PHM 114 Week 3-4

70%

• 1) Simple seizures
•     i) Varies from person to person but person                      always remains alert
• 2)  Complex
•     i)  Some loss of conscious awarness
• 3)  Secondary generalized
•     i) Starts on one side of the brain and then spreads to the other side.

May be simple (just stares) or complex (stares and muscle movement

Consists of temporary lapses in consciousness that last for a few seconds.

Most commonly "seen" by observers (because patient can be SEEN falling to the ground and having convulsions for several minutes).

Clinical emergency

• i) consciousness
• ii) 10-20% mortality rates results from anoxia
• iii) Major cause is non compliance with drug therapy

• 1) Drug should be highly effective with a low incidence of toxicity
• 2) Drug would be long acting and non sedating
• 3) Tolerance to therapeutic effect would not develope

• 1) Phenytoin (Dilantin)
• 2) Fosphenytoin (Cerebyx) Prodrug of Phenytoin that was formulated to reduce problems associated with the IV use of Phenytoin

Prototype barbiturate to treat epilepsy.

Used parenterally for status-epilepticus and for severe recurrent convulsive seizures.

Used for partial and secondary seizures refractory to other meds.

Drug is bitter and should NOT be cut or crushed before administration.

A condition characterized by excessive drowsiness and uncontrollable sleep attacks during the day.

MOA - releases norepinephrine from storage and also a direct stimulating effect on alpha and beta receptor sites.

Action is similar to amphetamines.  In patients with ADD with hyperactivity, methylphenidate reduces motor activity and increases the attention span.

Mental disorder that involves a breakdown of the personality.

Accumulation of anxiety and tension, which leads to emotional changes and abnormal behavior.

Positive symptoms include agitation, anxiety, hallucinations, poor hygiene and dress, hyperactivity, delusions, paranoia and hostility.

• 1) Exogenous - caused by external factors
• 2) Endogenous - Usually requires psychotherapy and drug treatment.

Manic-depressive

Treatment of psychosis, treatment of nausea, vomiting, pain, and sedation.

The first phenothiazine developed; Indications: Antipsychotic, Antiemetic, hiccups.

Associated with significant extrapyramidal side effects (example=tremors, slurred speech, anxiety, distress, and paranoia)

Treatment is closely monitored and either weekly or biweekly WBC tests must be performed prior to dispensing any medication.

Side effects include headache, agitation, constipation, orthostatic hypotension, sedation, weight gain, and somnolence (excessive sleepiness).

Patients coming our of depression are at an increased risk of committing suicide because they regain their energy to fulfill their ideations.

It is a Tricyclic antidepressant and is also used for enuresis (bed wetting).

Tricyclic antidepressant and is also used for most severe anticholinergic effects. It is also highly sedating.

It is an Atypical Antidepressant and is a Dopamine Reuptake inhibitor.

It is an Atypical Antidepressant and is a Serotonin Reuptake Inhibitor.

It is an Atypical Antidepressant and is a potent serotonin receptor antagonist.

Monoamine Oxidase Inhibitors (MAOI).  Indicated as second or third line antidepressants for patients that do not respond to other antidepressants.

• 1) Tyramine containing foods and beverages
• 2) The major adverse reaction is the occurrence of sudden and possibly very severe hypertension that if untreated can progress to vascular collapse and fatality.

Therapeutic doses may take weeks to attain a maximal effect.

• 1) Fluoxetine (Prozac)
• 2) Paroxetine (Paxil)
• 3) Sertraline (Zoloft)

Lithium

Refers to norepinephrine, epinephrine and dopamine which all are chemically related.

• 1) Bethanechol (Urecholine)
• 2) Carbachol (Isopto Carbachol) - used to decrease intraocular pressure after cataract surgery and in glaucoma patients.

• 1) Atropine - Acts by occupying receptors and preventing or reducing the response to ACh
• 2) Scopolamine (Transderm Scop) - Indicated for the treatment of irritable bowel syndrome and renal or ureteral colic, for motion sickness to prevent nausea and vomiting.

• 1) Symptomatic relief of acute hypersensitivity reactions. Adjunct to local anesthetics.
• 2) Used to treat cardiac arrest or cardiac standstill.
• 3) Side effects are as follows - OTC inhalers contain as much as 1% EPI

• 1) Nonselective beta-adrenergic drug
• 2) Relieves bronchospasm associated with bronchial asthma, pulmonary emphysema and bronchitis.

1) Short-term management of patients requiring inotropic support as in CHF or after cardiac surgery.

1) Acts by both directly and indirectly releasing norepinephrine; varied effects based on dosage.

Synthetic drug chemically related to epinephrine, norepinephrine and ephedrine.

Indicated for acute hypotensive states occurring with spinal anesthesia.