Term
| Drugs for Tonic Clonic or Partial Seizures |
|
Definition
Carbamazepine
Phenytoin (dilantin)
Valproic acid |
|
|
Term
| Drugs for Absence Seizures |
|
Definition
Ethosuximide
Clonazepam
Valproic |
|
|
Term
| Drugs you shouldn't use in Absence seizures |
|
Definition
Carbamazapime
Gabapentin
Tiagabine |
|
|
Term
| Drugs used for Myoclonic Seizures |
|
Definition
|
|
Term
| Drugs 1st line: Complex Partial with Secondary Generalized Seizure |
|
Definition
|
|
Term
| Drugs for Status Epilepticus |
|
Definition
1. Lorazepam
2. Phenytoin or fosphenytoin
3. more phenytoin or fosphenytoin
4. phenobarbital
5. more phenobarbital
6. Anesthesia Midazolam or propofol |
|
|
Term
|
Definition
one of the best tolerated anticonvulsants
reduces maximal activity of brain stem centers for tonic phase of tonic clonic seizures |
|
|
Term
| 75mg Fosphenytoin sodium IV is equivalent to ________ phenytoin sodium oral |
|
Definition
|
|
Term
phenytoin/ fosphenytoin (dilantin/cerebyx)
used in 3 types of seizure disorders: |
|
Definition
1.partial seizures with or with out secondary generalizations
2. generalized tonic clonic seizures
3. status epilepticus |
|
|
Term
| Gingival hyperplasia is associated with what drug |
|
Definition
|
|
Term
| Phenytoin is highly bound to what? |
|
Definition
| protein: must adjust phenytoin dose for hypoalbuminemia |
|
|
Term
| effective as monotherapy and adjunctive therapy for: simple partial, complex partial, partial with secondary generalized and generalized tonicclonic |
|
Definition
|
|
Term
What am I?
Atypical absence seizures may worsen in frequency
Do not use to relieve aches or pains
It induces its own metabolism eats its own tail |
|
Definition
Carbamazepine- Tegretol
also used in Bipolar depression |
|
|
Term
Used with all seizures
Not an inducer of hepatic P 450 it is an inhibitor
Most commonly associated with hepatoxicity
It is combined with lamotrigine often |
|
Definition
| Valproate Sodium (Depakote) |
|
|
Term
Indicated for Absence (petit mal) seizures
Most common SE: Nausea |
|
Definition
|
|
Term
Add-on therapies for partial seizures with or with out secondary generalization in adults.
or with Lennox Gastaut syndrome in children |
|
Definition
Lomotrigine (lamictal)
Felbamate (Felbatol) |
|
|
Term
| Lennox Gastaut Syndrome associated with a triad what is it |
|
Definition
| intractable seizures, mental retardation, characteristic EEG of spikes and low frequency waves different from petit mal |
|
|
Term
| Black box warning for Lamotrigine |
|
Definition
| skin rash affecting 10-12% of patient taking rash progresses to erythema multiforme, stevens johnson syndrome or even toxic epidermal necrolysis |
|
|
Term
| Structurally related to GABA but does not act at the GABA receptor site to cause opening of CL channels |
|
Definition
|
|
Term
| Has good analgesic activity for neuropathic pain and also used in spasticity, RLS, tremors, mood disorders and anxiety |
|
Definition
|
|
Term
| Monotherapy and adjuctive therapy in adults with partial onset seizures and adjuctive therapy in children with partial onset seizures |
|
Definition
Oxcarbazepine (Trileptal)- Like carbamazepine, exert their anticonvulsant effects by blocking the spread of sizures rather than by raising seizure threshold.
unlike carbamazepine, no auto-induction occurs |
|
|
Term
| Drug used to treat refractory partial seizures and tonic clonic: Black Box warning for aplastic anemia (death)- very restricted now |
|
Definition
|
|
Term
drug does not appear to affect known excitatory or inhibitory neurotransmitters but does inhibit burst firing w/o affecting normal neuronal activity
Adjuctive therapy for partial onset seizures |
|
Definition
|
|
Term
| drug that selectively inhibits the neuronal and glial reuptake of GABA and enhances GABA mediated inhibition at both the GABA-A and GABA-B receptors |
|
Definition
|
|
Term
| extravasation into tissues and can cause hypotenstion at high doses |
|
Definition
|
|
Term
| Approved for may seizure types and migrain headaches, diabetic neuropathy, essential tremors, and bipolar |
|
Definition
|
|
Term
| drug is a sulfonamide used for adjuctive therapy for partial onset seizures in adults |
|
Definition
|
|
Term
| _______ increase the frequency of opening of CL channels whereas _______ increase duration of openings of these channels |
|
Definition
| Benzodiazepines Barbiturates |
|
|
Term
| Gabapentin has low bioavailability. With increased doses the bioavailability does what?_____ with a high protein meal the bioavailability does what?______ |
|
Definition
|
|
Term
| Activation of metabotropic receptors located presynaptically causes inhibition by decreasing the inward flux of what? |
|
Definition
|
|
Term
| General anesthesia is essential to surgical practice because it renders patients |
|
Definition
| analgesic, amnesic, and unconscious while causing muscle relaxation and suppression of undesirable reflexes |
|
|
Term
| Two principle classes of anesthetics? |
|
Definition
| inhalation and intravenous |
|
|
Term
| Minimal Alveolar Concentration : |
|
Definition
| The Potency of the drug is a pharmacological property - a pharmacodynamic effect. |
|
|
Term
| ! Potency is described in inhalational anesthetics by the term |
|
Definition
| MAC: Minimal Alveolar Concentration |
|
|
Term
| What people forget about MAC.... MAC does not equal.... |
|
Definition
| anesthesia...as 50% of patients will move at this concentration |
|
|
Term
|
Definition
Pre-anesthetic Medication
Muscle relaxants |
|
|
Term
| Smaller MAC value = ______ potency |
|
Definition
|
|
Term
| Higher Lipophilicity of an inhaled anesthetic means a higher/lower concentration is needed for the effect. |
|
Definition
|
|
Term
| Tissue uptake of Anesthetic depends on: |
|
Definition
1. pressure Gradient of gas in blood
2. solubility/storage capacity of various tisues |
|
|
Term
|
Definition
Sex
Acid-Base status of patient |
|
|
Term
|
Definition
The type of noxious stimuli applied
Of BMI of patient |
|
|
Term
|
Definition
| Age: higher dose in infants and lower in geriatric patients |
|
|
Term
| Highly perfused tissues rapidly by inhaled anesthetic: |
|
Definition
| Brain, Heart, Liver, Kidney, endocrine glands. |
|
|
Term
|
Definition
1. Induction
2. Maintenance
3. Recovery |
|
|
Term
|
Definition
Stage 1: Analgesia
Stage 2: Excitement
Stage 3: Surgical Anesthesia
Stage 4: Medullary paralysis |
|
|
Term
|
Definition
1. potentiating the action of an inhibitory ionophore (the GABAa receptor)
2. Blocking the action of excitatory ionophores (nicotinic, Ach and NMDA receptors) |
|
|
Term
| The use of Halothane and Succinylcholine is associated with the highest incidence of ? |
|
Definition
|
|
Term
| Inorganic gas that is a general anesthetic |
|
Definition
Nitrous oxide: laughing gas
start w 100% O2 gradually add 5-10% increments |
|
|
Term
Inhaled Organic Gen Anes. with MAC= .75% potent anestetic weak analgesic
vagomimetic. Drug of choice for children |
|
Definition
|
|
Term
Inhaled organic Gen Anes. MAC=1.68%
contraindicated w kidney failure
fewer arrhythmias than halothane
disadvantage: causes CNS excitation so may cause seizures |
|
Definition
|
|
Term
| organic inhaled gen anesth for OB procedures |
|
Definition
|
|
Term
| Inhaled organic Anesthetic MAC=6% Very pungent |
|
Definition
|
|
Term
| Intravenous Anestetic Barbituates: |
|
Definition
short Acting, they are very alkaline so avoid extravastion=thrombophlebitis
add scopolomine to decrease coughing or laryngospasm
Pentobarbital, Thiopental, Methohexital |
|
|
Term
| Dissociative Intravenous Anesthetic causes what? |
|
Definition
catonia, amnesia and analgesia but not true surgical anesthesia: used in OP procedures children and burn dressings
Ketamine (Ketalar) |
|
|
Term
|
Definition
|
|
Term
| IV anesthetic Benzodiazepine |
|
Definition
Midazolam (Versed)
short acting
conscious sedation
potent
used for sedation, anxiolysis, amnesia |
|
|
Term
| hypnotic with no analgesic used as a supplement to N2O |
|
Definition
|
|
Term
Milk of Amnesia
contraindicated in children <3 yo
used for minor surgical procedures |
|
Definition
|
|
Term
conopeptide found in snail: Conus Magus
contraindicated Hx of psychosis
no affinity for opioid receptors |
|
Definition
|
|
Term
| Most effective against throbbing pain than stabbing pain |
|
Definition
|
|
Term
inhibits cox enzyme which inhibits prostaglandins which keeps pain receptors from becoming sensitive to bradykinin.
also prevents thromboxane A-2 at low doses
Zero order kinetics |
|
Definition
|
|
Term
|
Definition
Celebrex:
Drug to drug interactions: Lithium toxicity, inc. effect of digoxin, decr effect of antiHTN. Contraindicated in patients with renal impairment and pregnancy |
|
|
Term
Analgesic that has minimal antiiflammatory effects
appears to work by elevating pain threshold
good antipyretic
no effect of CV system
no drug interactions except alcohol |
|
Definition
|
|
Term
Anticonvulsant Adjunvant Analgesic
1st line for neuropathic pain
start 100-300 mg/day up to 600-3600 mg/day |
|
Definition
|
|
Term
| Anticonvulsant Adjunvant analgesic used in cancer patients |
|
Definition
|
|
Term
Adjunvant analgesic for refractory neuropathic pain, cancer pain
longterm use is limited to inflammation |
|
Definition
|
|
Term
alpha 2 adrenergic Agonist for postherpatic pain, Neuropathic pain with diabetic neropathy
max dose 100mg TID
dose adjust 4 renal impairment |
|
Definition
|
|
Term
NMDA Receptor agonist
for dissociate anestetic |
|
Definition
|
|
Term
name some pure opiod agonist:
Do pure agonist have a ceiling effect?
can they reverse or antagonize the effects of other full agonists? |
|
Definition
codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone
No ceiling effect
No they do not reverse or antagonize full agonists given simultaneously |
|
|
Term
| partial agonists are selective agonists at the _________receptor with limited efficacy |
|
Definition
|
|
Term
| mixed agonist-antagonists are weak antagonists at the ____ receptor and agonists at the _______ receptor |
|
Definition
|
|
Term
| because of their ceiling effect for analgesia and their potential for reversing analgesia from pure agonists in physically dependent patients the ________________ subclass of drugs are not preferred for the treatment of chronic pain |
|
Definition
|
|
Term
| conventionaly used for moderate pain in patients with limited opiod exposure |
|
Definition
| codeine, hydrocodone, tramadol |
|
|
Term
| conventionaly used for moderate-to-severe pain |
|
Definition
| fentanyl, hydromorphone, morphine, methadone, oxydocone |
|
|
Term
| with opioids there is no maximal _______ or _______dose |
|
Definition
| ceiling or correct. titrate up slowly to get good pain control with out SE |
|
|
Term
|
Definition
| Asa, Acetaminophen, NSAIDs +/- Adjuvants |
|
|
Term
who step ladder
Moderate Pain |
|
Definition
APAP/ Codeine, hydrocodone, oxycodone,
Tramadol
+/- Adjuvants |
|
|
Term
Who Step Ladder
Severe Pain |
|
Definition
Morphine, Hydromorphone, Methadone, Levorphanol, Fentanyl, Oxycodone
+/- adjuvants |
|
|
Term
| 30 mg Morphine PO/PR is = to how much SC/IV/IM |
|
Definition
|
|
Term
| 4-8mg PO/PR of Hydromorphone = to ______ SC/IV/IM |
|
Definition
|
|
Term
| 20mg Oxycodone PO/PR is = to ______SC/IV/IM |
|
Definition
| Zero there is no Parenteral dose |
|
|
Term
| 20mg Methadone PO/PR = to ___________ SC/IV/IM |
|
Definition
|
|
Term
| when switching drugs the equianalgesic dose must be reduced by 25 to 50% the exceptions to this are |
|
Definition
| Transdermal Fentanyl (not reduced) and methadone (reduced by 75% to 90%) |
|
|
Term
Strong Opioid Agonist
can cause Euphoria, Emesis, decreased GI motility, contraindicated in severe Brain injury
decreases testosterone and cortisol levels |
|
Definition
|
|
Term
| Strong synthetic opioid agonist, long acting, potency similar to morphine, with less euphoria than morphine can be addicting, used in addiction programs |
|
Definition
|
|
Term
Synthetic opioid agonist, greatest affinity for Kappa receptors, Absolute contraindication with MAOIs
Used for acute pain |
|
Definition
|
|
Term
80x more potent than morphine, related to meperidine,
used in anesthesia, in cancer patients |
|
Definition
Fentanyl
patch (duragesic)
Actiq for break thru cancer pain |
|
|
Term
| strong opioid analgesic and antitussive |
|
Definition
|
|
Term
used in combo with APAP or aspirin
mod-severe pain
can have cross allergenicity to opiods |
|
Definition
|
|
Term
mild to moderate pain
usually in combo w APAP
toxicities in abuse:
highly toxic w other CNS depresseants including ETOH
caution in depressed or suicidal patients |
|
Definition
| Propoxyphene (Darvon, Darvocet) |
|
|
Term
effective orally
mild to moderate pain
Class II alone
used in combo tylenol
commonly used for antitussive |
|
Definition
|
|
Term
Mu opioid agonist and is a schedlue II controlled substance
for relief of mod to severe pain in paitents 18 or older
contraindicated pts with respiratory depression, acute or severe bronchial asthma or hypercapnia
seritonin sydrome |
|
Definition
|
|
Term
potent analgesic, weakly antagoizes the effects of morphine, meperidine and other opiates at the mu opid receptors. Can pass into fetal circulation
effects are on kappa and delta receptors |
|
Definition
| Pentazocine (Talwin/ TalwinNX) |
|
|
Term
| semisynthetic centrally-acting opioid analgesic derived from thebaine. Has high affinity binding of CNS opiate receptors. High affinity for the mu receptors and dissociates from them slowly giving its long duration of action and low physical dependence |
|
Definition
|
|
Term
| used for complete or partial reversal of narcotic depression including respiratory depression, induced by opioid including natural and synthetic narcotics, propoxyphene, methadone, nalbuphine, butorphanol and pentazocine |
|
Definition
|
|
Term
| pure opioid antagonist, reversibly blocks the subjective effects of IV opiods. It competes binding at opioid receptprs. before using be sure patient is heroin free for 7-10 days(so you don't elicit withdrawl symptoms. |
|
Definition
|
|
Term
| Rapid reversal of opioid effects with minimal reversal of analgesia |
|
Definition
|
|
Term
name the opioid receptor:
analgesic, respiratory depression, euphoria, reduced GI motility |
|
Definition
|
|
Term
name the opioid receptor:
analgesic, dysphoria |
|
Definition
|
|
Term
| possibly analgesics, positive reinforcing effects |
|
Definition
|
|
Term
|
Definition
noradrenergic and seretonergic
Lipase Inhibitor |
|
|
Term
| example of an noradrenergic agent for wt loss |
|
Definition
Phenylpropanolamine (Acutrim Dexatrim)
affects the brain's appetite center |
|
|
Term
| Example of Serotonergic agent for wt loss |
|
Definition
Fenfluramine and Dexfenfluramine (fen/phen, Redux)
affect the brain's satiety center |
|
|
Term
| lipase inhibitor decreases as much as one third the amount of dietary fat absorbed by GI tract: approved for long term use |
|
Definition
|
|
Term
|
Definition
| 120 mg 3x a day with meals containing fat: consuming more than 100 grams of fat could cause extreme SI and GI discomfort |
|
|
Term
| drug binds to lipase enzyme. without lipase the fat is not broken down and is excreted in the feces |
|
Definition
|
|
Term
| With this drug you can get increased flatus, oily spotting, fat soluble vitamins may be malabsorbed, daily multivitamin is recommended |
|
Definition
|
|
Term
This wt loss drug suppresses appetite by inhibiting the reuptake of NTs NE and 5HT.
Indicated for obese with BMI at least 30: approved for longterm use
this drug also accelerates peripheral nrg expenditure |
|
Definition
| Meridia: Sibutramine Hydrochloride |
|
|
Term
| Main SE of Sibutramine: Meridia |
|
Definition
| increases in Bp and Hr which are small but may be some concern. Monitor Bp |
|
|
Term
| Sympathomimetic amine like amphetamine for wt loss: one 30mg dose QD adequate depression of appetitie for 12-14 hrs take in morning around 10am avoid evening: wt loss 10-11 pounds |
|
Definition
Phentermine (Adipex-p, Fastin, Ionamin, Obenix, phentride, phentercot, teramine zantryl)
tolerance develops rapidly, abuse, preg cat C, unsafe with breast feeding |
|
|
Term
Sympathomimetic wt loss drug: actions include some CNS stimulation and elevation in BP.
indicated in the management of exogenous obesity as short term adjuct a few weeks with calorie reduction: |
|
Definition
| Diethylpropion (Tenuate and Tenuate Dospan) |
|
|
Term
| Wt loss drug: Stimulates beta-adrenergic receptors, inhibits the feeding center (lateral hypothalmus), stimulates satiety cntr in ventromedial hypothalmus, An |
|
Definition
| Mazindol (Mazanor, Sanorex) |
|
|
Term
| What is the % of wt loss that occurs with any single drug? |
|
Definition
|
|
Term
|
Definition
AGB ( adjustable Gastric Band)
VBG (vertical band gastroplasty
RNY (gastric bypass
BPD Biliopancreatic diversion
DS Duodenal switch |
|
|
Term
| Name the 3 psychomotor Stimulants |
|
Definition
| Caffeine, Theobromine, Theophylline |
|
|
Term
| One of the most toxic of all poisons? |
|
Definition
Nicotine: low dose arousal and relaxation at high doses respiratory paralysis
triggers the release of NE, Epi, and DA |
|
|
Term
what is the antidote to Cocaine?
what can be used to treat arrhythmias from too much cocaine |
|
Definition
|
|
Term
used for narcolepsy and ADHD,
blks reuptake of DA and NE from synapse increasing concentratin in cerebral cortax and RAS and stimulates the release of catecholamines from storage |
|
Definition
|
|
Term
| Lisdexomfetamine Vyvanse: Black Box warning: |
|
Definition
High abuse
max dose 70mg qd |
|
|
Term
drug for ADHD and narcolepsy
mild CNS stimulant blds reuptake of DA
can cause growth retardation/delayed growth |
|
Definition
| Methylphenidate HCL- Ritalin |
|
|
Term
drug increases alertness associated with narcolepsy
memory improving and mood brightening psycho stimulant
preg cat C |
|
Definition
|
|
Term
| help with wakefullness in pts with Obstructive sleep disorder |
|
Definition
|
|
Term
drug for ADHD
selective NRI
watch out for suicidal tendencies |
|
Definition
Atomoxetine HCL
(Straterra) |
|
|
Term
| Hallucinogen Lysergic acid diethylamide |
|
Definition
|
|
Term
| Phencyclidine what is it? |
|
Definition
PCP angel dust
overdose can be fatal |
|
|
Term
| drug for pain associated with metastatic carcinoma as potent as morphine |
|
Definition
|
|
Term
| tolerance to opiods leads to tolerance to analgesic, euphoric, sedative actions, emetic effects but not to |
|
Definition
| constipating effects or miotic actions |
|
|
Term
| variations in analgesic response attributed to genotypic polymorphisms |
|
Definition
|
|
Term
| can be used in pts with pulmonary edema from LHF: decreases the perception of SOB, relief of anxiety and reduction in cardiac preload |
|
Definition
|
|
Term
| detoxification during withdrawl from physiologic dependence on barbiturates, benzos or eTOH involves long acting sedative hypnotics with dose tapering |
|
Definition
| Diazepam or chlordiazepoxide |
|
|
Term
| drug of choice for myoclonic seizures without causing drowsiness |
|
Definition
|
|
Term
| target plasma concentrations for valproate sodium |
|
Definition
50-100mcg/ml
toxic > 200mcg/ml |
|
|
Term
| anticonvulsant: serum concentration is reduced by binding to albumin |
|
Definition
|
|
Term
| inhalation anesthetic with the fastest onset of action is |
|
Definition
|
|
Term
| used estensively in anesthesia for day surgery: antiemetic effects and recovery more rapid than that after use of IV drugs |
|
Definition
|
|
Term
| primary generalized tonic clonic seizures |
|
Definition
| valproic acid, topiramate, or lamotrigine |
|
|
Term
| 1st line partial onset seizures |
|
Definition
|
|
Term
| Anticonvulsants that are broad spectrum |
|
Definition
Valproic acid, lamotrigine, topiramate, or felbamate(last resort)
myoclonic, lennox gastout, primarily generlized tonic clonic |
|
|
Term
| Cardiac output and blood pressure are reduced most by this general anesthetic |
|
Definition
|
|
Term
| ventilatory response to CO2 is blunted during anesthesia with what drugs? |
|
Definition
| All volatile anesthetics and morphine like opiods dcrease the sensitivity of chemoreceptors in the respiratory centers of the brain stem to CO2 blunting CO2 response |
|
|
Term
| MAC of an inhalation anesthetic is higher |
|
Definition
| in an infant than in an elderly patient |
|
|
Term
| A competitive receptor antagonist is available for reversing the undesirable postoperative effects of: |
|
Definition
|
|
Term
| advantages of fentanyl over morphine for the induction or maintenance of anesthesia include |
|
Definition
|
|
Term
| NMDA receptor Agonist: adjunvant analgesics |
|
Definition
| Ketamine,dextromethopham, amantadine |
|
|
