AntiEpileptics, Lipids, Tb drugs Flashcards
Antipsychotics
Both work similiarly, you pick drug based on SEs; long half lives; concerned with tardive dyskinesias as SEs—irreversible and immediate stoppage required. Toxicity—parkinsonian effects, SNS effects from muscarinic blockade; also an Alpha adrenergic blockade=postural hypotension and failure to ejaculate, cardiac=prolonged QT Typical (first generation)–D2 antagonists: most have “-zine” cuz the make you zzzzzz -SEs: Extrapyramidal neuro effects (neuroleptic drugs–tranquilizers, bradykinesia, mild rigidity, tremor, akathisia–subjective restlessness) -Also increased release of prolactin–>lacrimation; Dystonias caused by typcals can be relieved via diphenhydramine (benadril) or benzotropine -NB: Haloperidol (haldol), chlorpromazine (thorazine), thioridazine (mellarlil) Atypical (2nd generation): 5-Ht2 antagonists > D2 antagonists; most have “-pine” -SEs: less extrapyramidal symtoms. Do have hypotension, seizures, weight gain, increased risk of type II db, ad hyperlipidemia -NB: Clozapine (clozaril), risperidone (risperdal), paliperidone (invega), olanzapine (zyprexa), quetiapine (seroquel) short half life , ziprasidone short half life, aripiprazole (abilify) Neuroleptic Malignant syndrome: Bromocriptine (ergot DA agonist) and stop antipyshcotic
Chlorpromazine
Typical Antipsychotics–D2 Antagonist; originally called neuroleptic drugs=tranquilizers SEs-Extrapyramidal effects: bradykinesia, mild rigidity, tremor, subjective restlessness (akathisia), reduced initiative and interest, emotional manifestations.
Thioridazine
Typical Antipsychotics–D2 Antagonist; Also has mACh activity which might explain less extrapyramidal effects. Orthostatic hypotension and urinary retention originally called neuroleptic drugs=tranquilizers SEs-Extrapyramidal effects: bradykinesia, mild rigidity, tremor, subjective restlessness (akathisia), reduced initiative and interest, emotional manifestations.
Haloperidol
Typical Antipsychotics–D2 Antagonist; Increased risk for extrapyramidal effect originally called neuroleptic drugs=tranquilizers SEs-Extrapyramidal effects: bradykinesia, mild rigidity, tremor, subjective restlessness (akathisia), reduced initiative and interest, emotional manifestations.
Clozapine (as opposed with Clonidine)
Clozaril; Reduced risk of extrapyrmaidal effects, saved for tx resistant psychosis, works well but risk of agranulocytosis (monitor blood counts) Atypical Antipsychotic–5-ht2 antagonists and D2r antagonist SEs-Seizures, hypotension, weight gain, increased risk for type II db, and hyperlipidemia (clonidine: central alpha 2 agonist which decreases SNS tone in HTN)
Clozapine (as opposed with Clonidine)
Clozaril; Reduced risk of extrapyrmaidal effects, saved for tx resistant psychosis, works well but risk of agranulocytosis (monitor blood counts) Atypical Antipsychotic–5-ht2 antagonists and D2r antagonist (WORKS ON D4 agonists as welL) SEs-Seizures, hypotension, weight gain, increased risk for type II db, and hyperlipidemia (clonidine: central alpha 2 agonist which decreases SNS tone in HTN)
Paliperidone
Atypical Antipsychotic–5-ht2 antagonists and D2r antagonist SEs-Seizures, hypotension, weight gain, increased risk for type II db, and hyperlipidemia
Olanzapine
Atypical Antipsychotic–5-ht2 antagonists and D2r antagonist SEs-Seizures, hypotension, weight gain, increased risk for type II db, and hyperlipidemia
Quetiapine
Atypical Antipsychotic–5-ht2 antagonists and D2r antagonist SEs-Seizures, hypotension, weight gain, increased risk for type II db, and hyperlipidemia
Ziprasidone
Atypical Antipsychotic–5-ht2 antagonists and D2r antagonist SEs-Seizures, hypotension, weight gain, increased risk for type II db, and hyperlipidemia
Aripiprazole
Abilify Atypical Antipsychotic–5-ht2 antagonists and D2r antagonist SEs-Seizures, hypotension, weight gain, increased risk for type II db, and hyperlipidemia
Datrolene
Antidote for malignant hyperthermia. Inhibits release from sarcoplasmic reticulum
NO
Inhaled Anesthetic Used as adjunct for amnesia and has analgesic actions
Isoflurane, Sevoflurane, Desflurane
Volatile Inhaled Anesthetics Sevoflurane is the most pleasant to inhale and used for induction of kids Iso>Sevo>Des (least soluable thus better (Lower) MAC=minimum alveolar concnetration)
Propofol
IV anesthetic “MJ Juice, Milk of amnesia” Used as induction agent Vasodilatory and negative inotropy, decreases tidal volume, RR and minute volume, decrease in upper airway reflexes antiemtic
Etomidate
IV Anesthetic Use with Cardiovascualry comprimised patient (no hemodynamic effects: HR, BP, inotropy) Non-analgesic, Respiratory depressant, associated with PONV (post op nausea and vomitting)
Ketamine
IV Anesthetic Airway reflexes are preserved in most situations, secretions/lacrimations are increase, hallucinations and upleasant emergence might occur (suggested benzo co-administration) sub-analgesic doses might help in limiting or reversing opioid tolerance (effectively lowering the therapuetic doses necessary for opioids)
Dexmedetomidine
IV Anesthetic Used for sedation or adjunct to general anesthetic, and analgesic Significant deceases in BP/HR (to the point you need to give atropine sometimes) Mechanism of action: Alpha 2 agonist in LC and SC Good cuz preserve respiratory drive, context sensitive half life significantly increases after 8 hours of infusion
Antiepileptics
3 Mechanisms of action: 1) Decrease Glutamate 2) Increase GABA 3) Modify Na/Ca Conductances Partial Seizures: Phenytoin, Carbamazepine, Valproate Generalized Tonic-Clonic (grand mal): Phenytoin, Carbamazepine, Valproate Absent (petit mal Seizures): Ethosuximide, Valproate (clonazepam) Myoclonic Seizures: Phenobarbital, Valproate (Clonazepam) Status Epilepticus: Phenobarbital, Diazepam (REALLY YOU WANT THEM UNDER GENERAL ANESTHESIA)
Phenytoin
Used for? Mechanism? SEs?
Tonic-Clonic, simple, partial. ** First line for prophylaxis of Status epilepticus.**
Increases Na channel inactivation (ZERO ORDER KINETICS: “PEAs”: Phenytoin, Ethanol, Aspirin)
“Phenytion makes you look funny”
SEs: GINGIVAL HYPERPLASIA, course facial features, lymphadenopathy, Megaloblastic anemia (inhibits folate), Drug Induced SLE, SJS
Ethosuximide
Used for? Mechanism? SEs?
Absence seizures: “Kids Stare into the Ethos”
slows T-ca2+ channels in thalmus (make sense since you are losing input)
EFGHI: Ethos causes Fatigue, GI, H/A, Itching, stevens Johnson syndrome
Valproate
Used for? Mechanism? SEs?
Myoclonic/atonic, Gen Tonic-clonic. Can be used for 2nd line for absence. Also used as Mood stabilizer.
Increases Na channel inactivation and Increases GABA.
HEPATOTOXIC, Teratogenic (NT tube defects) Weight gain
Carbamazepine
Used for? Mechanism? SEs?
Simplex/Complex and Tonic Clonic Seizures. Also first line for **Trigeminal neuralgia **
Also Mood stabilizer (BP) and antipsychotic agent for schizo.
Increases Na Channel Inactivation
SEs: AGRANULOCYTOSIS AND APLASTIC CRISIS; Diplopia, Ataxia, Teratogenesis, Inducer of Cyp450s, SIADH, Steven Johnson Syndrome
Lamotrigene
Used for? Mechanism? SEs?
Antiepileptic
Increases inactivation of Na channels
Toxic-epidermal necrosis (Stevens-Johnson syndrome)
Dementia Txs
AChEI’s and NMDA’s Receptor Antagonists
Donepazil, Rivastigmine, Galantamine
Dementia Txs: AChEI’s
Mementine
Dementia Tx: NMDA receptor antagonists (protects against glutamate excitotoxicity)
Drug used to prevent cerebral vasospasm following stroke?
Nimodipine (Calcium channel blocker)
Most common cause of bacterial meningitis in adults?
Lancet Gram positive Cocci in pairs (strep pneumonia)
Tramidol?
“Tram it all” works on multiple NTs.
Very weak opioid agonists (inhibits 5ht and NE too)
