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Quarter 4 > pharm > Flashcards

pharm Flashcards

1
Q

Anticonvulsant meds

A

GABA (increase activity)

Glutamate (decrease activity by blocking Na, Ca, etc channels)

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2
Q

Anticonvulsant med that Blocks GABA re-uptake

A

Tiagabine

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3
Q

Anticonvulsant med that inhibits GABA metabolism/breakdown

GABA-T

A

Viabatrin

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4
Q

Anticonvulsants that work by stimulating GABAa receptors

A

Benzos and Barbs

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5
Q

SV2A vesicular protein binding

Anticonvulsant med

A

Levetiracetam

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6
Q

Tigabine

A

few drug interactions; GOOD

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7
Q

Vigabatrin

A

Use: Refractory complex partial, and Infantile West Synd

inhibits the breakdown of GABA (GABA-T)

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8
Q

SE of Vigabatrin

A

Visual field: retinal problems

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9
Q

Benzos “PAM” use for anticonvulsants

A

Clonazepam: Abscence, myoclonic, Infantile West

Diazepam and Lorazepam: Status Epilepticus!!

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10
Q

SE of Benzos “PAM”

A

Paradoxical excitement, sleep walking, tolerance

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11
Q

Contra to Benzoa “PAM”

A

Pregnant
Sleep apnea
Elderly

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12
Q

Pregabalin (lyrica)

A

Use: Generalized anxiety

also: neuropathic pain, fibromyalgia, post op pain

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13
Q

Pregabalin (lyrica) and Gabapentin (neurontin) mechanism

A

GABA analog

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14
Q

Pregabalin (lyrica) and Gabapentin (neurontin) good characteristic

A

NO DRUG INTERACTIONS

safe

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15
Q

SE of Pregabalin (lyrica)

used for anxiety

A

peripheral edema
weight gain
xerostomia
ataxia

Contra: pregnant

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16
Q

Use of Gabapentin (neurontin)

A

Adjunct for Partial and Gen T-C seizures

Neuropathic pain

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17
Q

PhenoBARBitol use for seizures

A

Partial
Gen T-C

prolong opening of Cl- channel

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18
Q

Levatiracetam (Keppra)

A

Use: Partial, myoclonic, T-C

Minimal drug interactions

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19
Q

Drugs with few drug interactions

A

Levatiracetam (keppra)

Tigabine

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20
Q

Drugs with NO drug interactions

A

Pregabalin (lyrica) and

Gabapentin (neurontin)

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21
Q

Phenytoin (dilantin)

A

Partial

Gen T-C

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22
Q

SE of Phenytoin (dilantin)

A

Gingival hyperplasia
SJS risk
Pregnancy:D

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23
Q

Fosphenytoin

A

Partial

Gen T-C

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24
Q

Phenytoin and Fosphenytoin dangerous characteristic

“PHENY”

A

Zero order elimination at high/therapeutic doses

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25
Q

Carbamexapine

A

DOC for Partial seizures
Trigeminal neuralgic pain

Also used for: Gen T-C, Bipolar

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26
Q

Carbamexapine SE

A

Aplastic anemia
Agranulocytosis
SJS risk- SCREEN FOR HLA gene
Preg;D

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27
Q

Topiramate

A

Partial, Gen T-C, and Migraine prevention

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28
Q

Topiramate SE

A

Acute myopia

Glaucoma

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29
Q

Ethosuximide

A

DOC for Absence seizure

inhibit low threshold Ca channels

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30
Q

Ethosuximide SE

A

Hiccups

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31
Q

Drug interaction with Ethosuximide

A

metabolism is inhibited by Valproic acid

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32
Q

Valproic acid

A

Mixed seizures
blocks multiple channels!!

Also used for: Bipolar, migraine prophylaxis

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33
Q

SE of Valproic Acid

A

HEPATOTOXICITY (monitor LFT)

Preg: D

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34
Q

Anticonvulsants that have eye related SE

A

Topiramate: Acute myopia and Glaucoma

Vigabatrin: Retinal problems

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35
Q

Anticonvulsants that can help with Migraines

A

Topiramate: prevention

Valproic acid: prophylaxis

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36
Q

Anticonvulsants that treat Infantile West Syndrome

A

Vigabatrin

Clonazepam

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37
Q

Anticonvulsants that treat Bipolar

A

Valproic acid
Carbamezapine
Gabapentin (off-label)

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38
Q

DOC for Partial seizures

A

Carbamazepine

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39
Q

DOC for Absence seizures

A

Ethosuximide

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40
Q

DOC for Mixed seizures

A

Valproic Acid

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41
Q

DOC for Status Elepticus

A

Diazepam

Lorazepam

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42
Q

Long duration Benzos “pam”

A

Diazepam

Flurazepam

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43
Q

Intmdt duratin Benzos “pam”

A

Alprolozam/Oxozepam

Lorazepam

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44
Q

Benzos “pam” for insomnia that have the “hangover effect”

A

Flurazepam (long acting)

Temazepam

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45
Q

Midalozam

A

Short acting- use b4 short procedures

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46
Q

SE of Midolazam

A

Anterograde amnesia

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47
Q

Z drugs for Insomnia

A

Zolpidem
Zoleplon
EsZoplicone (long term tx)

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48
Q

Zolpidem, Zaleplon, Eszopiclone (Z drugs)

mechanism

A

Bind to BZ1 subtype of GABA receptor

enhance GABA inhibitory effect

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49
Q

Z drugs have a short half life (besides Eszopiclcone) and therefore

A

peak level 30-60 min
No hangover effect
HIGH MARGIN OF SAFETY; good

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50
Q

Suvorexant

A

for Insomnia
Orexin antagonist
SE: worsening depression, sleep paralyisis, hallucinate

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51
Q

Do NOT use Suvorexant in pts w hx of

A

Narcolepsy

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52
Q

Flumenazil

A

Benzo ANTAGONIST

Use for hypersomnia (too much sleeping)

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53
Q

Do NOT use Flumenazil (the benzo antagonist) in pt with hx of

A

SEIZURE!!!

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54
Q

If pt has Narcolepsy, do NOT use

A

Suvorexant

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55
Q

If pt has Seizures, do NOT use

A

Flumenazil (the benzo antagonist)

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56
Q

Ramelteon

A

Insomnia
Melatonin analog
Do NOT combine w other Sedatives or Alcohol

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57
Q

Benzos usually act _____ of GABA

A

Dependent

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58
Q

Barbiturates usually act _____ of GABA

A

INDEPENDENT

Barb is independenta nd dangerous

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59
Q

The two Benzos that are independent of GABA (unusual for Benzos)

A

Ramelteon and Buspirone

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60
Q

Diphenhydramine (benadryl)

A

Antihistamine
Use for occasional insomnia

Good for recovering addicts

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61
Q

Chloral Hydrate

A

Use for:
children dental
nursing home
chronic care

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62
Q

Chloral Hydrate mechanism

A

Converted to tri-chloro-ethnanol which acts on GABAa receptor

LOW MARGIN OF SAFETY, dangerous

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63
Q

Long term damage of Chloral Hydrate

A

Liver damage

Fatal intoxication

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64
Q

Buspirone

A

Generalized anxiety
Agonist at 5HT-1 receptor

very good for recovering addicts

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65
Q

Hydroxyzine

A

Anxiety use
Antihistamine
(sedation 1st generation)

No abuse potential

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66
Q

Hydroxyzine use

A

Anxiety

Also: motion sickness, Parkinson

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67
Q

4 drugs discussed for Alcoholism tx

A

Naltrexone
Acamprosate
Disulfuram
Topiramate

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68
Q

Naltrexone

Alcoholism tx

A

Opoid receptor antagonist

Blocks reward pathway

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69
Q

Naltrexone

(Alcoholism tx) SE

A

Large dose –> Liver damage

CONTRA in pts w/ Liver failure

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70
Q

Acamprosate

Alcholism tx

A

Structural analog of GABA

Restore normal balance of GABA and glutamate

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71
Q

Good trait of Acamprosate

Alcoholism tx

A

Excreted by kidneys

NO LIVER TOXICITY

72
Q

Disulfuram

A

Inhibit Aldehyde DH (therefore Acetaldehyde builds up) person feels like crap

but effects can be severe: vomiting, hypotension, blurred vision, shock

73
Q

Topiramate

A

Use: Anticonvulsant, Alcoholism

74
Q

Genetics and alcoholism

A

Marked increase of beta-endorphins in dopamine reward pathway

75
Q

Treatment of Alcohol WITHDRAWAL

A

Diazepam
Chlordiazepoxide
Lorazepam (ativan)
Phenytoin (dilantin)

76
Q

Drug used to taper pt off of Alcohol WITHDRAWAL

A

Diazepam and
Chlordiazepoxide

prevent seizure and DT, taper sx

77
Q

Esters in general

A

Short duration

Metabolized by butrylcholinesterase in plasma

78
Q

Amides in general

A

Long duration

Metabolized by CYP3A4 in Liver

79
Q

Procaine

A

SHORT lived
Diagnostic nerve block

bad: PABA metabolites –> hypersensitivity

80
Q

Tetracaine

A

Ester- but has SLOW onset

Ophtho (EYE STUFF)
Retrobulbar procedure

81
Q

Tetracaine

A

Slow onset and long duration of action- wierd for an Ester

82
Q

Benzocaine

A

Ester
SUNBURN (topical, OTC)
Always in non-ionized form, diffuses readily

83
Q

Two drugs that have SE of Methemoglobinemia

A

Benzocaine (sunburn)

Prilocaine (dentistry)

84
Q

Two drugs used for DENTISTRY

A

Prilocaine- Amide

Articaine- Amide and Ester (safe, can keep adding more)

85
Q

Cocaine

A

increase Dopamine and inhibit Na+ channel

Topical for mucous membranes, stops bleeding

86
Q

Lidocaine

A

Amide, medium duration

Infiltration block
Epidural (non-labor)
Rapidy absorbed, immediately acts

87
Q

Lidocaine risk if accidentally gets into Spinal fluid

A

TNS

88
Q

Prilocaine

A

DENTISTRY
High rate of clearance- safe

Contra: Cardiac/resp distress

89
Q

Bupivacaine

A

Epidural during CHILDBIRTH and LABOR
Long duration, stays at cardiac Na+ channels long thus CARDIOTOXICITY is concern

Very potent SENSORY> motor

90
Q

Bupivacaine is used for _____ in addition to Epidural for Childbirth and Labor

A

Post op pain
Spinal anesthesia
Infiltrate

91
Q

Ropivacaine

A

Peripheral and Epidural block
the S-Enantiomer for Bupivacaine

less cardiotoxic but hits motor neurons more, so the other is still DOC for Epidural LABOR and DELIVERY

92
Q

Ideal drug for LABOR and DELIVERY

A

Hits all sensory neurons, NOT motor neurons (mom still needs to push)

DOC: Bupivacaine

93
Q

Mepivacaine

A

Amide, medium duration
Peripheral nerve block
less popular

ehh

94
Q

Etidocaine

A

Inverse differential block
MOTOR NEURONS> sensory

this is unique

95
Q

Articaine

A

Amide AND Ester
DENTISTRY
Low risk, can keep adding more as procedure goes with no risk bc it’s metabolized by both Butylcholinesterase AND CYP3A4 in liver

96
Q

Rare SE of Articaine (dentistry)

A

Persistent paresthesia

97
Q

Dibucaine

A

test

test cholinesterase activity
Will tell us whether Ester drugs are safe or nah

98
Q

Diazepam

A

Centrally acting
GABAa

Use: Local muscle trauma, adjunct in chronic spasticity

@ doses high enough to make a muscle diff, causes HEAVY SEDATION

99
Q

Baclofen

A

GABAb (GPCR)

opens K and Ca channels

100
Q

Tizanidine

A

Centrally acting- A2 Adrenergic agonist

Decreases glutamate activity

101
Q

Tizanidine use

A

Chronic/acute muscle spasm

A2 adrenergic agonist

102
Q

Dantrolene

A

Neuroleptic Malignant Syndrome

Malignant Hyperthermia

103
Q

Dantrolene mechanism

used for “Malignant”

A

Inhibit Ca release @ SR Ryanidine Receptor

Messes up exc/cont coupling

104
Q

Botox

A

Locally control muscle spasm after stroke

inhibit Ach release

105
Q

Direct acting spasmolytics (act right at the NMJ)

A

Dantrolene (Ca release)

Botox (Ach release)

106
Q

TCA

A

inhibit reuptake of:

NE and 5-HT

107
Q

SSRI

A

inhibit reuptake of:

5-HT only

108
Q

SNRI

A

inhibit reuptake of:

NE and 5-HT

109
Q

What two classes of anti-depressants inhibit reuptake of both NE and 5-HT

A

TCA and SNRIs

110
Q

Dopamine reuptake inhibitor

A

Bupropion

111
Q

MAOI

A 
inhibit metabolism (breakdown) of:
NE, 5-HT, and DA
112
Q

TCA side effects: block NE and 5HT, but also block

A

Histamine: drowsy, sedation

Alpha: cardiac, arrhythmia

Cholinergic: blurry vision, tachycardia, dry mouth

113
Q

Seretonin syndrome

A

associate with MAOIs combined many other drugs

114
Q

What is DOC for Depression and very safe for children/teens?

A

Selective Seretonin Reuptake Inhibitors-SSRIs

(Fluoxetine [prozac], Sertraline [zoloft], Citalopram [celexa], Escitalopram [lexapro]

115
Q

Vit D

A

Calcium absorption

116
Q

Vit K

A

clotting

117
Q

Vit A

A

vision

118
Q 
B1
B2
B3
B5
B6
A 
T
R
N
P
P
119
Q

T R N P P

A 
Thiamine
Ribaflavin
Niacin
Pantothenic
Pyridoxine
120
Q 
B1 deficiency
(Thiamine)
A

Beriberi (neuropathy, edema)

Wernicke-Korsakoff (neuro)

121
Q

B1 def

A

Beriberi and Wernicke

122
Q

B2,3,6 def

A

Chelitis, angular stomatitis, glossitis

123
Q

Pellagra (diarrhea, dermatitis, dementia)

A

Niacin deficiency

B3

124
Q

Na def

A

confusion
hypotension
tachycardia

125
Q

Taste disturbance

A

Zinc

126
Q

EKG w U waves
Muscle cramping
fatigue

A 
K deficiency
(potassium)
127
Q

Pica

Koilonychia

A

Iron deficiency

128
Q

Too much copper

A

golden-brown discoloration of iris

129
Q

EKG w peaked T waves

A

too much Potassium (K)

130
Q

Which diet are we concerned about a B12 deficiency?

A

Vegan

131
Q

Alcohol use disorder is associated with which nutritional deficiency

A

Thiamine

132
Q

Parenteral nutrition

A

delivered directly into vein

133
Q

Enteral nutrition routes for <4-6 weeks

A

Naso____

134
Q

Supine abdominal X Ray

A

“KUB”

Dilation

135
Q

Upright abdominal X ray

A

air fluid levels

136
Q

PA chest X ray

A

assess for Perforation

137
Q

Diagnostic test of choice for Cholelithiasis

A

Ultrasound (gallbladder or RUQ)

138
Q

CT A/P, when do we NOT use contrast?

A

When looking for Renal stone

139
Q

Preferred test when evaluating Pancreatitis

A

CT

140
Q

HIDA scan

A

assess function of Liver and Gallbladder

141
Q

Barium and Fluoroscopy

A

X Ray movie

142
Q

ERCP and
MRCP

bile and pancreatic ducts

A

Takes trained person
ERCP: diagnostic and therapeutic (invasive)
MRCP: only diagnostic (non-invasive)

143
Q

Complication with ERCP

A

Pancreatitis

144
Q

Contraindications to Colonoscopy

A

Active diverticulitis

145
Q

MRCP

A

Not invasive!

just for diagnosis

146
Q

Montreal classification to diagnose GERD

A

reflux of stomach contents cause troublesome sx or complications

147
Q

Hallmark sx of GERD

A

Heartburn (pyrosis) usually after a meal

148
Q

Example of a med that can exacerbate GERD sx

A

Bisphosphonates

149
Q

Most asymptomatic and incidental finding that can cause GERD

A

Hiatal hernia

150
Q

Subtypes of hiatal hernia

A

Sliding- most common

Paraesoph- need surgery, dangerous, can cause necrosis

151
Q

What test can you use to see Hiatal hernia and Strictures?

A

Barium contrast esophagram

152
Q

Best diagnostic study to evaluate mucosal injury

A

EGD

153
Q

Esophogeal IMPEDENCE testing

A

bolus transit

154
Q

Esophogeal MANOMETRY

A

fx of LES and peristalsis

Motility disorders

155
Q

What is considered Mild/intermittent GERD

A

<2 episodes per week

Use Step up therapy
H2 meds

156
Q

What is considered Severe GERD?

A

2 or more episodes per week

Use Step down therapy
PPI

157
Q

H2 blockers

A

For Mild GERD

Ranitidine, Famotidine

158
Q

When to take PPI

A

30 min before breakfast

159
Q

Risks assoc w/ long term use of PPI

A

Infection

Malabsorption

160
Q

Tx of Barrett esophagus

A

Endoscopic Eradication Therapy

EA- endoscopic ablation
ER- endoscopic resection

161
Q

Two main types of esophogeal CA

A

Adenocarcinoma

Squamous cell carcinoma

162
Q

White, male
obese, smoker
has Barrett

What type of CA is he likely to develop?

A

Adenocarcinoma

163
Q

African american man, urban area

What type of esophogeal CA is he likely to have?

A

Squamout cell carcinoma

164
Q

What is recommended in all patients with dysphagia?

A

Endoscopy

165
Q

Tx for Eisinophillic esophagitis

A

Diet (remove allergens)
PPI
Steroid spray- SWALLOW

166
Q

Pt has difficulty swallowing, CP that is not cardiac, and GERD that keeps coming back?

A

Consider esophogeal Motility disorder

167
Q

Major motility disorders of esophagus

A

Hypercontractile Jackhammer
Disteal esoph spasm (DES)
Achalaisa

168
Q

Hypercontractile Jackhammer and Distal esoph spasm (DES)

A

High pressure contractions in esophagus

CP usually occurs w meals

169
Q

Tx of Jackhammer and DES

A

PPI

CCB or TCA

170
Q

Tx of Jackhammer and DES

A

calcium channel blocker

tricyclic antidepressants

171
Q

Achalasia

A

no contraction of distal 2/3 of esophagus and incomplete relaxation

172
Q

Birds beak on Barium esophagram

A

Achalasia

173
Q

Diagnose Achalasia

A

Manometry is required

174
Q

Drinking too much alchy

A

Mallory-weiss syndrome (tear) in esophagus

175
Q

Predisposing factors to Mallory Weiss

A

Drinking too much

Hiatal hernia

176
Q

Manometry required for what diagnosis

A

Achalasia

AND do EGD to r/o CA

Quarter 4 (10 decks)

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