Alcohol/psych drugs Flashcards
Alcohol causes metabolic acidosis or alkalosis?
Metabolic acidosis
What is the end product of ethylene glycol metabolism and what organ does it affect?
Glycolic and oxalic acid/kidney damage
What is the product of methanol metabolism and what damage does it do?
Methanol—>formaldehyde—>formic acid
Ocular damage
What is ethanol metabolism pathway?
Ethanol—(alcohol dehydrogenase)—>acetaldehyde (hangover)—(acetaldehyde dehydrogenase)—>acetic acid
What is the antidotes for methanol and ethylene glycol overdose?
Ethanol (best substrate for alcohol dehydrogenase)
Fomepizole—>inhibitor of alcohol dehydrogenase
What is the mechanism of disulfram?
Inhibit acetaldehyde dehydrogenase—>accumulation of acetaldehyde—>nausea vomiting
What other drugs have disulfram like affect?
Metronidazole
What drug is used for alcohol withdraw and what are used to prevent Wernicke syndrome?
Long acting benzo
Thiamine and folic acid
What are the DA and ACh level in substantial nigra of Parkinson’s disease?
What about the DA and 5HT level in mesolimbic tract of psychosis?
What about NE and 5HT level in depression?
Parkinson’s—>decreased DA/increased ACh
Psychosis—>increased DA and 5HT
Depression—>decreased NE and 5HT
What are the uses for SSRI? what is its major side effect?
Depression/OCD/bulimia/chronic anxiety/PTSD
Sexual dysfunction—>aorgasm/decrease libido
Watch for serotonin syndrome
Which SSRIs are P450 inhibitors? what is their drug interaction? and which SSRI is safer in terms of drug interaction
Fluoxetine and fluvoxamine
Increase level of benzo
Citalopram
What is the mechanism of TCAs? what do you use it for?
NE and 5HT reuptake inhibitor
Diabetic or postherpetic neuralgia
Enuresis (bed wetting)
What are the drugs that are used for diabetic or postherpetic neuralgia?
TCAs/gabapentin/pregabalin
What other receptors do TCA block?
Antimuscarinic/alpha 1 blockers/antiH1—>sedating
The 3Cs of TCA toxicity?
Coma/convulsion/cardiotoxicity (also cause torsades)
Drug interaction with TCAs?
HTN crisis—>with MAO
Serotonin syndrome—>with MAO/SSRI/meperidine
What are some of the TCAs?
“ipramine”
Amitriptyline
Imipramine
Clomipramine
What are the nonselective MAOi? and how is it used for depression?
Phenelzine and tranylcypromine
Used when the pt is not responsive to SSRI
MAOi + tyramine =?
HTN crisis
What are SNRI and why are they a good alternative for SSRI?
Venlafaxine and duloxetine
Block NE and 5HT reuptake like TCA but without blocking M and alpha1 receptor
What are trazodone and bupropion?
They are antidepressants
Trazodone—>side effects including cardiac arrhythmia and priapism
Bupropion—>dopamine reuptake inhibitor (low risk for seizure)
Used in smoking cessation/switch from SSRI when pt complains about sexual dysfunction
What is mirtazapine? and it’s use and its side effect?
Alpha 2 antagonist
Used for antidepressant
Cause weight gain
How is varenicline used?
It is a partial agonist of nicotinic receptor
Used for smoking cessation
What is the mechanism of Li+ in treating bipolar?
Blocking inositol monophosphatase—>prevent recycling of inositol
What is Li+ side effect?
LMNOP Li side effect Movement tremor Nephrogenic diabetes insipidus Hypothyroidism Pregnancy problem (teratogen)
What effect does Li have on the fetus?
Cause Ebstein’s anomaly (malformed tricuspid valve)
What other drugs can be used for bipolar besides Li+?
Valproic acid/carbamazepine/atypical antipsychotic
What drugs do we use for ADHD?
1st line—>Methyhenidate (amphetamine like)—>increase NE level
Atomoxetine—>NE reuptake inhibitor
What are some SSRIs?
Fluoxetine/citalopram/sertraline
