Exam 3: Pathways and Notes Flashcards
Carbamazepine Uses
*What does it mean by Autoinducer?
Generalized Tonic-Clonic, Focal DOC, TGN, Bipolar
*Autoinduces CYP450, so degraded quick
3 Drugs for Tx of Alcohol Withdrawal
Naltrexone, Acamprosate, Disulfiram
Long Term Relievers for Asthma
*Classes with Drugs
- Corticosteroids - Prednisone, Fluticasone
- Leukotriene Blockers - Montelukast
- Monoclonal Antibodies - Omalizumab
AED DOC for Infantile Seizures [NOT SPASMS]
*MOA
Phenobarbital
*Sedation-Hypnotic
Common Alcohol Dehydrogenase Pathway
Alcohol to Acetaldehyde [by Alcohol Dehydrogenase]
Acetaldehyde to acetate [by Aldehyde dehydrogenase]
Immune Response: Pt.2
*Mast Cells
*Neutrophils/Eosinophils
*Mast cells: Contain granulations with histamine inside; IgE mediated; chemical/mechanical destruction = histamine release
*Neutrophils/Eosinophils: release proteases and cause fluid leakage/inflammation in tissue
AED DOC for Absense Seizures
*MOA
Ethosuximide
*Blocks Ca++ channel
Valproic Acid Use
*Displaces what other drug to cause increased risk for toxicity
Absence, Tonic-Clonic, Clonic, Bipolar, Migraine
Serotonin Syndrome
*S/S
*Tx
S/S: Vasoconstriction, Tachycardia, Flushing, sweating, hyperthermia, clonus, mydriasis
Tx: Intubate, sedate [benzos], paralyze, cool
Dopamine Mesolimbic Pathway
Tyrosine (Broke down by T Hydroxylase) - L-DOPA (broke down by Dopa Decarboyxlase) - Dopamine
Narrow TI/ 0 Order Kinetics
*Drugs from all
Theophylline, Phenytoin, Alcohol
Histamine Antagonists
*1st vs 2nd Gen
Inverse Agonists [antagonists]
*1st - BBB; Benadryl, dramamine, phenergran
*2nd - NO BBB; claritin, allegra, zyrtec
H2 Blockers - OTC Antacids
Ethosuxamide Use
DOC for Absence
Early Response to Allergen
Mast Cells: Histamine, PGD, IL
How does Disulfiram work?
*When to give it
*S/S
Blocks Aldehyde dehydrogenase
*Give for chronic alcoholics
*S/S: N/V, HA, tremors [worst hangover ever]
3 Types of Partial Seizures
Simple [aware]
Complex [impaired aware]
2nd Generalized [Focal - Bilateral Tonic Clonic]
How many drinks/hr can an adult metabolize?
1
Status Epi Meds in Order
Diazepam, Fosphenytoin, Phenobarb
Tx: West Syndrome [Infantile Spasms]
*What not to give
Palliative, Steroids, Vigabatrin
*DO NOT give Phenobarb
Levels of Sleep: With Hypnotics
Decreased Time to fall asleep [P1]
Increased time in NREM [Stage 2 - desired]
Decreased REM - NOT desired
Decreased Stage 4 NREM - NOT desired
Phenytoin Uses
*Displaced by what other med, leading to increased risk of toxicitiy
Generalized Tonic-Clonic, ALL Focal
*Valproic Acid
Pharmacologic Tx for Sleep Problems
Ambien and Lunesta
Causes of Serotonin Syndrome
SSRI, MAOIs, Sumitriptan, MDMA, St. Johns Wart
Late Response to Allergen
WBC: Neutrophils and Eosinophils [Proteases]
Short Term Relievers for Asthma
*Classes with Drugs
- Beta Agonists - Epi, Isoproterenol, Albuterol, Salmeterol/Formotorol
- Methylxanthines - Theophylline
- M3 Antagonists - Atropine, Ipratropium, Tiotropium
Tryptophan Pathway
L-Tryptophan (broke down by TPH) –> 5HTP (broke down by 5HT decarboxylase) –> 5HT = Melatonin, OR 5HT (broke down by MAO) –> 5-HIYAA
Pt comes in after not drinking alcohol for a while and is confused with paralysis of their eye muscles. What is most likely the cause and what is the Tx?
Wernicke-Korsakoff syndrome from B1 deficiency
*Give thiamine/banana bag
When do avoid giving Phenobarb
Absence, Drop, Infantile Spasms
AED DOC for Focal Seizures
*MOA
Carbamazepine
* Blocks Na+ channel
Historical Tx of Seizures
Trephining [burr holes]
Cupping
Herbal
Animal Extracts
How does Phenytoin effect the NMB
Blocks it at lose dose
At higher doses, enhances it
What is the most common cause of seizures in adults
Alcohol Withdrawal Seizures
Chronic Alcohol MEOS Pathway
*This causes ? to weight
Ethanol to Acetaldehyde [MEOS]
Acetaldehyde to Acetate [Aldehyde Dehydrogenase]
*Decreased Calories = skinny
Serotonin Agonists w/ Receptors
Buspirone - 5-HT 1A
Sumitriptan - 5-HT 1B/1D
Phenytoin Levels
*Therapeutic
*Free
*Toxic
*Lethal
10-20 mcg/mL
1-2.5 mcg/ml
30-50 mcg/mL
>100 mcg/mL
Use for Lamotrigine
*MOA
Partial and Absence Seizures
*Ion channel blocker
Immune Response: Pt.1
*Dendrite Cells
*T-Cells
*B-Cells
*Dendrite Cells: mucus breaks down allergen and presents it on MCH2-R, which activates immune cells in Lymph Node
*T-Cells: Activated in allergic reaction; release IL4, which dupixent can block
*B-Cells: Turn into plasma cells and are used for memory and antibody production
2 Main Drugs for “General” Seizures; not Focal or General Tonic-Clonic
Ethosuximide
Valproic Acid
Serotonin Antagonists w/ Receptors
Phenoxybenzamine - 5-HT2
Zofran - 5-HT3
Cyproheptadine - 5-HT2, H1
Serotonin Effects:
*Respiratory
*CV
*CNS: include chemoreceptor reflex
*GI
*Bronchoconstriction, hyperventilation
*Inotrope, vasoconstriction, platelet aggregation
*Vomiting, Pain and Itch, Bradycardia and hypotension [Chemoreceptor]
*Increased Peristalsis
How does dupixent work?
Blocks IL4 produced by T-Cells
What 3 Drugs to avoid if a Pt has a Hx of Seizures
Demerol, Sevo, methohexital [barb]
How does Fomepizole work?
*When to give it
Blocks Alcohol Dehydrogenase
*Given for Methanol/Antifreeze ingestion
