Term
|
Definition
Chronic condition of the lungs
-Constriction (reversible)
-Inflammation (treatable) |
|
|
Term
| endogenous bronchodilators |
|
Definition
epinephrine (b-2 effect)
prostaglandins |
|
|
Term
| asthma sensitive to what bronchodilators |
|
Definition
ACh/muscarinic agonists
histamine |
|
|
Term
|
Definition
corticosteroid
leukotriene modifiers
IgE antibodies |
|
|
Term
|
Definition
pneumovax
pertussis
influenza |
|
|
Term
|
Definition
rapid-acting adrenergic bronchodilator
inhaled corticosteroid
oral steroid |
|
|
Term
|
Definition
Symptoms < 2d/wk
Night-time awakenings < 2x/month
Rescue use for symptom control <2d/wk
Interference with normal activity None
no treatment done |
|
|
Term
|
Definition
Symptoms >2d/wk
Night-time awakenings 3-4x/month
Rescue use for symptom control >2d/wk
Interference with normal activity Minor
treatment: inhaled corticosteroid (low dose) |
|
|
Term
|
Definition
Symptoms daily
Night-time awakenings >1x/week
Rescue use for symptom control: not more than once/day
Interference with normal activity: some limitation
treatment: Inhaled corticosteroid (low-moderate dose) + Long acting B-agonist |
|
|
Term
|
Definition
Symptoms : throughout the dat
Night-time awakenings: often 7x/week
Rescue use for symptom control: several times a day
Interference with normal activity: extremely limited
Treatment: Inhaled corticosteroid (high dose) + Long acting B-agonist + Oral steroid (prn) |
|
|
Term
|
Definition
(glucocorticoids)
preferred drug for treating asthma
CNS effect!!!! but less if inhaled
ONLY decreases inflammation |
|
|
Term
| corticosteroids and cortisol |
|
Definition
stops adrenal medulla from making cortisol
result: helps immune system and decreases gluconeogenesis |
|
|
Term
|
Definition
Na/H2O retention
Altered fat, protein, glucose metabolism
Long term ↓ of endogenous cortisol production, release, regulation
Immunosuppression
CNS/mood changes
Attention deficits, memory deficits, mania, and immune suppression |
|
|
Term
|
Definition
for severe
difficult to discontinue |
|
|
Term
| prototype for inhaled steroid |
|
Definition
| Beclomethasone (Vanceril) |
|
|
Term
|
Definition
(Vanceril)
anti-inflammatory
profylaxis NOT rescue |
|
|
Term
|
Definition
(Vanceril)
Hoarseness, cough
Thrush (tell them to rinse their mouth after) |
|
|
Term
|
Definition
Oral: systemic effect-suppresses the adrenal medulla
inhaled: no systemic effect
when you switch: be careful because you wont have cortisol so you wont have response to stress |
|
|
Term
Prototype for Leukotriene modifiers
(less effective than corticosteroids-produce inflammation & activate immune system-cause constriction) |
|
Definition
|
|
Term
|
Definition
(Singular)
block receptor, interrupt inflammatory process
not bronchodilator
control therapy only! modest effect-helper |
|
|
Term
|
Definition
(Singular)
alternative to inhaled steroid
supplement to inhaled steroid |
|
|
Term
Sympathomymetic Drugs for Asthma
(Selective B-2 Agonists) |
|
Definition
Albuterol (Proventil)
Salmeterol (Serevent) |
|
|
Term
|
Definition
(Proventil)
bronchodilate
no antiinflammatory action
RESCUE drug! |
|
|
Term
|
Definition
(Serevent)
slow onset, long duration
NOT rescue
NOT a substitute for corticosteroids (use first then you use LABA) |
|
|
Term
|
Definition
(Serevent)
Moderate-persistent
Severe-persistent
Adjunct to steroid |
|
|
Term
|
Definition
(Serevent)
not using a corticosteroid before!!
YOU HAVE TO! |
|
|
Term
|
Definition
|
|
Term
| sympathomymetic tolerance |
|
Definition
Long-term use and/or overuse
Lose efficacy in severe hypoxia, acidosis |
|
|
Term
|
Definition
Cardiac/cardiovascular
Skeletal muscle tremor
Metabolic problems |
|
|
Term
| Overuse of rescue inhaler |
|
Definition
More than once a day
More than twice a week
Refill more than twice a year |
|
|
Term
|
Definition
Isoproterenol
Ephedrine
Epinephrine |
|
|
Term
|
Definition
(Xolair)
severe ALLERGIC asthma not controlled by corticosteroids
stops IgE
has to be given in physicians office and stay for 2-4 hrs |
|
|
Term
Methylxanthines
prototype |
|
Definition
related to caffeine-tea with cold-bronchodilates
prototype: Theophylline |
|
|
Term
|
Definition
CNS, CV, GI SEs
mild-moderate relaxation of airway
dose-body weight
LOW TI |
|
|
Term
|
Definition
| decrease ACh-bronchoconstrict and mediate mucus secretion (makes mucus super thick and sticky-make it worse) |
|
|
Term
| drugs to avoid with Asthma |
|
Definition
B-blockers: bronchoconstriction
Muscarinic agonists: bronchoconstriction
Acetylcholinesterase inhibitors: bronchspasms
Antimuscarinics: Dry up secretions
Diuretics: Dries up secretions
Iffy-nonsteroidal anti-inflammatories: Stop prostaglandins (Prostaglandins are natural bronchodilators) |
|
|
Term
|
Definition
local hormone
mast cells
trigger inflammatory process
regulate gastric secretions-H2 receptor
CNS neurotransmitter
Autoimmune-MS, RA
reproduction-testes & endometrium-break down & suppression of function |
|
|
Term
|
Definition
not vascular-doesnt affect BP
on post capillary venuoles-close to surface
permeable-nose drips |
|
|
Term
| mast cells release things that cause... |
|
Definition
| bronchial constriction, inflammation, and dilate blood vessels |
|
|
Term
histamine release
-physiologic
-drug-induced
-other |
|
Definition
physiologic-gastric acid secreting cells and brain cells
drug-induced-tubocurarine, morphine, plant toxins, animal venoms (bees)
other-trauma and burns |
|
|
Term
|
Definition
Smooth muscle: Bronchoconstriction/vasodilation
Endothelium: Separation of endothelial cells (hives, pain, itching allergic rhinitis)
Central nervous system: Motion sickness and Sleep regulation (Benadryl) |
|
|
Term
|
Definition
Parietal cells: Stimulate gastric acid secretion
Vascular smooth muscle cells: Vasodilation |
|
|
Term
|
Definition
CNS: Decreased neurotransmitter
PNS: release: Histamine, acetylcholine, norepinephrine, & serotonin |
|
|
Term
|
Definition
|
|
Term
| microvascular effects of histamine |
|
Definition
arterioles dilate more than venules
cap inflow > outflow = ^ pressure
fluid and protein leak out-local swelling |
|
|
Term
antihistamines
-h1 blocker
-h2 blocker |
|
Definition
h1 blocker: Diphenhydramine (Benadryl)
h2 blocker: Cimetidine (Tagamet)-used infrequently-DDI-CD450 system
-all competitive antagonists!! |
|
|
Term
h1 blocker
-1st generation
-2nd generation |
|
Definition
1st gen: cross BBB, older, OTC, cough and flu meds, induce sleep, but causes dry nose
2nd gen: no BBB, newer, narrow spectrum which is better |
|
|
Term
|
Definition
(Benadryl)
1st gen
block h1
atropine-like actions (blocks ACh-dont use with glaucoma)
sedating
stop itching-anesthetic agent |
|
|
Term
|
Definition
mild allergy
sedative/hypnotic
anesthetic
manages parkinson's fine tremor
treats side effects of antipsychotics |
|
|
Term
|
Definition
| same as atropine + sedation, crosses BBB so confusion, delusion, hallucination (on BEERS list) |
|
|
Term
|
Definition
| MAOI and anticholinergic effects |
|
|
Term
|
Definition
same as atropine + (confusion, hallucination, seizure, coma)
Adults – progressive CNS depression → coma, seizures
Children – seizures come quickly |
|
|
Term
|
Definition
same as atropine
More as OTC than prescription
NO ANTIDOTE
Treatment to atropine is physostigmine
Treat overdose by treating symptoms-Regular NG tube will not work because it is too small (pills will not work) so another thing they can do is drink charcoal |
|
|
Term
| 2nd generation h1 blockers |
|
Definition
Fexofenadine (Allegra)
Loratadine (Claritin)
Desloratadine (Clarinex)
Cetrizine (Zrytec)
-no atropine like SE/CI
-use allergy
OK for asthmatic patients |
|
|
Term
|
Definition
gastric acid production (vagus nerve)-parietal cells
-2 ways-direct stimulation or histamine |
|
|
Term
|
Definition
Cimetidine (Tagamet), Ranitidine (Zantac)(most common), Nizatidine (Axid), Famotidine (Pepcid)-all OTC
-start with Ranitidine |
|
|
Term
|
Definition
| suppress gastric acid secretion for peptic ulcer disease and GERDs |
|
|
Term
|
Definition
reduce unpleasant sensations-localized region without LOC
infiltration is most common route-inject into area |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
(Xylocaine)
-fast, low toxicity, low risk for allergy
-most used
-inactivated in LIVER |
|
|
Term
|
Definition
Bupivacaine (Marcaine)
Mepivacaine (Carbocaine)
Prilocaine (Citanest) |
|
|
Term
|
Definition
|
|
Term
|
Definition
(Novocaine)
-not used much
-not potent
-slow onset |
|
|
Term
|
Definition
Clorprocaine (Nesacaine)
Tetracaine (Pontocaine)
Benzocaine
Cocaine |
|
|
Term
|
Definition
-prevent depolarization
-all nerves can be depressed if dose too ^
-slower rate of metabolism-faster onset, last longer, ^ potency & toxicity |
|
|
Term
|
Definition
little epinephrine causes this-keep blood from moving the LA
-shortens onset, lasts longer, ^ intensity, may not be safe |
|
|
Term
|
Definition
CV depression
depressant effect on ventilator control center of the brain
seizures/convulsants |
|
|
Term
|
Definition
LA for nose/eye surgery
Powerful cerebral cortical stimulant
Intrinsic sympathomimetic activity
NEVER use with vasoconstrictor |
|
|
Term
|
Definition
| Main ingredient in OTC anesthetic products (for skin rashes etc) |
|
|
Term
depression
-low levels of monoamine neurotransmitters (3) |
|
Definition
Serotonin (5-HT)
Norepinephrine (NE)
Dopamine (DA) |
|
|
Term
| Classes of antidepressants |
|
Definition
SSRI
Tricyclics
Atypical agents
MAOI |
|
|
Term
|
Definition
selective serotonin reuptake inhibitor
-new, most widely used
only affect serotonin
EXPENSIVE |
|
|
Term
|
Definition
was most widely used
cheaper
a lot of side effects and DDIs |
|
|
Term
|
Definition
monoamine oxidase inhibitor
-old and new agents
-DDIs and drug-food interactions!
--no cheese, fava beans, or wine |
|
|
Term
antidepressant USE
-primary
-other |
|
Definition
primary: depression (melancholia), anxiety, panic attach, OCD
other: mood stabilizer, epilepsy, chronic pain, migraine |
|
|
Term
|
Definition
reverse depression s/s: slow onset (2-4 weeks), months to reach optimal effect
^risk of suicide: gain energy to be able to kill self |
|
|
Term
prototype for SSRIs
(bone mass loss-osteoporosis) |
|
Definition
|
|
Term
|
Definition
(Prozac)
dec serotonin reuptake -> ^ postsynaptic serotonin levels -> decrease symptoms |
|
|
Term
|
Definition
(Prozac)
major depressive disorder
obsessive-compulsive disorder
bulimia nervosa
premenstrual dysphoric disorder
panic disorder |
|
|
Term
|
Definition
(Prozac)
most common-sexual dysfunction
weight gain
serotonin syndrome
withdrawal syndrome
hyponatremia-dysfunction of kidneys and nervous system
suicide risk |
|
|
Term
| serotonin syndrome (4 causes) |
|
Definition
too much serotonergic transmission
-agitation, confusion, anxiety, hallucinations, myocolonus (ataxia) incoordination, hyperreflexia, tremor, fever
DDI between SSRI and MAOI
-MAOI inhibit deactivation of serotonin
citalopram (celexa) and omeprazole
-compete for p450 and beats it
Triptan meds
-migraine headaches |
|
|
Term
tricyclic antidepressants (TCAs)
-prototype |
|
Definition
block reuptake of norepinephrine
Imipramine (Tofranil) |
|
|
Term
|
Definition
(Tofranil)
older, cheaper
block muscarinic receptors-anticholenergic SE
dec uptake of NE
safe in elderly
inhibit sodium (fluid) and calcium (muscle contraction) |
|
|
Term
|
Definition
(Tofranil)
depression, bipolar, neuropathic pain, and insomnia |
|
|
Term
|
Definition
(Tofranil)
CNS:sedation, mania, seizure
Peripheral: anticholenergic effects
CV: OH and tachycardia
sexual dysfunction
yawngasm |
|
|
Term
|
Definition
atropine poisoning
-hot as a furnace, red as a beat, dry as a bone
-delirium
-seizures
treat symptoms |
|
|
Term
Atypical antidepressants
prototypes |
|
Definition
Bupropion (Wellbutrin)
Mirtazapine (Remeron)
SNRIs |
|
|
Term
|
Definition
(Wellbutrin)
dopamine uptake (reward, motivation, memory, and learning) |
|
|
Term
|
Definition
(Wellbutrin)
Major depressive disorder
Seasonal affective disorder
Smoking cessation
Female hypoactive sexual disorder: Menopausal disorder |
|
|
Term
|
Definition
(Wellbutrin)
No weight gain
No sexual dysfunction
Seizures
Desvenlafaxine (Pristiq), Duloxetine (Cymbalta) |
|
|
Term
|
Definition
(Remeron)
^ release of serotonin and NE and block histamine |
|
|
Term
|
Definition
(Remeron)
give at night!
-depression, insomnia, weight loss |
|
|
Term
|
Definition
Venlafaxine (Effexor)
-as effective as SSRI but not as safe |
|
|
Term
|
Definition
(Effexor)
nausea, headache, anorexia, sweating, insomnia |
|
|
Term
|
Definition
(Effexor)
SSRI-just be cautious!
MAOIs-NEVER |
|
|
Term
|
Definition
isocarboxazid (Marplan)
selegiline (Emsam)-transdermal form (less systemic effects, release slow, compliance is hard) |
|
|
Term
isocarboxazid
selegiline
MOA |
|
Definition
(Marplan)
(Emsam)
-inhibit inactivation of monoamines (NE, DA, 5-HT) and does not decrease the release of them |
|
|
Term
isocarboxazid
selegiline
USES |
|
Definition
(Marplan)
(Emsam)
SEVERE refractory depression (bad SE) |
|
|
Term
|
Definition
Hypotension (common/usually severe)
Hypertensive crises from drug-drug interactions and drug-food interactions
NEVER use with SSRI |
|
|
Term
| Antipsychotic Agents used for |
|
Definition
| SEVER psychiatric disorders |
|
|
Term
mood stabilizer/antipsychtic
(old drug) |
|
Definition
|
|
Term
|
Definition
| treat bipolar disorder-best! |
|
|
Term
Lithium
-most effective
-less effective |
|
Definition
Most effective – grandiosity, mania, flight of ideas, irritability, anxiety
Less effective – insomnia, psychomotor excitation, assaultive behavior, difficulty concentrating/distractability |
|
|
Term
|
Definition
unclear-may alter electrical activity
LOW TI!! |
|
|
Term
|
Definition
Cardiac, renal, thyroid disease
Pregnancy, breast feeding
Dementia
Neurological disorders
Myasthenia gravis |
|
|
Term
|
Definition
Normal levels: fine hand tremor, mild thirst, polyuria, mild nausea, weight gain
Slightly elevated levels: N/V/D, thirst, slurred speech, muscle weakness
Moderately elevated levels: coarse hand tremor, persistent GI disturbances, EEG changes, mental confusion, incoordination
Severely elevated levels: severe hypotension, severe polyuria, serious EEG changes, stupor, coma, death |
|
|
Term
|
Definition
Diuretics contraindicated
6-8 glasses water daily
Do not restrict sodium (4-5 gms daily)
Take with food
Report nausea, vomiting, diarrhea |
|
|
Term
|
Definition
schizophrenia
o Altered thought processes, disconnect from reality
o Sensory perceptual alteration
o Reduce relapse
o Reduce violent and aggressive behavior
o Improve ADLs and sleep patterns
o CANNOT cure schizophrenia-treat some symptoms |
|
|
Term
|
Definition
| block dopamine in basal ganglia, muscarinic, ACh, and NE |
|
|
Term
|
Definition
Anticholenergic: dry mouth&skin, tachycardia, constipation, urinary problems
Extrapyramidal side effects: acute dystonic reactions, akathisia (pace), akinesia, parkinsonism (tremors), tardive dyskinesia (involntary movement of face), hypotension, tachycardia, gynecomastia, neuroleptic malignant syndrome |
|
|
Term
neuroleptic malignant syndrome
S/S |
|
Definition
Mental Changes
Rigidity, hyperreflexia
Hyperthermia
Diaphoresis
Tachypnea
Autonomic dysfunction: Hypotensive, tachycardic
Agitation
^ potassium, decrease sodium, and ^ WBC count |
|
|
Term
neuroleptic malignant syndrome
RISK FACTORS |
|
Definition
Young adulthood
Dehydration
Male sex
Alcoholism
Organic brain syndrome
Prev. brain injury
Parkinson’s disease
Iron deficiency
Catatonia
Coadministration lithium
Withdrawal from anticholinergics |
|
|
Term
neuroleptic malignant syndrome
TREATMENT |
|
Definition
| Stop drug, pt goes to ICU, fever (antipyretics), increased potassium (give fluid to dilute it and decrease it), heparin (CK and rhabdomyolosis), and treat muscle rigidity |
|
|
Term
|
Definition
now 2nd choice
high potency-more early EPS
less sedation, orthostatic hypotension, and anticholenergic effects-SE not as bad
and medium and low potency |
|
|
Term
|
Definition
|
|
Term
|
Definition
(Haldol)
agitation, schizo, acute psychosis outbreak |
|
|
Term
|
Definition
(Haldol)
EPS, TB, gynecomastia, galactorrhea, prolonged OT interval |
|
|
Term
|
Definition
chlorpromazine (Thorazine)
most effective but BAD SE |
|
|
Term
|
Definition
(Thorazine)
Schizophrenia
Psychotic disorders
Shizoaffective disorder
Suppression of emesis
Relief of intractable hiccups |
|
|
Term
| chlorpromazine SIDE EFFECTS |
|
Definition
(Thorazine)
Sedation
Orthostatic hypotension
Anticholinergic effects
EPS (low risk)
TD |
|
|
Term
2nd generation antipsychotics (atypical)
prototype |
|
Definition
|
|
Term
clozapine
-FDA used
-non approved uses |
|
Definition
(Clozaril)
FDA:resistant schizo
non-FDA: bipolar, dyskinesiasin Parkinson’s, behavior from denentia, BPSD |
|
|
Term
|
Definition
(Clozaril)
block receptor for dopamine and serotonin |
|
|
Term
|
Definition
(Clozaril)
orthostatic hypotension, tachycardia, weight gain, metabolic syndrome, sialorrhea, sedation & constipation |
|
|
Term
|
Definition
(Clozaril)
increased seizure risk, potentially fatal myocarditis(rare), risk of agranulocytosis |
|
|
Term
|
Definition
(Clozaril)
blood glucose, lipids, LFTs (liver function), weight, *WBC& neurologic function* |
|
|
Term
| Other atypical antipsychotics |
|
Definition
Risperidone (Risperdal)
Olanzapine (Zyprexa)
Ziprasidone (Geodon)
Aripirazole (Abilify) |
|
|
Term
|
Definition
autistic disorder
psychotic depression
Tics |
|
|
Term
|
Definition
agitation from schizo&bipolar disorder
chronic pain, n/v with chemo |
|
|
Term
|
Definition
|
|
Term
|
Definition
| prolongation of QI interval |
|
|
Term
pediatric therapy
-uses
-SE
-1st choice
-Abilify
-Monitoring |
|
Definition
-Autism, bipolar, schizophrenia, severe disruptive & aggressive behavior disorders
-SE same as adult
-Risperdal is 1st choice
-Abilify: less weight gain and more activating than sedating
-weight, BP, lipid & glucose |
|
|
Term
| worst side effects-what med? |
|
Definition
|
|
Term
|
Definition
Atypical antipsychotics have less movement side effects than typical antipsychotics.-First generation = worse
The side effect profiles of atypical antipsychotics often limit their use. May be necessary in elderly and children-just be careful!
There is a place in therapy for antipsychotics other than just schizophrenia.
Pros and cons must be weighed in the decision to use atypical antipsychotics.
There are times when atypical antipsychotic use is warranted in elderly, adults, adolescents and children. |
|
|
Term
| normal brain vs. parkinson's brain |
|
Definition
normal
-Dopaminergic inhibition = cholinergic excitation
Parkinson's
-Dopaminergic inhibition > cholinergic excitation |
|
|
Term
|
Definition
| ^ dopamine or dec ACh (antimuscarinic) |
|
|
Term
|
Definition
| dopaminergics and centrally-acting antimuscarinics |
|
|
Term
|
Definition
Pramipexole: Dopamine receptor agonist
Levodopa: makes more DA
Entacapone, carbidopa: inhibit breakdown of L=DOPA
Seligiline: inhibits breakdown of DA -DRUG OF COICE |
|
|
Term
Pramipexole
-USES-alone
- with L-DOPA
-Mechanism |
|
Definition
(Miraprex)
-alone for: young pt, early disease
-with LDOPA for: severe and when LDOPA loses effectiveness
-Mechanism: stimulates DA receptors in brain-doesn't ^ DA |
|
|
Term
|
Definition
(Miraprex)
nausea, dizzy, daytime sleepiness, constipation, muscle weakness, hallucination
with Levodopa: ^risk hypotension, dyskinesias, hallucinations, and psychosis |
|
|
Term
Levodopa (LDOPA, Lardopa, Dopar)
-metabolism
-uses |
|
Definition
-metabolism: in brain and outside of brain-DA formed outside cannot cross BBB-98% metabolized in gut-bad!
-use: PD (cant treat drug induced PD), severe or doesn't respond to Mirapex |
|
|
Term
|
Definition
only 2% gets to brain
causes side effects |
|
|
Term
|
Definition
combined with levodopa to dec metabolism-gets ~30% instead of 2%
less SE |
|
|
Term
|
Definition
| n/v, OH, palpitations, dysrhythmias, dyskinesia, anxiety, insomnia, hallucinations, psychosis |
|
|
Term
| what happens when you are on levodopa for a long period of time? (3) |
|
Definition
wearing off phenomenon
on-off phenomenon
secondary levodopa failure |
|
|
Term
|
Definition
Give dose-good effect-wears off before next dose is given
Increase FREQUENCY |
|
|
Term
|
Definition
| Good control to bad control really quickly in a matter of minutes |
|
|
Term
| Secondary levodopa failure |
|
Definition
After years of good efficacy, levodopa gradually loses its effectiveness over a period of months, eventually not seeming to control symptoms well at all
Just doesn’t work anymore |
|
|
Term
|
Definition
Potentiates: cardiac stimulates and antihypertensives
Possible hypertensive crises w/ MAOIs. Sellegeline can act as an MAOI so it is contraindicated
Decrease effectiveness of anticonvulsants-Alter seizure threshold-More prone to seizures |
|
|
Term
|
Definition
|
|
Term
|
Definition
(Comtan)
inactivates LDOPA outside dopaminergic neurons-more LDOPA to cross the BBB
use only with LDOPA
doesn't cross BBB |
|
|
Term
|
Definition
MAO-A: outside the brain-Selegiline doesn’t affect
MAO-B: in brain (exrapyramidal system)-Selegiline affects this |
|
|
Term
|
Definition
(Eldepryl)-MAOI
selective for MAO-B
dec metabolic inactivation of DA by MAO-^ed DA dec.s parkinsonism
adjunct to levodopa for advanced PD
SE and DDI same as other MAOIs |
|
|
Term
| Central Acting Antimuscarinics |
|
Definition
Trihexyphenidyl (artane)
Benztropine (Cogentin)
Diphenhydramine (Benadryl)
-Block ACh muscarinic receptors → better balance between DA and ACh |
|
|
Term
|
Definition
alone for mild PD
adjunct to levodopa/dopaminergic agents for moderate to advanced s/s, tx EPS caused by 1st gen antipsychotic drugs |
|
|
Term
| Antimuscarinics/Antiparkinson Drug SEs and CIs |
|
Definition
Atropine-like effects
CNS: Drowsiness, confusion, hallucination
ANS: Dry mouth, urinary retention, blurred vision-Hydrate them, scheduled toileting (q2h), get glasses! |
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Term
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Definition
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Term
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Definition
| relieve anxiety, manage sleep, treat seizures, before/during anesthesia |
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Term
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Definition
main inhibitory neurotransmitter in CNS
brain and spinal cord depression
dec neuron function |
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Term
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Definition
Gamma Hydroxybutyrate
-crosses BBB-metabolized to GABA=CNS depression
-use sedative, hypnotic, anesthetic (date rape drug!)
-with ETOH causes worse CNS depression
-illegal in US |
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Term
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Definition
hangover effect, potentiate actions of GABA
advantages:no p450 (few DDI), high TI, low tolerance risk
-slow onset
-fast onset
-parenteral |
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Term
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Definition
long duration, longer onset
use-anxiety&sedation NOT sleep |
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Definition
short duration, short onset
use-hypnosis&sleep |
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Term
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Definition
| use-adjust to anestesia, treat seizures, acute anxiety/agitation |
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Term
benzo anxiolytics (anxiety)
(2 drugs) |
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Definition
Diazepam (Valium)
Lorazepam (Ativan) |
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Term
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Definition
| preferred for anxiet, sedation, ^ risk for seizure in pt with hx of epilepsy, widely misused |
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Definition
^ risk of hangover
-Flurazepam (Dalmane): Not used much anymore, bad hangover effects
-Temazepam (Restoril): sleeping aid
-Triazolam (Halcion): Not used much anymore |
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Term
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Definition
induce sleep, vivid nightmares, daytime drowsiness
-abrupt discontinuation: worse insomnia, weaning may take months |
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Term
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Definition
-preanesthetic: calm people
-conscious sedation: Midazolam (Versed) + Fentanyl (pain meds) no effect on ventilation, given ^ dose & together produces amnesia for colonoscopy
-antegrade amnesia-versed
-relieve muscle strain-valium
-anticonvulsant-ativan |
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Term
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Definition
| ataxia, cognitive impairment, confusion |
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Term
benzo
-toxicity & treatment of OD |
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Definition
oral: deep sleep, CV and resp. depression
oral + CNS depressant: ^ risk resp arrest, CV depression, death
IV: resp/CV depression, arrest
treat: flumazenil (Romazicon) (Narcan does NOT work) |
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Term
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Definition
tolerance
physical dependence
treat: only use 2-6 weeks & pt ed |
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Term
benzo-like hypnotics
-used
-3 drugs |
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Definition
-ONLY sleep NOT anxiety
-Sonata, Ambien, Lunesta |
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Term
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Definition
sleep, anxiety, anesthesia
dec cerebral edema, psych, neurology, phenobarbital-status epilepticus |
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Term
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Definition
| low TI, many DDIs, ^ risk independence and abuse behaviors, similar to alcohol |
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Term
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Definition
1st gen antihistamine
trazodone (desyrel)
ETOH |
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Term
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Definition
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Term
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Definition
depression and sleep problems
-good for elderly
-no hangover |
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Term
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Definition
| dose-dependent depression, tolerance, dependence, withdrawal, hepatotoxicity, DDI |
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Term
CNS stimulants-schedule 2 drug
-indirect acting sympathomimetics |
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Definition
Dextroamphetamine (Dexedrine)
Amphetamine mixture (Adderall)
Methylphenidate (Ritalin) |
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Term
| Amphetamine mixture (Adderall) |
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Definition
for hyperactivity disorder
low dose activate
high dose-cerebral cortico stimulation, increase arousal from coma, dec appetite |
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Term
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Definition
| narcolepsy, morbid obesity, ADD, ADHD |
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Term
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Definition
seizures
and indirect acting sympathomimetic SE |
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Term
CNS stimulants
-Abuse potential |
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Definition
| very high, tolerance develops quickly |
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Term
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Definition
action drug similar to morphine
opiate-similar to opium |
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Term
| endogenous opioid peptides |
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Definition
our body makes ourselves-opiate-like properties
-endorphines |
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Term
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Definition
opioids-CNS depressants
any medication that causes dependence |
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Term
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Definition
pure opioid agonists
mixed agonist
pure opioid antagonist |
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Term
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Definition
Morphine
-Stimulate mu and kappa receptors |
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Term
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Definition
Pentazocine
-Block mu receptors
-Stimulate kappa receptors (weakly) |
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Term
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Definition
naloxone (Narcan)
-Block mu and kappa receptors |
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Term
| classification of controlled substance |
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Definition
schedule 1-4
1-no approved medical use, illegal, marijuana-cancer pain and glaucoma
2-4 have potential for abuse (4 is lowest) |
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Term
Morphine (pure opioid agonist)
-pharmacokinetics |
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Definition
absorbed well from injection site
oral: not good
-first pass metabolism, needs 6x the dose, slow onset |
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Term
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Definition
used for moderate->severe pain
euphoria, dysphoria, sedation, drowsy, ventilatory depression (if head injury, do not give morphine-high CO2), ^ ICP, constipation, urinary retention, biliary tract spasm, vasodilation-hypotension, miosis, emesis, antitussive (stop coughing-bad for asthma) |
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Term
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Definition
| reduce discomfort, anxiety, lowers BP-vasodilates, reduce cardiac workload, and reduce pulmonary congestion |
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Term
TI
barbiturate/alcohol vs opioid |
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Definition
barbiturate/alcohol-TI ^ but lethal dose does not-lowers TI so margin of safety decreases!
opioid-TI and lethal dose ^ so margine of safety stays the same |
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Term
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Definition
ventilatory depression
-tolerance: requires larger dose, SE not affected by tolerance
-dependence: occurs when abruptly discontinued
-withdrawal: intensity is proportional to dose, rarely fatal |
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Term
| Other Pure Opioid Agonists |
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Definition
Meperidine (Demerol)
Codeine/Hydrocodone (lortab, vicodin)
Hydromorphone (Dilaudid)
Methadone (Dolophine)
Propoxyphene (Darvon)
Oxycodone
Fantanyl |
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Term
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Definition
gallbladder disease
short term
moderate to sever pain
MAOI-possible fatal reaction |
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Term
| Codeine/Hydrocodone (lortab, vicodin) |
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Definition
mild to moderate pain
enhanced by ASA, APAP |
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Term
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Definition
severe pain
10x more potent than morphine |
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Term
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Definition
same potency as morphine
better than morphine for oral
long duration |
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Term
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Definition
| recalled due to risk of CV event |
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Term
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Definition
schedule 2-risk for abuse
Oxycoton-sustained release form
moderate to severe pain
deadly if OD |
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Term
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Definition
100x more potent than morphine!!
-sublimaze: given with Versed for conscious sedation
-Oralet: lollipop-chronic pain and cancer
-duragesic: patch-chronic pain (72 hours) not for break-through pain |
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Term
Mixed opioid agonist-antagonist
prototype |
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Definition
Pentazocine (Talwin)
AKA partial opioid agonist: weak agonist effect
mild to moderate pain
dec cardiac output
precaution: dont give with pure opioid agonist, may induce withdrawal |
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Term
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Definition
Naloxone (Narcane)
OD-you know its opioid OD if you give Narcane and they wake up.
speed recovery of spontaneous ventilation
very short half life so you dose them a lot more
they will be in terrible pain!! |
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