Exam 4 Blueprint Flashcards
Barbiturates
- stronger than benzos
- phenobarbital (luminal)
Benzodiazepines
- most frequently used
- African Americans have a higher risk of toxicity
- diazepam (Valium)
Antidote for diazepam (Valium)
Flumazenil (romazicon)
Acute withdrawal syndrome
- abrupt cessation
- causes nausea, headache, malaise, vertigo, nightmares
TCAs
- bad side effects
- interacts with many drug classes
- doses should be delivered at bedtime
- imipramine (tofranil)
MAOIs
- bad drug..many interactions
- can cause htn crisis of taken with TCA
- no tyramine foods allowed
- phenelzine (Nardil)
Tyramine containing foods
- aged cheese
- avocados
- chocolate
- wine
- aged meats
Drug used to treat HTN crisis
Pentolamine (regitine)
SSRIs
- better drug because less adverse effects than TCAs and MAOIs
- suicide risk especially in adolescents
- fluoxetine (Prozac)
Neuroleptics
- not called tranquilizers anymore
- block dopamine
- can cause neuro malignant syndrome
- typical: chlorpromazine (Thorazine)
- atypical: clozapine (clozaril)
Neuro malignant syndrome
- caused by General anesthetics and drugs that have direct CNS effects
- includes high fever
- EPS, rigidity, htn, tachycardia
Lithium (lithobid)
- anti manic drug
- contraindicated in hyponatremia
- drug should be held if lithium levels are high or Na levels are low
- therapeutic: (0.6-1-2)
- risk of death: 2 mEq/L
CNS stimulants
- tricks the brain and allows the ADD person to be more calm
- controlled substance
- methylphenidate (Ritalin)
Generalized antiseizure agent
- effect the entire brain and reduce the chance of sudden electrical outbursts
- patients should wear a medical alert tag
- phenytoin (Dilantin)
Phenytoin (Dilantin) levels
10-20 mcg/ml
Dopaminergic drugs
- act like or increase dopamine at the receptor sites
- more effective than anticholinergics at treating Parkinson’s
- levodopa (dopar)
Levodopa (dopar)
- helps to create balance between stimulating and inhibitory neurons
- cause bone marrow depression
- interacts with MAOIs and phenytoin (Dilantin)
- avoid tyramine containing foods
Skeletal muscle relaxant: central acting
- spasmolytics
- baclophen (lioresol)
Baclophen (lioresol)
- works in the CNS to interfere with the reflexes that are causing spasms
- causes depression, drowsiness, fatigue, dry mouth, constipation
- discontinue the drug slowly so that hallucinations and psychosis won’t occur
Anxiolytics
- high risk of cleft lip and palate in African American pregnant women
- prevent fear or tension
- sedatives/hypnotics
Morphine (Roxanol)
- narcotic
- major CNS depressant
- will hold if respiratory rate is 12
- controlled substance
Antidote for morphine overdose
Naloxone (narcan)
Ergots
- used in relief of migraine or vascular headaches
- don’t take with beta blockers
- causes severe thirst, hypoperfusion, chest pain, BP changes, confusion
- ergotism
Antidote to NMJ blocking agents
Cholinesterase inhibitor
Pancuronium (pavulon)
- nondepolarizing NMJs
- act as antagonist to Ach in the NMJ to prevent depolarization of muscle cells
- can cause malignant hyperthermia and paralysis of muscles
Succinylcholine (anectine)
- depolarizing agent
- depolarization causes stimulation of muscle and the muscle contracts then causes flaccid paralysis
- can cause malignant hyperthermia
Alpha 1
- generally about excitation/stimulation
- located in eye, salivary glands, GI/GU sphincters, arterioles
phenylephrine (Sudafed PE)
- Alpha 1 agonist
- decongestant drug
doxazosin (Cardura)
- Alpha 1 antagonist
- causes relaxation
- used for BPH
Stimulation of alpha 1 causes..
- mydriasis (pupil dilation)
- arterial constriction which allows for fight or flight
Alpha 2
- generally about relaxation
- located in smooth muscle NMJ synapse
clonidine (Catapres)
- Alpha 2 agonist
- causes more relaxation
- good BP medication
Stimulation of alpha 2 causes..
more relaxation
Blocking of alpha 2 causes..
less relaxation
Blocking of alpha 1 causes..
- miosis (pupil constriction)
- vasodilation of arterioles
Beta 1
- generally about stimulation
- located in the heart, brain and kidney
Stimulation of beta 1 causes..
- more stimulation
- increase conductivity
- increase renin production
- sympathetic
Blocking of beta 1 causes..
- less stimulation
- decrease conductivity
- decrease renin production
- anti sympathetic
Atenolol (tenormin)
- beta 1 blocker (selective antagonist)
- lowers BP
- less stimulation, decrease conductivity
dobutamine (dobutrex)
- beta 1 selective agonist
- use in shock to improve conductivity stimulation of the heart
Beta 2
- generally about stimulation
- located in smooth muscle, bronchioles, liver, uterus
Stimulation of beta 2 causes..
- more stimulation
- dilation
- increase lipolysis
- improves insulin
Blocking of beta 2 causes..
- less stimulation
- constriction
- decrease lipolysis
- impairs insulin
albuterol (Proventil)
- beta 2 agonist
- used to open airways
- dilation of the bronchioles
- will also hit beta 1 and caused increase in heart rate
terbutaline (Brethine)
- beta 2 agonist
- used for premature labor which causes the uterus to relax
If we over stimulate the sympathetic nervous system…
-have a decrease in CO because of too fast of HR, too slow of contraction
Beta 1 selective adrenergic blockers are..
- preferred in patients with respiratory problems
- used to treat HTN, angina, and HF
- must be tapered
- causes hypersensitivity to catecholamine
M1 receptors are located..
CNS and enteric nervous system
M2 receptors are located..
Heart
Me receptors cause
- increase exocrine gland secretion
- increase gut motility
- miosis
- accommodation
- broncho constriction
- bladder constriction “M3 makes you pee”
What is primarily the neurotransmitter for the parasympathetic nervous system?
Ach
bethanechol (Urecholine)
Used for urinary retention
-direct cholinergic drug
carbechol (Carbastat)
Used for glaucoma, urinary retention
-direct cholinergic drug
methacholine (Provocholine)
asthma challenge test
- If the pt wheezes faster than they should, we know we have disease in the bronchioles
- direct cholinergic drug
pilocarpine (Salagen)
- used to test for cystic fibrosis
- stimulation causes increased exocrine function
- direct cholinergic drug
Anti-acetylcholine esterases
- you become more cholineric
- prevent enzymes from breaking down Ach
- indirect cholinergic drug
neostigmine (Prostigmin)
pyridostigmine (Mestinon)
- used for urinary retention
- used as an antidote to NMJ blocker
- used in myasthenia gravis
- indirect cholinergic drug
physostigmine (Antilirium)
- FIXostigmine
- used to counteract atropine overdose
- indirect cholinergic drug
The rescue drug for an anticholinergic is..
a cholinergic drug
donepezil (Aricept)
- used to treat Alzheimer’s/dementia
- works on the M1 receptors in the brain
- indirect cholinergic drug
Antagonizing M3 receptor
- decrease exocrine secretions
- decrease gut motility
- mydriasis
- no accommodation
- broncho relaxation
- bladder distention
atropine (Atreza)
- used to create mydriasis in the eye to see retina better
- used as an antidote to cholinergic poisoning
- used to prevent or slow down drooling
- used as a rescue drug for bradycardia
ipratropium (Atropent)
-used to treat asthma
oxybutinin (Ditropan)
used to help with bladder spasms and urinary retention issues
scopolamine (Maldemar)
- used for motion sickness
- Hits M1 and causes CNS depression
Cholinergic/Myasthenia crisis
Patient presents with progressive muscle weakness and respiratory difficulty
Drug to treat a cholinergic crisis
atropine
edrophonium (Tensilon)
used to discern between cholinergic and myasthenia crisis
- pt will get better if it’s a myasthenia crisis
- pt will not get better if it’s a cholinergic crisis
fluoroquinolones
- Antibiotic
- broad spectrum: treat gram negative and positive infections
ciprofloxacin (Cipro)
- interferes with DNA replication
- fluoroquinolones
- BBW for achilles tendon pain
- if given with theophylline, both drugs become toxic
rifampin (Rifadin)
- treat Tb
- treat meningococcal meningitis or for prophylaxis
- narrow spectrum
What is the main goal for Tb treatment?
Protection of the population
Antiviral agents
- Viruses are really hard to kill because they become a part of us
- Must kill the virus and the cell the virus has invaded
rimantadine (Flumadine)
- treats influenza A
- prevents the shedding of the viral protein coat…means it cannot replicate
- has anticholinergic effects
acyclovir (Zovirax)
- treats herpes and CMV
- causes neuropathy, paresthesia, confusion, renal toxicity, bone marrow suppression
HIV treatment
- takes a lot of drugs to treat HIV
- HIV is no longer a death sentence
- all have terrible side effects
terbinafine (Lamisil)
- antifungal
- causes major bone marrow suppression
- GI problems
- liver toxicity
- have good results with this drug except on the scalp, nails
Most common protozoal infection
Giardia
metronidazole (Flagyl)
- antiprotozoal agent
- considered cancer causing, causes Steven Johnsons
- can cause cinchonism
cinchonism
poisoning
-causes vertigo, tinnitus, bone marrow suppresion
