Quick And Dirty Review Flashcards
1
Q
Sodium channel blocking drugs (anti epileptics)
A
Carbamazepine
Phenytoin
Valproic acid
2
Q
Calcium INflux anti seizure
A
Valproic acid
Ethosuximide
3
Q
Potassium eflux blocker
A
Ezogabine
4
Q
Glutamate
A
Primary CNS excitatory
Works on AMPA and NMDA
Felbamate
Topirimate
5
Q
Barbs and gabapentin
A
Barbs potentiates and mimicks gaba
GABApentin promotes release
Tiagabin inhibits reuptake
Vigabatrin inhibits gaba metabolism enzymes
6
Q
Phenytoin
A
Dilantin, most widely used, good for partial and primary generalized seizures
Selective sodium channel inhibitor
Only hits hyperactive neurons
Above 20mcg/mL nystagmus, cognitive impairement, sedation
Preggo - cleft palate, heart malformations, other serious sides
Hypotension and dysrhythmias
Gingival hyperplasia, rash, ataxia, diplopia,
7
Q
Phenytoin contras
A
ETOH allergy, TCA coke OD, heart block, sinus brad, adams stokes,
20mg/kg max 10 concentration 10mg/ml
8
Q
Carbamazepine
A
Tegretol, also selective inhibition of sodium channels, safer/fewer sides than phenytoin, CYP inducer/inhibitor, used for bipolar and neuralgias,
9
Q
Valproic acid
A
Epival and depakene
Suppression of high frequency Na+
Suppression of Ca2+
Augments GABA
10
Q
Moderate opioids
A
Codeine and hydro/oxy codone. 30mg = 325 tylenol
11
Q
Morphine resp depression
A
7 minutes IV, 20 minutes IM, lasts 4-5 hours, N/V worse from first dose
Biliary colic is questionable at best
0.1mg/kg max 2.5 q 15 max 15
12
Q
PD
A
EPS associated with striatum
Dys and akinesia
Too little dope, too much ACh causes too much GABA
Dope agonists OR Antichols work
13
Q
Benztropine
A
Antichol for PD, reduce tremor but not bradykinesia, less effective than levadopa but better tolerated
14
Q
PD other symptoms
A
Depression dementia psychosis autonomic (constipatioon, urinary incontinence, drooling, orthostatic hypotension, and cold intolerance)
15
Q
3 main sedative/hypnotic drugs
A
Barbs
Benzos
Benzo-like
16
Q
Barbs
A
Anxiety/insomnia prior to benzos
Powerful resp depression (popular for suicide)
Tolerance, dependence, multiple interactions
17
Q
Three classes of barbs
A
Ultrashort (thiopental)
Short-intermediate (secobarbital)
Long (phenobarb)
18
Q
Barbs MOA
A
Enhance inhibitory action of GABA AND mimic GABA
19
Q
Barbs tox
A
Resp depression
Coma
Pinpoint
TX activated charcoal and maintenance of O2
20
Q
Common barbs
A
Phenobarbital (phenobarb) Amobarbital (amytal) Pentobarbital (nembutal) Secobarbital (seconal) Butabarbital (butisol)
21
Q
Benzos anxiety
A
Reduce anxiety through limbic system (thalamus, basal ganglia)
22
Q
Benzos promote sleep through
A
Effects on cortical areas
23
Q
Benzos muscle relaxation
A
Supraspinal motor areas (cerebellum)
24
Q
Benzos confusion
A
Confusion and antegrade amnesia (after dosing) from effects on hippocampus and cerebral cortex
25
Common benzos
```
Alprazolam (xanax)
Clobazam (onfi)
Clonzaepam (klonopin)
Diazepam (valium)
Estazolam (prosom)
Lorazepam (ativan)
Temazepam (restoril)
Different benzos favor anxiety, insomnia, seizures etc
```
26
Flumazenil
Anexate, don't give with TCA OD or pts receiving benzos for status epilep
27
Benzo like drugs
Only for insomnia, not anxiety. Structurally different than benzos but same MOA
Low potential for tolerance, dependence and abuse
Zolpidem (ambien)
Zaleplon (sonata)
Escopiclone (lunesta)
28
OCD
Persistent obsession, compulsion at least 1 hour each day.
29
3 core symptoms of PTSD
Re-experiencing event
Avoiding reminders of the event
Persistent state of hyperarousal
30
Neuroleptic drugs
Reduce and depress nerve functions (slow movement)
31
Antipsychotic meds
Also called neuroleptics because of EPS effects they may produce
Chemically diverse, for schizo, delusional, bipolar, depressive pyschoses
Should not be used for dementia related pychosis (increased mortality)
Created around 1950
32
Anti depressents
Do not alter movement, and so in a different category
33
Two classes of antipsychos
FGAs and SGAs (first and second gen)
34
FGAs antypsychos
Strong blockade of dope receptors, can induce EPS
35
SGAs anyipsychos
Moderate block of dope, stronger block of serotonin
| EPS risk lower, but significant risk of effects such as weight gain and the beeties
36
Specific neuroleptic agents
Olanzapine (zyprexa) risperidone (risperdal) quetiapine (seroquel) are 2nd gen, which outsell 1st gen 10-1, haloperidole is 1st gen
37
FGA MOA
Variety or receptors in and outside CNS, to varying degress dope, ACh, histamine, NE
Work by blocking D2 receptors in brain
Primary condition used for is schizo, takes 2-4 weeks, work well
EPS, particularly tardive dyskinesia, is worst side effect generally safe, OD almost unheard of
38
Tardive dyskinesia
Involuntary repetitive movements which may include grimacing, sticking out tongue, smacking of lips, rapid jerking movements, slow writhing movements
39
EPS acute dystonia
Acute dystonia - continuous spasms and contractions of face, neck, tongue, and back upward deviation of the eyes. Hours to days onset, treated with benztropine mesylate, resolve within 5-10mins of treatment
40
EPS Parkinsonism
Muscle rigidity with bradykinesia, shuffling gait, drooling, stooped posture, mask like facies (no expression) 5-30 day onset, treated with benztropine or dimenhydrinate or benadryl
41
EPS Akathisia
Feeling of needing to be in constant motion, rocking while standing or sitting, marching on spot, crossing/uncrossing legs 5-60 day onset
Switch to lower potency antipsycho treat with benzos, beta blockers, antichols
42
Tardive dyskinesia
Irregular, jerky movements primarily in face. Involuntary twisting, squirming movements of tongue, smacking and fly catching movements (takes months to appear, no reliable treatment) prevention is best approach
43
FGAs muscarinic cholinergic blockade
Dry mouth, blurred vision, photophobia, constipation, tachy, dry hot skin, CNS excitation
44
Other FGA adverse effects
Orthostatic hypo (A1 block)
Sedation (H1 block in CNS)
Seizures (reduuce threshold)
Sexy dysfunc (suppress libido, A2 suppression)
45
Halo
Contras parkinsons CNS depression seizure hx 5mg q 15 max 10
Use caution if taking antichol meds, benzos or ETOH
May prolong QT
46
Benztropine Mesylate
Cogentin
ANtichol, antipark for acute dystonic reactions
Increases occular pressure, dose is 1-2mg
47
SGAs
Or atypical antipsychos
Popular in 90s
Metabolic sides (get fatty beeties)
Minor D2 agonisms, strong serotonin 5Ht
48
Depot forms of neuroleptic agents
Haldol, risperidone, sustenna, abilify, zyprexa
49
TCAs
Introduced in the 1950s, were first line.
Block neuronal reuptake of NE and sometimes serotonin for depression, bipolar, fibromyalgia, insomnia
8X therapeutic is toxic from antichol properties
50
TCA OD
Combo of cholinergic blockade, and direct cardiotox effects
| Tachy, AV blocks, Vtach/fib, seizures cardiac arrest
51
Common TCAs
```
Amitriptyline
Amoxapine
Desipramine (norpramin)
Doxepin
Imipramine (tofranil)
Nortriptyline (pamelor)
Protriptyline (vivactil)
Trimipramine (surmontil)
```
52
MAOIs
More toxic than TCAs, hypertensive crisis from tyramine rich foods (pickled cheese, sausage, soy sauce, beans, snow peas)
53
MAO found in
Liver, intestinal walls, terminals of terminals of some neurons
Functions to convert dope, 5HT, NE into inactive
54
MAO OD
Tyramine promotes release of NE
| HTN, headache, tachycardia, N/V, confusion
55
Common MAOIs
```
Rasagiline (azilect)
Selegiline (eldepryl, zelapar)
Isocarboxazid (marplan)
Phenelzine (nardil)
Tranylcypromine (parnate)
```
56
SSRIs
1987, N, agitation/insomnia & sexy desfunc
Just as effective but much safer
They selectively block reuptake of serotonin OBVI
Don't block dope, NE, histamine, cholinergic, A1 receptors
57
SSRIs sides
Impotence, delayed/absent orgasm, weight gain, withdrawal syndrome - headache, dizziness, N/V if stopped suddenly
58
Serotonin syndrome
Onset 2-72 hours
| Agitation, anxiety, hallucinations, sweating, tremors
59
Common SSRIs
```
Citalopram (celexa)
Escitalopram (lexapro, cipralex)
Paroxetine (paxil, seroxat)
Fluoxetine (prozac)
Fluvoaxmine (luvox)
Sertraline (zoloft, lustral)
```
60
General anesthetics
Drugs that produce unconsciousness and lack of responsiveness to painful stimuli
61
General anesthetics two main groups
Inhalation anesthetics
| Intravenous anesthetics
62
IV anesthetics
```
Short acting barbs (thiobarb)
Benzodiazepines
Propofol
Etomidate
Ketamine
```
63
Benzos
Large doses for unconsciousness and amnesia, diazepam, lorazepam, midaz can all be given IV for amnesia
64
Diazepam for induction
Unconsciousness within 1 minute
| Very little muscle relaxation
65
Midaz for induction
Unconsciousness within 80 seconds, dangerous cardioresp effects
66
Propofol anesthetic
Unconscious within 60 seconds, lasts 3-5 mins
Sedative-hypnotic
Can cause resp depression, hypotension, risk of bacterial infection
67
Propofol MOA
Promotes release of GABA, causing CNS depression, no analgesic actions
Extended sedation infusions up to 4mg/kg/min given
Contras are egg or soy allergy
Dose is 2-2.5mg/kg IV
40mg bolus q10 until desired effects
68
Ketamine
Dissociate anesthesia, sedation, immobility, analgesia, amnesia
Can cause delerium, disturbing dreams which decrease with calmed environment and benzos
Schedule 1
69
NMBA block
ACH at Nm receptors
70
Order of paralysis
Eyes and face, then limbs, abdo, glottis. Last are resp muscles (intercostals and diaphragm)
71
Contras to succ
Hypersensitive
HyperK+
Family hx of malignant hyperthermia
Myopathies associated with elevated CK
72
Vec weight based dose
0.1mg/kg IV IO maintenance 0.01-0.05mg/kg IV/IO q 20-40
73
5 neurotransmitters
NE, ACh, Serotnin, Glutamate, GABA
74
3 things that happen after termination of neurotransmitter
Reuptake, enzymatic degrade, diffusion
75
5 effects of muscarinic receptors being activated
```
Increased gland secretion
Smooth muscle contraction in bronchi and GI
Slowing of HR
Pupil contraction (miosis)
Dilation of vessels
Relaxation of urinary bladder
```
76
Midaz ceaser dose
10 IM 5 IV max 20 total
77
Maintanence ketamine dose
0.5mg/kg SIVP q10 prn
78
Acute toxicity triad for barbs
Resp depression
Coma
Pinpoint pupils
79
Flumazenil dose
0.2mg IV over 15 seconds q1 prn max 3 mg
80
3 uses of benzos
Anxiety, insomnia, seizures, combative pts, procedural sedations, ETOH withdrawal, muscle spasms
81
4 mechanisms of adrenergic agonists
Direct receptor binding
Promotion of NE release
Inhibit NE reuptake
Inhib NE inactivation
82
A2 activation
Reduction of sympathetic outflow to heart/vessels
| Relief of severe pain
83
Isoproterenol
Activate B1, B2
84
4 ways drugs activate adrenergic receptors
Direct binding (most common)
Promotion NE release
Inhibition NE reuptake (TCAs, coke)
Inhibition NE inactivation
85
A1 activation causes 2 main responses
Vasoconstriction in blood vessels of skin, viscera, and mucous membranes
Mydriasis of the eye
86
A2 agonists are located
presynaptically
87
A2 agonsits therapeutic applications
none in PNS
88
A2 in CNS
Reduction of sympathetic outflow to heart/blood vessels
Relief of severe pain
Clonidine - reduces sympathetic tone to blood vessels/heart
89
B1 agonists
```
Heart failure, maintain blood flow to organs in shock (chrono and inotropic effects)
AV blocks (enhance conduction through AV node)
Asystole - initaite contraction
```
90
B1 adverse effects
Tachycardia, dysrhythmias, angina, increase MVO2
91
B2
Lungs and uterUS
Mostly for bronchodilation
Isoproternol hits B1 and B2
Activating B2 has ability to delay preterm labour
92
Adrenergic antagonists LPT
Direct blockade of adrenergic receptors, nearly all cause reversibly (competitive) blockade
93
A1 and A2 antags
Phentolamine for prevention of necrosis following extravasation of IV A1 blockers and reversal of soft tissue anesthesia
94
Beta 1 blockers
Metoprolol, labetalol, bisoprolol, atenolol, esmolol
Reduced heart rate, force of contraction, and impulse conduction through AV
A fib by lowering sinus nodal discharge rate
Conduction of atrial impulses through AV node is slowed
95
Beta blockers others
Angina, HTN, MI, CHF, pheochromocytoma
96
Excitation contraction coupling
Process by which an action potential in a motor neuron leads to contraction of a muscle
97
6 steps of a muscle contraction
Action potential releases ACh into junction
ACh binds to nic M on motor end plate
Binding causes depol
Depol creates muscle action potential
Muscle action potential causes calcium release from SR
Calcium allows actin/myosin to interact and contract muscle
98
Non depol NMBA
Competitive, bind to Nic m and block ACh.
| Eyes/face then limbs abdo glottic and last intercostals and diaphragm
99
NMBA sides
Hypotension from nic m block and histamine release
No crossing of BBB
Rule 1, don't be a dick
100
Depol NMBA
Only succ
Binds to nic M and causes depol, fasciculations occur, prevents repol for 4-6 mins at EMS dose
Peak paralysis 1 min, max 10
Malignant hypertherm (1 in 25,000) causes Muscle rigidity and temp up to 43 from increased Ca2+ release from SR
101
Succ degraded by
Pseudocholinesterase
102
Hyperk succs
Rare for enough k+ from succ to causes severe hyperk, more likely to occur in major burns, significant trauma, rhabdo
103
Succ slide
Anectine
Contras hyperk, family hx of malig hypertherm, pseudocholinerserate defic, myopathies with elevated CK
Adult 1.5mg/kg max 150
peds 1.5-2.0 mg/kg
104
Addtional consids succ
Don't be a dick, give sedsation first
Don't give for difficult airways
Takes 60-90 seconds
Acute airway burns will not cause hyper k
105
Roc slide (lol get it?)
Zemuron
only contra is hypersens
1mg/kg repeat 0.5mg/kg IV/IO prn
Ped samesies
106
Roc additional consids
Don't be a dick, give sedation first
Micins (antibis) Dipine (ccb) can potentiate effects of roc
Increases in BP, hrt rate, or bronchospasm possible
No histamine release
Peaks 1-3 mins, lasts 20-40
107
Vecuronium
Norcuron, NMBA, only contra is hypersens
0.1mg/kg maintain at 0.01-0.05mg/kg q 20-40
Peds same
108
Vecuronium addtional consids
Don't be a dick
micins and ccbs potentiate effect
Nohistamine release
109
Pancuronium
Pavulon, NMBA, only contra is hypersens
| 0.1mg/kg maintain at 0.01mg/kg q 20-40 peds samesies
110
Panc additional consids
Was prototype NMBA
Don't be a dick
No histamine release
30-45% hepatic metab
111
2 basic steps in process by which neurons influence bevhaior of post synaptic cells
Axonal conduction, AP travels down neuron
| Synaptic transmission - info carried across gap b/w neuron and postsynaptic cell
112
Axonal conduction synaptic transmyssion
Most drugs act on altering synaptic transmission, only a few alter axonal conduction.
Synaptic trans can produce more selective effects
Local anesthetics alter axon conduction (not selective as all axons are alike)
113
5 steps in receptor activiting
Transmitter synthesis, storage, release
Receptor binding
Termination of transmission
114
Peripheral nervous system includes
Autonomic which has parasympa and sympa
| Somatic motor system voluntary nervous system
115
Three principal functions of ANS
Regulat heart, secretory glands, smooth muscle
116
Parasympa 7 functions
Slow hrt rate, increase GI secretions, empty bladder, empty bowel, focus eye for near vision, constrict pupil, contract smooth muscle
117
Sympa 3 main functions
Regulate cardiovasc (bloodflow to brain, dedistribute blood, compensate for blood loss)
Reg of body temp (blood flow to skin, secretion of swetat, piloerection)
Fight or flight (increase hrt and BP, shunt blood from skin/viscera, dilate bronchi, dilate pupils, mobilize stored energy)
118
Two main site for parasympa drug actions
Between pre and post ganglionic neurons
| Junctions between effector organs and postganglionic neurons
