| Flap 1 | Flap 2 |
| Why can lorazepam be safely used as preanesthetic in a pt undergoing liver transplantation without fear of excessive CNS depression? | has extrahepatic metabolism --> don't form active metabolites like other BZ's that are metabolized in the liver |
| BZ's cause sedative and/or anxiolytic effects by…. | facilitating GABA-mediated inc in Cl- ion conductance |
| Name 4 CNS receptors directly coupled to ion channel so that no second messenger systems are involved | GABA, glutamate glycine, Ach - nicotinic (N) |
| Is morphine used to treat pulmonary congestion? Why or why not? | Yes. 1. sedative and analgesic effects, 2. vasodilation --> favorable cardiac and pulmonary hemodynamics |
| Is morphine used to treat MI? Why or why not? | Yes. 1. sedative and analgesic effects, 2. vasodilation --> favorable cardiac and pulmonary hemodynamics |
| Is morphine used to treat biliary colic? Why or why not? | No. Causes contraction of the sphincters of Oddi --> spasms. |
| Heroin addict comes to ER with painful stab wound. Why wouldn't you use nalbuphine for the pain? | Nalbuphine and morphine are both opioids, but morphine is mu agonist, while nalbuphine is kappa agonist and weak mu ANTAGonist. Nalbuphine could displace morphine from the mu receptors --> precipitated withdrawal sx's |
| What type of drugs is most likely to alleviate extrapyramidal dysfunction caused by neuroleptics? | Neuroleptics/antipsychotics block DA receptors --> extrapyramidal dysfxn (e.g. pseudo-parkinsonism); alleviated by drugs that increase Ach-M receptor block. |
| T or F: TCA's should not be used in pts with glaucoma | True. TCA's block NA and 5HT, M and alpha receptors (causing postural hypotn). Block of M receptors in eye --> mydriasis --> exacerbating glaucoma. |
| What do morphine and D-tubocurarine have in common? | releases histamine from mast cells --> vasodilation. Morphine is opioid, tudocurarine is Nm antagonist (muscle relaxant) |
| What is bradykinesia? | Slowed ability to start and continue movements, and impaired ability to adjust the body's position. Can be a symptom of neurological disorders, particularly Parkinson's disease, or a side effect of medications |
| Side effect of taking SSRI's | agitation and the jitters (sometimes requires concomitant use of sedatives like trazodone) |
| What time of day should pts take SSRI's? | morning to avoid insomnia |
| Do SSRI's cause weight gain, loss, or neither? | weight gain that resolves after 12 months |
| What type of drugs would you use for both major depressive and OCD disorders? | SSRI's |
| Drugs that block the reuptake of DA -- what would they be useful for? | Parkinson's |
| Drugs that block the reuptake of GABA -- what would they be useful for? | anti-anxiety or anti-seizure meds |
| Which of these drugs to treat bipolar disorder can be used in pregnancy? Clonazapam, gabapentin, valproic acid, phenytoin, carbamazepine. | Clonazapam and gabapentin can be used in pregnancy. The others are teratogenic. |
| What is methylphenidate? | used for attention deficit disorder |
| What is buspirone used for? | a non BZ that is used for generalized anxiety disorder (anxiolytic), no abuse liability, won't suppress withdrawal sx's of dependence on other drugs such as EtOH, barb's or BZ's |
| What is bupropion? | antidepressant, increase DA transmission - approved for management of dependence on nicotine |
| What is baclofen? | a spasmolytic, spinal cord muscle relaxant, facilitates GABA action at GABAb receptor --> increase inhibition of muscle spasticity |
| What is buprenorphine? | long acting opioid analgesic |
| What is butabarbital? | barbiturate that may cause dependence |
| What is distinctive about side effects of thioridazine? | the only phenothiazine (DA receptor block) that has significant cardiotoxicity potential --> quinidine-like action on heart --> inc action potential duration and effective refractory period --> cardiac arrhythmia |
| T or F: TCA's inhibit the repolarizing K current in the cardiac action potential. | True --> cardiotoxic potential --> cardiac arrhythmias |
| The following are characteristic sx's of withdrawal from which type of drug? 8 hr: anxious, diaphoretic, severe abd pain with diarrhea. 12h: runny nose, lacrimating uncontrolled yawning, muscle cramping, jerking. | Withdrawal from full agonist opioid like meperidine |
| TCA's and thioridazine cause what in common? | 1. autonomic dysfxn by blocking neg fdbk alpha2 receptor --> cardiotoxicity, orthostatic hypoTN due to dec a2 response in venous beds. 2. Also block M receptors --> xerostomia, mydriasis. 3. dec seizure threshold, 4. wt gain. |
| Signs of OD from what type of drug? Inc HR and BP, mydriasis, behavioral excitation, aggressiveness, paranoia, hallucinations | CNS stimulant like amphetamines. Promotes the release of NE --> CV simulation and dilated pupils. Inc DA/NE/5HT in CNS --> behavioral excitation and psychosis state. |
| What is apomorphine? | emetic, opioid |
| What is docusate? | stool softener; used on pts with too much constipation (usually given in conjunction with opioid analgesics because people on opioids are almost always constipated |
| What is loperamide? | stool hardener; used on pts with diarrhea |
| What is naloxone? | opioid antagonist - used IV in OD situation; not given PRN |
| What is fentanyl? | full agonist at opioid receptors, analgesia in cancer pain equal to morphine |
