Anti-seizure, Anesthetics, Muscle Relaxants Flashcards
Drugs for absence seizures
Clonazepam
Ethosuximide
Valproic acid
Drugs for myoclonic seizures
Clonazepam
Lamotrigine
Valproic acid
Sudden, brief, shock-like contractions
Myoclonic seizures
MOA of phenytoin
Blocks voltage-gated sodium channels
Similar drugs: fosyphenytoin, mephenytoin, ethotoin
Fetal hydantoin syndrome
Upturned nose
Mild midfacial hypoplasia
Long upper lip with thin vermillion border
Lower distal digital hypoplasia
MOA of carbamazepine
Blocks voltage-gated sodium channels and decreases glutamate release
Tricyclics
Teratogenic side effects of valproic acid
Neural tube defects
Spina bifida
“Valproate ate the folate”
MOA of ethosuximide
Decreases calcium currents (T type) in thalamus
Similar drugs: phensuximide, methsuximide
MOA of gabapentin and pregabalin
Blocks calcium channels
Increases GABA release
Inhibits neuronal discharge from seizure foci
MOA of lamotrigine
Blocks sodium and calcium channels
Decreases glutamate
MOA of levetiracetam and piracetam
Selectively binds synaptic vesicular protein SV2A
Modifies synaptic release of glutamate and GABA
Not metabolized by cytochrome P450
Antiseizure drug with the most number of MOA
Topiramate (monosaccharide derivative)
Multiple actions on synaptic function, probably via sodium, calcium, GABA, AMPA-glutamate, carbonic anhydrase
Used in Lennox-Gastaut syndrome (difficult form of epilepsy, 2-6 y/o)
Topiramate
First line drug for mania
Valproic acid
DOC for trigeminal neuralgia
Carbamazepine
Can be used for migraine
Gabapentin
Phenytoin
Topiramate
Drugs for tonic-clonic seizures
Carbamazepine
Lamotrigine
Phenytoin
Valproic acid
Stages of anesthesia
Analgesia
Disinhibition
Surgical anesthesia
Medullary depression
Inhalational anesthetics
Nitrous oxide Desflurane Sevoflurane Isoflurane Enflurane Halothane Methoxyflurane
SE include megaloblastic anemia and euphoria, lowest potency, highest MAC
Nitrous oxide
Pulmonary irritant, pungent, poor induction agent
Desflurane
SE include renal insufficiency
Sevoflurane
Metabolite is nephrotoxic
Associated with coronary steal syndrome
Isoflurane
SE include spike-and-wave activity, muscle twitching, breath holding
Enflurane
Can cause post operative hepatitis and malignant hyperthermia when mixed with succinylcholine
Halothane
Highest potency and lowest MAC, obsolete
Methoxyflurane
Antidote to benzodiazepines
Flumazenil
Dissociative anesthetic, MOA?
Ketamine
Blocks excitation of glutamate at NMDA receptors
IV anesthetic with minimal effects on CV and respiratory functions, no analgesic properties
Etomidate
Opioid analgesics
Fentanyl
Morphine
Alfentanil
Remofentanil
Antidote to fentanyl
Naloxone- antidote for opioids
Milk of amnesia, MOA?
Propofol
Potentiates GABA-alpha receptors, blocks sodium channels
Local anesthetics
Esters, 1 i: tetracaine, procaine, benzocaine
Amides, 2 i’s: bupivacaine, ropivacaine, lidocaine
MOA of local anesthetics
Block voltage-dependent sodium channels, reducing influx of sodium, thereby preventing depolarization
All local anesthetics are vasodilators except…
Cocaine
Shortest half life among local anesthetics
Procaine
Novocaine
Prevents reuptake of epinephrine and norepinephrine
Cocaine
Topical ophthalmic anesthesia, with most allergenic potential
Tetracaine
Local anesthetic with group 1B antiarrhythmic activity
Lidocaine
Toxic dose of lidocaine
5 mg/kg
1%=10 mg/ml
Used in dental anesthesia, can cause methemoglobinemia
Prilocaine
Used in epidural anesthesia
Bupivacaine
Ropivacaine
Treatment for cardiotoxicity of bupivacaine
INTRALIPID (fat emulsion used in TPN)
MOA of succinylcholine
Agonist at Ach-N receptors causing initial twitch then persistent depolarization.
Nondepolarizing neuromuscular blockers
Tubocurarine Mivacurium Atracurium Vecuronium Rocuronium Pancuronium
Long acting nondepolarizing neuromuscular blocker
Tubocurarine
Used in strychnine poisoning, lethal injection
Pancuronium
Undergoes Hofman elimination (rapid spontaneous breakdown)
Atracurium
Drugs used in lethal injection
Thiopental
Pancuronium
Potassium chloride
Metabolized by pseudocholinesterase
Mivacurium
Succinylcholine
Undergoes elimination in bile
Vecuronium
Can cause malignant hyperthermia
Succinylcholine interaction with halothane and possibly tubocurarine
Treatment includes rapid cooling and administration of dantrolene
