Flashcards in Pharmacology Deck (65)
Pt treated for psychosis develops generalized muscle stiffness and shaking of hand -- treatment?
caused by antipsychotics that block D2 receptors
- antimuscarinic agents like benztropine
Levodopa and dopamine agonists like bromocriptine are CONTRAINDICATED because they can precipitate psychosis
Antibiotic that can precipitate serotonin syndrome?
Commonly used drugs that can precipitate serotonin syndrome in pts using other serotonergic drugs?
Atypical antidepressant that treats insomnia and is associated with priapism?
also side effect of postural hypotension (strong alpha1 blockade in addition to 5-HT2 blockade)
Treatment for tonic-clonic seizures and bipolar disorder?
What class of drugs is used to treat motion sickness? Side effects?
Antimuscarinics (like scopolamine) and antihistaminics
Antimuscarinic side effects: blurry vision, dry mouth, palpitations, urinary retention, constipation
How to treat symptoms of pt with pronounced negative symptoms of schizophrenia?
Atypical antipsychotics treat both positive and negative symptoms (vs. typical antipsychotics that work only on positive symptoms)
It's ATYPICAL for OLd CLOSets to QUIETly RISPER from A to Z.
Feature of methadone that makes it an effective substitution for heroin addiction treatment?
slow kinetics means there is no "rush" and prolonged effects with tapering effect is used to suppress withdrawal symptoms in heroin dependent patients
Schizophrenia pt with retinal deposits? with corneal deposits?
reTinal deposits - Thioridazine
Corneal deposits - Chlorpromazine
both are antipsychotics (block D2 receptors)
What is naloxone and what is it used for?
opioid receptor antagonist
used to treat opioid toxicity/overdose
What is used for benzodiazepine toxicity?
Flumazenil (competitive antagonist at the GABA benzodiazepine receptor)
Dilated pupils, yawning, rhinorrhea, lacrimation, diarrhea, nausea/vomiting may be due to withdrawal from what type of drugs?
Opioids (e.g., heroin, morphine, etc.)
Mechanism of action of ethosuximide? Use?
blocks thalamic T-type Ca2+ channels
used for absence seizures
What is the mechanism of action for phenytoin, carbamazepine, and valproic acid?
all increase Na+ channel inactivation (reducing ability of channels to recover from inactivation)
Valproic acid also:
- increases GABA concentration by inhibiting GABA transaminase
- blocks T-type Ca2+ channels so can be used in absence seizures
What are the COMT inhibitors?
prevent L-dopa degradation to increase availability to the CNS/brain
Which opioid side effects are most resistant to tolerance?
Miosis/pinpoint pupils and constipation
What is lamotrigine? Side effects?
blocks voltage-gated Na+ channels
Stevens-Johnson syndrome: malaise and fever prodrome followed by rapid onset of erythematous/purpuric macules (oral, ocular, genital) that progresses to epidermal necrosis and sloughing
also seen in carbamazepine and ethosuximide (other antiepileptics)
Farmer with sweating, wheezing, bradycardia, constricted pupils? Treatment? What symptoms are addressed by each treatment?
Organophosphate poisoning / cholinesterase inhibitor poisoning
atropine (competitive muscarinic inhibitor) -- ONLY treats the side effects due to muscarinic receptor stimulation (DUMBELSS except for the Excitation of muscle/muscle paralysis)
pralidoxime -- regenerates AChE if given early enough and thus reverses BOTH muscarinic and nicotinic effects
Which sympathetic receptors increase insulin release? decrease insulin release?
beta-receptors stimulate insulin secretion (beta2)
alpha-receptors inhibit insulin secretion (alpha2)
Pt treated for MI with prolonged expirations and wheezing -- explanation?
beta blockers -- inhibit NT interaction with receptor in adrenergic synapses
beta1 blockade = decreased heart rate
beta2 blockade = bronchoconstriction and wheezing
BETA2 BLOCKADE EXACERBATES COPD AND ASTHMA
What is the mechanism of beta blocker use in glaucoma?
decreases secretion of aqueous humor from the ciliary epithelium (mediated by beta2 receptors)
timolol and other nonselective beta blockers
What are the high potency antipsychotics? What are the low potency antipsychotics? What are the major side effects of each?
High potency: "Try to Fly High"
Low potency: "Cheating Thieves are low"
High potency antipsychotics = more likely to cause extrapyramidal symptoms
Low potency antipsychotics = more likely to cause non-neurologic side effects (sedation, anticholinergic, orthostatic hypotension)
What is minimal alveolar concentration (MAC) for an inhaled anesthetic? What is the relationship between MAC and potency?
percentage of anesthetic in the inspired gas mixture that renders 50% of pts unresponsive to painful stimuli (ED50)
MAC and potency: inverse relationship
lower the MAC, the more potent the anesthetic
What are the symptoms of serotonin syndrome? What is the precursor AA for serotonin?
hyperthermia, sweating, confusion, myoclonus, muscle rigidity, cardiovascular collapse
What does adding carbidopa to levadopa treatment do?
Carbidopa inhibits peripheral conversion of levadopa to dopamine
reduces most of the peripheral side effects of levodopa (including nausea/vomiting due to CTZ in area postrema, which is OUTSIDE the BBB)
behavioral/central changes can worsen with carbidopa thought, because more dopamine available to brain
Treatment for narcolepsy?
modafinil (non-amphetamine stimulant)
nighttime sodium oxybate (GHB)
What psychotropic medication has a side effect of hypothyroidism?
also causes nephrogenic diabetes insipidus (polyuria)
What is the treatment for alcohol withdrawal and DTs?
benzodiazepines (diazepam, chlordiazepoxide)
Barbiturates like thiopental have rapid recovery from anesthesia (used for induction and short procedures) -- what is the mechanism of recovery?
Effect terminated by rapid redistribution of drug into tissue and fat (NOT due to metabolism of drug)