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CNS agents
NOVA spring
116
Medical
Graduate
03/05/2011

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Term
name all 6 drugs that are SSRI
Definition
Fluoxetine, Paroxetine, Sertraline, Fluvoxamine, Escitaloprm, & Citalopram
Term
what are uses of SSRI?
Definition
Major depression, anxiety disorders, obsessive-compulsive disorder, eating disorders, & premenstrual dysmorphic disorder
Term
what is the main SE of SSRI?
Definition
sexual dysfunction, GI upset, loss of appetite and weight loss, tremor.
Serotonin syndrome
Term
Fluoxetine is unique and could enhance effects of other drugs by inhibiting what
Definition
cytochrome P450
Term
3 drugs that are MOIs
Definition
Tranylcypromine, phenelzine, & isocarboxazid
Term
what three thing monominase oxidase metobolize
Definition
NE, Serotonin, and dopamine
Term
what is a DOC for atypical depression?
Definition
Tranylcypromine, phenelzine, & isocarboxazid
Term
pt has agoraphobia and stays home all day. what drug would you give him to cope with his condition?
Definition
MOIs: Tranylcypromine, phenelzine, & isocarboxazid
Term
what could be used for panic disorder?
Definition
tricyclic anti-depressant,
MOIs
or benzodiazepines
Term
why do pt on MOIs get hypertensive crisis?
Definition
they eat tyramine-containing food. inhibition of M. oxidase also prevents tyramine metabolizism. so tyramine builds up in the gut and stimulates rlz of epi and NE causes HTN crisis.
Term
what is the name of drug that inhibits monoaminase oxidase B? what is it used for?
Definition
Selegiline. it inc level of dapamine -- used as adjunct tx for parkinson
Term
give 4 drugs that are heterocyclic anti-depressant?
Definition
• Heterocyclic Anti-Depressants
o Drugs: Nefazodone, Mirtazapine, Venalfaxine, & Maprotiline
Term
waht two neurotransmitter reuptake are blocked by heterocyclic anti-depressant?
which heterocylic doesnt block the reuptake but works differently?
Definition
 NE and Serotonin - Nefazodone, maprotiline, & venlafaxine

-->  Mirtazapine: Inhibits activation at a2-adrenergic receptors & at 5HT2 receptors thereby increasing the release of norepinephrine & serotonin
Term
what two durgs are used for generalized anxiety disorder?
Definition
Heteroxyclic anti-depressant (4drugs)
and
Buspirone
Term
if i put pt on effaxor (venlafaxine), what is the SE that i would tell him/her to watch for.
Definition
tachycardia and HTN
Term
what are 1st gen tricyclic? 2nd gen
Definition
o Drugs:
 1st Generation: Desipramine, Nortriptyline, Imipramine, Amitriptyline, & Doxepin
 2nd Generation: Amoxapine, Trazodone, & Bupropion
Term
tricyclic anti depressants blocks what two neurotrnas..
Definition
sero and NE
also inhibit muscarinic, histamine, & a-adrenergic receptorsm
Term
12 yo boy is bedwetting more than 3 times a week. he also seems depress. what medication would he be given?
Definition
tricyclic anti-depressant
Term
if i want to give pt one who is depressed and suffer from insomnia, which tricyclic would be appropriate. what would you tell that pt to watch for as a SE.
Definition
Trazodone - priapism
Term
what class drug are good for chronic pain syndrome?
Definition
tricylic anti-depressant
Term
what are SE of tricyclic anti-depressant
Definition
sedation, cardiac arrhythmias postural hypotension, urinary retention, dry mouth, constipation, blurred vision
Term
with MOIs what two class drug should not be used?
Definition
SSRI and TCAs
Term
what drug is used as mood stabilizer and bipolar disorder?
Definition
Lithium (ppt: first line agent for acute mania and contination tx.)
Term
young female very sexually active and not on BC is suffering from bipolar disorder. what medication is good for her condition?
Definition
Atypical anti-psychotics -- becz what if she becomes pregnant and she is on Lithium and valporic acid -- then u got a big problem
Term
schizoaffective is tx with only one drug from our list which one is that
Definition
Lithium
Term
schizophrenia is tx with 3 drugs from our list what are they
Definition
Lithium
typical anti-psychotics (haloperidol and fluphenazine)
atypical anti-psychotics
Term
what 4 main SE of lithium? which one is most common
Definition
Tremor(most common), hypothyroidism
nephrogenic diabetes insipidus
leukocytosis
Term
what should be done to avoid lithium intoxication?
Definition
check therapeutic drug level every month..
it has narrow therapeutic window
Term
block of D2 receptor
Definition
Typical anti-psychotics: Haloperidol & Fluphenazine (both high-potency drugs) & chlorpromazine & thioridazine (both low-potency drugs)
Term
what else is inhibited than D2 by haloperidol like drugs?
Definition
H1 receptor, cholinergic and adrenergic receptors.
Term
Pt with schizophrenia is having delusions and hallucination in the hospital bed. he has a long hx of this disease. what medication would you give
Definition
Haloperidol/fluphenzine Chlorpromazine/thioridazine

o Uses: Positive symptoms of schizophrenia (eg delusions, hallucinations), Tourette syndrome, & delirium & agitation
Term
what are highlighted SE of haloperidol ..?
Definition
SEdation (H1 inhibition )
extrapyramidal system SE (dystonia/akinesia)
galactorrhea/amenorrhea (no dopamine-inc prolactin)
Term
pt on what medication could develop neuroleptic malignant syndrome? what should be given to tx it?
Definition
typical anti-psyc (fluphenazine, chloropromazine, thioridazine, halope..)

give Dantrolene or dopamine agonists
Term
Atypical anti-psyc agents are ...6 of them
Definition
clozapine, olanzapine, quetiapine
risperidone, ziprasidone, aripriprazole
Term
this drugs block both Serotonin and dopamine receptors D2 in limbic system.
Definition
Atypical-anti psyc - ziprasidone, quetiapine, olanzapine, risperidone ..
Term
this pt shows sx of schizophrenia but now he demonstrates both neg and positive sx. he has been to your office before and you decide to change his meds from haloperidol to what drug? (give atleast one specific drug name)
Definition
quetipine, olanzapine, risperidone, clozapine, aripriprazole, ziprasidone
Term
this pt present with 2 days hx of delirium. he should be treat with what class and what drugs in that class. (3 drugs)
Definition
Delirium: Atypical anti-psyc
olanzapine, risperidone, quetiapine
Term
which of the atypical anti-psyc would you not want to use as it requires weekly monitoring of WBC
Definition
Clozapine - causes leukopenia and agranulocytosis
Term
what is the difference between atypical and typical anti-psyc?
Definition
fewer extrapyramidal and anticholinergic SE than typical.

use: typical for + schizophrenia
atypical both + and neg sx for schizophrenia
Term
benzo enhance which receptors by bind with them.
Definition
GABAa receptors. -- they hyperplorize the cell membrane --> dec activity of the neurons of the limbic thalamic and hypothalamic regions of CNS.
Term
alcoholic comes in to hospital and goes thrw withdraw..what drug would you give? give me atleast 2 drugs from each subclass of benzo
Definition
midazolam and triazolam

lorazepam, temazepam, oxazepam, alprazolam, chlordiazepoxide

Diazepam, prazepam, clonzapem, and flurazepam
Term
what r some uses of benzo?
Definition
anxiety, seizures and status epilepticus, alcohol withdraw, mucle spasm, insomnia, panic do,

midozolam (versed) and Diazepam are also used as anesthetics
Term
this class of drug should not withdrawn abruptly because it could cause withdrawal sx.
Definition
Benzo
Term
what is the reversal for benzos?
Definition
flumazenil -- competitive antagonist
Term
what 5 drugs for barbituates?
Definition
phenobarbital, thiopental, secobarbital, amobarbital, phentobarbital
Term
indirectly potentiate GABA receptors activity in brain. it inc Cl- ion flow making membrane hyperpolorized..which dec activity of CNS neurons.
Definition
Barbituates
Term
thiopental is used for what?
Definition
induction of anesthesia
Term
tx for neonatal seizures and hyperbilirubinemia.
Definition
phenobarbital
Term
can you give phenobarbital in preg.
Definition
no
Term
which drugs inhibits p450 and which on induces it
Definition
barbituates and pheytoin induces p450 -- secretes the drugs

SSRI inhibits p450--keeps the drugs
Term
overdose of barbituates does what to pt.
Definition
cardiac and resp arrest.--tx with hemodialysis and alkalinization of urine
Term
barbituates should not be given to pt with..
Definition
porphyria, alcoholics, preg, liver disease
Term
1st line tx for depression
Definition
SSRI
Term
what should you give for malignant hyperthermia caused by succinylcholine?
Definition
Dantrolene
Term
what are the four seizure type that phenytoin is used for?
Definition
Simple and complex partial sezire, tonic-clonic and status epilepticus
Term
if pt present with trigeminal neuralgia, and while waiting in the exam room goes in to torsades de pointe...what medication would tx both?
Definition
Phenytoin. treat trigeminal neuralgia and torsades de pointe
Term
pt has been on this drug for 3 yrs to seizure and shows sign of SLE. pt blood work come positive for anti-histone abs.
Definition
Phenytoin: durg-induce lupus
Term
if preg female is given phenytoin what would happen to fetus?
Definition
Fetal hyantoin syndrome. prenatal growth deficiency and congenital cardiac and palate malformation
Term
this drug dec Ca++ currents across neuronal cells and inhibits GABA metabolism. what is it used for and name the drug?
Definition
Ethosuximide: Absence seizures
Term
inhibits GABA metabolism and modulates Na-K pump thus hyperpolorizing the neuronal cell membrane. what drug is this?
Definition
Valporic acid
Term
pt is bipolar and has episodes of mania. he also suffers from myoclonic seizures. what drug is good for him?
Definition
Valporic acid:
o Uses: Generalized tonic-clonic seizures, myoclonic seizures, & absence seizures. Also has been used in the treatment of mania assoc with bipolar disorder & in the prevention of migraines
Term
female pt finds out that she is preg after 30days. pt was on valporic acid but upon finding out that she is preg PCP stop the drug. what is the fetus at risk of having?
Definition
neural tube defect
Term
what are is major SE of valporic acid?
Definition
hepatoxicity, thrombocytopenia, teratogen,
Term
topiramate is used for?
Definition
simple and complex partial seizure
Term
what two drug would tx trigeminal neuralgia?
Definition
Carbamazepine and phenytoin
Term
only one drug from our list causes aplastic anemia?
Definition
Carbamazepine: SE: hepatotoxicity and agranulocytosis
Term
tiagabine and vigabatrin is used for what kind of seizures?
Definition
partial
Term
how does succinylcholine works?
Definition
Depolarizing neuromuscular blocker that competes with acetylcholine to reversibly bind to the nicotinic receptors
Term
what medication given with succinycholine could result in malignant hyperthermia?
Definition
Halothane - tx with dantrolene
Term
what is MOA of pancuronium?
Definition
: Nondepolarizing neuromuscular blocker that acts to competitively bind nicotinic receptors at the neuromuscular junction
Term
pt is being intubated by it is starting to be a difficult intubation as pt cant relax his skeletal muscles. pt is fighting even with the sedation and starting to develop cyanosis. what drug adjunct to general anesthesia would give?
Definition
Pancuronium
Term
pt is still paralyzed from pancuronium. what drug is given to reverse its effects?
Definition
Neostigmine - cholinesterase inhibitor.
Term
how does lidocain work?
Definition
by blocking Na+ channels on neuronal cell membrane. thereby dec activation of these neurons
Term
what is the main SE that needs to be monitor with local anesthetics like procaine, cociane, tetracaine...
Definition
Seizure, neurotoxicity, myocardial depression and hypotension.
Term
which one has longer half life? Esters or Amides - local anesthetics. what are two amides?
Definition
Amides have longer half-life than esters.
amides: bupivacaine and lidocaine
Term
how do inhaled anesthetics work?
Definition
they directly activate GABA throw out the brain. == leading to dec neuronal activity.
Term
what is main side effect of halothane?
Definition
causes fulminant hepatic necrosis. hypotension and cardiac arrhythmias
Term
in the list of inhaled anesthetics which two causes nephrotoxicity?
Definition
Methoxyflurane and enflurane
Term
which one causes chemical pancreatitis?
Definition
Propofol
Term
which one is used for conscious sedation other tahn propofol?
Definition
etomidate: SE: myoclonus adrenal suppression
Term
what r some SE of ketamine which limits its use?
Definition
hallucination, cardiac and resp depressant
Term
first line tx for parkinson.
Definition
levodopa...it is converted to dopamine in brain.
Term
what are the SE of Levodopa?
Definition
Dyskinesia. Cardiac arrh*, hallucination and depression
Term
what is the drug that is given with levodapa?
Definition
Carbidopa
Term
what is on off phenomenon?
Definition
on period : marked dyskinesia

off periods: marked Akinesia (the inability to initiate movement due to difficulty selecting and/or activating motor programs)
Term
which drug is given to parkinson pt in off-period?
Definition
Apomorphine
Term
if lithium fails in tx mania which one you should use?
Definition
valporic acid
Term
best treatment for tics
Definition
haloperidol: most effective.
Clonidine could also be used
Term
to tx tremor which is a SE of lithium what drug could be used?
Definition
propranolol and atenolol
Term
which one is most selective SSRI?
Definition
Citalopram
Term
do intravenous anesthetics help with pain?
Definition
no
Term
most commonly used steroid muscle relaxants (part of Non-depo NMB)
Definition
Vecuronium and Rocuonium
Term
most commonly used inhaled anesthetics
Definition
isoflurane
Desflurane
Sevoflurane
Term
which of the barbituates is commonly used for anesthesia induction?
Definition
thiopental
Term
which is agent of choice for ambulatory surgery?
Definition
Propofol
Term
good summary for C. Sedation
Definition
BZDs: control anxiety, facilitate amnesia
Barbiturates: sedation
Antihistamines:
Diphenhydramine: prevention of allergic reactions
Ranitidine: reduce gastric acidity
Ondansetron: antiemetic
Opioids: analgesia
Anticholinergics: amnesia
Also used to prevent bradycardia and secretion of fluids into the respiratory tract
Term
which drug is partial dopamine receptor agonist?
Definition
bromocriptine --for parkinson and hyperprolactinemia
Term
which group of pt should not receive sumatriptan?
Definition
Cardiac - as it causes coronary vasospasm
Term
what is the main use of Sumatriptan?
Definition
Migraines and cluster HA
Term
this drug is used for smoking cessation and antidepressant.
Definition
Bupropion
Term
Varenicline's brand name
Definition
Chantix
Term
postherpetic neuralgia is tx with this medication
Definition
Gabapentin
Term
what two drug are used in chronic neuropathic pain ?
Definition
gabapentin and pregabalin(fibromyaagia)
Term
peripheral edema could be caused by which seizure drug
Definition
Gabapentin
Term
most commonly abused sedative hypnotics
Definition
barbiturates
Term
heroin addicts could be put on what drug? it is also used for opioid substitution
Definition
methadone
Term
FDA approved tx for opioid and alcohol addiction
Definition
Naltrexone
Term
what two drugs causes agranulocytosis?
Definition
Clozapine and carbamazepine
Term
works on Late S-G2 phase
Definition
Etoposide
Term
works on S phase - cell cycle specific
Definition
5-FU
Term
Vincristine and vinblastine works on which phase in cell cycle specific
Definition
VV - turn it upside down -^^ M
Term
what is the The treatment for CML
Definition
Imatinib
Term
pt present with neuropathic pain what agents would tx this...
Definition
Amitriptyline
pregabalin/gabapentin
Levetiracetam
Ketamine
Term
pt present with neurolaptic pain and signs of depression.
Definition
Amitriptyline
Term
pt present with neurolaptic pain who has hx of seizure.
Definition
Gabapentin/ pregabalin
Term
what four drug causes weight gain?
Definition
MOI, heterocyclic, atypical, valporic acid
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