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opioid and neuro rev

advanced pharm

QuestionAnswer
TCA causes blocks sodium channel so arrhythmia- alpha blocking, antihistamine- sedating, anticholinergic
MAOI potent antidepressant- MOAIA→ phenylzine/Nardil- MAOIB→ for parkinsons-selegline- nonselective-
Antipsychotics→ typical haldol→ parental for agitation
Atypical antipsychotic metabolic syndrome-→ ziprasidone→ QT
Benzos open gaba receptors in the brain→ allow Cl- inside, which is negative and sedates→ dependence and withdrawal→ prefer SSRIs for chronic- metabolized in liver except OTC
Management of insomnia antihistamines short term- d/t tolerance- ideal is ambien- NOT- for long hours use lunesta/eszopiclone
ADHD and narcolepsy non-stimulants ADHD only→ Strattera and LA guanfacine- no blunting/non-scheduled vs stimulant amphetamines and non-amphetamines (scheduled) – modafanil- narcolepsy- amphetamines are used for both except focaline (just ADHD)= emotional blunting
Transduction site for NSAIDs- prevent prostaglandins- nerve endings
Transmission phase local anesthetics for the Na+ channel blocker
Modulation phase opioids (endorphins/enkephalins), GABA, NE, 5HT (TCA)
Perception phase benzos, CBT, imigary
Morphine it’s metabolite is nephrotoxic- methadone and fentanyl is safer
Hydrocodone and Vicodin when used with Tylenol or NSAID schedule II- triplicate needed
Opioids work on mu receptor- s/e does not include miosis and constipation
Codeine potent antitussive, and prodrug and needs 2D6 which some don’t genetically have
Meperidine/Demerol causes mydriasis and seizures d/t anticholinergic
Nucynta/tapentadol lack GI s/e as an opioid (no constipation)
Methadone used for detox
NSAIDS, ACETAMINOPHEN and ASA all of them are analgesic and antipyretics, Tylenol has no anti-inflammatory, and ASA has only anti-platelet effect
RA for s/s use NSAIDS and for the dz we use DMARDs and in between, we use steroids as a bridge
DMARDS are classified into further categories of old traditional synthetic (methotrexate and Leflunomide/arava) newer biologic etanercept and –mab drugs
Methotrexate is a folate antagonist so they may need a supplement and need to avoid Bactrim
Gout acute- NSAIDS, steroids and colchicine and for chronic use allopurinol- decrease synthesis of uric acid by inhibiting enzyme
Probenecid Uricosuric drug not commonly used- ↑ concentration other drugs like PNC and methotrexate
Fibromyalgia least effective is NSAIDS and also cyclobenzaprine-flexeril but helps in some
Temporal headaches give prednisone
Migraine acute- sumitriptan and dihydroergotamine chronic topiramate and for kids Phenergan/promethazine antihistamine
Cluster immitrex/sumitrptan and high flow O2 and chronic is lithium or CCB
Tension headache acute is NSAIDS/Tylenol and chronic is TCA
Antiseizure block the sodium channel- carbamazepine- phenytoin- lamictal- GABA- and for absence- Ethosuximide as CCB- and Felbamate which is glutamate antagonist
Carbamazepine auto induction- and used for trigeminal neuralgia
Phenytoin zero order kinetic- can cause gingival hyperplasia
Topiramate is a carbonic anhydrase inhibitor- nephrotoxic
Parkinsons ↑ DA or antagonize Ach- depends on s/s or pts age
If parkinsons pt is young with mild s/s use benzatropine, Cogentin or trihexyphenidyl
If parkinsons pt is 60 with mild s/s you give amantadine
Severe s/s of parkinsons you give sinamet/levocarbidopa- on/off phenomenon- use ramiprol/pramipraxol before if possible earlier, adjuvant to sinamet is entecapone, tolcapone or selegline
Drug management for alzheimers any drug that ↑Ach (like Ach esterase inhibitors)- donepezil or memantine/namanda
Created by: arsho453
 

 



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