pharmcology III Flashcards
what should be avoided in hepatic impairment
TCA
MAOI
which meds are safe in hepatic impairment
lithium
lorazepam
zopiclone
sertraline
citalopram
paroxetine
vortioxene
what is seen on CT in herpes encephalitis
CT changes in temporal lobes / frerior frontal too
what is the cause for herpes encephalitis
95% causes by HSV 1
symptoms of herpes encephalitis
fever
headache
sieuzre
vomiting
aphasia
cold sores
diagnosis and Rx in herpes encephalitis
MRI»_space;»
CSF raised protein
aciclovir
which antidepressants are safe for use in HIV patients
fluxoetine
paroxetine
what does prolactin increase risk of
breast cancer and oesghageal cancer
which antipsyhcotics cause raised prolactin
rispiderone
paliperdone
sulpride
all typical
amisulpide
how does doapmine work with prolactin
dopamine inhibits prolactin
what is lamotrigine used for
to prevent and manage depression in bipolar
also used for epilpsey
how does lamotrigine work
stabilises nA
blocks calcium
NMDA receptor antogreine
which other anti psychotics impact lamotrigine levels
inducer- speed enzyme so reduce level
Carbmazeine, phenytoin
inhibitor - reduce enzyme therefore increase levels
Na valproate
when is lithium contradicted
addision
brugada
heart diseases
renal impairment
what is diabetes inspidus
unresponsive to ADH vasopressin
what is used to Rx diabetes inspidaus
amiloride
indomethacin
desmopressin
what is used to monitor for ltihium toxicity
AMDISEN
when a new dose of lithium is started whas the monitoring rquirement
weekly until stable
then 3 monhtly when stable by ice but mausldey says 6 mon
what is modafinil
who for
it s used to promote wakeful attention , viligence, it is a dosapmine reuptake inhibtor
narcolepsye wthout catplexy
how does MS present
initially very unspecific
tiredness 75%
pins needles
trigmeninal neuralgia
lhermitte phenomnia
spasctic weakness
tremor
sexual dysunfction
urinary incontention
uffhoff hpenhemoa - raised body temp
optic neuritis
neuromuscular blocking drugs
depolarizing neuromuscular blocking agents (eg, succinylcholine) and nondepolarizing neuromuscular blocking agents (eg, rocuronium, vecuronium, atracurium, cisatracurium, mivacurium
name the opoid receptors
mui
gamma
kappa
name the specifc feature of each receptor
mui
analgesia, euphoria, constopation, respiratory depression , dependence
delta
anoxilytic
analgesia
kappa -mood regulator
analgesia
dysphoria
where are the dominergic cells in the brain
ventral tegemenal area
where dopamine into mucleus
which stimulis mui cells
which are the four opoid treatments seen in addictions
methadone
buprenoprhine
naletrexene
naloxone
what are the half lives for these medications
methadone 15-20 hours -mui
naloxone 30-120 mins - all receptors
naltrexene - 4-6 hours
buropjnhripine 24-42 hours
what is parkinson dx
neurodegenerative condition
recognised by the triad of : pin rolling tremor, lead pipe cogwheeel rigidity, bradykinesia
loss of doapnergic neurosn in substantia nigra
what is the management of parkinson
doapmine receptor agonist - bromcriptine, ropinirole,
levodopa
- decarboyxlase inhibitor -metabolism of levodopa into doapmine
MAOI-B selegine parkinson breakdown of doapmine secretation by neiron
amantadine
increase doapmien release
ataxia, slurred speech, confusion, diziness
what is COMT
caecinol o methyl transferase entacapone
encyme which brasks down doapmine
two medications cause pripaism
chlorpromazine
trazadone
vigabtrin is associate with wha t
visual field defects
its an antiepileptic medication
irrversible inhibitor of GABA transminase
increase GABA in CNS
varenicline and which receptor
alpha4 beta 2 nicitione receptor
downsidew of varencline
worsening MH SYMPTOMS
what are triptans
5HT1 agonists
which medication can cause nephrolithalsis
toperimate
best anti psyshotic in Renal impiarmene t
haloperidol
antidepressant in renal impairement
sertraline
citalopram
fluxetine
which mood stabiliser is OK in renal impairement and which is ci
LMOATRIGINE, VALPROATE OK
DO NOT USE LITHOUM
anyxiolics in renal impiarement
lorazepam
anti demenetia med in renal impiarement
rivastigamine
what criteria can be used for SIADH
barter and schwartz
triad in sertaonin syndrome
clonus
hyperreflexia
altered conscious state
which tool is used to help diagnose seratonin syndrome
hunters decision rules for diagnosis
usually within 2-3 doses of the medcation within 24 hours
mild to lifethreatening
hjow to treatment seratonin syndrome
withdraw cause
supportive care
5HT2 antagonist - cyprpohepatadine
benzo
fluids
ITU
Neurolpetic malginant syndrome when does it usually occur
within 2 weeks of starting an antipsychotic but usually around day 9-14
how does NMS rpesent
fever
hyporeflexia
lead pipde rigidity
leucocysosis
raised ck
Fluctating consciousness
tachycardia
confusion
rigidity
how is nMS management occurs
bromziptive dantrolene rehydration
stop for 5 days
what is chelation
binding of one drug to another forming insuoluve complex whichc annot be absorbed
an example of chelation
tetracycline binding to calcium/iron so no longer as effectiv
another was drugs can interact
compete for renal tubular transporter
therefore reducing excretion
define pharmocydnamic
pharmokinetic
drug affects body
kinetic
body on drug
synergism and antagonism
work togerther same affect e.g. apsirin and clopi
therefore increased bleeding risk
vs antagonsm e.g. vitamin K and warfarin -opposing effects
what can occur at a receptor
interacton at a receptor leading to allosteric modulation
drug bindign at a site on a receptor
different to alloteric which changes shape and activity
what does zopiclone work on
cyclopurroline
ci IN RESP WEAKNESS E.G. MYantha gravis resp failure,
what does zopiderm work on
BZ1 receptors
which medicaiton has gucometation directly
lorazepam
what is 10mg diazepam equaivelent to
1mg lorazepam
how is the ga ba receptor activated
alpha and beta subunits proteins form the bindign site for GABA
activation occurs when conformational change to the central pore
chloride ions enter the neuron and cause hyperpolarisation to neuron
what is Daridorexant
Daridorexant is an orexin OX1- and OX2-receptor antagonist that blocks the action of orexin neuropeptides, thereby decreasing wakefulness.
not in narcloepsy
mechanism of recreational drugs
monamine transporter
ectasy
cocaine
amphetamines
which drugs intefere with g coupled protein receptors
GHB
cannoboids
opoids
which drugs work on 5ht
hallucinogens
LSD
DMT
nitrious oxide
which drugs act on canniboid receptor
THC
Which act on GABA
benzo
what is difference between A and b mAOI
A sertonin noradrenaline
B phenyloaline tyrtamine by B
what happens with MAOI and chesse
cheese reaction
HTN
tyrosine in foods
key facts aboout pregablin
receptor
elimination
kidney unchanged
increased use leads to tolerance
alpha 2 delta subunti
high bioavailability
olazapine by IM
where is it given
name of it
dose
Olanzapine pamoate / embonate c
significant weight gain and is associated with inadvertent intravascular injection or post injection syndrome.
Only gluteal injection is licensed (deltoid injection is less effective).
The maximum dose is 300mg every 2 weeks which is equivalent to 20 mg / day.
management of antidepressant induced hyponatremia?
Demeclocycline.
Subutex
burphrnoine alone
what is suboxone
buprhohine and nalaxone
4;`1
what can stopping paroxetine do
cause suicidal thoughts
which medications can impact lamotigine levels
increase valproate
decrease the pill
e first SSRI to be developed
zimeldine
what is allosteric modulation
Allosteric modulation involves a drug binding to a site on a receptor that is different from the active site (allosteric site). This binding can change the receptor’s shape and activity, either enhancing (positive allosteric modulation) or inhibiting (negative allosteric modulation) the effect of the primary ligand.
P
what are positive allosteric modulation
positive allosteric modulators (PAMs): These enhance the effects of the primary ligand. For example, benzodiazepines act as PAMs at the GABA-A receptor, increasing the effect of the neurotransmitter GABA and resulting in sedative and anxiolytic effects.
what are negative allosteric
Negative allosteric modulators (NAMs): These inhibit the effects of the primary ligand. For example, some experimental drugs that act as NAMs at the mGluR5 receptor are being studied for the treatment of disorders like anxiety and depression by dampening overactive glutamatergic signalling.
lowest risk of orthostatic hypotension
senapine and lurasidone.
zopiclone on which receptor
gaba A
what does CYP26 encode
CYP2D6 is a gene that encodes for an enzyme called debrisquine hydroxylase.
Chlorpromazine synthesis = Charpentier (sharpentier)
Chlorpromazine introduction = Delay and Deniker
