Pharm2 Sedative/Hypnotic; Anticonvulsants Flashcards
CI: porphyria
barbs
methohexital and thiopental?
barbs
nonbenzos - main use?
- decreases rem?
- no effect on rem?
- long-term insomnia?
insomnia
zolpidem (ambien)
zaleplon
eszopiclone
misc sedative/hyp- has become a street drug?
meprobamate
misc sedative/hyp for GAD- CAN DRINK ALC
buspirone
only other for long term insomnia (besides eszopiclone); IS ONLY SED THAT’S NOT a ?
ramalteon, controlled substance!
IBS, high strung women w/ high BP?
diazepam
benzo PK
in liver no ? but extensive ?
induction, metabolism
benzos
- T1?
- near delivery?
fetal abn
floppy baby syn/hypotonia
main a/e in benzos?
cognitive impairment and dec motor fxn
2 drugs for hepatic disease? have no active metabolites/do not undergo?
oxazepam, lorazepam
glucoronidation
PO/IV for dental surgery, endoscopy, cardioversion? CI in ?
diazepam (also status eli, anxiety, alc w/drawal
closed angle GLC, m gravis
no active met, int half life, good for w/draw sx
lorazepam (everything else same as diazepam)
oral syrup for kids that would ned IV sedation; anxiety for med procedures?
black box?
midazolam
resp arrest
acute mania adjunct, long 1/2 life? also?
clonazepam
myoclonic, absence seizures
barbas
NOT ?, ?, or ?
can cause ? in elderly
analgesia (actually increases pain sensation!), anxiolytic, hypnotic
PARADOXICAL excitement
in barb OD inc excretion of drug by?
alkalinizing urine
used in convulsive d/o, status epi, alc w/draw, STRONG ODOR/BAD TASTE- can give IM/rectal
paraldehyde
insomnia for institutionalized, bedtime sed** (short half life), ‘knockout drops/slipping one a Mickie’
choral hydrate
slow onset- 1 week to kick in-GAD? can drink alc NO CROSS TOL/little abuse or addiction MOA? CI? safe in?
buspirone
partial agonist at 5HT1a; D2 rec
kidney/liver dz
preggo!
binds MT1/MT2 melatonin rec to reg circadian rhythm?
ramalteon
tx agoraphobia?
alprazolam
secondary TC different in Tx from simple/complex bc they also use ? and ?
phenobarb
primidone
used only for complex partial?
clorazepate (benzo)
primidone (barb) is met into ? actually like 3 drugs
PEMA, PHB
? is used to tx west syn (infantile spasms)
vigabatrin
misc- ok in hepatic and liver dz?
gabapentin (wt gain)
levetiracetam
glycine antagonist on NMDA; misc anticonvulsant? s/e?
felbamate
aplastic anemia
enhance GABA for anticonvulsants?
benzos barbs tigabine vigabatrin valproate
inhibit Ca channels?
zonisamide
ethosuximide
increases Na channel INactivation
- only works on active channel?
- also inh Ca channels
- at low levels- first order kin but at high levels?
- protein bound?
- monitor?
- main s/e?
- still used bc ?
phenytoin
zero order
90%
clotting factors (plasma levels), immunosuppression
-osteoporosis, nystagmus, ataxia; less common- hirsutism, gingival hyperplasia
-QID, efficacy, experience
fosphenytoin
- more exp and safer
- only ?
parenteral
carbamazepine
- dont take w/ ?; will reduce levels
- dont take w/?; toxicity
grapefruit, st john’s wort (induces CYP3A4)
macrolides, CCB, cimetidine, propxyphene (inhibit CYP3A4)
clonazepam, phenytoin, lamotrigine, valproate, carbamazepine?
drugs metabolized by CYP3A4 (drug int)
oxcarbazepine
-unlike carbamazepine, no?
autoinduction
no active metabolites!
partial onset in older than 16?
no drug interactions!
100% BA
lacosamide
originally antifolate? used in ? safe in ? and ? no active metabolites only drug int? s/e?
lamotrigine ALL seizures (adjunct bc new) elderly, preggo valproate rash- SJS
actions: inhibit Na channel conductance increase GABA antagonize kainite and AMPA RECENT BUT RARE s/e?
topiramate
myopia, GLC (immediate drug removal!)
actions:
inhibit Na/K conductance
dec Ca influx
dec glutamate excitability
bad s/e?
still used in developing ctrs bc?
phenobarbital
sedation
cheap
derivative of GABA uptake inhibitor- keeps GABA in synapse? (GABA transporter-1)
? acid
only ? seizures
tiaGABine
nipecotic
partial
IRREVERSIBLE inhibition of GABA; toxic SO restricted to ?
neurotoxicity and visual impairment
vigatrabine Wests syn (infantile spasms)
treats absence when it has TC too?
valproate
adjunct in partial seiz for those >12yo?
zonisamide
little/no action on GABA but looks exactly like it?
gabapentin
good for liver and kidney dz? 2
also have NO DRUG INT
gabapentin (pregabalin)
levetiracetam