What are the three components of post intubation mgmt?
Continued sedation Continued pain mgmt Continued tube security
What is the path of blood flow through the heart?
SVC/IVC > RA > Tricuspid Valve > RV > Pulmonary semilunar valve > Pulmonary artery > Lungs > LA > Bicuspid > LV > Aortic semilunar > Aorta > Body
The elec pathways of the heart follow what route?
SA node > Internodal > AV node > Bundle of His > R & L bundle branches > Purkinje Fibers
What is Bachmans Bundle?
Conduction tract in the heart that originates @ SA node & conducts action potentials to the LA
Class IA antidysrhythmics are ___ ___ ___ w/ the mechanism?
Sodium Channel Blockers Slow conduction & decrease repolarization rate
Prototype Sodium Channel Blockers (class ____) are what 3 drugs?
IA Quinidine, Procainamide & Disopyramide
Class IB (aka ___ ___ ___) include what 4 drugs?
Sodium Channel Blockers Lidocaine (xylocaine) Phenytoin (Dilantin) Tocainide (Tonocard) Mexiletine (Mexitil)
The mechanisms for Class IB Sodium Channel blockers are what?
Increased rate of repolarization Reduced automaticity in ventricular cells
Class IA Sodium Channel Blockers show on an ECG in the form of . . .
Class IB Sodium Channel Blockers show on an ECG in the form of . . .
Class IC sodium channel blockers include what 2 drugs/
Flecainide (Tambocor) Propefenone (Rythmol)
Actions of a class IC sodium channel blocker are . . .
Decrease conduction velocity thru Atria, ventricles, bundle of His & purkinji network Delay ventricular repolarization
What are the actions of moricizine (Ethmozine) (class ____)?
Decreases conduction velocity Depresses myocardial contractility Blocks Na influx during fast potential depolarization Class I miscellaneous
Class II drugs (___ ___) include what 3 drugs?
Propranolol (Inderal) Acebutolol (Sectral) Esmolol (Brevibloc)
The non selective beta blocker is ____ while acebutolol & Esmolol are selective for what?
Propranalol Beta1 receptors in the heart
Beta blockers are indicated in the treatment of what?
Tachycardias resulting fr excessive sympathetic stimulation
How does a selective Beta blocker work?
Blocking Beta1 blocks Ca channels preventing gradual influx of Ca in phase 0 of slow potential
K channel blockers (class ___) include what 2 drugs?
Bretylium (bretylol) Amiodarone (Cordarone)
The mechanism of action for Class III (aka ___ ___ ___) drugs is?
K channel blockers Blocks efflux of K in fast channels
K channel blockers are indicated for what?
CCB�s or class __ drugs effects are almost identical to ____?
What are the only 2 CCB�s that affect the heart?
Verappamil (calan) Diltiazem (cardizem)
CCB�s slow ____ ____of A fib & flutter & they can terminate ____ ____ originating fr a reentrant circuit.
Ventricular conduction Superventricular tachycardias
What are the 2 chief side effects of CCB�s?
Adenosine is described as an & what does it act on?
Endogenous nucleoside w/ a very short half life (about 10 secs) Both K & Ca channels; ^ K efflux & inhibiting Ca influx
What are side effects of adenosine?
Facial Flushing SOB Chest Pain Marked Bradycardia
When should adenosine dosages be increased?
In pts taking adenosine blockers such as aminophylline or caffeine
When should adenosine dosages be decreased?
In pts taking adenosine uptake inhibitors such as dypyridamole (Persantine) or Carbamazapine (Tegretol)
What are the effects of digoxin on the heart?
Decreases intrinsic firing rate in the SA node Decreases conduction velocity in the AV node ^ cardiac contractility
What are the effects of digoxin on Purkinji Fibers & ventricular myocardial cells?
Dig causes a decrease in the effective refract period & ^ automaticity
What are the side effects of digoxin (6)?
Bradycardias AV blocks PVCs V Tach V Fib A Fib
What is digoxin indicated for?
A Fib w/ rapid ventricular conduction Chronic treatment of CHF
What is Torsades de pointes?
A polymorphic V Tach
What is the drug of choice for Torsades?
Magnesium
What is the formula for BP?
BP=Cardiac output x peripheral vascular resistance
What is cardiac output equal too?
Cardiac output = HR x Stroke Volume
What is a diuretic?
Drug used to reduce circulating blood vol by ^ amt of urine
What are the 3 main categories of diuretics?
Loop or High ceiling diuretics Thiazides K sparing diuretics
What is the prototype loop diuretic?
Lasix
Loop diuretics are one of the primary tools in treating what?
Left ventricular heart failure (CHF)
How does Furosemide (aka____) work?
Lasix By blocking Na reabsorption in the ascending loop of Henle decreasing the pull of H2O fr the tubule & into the capillary bed
What are furosemides main side effects?
Hyponatremia Hypovolemia Hypokalemia Dehydration
What is the difference between loop diuretics & thiazides?
Thiazides mechanism affects the early part of distal convoluted tubule & therefore cannot block as much Na fr reabsorption
What is the prototype thiazide?
Hydrochlorothiazide
What is the 1 important thing that distinguishes thiazides?
They depend on glomerular filtration rate
How do K sparing diuretics work?
Na absorption is affected be inhibiting the effects of aldosterone on the distal tubules or the specific Na/K exchange mechanism
What is the prototype K sparing diuretic?
Spironolactone (Aldactone)
What are the 5 types of adrenergic inhibiting agents?
Beta adrenergic antagonists Centrally acting adrenergic inhibitors Peripheral adrenergic neuron blocking agents Alpha1 antagonists Combined Alpha/Beta antagonists
What is the prototype Selective Beta1 Blocker?
Metoprolol (Lopressor)
What is the prototype non-selective Beta1 Blocker?
Propranolol (Inderal)
Of the Centrally Acting Adrenergic Inhibitors, the prototype is ____ (aka ____) w/ side effects of ____ & ____.
Clonidine aka Catepres Drowsiness & Dry Mouth
The prototype Peripheral Adrenergic Neuron Blocking Agent is what?
Reserpine aka Serpalan
What is the prototype Alpha1 antagonist?
Prazosin aka Minipress
How does an Alpha1 antagonist work?
Competitively blocks Alpha1 receptors inhibiting sympathetically mediated increases in peripheral vascular resistance
Alpha/Beta antagonists act by . . . .
Decreasing Alpha mediated vasoconstriction & the Beta1 blockade decreases HR, contractility & rennin release fr kidneys
2 Alpha/beta antagonist drugs are ____ & ___.
Labetalol (normodyne) Carvedilol (Coreg)
What do ACE inhibitors do?
Interrupt the rennin-angiotensin-aldosterone-sys by preventing the conversion of angiotensin1 to angiotensin2 leading to a decrease in peripheral vascular resistance
What is the prototype ACE inhibitor?
Catopril (Capoten)
Name 2 common ACE inhibitors other than the prototype which is___.
Enalapril (Vasotec) & Lisinipril (Zestril) Catopril (Capoten)
1 category for CCBs is antidysrhythmic. What is the other & what is the prototype?
Dihydropiridines Nifedipine (Procardia, Adalat)
What is Stoke-Adams Syndrome?
Heart condition characterized by fainting, blackouts & fainting while sitting
What is the prototype for selective arteriole dilators?
Hydralazine (Apresoline)
How does Hydralazine work?
It decreases peripheral vascular resistance & afterload therefore BP.
Alpha 1 receptors cause what response where?
Constriction � Arterioles & veins Mydriasis � eye Ejaculation � penis
Alpha2 receptors cause what response where?
Inhibits release of norepi in presynaptic terminals
Beta 1 receptors cause what response where?
^ HR, conductivity, automaticity, contractility � heart Renin release � kidneys
Beta 2 receptors cause what response where?
Bronchodilation � lungs Dilation � arterioles Inhibition of contractions � uterus Tremors � skeletal muscle
Beta 3 receptors cause what response where?
Lipolysis � adipose tissue
Dopaminergic receptors cause what response where?
Vasodilation � kidney
All antidysrhythmics have arythmogenic properties. This means?
All antidysrhythmics have the ability to cause dysrhythmias
What are the 2 cardiac glycosides?
Digoxin (Lanoxin) Digitoxin (Crystodigin)
How does digoxin reduce symptoms of CHF?
By ^ myocardial contractility & cardiac output
What are side effects of digoxin?
Fatigue Anorexia Nausea Vomiting Blurred vision w/a yellowish haze & halos around dark objects
Name the 2 bronchodilators that are non-specific agonists.
What are the 4 Beta2 specific agonists that are short acting?
Albuterol (Ventolin, proventil) Metaproterenol (Alupent) Terbutaline (Brethine) Levalbuterol (Xopenex)
What is the Beta 2 specific agonist that is long acting?
Saslmeterol (Serevent)
What are methylxanthines & what 2 drugs are in this category?
CNS stimulants w/ additional bronchodilatory properties Theophylline & Aminophylline
What are the 2 anticholinergics used to treat asthma?
Atropine Ipratropium (Atrovent)
What are the 3 inhaled glucocorticoid anti-inflammatory agents for treating asthma?
Beclomethasone (Beclovent) Flucticasone (Flovent) Triamcinolone (Azmacort)
What is the oral glucocorticoid anti-inflammatory agents for treating asthma?
Prednisone (deltasone)
What are 2 injected glucocorticoid anti-inflammatory agents for treating asthma?
Methyprednisolone (solu-medrol) Dexamethasone (Decadron)
What are the 2 leukotriene Antagonists for treating asthma?
Zafirlukast (Accolate) Zileuton (Zyflo)
What is the 1 Mast-cell membrane stabilizer used in treating asthma?
Cromolyn (Intal)
What are the 2 basic components of the pathophysiology of asthma?
Bronchoconstriction & Inflammation
Common causes of asthma are ?
Pet dander, mold, dust etc.
True or false. . . .All that wheezes is asthma.True False
False
For asthma, what is the first line mechanism for treatment especially for daily use?
Beta2 specific agents
How do beta2 specific agents work in asthma?
Relax bronchial smooth muscle resulting in bronchodilation & relief fr bronchospasm
What is the prototype beta 2 specific agent for daily use in asthma?
Albuterol
What is rhinitis & what are some symptoms?
Inflammation of nasal lining w/ symptoms nasal congestion, itching, redness, sneezing & rhinorrhea (runny nose)
What is the main pharmacological classification for nasal decongestants?
Alpha 1 agonists including phenylephrine, pseudoephedrine, phenylpropanolamine
What is rebound congestion?
A form of tolerance that is caused by long term use of nasal decongestants.
What are antihistamines?
Med that arrests the effects of histamine by blocking its receptors
What is a histamine?
An endogenous substance that affects a wide variety of organ systems.
Name 5 antihistamines.
Benadryl Seldane Claritin Zyrtec Allegro
What is the chief side effect of antihistamines?
Sedation
Why do second generation antihistamines not cause sedation?
B/c they do not cross the blood brain barrier
Why should I not give an antihistamine to my asthma pt?
B/c they can thicken bronchial secretions
If my pt has a productive cough should I treat it? Why or why not?
No b/c it is performing a useful function
If a nasal decongestant is overused it can cause an elevation in what?
Pulse Rate & BP
An antitussive is defined as what?
Med that suppresses a stimulus to cough in the CNS
What is an expectorant?
Med intended to ^ the productivity of a cough
What is a mucolytic?
Med intended to make mucus more watery
What are the 4 main indications for gastrointestinal drug therapy?
Peptic ulcers Constipation Diarrhea & emesis Digestion
Peptic ulcer disease is characterized by. . . .
An imbalance between factors in the gastrointestinal sys that ^ acidity & those that protect against acidity
What is the most common cause of peptic ulcer disease?
Helicobacter pylori bacterium infestation in the space between the endothelial cells & the mucus lining of the stomach & duodenum Often found in pts w/ failing gall bladders
4 H2 receptor antagonists for treating PUD are?
Cimetidine (Tagamet) Ranitidine (Zantac) Famotidine (Pepcid) Nizatidine (axid,pulvulex)
Proton pump inhibitors used to treat PUD are?
Omeprazole (prilosec) Lansoprazole (prevacid)
5 treatment modalities for treating PUD are?
H2 receptor antagonists Proton pump inhibitors Antacids Aluminum, Magnesium or Na compounds Anticholinergics
What is the anticholinergic used for treating PUD?
Pirenzepine (gastrozepine)
What are the 4 categories of laxatives?
Bulk forming Stimulant Osmotic Surfactant
What is a laxative?
Med used to decrease a stools firmness & ^ its water content
What is surfactant?
Substance that decreases surface tension
What are 2 examples of bulk forming laxatives?
What are 2 examples of a stimulant laxative?
What is an example of an osmotic laxative?
Milk of magnesia
What is an example of a surfactant laxative?
Colace
What are the 4 categories of drugs for treating emesis?
Anticholinergic Serotonin antagonists Dopamine antagonists Cannabinoids
What is 1 example of a serotonin antagonist?
Ondansetron (zofran)
Give 4 examples of dopamine antagonists for emesis?
Compazine Phenergan Inapsine Reglan
What are 2 examples of cannabinoids used for emesis?
The sympathetic NS is aka ____ or the ____ division?
Fight & flight Thoracolumbar
The parasympathetic NS is aka ____ or the ____ division?
Where are the ganglia located in the sympathetic NS?
Near the spine
Where are the ganglia located in the parasympathetic NS?
Ganglia are in or near target organs
Preganglionic fibers release ____ & postganglionic fibers release ____ in the sympathetic NS.
Preganglionic fibers release ____ & postganglionic fibers release ____ in the parasympathetic NS.
ACh & Ach
What is meant by cholinergic?
Pertaining to the neurotransmitter Ach
What is meant by adrenergic?
Pertaining to the neurotransmitter NE.
What cranial nerves carry parasympathetic fibers?
3,7,9,10
Adverse effects of cholinergics are known as ____ which stands for what 6 things?
SLUDGE Salivation, Lacrimation, Urination, Defacaction, Gastric Motility, Emesis
How do chlolinergics work?
By stimulating the effects of Ach by binding w/ cholinergic receptors
What do anticholinergics oppose?
The parasympathetic NS
Name 4 MAO inhibitors.
Phenelzine (Nardil) Octamoxen (Ximaol, Nimadol) Caroxazone (Surodil, Timostenil) Linezolid (Zyvox, Zyvoxam, Zyvoxid)
Name the 4 classes of cardiac Drugs.
Antidysrhythmics Antihypertensives Hemostatic Agents Anyihyper-lipidemic Agents
Name 2 Na channel blockers.
What is the definition of drug?
Chemical used to diagnose, treat or prevent disease
Define pharmacology.
Study of drugs & their interaction w/ the body
What are the 4 names for a drug?
Chemical Generic Official Brand
Drug info is provided by what 5 sources?
US Pharmacopeia PDR Drug Info Monthly prescribing reference AMA Drug eval
What 12 things compromise a drug profile?
Name Classification Mechanism of Action Indications Pharmacokinetics Side effects/ Adverse reactions Routes of Admin Contraindications Dosage How Supplied Special considerations
What are characteristics of a Schedule I drug?
High abuse potential Possible severe dependance No medical indication Used for research, analysis or instruction only
What are examples of Schedule I drugs?
Heroin, LSD, Mescaline
What are characteristics of Schedule II drugs?
High abuse potential Possible severe dependance Accepted medical indications
Examples of Schedule II drugs are?
Morphine, Codeine, Oxycodone, Methadone, cocaine
What are characteristics of Schedule III drugs?
Less abuse potential than Schedule I & II May lead to moderate to low physical dependance or high psychological dependance Has acceptable medical uses
Examples of Schedule III drugs are?
Limited opioid amts or combined w/nonctrled substances Vicodin Tylenol w/codeine
What are characteristics of Schedule IV drugs?
Low abuse potential Limited psychological &/or physical dependance Accepted medical indications
Some examples of Schedule IV drugs are?
Diazepam, Lorazapam, phenobarbital
What are characteristics of Schedule V drugs?
Low abuse potential May lead to limited physical or psychological dependance Accepted Medical indications
Some examples of Schedule V drugs are?
Limited amts of opioids Often for cough or diarrhea
What is assay?
Test that determines the amt & purity of a given chemical in a preparation in a laboratory
Define Bioequivalence.
Relative therapeutic effectiveness of chemically equivalent drugs
Define Bioassay.
Test to ascertain a drugs availability in a biological model
Medication packages containing a single dose for a single pt. is called?
Dose Packaging
What is a med that may kill of deform a fetus called?
Teratogenic Drug
Describe free drug availability.
The proportion of a drug available in the body to cause either desired or undesired effects
Define pharmacokinetics.
How a drug is absorbed, distributed, metabolized (biotransformed) & excreted; how drugs are transported into & out of the body
Define pharmacodynamics.
How a drug interacts w/ the body to cause its effects
What is carrier mediated diffusion or facilitated diffusion?
Process in which carrier proteins transport lg molecules across the cell membrane
What is the movement of solute in a solution fr and area of higher concentration to an area of lower concentration called?
Diffusion
Osmosis is ______?
The movement of solvent in a solution fr and area of lower solute concentration to an area of higher solute concentration
Filtration is the movement of ______?
Molecules across a membrane fr an area of higher pressure to an area of lower pressure
What are the 4 pharmacokinetic processes?
Absorption Distribution Biotransformation Elimination
Bioavailability is the amt of a drug _____?
That is still active after it reaches its target tissue
Describe the blood brain barrier.
Tight junctions of the endothelial cells in the CNS vasculature thru which only non protein bound highly lipid soluble drugs can pass
Define the Placental Barrier.
Biochemical barrier at the maternal/fetal interface that restricts certain molecules
What term describes the body's breaking down of chemicals into different chemicals?
Metabolism
What is the special name given to the metabolism of drugs?
Biotransformation
What is a prodrug?
A med that isnt active when administered, but whos biotransformation converts it into active metabolites
What is the first pass effect?
The livers partial or complete inactivation of a drug b/f it reaches the systemic circulation
What is oxidation?
The loss of hydrogen atoms or the acceptance of an O2 atom ^ pos charge on the molecule
Hydrolysis is the . . . .
breakage of a chem bond by adding H2O or by incorporating a hydroxyl group into 1 fragment & a hydrogen atom into the other
Enteral delivery of a med means the med is delivered . . . .
Through the intestinal tract
Parentarel delivery of a med is any route that . . . .
Outside the gastrointestinal tract, typically using needles to inject directly into the circulatory sys or tissue
Give 5 examples of enteral med routes.
PO Orogastric/Nasogastric Tube (OG/NG) SL Buccal PR
Parenteral Routes include (12):
IV ET IO Umbilical IM SC Inhalation/Neb Topical Transdermal Nasal Instillation Intradermal
Give 5 examples of drugs in solid forms. . . .
Pills Powders Tablets Suppositories Capsules
Liquid drugs come in what 7 forms?
Solutions Tinctures Suspensions Emulsions Spirits Elixers Syrups
What is the difference between a pill & a tablet?
A pill is a drug shaped spherically where as a tablet is compressed powder
Define a capsule. . . .
Gelatinus container filled w/ powder or tiny pills
What is a tincture?
Liquid drug preparation using an alcohol extraction process
Describe an emulsion.
Drug suspension w/ an oily substance in the solvent
What is a spirit?
Drug solution of a volatile drug in alcohol
Describe an elixer.
Alcohol & water solvent usually w/ flavoring to improve taste
What are the 4 types of drug actions?
Binding to a receptor site Changing physical props of cells Chemically combining w/other chemicals Altering normal metabolic pathway
A receptor is a. . .
Specialized protein that combines w/ a drug resulting in a biochemical effect
Define affinity.
Force of attraction between a drug and receptor
What is efficacy?
A drugs ability to cause the expected response
A 2nd messenger is a chemical that
Participates in complex cascading reactions that eventually cause a drugs desired effect
What is the binding of a drug or hormone to a target cell receptor causing number of receptors to decrease called?
Down Regulation
When a drug causes the formation of more receptors than normal it is known as ____-____.
Up-regulation
An agonist is a drug that . . . .
binds to a receptor but does not cause it to initiate the expected response
An antagonist is a drug that . . . .
binds to a receptor but does not cause it to initiate the expected response
An agonist-antogonist (partial agonist) is a drug that binds to a receptor & . . .
stimulates some of its effects but blocks others
Competitive antagonism is when 1 drug . . . .
binds to a receptor & causes the expected effect while also blocking another drug fr triggering the same receptor
What is non-competative antagonism?
The binding of an antagonist causes a deformity of the binding site that prevents an agonist fr fitting & binding
Irreversible antagonism is a . . . .
Competitive antagonist permanently binds w/a receptor site
What are side effects?
Unintended response to a drug
List some side effects (13).
Allergic reaction Idiosyncrasy Tolerance Cross-tolerance Tachyphylaxis Cumulative Effect Drug dependance Drug interaction Drug antagonism Summation Synergism Potentiation Interference
An allergic reaction (aka ____) occurs when the drug is. . . .
Antigenic & activates the immune sys, causing effects that are normally more profound than seen in general population
The side effect idiosyncrasy is a drug effect that is . . .
Unique to the individual; different than seen or expected i the population in general
Tolerance is defined as a . . .
Decreased response to the same amt of drug after repeated administrations
Cross-tolerance is defined as. . . .
Tolerance for a drug that develops after administration of a different drug
Rapidly occurring tolerance to a drug is called ____.
Tachyphylaxis
Increased effectiveness when a drug is given in several doses is called ____ ____.
Cumulative Effect
Define drug dependance.
When a pt becomes accustomed to the drugs presence in his body & will suffer fr w/d symptoms upon its absence; psychological or physical
When the effects of 1 drug alter the response to another drug a ____ ____ occurs.
Drug interaction
Drug antagonism occurs when the effects of 1 drug ____ the ____ to another drug.
Block, response
Summation (aka ____ ____) occurs when . . . .
2 drugs that both have the same effect are given together; 1+1=2
Synergism occurs when . . . .
2 drugs w/ the same effect are given together & produce a response > the sum of their individual responses; 1+1=3
Potentiation occurs when . . .
1 drug enhances the effect of another
Interference is. . . .
The direct biochemical interaction between 2 drugs; 1 drug affects the pharm of another
What is a drug response relationship?
Correlation of different amts of a drug to clinical response
What is the plasma level profile?
Describes lengths of onset, duration & termination of action as well as the drugs min effective concentration & toxic levels
What is the onset of action?
Time from administration until a med reaches its minimum effective concentration
The minimum effective concentration of a drug is. . . .
Minimum level of a drug needed t cause a given effect
The duration of action of a drug is what?
The length of time a drug remains above its minimum effective concentration
Define termination of action.
Time fr when a drugs level drops below its minimum effective level until it is eliminated fr the body
What is a drugs therapeutic index?
Ratio of a drugs lethal dose for 50% of the population to its effective dose for 50% of the population
What is biological half-life?
Time the body takes to clear 1/2 of a drug.
What is a prototype drug?
Drug that exhibits a classes common properties & illustrates its particular characteristics
What is the prototype opiod agonist?
Morphine
What is an analgesic?
Med that relieves the sensation of pain
What is analgesia?
The absence of the sensation of pain
What is anesthesia?
Absence of all sensations
What is an adjunct med?
Agent that enhances the effects of other drugs
What are the 2 components of the CNS?
Brain & spinal cord
What makes up the peripheral nervous sys?
Everything that doesn't fall into the CNS
WHat does the somatic nervous sys control?
Ctrls voluntary or motor functions
The autonomic nervous sys ctrls what & is further divided into ____ & ____?
Involuntary or automatic functions Sympathetic & parasympathetic nervous sys
What are the effects of opiod agonists?
Analgesia Euphoria Sedation Miosis
What effect does morphine have on the heart?
Decreases preload & afterload
What are the 3 types of nonopiod meds w/analgesic properties?
Salcylates (ie aspirin) NSAIDS (ie ibuprofen) Para-aminophenol derivates (ie acetaminophen)
What are opiod antagonists?
Drug that completely binds w/opiod receptors w/o causing the effects of opiod bonding. (ie Narcan)
What is an opiod agonist-antagonist?
Drug that displays both agonist & antagonistic props. ie Nubain decreases pain response w/o resp & addictive side effects
What is a anesthetic?
Med that induces loss of sensation to pain or touch
What is neuroleptanesthesia?
Anesthesia that combines decreased sensation of pain w/amnesia while pt remains conscious
Define sedation.
State of decreased anxiety & inhibitions
Define hypnosis.
Instigation of sleep
What is the benzodiazepine antagonist and what is its dose?
Romazicon dosed @ 0.2 mg up to 1mg
What is a seizure?
State of hyperactivity in either a section of the brain or all of the brain
Explain tonic clonic seizures.
Periods of muscle rigidity (tonic stage) followed by spazmotic twitching (clonic stage) then flaccidity & a gradual return to consciousness (postictal stage)
How do Na ion blockers work for seizure treatment?
They inhibit the influx of Na into the cell decreasing the cells ability to depolarize & propagate seizures
How do Ca ion blockers work for seizure treatment?
They inhibit influx of Ca in Ca channels in the hypothalmus
What are the 2 Na ion blockers used for seizure treatment?
Phentoin aka Dilantin Carbamazapine aka Tegratol
What is the Ca ion blocker used for seizure treatment?
Valproic Acid
How do Benzos mitigate seizures?
They interact w/the GABA receptor-chloride ion channel complex. They hyperpolarize the membrane of the CNS neurons decreasing their response to stimuli
What is the prototype benzo & what is it dosed @?
Lorazapam aka Ativan 2-4 mg IM, 0.5-2mg IV for sedation 2mg slow IV/PR for status epilepticus
What are the 2 benzos we use & their doses?
Lorazapam 2-4mg IM, 0.5-2mg IV for sedation 2 mg slow IV/PR for status epilepticus Diazepam 5-10mg IV/IM seizure 2-5mg IV/IM acute anxiety 5-15mg IV premed
What are the effects of a prototype benzo?
Antianxiety Hypnotic Anesthetic Anticonvulsant Sedative
What are the 2 methods used to stimulate the CNS?
^ release or effectiveness of exicitatory neurotransmitters Decrease release or effectiveness or inhibitory neurotransmitters
What are the most common uses of amphetamines?
Treating drowsiness, fatigue & appetite suppressant
What are the side effects of amphetamines?
Tachycardia & Dysrhythmias Hypertension Convulsions Insomnia Psychosis w/hallucinations & agitation
What is the most commonly prescribed drug for ADHD?
Methylphenidate aka Ritalin
What is the prototype amphetamine?
Caffeine even tho it has few clinical uses
What is EPS (aka ___) & what causes it?
Extrapyramidal Symptoms Dystonic Reaction Caused by brain damage & antipsychotic drugs
How to TCA's work?
By blocking the reuptake or nor-epi & serotonin thus extending the duration of their action
How do SSRIs work?
By selectively blocking the reuptake of serotonin but they do not affect dopamine or nor-epi
Whats used to treat ODs of TCAs?
Sodium Bicarbonate
3 SSRIs are____, ____ & ____.
Prozac Sertaline (Zoloft) Paroxetine (Paxil)
MAOIs work by what mechanism?
Inhibiting monoamine oxidase & blocking monoamines breakdown thus ^ their availability
What is the prototype MAOI & when are they used?
Phenelzine (Nardil) They aren't commonly used but when they are its usually for treating depression refractory to TCAs & SSRIs.
What is parkinsons disease?
A nervous disorder caused by the destruction of dopamine releasing neurons in the substantia nigra, part of the basal ganglia, which is a specialized area of the brain that crtl fine motor movement
What is dyskinesia?
Disfunctional movements such as involuntary tremors, unsteady gait & postural instability
What is the drug of choice for treating Parkinsons & why?
Levodopa b/c it can readily cross the blood brain barrier where it is absorbed by dopamine releasing neuron terminals
