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Myasthenia Gravis has the Tensilon test
- whats the test for
What drug do you give for that?
Tensilon test ( Edrophium) = a short acting cholinergic drug
- Give by IV have atropine in case
- dont give it to those with asthma, or sick sinus, BPH, or urinary retention
Its to diagnose myasthenia gravis vs cholinergic crisis
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5 Myasthenia crisis signs
- Breathing should improve with edrophium
- 1) receptors go down
- 2) normal secretions
- 3) tachycardia
- 4) normal/dilated pupil
- 5) muscle weakness
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5 signs of a cholinergic crisis
what to give
weakness with edrophium
- -- stop anticholinesterase ( it overstimulates the parasympathetic syst)
- - give atropene
- (SLUD)
- 1) cholinergic goes up
- 2) more secretions
- 3) bradycardia
- 4) pupil constriction
- 5) weak muscle and fasciculation
-
Name an acetylcholinesterase inhibitor ( indirect- acting cholinergic)
When to give it
How to give it
Contraindications
Neostigmine for myasthenia crisis
- - by slow IVP w food
- - rest between activities
- - dont give it to elderly
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Name a reversible indirect acting cholinergic
When to take it
effects
who shouldn't take it
Donepezil ( for Alzheimer's)
- Take it before bed
- It may take weeks/months to notice effects
- Dont give to those with liver failure
AE: n/v, insomnia, dizzy
Dont give memantine ( in the same class) to those with kidney failure
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The medication for urinary retention ( flaccid bladder)
- how to give it
-what to check while on it
- when to give it
Bethanechol Chloride
PO on an empty stomach, post op and post partum
- - check for a cholinergic crisis
- - if someone is orthostatic
- - for heart block
Should pee 1 hr after taking
-
Name a dopamine receptor agonist
how to take it
what not to take it with
Levodopa-Carbidopa ( for Parkinsons)
PO with food ( not iron, high protein, B6) dont stop abruptly
- - Dont take it with benzos
- - No MAOI ( cause hypertensive crisis)
- - not for those with glaucoma
- - not for malignant melanoma
Given with dihydrochloride + ropinirole hydrochloride for restless leg syndrome
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Name a catechol-o-methyltransferase inhibitor
what is it taken with
black box warning
Tolcapone
PO with levodopa/carbidopa
- - can cause acute liver failure
- -must be tapered off
-
Name a bella donna alkaloid anticholinergic
What to do before giving and during
What it reacts with + antidotes
Atropine sulfate
IV - void before admin, and drink a lot
check for urinary retention, bowel, temperature ( hot)
NO tricyclic antidepressants, anti histamines while on it
The antidote for cholinergic crisis, mushroom poisoning
-
Central anticholinergic
AE
Benzotropine mesylate
- restore cardiac/ arterial pressure
- AE: hot, blind, red, mad, dry
-
GI Anticholinergic
whats it for
Diclomine hydrochloride
for IBS ( overactive bladder)
AE: hot, blind, red, mad, dry
-
Urinary anticholinergic
whats it used for
how to give
Oxybutynin
neurogenic bladder ( incontin, urg, freq)
Patch q 3-4 days
AE: hot, blind, red, mad, dry
-
Name a opioid agonist
Contraindications
Antidote
What not to take it with
Morphine
- Dont give to those with ...
- -respiratory depression
- -BPH
- -Chronic lung,liver, kidney disease
- -Raised intracranial pressure
Antidote: naloxone ( opiod antagonist)
Dont take it with...
- antidep/psychotic, barbituates, benzos, sedatives, antihistamines, MAOI
- Other drugs in the same class...
- - fentanyl
- - oxycodone
- - methadone ( used for opioid withdrawal)
-
Opioid Agonist/ Antagonists -- 3 of them
AE
Butorphanol : cautious if pregnant causes withdrawl
Nalbuphine: not controlled
Pentazocine
1/3 as strong as morphine ( not as addictive)
- Cautious in older adults
- - Resp depression with ceiling effect, BP goes up in large doses
-
NSAID for migraine treatment
how to take it
Naproxen
Dont crush/chew , take with food
AE: GI upset/ bleeding
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Ergot Alkaloid
when/how to take/ interventions
AE
ergotamine tartrate
take it with onset of a migraine, sublingual
AE: tachy/brady
stay in a dark room 2-3 hrs after
caffeine/grapefruit increase the effects
-
Triptan
when to take
max amount
what to report
Sumatriptan
take at the 1st sign of a migraine
max amount 2 injections in 24 hrs
AE: chest pain
report heat/flushing
-
Hydantoin drug
whats it for
how to take
serum level should be at
AE
when not to give it
Phenytoin ( -toin)
For tonic-clonic seizures, psychomotor seizure, and non-epileptic seizures
- PO
- serum level 5-20
- AE: gingival hyperplasia, steven johnson
- Dont stop abruptly
- dont give to hypoglycemic, bradycardia, or heart block
-
Barbiturate drug
serum level
AE
Dont use it with
Phenobarbital for long term use
serum level 10-40
AE: SJS, depression, suicide
Dont use with ETOH, MAOI
-
Benzodiazepine drug
whats it for
what not to mix it with
Diazepam is for status epilepticus
Dont mix it with ETOH
theophylline, and ranitide lowers the effects
-
Iminostibenes drug
whats it for
AE
carbamezepine is for partial seizures with complex symptoms
AE are av block and suicide
drug in another class= Valproic acid serum level should be 50-100
-
Whats carisoprodol for
for acute muscle spasm
AE: irritable, dizzy
class: carbamate derivative
-
what is baclofen for
Multiple sclerosis muscle spasms
AE: CNS depression
class: gamma aminobutric acid
-
Cyclobenzaprine is for?
muscle spasms
- AE: anticholinergic effects
- class: tricyclic antidepress
-
Tizanidine is for
muscle spasms
AE: hypotension
-
2 Stimulants used for ADHA/Narcolepsy
- Amphetamine
- Xanthine
- Modanifil specificially for narcolepsy
Contra: CV disorder, hyperthyroidism
-
Name a Benzodiazepine
what are they for
whats the antidote
- Diazepam ( -pam: clonazepam,)
- Alprazolam ( -lamL midazolam)
PO/IV for anxiety
DONT stop abruptly or use with alcohol
Antidote: Flumazenil
-
Chloral hydrate is for
how to give
sleep and anxiety
doesnt suppress REM
PO in cold liquid
-
Eszopiclone
whats it for
how long to take
- long term sleep aid
- sched IV
- adverse : weird/aggressive behavior
-
Zolpidem
whats it for, how long to take
-
2 Stimulates given for ADHD/Narcolepsy
Modanifil specifically for narcolepsy
Dont give if CV disorder , hyperthyroidism
-
Name Benzodiazepine
How to give
Antidote
- For anxiety
- Diazepam ( -pams ex. clonazepam)
- (-lam ex. alprazolam, midazolam, cloridiazepoxide for withdrawal)
PO/IV dont give to sedated kid/liver
Dont stop abruptly
Antidote= Flumazenil
-
Chloral Hydrate
drug class
what its for
how to take
Non Benzo/Hypnotic
- Its for sleep and anxiety
- PO in cold liquid
doesnt suppress REM
-
Eszopiclone
drug class
what its for
AE
Non benzo/hypnotic
Long term sleep aid
adverse: aggressive/bizarre behavior
-
Zolpidem
drug class
whats it for
how long to take it
Benzo/hypnotic
for insomnia
can only be taken 7-10 days
-
Name Tricyclic Anti-Depressants
How to give
What not to give with
Amitriptyline, Clomipramine, Desipramine, Nortriptyline, Imipramine
- PO HS
- Dont stop abruptly, dont give post acute MI, MAOI
Avoid ETOH, CNS, other CNS depressants, St Johns Wort
-
Name Monamine Oxidase Inhibitor (MAOI)
when is it used
what to avoid
- Phenelzine
- Isocarboxazid
- Tranylcypromine
Used when other antidepressants dont work
- Dont give to kids
- dont stop abruptly
Dont eat tyramine --> hypertensive crisis
Tryptophan ex. meat, soy, seaweed. seafood increase the effects
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Name a Selective Serotonin Reuptake Inhibitor SSRI
whats it for
how to give
AE
contrainidications
- Fluoxetine
- Citalopram
- escitalopram
- paroxetine
- For depression, anxiety, OCD, bulimia, PND
- PO AM
AE: serotonin syndrome, DM= hypoglycemia
contra: MAOI--> serotonin synd
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Serotonin Norepinephine Reuptake Inhibitors SNRI
whats it for
when to give
what not to give
- Venlafaxine
- Desvenlafaxine
- Duloxetine
- First line treatment for depression
- PO AM
- Suicide 18-24, dont stop abruptly
Dont take with MAOI-> serotonin synd
-
Bupropion
class
whats it for
Atypical antidepressant
For depression, bipolar, SAD, smoking censation
another drug in class mirtazipine
-
Lithium
whats it for
AE
serum
Mood stabilizer for mania
excreted but not metabolized by the kidneys
Serum .5-1.2 ( dont take salt sub)
- AE: metallic , polyuria
- No diuretics--> lose salt, no pregnancy
-
Aripiprazole is for
what class
who not to give it to
Atypical antipsych for compulsive gambling, shopping, binging
not for dementia
-
Gen 1 antipsychotics
whats it for
how to give
who not to give to
- Chlorpromazine - phenothiazine gen 1
- Haloperidol - non phenothizaine gen
for psychosis, and schizophrenia
IM. PO with food HS
Dont stop abruptly, give to 65+, pregnant, parkinsons, seizures
-
Gen 2 drug for psychosis, schizophrenia
how to give
what to monitor
contraindications
Clozapine
PO/IM 1 week at a time
monitor CBC ( wbc and neutrophils can go down)
- dont give to dementia/old = death
- contra: seizures, hyperglycemia, agranulo
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