Term
| What's the difference between seizure and convulsion? |
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Definition
| Seizure = abnormal discharge of cerebral neurons, Convulsion = abnormal discharge of motor neurons |
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Term
| What anti-epileptics are contraindicated (cautioned against) in children? |
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Definition
| Lamotrigine (SJS), valproate (hepatoxicity), zonisamide (heat stroke) |
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Term
|
Definition
| Loss of GABA interneurons (inhibition) or increased glutamate (excitation) *hypocalcemia and hypoxia can cause seizures* |
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Term
| What are absence seizures? |
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Definition
| 3hz spike and wave, self-sustained (can be thalamic-cortical cycle), blank stares, often remits in adolescence |
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Term
| Common side effects of sodium channel inhibitors? |
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Definition
General - diplopia, ataxia, nystagmus, NV, cerebellar problems.
CNS depression - dizziness, drowsiness, confusion, hallucinations.
Hypersensitivity - rash, fever, stevens johnson syndrome |
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Term
| Prophylactic for migraines? |
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Definition
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Term
| Which drug causes gingival hyperplasia, hirsutism, megaloblastic anemia, ataxia, nystagmus, diplopia |
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Definition
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Term
| Signs of Fetal Phenytoin Syndrome |
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Definition
| MR, malformation of ear, lips, and palate, congenital HD. |
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Term
|
Definition
| Blocks sustained high frequency repetitive firing (use-dependent block) - more effective against high frequency firing (partial seizures). |
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Term
| epileptic DOC for cardiac arrhythmias? |
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Definition
|
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Term
| DOC for trigeminal neuralgia? |
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Definition
|
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Term
| Asian pts must have genetic testing for what allele to protect against SJS? |
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Definition
|
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Term
|
Definition
Phenytoin
Carbamazepine
Lamotrigine |
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Term
| Which antiepileptic does not have enzyme induction? |
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Definition
|
|
Term
| Broad spectrum antiepileptics |
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Definition
| Lamotrigine, Valproic acid, Felbamate |
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Term
| DOC for absence seizures in children? MOA? |
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Definition
| Ethosuximide, MOA = inhibit low-threshold Ca currents (T-currents) in thalamic neurons |
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Term
| Drug indicated for neuropathic pain? |
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Definition
|
|
Term
| Drug indicated for fibromyalgia? |
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Definition
|
|
Term
| Side effects of GABA channel potentiators? |
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Definition
|
|
Term
| Inhibitor of CYP450 enzymes |
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Definition
|
|
Term
| Benzodiazepine with long DOA? |
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Definition
|
|
Term
| DOC for febrile seizures in infants and resistant status epilepticus? |
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Definition
|
|
Term
|
Definition
| Topiramate and Valproic Acid |
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Term
| Which drug causes weight loss? |
|
Definition
|
|
Term
|
Definition
| Diazepam (IV) --> Lorazepam --> Phenytoin --> Phenobarbital |
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|
Term
| Which drugs cause aplastic anemia? |
|
Definition
| Carbamazepine and Felbamate |
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|
Term
| Which side effects of opioids do not develop tolerance? |
|
Definition
| Pinpoint pupils and constipation |
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Term
|
Definition
| Decrease Ca current and NT release. |
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Term
|
Definition
| Increase K current --> hyperpolarization |
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|
Term
| Opioid analgesic effect works by: |
|
Definition
1. Increase pain threshold at spinal cord
2. Alter pain perception in brain |
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|
Term
| MOA of opioid effect on respiration |
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Definition
| Decrease sensitivity of brain stem respiratory center to CO2 tension --> decrease respiration |
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|
Term
| How do opioids cause miosis? |
|
Definition
| Excite CNIII with increased parasympathetic stimulation |
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|
Term
| Pathognomonic triad for opioid OD? |
|
Definition
| coma, pinpoint pupils, respiratory depression |
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|
Term
| Abstinence syndrome includes which symptoms? |
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Definition
| Autonomic hyperactivity, behavioral excitability, muscle and joint pain. |
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|
Term
| Large doses of opioids cause orthostatic hypotension and bradycardia except for? |
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Definition
|
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Term
|
Definition
|
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Term
|
Definition
| Diphenoxylate and loperamide |
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|
Term
| DOC's for maintenance of withdrawal? |
|
Definition
| Methadone, buprenorphine, naltrexone |
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|
Term
|
Definition
|
|
Term
| Office-based opioid detoxification = ? and MOA? Why office-based? |
|
Definition
| Buprenorphine - partial mu-R agonist - cannot treat OD with naloxone (buprenorphine is resistant to naloxone) |
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|
Term
| Naloxone does not work well on which drugs? |
|
Definition
| Buprenorphine and Tramadol |
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|
Term
|
Definition
| Inhibit reuptake of NE and 5HT in the brain |
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|
Term
| Opioid antagonist for tx of alcoholism |
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Definition
|
|
Term
| Contraindications for opioids |
|
Definition
| COPD, asthma, elderly, neonates |
|
|
Term
| Drug interactions for opioids |
|
Definition
| MAOIs (mepiridine --> coma), sedative hypnotics, antipsychotics, tricyclic antidepressants |
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|
Term
| Opioids indicated for severe pain? |
|
Definition
| Morphine sulfate, hydromorphone, levorphanol |
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|
Term
| Antimuscarinic effects of meperidine? |
|
Definition
| Dilated pupils, less constipation, tachycardia |
|
|
Term
| Meperidine is metabolized to? |
|
Definition
| Normeperidine = toxic, especially at high doses or with liver impairment. |
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|
Term
| Acute side effects of aspirin in elderly? |
|
Definition
|
|
Term
Acute side effects of aspirin in children with viral infection?
|
|
Definition
| Reye's syndrome (hepatic injury, encephalopathy, coma) |
|
|
Term
Acute side effects of aspirin in pts with RA or lupus?
|
|
Definition
| Hepatitis (increased liver enzymes) |
|
|
Term
| Therapeutic side effects of aspirin? |
|
Definition
| GI irritation and bleeding, asthmatics --> anaphylaxis (bronchoconstriction and shock mediated by leukotrienes) |
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|
Term
| What is prescribed for patent ductus arteriosis? |
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Definition
|
|
Term
| Common characteristics of NSAIDs |
|
Definition
| Reversible inhibition of PA and PG synthesis. Similar adverse reactions, most useful for RA, some for dysmenorrhea |
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|
Term
|
Definition
| gastric irritation and renal toxicity |
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|
Term
| Why is indomethacin not commonly used? |
|
Definition
| High incidence and severity of adverse reactions (severe frontal headache - vertigo, confusion, depression, psychosis). |
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Term
| Ketorolac should not be used for more than ____ since there is an increased risk of serious adverse reactions. |
|
Definition
| 5 days (short term management of moderate-to-severe pain as an alternative to opioids). |
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|
Term
| Osteoarthritis patients at high risk of ulcers should take? |
|
Definition
| Diclofenac with misoprostol (arthrotec) |
|
|
Term
|
Definition
D - Diclofenac (for OA taken with Miso)
I - Indomethacin (severe frontal headache)
S - Sulindac (weaker indomethacin)
K - Ketorolac (not > 5 days) |
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|
Term
| Proprionic acid derivatives (NSAIDs) |
|
Definition
F - Fenoprofen (Short half life - causes HA)
I - Ibuprofen (dysmenorrhea, fever)
N - Naproxen (longer half life than ibu - 14 hrs)
K - Ketoprofen (short half life) |
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|
Term
| Side effects of Fenamates |
|
Definition
| 25% GI side effects, especially diarrhea |
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|
Term
| Mefenamic acid should not be used longer than ___? |
|
Definition
| >1 week (for dysmenorrhea, myalgia) |
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|
Term
|
Definition
|
|
Term
| Concerns for those on chronic oxicam therapy? |
|
Definition
| Kidney and GI toxicity (for RA pts, elderly, impaired renal function). |
|
|
Term
| COX 2 selective inhibitors |
|
Definition
| Meloxicam, Nabumetone, Celecoxib |
|
|
Term
| 2 situations with less GI side effects in NSAIDs? |
|
Definition
| Selective for COX2 and longer half-life. |
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|
Term
| Which drug should be maintain under 100mg bid to prevent CV risk |
|
Definition
|
|
Term
| Of celecoxib, naproxen, diclofenac, ibuprofen, which has the least incidence of gastroduodenal ulcers? |
|
Definition
|
|
Term
| True or False: Acetaminophen is an anti-inflammatory and anti-coagulant. |
|
Definition
| False. does not inhibit Cox2, weaker inhibitor of peripheral COX and PGs. |
|
|
Term
| True or False: Acetaminophen is an analgesic and antipyretic. |
|
Definition
| True. Possible COX3 inhibitor (alternative to ASA when contraindicated and not needed for anti-inflammatory) |
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|
Term
| True or False: Aspirin and acetaminophen have the same potency. |
|
Definition
|
|
Term
| True or False: acetominophen has a synergistic effect with opioids. |
|
Definition
|
|
Term
| How does acetaminophen become hepatotoxic? And what is the tx? |
|
Definition
| A reactive metabolite covalently binds glutathione --> hepatic necrosis. Tx = acetylcysteine - replaces GSH. |
|
|
Term
| Contraindications of acetaminophen? |
|
Definition
| EtOH, barbiturates, phenytoin, impaired liver function. |
|
|
Term
|
Definition
| HA, tinnitis, dizziness, hyperthermia, hyperventilation and respiratory alkalosis, metabolic and respiratory acidosis (peds), diarrhea, sweating, deafness. |
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