Term
| What are the two pathways of ethanol metabolism to acetaldehyde? Which is the main one? How is acetaladehyde oxidized? |
|
Definition
| Alcohol dehydrogenase and Microsomal ethanol-oxidizing system. Alcohol dehydrogenase (ADH) is the main system. Acetaladehyde is then oxidized by aldehyde dehydrogenase (ALDH). |
|
|
Term
| How does Disulfiram deter drinking? What other drugs can be used by similar mechanisms to deter drinking? |
|
Definition
It in inhibits the oxidation of acetaldehyde and acetaldehyde accumulates and causes nausea, vomiting, dizziness, headache and facial flushing.
Metronidazole, Cefotetan and Trimethoprim follow similar mechanisms. |
|
|
Term
| How does ethanol effect the action of GABA at its receptors? |
|
Definition
| It enhances it, that is why alcohol is a CNS depressant. |
|
|
Term
| What is acute alcohol comsumptions's effect on the heart and smooth muscle? Extreme acute ethanol consumption's effect on smooth muscle? |
|
Definition
| It decreases contractility of the heart myocardium, is associated with dilated cardiomyopathy with ventricular hypertrphy and fibrosis, and it causes atrial and ventricular arrythmias due to potassium or magnesium abnormalities and it is a vasodilator. It can cause hypothermia due to vasodilation in extreme cases. |
|
|
Term
| Which organs are most effected by alcohol consumption? |
|
Definition
| Liver, skeletal muscle, CNS, GI, cardiovascular and immune system. |
|
|
Term
| What is the most common medical complication of chronic alcohol comsumption? |
|
Definition
|
|
Term
| What is the most common cause of chronic pancreatitis in the western world? |
|
Definition
| Chronic Alcohol consumption |
|
|
Term
| What is Naltrexone's role in alcoholism? |
|
Definition
| It helps patients that are recovering from alcoholism to abstain from drinking by nonselectively blocking opioid receptors. |
|
|
Term
| What is the most common neurological abnormality associated with chronic alcohol consumption? |
|
Definition
| generalized symmetric peripheral nerve injury that begins with distal paresthesis of the hands and feet. |
|
|
Term
| What is the Wernicke-Korsakoff Syndrome? What is given to alcoholics to protect against W-K syndrome? |
|
Definition
| Seen almost exclusively in chronic alcoholism and it is characterized by paralysis of the external eye muscles, ataxia, confusion, coma and death. It is associated with an alcohol induced thiamine deficiency so thiamine is given. |
|
|
Term
| How does chronic alcohol consumption effect BP? |
|
Definition
| It is responsible for 5% of all HTN cases. |
|
|
Term
| What is chronic alcohol consumption's relation to coronary heart disease? |
|
Definition
| It is associated with CHD in heavy drinkers but there is controversy for moderate drinking because it raises HDL cholesterol, inhibits some inflammatory processes and the presence of antioxidants. |
|
|
Term
| How does chronic alcohol consumption cause anemia? |
|
Definition
| Most commonly through folic acid deficiency but also through GI bleeding, bone marrow inhibition and hemolytic syndromes. |
|
|
Term
| What are the consequences of chronic alcohol consumption on the endocrine system? GI system? |
|
Definition
| Can cause steroid hormone imbalances leading to gynecomastia and testicular atrophy. GI = Reversibly injures small intestine leading to diarrhea, weight loss and multiple vitamin deficiencies |
|
|
Term
| Describe Fetal alcoholism syndrome. |
|
Definition
| It is due to chronic consumption during pregnancy in which the ethanol crosses the placenta. It is the leading cause of mental retardation and congenital malformation. It is characterized by growth retardation, microcephaly, poor coordination, flattened face and minor joint anomalies. |
|
|
Term
| What kinds of cancer is chronic alcohol consumption linked to? Is alcohol a carcinogen? |
|
Definition
| mouth, pharynx, larynx, esophagus and liver but alcohol itself is not a carcinogen. |
|
|
Term
| How does chronic alcoholism affect drug metabolizing enzymes? |
|
Definition
| It increases their activity. |
|
|
Term
| What genetic abnormality seems to be protective against alcoholism? Why? |
|
Definition
| Polymorphism in alcohol dehydrogenase and aldehyde dehydrogenase because it leads to more hangover symptoms. |
|
|
Term
| What two systems need to be supported to ensure survival at the highest levels of acute alcohol intoxication? What are the specific goals in controlling the respiratory system in a severe acute intoxication? |
|
Definition
| Respiratory and cardiovascular systems. Goals for a severe acute intoxication include preventing severe respiratory depression and preventing aspiration of vomit. |
|
|
Term
| What is given to treat the hypoglycemia and ketosis associated with ethanol OD? |
|
Definition
|
|
Term
| What is given to protect again Wernicke-Korsakoff syndrome of ethanol OD? |
|
Definition
|
|
Term
| What is given to treat the dehydration and vomiting associated with ethanol OD? |
|
Definition
|
|
Term
| What is the symptoms of alcohol withdrawal? Severe symptoms? |
|
Definition
| motor agitation, anxiety, insomnia and reduction in seizure threshold. More severe symptoms include hallucinations and disorientation. |
|
|
Term
| What is the most common cause of seizures in adults? |
|
Definition
|
|
Term
| What is the drug treatment of choice for detox in severe cases of alcoholism? What must you monitor for while on these drugs? |
|
Definition
Benzodiazepines (BZD).
Pharmacologically active metabolites may accumulate, especially if the patients have liver dysfunction. |
|
|
Term
| When would long acting and short acting Benzodiazepines be useful for treating detox in severe alcoholism patients? Examples of each. |
|
Definition
| Long acting BZD's are useful in patients that do not have liver dysfunction because because they require less frequent dosing but pharmacologically active metabolites can accumulate, especially in patients with liver dysfunction. In the case of liver dysfunction, it would be better to use short acting BZD's because they are rapidly converted to inactive metabolites. Examples of long acting = (chlordiazepoxide, clorazepate, diazepam). Examples of short acting = (lorazepam and oxazepam). |
|
|
Term
| What other kind of treatment is usually needed after detox treatment is complete for alcoholism? |
|
Definition
| Psychosocial therapy either outpatient or inpatient is usually needed because psychiatric problems often coexist and can lead to a relapse if not treated as well. |
|
|
Term
| What are the 3 drugs that have FDA approval for treatment of alcohol dependence? |
|
Definition
| Naltrexone, Acamprosate, and Disulfiram |
|
|
Term
| What is the MOA for Naltrexone as treatment for alcohol dependence? |
|
Definition
| It is an active opioid receptor antagonist. |
|
|
Term
| Naltrexone and Disulfiram are both used to treat alcohol dependence but are toxic towards what organ? |
|
Definition
| They are both hepatotoxins. |
|
|
Term
| What is the MOA of Acamprosate on treating alcohol dependence? |
|
Definition
| It is a weak NMDA (glutamate) receptor antagonist and a GABA receptor agonist. |
|
|
Term
| What is the MOA of Disulfiram in treating alcohol dependence? |
|
Definition
| It causes extreme discomfort in those that ingest alcohol because it inhibits the oxidation of acetaldehyde and results in acetaldehyde accumulation leading to:(flushing, headache, nausea, vomiting, sweating, hypotension, and confusion occurring within few minutes of drinking). |
|
|
Term
| What is the role of Topiramate and Ondansetron in alcoholism? |
|
Definition
| They are effective at reducing cravings. |
|
|
Term
| How are methanol and ethylene glycol toxic? |
|
Definition
| They are from used in industrial solvents (methanol) and antifreeze (Ethylene glycol) and can lead to severe poisoning because they are oxidized to formaldehyde, formic acid and carbon dioxide and can lead to coma, seizures and resistant acidosis. |
|
|
Term
| What are the treatments for methanol poisoning? |
|
Definition
| Treat by IV ethanol (because it has a higher affinity to alcohol dehydrogenase than methanol), respiratory support, hemodialysis, alkalinization (bicarbonate administration), folic acid and suppression of metabolism (Fomepizole) so the toxic products are not formed. |
|
|
Term
| What is the role of Fomepizole in treating methanol/ethylene glycol poisoning? |
|
Definition
| It is an alcohol dehydrogenase inhibitor that acts to suppress the metabolism of methanol or ethylene glycol and is approved for the treatment of methanol and ethylene glycol poisoning. |
|
|
Term
| Describe the clinical effect seen with BAC concentrations of (50-100 mg/dL), (100-200 mg/dL), (200-300 mg/dL), (300-400 mg/dL), and (>500 mg/dL). |
|
Definition
50-100 mg/dL – sedation, “subjective high”, slower reaction time.
100-200 mg/dL – impaired motor function, slurred speech, ataxia.
200-300 mg/dL – emesis, stupor.
300-400 mg/dL – coma.
>500 mg/dL – Respiratory depression, death. |
|
|
Term
| Describe where H1-H4 Histamine receptors are found. |
|
Definition
H1 - smooth muscle, endothelium and brain.
H2 - Gastric mucosa, cardiac muscle, mast cells and brain.
H3 - Presynaptic brain and myenteric plexus.
H4 - Eosinophils, neutrophils and CD4 T cells. |
|
|
Term
What are the Adverse Effects of histamine?
What are the contraindications of histamine use? |
|
Definition
AE's = flushing, hypotension, tachycardia, headache, wheals, bronchoconstriction, & GI disturbances.
Contraindications = patients with asthma, active ulcer or other GI bleeding. |
|
|
Term
| What are physiologic antagonists, release inhibitors (examples of release inhibitors) and receptor antagonists of Histamine? |
|
Definition
| Physiologic antagonists have smooth muscle actions that are opposite of histamine but they work on different receptors (epinephrine). Release inhibitors reduce the degredation of mast cells from the antigen-IgE interaction (Cromolyn and Nedocromil). Receptor antagonists competitively antagonize the actions of histamine. |
|
|
Term
| How are Cromolyn and Nedocromil related to Histamine? Use? |
|
Definition
| They inhibit the release of histamine by reducing the degredation of mast cells that result from the antigen IgE interaction (mast cell stabilizers). Useful for long term control of asthma and Cromolyn can be used to reduce symptoms of rhinoconjunctivitis. |
|
|
Term
| What receptor do standard reference of "antihistamines" block? What is the main example of this receptor blocker? |
|
Definition
| H1 receptors (smooth muscle, endothelium and brain). Diphenhydramine (Benadryl) |
|
|
Term
What is the purpose of H2 blockers?
What are the main 2 H2 blockers for our testing purposes? |
|
Definition
| They are used for the reduction of stomach acid. The main two are Zantac (Ranitidine) and Tagamet (Cimetidine). |
|
|
Term
| What are the brand names and functions of Ranitidine and Cimetidine? |
|
Definition
| They are both H2 blockers that reduce the production of stomach acid. Ranitidine is Zantac and Cimetidine is Tagamet. |
|
|
Term
| What are some characteristics of 1st generation antihistamines vs 2nd generation antihistamines? |
|
Definition
| 1st generation are generally more sedating, have a shorter duration of action, more lipid soluble so cross the BBB. |
|
|
Term
| What are some of the clinical uses of antihistamines? |
|
Definition
| Allergic reactions, motion sickness, nausea and vomiting of pregnancy. |
|
|
Term
| What are some clinical uses of Serotonin Agonists? |
|
Definition
| Antianxiety, appetite supressant, migrane headaches, GI reflux, IBS and depression. |
|
|
Term
| What are some clinical uses of Serotonin antagonists? |
|
Definition
| Carcinoid tumor, Serotonin syndrome, nausea/vomiting, and to reduce thromboxane formation. |
|
|
Term
| What is the Serotonin Agonist Buspirone (BuSpar) used for? |
|
Definition
| It is an antianxiety drug. |
|
|
Term
| What is the Triptan group of Serotonin Agonists used for? |
|
Definition
| They are used for acute migraines and cluster headaches. |
|
|
Term
| What classes of drugs are used to treat Migraines? |
|
Definition
| Triptans (serotonin agonists), Ergot alkaloids, NSAIDS, BB's, CCB's, Antidepressants and Antiseizure agents. |
|
|
Term
| What is the clinical presentation of Serotonin Syndrome? |
|
Definition
| HTN, hyperreflexia, tremor, clonus, hyperthermia, hyperactive bowel sounds, diarrhea, mydriasis, agitations and coma. |
|
|
Term
| What is the treatment of Serotonin Syndrome? |
|
Definition
| Sedation by Benzodiazepines, paralysis, intubation and ventilation. |
|
|
Term
| What are the uses of Ergot Alkaloids? |
|
Definition
| Migraines, Hyperprolactinemia, Postpartum Hemorrhage, Diagnosis of Variant Angina and Senile Cerebral Insufficiency. |
|
|
Term
| Toxicity and Contraindications of Ergot Alkaloids? |
|
Definition
Toxicity = diarrhea, nausea, vomiting, vasospasm, drowsiness, uterine smooth muscle stimulation, demetia and hallucinations.
Contraindications = obstructive vascular disease and collagen disease. |
|
|
Term
| What is COX? What results from inhibition of COX? |
|
Definition
| It is cyclooxygenase, an enzyme responsible for the formation of prostaglandins, prostacyclin and thromboxane. Inhibition of COX results in relief from inflammation and pain. |
|
|
Term
| What is the function of COX-1 inhibitors? |
|
Definition
| They are involved in cell-cell signaling and in maintaining tissue homeostasis, "House-Keeping". |
|
|
Term
| What is the function of COX-2 inhibitors? |
|
Definition
| They are anti-inflammatory's and prevent oxidations, thus reducing the likehood of cancers. |
|
|
Term
| What is an example of a COX-2 selective antagonist? |
|
Definition
|
|
Term
| Which drugs block COX-1 and COX-2? |
|
Definition
| Ibuprofen (Motrin, Advil) |
|
|
Term
| How does Aspirin affect COX? |
|
Definition
| It irreversibly binds it (book says COX-1 and COX-2) |
|
|
Term
| What are the 3 enzymes that synthesize Nitric Oxide? |
|
Definition
| Neuronal NOS, Macrophage NOS and Endothelial NOS. |
|
|
Term
| What are the 3 major effector targets for NO? |
|
Definition
| Metalloproteins (iron in heme), Thiols and Tyrosine nitration. |
|
|
Term
| What are the functions of Nitric Oxide? |
|
Definition
| vasodilator, platelet inhibitor, immune regulator and neurotransmitter |
|
|
Term
| What is the function of NitrOUS Oxide? |
|
Definition
|
|
Term
| What is protein tyrosine nitration used as a marker of? |
|
Definition
| Oxidative and Nitrosative stress. |
|
|
Term
| What is Nitroglycerine's effect on the vasculature? |
|
Definition
| Nitroglycerine is metabolized to NO and it dilates veins and coronary arteries. |
|
|
Term
| What is the action of Sodium Nitroprusside? |
|
Definition
| It is used for rapid arterial dilation. |
|
|
Term
| What is the result of NO gas inhalation? Uses? |
|
Definition
Inhalation of NO results in reduced pulmonary artery pressure and improved perfusion of ventilated areas of the lungs.
Uses - Acute respiratory distress syndrome, Pulmonary Artery HTN, Acute hypoxemia and CPR. |
|
|
Term
| What is the most effective and widely used treatment for short term relief of asthma? Others for short term relief? |
|
Definition
| Beta agonist is MC. Also use Theophylline and antimuscarinic agents. |
|
|
Term
| What are some long term treatments for asthma? |
|
Definition
| Inhaled corticosteroid, long acting beta-2 agonists, leukotriene inhibitors, mast cell stabilizers (Cromolyn and Nedocromil), and antibodies against IgE. |
|
|
Term
| What are the most common short acting sympathomimetic agents used for asthma? |
|
Definition
| Albuterol, Terbutaline, Metaproterenol and Pirbuterol. |
|
|
Term
| What are the 2 most common long acting B2 agonists? What are these recommended to be given in combo with? |
|
Definition
| Salmeterol and Formoterol, recommended to be given with inhaled corticosteroids. |
|
|
Term
| What drugs make up the Methylxanthine class? MOA? |
|
Definition
Theophylline, Theobromine and Caffeine.
MOA is that they inhibit cell surface receptors for adenosine (which contract airway smooth muscle and cause the release of histamine from airway mast cells). |
|
|
Term
| What are the effects on the cardiovascular system of the Methylxanthine drugs (Theophylline, Theobromine and Caffine)? |
|
Definition
| They are positive chronotropic and inotropic agents. |
|
|
Term
| What are the effects on the GI system of the Methylxanthine drugs (Theophylline, Theobromine and Caffine)? |
|
Definition
| Stimulate secretion of gastric acid and digestive enzymes (stimulate digestion). |
|
|
Term
| What are the effects on asthma of the Methylxanthine drugs (Theophylline, Theobromine and Caffine)? |
|
Definition
| They bronchodilate and they inhibit the release of histamine from lung tissue. |
|
|
Term
| What are the effects on skeletal muscle of the Methylxanthine drugs (Theophylline, Theobromine and Caffine)? |
|
Definition
| Strengthen muscle contraction |
|
|
Term
| We know that theophylline is a Methylxanthine class drug that is used as a bronchodilator in asthma treatment, however it has a narrow therapeutic index, what is the level where negative effects will start to occur? |
|
Definition
| Adverse effects start to occur in some patients at 15mg/L but usually in 20 mg/L or more. |
|
|
Term
| What are the adverse effects associated with Theophylline? What level is necessary to provoke seizures and arrythmias? |
|
Definition
| anorexia, nausea, vomiting, abdominal discomfort, headache and anxiety. A level over 40mg/L will cause seizures and arrythmias. |
|
|
Term
| Where are Methylxanthine drugs metabolized? |
|
Definition
| They are metabolized in the liver so liver disease could lead to toxic levels. |
|
|
Term
| What is the MOA of antimuscarinics (Atropine or Ipratropium) in treating asthma? |
|
Definition
| They block muscarinic receptors and thus block the contraction of airway smooth muscle and block the secretion of mucus. |
|
|
Term
| What is the MOA for corticosteroids in the treatment of asthma? |
|
Definition
| Anti-inflammatory by inhibiting inflammatory cytokines and indirectly relaxes smooth muscle. |
|
|
Term
| Complications of long term corticosteroid use? |
|
Definition
| osteoporosis and cararacts |
|
|
Term
| What is the MOA for Leukotriene inhibitors in the treatment of asthma or allergies? Examples of Leukotriene Inhibitors? |
|
Definition
| They block arachidonic acid production and result in airway dilation. Examples = Zafirlukast (Accolate) and Montelukast (Singulair). |
|
|
Term
| What class of drugs do Zafirlukast and Montelukast belong to? What are their uses? |
|
Definition
| They are Leukotriene inhibitors and Zafirlukast (Accolate) / Montelukast (Singulair) are used to inhibit the action of leukotrienes to treat asthma and allergies. |
|
|
Term
| What is Omalizumab used to treat? MOA? |
|
Definition
| It is used to treat asthma and allergies by lowering plasma IgE levels to undetectable levels. |
|
|
Term
| How many canisters of inhaled beta agonist use per month is a marker for increased risk of asthma fatality? |
|
Definition
|
|
Term
| When is Theophylline used in the treatment of asthma? |
|
Definition
| Theophylline reserved those in whom symptoms remain poorly controlled despite combination of regular treatment with inhaled anti-inflammatory agent and as needed beta agonist. |
|
|
Term
| What are muscarinic antagonists role in the treatment of asthma? What are they used more for? |
|
Definition
| They have a limited place in therapy for asthma and are of greater value for COPD patients. |
|
|
Term
| What should you add to an asthma patients treatment plan that has severe asthma that is poorly controlled by a standard dose of inhaled corticosteroid? |
|
Definition
| Double dose of inhaled corticosteroid and/or add a long acting beta agonist. |
|
|
Term
| What should you add to an asthma patients treatment plan that has severe asthma that is poorly controlled by high dose inhaled corticosteroids and long acting beta agonist? |
|
Definition
| Anti-IgE monoclonal antibody (Omalizumab) |
|
|
Term
| What are the treatments for severe asthma attacks? |
|
Definition
| oxygen, frequent albuterol administration and systemic corticosteroids (Prednisone or Methylprednisone). |
|
|
Term
| What is the MOA for cocaine? |
|
Definition
| It blocks the reuptake of catecholamines at adrenergic synapses which prolongs the action of the catecholamines. |
|
|
Term
| What is the MOA for Barbiturates? |
|
Definition
| They block channels of many excitatory ligand-gated channels. |
|
|
Term
| Is glutamate excitatory or inhibitory? What kind of neurons release glutamate? |
|
Definition
| It is an excitatory transmitter released from projection neurons. |
|
|
Term
| Are GABA and glycine excitatory or inhibitory? What kind of neurons release them? |
|
Definition
| They are both inhibitory and are released from local circuit neurons. |
|
|
Term
| What is the very brief difference between GABA-a and GABA-b receptors? |
|
Definition
| GABA-a mediates the fast component and GABA-b mediates the slow component. |
|
|
Term
| What are dopamines roles in the CNS? |
|
Definition
| it generally exerts a slow inhibitory action on CNS neurons and also plays an important role in regulating hypothalamus function. |
|
|
Term
| Is 5-hydroxytryptamine (Serotonin) excitatory or inhibitory in the CNS? |
|
Definition
| It has a strong inhibitory action in most areas but it can be excitatory and inhibitory on the same neuron. |
|
|
Term
| What are the most effective anti-anxiety drugs? |
|
Definition
|
|
Term
| What is Buspirone (BuSpar) used for? |
|
Definition
| used in generalized anxiety and chronic sleep disorders |
|
|
Term
| What are SSRI's (Selective serotonin reuptake inhibitors) effective in treating? |
|
Definition
| Effective in treating Obsessive-Compulsive Disorder (OCD), Panic Disorder and Generalized Anxiety Disorder. |
|
|
Term
| What is the MOA for Benzodiazepines in the treatment of anxiety? |
|
Definition
| They are GABA agonists so they treat anxiety by increasing the inhibitory effects of GABA. |
|
|
Term
| What are the general effects of Benzodiazepines? |
|
Definition
| It is an anti-anxiety, anti-convulsant, hypnotic, amnestic and a muscle relaxant. |
|
|
Term
| Do benzodiazepines cross the placenta? |
|
Definition
| Yes, so you should not use them in pregnant women. |
|
|
Term
| What class of drugs are Alprazolam, Clonazepam, Diazepam, Flurazepam, Lorazepam, Midazolam, Temazepam and Prazepam? |
|
Definition
| They are all Benzodiazepine agonists. |
|
|
Term
| What is the preferred benzodiazepine for anxiety disorders? |
|
Definition
|
|
Term
| Which benzodiazepine is effective for short and long term treatment of anxiety disorders? |
|
Definition
|
|
Term
| Which benzodiazepine is used for muscular disorders? |
|
Definition
|
|
Term
| Which benzodiazepine is used for myoclonic (jerking) seizures and in absence (petit mal) seizures? |
|
Definition
|
|
Term
| Which benzodiazepine is used for grand mal seizures? |
|
Definition
|
|
Term
| Which benzodiazepines are used for alcohol withdrawal seizures? |
|
Definition
|
|
Term
| Which benzodiazepine is the drug of choice for status epilepticus and petit mal seizures? |
|
Definition
|
|
Term
| Which benzodiazepam is the treatment of choice for panic disorder and generalized anxiety? |
|
Definition
|
|
Term
| Which benzodiazepine is used in treating insomnia? |
|
Definition
|
|
Term
| Which benzodiazepine is used IV as a pre-operative anesthetic? |
|
Definition
|
|
Term
| What is the MOA of benzodiazepine antagonists and how are they administered? |
|
Definition
| They competitively inhibit BZD site at the GABA/BZD receptor site. They are administered IV only. |
|
|
Term
| What is Flumazenil and what are its uses? |
|
Definition
| It is a BZD antagonist and is used post anesthesia to awaken the patient and it is used to treat a BZD overdose. |
|
|
Term
| How does Cimetidine (Tagamet) affect BZDs? Which BZDs are indicated for use with Tagamet? |
|
Definition
| It inhibits liver function and thus prolongs the action of most BZDs except lorazepam and alprazolam, so use these BZDs if a patient is taking Cimetidine (Tagamet) - H2 blocker. |
|
|
Term
| Is BZD overdose life threatening? |
|
Definition
| Only if it is mixed with alcohol or opioids. |
|
|
Term
| What is the maximum number of consecutive days that a patient with insomnia should use pharmacologic treatment? |
|
Definition
|
|
Term
| What is the limit for consecutive days that BZDs can be used? |
|
Definition
| Never use them for more than 3 consecutive days. |
|
|
Term
| What can result if drug administration of BZDs stops spontaneously or an antagonist is given? |
|
Definition
| BZD abstinence syndrome (tremors, seizures, anxiety, insomnia, nausea and malaise. |
|
|
Term
| Describe the differences between sedative and hypnotic agents. |
|
Definition
| Sedative agents diminish awareness, cause drowsiness and diminish motor activity. Hypnotic agents promote sleep and inhibit wakefulness. |
|
|
Term
| What are the therapeutic uses of Barbiturates? Why aren't they used as much anymore? |
|
Definition
| Therapeutic uses: anesthesia, seizures insomnia & anxiety. They are not really used as much anymore because they have a narrower therapeutic index than BZDs. |
|
|
Term
| What is the longest acting Barbiturate? How long does it last? What are its uses? |
|
Definition
| Phenobarbitol, it lasts more than 6 hours and is used as a hypnotic and a sedative. |
|
|
Term
| What are some side effects of Barbiturates as a class? |
|
Definition
| cardiac and respiratory depression, hallucination, agranulocytosis (failure of the bone marrow to make enough neutrophils), thrombocytopenia, megaloblstic anemia, CNS depression and dependence. |
|
|
Term
| What is the therapeutic use of the Benzodiazepine Flurazepam (Dalmane)? SE's? Positives for this drug when compared to other BZDs? |
|
Definition
| Long acting hypnotic used to treat insomnia but it has a hangover effect because it is so long acting. It is good because it has low addiction and withdrawal potential. |
|
|
Term
| What is the therapeutic use of the Benzodiazepine Temazepam (Restoril)? What are its contraindications? |
|
Definition
| It is used in the short term treatment of insomnia. It is contraindicated in closed angle glaucoma and pregnancy. |
|
|
Term
| What is Zolpidem? Therapeutic uses? |
|
Definition
| It is Ambien and is not a BZD but binds to a subset of BZD receptors (BZD1) and is just as effective at producing sleep as BZDs but it has much less side effects and a lower potential for dependence. |
|
|
Term
| What are the therapeutic uses of the Histamine Antagonist Diphenhydramine (Benadryl)? |
|
Definition
| Local anesthetic and anti-pruritic effects as well as sedative properties. |
|
|
Term
| What drug is the first line agent for partial seizure (local) and generalized tonic-clonic seizures (Loss of consciousness, stiffened body, and then falls to the ground, followed by jerking movements)? |
|
Definition
|
|
Term
| What are the toxicities/side effects for Phenytoin (Dilantin)? |
|
Definition
| Toxicity/side effects: gingival hyperplasia, hirsutism (increased hair growth), osteomalacia (softening of the bone), lymphoma, teratogenic effects and rash. |
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Term
| What are the therapeutic levels of Phenytoin (Dilantin) for free and total? |
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Definition
Free = 1-2 mcg/ml.
Total = 10-20 mcg/ml. |
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Term
| Describe the dosing regimen for Phenytoin for adults and children. Max dose for adults and children? |
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Definition
| For adults initiate 300 mg daily in adults and increase by 25-30 mg after steady state has been reached. For kids, initiate 5mg/kg/day. Max dose for adults is 600mg/day. Max dose for kids is 300mg/day. |
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Term
| What is the drug of choice for simple and complex partial seizure? |
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Definition
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Term
| What is the therapeutic range for Carbamazepine? What is the adult and child daily dose range for Carbamezapine? |
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Definition
Therapeutic range is 4-12 mcg/ml.
Adult daily dose range = 800-1200 mg/day.
Child daily dose range = 400-800 mg/day. |
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Term
| What is the drug of choice for neonatal seizures? |
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Definition
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Term
| Phenobarbital has a narrow therapeutic range, what it is? |
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Definition
| Therapeutic range 10-40 mcg/ml |
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Term
| What is the clinical use of Lamotrigine (Lamictal)? |
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Definition
| Clinical use: Mainly partial seizure |
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Term
| What is the therapeutic use of Felbamate (Felbatol)? Why is its use limited? |
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Definition
| It is used for partial seizures but its use is limited due to its SEs of aplastic anemia, hepatotoxicity and drug interactions. |
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Term
| What is the therapeutic use of Gabapentin (Neurontin)? |
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Definition
| It is used as an adjunct for partial and tonic clonic seizure. |
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Term
| What drug is used first line for tonic-clonic and absence seizure in combination? |
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Definition
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Term
| What is the dose for Valporic Acid (Depakene)? What is the therapeutic range? |
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Definition
Dose = 25-60 mg/kg/day.
Therapeutic range = 50-100 mcg/ml. |
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Term
| What is the drug of choice for absence seizure (petit mal) but is not useful for other seizures? |
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Definition
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Term
| What drug is given IV and is the drug of choice for status epilepticus in adults and is also effective against other seizures? |
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Definition
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Term
| What is a new epileptic drug that is used as an adjunct for partial and tonic-clonic seizures? |
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Definition
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Term
| What is the indication for the BZD, Prazepam? |
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Definition
| It is indicated for the short term treatment of anxiety. |
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Term
| What is Haloperidol and what is it used to treat? |
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Definition
| It is a dopamine antagonist antipsychotic drug that is used to treat Schizophrenia, acute psychotic states and delirium. |
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Term
| What is prednisone? Uses? |
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Definition
| It is a corticosteroid used to treat severe inflammatory diseases such as asthma attacks. |
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Term
| Briefly explain the pharmacology of how Benzodiazepines work. |
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Definition
| They bind to the GABA receptor which opens the Cl- channels and hyper-polarizes the cell, which reduces the cell excitability. This is how they treat anxiety, seizures, and insomnia. |
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Term
| Where is over 90% of ethanal oxidized? Where is the rest excreted? |
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Definition
| over 90 % is oxidized in the liver, the other 10% is excreted by the lungs and in urine. |
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Term
| What is the legal limit for adults and those under 21 for alcohol? |
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Definition
| Legal limit is above 80-100 mg/dL for adults or 10 mg/dL for those under 21 which is sufficient for conviction of driving under the influence |
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Term
| Briefly explain the pharmacology of acute ethanol consumption effect on the body. |
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Definition
| It inhibits Na/K ATPase and adenylyl cyclase enzymes, it affects ion channels, it enhances the action of GABA at its receptors and it inhibits the actions of glutamate. |
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Term
| What medications could lead to Serotonin Syndrome? |
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Definition
| SSRIs, secoond generation antidepressants, MAOIs (Monoamine oxidase inhibitors), MDMA (ecstacy), LSD, St, John's Wort and Ginseng. |
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Term
| What classes of drugs have anti-emetic actions? |
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Definition
| serotonin blockers, 1st generation antihistamines, cannibinoids, and benzodiazepines. |
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Term
| What would you use to treat shock or bronchospasm of anaphylaxis? |
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Definition
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Term
| What is Phenergan (promethazine)? Use? Dosage? |
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Definition
| It is an anti-histamine that is used as an anti-emmetic. Its usual dosage is 10-25mg. |
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Term
| What is the normal dosage of benadryl (diphenhydramine)? |
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Definition
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