Exam 4 Flashcards
Blocks the reuptake of Norepi
T x: 1 st - Fibromyalgia, Neuropathic 2nd - Depression
C ardiac toxicity (arrhythmias by overdose)
A nticholinergic (blurry vision/dry mouth)
S econd line drug, decrease seizure threshold
Orthostatic Hypotension
__________: BBW - Suicide in children/Maximal effects up to months
__________
__________: Yawngasm
Desipramine
Doxepin
Clomipramine
Pramine & Doxepin
Serotonin SSRI - 1st Line Depression
Blocks reuptake of serotonin ONLY
S-erotonin syndrome (Agitation and Tremors)
S-exual dysfunction
S-uicidal risk (BBW in children)
S-edation
WD: taper dose off
*Neonatal effects: abistenece syndrome (Newborn experience withdrawal symptoms)
Most commonly used for depression
__________
__________
__________
Feluoxetine
Escitalopram
Sertraline
FES
- tine
- lopram
- line
Feluox, Escibar, and Sertra experience the S’s
Serotonin SNRI - 1st Line Depression
Blocks reuptake of Norepi and Serotonin
S-exual dysfunction - Anorgasm
S-uicidal risk (BBW in children)
WD: taper dose off
Similar effect to SSRI’s but MORE adverse
__________
__________
Venlafaxine
Duloxetine
Atypical Drug
Tx: Depression and Smoking cessation
Stimulant Activity - No weight gain
Increase sexual desire
___________ will make you well
_____ will help stop smoking
Bupronion
Wellbutrin
Zyban
(Bedica)
Atypical Drug
RELEASE Norepi and Serotonin
Tx: Depression
Less Sexual Dysfunction
Drowsiness and weight gain
__________
Mirtazapine
Mirtal
Monoamine oxidase inhibitor - MAOI
Block MAOI
3rd line depression - This drug are not used often due to their adverse effects
Severe Adverse Effects:
CNS: Anxiety, Mania
HTN CRISIS! - when given with norepi releasing drugs
__________
Phenelzine
Mood Stabilizer
Bipolar - reduce fluctuations of mania and depression symptoms
Therapeutic doses:
- Teratogenesis - developmental abnormalities in fetus
- Fine hand Tremors
- Polyuria
Excessive Doses:
- COARSE hand tremors
- confusion/incoordination
- seizures
- LOW therapeutic index = need to monitor _______ levels
- Low plasma sodium –> increase _______ toxicity
__________
Other Mood stabilizer drugs:
__________
__________
Lithium
Valproic Acid - want to obtain baseline tests of live function.
Carbamazepine
Not an approved use for depression
Serotonin Sydrome! (Agitation and Tremors)
Monoamine theory of depression: a decrease in norepi and serotonin in brain = cause depression overtime
St. John’s Wort
Serotonin Syndrome - Think Harmful
H - \_\_\_\_\_\_\_\_\_ A - Agitation R - Reflexes (hyperrefelxia) M - \_\_\_\_\_\_\_\_\_ (twitching) F - Fast heart rate and fever U - \_\_\_\_\_\_\_\_\_ L - \_\_\_\_\_\_ of GI control
Hyperthermia
Myoclonus
Unconsciousness
Loss
Antiparkinson’s
Crosses BBB
*Loss of impulse control
Dark urine/sweat
Dyskinesias (involuntary movement)
Food decreases absorption
“wearing off” – lasts few hr
“unpredictable off” – not working @ high drug level
“failure of on” – never kicks in
__________
Don’t use to treat alone
Levodopa
Antiparkinson’s
DA receptor agonist – directly stim DA receptors
1st line drugs, but not as efficacious as Levodopa + Carbidopa
AE:
Nausea, dizzy, drowsy, insomnia, constipation, weak, hallucinations
-impulse control disorder
Pramipexole
Antiparkinson’s
Inhibit of MAO-B in brain
1st line (prolongs levodopa - unpredictable on/off are less)
Mild Parkinson’s
Metabolizes into amphetamine (cause insomnia)
Selegiline
Antiparkinson’s
2nd line (short-term & limited in use)
livedo reticularis (excess DA causing vasodilation of veins)
Amantadine
Antiparkinson’s
Inhib COMT in brain (catechol-o-methyl transferase)
Used ONLY w/ levodopa
Orthostatic hypoTN
Colored urine
Entacapone
Tolcapone (can cause liver damage)
Antiparkinson’s
Blocks muscarinic receptor
• Reduce Ach
Antimuscarinic – dry mouth, blurry, urinary ret, tachy, constip.
Tx: Reduce tremors
*more severe CNS adverse effects in elderly
Benztropine
centrally acting antimuscarinic
Types of seizures
_______ (Aka Focal, local seizures):
• _______ partial: Do not have impaired consciousness
o Motor, sensory, psychic symptoms
• _______ partial: Consciousness impaired
o Simple partial onset followed by impaired consciousness
• Partial evolving to generalized seizures
o Tonic, clonic, or tonic-clonic
Partial
Simple
Complex
ANTICONVULSANTS
Types of seizures
\_\_\_\_\_\_\_\_\_\_\_ (Convulsive or nonconvulsive) *involve muscle movement or not • Myoclonic seizures • Clonic seizures • Tonic seizures • Tonic-clonic seizures • Atonic seizures
Generalized
ANTICONVULSANTS
ANTICONVULSANTS
Therapeutic considerations
- Eliminate or reduce seizures
- Match seizure type with drug
- Evaluate drug effectiveness (proper drug, proper dose)
- Measure _____ drug levels (variations among different people)
- Withdraw drug (If brain rewires, and restores normal function)
- Increased risk of suicidality in the young (all anticonvulsants)
- Drug groups (Traditional vs. Newer)
plasma
ANTICONVULSANTS
Traditional vs Newer
Equal Effectiveness More experience with traditional Newer = border uses Traditional = Complex More adverse effects with traditional
Pregnancy
Traditional = more dangerous
Newer = Generally safer
Traditional is less expensive
Study
ANTICONVULSANTS
Reduce neuronal excitability
↓ Vit D and bone mineral density
Gingival hyperplasia
**worsens absence seizures
Phenytoin - Traditional
ANTICONVULSANTS
First line drug for all partial and generalized seizures
Increase GABA
Blocks Ca channels
HIGH fetal abnormalities
Rare but serious liver toxicity
Can increase plasma levels of phenytoin
Valproic acid - Traditional
ANTICONVULSANTS
Inhib seizure spread
***partial seiz ONLY
Hyponatremia
Stevens-Johnson rash
Oxcarbazepine
ANTICONVULSANTS
*avoid grapefruit juice
Seizure, BP Disorder, Trigerminal neuralgia
Carbamazepine
ANTICONVULSANTS
Tx: absence seiz ONLY
Ethosuximide
ANTICONVULSANTS
Tx: seizure - used with other drugs
Also Tx neuropathic pain, migraines, fibromyalgia
Gabapentin
Gaba = fibromyalgia, neuropathic pain
ANTICONVULSANTS
Tx: seizure - partial and generalized
Also Tx neuropathic pain, wt loss, *binge-eating disorder
Topiramase
ANTICONVULSANTS
Tx: seizure
Also Tx fibromyalgia, neuropathic pain
Pregabalin
Gaba = fibromyalgia, neuropathic pain
ANTICONVULSANTS
Given IV for status epilepticus (tonic-clonic for 20-30min)
^ Convulsive Status Epileptic ^
Diazepam, Lorazepam
Indications: ADHD, narcolepsy
**give before 4pm
Stimulants
Stimulants
The term __________ refers to not a single compound but a 50/50 mix of dextroamphetamine and levamphetamine (racemic mixture).
*High abuse potential – Schedule II Controlled Substance
Alertness, decrease fatigue, increase mood
Increase HR
- Tolerance and physical dependence can develop. Abstinence syndrome occurs with abrupt withdrawal
- Paranoid psychosis
- Acute tox: halluc, delusions, dizzy, confusion, palpitations, dysrhy.
amphetamine
Stimulants
caffeine!
Cross placenta > small risk of birth defects
Peripheral vasodilation
CNS vasoconstriction
Methylxanthines
