Pharm2 Sedative/Hypnotic; Anticonvulsants

Question 1

CI: porphyria

Answer 1

barbs

Question 2

methohexital and thiopental?

Answer 2

barbs

Question 3

nonbenzos - main use?

• decreases rem?
• no effect on rem?
• long-term insomnia?

Answer 3

insomnia
zolpidem (ambien)
zaleplon
eszopiclone

Question 4

misc sedative/hyp- has become a street drug?

Answer 4

meprobamate

Question 5

misc sedative/hyp for GAD- CAN DRINK ALC

Answer 5

buspirone

Question 6

only other for long term insomnia (besides eszopiclone); IS ONLY SED THAT’S NOT a ?

Answer 6

ramalteon, controlled substance!

Question 7

IBS, high strung women w/ high BP?

Answer 7

diazepam

Question 8

benzo PK

in liver no ? but extensive ?

Answer 8

induction, metabolism

Question 9

benzos

• T1?
• near delivery?

Answer 9

fetal abn

floppy baby syn/hypotonia

Question 10

main a/e in benzos?

Answer 10

cognitive impairment and dec motor fxn

Question 11

2 drugs for hepatic disease? have no active metabolites/do not undergo?

Answer 11

oxazepam, lorazepam

glucoronidation

Question 12

PO/IV for dental surgery, endoscopy, cardioversion? CI in ?

Answer 12

diazepam (also status eli, anxiety, alc w/drawal

closed angle GLC, m gravis

Question 13

no active met, int half life, good for w/draw sx

Answer 13

lorazepam (everything else same as diazepam)

Question 14

oral syrup for kids that would ned IV sedation; anxiety for med procedures?
black box?

Answer 14

midazolam

resp arrest

Question 15

acute mania adjunct, long 1/2 life? also?

Answer 15

clonazepam

myoclonic, absence seizures

Question 16

barbas
NOT ?, ?, or ?
can cause ? in elderly

Answer 16

analgesia (actually increases pain sensation!), anxiolytic, hypnotic
PARADOXICAL excitement

Question 17

in barb OD inc excretion of drug by?

Answer 17

alkalinizing urine

Question 18

used in convulsive d/o, status epi, alc w/draw, STRONG ODOR/BAD TASTE- can give IM/rectal

Answer 18

paraldehyde

Question 19

insomnia for institutionalized, bedtime sed** (short half life), ‘knockout drops/slipping one a Mickie’

Answer 19

choral hydrate

Question 20

slow onset- 1 week to kick in-GAD?
can drink alc
NO CROSS TOL/little abuse or addiction
MOA?
CI?
safe in?

Answer 20

buspirone
partial agonist at 5HT1a; D2 rec
kidney/liver dz
preggo!

Question 21

binds MT1/MT2 melatonin rec to reg circadian rhythm?

Answer 21

ramalteon

Question 22

tx agoraphobia?

Answer 22

alprazolam

Question 23

secondary TC different in Tx from simple/complex bc they also use ? and ?

Answer 23

phenobarb

primidone

Question 24

used only for complex partial?

Answer 24

clorazepate (benzo)

Question 25

primidone (barb) is met into ? actually like 3 drugs

Answer 25

PEMA, PHB

Question 26

? is used to tx west syn (infantile spasms)

Answer 26

vigabatrin

Question 27

misc- ok in hepatic and liver dz?

Answer 27

gabapentin (wt gain) | levetiracetam

Question 28

glycine antagonist on NMDA; misc anticonvulsant? s/e?

Answer 28

felbamate | aplastic anemia

Question 29

enhance GABA for anticonvulsants?

Answer 29

``` benzos barbs tigabine vigabatrin valproate ```

Question 30

inhibit Ca channels?

Answer 30

zonisamide | ethosuximide

Question 31

increases Na channel INactivation - only works on active channel? - also inh Ca channels - at low levels- first order kin but at high levels? - protein bound? - monitor? - main s/e? - still used bc ?

Answer 31

phenytoin zero order 90% clotting factors (plasma levels), immunosuppression -osteoporosis, nystagmus, ataxia; less common- hirsutism, gingival hyperplasia -QID, efficacy, experience

Question 32

fosphenytoin - more exp and safer - only ?

Answer 32

parenteral

Question 33

carbamazepine - dont take w/ ?; will reduce levels - dont take w/?; toxicity

Answer 33

grapefruit, st john's wort (induces CYP3A4) | macrolides, CCB, cimetidine, propxyphene (inhibit CYP3A4)

Question 34

clonazepam, phenytoin, lamotrigine, valproate, carbamazepine?

Answer 34

drugs metabolized by CYP3A4 (drug int)

Question 35

oxcarbazepine | -unlike carbamazepine, no?

Answer 35

autoinduction | no active metabolites!

Question 36

partial onset in older than 16? no drug interactions! 100% BA

Answer 36

lacosamide

Question 37

``` originally antifolate? used in ? safe in ? and ? no active metabolites only drug int? s/e? ```

Answer 37

``` lamotrigine ALL seizures (adjunct bc new) elderly, preggo valproate rash- SJS ```

Question 38

``` actions: inhibit Na channel conductance increase GABA antagonize kainite and AMPA RECENT BUT RARE s/e? ```

Answer 38

topiramate | myopia, GLC (immediate drug removal!)

Question 39

actions: inhibit Na/K conductance dec Ca influx dec glutamate excitability bad s/e? still used in developing ctrs bc?

Answer 39

phenobarbital sedation cheap

Question 40

derivative of GABA uptake inhibitor- keeps GABA in synapse? (GABA transporter-1) ? acid only ? seizures

Answer 40

tiaGABine nipecotic partial

Question 41

IRREVERSIBLE inhibition of GABA; toxic SO restricted to ? | neurotoxicity and visual impairment

Answer 41

``` vigatrabine Wests syn (infantile spasms) ```

Question 42

treats absence when it has TC too?

Answer 42

valproate

Question 43

adjunct in partial seiz for those >12yo?

Answer 43

zonisamide

Question 44

little/no action on GABA but looks exactly like it?

Answer 44

gabapentin

Question 45

good for liver and kidney dz? 2 | also have NO DRUG INT

Answer 45

gabapentin (pregabalin) | levetiracetam