Term
| If whatever drugs you're giving for seizures are not working, ___ or __ are good to switch to. |
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Definition
- Valproate
- Lamotrigene
(after these 2- second choice would be Phenytoin) |
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Term
| DOC for status epilepticus: |
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Definition
|
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Term
| Why is Lorazepam not used long term for seizure control: |
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Definition
| tolerance develops in 2-3 days |
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Term
| Why is Lorazepam doc for status epilepticus over Diazepam: |
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Definition
| Lorazepam is more water soluble so it lasts longer |
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Term
| When can you take a pt off of seizure meds? |
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Definition
| seizure free for 4 years, taper off slowly |
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Term
| Kids with absense seizures are already ADD in school, the antiseizure meds you give them tend to make this __. |
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Definition
|
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Term
|
Definition
- really hard on GI tract
- liver toxicity
- doubles risk of spina bifida |
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Term
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Definition
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Term
| Patient doesn't like side effects of Valproate and Lamotrigene is not controlling her seizures. What drug would you switch her to? |
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Definition
|
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Term
| Main advantage of Phenytoin: |
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Definition
| clear consciousness (awake) |
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Term
| Side effects of phenytoin: |
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Definition
- gingival hyperplasia
- acne
- hirsutism |
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Term
| Precaution to give with Carbamazepine: |
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Definition
| have pt contact you immediately if they get a RASH |
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Term
| Anti-seizure drug that may cause Stephen-Johnsons syndrome: |
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Definition
|
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Term
| Population most susceptible to Stephen Johnsons Syndrome: |
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Definition
|
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Term
| 2 antiseizure drugs that are effective against all seizure types: |
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Definition
|
|
Term
| Drug that is good for absense (petit mal) seizures: |
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Definition
|
|
Term
| MONOTHERAPY IS ALWAYS WHAT YOU WANT WITH SEIZURE MEDICATIONS. |
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Definition
|
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Term
| Antiseizure drug that is good for tonic clonic seizures (grand mal) but will make absense seizures (petit mal) worse: |
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Definition
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Term
| Fever of __ catches pediatricians attention. Below this take 2 __ and observe. |
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Definition
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Term
| Kids with high fever alternate __ with __ every 3 hours. |
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Definition
|
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Term
| Pts who have had benign febrile seizures are/are not at increased risk for more seizures later in life? |
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Definition
|
|
Term
| Carbamazepine is good for what type of seizures? |
|
Definition
| Grand mal (tonic clonic)- but watch for rash |
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Term
| Benign febrile seizures occur in kids when their fever gets over __. |
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Definition
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Term
| CNS disorder with delusions and hallucinations (mostly auditory); |
|
Definition
Schizophrenia
(delusions tend to be more of a problem than the hallucinations) |
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Term
| 22 y/o female brought to er by friends. Been hearing voices telling her to repnt. Thin disheeveld, anxious. Garbled, flights of ideas and mistaken ideas. She thinks you’re a federal agent. What drug do you give to calm agitated behavior? |
|
Definition
D2 blocker
(schizophrenia) |
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|
Term
| Determinants of prognosis with Schizophrenia: |
|
Definition
- age of onset
- abruptness of onset |
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Term
| The __ the age of onset of schizophrenia and the more __ the onset, the worse the prognosis. |
|
Definition
- younger
- insidious
Better to be older and abrupt onset. |
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Term
| With Schizophrenia drugs, __ comes under control first, but thinking remains strange longer. |
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Definition
|
|
Term
| Common ages of onset for schizophrenia in females and males: |
|
Definition
- under 20s for women
- early 20s for men |
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Term
| With Parkinson's and Huntington's the problem is with the __ __ in the __ __. |
|
Definition
| substantia nigra in the basal ganglia |
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Term
| With Schizophrenia there is __ dopamine in the __ __. |
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Definition
| - excess dopamine in the basal ganglia |
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Term
| Atyical antipsychotics block the ___ receptor. |
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Definition
| 5-HT2. These receptors are thought to be more associated with bizarre thinking aspect of Schizophrenia |
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Term
| Aripiprazole is an __ antipsychotic that is a weak __ __ and __ __. How long does it take to control delusional thinking? |
|
Definition
- atypical antipsychotic
- D2 agonist and 5HT2 blocker
- 1-3 weeks (older agents took 5-6 weeks)
So with the atypicals it still takes longer to get delusions under control, but not as long as they typicals took. |
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Term
| Pt started Haloperidol and it made his hands shaky,rigid muscles, and shuffling gait. This is called __ __. |
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Definition
|
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Term
|
Definition
| can't stop walking, even when sitting feet are still moving, striated issue |
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Term
|
Definition
| twisting hands, striated issue |
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Term
| D2 blocking drugs result in excess __ which causes __ __ and __ __. |
|
Definition
- acetylcholine
- iatrogenic Parkinsonism
- tardive dyskinesia |
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|
Term
| Now we have tardive thing going on, what happens if remove haloperidol (d2 blocker?)? |
|
Definition
- Tardive will initially get much worse b/c all of the sudden the dopamine can access the receptors
- Psychosis returns in full force over 3-6 weeks
- Tardive will eventually settle down, but will never be completely gone |
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Term
| Patient has tardive dyskinesia. What happens if we increase his Haloperidol (D2 blocker)? |
|
Definition
| - tardive will initially improve b/c more D2 receptors get covered, but then receptors will upregulate> tardive gets worse |
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Term
| What are the therapeutic options for tardive dyskinesia? |
|
Definition
| switch to an atypical antipsychotic |
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|
Term
| Haloperidol is __ antipsychotic __ blocker. |
|
Definition
|
|
Term
| Atypical antipsychotics blocker more __ receptors and some __ receptors. Main advantage of these is: |
|
Definition
- 5HT2
- D2
- Much less likely to cause tardive dyskinesia |
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|
Term
| 39 y/o on haloperidol for many years, more withdrawn over past several year. Doesn’t talk much, nothing gives him pleasure. What would you do for w/drawn aspect? |
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Definition
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|
Term
| Main side effect of Clozapine; |
|
Definition
| - bone marrow suppression (fatal blood diascrasis)> as soon as count begins to drop stop Clozapine |
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Term
| All antipsychotics lower the __ __. |
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Definition
|
|
Term
| Olanzapine is an __ antipsychotic. |
|
Definition
|
|
Term
| Atypical antipsychotics are known for causing __ and __ __ __ __. |
|
Definition
hyperosmolarity
Type II Diabetes Mellitus |
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|
Term
| Atypical antipsychotic that is less likely to cause TIIDM: |
|
Definition
|
|
Term
| Atypical that is still pure D2 blocker: |
|
Definition
|
|
Term
| strange side effect of D2 blockers: |
|
Definition
- females: galactorrhea
- males: gynecomastia |
|
|
Term
| How do D2 blockers cause galactorrhea/gynecomastia: |
|
Definition
Normally dopamine drops down from the hypothalamus to the pituitary and inhibits the production of prolactin.
So with all the D2 receptors being blocked in the pituitary, there is no inhibition of prolactin anymore> milk/boobs |
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Term
| There is no approved tmt for violence, but at high doses __ make a chemical straight jacket. |
|
Definition
antipsychotics
So you can give haloperidol to calm agitation |
|
|
Term
| Advantage of giving Haloperidol to calm agitation/violence: |
|
Definition
| - minimal sedating and cardiovascular effects |
|
|
Term
| dosage of haloperidol to calm agitated person: |
|
Definition
5-10 mg PO/IV/IM every 10-30 minutes as needed
peak level after 20-40 minutes of dose |
|
|
Term
| There is no recognized __ __ with haloperidol. |
|
Definition
|
|
Term
| Don't use benzos to calm an agitated person b/c then you just have a violent drunk. |
|
Definition
|
|
Term
| After getting multiple doses of haloperidol to calm down, a pt becomes febrile and rigid. Whats going on? |
|
Definition
Drug Induced Neuroleptic Malignancy Syndrome
(fever is life threatening> ice bath) |
|
|
Term
| High dose D2 blockers can cause; |
|
Definition
| Drug Induced Neuroleptic Malignancy Syndrome (fever and rigid) |
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|
Term
| ATYPICALS ARE BETTER AGAINST NEGATIVE SYMPTOMS, BUT EVIDENCE FOR THAT HAS BEEN DSENEGRATING. ATYPICALS LESS LIKELY TO PRODUCE TARDIVE, BUT ATYPICALS CAN CAUSE DIABETES. |
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Definition
|
|
Term
| Hydrocodone is schedule _. |
|
Definition
|
|
Term
| Hydrocodone works on the __ receptors. |
|
Definition
| mu receptors in brain and spinal cord (not joints) |
|
|
Term
|
Definition
- analgesia
- cough suppression
- constipation
- miosis |
|
|
Term
| Opioid pain relief: pain is still there but the patient doesn't care anymore |
|
Definition
|
|
Term
| The runners high is linked to stimulation of __ receptors causing release of beta endorphins. |
|
Definition
|
|
Term
| What drug would block the "runner's high"? |
|
Definition
| Naltrexone- mu antagonist (blocker) |
|
|
Term
| Are opioids better for brilliant pain (knife) or dull pain (tooth ache)? |
|
Definition
|
|
Term
| Are opioids better for brilliant pain (knife) or dull pain (tooth ache)? |
|
Definition
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|
Term
| 24 y/o females has nonproductive cough with seasonal rhinitis and coughing disrupts sleep. What can use for cough without danger of opiod dependence? |
|
Definition
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|
Term
| 4 y/o signif nonproductive cough aggravated by viral URI. Coughing disrupts sleep. Child now has pain in abdomen b/c coughing so hard. Which is best choice for cough suppression if dextromethorphan is not effective? |
|
Definition
|
|
Term
| 2 opioids good for cough suppression: |
|
Definition
1. Dextromethorphan
2. Codeine |
|
|
Term
| A pt is involved in MVA has head and rib truam. Significant pain. The head injury may increase which of the following effects of meperidine? |
|
Definition
- RESPIRATORY DEPRESSION
-OPIODS CONTRAINDICATED WITH HEAD INJURY |
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|
Term
| Opioids are CI with __ _. |
|
Definition
|
|
Term
| Cornerstone drug for pain management: |
|
Definition
antidepressants: TCAs- reduce emotional component
avoid opioids if at all possible |
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|
Term
| The addition of an NSAID will increase pain relieving efficacy of which of the following the most? |
|
Definition
| - Hydrocodone much more effective with NSAID, hydrocodone + nsaid almost as effective as morphine |
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|
Term
| Respriatory depression caused by opiod overdose can be reversed most effectively by administering what? |
|
Definition
NALOXONE- IV
NALTREXONE- ORAL |
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|
Term
| What do you NOT want to do immediately if a pt has respiratory depression b/c overdosed on opioids? |
|
Definition
| oxygen- this would put them into respiratory distress- kill pt |
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|
Term
| In a pt that has a one time overdose on opioids, but is not dependent, what will the side effect of Naloxone be? |
|
Definition
|
|
Term
| Dependence requires a sufficient dose for a sufficient period of time. Once dependence has developed, if you give an antagonist, __ will develop. |
|
Definition
|
|
Term
|
Definition
- COMA
- REPSIRATORY DEPRESSION
- MIOIS- pin point pupils |
|
|
Term
| What do you do if you see the Opioid poisoning triad? |
|
Definition
|
|
Term
| 39 yo scheduled for surgery for internal hemorrhoids. Hx of drug and alcohol abuse. Oxycontin for 6 days after surgery to control pain. What would you after the oxycontin for 6 days that has little dependence risk? |
|
Definition
| Tramadol- SNE reuptake inhibitor |
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|
Term
| Pt treated for back pain with hydrocodone and other pain meds. Having bad constipation, what do you tell them? |
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Definition
|
|
Term
| The longer and greater the dose with opioids, the worse the tolerance. But what are two effects of opioids in which tolerance does not occur? |
|
Definition
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