Section 3 - Last minute things that aren't sticking! (everythin until the illegal drug section.) Flashcards
Local Anesthetics - the balance between rate of ____ and rate of ____ is of clinical significance.
Absorption/Metabolism.
If absorption rate is lower than metabolic rate, then plasma levels will be ___ and so will be ___.
Lower/toxicity.
Balanced anesthesia - def
refers to use of combinations of drugs to accomplish what inhalation anesthetic can not do alone.
What are some of the drugs used for balanced anesthesia?
Short acting barbiturates, neuromuscular blockers, opioids and Nitrous Oxide, etc.
Procaine is an Ester or Amide?
Ester.
Drugs not recommended for Treating Cancer Patients - Pure Opioid Agonists - Meperidine -
toxic metabolite accumulates with prolonged use.
Drugs not recommended for Treating Cancer Patients - Opioid Agonist-Antagonists - Buprenorphine, Butorphanol, Nalbuphine, Pentazocine -
Ceiling to analgesic effects; can precipitate withdrawal in opioid-dependent patients; causes psychomimetic reactions.
Drugs not recommended for Treating Cancer Patients - Opioid Antagonists - Naloxone/Naltrexone
Can precipitate withdrawal in opioid-dependent patients - limit use to reversing life-threatening respiratory depression caused by opioid overdose.
Drugs not recommended for Treating Cancer Patients - Benzodiazepines - Diazepam, Lorazepam, and others.
Sedation from Benzos limits opioid dosage; no demonstrated analgesic action.
Drugs not recommended for Treating Cancer Patients - Barbiturates - Amobarbital, Secobarbital, and others.
Sedation from barbiturates limits opioid dosage; no demonstrated analgesic action.
Drugs not recommended for Treating Cancer Patients - Misc - Cocaine -
no analgesic efficacy, either alone or in combination with an opioid.
Drugs not recommended for Treating Cancer Patients - Misc - Marijuana
Side effects (dysphoria, drowsiness, hypotension, bradycardia) preclude routine use as an analgesic.
Drugs not recommended for Treating Cancer Patients - Misc - Brompton’s Cocktail
analgesic efficacy is no better than that of a single opioid.
WHO Analgesic Ladder - what are the 3 steps?
Step 1 - Mild to Moderate Pain (Non-opioid Analgesic)
Step 2 - More severe pain - add opioid analgesic.
Step 3 - Severe pain - substitute opioid - MORPHINE.
Non-drug treatment for pain management (5)
Heat, cold, massage, exercise, acupuncture.
Migraine - drugs to abort an attack -
opioid analgesics (aspirin like analgesics - motrin - or opioid analgesics, like Demerol), ergot alkaloids (Ergotamine) and Serotonin Receptor Agonist (Sumaptriptan)
Drugs for migraine prevention -
Beta blockers (atenolol), Calcium Channel Blockers (verapamil), Tricyclic Antidepressant (amitriptyline), Methysergide (sansert), Sodium Divalproex (depakote.)
Conventional Antipsychotic Agents - Classifications (3) and drugs!
Low - Chlorpromazine (Thorazine)
Medium - Loxatine
High Potency - Haloperidol (Haldol.)
Conventional Antipsychotic Agents - MOA -
block receptors within and outside the CNS - block Dopamine, ACH, Histamine, ETC.
Therapeutic Uses - Conventional Antipsychotics -
Schizophrenia, Bipolar Disorder, Tourette’s Syndrome, Prevention of emesis.
Conventional Antipsychotic Agents - Blocking… D2 Dopamingergic receptor
EPS, Prolactin Release
Conventional Antipsychotic Agents - Blocking… H1 Histamine -
Sedation
Conventional Antipsychotic Agents - Blocking… - Muscarinic Cholinergic -
Dry mouth, blurred vision, urinary retention, constipation, tachycardia.
Conventional Antipsychotic Agents - Blocking… - Alpha-1 Adrenergic -
Orthostatic Hypotension, Relfex Tachycardia.
Conventional Antipsychotic Agents - Blocking… - 5-Ht2 -Serotoninergic -
Weight Gain.
Tricyclic Antidepressants - toxicity.
Avoid lethal dose, only dispense one-week supply..
What is the antidote for Tricyclic Antidepressant Toxicity?
Cholinesterase inhibitor (physostigmine)
Bubroprion (Wellbutrin) Basic info, MOA, Adverse Effects -
Similar structure to amphetamines, Response 1-3 weeks, MOA - Unknown, Adverse - agitation, headache, constipation, dry mouth.
What are some treatments for benzodiazepine toxicity?
Gastric Lavage, Activated Charcoal, Flumazenil (Romazicon) - a benzodiazepine receptor antagonist , dialysis, IV fluids.
Barbiturates - for ___ depression of the CNS.
Non-specific.
Barbiturates - classification (3.) - and drugs for the categories.
Ultra-short acting - Thiopental.
Short to intermediate acting - Secobarbital.
Long-acting - Phenobarbital.
Barbiturates - MOA -
Bind to gaba receptor-chloride channel complex to..enhance inhibitor action of gaba, directly mimic actions of gaba, etc…
Since barbiturates can act as agonists, there is no end to how much they can suppress. T/F?
True!
OCD - Treatment - Drug Therapy -
Clomipramine (Anafranil)
Clomipramine - Anafranil - only ___ effective in treatment of OCD, Takes ____ to ____ weeks to see maximal improvements. It blocks uptake of __ in addition to ___.
TCA/4-12 weeks/NE, Serotonin
SSRI Drugs for OCD Treatment - 3
Prozac, Luvox, Zoloft
What are the drug choices in treating ADHD? (2)
Wellbutrin (bupropion) and Inderal (propanolol)
CNS Stimulations - used for…and also increase activity of…
ADHD, narcolepsy, obesity….. and increase activity of the CNS.
Amphetamine - CNS Stimulant - releases….
NE, Dopamine, Serotonin…
Amphetamine - uses?
Arouse mood, increase self confidence, suppress appetite and pain perception.
