neuro/psych drugs

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agonize dopamine receptors: bromocriptine, pramipexole, ropinirole
increase dopamina: amantadine, l-dopa/carbidopa
prevent dopamine breakdown: selegiline, entacapone, tolcapone
prevent dopa methylation in periphary that leads to competitive antagonism of BBB uptake: entacapone, tolcapone
MAO type B inhibitor: selegiline
curb excess cholinergic activity: benztropine
what is benztropine good for?: tremors and rigidity
what is benzotropine not good for: bradykinesia
what is the overall effect of benzotropine: antimuscarinic
toxicities of l-dopa/carbidopa: arrythmias, dyskinesia following administration, akinesia between administraitons
5-HT1D agonist: sumatriptan
migraines, cluster headaches: sumpatriptan
toxicity of sumatriptan: hypertensive crises
why does sumatriptan contraindicated in CAD patients?: it's a vasoconstrictor
1st line for tonic-clonic: phenytoin
1st line for prophylaxis of status epiplepticus: phenytoin
1st line for trigeminal neuralgia: carbamazepine
1st line in pregnant women and children: phenobarbital
myoclonic seizures: valproic acid
1st line absence seizures: ethosuximide
1st line acute status epilepticus: diazepam/lorazapem
first line seizures of preeclampsia: magnesium sulfate
how does ethosuximide work?: blocks thalamic T-type calcium channels
what is an antiepileptic that works for seizures of preeclampsia?: diazepam/lorazepam
toxicity: kidney stones, weight loss: topoiramate
how does topiramate work?: blocks sodium channels, increase GABA action
induce p-450, teratogen, liver toxicity, agranulocytosis, aplastic anemia: carbamazepine
urticaria, stevens johnson: ethosuximide
sedation, tolerance, induce p-450: phenobarbital
gingivial hyperplasia: phenytoin
hirsutism: phenytoin
megaloblastic anemia: phenytoin
SLE-like snydrome: phenytoin
what two anti-epileptics are teratogens?: phenytoin, carbamazzapine
what 3 anti-epileptics induce p-450: phenytoin, carbamazepine, barbituates
neural tube defects: valproic acid
weight gain, tremors: valproic acid
rare but fatal hepatotoxicity (need to measure LFTs): valproic acid
two drugs that cause stevens johnson: lamotrigine and ethosuximide
how does phenytoin work?: increase sodium channel inactivation
how does carbamazepine work: increase sodium channel inactivation
how does lamotrigine work?: blocks voltage-gated sodium channels
how does gabapentin work?: increases GABA release
how does phenobarbital work?: incrases GABA action
what drug can be used for peripheral neuropathy: gabapentin
used for alcohol withdrawal (DTs): benzodiazepens
used for anxiety and spasticity (anti-epileptic): benzodiazepene
less risk of respiratory depression than barbituates: benzodiazpenes
treatment for benzo overdose: flumaeznil
name 4 antipsychotics: thioridazine, haloperidol, fluphenazine, chlorpromazine
mechanism for neuroleptics: blocks D2 receptors
describe evolution of EPS side effects in neuroleptics?: 4 hours acute dystonia, 4 days akinesia, 4 weeks akathisia, 4 months tardive dyskinesia (irreversible)
clinical uses for neuroleptics (4): schizophrenia (only positive syndromes), psychosis, acute mania, Tourette's
how do you treat neuroleptic malignant syndrome?: dantrolene, dopamine agonists
what are 4 factors in neuroleptic malignant syndrome?: rigidity, myoglobinuria, hyperpyrexia, autonomic instability
what drug causes hyperprolactinemia and gynecomastia?: neuroleptics
3 general side effects for neuroleptics: muscarinic blocker (dry mouth, constipation), alpha blocker (hypotension), histamine blocker (sedation)
define tardive dyskinesia: sterotypic oral-facial movements
what is the mechanism for tardive dyskinesia?: dopamine receptor sensitziation due to upregulation (long-term antipsychotic use)
name 3 atypical antipsychotics: clozapine, olanzapine, risperidone
what is the mechanism of atypical antipsychotics: blocks 5-HT2 and dopamine receptors
what 5 disorders is olanzapine useful for?: OCD, anxiety disorder, depression, mania, tourette's
what are atypical antipsychotics used for?: good for negative and positive symptoms of schizophrenia
what is a side effect of clozapine: agranulocytosis
mechanism of lithium: blocks phosphoinositol cascade
what is lithium used for?: mood stabilizer for bipolar disorder
causes nephrogenic diabetes insipidus: lithium
causes polyuria: lithium
ADH antagonist: lithium
hypothyroidism: lithium
is lithium a teratogen?: yes
why do you need to closely monitor lithium levels?: narrow therapeutic window
name 4 SSRIs: fluoxetine, sertraline, paroxetine, citalopram
how long does it take for antidepressants to work?: 2-3 weeks
how do SSRI's work?: seratonin-specific reuptake inhibitor
what 2 things can SSRI treat?: OCD, endogenous depression
side effect: anorgasmia: SSRIs
side effect: seratonin syndrome: SSRIs
define seratonin syndrome: hyperhtermia, msucular rigidity, cardiovascular collapse
what two combos cause seratonin syndrome?: SSRI + MAO inhibitors, beta-agonists + MAO inhibitors
name 6 tricyclic antidepressants: imipramine, desipramine, clomipramine, amitriptyline, nortriptyline, doxepin
mechanism of tricyclics: block NE and seratonin
general use for TCAs: major depression
specific use for imipramine: bedwettin
specific use for clomipramine: OCD
what drug causes atropine-like (anticholinergic side effects): TCAs
what are some atropine-like side effects?: tachycardia, urinary retention
what has more anticholinergic effects, amitriptyline or nortriptylne?: amitriptyline
what is the least sedating TCA: desipramine
name the 5 main side effects of TCAs: convulsions, coma, convulsions (arrythamias ) 3 C's + respiratory depression and hyperpyrexia
what side effects are found in elderly with TCAs: confusions and hallucinations
what TCA do you switch to when you see elderly side effects?: nortriptyline
alternative function for bupropion: smoking cessation
mechanism for bupropion: not known
major toxicity of bupropion: seizures in bulemic patients
what heterocyclic can you use that does not cause sexual side effects?: bupropion
heterocylic also used for generalized anxiety disorder: venlafaxine
mechanism: inhibts seratonin, norepinephrine, dopamine reuptake: venlafaxine
major venlafaxine side effect: stimulant side effects
mechanism of mirtazapine: alpha2 anatagonist (increases relaease of NE and seratonin) + 5-HT2 and 5-HT3 antagonist
3 side effects of mirtazapine: increased appetite, weight gain, dry mouth
mechanism of maprotiline: blocks NE reuptake
major side effect of maproptiline: orthostatic hypotension
2 major side effects of trazadone: priapism, orthostatic hypotension
primary mechanism of trazadone: inhibits seratonin reuptake
name the 5 heterocyclics: buproprion, venlafaxine, mirtazapine, maprotiline, trazadone
name 2 MAO inhibitors: phenelzine, tranylcypromine
3 uses for mao inhibitors: atypical depression (w/ psychosis or phobia), anxiety, hypochondriacs
what drug is used for hypochondriacs?: mao inhibitors
what 2 substances causes hypertensive crises in mao inhibitors: tyramine ingestion, meperidine (opioid)
what characteristic is required in anesthetics for rapid induction and recovery: decreased solbulity in blood
what characteristic in necssary for anesthetics to be potent: incresaed solbulity in lipids
what does MAC stand for: minimal anesthetic concentratoin
what is a mathematical expression for anesthetic potency: 1/MAC
name 6 inhaled anesthetics?: halothane, enflurane, isoflurane, sevoflurane, methoxyflurane, nitrous oxide
4 major side effects of inhaled anesthetics: myocardial depression, respiratory deprssion, nausea/emsis, incresaed cerebral blood flow
anesthetic that causes hepatotoxicity: halothane
anesthetic that causes nephrotoxicity: methoxyflurane
proconvulsant anesthetic: enflurane
what is the main purpose of using inhaled anesthetics?: maintenance after induction w/ IV anesthetics
what is the major barbituate anesthetic: thiopental
which anesthetic leads to decreased cerebral blood flow: thiopental
is thiopental potent or not potent?: potent
what is the major use of IV anesthetics?: rapid induction of anesthesia, maintained though with inhalation agents
what is the most common anesthetic used for endoscopy: midazolam
what is a dissociative anesthetic (appear to be awake but unconscious and feel no pain): ketamine
side effects: disorientaiton, hallucination, nightmares: ketamine
which anesthetic is a cardiovascular stimulant and cannot be used in those w/ hypertension/ stroke: ketamine
what anesthetic is best for those who are hypovolemic or in shock: ketamine
name 2 opiates used for anesthesia: moprhine, fentanyl
what is the major benefit of using propofol?: less postoperative nausea than tiopental
name 3 ester anesthetics: procaine, cocaine, tetracaine
name 3 amide anesthetics: lidocaine, bupivacaine, mepivacaine
how do local anesthetics work?: blocks sodium channel by bidning to specific receptors in inner portion of channel
in what form (charged or uncharged) do local anesthetics bind to ion channels?: charged
why do you need to use more anesthetic in infected tissue?: it's acidic so anesthetics become charged and can't penetrate as well
what is the general order of nerve blockade for local anesthetics?: small>large, myelinated>unmyelinated
what is the order of sensation loss for local anesthetics: pain first then temprature then touch then pressure
what do you give with local anesthetics to enhance local actoin?: vasoconstrictors (epinephrine)
how do vasoconstrictors + local anesthetics work?: decrease bleeding and systemic concentratoin so increase local action
what do you use for spinal anesthesia?: local anesthetics
if you are allergic to ester anesthetics, what do you do?: give amide anesthetics
anesthetic that causes severe cardiovascular toxicity: bupivacaine
anesthetic that causes arryhtmias: cocaine
what is the use for neuromuscular blockade drugs (2): muscle paralyis in surgery or mechanical venitilatoin
what is the selectivity of neuromusclar blocking drugs?: selective for motor vs autonomic nicotinic receptor
what is a depolarizing neuromusclar blocking drug: succinylcholine
what are the 2 phases in succinylcholine action?: phase I (prolonged depolarizatoin), phase II (repolarized but blocked)
which phase of succinylcholine is potentiated by cholinesterase inhibitors: phase I
what phase of succinylcholine can you use neostigmine as an antidote?: phase II
name 2 nondepolarizing neuromusuclar blockers: atracurium, mivacurium
what is the mechanism of nondepolarizing neuromuscular blocing drugs: competitive inhibitor with ACh for ACh receptors
how do you reverse atracurium blockade?: give neostigmine or edrophonium
drug used to treat malignant hyperthemia: dantrolene
what 2 anesthetic drugs in combination cause malignant hyperthemia: inhalation anesthetics (Except nitric oxide) + succinylcholine
what is the drug used to treat neuroleptic malignant syndrome: dantrolene
what is the mechanism of dantrolene: prevents release of caclium fromsarcoplasmic reticulum of skeletal muscle
what drugs are good for OCD?: olanzapine, SSRIs, clomipramine
what drugs are good for generalized anxiety disorder? (5): barbituates, benzodiazepens, olanzapine, venlafaxine, MAO inhibitors

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