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USMLE - Pharm

Kaplan Section 4 Chapter 1 CNS Pharm - Review

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
Created by: christinapham
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