Exam 3: Pathways and Notes Flashcards by Nic Stroud

Carbamazepine Uses
*What does it mean by Autoinducer?

Generalized Tonic-Clonic, Focal DOC, TGN, Bipolar
*Autoinduces CYP450, so degraded quick

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3 Drugs for Tx of Alcohol Withdrawal

Naltrexone, Acamprosate, Disulfiram

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Long Term Relievers for Asthma
*Classes with Drugs

Corticosteroids - Prednisone, Fluticasone
Leukotriene Blockers - Montelukast
Monoclonal Antibodies - Omalizumab

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AED DOC for Infantile Seizures [NOT SPASMS]
*MOA

Phenobarbital
*Sedation-Hypnotic

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Common Alcohol Dehydrogenase Pathway

Alcohol to Acetaldehyde [by Alcohol Dehydrogenase]
Acetaldehyde to acetate [by Aldehyde dehydrogenase]

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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

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AED DOC for Absense Seizures
*MOA

Ethosuximide
*Blocks Ca++ channel

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Valproic Acid Use
*Displaces what other drug to cause increased risk for toxicity

Absence, Tonic-Clonic, Clonic, Bipolar, Migraine

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Serotonin Syndrome
*S/S
*Tx

S/S: Vasoconstriction, Tachycardia, Flushing, sweating, hyperthermia, clonus, mydriasis
Tx: Intubate, sedate [benzos], paralyze, cool

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Dopamine Mesolimbic Pathway

Tyrosine (Broke down by T Hydroxylase) - L-DOPA (broke down by Dopa Decarboyxlase) - Dopamine

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Narrow TI/ 0 Order Kinetics
*Drugs from all

Theophylline, Phenytoin, Alcohol

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Histamine Antagonists
*1st vs 2nd Gen

Inverse Agonists [antagonists]
*1st - BBB; Benadryl, dramamine, phenergran
*2nd - NO BBB; claritin, allegra, zyrtec
H2 Blockers - OTC Antacids

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Ethosuxamide Use

DOC for Absence

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Early Response to Allergen

Mast Cells: Histamine, PGD, IL

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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]

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3 Types of Partial Seizures

Simple [aware]
Complex [impaired aware]
2nd Generalized [Focal - Bilateral Tonic Clonic]

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How many drinks/hr can an adult metabolize?

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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

1. Beta Agonists - Epi, Isoproterenol, Albuterol, Salmeterol/Formotorol 2. Methylxanthines - Theophylline 3. 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