psychopharm Flashcards
most potent inhibitor of CYP 450
fluoxetine
biggest anesthesia concern with SSRIs
antiplatelet activity! ( inhibition of CYP450 and serotonin syndrome also other concerns)
what monoamine does MAO B block
phenyethylamine
most common MAOI SE
orthostatic HoTN, especially prominent in the elderly
MAOI OD tx
will look like excessive sympathetic discharge- tachy, hyperthermia, mydriasis, sz–>coma. tx supportive, try gastric lavage or dantrolene
phenothaizines and thioxanthenes
for generalized anxiety disorder, but takes two weeks to work. non benzo, partial agonist at serotonin receptor. no direct effect on GABA (no cross reactivity with benzo, barbs, ETOH)
droperidol metabolism
liver, clearance is perfusion dependent, accumulation of drug with decreased hepatic blood flow
drug that causes dysphoria
butyrphenones
2nd generation antipsychotics
MOA-antagonize D2 and serotonin receptors, metabolized by CYP450
all can cause extrapyramidial symptoms
risperidone- severe HoTN, active metabolite, zip- prolonged QT, torsaddes, olanzapine- severe HoTN, thrombocytopenia
therapeutic and toxic lithium range
therapeutic range: 1-1.2 mEq/L
toxic: 2.5 mEq/L
amiloride
drug protective against lithium kidney damage, a potassium sparing diuretic- can decrease urine volume
drugs to avoid with lithium
-NSAIDs, esp ketorolac, anesthetic requirements may be decreased esp, CNS agents like benzos, induction agents, action of NMB may be PROLONGED
seizure drugs that do not affect CYP450
keppra and gabapentin
seizure drugs that induce CYP450
phenobarb, phenytoin, carbamezapine
phenytoin administration
precipitates. do not mix with anything or give IM, do not run faster than 50mg/min or 1-3mg/kg/min
COMT inhibitors
entacapone, added to sinemet when the effects wane
tolcapone
levodopa lab measurements
can cause false positive test for ketoacidosis, transient increase in BUN, increase in liver enzymes
decarboxylase inhibitors
carbidopa, benserazide
synthetic dopamine agonists
longer 1/2 life than levodopa, no enzymatic conversion required. parlodel (ergot), pramipexole, ropinerole (nonergot)
anticholinergics for parkinsons
trihexyphenidyl and benztropine (cogent). help correct balance between Ach and dopamine
amantadine
enhances dopamine release into the synapse and delays reuptake into the nerve endings, an antiviral drug
alzheimers disease patho
deficits in cholinergic signaling and cholinergic neuron loss in hippocampus and frontal cortex (executive functioning). decreases in choline acetyltransferase, Ach, acetyllcholinesterase, choline transport, NaCh receptor expression, amyloid plaques, neurofibrillary tangles
alzheimers 2 drug classes
cholinesterase inhibitors, NMDA receptor antagonists
