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Pharm II > Neuro-psych Drugs > Flashcards

Neuro-psych Drugs Flashcards

(46 cards)

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1
Q

Role of tertiary amines in TCAs

A

Have two methyl groups in side chain with dominant effect on serotonin reuptake

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2
Q

Role of secondary amines in TCAs

A

Single methyl group with dominant effect on norepinephrine reuptake

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3
Q

TCA pharmacokinetics

A

Good GI absorption but high first pass (50%)

Large Vd

Liver metabolism

Long half-life >24hrs

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4
Q

Adverse effects of TCAs

A

Dry mouth (xerostomia)
Urinary hesitancy
Decreased gastric motility
Blurred vision

Orthostatic hypotension

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5
Q

Cardiac effects of TCAs

A

Increased Arrhythmogenicity
-tachycardia/palpitations
-Prolonged QTc
-narrow therapeutic index should be considered in patients with suicidal ideation

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6
Q

Anesthesia Implications: TCAs

A

Exaggerated response to indirect Sympathomimetics- ephedrine

Prolonged use- adrenergic desensitization and catecholamine depletion=vasoplegia

Pro-arrhythmic effect with volatiles

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7
Q

SSRI mechanism

A

5-HTT inhibition and modulation of post synaptic 5-HT receptors

Also production of neuroprotective proteins along with anti-inflammatory effects

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8
Q

SSRI pharmacokinetics

A

Hepatic metabolism

Most have inactive metabolites

Half-life about a day- can take weeks for adverse reactions to resolve completely

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9
Q

SSRI adverse effects

A

Mostly well tolerated

Sexual dysfunction, weight changes, dizziness, sleep disturbances

Serotonin syndrome- agitation-increased sympathetic outflow, can mimic malignant hyperthermia, -usually occurs in combination with other drugs modulating serotonin activity

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10
Q

SSRI anesthetic considerations

A

Prolonged QTC

Inhibit platelet aggregation

Serotonin syndrome

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11
Q

MAOI mechanism

A

Irreversibly binds MAO, inhibits enzyme for up to two weeks

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12
Q

MAO-A

A

Metabolizes via deamination: serotonin, epinephrine, norepinephrine, melatonin, dopamine, tryptamine

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13
Q

MAO-B

A

Metabolizes via deamination: phenylethylamine, tyramine, dopamine, tryptamine,

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14
Q

Adverse effects of MAOIs

A

Avoid foods containing large amounts of tyramine

Orthostatic hypotension

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15
Q

MAOI drug interactions

A

Indirect acting Sympathomimetics may case hypertensive crisis
AVOID ephedrine
AVOID phenylpiperidine opioids, especially meperidine=life threatening hypertensive crisis

Morphine is opioid of choice

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16
Q

First generation antipsychotics

A

Blockade of D2 dopamine receptors

Compazine
Phenergan
Haldol
Reglan

Not commonly given due to high incidence of adverse effects

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17
Q

Extrapyramidal symptoms

A

Involuntary movement disorders

Dystonia-acute spasm/muscle contraction-give anti cholinergic to reverse- can occur after one dose

Akathesia- restlessness-same treatment

Pseudoparkinsonism- generally reversible- typically don’t give dopamine antagonists with Parkinson’s since it exacerbates symptoms

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18
Q

Tardive dyskinesia

A

Choreoathetoid movements (wormlike)
From Chronic therapy

Anticholinergic agents may worsen TD

Administration of D2 antagonist will exacerbate TD

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19
Q

Neuromalignant syndrome

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A

Closely resembles malignant hyperthermia and serotonin syndrome

Mortality 50%, rare, rhabdo in severe cases

Treatment- dantrolene and supportive care- with addition of a dopamine agonist (bromocriptine)

20
Q

Clozapine (clozaril)

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A

2nd Gen
Dopamine Antagonist (D4) and 5-HT 2c/2a serotonergic receptors

Schizophrenia

Adverse effects:
agranulocytosis-low wbcs
Myocarditis
Orthostatic hypotension, ketoacidosis

21
Q

Olanzapine (zyprexa)

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A

2nd gen
Dopamine antagonist, 5-HT2a, & alpha1-adrenergic antagonism…. Also weak GABAa agonist

Bipolar

Adverse: POTENTIATION OF BENZOS
Weight gain, diabetogenesis
EPS

22
Q

Quetiapine (Seroquel)

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A

2nd Gen
Less D2, high affinity for 5-HT2a and H1 histamine=sedation

Schizophrenia/ bipolar-polar

Adverse effects:
Sedation
Weight gain
Diabetogenesis

23
Q

Aripiprazole (abilify)

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A

2nd gen

Schizophrenia/ bipolar

Partial antagonism/agonism of serotonin and dopamine systems

24
Q

Risperidone (Risperdal)

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A

2nd Gen

High affinity for 5-HT2a

Schizophrenia/bipolar

Well tolerated generally

25
Lithium
Narrow therapeutic index= increased toxicity Thiazide diuretics/ACEI/ARA blockers/NSAIDS all increase blood levels Prolongs NMBDs duration of action
26
Valproate (depakote)
Anticonvulsant Hepatitis/pancreatitis Thrombocytopenia/platelet dysfunction Increases metabolism of NMBDs
27
Carbamazepine (Tegretol)
Anticonvulsant Blood dyscrasias SIADH Increased metabolism of NMBDs as well as versed/fentanyl/tramadol
28
Lamotrigine (lamictal)
Anticonvulsant Severe derm reactions Increased metabolism of NMBDs
29
Amphetamine MOA
enhances dopaminergic/serotnergic and noradrenergic release
30
Methylphenidate MOA
Norepi and dopamine reuptake inhibitor ADHD/Narcolepsy/obesity
31
Levodopa Mechanism
Converted to dopamine in CNS- normalizing dopamine levels in corpus striatum and binding pre/post dopamine receptors
32
Why is levodopa administered with carbidopa?
Carbidopa is a AAAD (aromatic L-amino acid decarboxylase) Prevents accumulation of dopamine in the periphery and increases cerebral bioavailability of levodopa
33
Levodopa anesthetic considerations
Continue in perioperative period due to short half-life Give just before surgery and just after- have patient bring it in Consider NG for longer procedures for intraop admin
34
Pramipexole
Adjunct with levodopa/carbidopa No major anesthetic considerations
35
Treating Myasthenia Gravis
In addition to immunomodulators, anticholinesterases are used to increase ACh at the NMJ -primarily pyridostigmine Interference with NMBDs and potential to prolong ester-local anesthetics and succinylcholine
36
SSRI with active metabolite
Fluoxetine- extends typically SSRI half-life from 1 to 2-3 days
37
Phenothiazine examples and class
First generation antipsychotics Prochlorperazine (compazine) promethazine (phenergan) Chlorpromazine (Thorazine)
38
Butyrophenones
First Gen antipsychotics Haloperidol (haldol) Droperidol (Inapsine)
39
Benzamide class and example
Metoclopramide (reglan)
40
Clozapine (clozaril) adverse effects
Agranulocytosis Myocarditis/cardiomyopathy Hyperglycemia/DKA
41
2nd gen antipsychotic with benzo potentiation
Olanzapine (zyprexa) Also weak gaba receptor agonist
42
Reason for sedation with seroquel
Histamine 1 receptor affinity
43
Interesting thing about aripiprazole (abilify) MOA
Partial AGONIST of D2 and 5HT, also strong antagonism of other Dopamine/serotonin receptors…
44
Compared to clozapine, Risperidone (risperdal) has:
20-50 times higher affinity for 5HT and D2 receptors Well tolerated/no QT prolongation
45
Avoid chronic NSAIDs with this antipsychotic
Lithium
46
QTC prolongers
SSRIs TCAs Ondansetron Granosetron Dolanosetron Promethazine Diphenhydramine Dimenhydrinate Droperidol Haloperidol Metoclopramide NOT: palonosetron/aprepitant or scopolamine

Pharm II (13 decks)

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