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ALL THE PHARM > Opiods, Antiepileptics, Anaesthetics > Flashcards

Opiods, Antiepileptics, Anaesthetics Flashcards

1
Q

What are some examples of opioid drugs?

A

Morphine, fentanyl, codeine, heroin, methadone, meperidine, dextromethorphan, diphenoxylate

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2
Q

Mechanism of opioids?

A

Agonists at opioid receptors to modulate synaptic transmission.

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3
Q

What drugs correspond to the following receptors?
mu
delta
kappa

A 
mu = morphine
delta = enkephalin
kappa = dynorphin
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4
Q

What channels do opiods act on?

A

open K+ channels, close Ca2+ channels

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5
Q

Which NTs are prevented from release by opioid activity?

A

ACh, NE, 5-HT, glutamate, substance P

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6
Q

Which opioid is indicated for cough suppression?

A

dextromethorphan

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7
Q

Which opioids are indicated for diarrhea?

A

loperamide and diphenoxylate

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8
Q

What analgesic class can be used to treat acute pulmonary edema?

A

opioids

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9
Q

What are two toxicities of opiods that patients do not develop tolerance to?

A

miosis and constipation

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10
Q

How can you treat toxicity of opioids?

A

opioid receptor antagonists: naloxone or naltrexone

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11
Q

What drug is a partial agonist of mu and kappa- receptors?

A

Butorphanol

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12
Q

What is the advantage of using Butorphanol over other opioids?

A

It causes less respiratory depression than full agonists

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13
Q

What are two toxicities of Butorphanol?

A
  1. Because it’s a partial agonist, it can cause withdrawal if giving concomitantly with full agonists
  2. Overdose not easily reversed with nalaxone
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14
Q

What is tramadol?

A

A very weak opioid agonist; it also inhibits serotonin and NE reuptake – “tram it all” with tramadol)

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15
Q

What is butorphanol indicated for?

A

Severe pain such as migraines and labor

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16
Q

What is tramadol indicated for?

A

chronic pain

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17
Q

What are toxicities of tramadol?

A
  1. similar to opiods
  2. decreases seizure threshold
  3. serotonin syndrome
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18
Q

What is the mechanism of Ethosuximide?

A

Blocks thalamic T-type Ca2+ channels

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19
Q

What are the side effects of Ethosuximide?

A

EFGHIJ: Ethosuximide causes fatigue, GI distress, Headache, Itching (urticaria), and Stevens-Johnson syndrome

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20
Q

What is ethosuximide used for?

A

absence seizures

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21
Q

What kind of seizures are benzodiazapenes used for?

A
  1. Status epilipticus

2. Eclampsia seizures (1st line is MgSO4)

22
Q

What is the mechanism of benzos?

A

Increases GABA(a) action

23
Q

What are side effects of benzos?

A

Sedation, tolerance, dependence, respiratory depression

24
Q

What are three indications for phenytoin?

A
  1. Partial seizures (simple and complex)
  2. tonic clonic (1st line)
  3. status epilepticus prevention
25
Q

Side effects of phenytoin:

A

Eyes: nastagmus, diplopia
Mouth: gingival hyperplasia
Nerves: ataxia, sedation, peripheral neuropathy
Metabolic: induction of P450
Blood: megaloblastic anemia (inhibits intestinal conjugase);
Lymph: lymphadenopathy
Bone: osteopenia
Skin: Stevens Johnson Syndrome
Developmental: fetal hydantoin syndrome (teratogenesis)

26
Q

What are the indications for carbamazepine?

A

1st line for partial (simple and complex) and tonic-clonic

27
Q

What is the mechanism of action of carbamazepine?

A

Na+ channel inactivation

28
Q

Side effects of carbamazepine:

A

Eyes: diplopia
Nerves: ataxia
Metabolic: induction of P450, liver toxicity
Blood: dyscrasias (agranulocytosis, aplastic anemia)
Skin: Stevens-Johnson
Development: Teratogenesis

29
Q

What is the mechanism of action of Valproic acid?

A

Na+ channel inactivation, increased GABA concentration by inhibiting GABA transaminase

30
Q

What are some toxicities of Valproic acid?

A

GI, distress, fatal hepatotoxicity (rare, measure LFTs), neural tube defects (spina bifida), tremor, weight gain, contraindicated in pregnancy

31
Q

What is valproic acid for?

A

all seizures except status epilepticus, myoclonic seizures, bipolar disorder

32
Q

What three drugs are used primarily for partial seizures?

A

Gabapentin, Tiaginbine, Vigabatrin

33
Q

Primary side effects of gabapentin?

A

Sedation, ataxia

34
Q

Mechanism of gabapentin?

A

high voltage-activated Ca2+ channels despite designation as GABA analog

35
Q

What drug can be used for migraine prophylaxis?

A

gabapentin

36
Q

Which antiepileptics can be used for bipolar d/o?

A

Valproic acid and gabapentin

37
Q

Which antiseizure drug is marketed for postherpetic neuralgia?

A

gabapentin

38
Q

Which antiseizure drug is marketed as first line for trigeminal neuralgia?

A

carbamazapine

39
Q

Phenobarbital mechanism and indications

A

Increases GABA(a) (like phenytoin) and is used to treat partial and tonic-clonic seizures

40
Q

What are the mechanism and indications for topiramate?

A

Blacks Na+ channels, increases GABA action

Indicated for partial and tonic-clonic

41
Q

Indications and mechanism for lamotrigine

A

partial, tonic clonic; blocks voltage-gated Na+ channels

42
Q

Toxicity of lamotrigine

A

Stephens-Johnson (must be titrated slowly)

43
Q

Mechanism and indications for levetiracetam

A

unknown (may modulate GABA and Glu release); partial and TC

44
Q

Indications and mechanisms for Tiagabine and Vigabatrin

A

both indicated for partial seizures; increase GABA by inhibiting uptake (Tiagabine) and transaminase (Vigabatrin)

45
Q

What are some barbituates?

A

Phenobarbital, penorbital, thiopental, secorbarbital

46
Q

What do barbituates work?

A

Facilitate GABAa action by increasing duration of Cl- channel opening–> decrease neuron firing

47
Q

Clinical uses for barbituates

A

sedative for: anxiety, seizures, insomnia, induction of anesthesia

48
Q

What drug is used as a sedative for induction of anesthesia? What class of drug is this?

A

Thiopental; barbituate

49
Q

Toxicities of barbituates

A

Respiratory and cardiovascular depression (can be fatal)
CNS depression (can be exacerbated by EtOH use)
Dependence
Drug interactions (induces P450)

50
Q

How do you treat a barbituate overdose?

A

Supportive: assist respiration and maintain BP

51
Q

What are some examples of Benzodiazepines?

A

Diazepam, lorazempam, triazolam, temazepam, oxazepam, midazolam, chlordiazepoxide, alprazolam

ALL THE PHARM (10 decks)

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