: n/v, respiratory depression, CNS depression, miosis, constipation, biliary colic (elevated lipase/amylase), tolerance, dependence, hyperalgias
30
Opioid withdrawal
rhinorrhea, lacrimation, yawning, hyperventilation, hyperthermia, muscle aches, vomiting, diarrhea, anxiety, mydriasis
31
Tramadol MOA
opiate MOA: weak mew, strong blockade serotonin and NE
32
Loperamide use/moa
opiate Use: diarrhea MOA: increase phasic segmentation, doesn't cross into blood
33
Diphenoxylate use/moa
opiate Use: diarrhea MOA: increase phasic segmentation, doesn't cross into blood
34
Codeine
Opiate Use: antitussive
35
Dextramethorphan
Opiate Use: antitussive MOA: mew agonist and NMDA antagonist
36
Methadone
Opiate Use: abstinence maintenance MOA: mew agonist extended serum half life, less addictive
37
Buprenorphine
Opiate Use: Withdrawal treatment MOA: Partial mew agonist, acts as mew antagonist if person already on opiate
38
Nalbuphine
Use: Withdrawal treatment MOA: Partial mew agonist, acts as mew antagonist if person already on opiate
39
Butorphanol
Use: Withdrawal treatment MOA: Partial mew agonist, acts as mew antagonist if person already on opiate
40
Naloxone
Use: Withdrawal treatment MOA: Partial mew agonist, acts as mew antagonist if person already on opiate
41
Naltrexone
Use: Withdrawal treatment MOA: Partial mew agonist, acts as mew antagonist if person already on opiate
42
SSRI/SNRI pharmacokinetics
Requires 1-2 months to reach max effect. Trials no less then 8-12 wks
43
Fluoxetine
SSRI Use: Depression, Anxiety (PTSD, OCD, GAD, Panic disorder, Social anxiety), bulimia (last two not with SNRI) MOA: Block 5-HT reuptake SE: SIADH, sexual dysfunction, weight gain, flu like sx's
44
Sertraline
SSRI Use: Depression, Anxiety (PTSD, OCD, GAD, Panic disorder, Social anxiety), bulimia (last two not with SNRI) MOA: Block 5-HT reuptake SE: SIADH, sexual dysfunction, weight gain, flu like sx's
45
Paroxetine
SSRI Use: Depression, Anxiety (PTSD, OCD, GAD, Panic disorder, Social anxiety), bulimia (last two not with SNRI) MOA: Block 5-HT reuptake SE: SIADH, sexual dysfunction, weight gain, flu like sx's
46
Citalopram
SSRI Use: Depression, Anxiety (PTSD, OCD, GAD, Panic disorder, Social anxiety), bulimia (last two not with SNRI) MOA: Block 5-HT reuptake SE: SIADH, sexual dysfunction, weight gain, flu like sx's, serotonin syndrome
47
serotonin syndrome
Hyperthermia, HTN, hyperreflexia, clonus NMS has first two but also rigidity and hyporeflexia Increased risk mixing SSRI, TCAD, MAO I
48
Venlafaxine
SNRI Use: Depression, GAD, diabetic neuropathy SOCIAL ANXIETY DISORDER, PANIC DISORDER, PTSD, OCD SE: HTN, sedation, nausea
49
Duloxetine
SNRI Use: Depression, GAD, diabetic neuropathy, FIBROMYALGIA SE: HTN, sedation, nausea
50
Cyproheptadine
use: Serotonin syndrome treatment MOA: 5-HT2 receptor antagonist
51
Imipramine
TCAD Use: 2nd/3rd line depression, nocturnal enuresis, peripheral neuropathy, migraine prophylaxis MOA: 5-HT/NE reuptake inhibition (block NET/SRET), anticholinergic, H1 receptor blockade, alpha 1 antagonism, fast Na channel blockade SE: Reduced libido, Sz, serotonin syndrome Anticholinergic: Dry mouth, constipation, blurred vision, urinary retention Antihistamine: increased appetite, weight gain Alpha 1: hypotension Cardiotox: Decreased contractility, QRS widening, torsades
52
Desipramine
TCAD Use: 2nd/3rd line depression, peripheral neuropathy, migraine prophylaxis MOA: 5-HT/NE reuptake inhibition (block NET/SRET), anticholinergic, H1 receptor blockade, alpha 1 antagonism, fast Na channel blockade SE: Reduced libido, Sz, serotonin syndrome Anticholinergic: Dry mouth, constipation, blurred vision, urinary retention Antihistamine: increased appetite, weight gain Alpha 1: hypotension Cardiotox: Decreased contractility, QRS widening, torsades
53
Clomipramine
TCAD Use: 2nd/3rd line depression, OCD, peripheral neuropathy, migraine prophylaxis MOA: 5-HT/NE reuptake inhibition (block NET/SRET), anticholinergic, H1 receptor blockade, alpha 1 antagonism, fast Na channel blockade SE: Reduced libido, Sz, serotonin syndrome Anticholinergic: Dry mouth, constipation, blurred vision, urinary retention Antihistamine: increased appetite, weight gain Alpha 1: hypotension Cardiotox: Decreased contractility, QRS widening, torsades
54
Amitriptyline
TCAD Use: 2nd/3rd line depression, peripheral neuropathy, migraine prophylaxis MOA: 5-HT/NE reuptake inhibition (block NET/SRET), anticholinergic, H1 receptor blockade, alpha 1 antagonism, fast Na channel blockade SE: Reduced libido, Sz, serotonin syndrome Anticholinergic: Dry mouth, constipation, blurred vision, urinary retention Antihistamine: increased appetite, weight gain Alpha 1: hypotension Cardiotox: Decreased contractility, QRS widening, torsades
55
Nortriptyline
TCAD Use: 2nd/3rd line depression, peripheral neuropathy, migraine prophylaxis MOA: 5-HT/NE reuptake inhibition (block NET/SRET), anticholinergic, H1 receptor blockade, alpha 1 antagonism, fast Na channel blockade SE: Reduced libido, Sz, serotonin syndrome Anticholinergic: Dry mouth, constipation, blurred vision, urinary retention Antihistamine: increased appetite, weight gain Alpha 1: hypotension Cardiotox: Decreased contractility, QRS widening, torsades
56
TCAD arrhythmia treatment
NaHCO3
57
Tranylcypromine
MAO I Use: Atypical depression MOA: MAO-A/B blockade increasing dopamine, NE, serotonin SE: weight gain, severe sexual dysfunction, HTN crisis w/ tyramine ingestion
58
phenelzine
MAO I Use: Atypical depression MOA: MAO-A/B blockade increasing dopamine, NE, serotonin SE: weight gain, severe sexual dysfunction, HTN crisis w/ tyramine ingestion
59
Isocarboxazid
MAO I Use: Atypical depression MOA: MAO-A/B blockade increasing dopamine, NE, serotonin SE: weight gain, severe sexual dysfunction, HTN crisis w/ tyramine ingestion
60
Selegiline
MAO I Use: Parkinsons MOA: MAO-B blockade Increasing dopamine in the brain
61
HTN crisis and tyramine
tyramine broken down in GI tract by MAO-A If block MAO-A, moves into circulation displacing NE from neuronal storage vesicles
62
HTN crisis treatment
Phentolamine, phenoxybenzamine
63
Buproprion
Use: depression w/ decreased energy, tobacco dependence MOA: Inhibit dpamine/NE reuptake (NET/DAT) SE: Sz (greatest w/ eating disorders), NO SEXUAL DYSFUNCTION, weight loss
64
Mirtazapine
Use: Depression w/ insomnia MOA: presynaptic alpha 2 inhibition --> Increased NE/serotonin. 5-HT2/3 antagonism, H1 receptor antagonism SE: sedation, weight gain, NO SEXUAL DYSFX
65
Trazodone
Use: Insomnia and major depression MOA: antagonize post synaptic 5-HT2, weakly inhibit serotonin reuptake. alpha 1 and H1 receptor blockade SE: priapism, hypotension, sedation, sexual dysfx, serotonin syndrome
66
Varenicline
Use: smoking cessation MOA: Nicotinic ach partial agonist SE: sleep disturbance, depressed mood
67
ADHD First Line
Stimulants (methylphenidate, amphetamines)
68
Alcohol withdrawal First Line
Bzd (chlordiazepoxide, lorazepam, diazepam)
69
Bipolar disorder First Line
Lithium, valproate, carbamazepine, lamotrigine, atypical antipsychotics
70
Bulimia First Line
SSRI
71
Depression First Line
SSRI
72
GAD First Line
SSRI, SNRI
73
OCD First Line
SSRI, Venlafaxine, clomipramine (TCAD)
74
Panic Disorder First Line
SSRI, venlafaxine, bzd
75
PTSD First Line First Line
SSRI, venlafaxine
76
Schizophrenia First Line
Atypical antipsychotics
77
SAD First Line
SSRI, venlafaxine performance only: beta blockers, bzd
78
tourette syndrome First Line
antipsychotics (fluphenazine, pimozide), tetrabenazine
79
Lithium
Use: Bipolar disorder (acute mania and maintenance) MOA: Not established, possible inhibition phosphinositol cascade SE: Reversible thyroid dysfx, nephrogenic DI, acute n/v/diarrhea, chronic tremor/confusion/ataxia, teratogen (ebsteins anomaly) DDI: Thiazides, NSAID's decrease elimination
80
Bipolar disorder medications
Mania and Maintenance: carbamazepine, valproate, lithium Acute mania: antipsychotics Maintenance: lamotrigine
81
Valproate
Broad spec Antiepileptic Use: Broad Spectrum sz, juvenile myoclonic epi, absence MOA: Extend inactive phase voltage gated Na channels. Increase GABA (either increase production or decrease degradation) SE: n/v, increased appetite, weight gain, tremor, hepatotoxic, acute pancreatitis, teratogen (NTD), CYP450 METABOLIZED
82
Topiramate
Broad spec Antiepileptic Use: Broad spec sz, juvenile myoclonic epi, possible absence MOA: Extend inactive phase voltage gated Na channels, allosterically bind and potentiate GABA-A SE: fatigue, somnolence, cognitive slowing, weight loss, urolithiasis, acute myopia, acute angle glaucoma, CYP450 METABOLIZED
83
Lamotrigine
Broad spec Antiepileptic Use: Broad spec sz, juvenile myoclonic epi, absence MOA: Increase Na channel inactivation SE: SJS, skin rash, diplopia, CYP450 METABOLIZED
84
Levitiracetam
Broad spec Antiepileptic Use: Broad spec sz, juvenile myoclonic epi SE: Somnolence, CYP450 METABOLIZED
85
Carbamazepine
Narrow spec antiepi Use: Focal sz, generalized sz (worsen other sz disorders), trigeminal neuralgia MOA: Extend inactivation voltage gated Na channels SE: diplopia, ataxia, DRESS syndrome, SJS (HLAB1502 asians), teratogen (NTD), SIADH, leukopenia, agranulocytosis, CYP450 INDUCER
86
Phenytoin
Narrow spec antiepi Use: Focal sz, generalized sz (worsen other sz disorders) MOA: Extend inactivation voltage gated Na channels SE: nystagmus, diplopia, ataxia, DRESS syndrome, SJS (HLAB1502 asians), teratogen (cleft palate), low folate, gingival hyperplasia, hirsutism, drug induced lupus, altered bone metabolism and decreased bone density, CYP450 INDUCER
87
Gabapentin/pregabalin
Narrow spec antiepi Use: focal sz add on, postherpatic neuralgia (VZV), diabetic neuropathy, fibromyalgia MOA: bind/block voltage gated Ca channel, inhibit inward Ca current SE: dizziness, sedation, ataxia
88
Vigabatrin
Use: Narrow spec antiepi MOA: irreversible inhibitor GABA transaminase, increase GABA CNS
89
Tiagabine
Use: Narrow spec antiepi MOA: Inhibit GABA reuptake
90
Status epilepticus treatment
Initial: IV diazepam or lorazepam Maintenance: IV phenytoin Not responsive: IV phenobarbital
91
Ethosuximide
Absence Use: Absence sz (3 hz spike wave complexes EEG), no other sz treatment MOA: Block T-type Ca channels of thalamus SE: n/v, abd pain, fatigue
92
Absence sz treatment
ethosuximide, valproate, lamotrigine
93
Haloperidol
High potency first gen antipsychotic
94
Trifluoperazine
High potency first gen antipsychotic
95
Fluphenazine
High potency first gen antipsychotic
96
First gen high potency antipsychotics
Use: Schizophrenia + sx's, psychotic mania, MDD w/ psychosis, delirium, tourettes MOA: high postsynaptic D2 receptor block CNS (mesolimbinc & striatal frontal)/ low anticholinergic, H1, and anti alpha 1 blockade SE: High: EPS (acute dystonia, akathisia, parkinsonism), tardive dyskinesia, prolactinemia, NMS (lead pipe rigidity, AMS, fever, autonomic instability, rhabdo) Low: anticholinergic (dry mouth, blurred vision, constipation, urinary retention) alpha 1 (orthostatic hypotension, tachy), H1 (sedation) Equal: QT prolongation, torsades, sz
97
Chlorpromazine Unique SE
Low potency first gen antipsychotic Unique SE: lens and corneal deposits
98
Thioridazine Unique SE
Low potency first gen antipsychotic Unique SE: Retinal deposits
99
First gen low potency antipsychotics
Use: Schizophrenia + sx's, psychotic mania, MDD w/ psychosis, delirium, tourettes MOA: Low postsynaptic D2 receptor block CNS (mesolimbinc & striatal frontal)/ high anticholinergic, H1, and anti alpha 1 blockade SE: Low: EPS (acute dystonia, akathisia, parkinsonism), tardive dyskinesia, prolactinemia, NMS (lead pipe rigidity, AMS, fever, autonomic instability, rhabdo) High: anticholinergic (dry mouth, blurred vision, constipation, urinary retention) alpha 1 (orthostatic hypotension, tachy), H1 (sedation) Equal: QT prolongation, torsades, sz
100
2nd gen antipsychotics
Use: schizophrenia (+ & - sx's), treatment resistance depression, bipolar, OCD (w/ SSRI), tourette's (risperidone) MOA: Low D2 receptor blockade/high 5-HT2A receptor block SE: H1 block (drowsiness), alpha 1 block (hypotension, tachy), anticholinergic (dry mouth, constipation, blurred vision, urinary retention), Metabolic (weight gain, dyslipidemia, hyperglycemia), Neutropenia, lower sz threshold, EPS, NMS, QT prolongation, torsades
101
Clozapine
SGA Unique SE: agranulocytosis, myocarditis, cardiomyopathy, anticholinergic High SE: H1 block, Metabolic (weight gain, dyslip, hyperglycemia)
102
Quetiapine
SGA High SE: H1 block
103
Olanzapine
SGA High SE: metabolic
104
Risperidone
SGA High: EPS, prolactinemia
105
Aripiprazole
SGA
106
Ziprasidone
SGA
107
Levodopa
Parkinsons drug MOA: Dopamine precursor that crosses BBB SE: peripheral dopamine: n/v, tachy, arrhythmia, a fib, ortho hypotension CNS dopamine: Anxiety, agitation, confusion, hallucination, insomnia Long term: Therapeutic window narrows, wearing off effect w/ dyskinesia in off period contraindicated psych patients
108
Carbidopa
Parkinsons drug MOA: peripheral dopa decarboxyalse inhibitor
109
Entacapone
Parkinsons drug Use: Only effective as add on to L dopa MOA: Peripheral COMT inhibitor (prevent conversion of dopamine to 3-O-methyldopa
110
Tolcapone
Parkinsons drug Use: Only effective as add on to L dopa MOA: peripheral and central COMT inhibitor (Prevent conversion dopamine to 3-O-methyldopa or 3-MT) SE: hepatic failure
111
Selegiline
Parkinsons drug use: Adjunctive agent to L-dopa MOA: MAO-B inhibitor SE: enhance L-dopa SE,
112
Ropinirole
Parkinson's drug use: First line therapy, restless leg syndrome MOA: D2 receptor agonist SE: Similar L-dopa, more sever psych (rock & roll)
113
Pramipexole
Parkinson's drug use: First line therapy, restless leg syndrome (rock and roll) MOA: D3 receptor agonist SE: similar L-dopa, more severe psych
114
Amantadine
Parkinson's drug MOA: Increase dopamine synthesis and release, inhibit reuptake
115
Benztropine
Use: Parkinson's tremor and rigidity, no effect bradykinesia MOA: Central acting antimuscarinic (park unbalanced high levels ACH)
116
Trihexyphenidyl
Use: Parkinson's tremor and rigidity, no effect bradykinesia MOA: Central acting antimuscarinic (park unbalanced high levels ACH)

Step pharm (9 decks)

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