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First Aid Drugs > Neuro/Psych > Flashcards

Neuro/Psych Flashcards

1
Q

Methadone =

- used for?

A

long-acting PO opiate

- heroin detox or LT maintenance

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2
Q

Naloxone + buprenorphine =

- used for?

A

opioid inverse agonist + partial agonist
- heroin addiction; long-acting w/ fewer withdrawal sx than methadone; naloxone not active when taken PO so only get w/drawal sx if injected (lower abuse potential)

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3
Q

Disulfiram =

- used for?

A

inhib’s aldehyde DH

- EtOH addiction

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4
Q

CNS stimulants =

- mech, clin use

A

methyphenidate (Ritalin, Concerta), dextroamphetamine, methamphetamine

  • incr catecholamines at synaptic cleft, esp NE and DA
  • ADHD, narcolepsy, appetite control
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5
Q

Antipsychotics =

  • mech, clin use
  • type of solubility?
  • SEs
  • endo SEs?
  • other SEs
A

haloperidol + “-azines” (trifluoperazine, fluphenazine, thioridazine, chlorpromazine)

  • block D2 R (incr cAMP)
  • schizophrenia (+ sx), psychosis, acute mania, Tourette’s synd
  • highly lipid soluble -> stored in body fat and slow to be removed from body
  • EPS (extrapyramidal system) SEs (dyskinesias)
  • antag DA -> hyperPRL -> galactorrhea
  • block M R (dry mouth, constipation), block a1 (hypotension), block hist R (sedation)
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6
Q

Neuroleptic malignant synd =

  • sx?
  • see w/
  • trtmt
A

rigidity, myoglobinuria, autonomic instability, hyperpyrexia

  • FEVER: F, encephalopathy, vitals unstable, elevated NZs, rigidity of m’s
  • antipsychotics (neuroleptics)
  • dantrolene, D2 agonists (bromocriptine)
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7
Q

Tardive dyskinesia =

- see w/

A

oral/facial movements

- LT antipsychotic use, usu irreversible

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8
Q

Extrapyramidal system SEs:

  • seen w/
  • 4 hr/d/wk/mo?
A 
antipsychotic use
4hr - acute dystonia
4d - akathisia (restlessness)
4wk - bradykinesia (parkinsonism)
4mo - tardive dyskinesia
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9
Q

High potency antipsychotics

- have what SEs?

A

Try to Fly High
Trifluoperazine, Fluphenazine, Haloperidol
- neuro SEs (EPS)

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10
Q

Low potency antipsychotics

- have what SEs?

A

Cheating Thieves are low
Chlorpromazine, Thioridazine
- non-neuro SEs (antiACh, antiHist, a1 block effects)

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11
Q

Chlorpromazine =

- SE

A

low-potency antipsychotic
- Corneal deposits
non-neuro SEs (antiACh, antiHist, a1 block effects)

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12
Q

Thioridazine =

- SE

A

low-potency antipsychotic
- reTinal deposits
non-neuro SEs (antiACh, antiHist, a1 block effects)

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13
Q

Haloperidol =

- SEs

A

high-potency antipsychotic

- NMS (think: FEVER), tardive dyskinesia

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14
Q

Atyp antipsychotics =

- mech, clin use, tox

A

“-apine” (olanzapine, clozapine, quetiapine) + risperidone, aripiprazole, ziprasidone

  • ?, varied effects on 5HT2, DA, a- and H1 Rs
  • schizophrenia (+/- sx), bipolar d/o, OCD, anxiety d/o, depression, mania, Tourette’s
  • less EPS and antiACh SEs than typ antipsychotics
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15
Q

Olanzapine =

- SE

A

Atyp antipsychotic

- wt gain

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16
Q

Clozapine =

- SEs

A

Atyp antipsychotic

- wt gain, agranulocytosis (do wk’ly WBC ct), seizure

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17
Q

Ziprasidone =

- SE

A

Atyp antipsychotic

- prolonged QT

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18
Q

Lithium

- mech, clin use, tox

A
  • ? inhib PI3 cascade?
  • mood stabilizer for bipolar, blocks relapse and acute manic events, SIADH
  • LMNOP: Li SEs=Movement (tremor), Nephrogenic DI, hypOthyroidism, Preg problems (Ebstein anomaly, malform of great vessels)
    Also: sedation, edema, heart block
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19
Q

Buspirone

- mech, clin use

A
  • stim’s 5HT1A Rs
  • “I’m anxious that the BUS will be ON time”
    Gen. anxiety d/o, takes 1-2wks to take effect, doesn’t interact w/ EtOH
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20
Q

4 types of antidepressants:

A

SSRIs, SNRIs, TCAs, MAOIs

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21
Q

SSRIs =

- mech, clin use, tox

A

Fluoxetine, paroxetine, sertraline, citalopram

  • 5HT sp reuptake inhib; take 4-8wks to take effect
  • depression, GAD, panic d/o, OCD, bulimia, social phobias, PTSD
  • fewer than TCAs; GI distress, sex dysfunc, serotonin synd
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22
Q

Serotonin synd =

- trtmt

A

w/ any drug that incr’s 5HT (MAOIs, SNRIs, SSRIs, TCAs) -> hyperthermia, confusion, myoclonus, CV collapse, flushing, D, seizures
- Cyproheptadine (5HT2 R antag)

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23
Q

SNRIs =

- mech, clin use, tox

A

Venlafaxine, duloxetine

  • inhib 5HT and NE reuptake
  • Depression
  • incr’d BP, also stimulant effects, sedation, N
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24
Q

Fluoxetine =

A

SSRI

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25
Q

Paroxetine =

A

SSRI

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26
Q

Sertraline =

A

SSRI

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27
Q

Citalopram =

A

SSRI

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28
Q

Venlafaxine =

- use for

A

SNRI

- depression, GAD and panic d/o’s

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29
Q

Duloxetine =

- use for

A

SNRI

- depression, DM periph neuropathy, has greater effect on NE

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30
Q

TCAs =

  • mech, clin use, tox
  • which have more antiACh affects?
  • which is less sedating but has lower seizure threshold?
  • how to treat its tox?
A

“-iptyline or -ipramine” + doxepin + amoxapine

  • block reuptake of 5HT and NE
  • major depression, bedwetting (imipramine), OCD (clomipramine), fibromyaligia
  • sedation, a1-blocking (hypotension, and antiACh SEs)
  • Tri-C’s: Convulsions, Coma, Cardiotox (arrhythmias); also resp dep’n, hyperpyrexia, confusions and hallucinations in old ppl from antiACh
  • 3* TCAs (amitriptyline) > 2* (nortriptyline)
  • Desipramine
  • NaHCO3 for cardiotox
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31
Q

MAOIs =

  • mech, clin use, tox
  • C/I’d w/?
A

“MAO Takes Pride In Shanghair” = Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline (selec MAO-B inhib)

  • ns MAO inhib incr’s levels of nt’s (NE, 5HT, DA)
  • atyp dep’n, anxiety, hypochondriasis
  • HTN crisis (esp when eat Tyr in wine/cheese), CNS stim’n
  • SSRIs, TCAs, St. John’s Wort, meperidine, dextromethophran
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32
Q

Bupropion

- mech, clin use, tox

A
  • incr NE and DA (don’t know how)
  • atyp antidepressant, also used for smoking cessation
  • stim. effects (tachy, insomnia), HA, seizure in bulimics (NO sex SEs :-)
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33
Q

Mirtazapine

- mech, clin use, tox

A
  • a2 agonist (incr release of NE/5HT) and 5HT2&3 R antag
  • atyp antidepressant
  • sedation (good if you have insomnia), incr’d appetite, wt gain, dry mouth
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34
Q

Maprotiline

- mech, clin use, tox

A
  • blocks NE reuptake
  • atyp antidepressant
  • sedation, orthostatic hypotension
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35
Q

Trazodone

- mech, clin use, tox

A
  • inhib’s 5HT reuptake
  • atyp antidepressant at high doses, so mainly used for insomnia
  • sedation, N, priaprism, postural hypotension
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36
Q

4 atyp antidepressants =

A

Burpropion, mirazapine, maprotiline, trazodone

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37
Q

How do these drugs help glaucoma:

  • a-agonists
  • b-blockers
  • diuretics
  • cholinomimetics
  • prostaglandin
A
  • decr aq humor syn via vasoconstriction (thus don’t use in closed angle glaucoma!)
  • decr aq humor syn
  • (acetazolamide) to decr syn bc no CA
  • incr aq humor outflow bc contract ciliary m’s and open trabecular meshwork (-> miosis)
  • incr outflow of aq humor (darkens color of iris)
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38
Q

Epinephrine for glaucoma

- mech, SE, C/I

A

a-agonist; decr aq humor syn via vasoconstriction

  • mydriasis
  • don’t use in closed angle glaucoma!
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39
Q

Brimonidine for glaucoma

- mech, SE

A

a2-agonist; decr aq humor syn

- blurry vision, ocular hyperemia, foreign body sensation, ocular allergic rxns, ocular pruritus

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40
Q

Timolol, betaxolol, carteolol - why use for glaucoma?

A

b-blockers -> decr’d aq humor syn

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41
Q

Acetazolamide, why use for glaucoma?

A

decr aq humor syn via inhibition of CA

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42
Q

Pilocarpine, why use for glaucoma?

- SE

A

cholinomimetic -> incr outflow of aq humor via contraction of ciliary m and opening of trabecular meshwork; use in emergencies bc very effective!
- miosis and cyclospasm (contraction of ciliary m’s)

43
Q

Carbachol, why use for glaucoma?
Physostigmine?
Echothiophate?

A

Direct cholinomimetic
Indirect
Indirect
-> incr outflow of aq humor via contraction of ciliary m and opening of trabecular meshwork

44
Q

Latanoprost, why use for glaucoma?

- SE

A

PGF2a -> incr’d outflow of aq humor

- darkens color of iris (browning)

45
Q

Opioid analgesics

  • mech, clin use, tox
  • trt tox w/?
A
  • agonists at opioid Rs (mu=morphine, delta=enkephalin, kappa=dynorphin) -> open K ch, close Ca ch -> decr’d synaptic trans; inhib release of ACh, NE, 5HT, Glu, subP
  • pain, cough (dextromethorphan), D (loperamide and diphenoxylate), acute pulm edema
  • addiction, resp dep’n, constipation, miosis (pinpoint pupil), additive CNS depression w/ other drugs
  • Naloxone or Naltrexone (opioid R antag)
46
Q

Fentanyl =

A

opioid

47
Q

Codeine =

A

opioid

48
Q

Heroin =

A

opioid

49
Q

Methadone =

A

opioid, for maintenance program for addicts

50
Q

Meperidine =

A

opioid

51
Q

Dextromethorphan =

A

opioid, for cough suppression

52
Q

Diphenoxylate =

A

opioid for D (slows down GI)

53
Q

Loperamide =

A

opioid for D (slows down GI)

54
Q

Butorphanol

- mech, clin use, tox

A
  • mu-opioid R partial agonist, k-opioid R agonist -> analgesia
  • severe pain (migraine, labor); less resp dep’n
  • opioid w/drawal sx if pt also taking full opioid agonist, overdose not easily revered w/ naloxone
55
Q

Tramadol

- mech, clin use, tox

A
  • wk opioid agonist, inhib’s 5HT and NE uptake
  • chronic pain
  • like other opioids (slows down everything), decr’s seizure threshold
56
Q

Phenytoin

  • mech
  • 1st line for?
  • toxicity?
A
  • incr Na ch inact’n (block Na ch’s), inhib of Glu release from presyn neuron
  • tonic-clonic (also carbamazepine and valprioic acid) and prophylaxis of status epilepticus [and IB antiarrhythmic]
  • BBESST Hirsutism 450!
    “bl, brain, eyes, SJS, SLE, teratogen, hirsutism, 450”
    …nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hirsutism, megaloblastic anemia bc decr’s folate ab’n, teratogenesis, SLE-like synd, induce P450, lymphadenopathy, SJS, osteopenia
57
Q

Carbamazepine

  • mech
  • 1st line for?
  • toxicity?
A
  • incr Na ch inact’n
  • partial seizures (simple and complex), tonic-clonic (also phenytoin and valproic acid), trigeminal neuralgia
  • BBB LESS 450: brain, blood, baby, liver, eye, SIADH, SJS, P450
    …diplopia, ataxia, bl dyscrasias (agranulocytosis, aplastic anemia), liver tox, teratogenesis, induce P450, SIADH, SJS!!!
58
Q

Lamotrigine

  • mech, use for?
  • toxicity?
A
  • blocks V-gated Na ch’s
  • seizures
  • SJS!!!
59
Q

Gabapentin

  • mech, use for?
  • toxicity?
A
  • inhib’s high-V-act’d Ca ch’s
  • seizures; ALSO periph neuropathy, postherpatic neuralgia, migraine prophylaxis, bipolar d/o
  • sedation, ataxia
60
Q

Topiramate

  • mech, use for?
  • toxicity?
A
  • blocks Na ch’s, incr’s GABA action
  • seizures, migraine prevention
  • sedation, mental dulling, kidney stones, wt gain
61
Q

Phenobarbital

  • mech
  • 1st line for?
  • toxicity?
A
  • incr’s GABA-A action
  • seizures in KIDS!
  • sedation, tol, dependence, induce P450
62
Q

Valproic acid

  • mech
  • 1st line for?
  • singular use for?
  • toxicity?
  • C/I’d in?
A
  • incr Na ch inact’n, incr GABA conc
  • tonic-clonic (also phenytoin, carbamazepine)
  • myoclonic seizures
  • Gi distress, rare/fatal hepatotox (LFTs), tremor, wt gain
  • preg -> neural tube defects
63
Q

Ethosuximide

  • mech
  • 1st line for?
  • toxicity?
A
  • blocks thalamic T-type Ca ch’s
  • absence seizures
  • EFGH: Ethosux: Fatigue, GI, HA/hives, PLUS SJS!!!
64
Q

Benzodiazepines (diazepam/lorazepam)

  • mech
  • 1st line for?
  • toxicity?
A
  • incr GABA-A action
  • acute status epilepticus
  • sedation, tolerance, dependence
65
Q

Tiagabine

- mech, use for?

A
  • inhib’s GABA reuptake

- partial (focal) seizures

66
Q

Vigabatrin

- mech, use for?

A
  • irreversibly inhib’s GABA transaminase, incr’s GABA

- partial (focal) seizures

67
Q

Levetiracetam

- mech, use for?

A
  • unknwn

- seizures

68
Q

Which epilepsy drugs can cause SJS?

Which induce P450?

A
  • CLEP: Carbamazepine, lamotrigine, ethosuximide, phenytoin

- CyPP: Carbamazepine, Phenobarbital, Phenytoin

69
Q

Barbiturates

  • end in?
  • mech, clin use, tox
  • overdose trtmt
A

“-barbital”, “-pental”

  • incr GABA-A action by incr’ing time of Cl- ch open -> decr’d neuron firing [barbiDURates incr DURation]
  • sedative for anxiety, seizures, insomnia, induction of anesthesia (thiopental)
  • resp and CV dep’n (can be fatal), CNS dep’n (more w/ EtOH), dependence, induces P450
  • supportive, assist resp and maintain BP
70
Q

Difference btwn barbiturates and benzodiazepines MoA?

A

BarbiDURates keep Cl- ch’s open longer, where benzo’s open Cl- ch’s more often -> help GABA to decr neuron firing

71
Q

Chlordiazepoxide =

A

benzo (only one that doesn’t end in -zepam or -ziolam

72
Q

Short acting benzo’s =

- have higher ? potential

A

TOM: Triazolam, Oxazepam, Midazolam

- addictive

73
Q

What are 3 drugs to bind GABA R and help it?

A

Benzo’s, barbiturates and EtOH

- R is a ligand-gated Cl ch

74
Q

Benzo’s

  • clin use
  • tox
  • trt overdose w/?
A

anxiety, spasticity, status epilepticus (lorazepam, diazepam), detox (esp DT in EtOH w/drawal), night terrors, sleepwalking, gen anesthetic (m. relax), hypnotic (insomnia)

  • dependence, additive w/ EtOH for CNS dep’n
  • Flumazenil (benzo->frenzo->flumazenil), GABA R antag
75
Q

Zolpidem =

- reverse w/?

A

nonbenzo hypnotic, for insomnia

- flumazenil

76
Q

Zaleplon =

- reverse w/?

A

nonbenzo hypnotic, for insomnia

- flumazenil

77
Q

Eszopiclone =

- reverse w/?

A

nonbenzo hypnotic, for insomnia

- flumazenil

78
Q

Inhaled anesthetics

  • end in?
  • effects?
  • tox?
A
  • flurane + halothane + NO
  • myocardial/resp dep’n, N/V, incr CeC bl flow (decr CeC metab demand)
  • malig hyperthermia (except: NO)
79
Q

Halothane =

tox?

A

inhaled anesthetic

- hepatotox (H=H)

80
Q

Methoxyflurane =

tox?

A

inhaled anesthetic

- nephrotox (meth+oxy -> junks up bl -> hurts kidney)

81
Q

Enflurane =

tox?

A

inhaled anesthetic

- proconvulsant (en = in brain -> convulsions)

82
Q

Thiopental =

- used for

A

IV barbiturate anesthetic

- induce anesthesia for short surgeries

83
Q

PCP = ketamine

- mech, SEs

A
  • block NMDA Rs

- CV stim’n, disorientation, hallucination, bad dreams, incr’d CeC bl flow

84
Q

Propofol =

- mech

A

IV anesthetic for sedation in ICU, rapid anesthesia induction, short procedures
- potentiates GABA-A

85
Q

Local anesthetics

  • 2 types?
  • mech
  • give w/ what to incr effect?
  • order of sensory loss?
  • tox
A 
esters and amides (have 2 I's in name)
(procaine, cocaine, tetracaine); (lidocaine, mepivacaine, bupivacaine)
- block Na ch's
- vasoconstrictors, like EPI
- pain > T > touch > P
86
Q

Succinylcholine =

- comp’s

A

depol’ing nm blocker (strong ACh R agonist -> depol)

- hyperCa/K, malignant hyperthermia

87
Q

Nondepolarizing nm blockers

  • end in?
  • mech?
A
  • curarine, -curium, -curonium

- competitive agonists of ACh -> block R

88
Q

Dantrolene

- mech, clin use

A
  • prevents release of Ca from SR of SkM

- malignant hyperthermia trtmt (SE of inhaled anesthetics), neuroleptic malignant synd

89
Q

Drugs for Parkinson’s dz?

A

BALSA:

Bromocriptine, Amantadine, Levodopa (w/ carbidopa), Selegiline (and COMT inhib’s), Antimuscarinics

90
Q

Bromocriptine =

A

DA agonist (ergot)

91
Q

Pramipexole =

A

DA agonist (ergot)

92
Q

Ropinirole =

A

DA agonist (non-ergot, preferred)

93
Q

Amantadine =

A

incr’s DA release (Parkinson’s dz)

antiviral for influenza A and rubella

94
Q

L-dopa/carbidopa

- mech, use for, tox

A

L-dopa Xs BBB -> converted to DA by dopa decarbosylase and incr’s DA conc in brain; carbidopa incr’s bioavailability of L-dopa in brain and limits periph SEs (is periph decarvoxylase inhib so L-dopa isn’t periph’ly act’d to DA)

  • PD
  • arrhythmias from incr’d periph formation of catecholamines, LT use -> dyskinesia after administration and akinesia btwn doses
95
Q

Selegiline

- mech, clin use, tox

A

MAO-B inhib (metab’s DA > 5HT,NE; prevents DA brkdown

  • PD, give as adjunct w/ L-dopa
  • may enhance adverse effects of L-dopa
96
Q

COMT inhib’s

  • end in
  • used for
A
  • capone (entacapone, tolcapone)

- prevent L-dopa degradation, incr DA availability, use in Parkinson’s dz

97
Q

Benztropine =

- use for

A

antiM
- PD: improves tremor and rigidity, but little effect on bradykinesia
“Park your mercedes-BENZ”

98
Q

Memantine

- mech, clin use, tox

A
  • NMDA R antag, helps prevent excitotox from Ca
  • Alzheimer’s dz
  • dizziness, confusion, hallucinations
99
Q

Donepezil =

A

AChEI for AD

100
Q

Galantamine =

A

AChEI for AD

101
Q

Rivastigmine =

A

AChEI for AD

102
Q

Huntington’s drugs work to?

=?

A
  • decr DA, bc low GABA and ACh, but high DA in dz
    Tetrabenazine, reserpine - inhib VMAT, so limit DA release
    Haloperidol - DA R antag
103
Q

Sumatriptan

- mech, clin use, tox

A

5HT(1B/1D) agonist, inhib’s trigem n. act’n, prevents vasoactive peptide release, induces vasoconstriction, t1/2s angina), mild tingling

First Aid Drugs (13 decks)

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