pharm Flashcards
1
Q
Anticonvulsant meds
A
GABA (increase activity)
Glutamate (decrease activity by blocking Na, Ca, etc channels)
2
Q
Anticonvulsant med that Blocks GABA re-uptake
A
Tiagabine
3
Q
Anticonvulsant med that inhibits GABA metabolism/breakdown
GABA-T
A
Viabatrin
4
Q
Anticonvulsants that work by stimulating GABAa receptors
A
Benzos and Barbs
5
Q
SV2A vesicular protein binding
Anticonvulsant med
A
Levetiracetam
6
Q
Tigabine
A
few drug interactions; GOOD
7
Q
Vigabatrin
A
Use: Refractory complex partial, and Infantile West Synd
inhibits the breakdown of GABA (GABA-T)
8
Q
SE of Vigabatrin
A
Visual field: retinal problems
9
Q
Benzos “PAM” use for anticonvulsants
A
Clonazepam: Abscence, myoclonic, Infantile West
Diazepam and Lorazepam: Status Epilepticus!!
10
Q
SE of Benzos “PAM”
A
Paradoxical excitement, sleep walking, tolerance
11
Q
Contra to Benzoa “PAM”
A
Pregnant
Sleep apnea
Elderly
12
Q
Pregabalin (lyrica)
A
Use: Generalized anxiety
also: neuropathic pain, fibromyalgia, post op pain
13
Q
Pregabalin (lyrica) and Gabapentin (neurontin) mechanism
A
GABA analog
14
Q
Pregabalin (lyrica) and Gabapentin (neurontin) good characteristic
A
NO DRUG INTERACTIONS
safe
15
Q
SE of Pregabalin (lyrica)
used for anxiety
A
peripheral edema
weight gain
xerostomia
ataxia
Contra: pregnant
16
Q
Use of Gabapentin (neurontin)
A
Adjunct for Partial and Gen T-C seizures
Neuropathic pain
17
Q
PhenoBARBitol use for seizures
A
Partial
Gen T-C
prolong opening of Cl- channel
18
Q
Levatiracetam (Keppra)
A
Use: Partial, myoclonic, T-C
Minimal drug interactions
19
Q
Drugs with few drug interactions
A
Levatiracetam (keppra)
Tigabine
20
Q
Drugs with NO drug interactions
A
Pregabalin (lyrica) and
Gabapentin (neurontin)
21
Q
Phenytoin (dilantin)
A
Partial
Gen T-C
22
Q
SE of Phenytoin (dilantin)
A
Gingival hyperplasia
SJS risk
Pregnancy:D
23
Q
Fosphenytoin
A
Partial
Gen T-C
24
Q
Phenytoin and Fosphenytoin dangerous characteristic
“PHENY”
A
Zero order elimination at high/therapeutic doses
25
Carbamexapine
DOC for Partial seizures
Trigeminal neuralgic pain
Also used for: Gen T-C, Bipolar
26
Carbamexapine SE
Aplastic anemia
Agranulocytosis
SJS risk- SCREEN FOR HLA gene
Preg;D
27
Topiramate
Partial, Gen T-C, and Migraine prevention
28
Topiramate SE
Acute myopia
| Glaucoma
29
Ethosuximide
DOC for Absence seizure
inhibit low threshold Ca channels
30
Ethosuximide SE
Hiccups
31
Drug interaction with Ethosuximide
metabolism is inhibited by Valproic acid
32
Valproic acid
Mixed seizures
blocks multiple channels!!
Also used for: Bipolar, migraine prophylaxis
33
SE of Valproic Acid
HEPATOTOXICITY (monitor LFT)
| Preg: D
34
Anticonvulsants that have eye related SE
Topiramate: Acute myopia and Glaucoma
Vigabatrin: Retinal problems
35
Anticonvulsants that can help with Migraines
Topiramate: prevention
| Valproic acid: prophylaxis
36
Anticonvulsants that treat Infantile West Syndrome
Vigabatrin
| Clonazepam
37
Anticonvulsants that treat Bipolar
Valproic acid
Carbamezapine
Gabapentin (off-label)
38
DOC for Partial seizures
Carbamazepine
39
DOC for Absence seizures
Ethosuximide
40
DOC for Mixed seizures
Valproic Acid
41
DOC for Status Elepticus
Diazepam
| Lorazepam
42
Long duration Benzos "pam"
Diazepam
| Flurazepam
43
Intmdt duratin Benzos "pam"
Alprolozam/Oxozepam
| Lorazepam
44
Benzos "pam" for insomnia that have the "hangover effect"
Flurazepam (long acting)
| Temazepam
45
Midalozam
Short acting- use b4 short procedures
46
SE of Midolazam
Anterograde amnesia
47
Z drugs for Insomnia
Zolpidem
Zoleplon
EsZoplicone (long term tx)
48
Zolpidem, Zaleplon, Eszopiclone (Z drugs)
| mechanism
Bind to BZ1 subtype of GABA receptor
| enhance GABA inhibitory effect
49
Z drugs have a short half life (besides Eszopiclcone) and therefore
peak level 30-60 min
No hangover effect
HIGH MARGIN OF SAFETY; good
50
Suvorexant
for Insomnia
Orexin antagonist
SE: worsening depression, sleep paralyisis, hallucinate
51
Do NOT use Suvorexant in pts w hx of
Narcolepsy
52
Flumenazil
Benzo ANTAGONIST
| Use for hypersomnia (too much sleeping)
53
Do NOT use Flumenazil (the benzo antagonist) in pt with hx of
SEIZURE!!!
54
If pt has Narcolepsy, do NOT use
Suvorexant
55
If pt has Seizures, do NOT use
Flumenazil (the benzo antagonist)
56
Ramelteon
Insomnia
Melatonin analog
Do NOT combine w other Sedatives or Alcohol
57
Benzos usually act _____ of GABA
Dependent
58
Barbiturates usually act _____ of GABA
INDEPENDENT
Barb is independenta nd dangerous
59
The two Benzos that are independent of GABA (unusual for Benzos)
Ramelteon and Buspirone
60
Diphenhydramine (benadryl)
Antihistamine
Use for occasional insomnia
Good for recovering addicts
61
Chloral Hydrate
Use for:
children dental
nursing home
chronic care
62
Chloral Hydrate mechanism
Converted to tri-chloro-ethnanol which acts on GABAa receptor
LOW MARGIN OF SAFETY, dangerous
63
Long term damage of Chloral Hydrate
Liver damage
| Fatal intoxication
64
Buspirone
Generalized anxiety
Agonist at 5HT-1 receptor
very good for recovering addicts
65
Hydroxyzine
Anxiety use
Antihistamine
(sedation 1st generation)
No abuse potential
66
Hydroxyzine use
Anxiety
| Also: motion sickness, Parkinson
67
4 drugs discussed for Alcoholism tx
Naltrexone
Acamprosate
Disulfuram
Topiramate
68
Naltrexone
| Alcoholism tx
Opoid receptor antagonist
Blocks reward pathway
69
Naltrexone
| (Alcoholism tx) SE
Large dose --> Liver damage
| CONTRA in pts w/ Liver failure
70
Acamprosate
| Alcholism tx
Structural analog of GABA
| Restore normal balance of GABA and glutamate
71
Good trait of Acamprosate
| Alcoholism tx
Excreted by kidneys
| NO LIVER TOXICITY
72
Disulfuram
Inhibit Aldehyde DH (therefore Acetaldehyde builds up) person feels like crap
but effects can be severe: vomiting, hypotension, blurred vision, shock
73
Topiramate
Use: Anticonvulsant, Alcoholism
74
Genetics and alcoholism
Marked increase of beta-endorphins in dopamine reward pathway
75
Treatment of Alcohol WITHDRAWAL
Diazepam
Chlordiazepoxide
Lorazepam (ativan)
Phenytoin (dilantin)
76
Drug used to taper pt off of Alcohol WITHDRAWAL
Diazepam and
Chlordiazepoxide
prevent seizure and DT, taper sx
77
Esters in general
Short duration
| Metabolized by butrylcholinesterase in plasma
78
Amides in general
Long duration
| Metabolized by CYP3A4 in Liver
79
Procaine
SHORT lived
Diagnostic nerve block
bad: PABA metabolites --> hypersensitivity
80
Tetracaine
Ester- but has SLOW onset
Ophtho (EYE STUFF)
Retrobulbar procedure
81
Tetracaine
Slow onset and long duration of action- wierd for an Ester
82
Benzocaine
Ester
SUNBURN (topical, OTC)
Always in non-ionized form, diffuses readily
83
Two drugs that have SE of Methemoglobinemia
Benzocaine (sunburn)
| Prilocaine (dentistry)
84
Two drugs used for DENTISTRY
Prilocaine- Amide
| Articaine- Amide and Ester (safe, can keep adding more)
85
Cocaine
increase Dopamine and inhibit Na+ channel
Topical for mucous membranes, stops bleeding
86
Lidocaine
Amide, medium duration
Infiltration block
Epidural (non-labor)
Rapidy absorbed, immediately acts
87
Lidocaine risk if accidentally gets into Spinal fluid
TNS
88
Prilocaine
DENTISTRY
High rate of clearance- safe
Contra: Cardiac/resp distress
89
Bupivacaine
Epidural during CHILDBIRTH and LABOR
Long duration, stays at cardiac Na+ channels long thus CARDIOTOXICITY is concern
Very potent SENSORY> motor
90
Bupivacaine is used for _____ in addition to Epidural for Childbirth and Labor
Post op pain
Spinal anesthesia
Infiltrate
91
Ropivacaine
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
Ideal drug for LABOR and DELIVERY
Hits all sensory neurons, NOT motor neurons (mom still needs to push)
DOC: Bupivacaine
93
Mepivacaine
Amide, medium duration
Peripheral nerve block
less popular
ehh
94
Etidocaine
Inverse differential block
MOTOR NEURONS> sensory
this is unique
95
Articaine
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
Rare SE of Articaine (dentistry)
Persistent paresthesia
97
Dibucaine
test
test cholinesterase activity
Will tell us whether Ester drugs are safe or nah
98
Diazepam
Centrally acting
GABAa
Use: Local muscle trauma, adjunct in chronic spasticity
@ doses high enough to make a muscle diff, causes HEAVY SEDATION
99
Baclofen
GABAb (GPCR)
| opens K and Ca channels
100
Tizanidine
Centrally acting- A2 Adrenergic agonist
Decreases glutamate activity
101
Tizanidine use
Chronic/acute muscle spasm
A2 adrenergic agonist
102
Dantrolene
Neuroleptic Malignant Syndrome
| Malignant Hyperthermia
103
Dantrolene mechanism
| used for "Malignant"
Inhibit Ca release @ SR Ryanidine Receptor
Messes up exc/cont coupling
104
Botox
Locally control muscle spasm after stroke
inhibit Ach release
105
Direct acting spasmolytics (act right at the NMJ)
Dantrolene (Ca release)
| Botox (Ach release)
106
TCA
inhibit reuptake of:
| NE and 5-HT
107
SSRI
inhibit reuptake of:
| 5-HT only
108
SNRI
inhibit reuptake of:
| NE and 5-HT
109
What two classes of anti-depressants inhibit reuptake of both NE and 5-HT
TCA and SNRIs
110
Dopamine reuptake inhibitor
Bupropion
111
MAOI
```
inhibit metabolism (breakdown) of:
NE, 5-HT, and DA
```
112
TCA side effects: block NE and 5HT, but also block
Histamine: drowsy, sedation
Alpha: cardiac, arrhythmia
Cholinergic: blurry vision, tachycardia, dry mouth
113
Seretonin syndrome
associate with MAOIs combined many other drugs
114
What is DOC for Depression and very safe for children/teens?
Selective Seretonin Reuptake Inhibitors-SSRIs
| (Fluoxetine [prozac], Sertraline [zoloft], Citalopram [celexa], Escitalopram [lexapro]
115
Vit D
Calcium absorption
116
Vit K
clotting
117
Vit A
vision
118
```
B1
B2
B3
B5
B6
```
```
T
R
N
P
P
```
119
T R N P P
```
Thiamine
Ribaflavin
Niacin
Pantothenic
Pyridoxine
```
120
```
B1 deficiency
(Thiamine)
```
Beriberi (neuropathy, edema)
| Wernicke-Korsakoff (neuro)
121
B1 def
Beriberi and Wernicke
122
B2,3,6 def
Chelitis, angular stomatitis, glossitis
123
Pellagra (diarrhea, dermatitis, dementia)
Niacin deficiency
| B3
124
Na def
confusion
hypotension
tachycardia
125
Taste disturbance
Zinc
126
EKG w U waves
Muscle cramping
fatigue
```
K deficiency
(potassium)
```
127
Pica
| Koilonychia
Iron deficiency
128
Too much copper
golden-brown discoloration of iris
129
EKG w peaked T waves
too much Potassium (K)
130
Which diet are we concerned about a B12 deficiency?
Vegan
131
Alcohol use disorder is associated with which nutritional deficiency
Thiamine
132
Parenteral nutrition
delivered directly into vein
133
Enteral nutrition routes for <4-6 weeks
Naso____
134
Supine abdominal X Ray
"KUB"
| Dilation
135
Upright abdominal X ray
air fluid levels
136
PA chest X ray
assess for Perforation
137
Diagnostic test of choice for Cholelithiasis
Ultrasound (gallbladder or RUQ)
138
CT A/P, when do we NOT use contrast?
When looking for Renal stone
139
Preferred test when evaluating Pancreatitis
CT
140
HIDA scan
assess function of Liver and Gallbladder
141
Barium and Fluoroscopy
X Ray movie
142
ERCP and
MRCP
bile and pancreatic ducts
Takes trained person
ERCP: diagnostic and therapeutic (invasive)
MRCP: only diagnostic (non-invasive)
143
Complication with ERCP
Pancreatitis
144
Contraindications to Colonoscopy
Active diverticulitis
145
MRCP
Not invasive!
| just for diagnosis
146
Montreal classification to diagnose GERD
reflux of stomach contents cause troublesome sx or complications
147
Hallmark sx of GERD
Heartburn (pyrosis) usually after a meal
148
Example of a med that can exacerbate GERD sx
Bisphosphonates
149
Most asymptomatic and incidental finding that can cause GERD
Hiatal hernia
150
Subtypes of hiatal hernia
Sliding- most common
| Paraesoph- need surgery, dangerous, can cause necrosis
151
What test can you use to see Hiatal hernia and Strictures?
Barium contrast esophagram
152
Best diagnostic study to evaluate mucosal injury
EGD
153
Esophogeal IMPEDENCE testing
bolus transit
154
Esophogeal MANOMETRY
fx of LES and peristalsis
| Motility disorders
155
What is considered Mild/intermittent GERD
<2 episodes per week
Use Step up therapy
H2 meds
156
What is considered Severe GERD?
2 or more episodes per week
Use Step down therapy
PPI
157
H2 blockers
For Mild GERD
| Ranitidine, Famotidine
158
When to take PPI
30 min before breakfast
159
Risks assoc w/ long term use of PPI
Infection
| Malabsorption
160
Tx of Barrett esophagus
Endoscopic Eradication Therapy
EA- endoscopic ablation
ER- endoscopic resection
161
Two main types of esophogeal CA
Adenocarcinoma
| Squamous cell carcinoma
162
White, male
obese, smoker
has Barrett
What type of CA is he likely to develop?
Adenocarcinoma
163
African american man, urban area
What type of esophogeal CA is he likely to have?
Squamout cell carcinoma
164
What is recommended in all patients with dysphagia?
Endoscopy
165
Tx for Eisinophillic esophagitis
Diet (remove allergens)
PPI
Steroid spray- SWALLOW
166
Pt has difficulty swallowing, CP that is not cardiac, and GERD that keeps coming back?
Consider esophogeal Motility disorder
167
Major motility disorders of esophagus
Hypercontractile Jackhammer
Disteal esoph spasm (DES)
Achalaisa
168
Hypercontractile Jackhammer and Distal esoph spasm (DES)
High pressure contractions in esophagus
CP usually occurs w meals
169
Tx of Jackhammer and DES
PPI
| CCB or TCA
170
Tx of Jackhammer and DES
calcium channel blocker
| tricyclic antidepressants
171
Achalasia
no contraction of distal 2/3 of esophagus and incomplete relaxation
172
Birds beak on Barium esophagram
Achalasia
173
Diagnose Achalasia
Manometry is required
174
Drinking too much alchy
Mallory-weiss syndrome (tear) in esophagus
175
Predisposing factors to Mallory Weiss
Drinking too much
| Hiatal hernia
176
Manometry required for what diagnosis
Achalasia
AND do EGD to r/o CA
