Drugs Last Day Flashcards
Reduce craving for alcohol - mech?
Naltrexone - block Mu receptor
1st Line Treat Alcohol Withdrawal
Benzodiazepines
- Long acting = chlordiazepoxide
- Long acting = diazepam
Treat GAD?
Venlafaxine/duloxetine = SNRI Fluoxetine/sertraline/citalopram/paroxetine = SSRI
Treat GAD w/ bu…
Buspirone = bus = slow onset of action (2 weeks)
- partial agonist 5HT-1A receptor
- few sedative effects
- no tolerance, dependence
- no muscle relaxant or anticonvulsant properties
Treat Panic Disorder:
Pt is not acutely symptomatic: SSRI
Acute need: benzodiazepine (bad for pt’s w/ substance abuse past, also tolerance issue)
Amitriptyline overdose
TCA overdose = tachy, delirium, dilated, flushed, sweating
- inhibit reuptake of NE & Serotonin
- die due to Na+ channel inhibition = arrhythmias
Sleep hygiene vs. Stimulus control
Hygiene: avoid naps, avoid caffeine after lunch; dark bedroom & cool; don’t exercise b4 bedtime
Stimulus: Bed only for sex & sleep, leave after 20 minutes; go to bed only when sleepy; fixed wake-up time
Tachy, HTN, dilated, agitation, seizure, myocardial ischemia
Cocaine intoxication - blocks presynaptic reuptake
Treat Obsessive-Compulsive
SSRI + Cognitive-Behavioral therapy
Treat specific phobias: fear of elevator
Behavioral therapy: exposure, systematic desensitization
Tremors, anxiety, perceptual disturbances, psychosis, insomnia
Seizure, tachy, palpitations
Benzodiazepine withdrawal
N/V, abdominal cramps, muscle aches
Dilated pupils, yawning, lacrimation, hyperactive bowel
Heroin withdrawal
Increased appetite, hypersomnia, severe depression (crash), intense psychomotor retardation
Cocaine withdrawal
Tremors, anxiety, agitation, delirium, psychosis
Seizures, tachy, palpitations
Alcohol withdrawal
Olanzapine side effects
Atypical Antipsychotic
- weight gain
- dyslipidemia
- hyperglycemia
Schizophreniform disorder
1month-6months = same symptoms as schizophrenia
- functional decline not required
Pica
Compulsive consumption of nonfood or non-staple food source for 1+ month
Treat Otitis Media
- Strep pneumo
- H. flu
- M. catarrhalis
Amoxicillin + clavulonic acid
Cephalosporins
If recurrent in kids: tympanostomy tubes
Name the SNRI’s
Venlafaxine
Duloxetine
Name the SSRI’s
Sertraline
Citalopram
Fluoxetine
Paroxetine
Drug classes to avoid in elderly?
TCA Barb/Benzo Antiarrhythmics 1st gen antihistamines Alpha blockers (orthostatic hypotension) Sulfonylureas Muscle relaxants
Lithium
Treat Bipolar
- Ebstein anomaly
- narrow TW
- tremor = early side effect
Low volume of distribution…
High molecular weight
High plasma protein binding
Hydrophilicity
High charge
If C1 C4 esterase inhibitor levels are low, don’t use…
ACE inhibitor - increased bradykinin - increased angioedema
Treat shock after ceftriaxone w/ low BP?
Epi
Isoniazid is metabolized by…
Acetylation
Neuroleptic malignant syndrome vs.
Serotonin syndrome
Both: Mental status, hyperthermia, autonomic instability
NMS: rigidity
SS: hyperreflexia, clonus, shivering
Sledge hammer
Funnel
MAOinhibitors
Sledge hammer = Selegiline = MAOB inhibitor
Phenelzine = MAO nonselective inhibitor
Tyramine - cheese, wine = usually degraded by MAOA but if on inhibitor = sympathomimetic effect
3rd line for Depression only for recalcitrant
Can cause HTN crisis or resistant HTN
Buspirone vs.
Bupropion
Buspirone: treat GAD; anxious if I miSS the Bus = Serotonin agonist at 5-HT1A
Buproprion: atypical antidepressant
- also reduce urge to smoke
- NO Sexual SE’s
- SE: Seizure - can’t use in anorexia/bulimia
Mirtazapine vs.
Trazodone
Mirtazapine: atpyical antidepressant + a2 antagonist - increase release NE & 5-HT - SE: weight gain (good for elderly) - SE: sedation (good for insomnia) Trazodone: atypical antidepressant - treat insomnia; block 5-HT and alpha2 - PRIAPISM
Treat insomnia, nothing else going on
Ramelteon
- melatonin agonist - few SE’s
Name the 2nd generation anti-histamines
Fexofenidine
Cetirizine
Loratidine dine zine dine
SE: far less than 1st gen; less lipophilic; don’t enter BBB as easily
1st Generation Histamine blockers & SE
Chlorpheniramine Diphenhydramine Dimenhydrinate - zine SE: anti-cholinergic, sedation, weight gain, easily cross BBB, anti-alpha1 adrenergic = hypotension/postural
