Exam 2 Flashcards
Alzheimers meds
1st- donepezil (Aricept)
- for low agitation clonazepam (Klonopin)
- for mod/severe memantine (Namenda)
CNS analgesia, fever reducer
-toxic intermediate metabolite
acetaminophen
-no anti-inflammatory or antiplatelet effects
aerosolized corticosteriods
budesonide (Pulmicort) and fluticasone (Flovent)
SABA
albuterol sulfate
rescue (<2x/week)
-s/e tachy, tremors
LABA
Advair (fluticasone and salmeterol)
- twice daily use
- maintenance
Parkinson’s meds
- benztropine (cogentin)
- carbidopa (Levodopa)
- haloperidol (haldol)
benztropine (cogentin)
treats parkinsonian symptoms (extrapyramidal) seen with psych drugs
-watch for abnormal involuntary movements
what and how does benztropine (Cogentin) work
mood stabilizer, anticonvulsant, seizures
-potentiates GABA
side effects and caution with benztropine (Cogentin)
s/e CNS, ataxia
-caution with bone marrow depression, induce drug metabolism
what and how does carbidopa (Levodopa work)
- PD med
- crosses BBB and is decarboxylated into dopamine
side effects and caution with carbidopa (Levodopa)
monitor renal/liver/cardiac fxn
-s/e hallucinations, dizziness, dyskinesia, depression
chlorpromazine (thorazine)
- typical antipsychotic
- blocks central dopaminergic receptors
- treats positive symptoms (tardive dyskinesia)
s/e of chlorpromazine (thorazine)
HA, tremors, bradycardia, bronchospasm, SIADH, heat intolerance, eye rolling, twisted neck
what and how does clonazepam (klonopin) work
- long acting benzo
- acts at GABA
- often used for seizures
- can treat alc withdrawal
caution and side effect with clonazepam (klonopin)
s/e drowsiness, CNS depression, hepatotoxicity
-need to taper
antidote to clonazepam (klonopin)
flumazenil
clonidine (catapres)
- central a-agonist, dec sympathetic outflow
- treats HTN, ADHD, drug withdrawal
- stimulates frontal lobe to control limbic system
what and how does clozapine (clozaril) work
- atypical antipsychotic
- antagonize serotonergic activity
- pos and neg symptoms
s/e and caution with cloapine (clozaril)
- s/e strong sedative, anticholinergic effects, postural hypotension, seizures
- WATCH FOR METABOLIC SYNDROME (AGRANULOCYTOSIS)- WEEKLY CBC
dantrolene
- treats malignant hyperthermia (fever and muscle rigidity), neuroleptic malignant syndrome, serotonin syndrome
- muscle relaxant
what is and how does diazepam (valium) work
- benzo, acts at GABA, multiple bioactive metabolites
- antiepileptic, muscle relaxant, ETOH withdrawal
s/e and caution with diazepam (valium)
s/e drowsiness, CNS depression, hepatotoxicity
-need to taper
antidote for diazepam (valium)
flumazenil
what is and how does donepezil (aricept) work
- acetylcholinesterase inhibitor
- 1st line for Alz
- metabolized in liver
s/e and caution with donepezil (aricept)
s/e N/V/D, weight loss, muscle cramping, rhabdomyolysis
- caution with preg, peptic ulcers, seizures, asthma
- avoid other cholinergics/anticholinergs
what is and how does epi work
- b adrenergic agonist (b1 inc HR and FOC, b2 bronchodilation, uterine relax)
- g protein complex, 2nd messenger system
fentanyl
ultra short acting synthetic opioid analgesic, powerful
fluoxetine (Prozac)
SSRI- depression, OCD, bulimia
- s/e HA, drowsiness, sexual dysfunction, GI upset
- drug/drug interactions
halothane (halogenated gas)
inhaled anesthesia
- monitor for hepatotoxicity
- risk of malignant hyperthermia if given with succinylcholine
type and what does haloperidol (haldol) treat
- typical antipsychotic
- dopamine antagonist
- avoid long term
- treats pos symptoms
- watch for abnormal movements
how to treat EPS and parkinsons symptoms
cogentin
how to treat neuroleptic malignant syndrome
dantrolene
lidocaine
- can be used in spinals, epidurals (give with epi if you want a longer effect)
- Na channel blocker
- caution in areas of bod with low blood supply
first line tx for bipolar
lithium (lithobid)
how and what is lithium (lithobid) used for
- manic phase or maintenance of BD
- interfere with NaK atpase
risks with lithium (lithobid)
- risk for drug induced nephrogenic diabetes
- frequent blood tests, renal fxn, thyroid, CBC, EKG, electrolytes
lopressor (metoprolol)
b1 antagonist
- decreases HR and FOC
- treats angina
what is memantine (namenda) used for
moderate to severe AD
-acts as NMDA receptor
s/e and cautionn with memantine (namenda)
s/e GI, drowsiness, HA, hallucinations, aggression
-dont use with amantadine, ketamine, robitussin DM!!!!!!
midazolam (versed)
- sedative with amnestic
- blocks substance p (slow severe pain)
antidote for midazolam (versed)
flumazenil- benzo antagonist, short half life
flumazenil reverses what 3 meds
- clonazepam (klonopin)
- diazepam (valium)
- midazolam (versed)
how and what is phenobarb used for
- increase Cl influx at GABA
- tx seizures and in OR
- often used for kiddos
s/e and caution with phenobarbital
- s/e drowsiness, withdrawal, fatigue
- caution with CNS depression, need to taper
- watch for growth spurts (monitor levels Q3 months)
propanolol (inderal)
- a and b blocker
- crosses BBB
- pts at risk of depression and fatigue
- caution in pts with asthma or HTN
sertraline (zoloft)
SSRI
- for depression and bulimia
- monitor for serotonin syndrome
- caution with driving
what is and s/e of trancyclpromine (parnate)
MAOI, tricyclic antidepressant
-s/e ortho hypo, wt gain, sexual dys, insomnia
all the cautions with tranylcypromine (parnate)
- avoid tyramine (risk of HTN and seizures)
- risk of serotonin syndrome if given with SSRI
- exacerbate hypoglycemia
- -exacerbate sympathomimetics
how do tricyclic antidepressants work
inhibit reuptake of serotonin and norepi
5 classes of tricyclics
MAOI, SSRI, SNRI, NDRI, SNDI
SSRIs
- imipramine
- elavil (amitriptyline)- chronic pain
- dont give to seizure patients
wellbutrin (buproprion)
NDRI
- smoking cessaion, not cardiotoxic
- used when SSRI caused sexual dysfunction
use and how does valproic acid (depakote) work
- increases available GABA
- tx seizures, bipolar (2nd line)
caution and s/e with valproic acid (depakote)
s/e GI, pancreatitis, tremor, sedation
- caution with liver toxicity, preg women, dec drug metabolism
- monitor LFTs, CBC
adrenergic agonists
clonidine, dopamine, epinephrine, norepi, phenylephrine
adrenergic antagonists
propanolol (inderal)
cholinergic antagonists
atropine, scopalamine
what is phenylephrine and what does it treat
A1 receptor agonist
- vasoconstriction, inc BP, def HR and FOC
- decongestant, shock
side effect of phenlephrine
arrhythmia, HF, HTN crisis, blurred vision
-caution with MAOI (increased sympathomimetic effect)
what can’t you give with fluoxetine (prozac)
MAOIs- risk for serotonin syndrome
**need to taper
a- agonist in the CNS
reduces the responses of the sympathetic nervous system.
MAOI meds
deprenyl and tranylcypromine/parnate ( use if tricyclics fail), watch for liver toxicity
theophylline
phosphodiesterase inhibitor
- promotes bronchodilation
- increases cyclic AMP
what does ach stimulate
both nicotinic and muscarinic receptor
atropine
cholinergic antagonist, antimuscarinic (blocks parasympathetic effect)
-use with severe bradycardia
scopalamine
cholinergic antagonist
-antimuscarinic, sedating, blocks short term memory
succinylcholine
neuromuscular blocker (paralytic)
- depolarizes nicotinic receptor at neuromusc junction
- ***malignant hyperthermia
alpha adrenergic response
vasoconstriction, intestinal relaxation, pupil dilation
beta 1 adrenergic response
inc HR, inc force of contraction
beta 2 adrenergic response
vasodilation, bronchodilation, intestinal/uterine/bladder relax
sympathetic receptor
adrenergic
parasympathetic receptor
muscarinic
ach acts first on what type of receptor
nicotinic
warfarin (Coumadin)
anticoagulant
- monitor ptt
- reverse with vit K
don’t mix coumadin with
asa, hepatic dx, hyperthyroid, antifungals
aldactone (spironolactone)
K sparing diuretic use in HF, edema, endometriosis
-caution in renal dx, B blockers, NSAIDS, ACE inhibitors
Baclofen
GABA receptor agonist
- muscle relaxant
- treat withdrawal
cimetidine (tagamet)
- antihistamine and antacid
- potentiates effects of anticoagulants and sedation, lots of med interactions!!!
codeine
- mild/moderate pain
- cough suppressant
- sometimes given with tylenol
too much dopaminergic tx of Parkinson’s can cause
psychosis
carbamazepine (Tegretol)
- typical antiepileptic, treats Bipolar
- potentiates GABA
- caution with bone marrow depression
concerta (methylphenidate)
stimulant med for ADHD
- child needs to have drug holidays in order to grow
- sympathomimetic (want for hyperthermia)
dextromethorphan
-OTC cough meds
=robitussin
-interacts at NMDA receptor in brain
-can’t give with Namenda or elderly
digoxin
- treats afib and CHF
- indirectly supports vagus nerve
- inhibits NaK atpase
- need good K levels
droperidol
- neuroleptic
- increases sensitivity to opioids
- used in anesthesia
flumazenil (Romazicon)
-reverses Versed
guaifenesin
- mucinex
- watch for multi-symptom OTC meds
ketoconazol
azol antifungal
-many drug/drug interactions
Lasix
- loop diuretic
- monitor electrolytes
leukotriene antagonists
-block leukotriene response in allergic asthma
narcan
blocks opioids
rivastigmine (Exelon)
for Alzheimers
tranylcypromine (parnate)
-MAOI
tricyclic antidepressants
- antimuscarinic effects
- low BP effects
- antihistamine, sedation
kindling effect
-a trigger which sets off seizure or bipolar episode
