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Neurosci Drugs
Question | Answer |
---|---|
what drug is commonly used in suicide attempts? | Barbituates because they can depress the respiratory centers and also have widespread effects. Often combined with alcohol |
Ethosuximide | Anti-epileptic that is effective at preventive "Absence Seizures". Other drug with similar indications for use is clonazepam |
tiagabine | prevents GABA reuptake. Used as add on drug |
vigabatrin | inactivates GABA-T (transaminase which deactivates GABA in the synaptic cleft).Used as add on drug |
phenytoin | class 1 anti-epileptic. It has dose dependent elimination. Less sedative effects than phenobarbital. Sides: gingival hyperplasia and excessive hair growth |
carbamazepine non-epileptic use | it is used for trigeminal neuralgia. (stops inappropriate firing of neurons which is associated with pain). Also approved for treatment of bipolar disorder |
-flurane (volatile anesthetic) contraindications | if patient has suffered blood loss (trauma), as it inhibits the baroreceptor reflex and the BP will drop. Patients with CAD because this (+) ionotrope and can cause ischemia.Contraindicated in M.S and DMD patients because of risk of malignant hyperthermia |
Dantrolene | it is the treatment for malignant hyperthermia (in addition to packing the patient with ice). It is also used to treat Neuroleptic Malignant syndrome. This drug works by blocking the ryanodine receptor |
How does smoking effect anesthetic management? | If you cannot stop a month before the surgery, then do not stop; eg if you stop 1 week pre-op airway can become more reactive |
What drug is typically used for status epilepticus? | Lorazapem; you would not use phenobarbital because a dose high enough to suppress respiration would be necessary |
Describe an antiepileptic drug that is approved for use for other conditions | Carbazamapine is approved for the treatment of trigeminal neuralgia, migraine, and bipolar disorder |
Lorezapam | Used intravenously to treat status epilepticus. Since it has a short half-life often the person will be control with this drug then switched to phenytoin |
valproic acid & lamotrigine | unlike other anti-epileptics these are effective at treating both grand-mal/focal seizures as well as "absence seizures" |
Balanced Anesthesia | The use of an intravenous hypnotic agent followed by a combination of intravenously administered drugs to maintain anesthesia (the desired effects) |
What are the clinical effects of a potent anesthetic? | A potent anesthetic must cause analgesia, amnesia, atonia, and hypnosis. |
sevoflurane | preferred drug for induction. Unlike the other fluranes, it is essentially odorless, does not irritate the airway, and is cardiostable. It can be transformed to a nephrotoxic compound by chemicals used in anesthesia machines |
Propofol | Is an IV agent used in general anesthesia. It has anti-emetic properties, quick induction of hypnosis. It also has a dose-dependent t1/2. Sides effects: CV depression, and allergic reaction to solvent (albumin), PRIS |
Bell's phenomena | Seen in phase II of anesthesia: it is a dangerous phase b/c of increased muscle tone and pooling of secretions |
Ketamine | is used when patient is severely hypovolemic because it ↑ sympathetic tone (1ary myocardial depressant) and has analgesic properties. Sides: emergence phenomenon |
Remifentanil is used for | analgesia in anesthesia. There is rapid sensitization and this drug has a short half life. Acute tolerance may develop and increased dose of opioids may be needed post-op |
desmedetomidine | |
scolopamine | used to ensure retrograde and anterograde amnesia |
desflurane | cannot be used for induction of anesthesia because it is very irritating to the airway |
isoflorune is | an old drug in this class. uses? |
nitrous oxide | A myocardial depressant and sympathomimetic effects typically cancel. It is contraindicated in those with HF, b/c it will cause decompensation (sympathetic tone is always high--compensation). Also, CI in those with pneumothorax or pneumocephalus |
Etomidate an agent used for INDUCTION of anesthesia is used... | when other agents are contraindicated due to head trauma and cardiovascular instability b/c it decreases CBF. Only used if no other option are available. sides: seizures, adrenal suppression(give cortisol), temporal phlebitis |
PRIS (PROPOFOL INFUSION SYNDROME) | Since propofol may interfere with long chain FA transport, use may lead to progressive hepatic encephalopathy, lactic acidosis, lipidemia, rhabdomyolisis, CVS collapse |
volatile agents | all of these agents, save NO2, are considered powerful agents and may cause Malignant hyperthermia. These agents mainly work on GABA(A)-R and by stabilizing the desensitized form of nAchR |
DILI (drug induced liver injury) | aka"halothane hepatitis". Metabolism of fluranes could lead to formation of a hapten and immune destruction of the liver. Diagnosis of exclusion with all but halothane. Also, Desflurane and sevoflurane are broken down to CO and nephrotoxins, respect. |
-fluranes | This class characteristically ↑ chronotropy (increase risk of ischemia). They also decrease SVR, thus can increase cerebral blood flow. They inhibit baroreceptor reflex. They also increase metabolic demand, eg dangerous to patients w/mitochondrial dsx |
flurane contraindications | may ↑ CBF and cause ↑ ICP leading to herniation. Blood loss due to any cause, b/c it inhibits the baroreceptor reflex. ↑ risk of malignant hyperthermia in those with MS or DMD. ↑ risk of arrhythmia when used with epinephrine |
TIVA (total intravenous anesthesia) | agents used are PROPOFOL to induce and maintain, KETAMINE to maintain anesthesia and for analgesia, desmedetomidine (sedation), and remifentanil (hypnotic analgesic). Etomidate |
ondansetron | a 5-HT3 receptor antagonist, which is used as an anti-emetic |
amisulpride | is a 2nd generation antipsychotic which is highly effective. It may have severe side effects including AGRANULOCYTOSIS |
clozapine | is used only when other antipsychotics are ineffective in treating schizophrenia. Significant weight gain can occur with the drug. Risk of agranulocytosis, |
aripiprazole | a D2 partial agonist--so it antagonizes when dopamine is high but stimulates when levels are low. |
The "Z drugs" | are zolpidem, zaleplon, zoplicone. They both work at GABAa agonist, but are not classified as benzodiazepines. They are used to treat "ZZZ" (sleep) disorders. Sides= fugue state |
citalopram | a pure SSRI (Selective serotonin reuptake inhibitor). Because it does not have effects on other pathways it lacks some side effects that produced by SSRIs like fluoxetine. Sides: sexual sides. do not use with MAOIs |
duloxetine | is an SNRI. At low doses it only acts as an SRI; medium doses SRI+NRI; high may affect the dopamine receptor. Used for MDE, anxiety, fibromyalgia. Sides; Sexual |
imipramine | A tricyclic antidepressant. Sides: anticholinergic side effects, cardiac conduction delays, drug-drug interactions. |
tranylcypromine | (irreversible) MAOIs; from the phenethylamine and amphetamine classes. Has may sides including--sexual dysfunction, insomnia, and can have pressor effects. It also requires a tyramine free diet. |