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43yr man, lethargic,fatigued over past several months, hard to
concentrate at work, mood is sad almost everyday for past 3months, no
longer enjoys hobbies, lost appetitie, early awakenings for no reason.
You suspect depression. What meds should you give that could cause
sexual dysfunction(dec libido)?
- First line depression- SSRIs
- MECH: inhib serotonin reuptake
- USES: MDE, OCD, (others: eating disorder,premenstrual dysmorphic disorder)
- ADV: sexual dysfxn (dec libido, difficulty with orgasms) 0therss--> GI upset, no appetitie,weight loss,tremors
- OTHER: MAOI c/i-->serotonin syndrome, inhib CYT P450
Name 6 impt SSRIs
Fluoxetine, Sertraline, Paroxetine,Fluvoxamine,Escitalopram,Citalopram
14 yr old boy with bladder incontinence during day over couple weeks. depressed, you r/o organic cause for enuresis. What psychotropic rx that potentiates 5HT and NE at synaptic cleft can you give?
- MECH: 5HT and NE reuptake inhib. Action at muscarinic, adrenergic, histamine Rc too
- USES: depression(not first line), enuresis, chronic pain syndromes, smoking cessation
- ADV: sedation, postural hypotension,urinary retention,dry mouth,priapism
- OVERDOSE: widen QRS, arrythmias,mental status changes,seizures
what drug class do these belong to:
what drug class can tx GAD, depression, and stimulate appetite?
name the 4 drugs in the class
Heterocyclic antidepressants: Mirtazapine, nefazodone,venlafaxine,maprotiline
whats the MECH and USES and ADV of Heterocyclics? name the 4 drugs in this class
- block NE and 5HT reuptake at cleft (all but mirtazapine)--potentiate their effects
- Mirataxapine: inhibt alpha2 Rc and 5HT2 Rc---inc their release
- USE: depressive disorders, GAD
- ADV: sedation, inc appetite-->wt gain(mirtazapine), inc BP/HR (venlafaxine)
36yr old female with depression w/ psychotic features. You decide to giver her a drug class but advise her to not eat cheese, red wine, or smoked meats..why?
- Risk a Hypertensive Crisis!
- you give her MAOIs, which increase NE, 5HT, and DA in presynaptic neuron.MAO metabolizes tyramine.NE,5HT made from tyramine and these foods have tyramine. MAOIS-->cant metabolize tyramine, hi NE,Epi-->headcahe,HTN,cardiac arrythmias
Name the 3 drugs in MAOIs class
Isocarboxid, Phenelzine, Tranylcypromine
36 yr F w/ bipolar disorder presents to ER due to following sx: headache, palpitations,dehydration. Intense/uncontrollable thirst, dehydration, excessive urination, lethargic, dry skin, dry mucous memb, fine hand tremor.Labs show hypernatremia. YOu suspect a Rx that acts as antidiuretic antag
- MECH: inhib phosphoinositol second messenger cascade
- USE: bipolar disorder mainly, other mood disorders w/ psychotic features
- ADV: fine hand tremor, hypothyroid, nephrogenic diabetes insipidus(hypernatremia, polyuria,polydipsia
- c/i: pregnancy..but if you do give it just hold it during delivery and resume after
- -narrow therapeutic window, monitor closely
74yr pt w/ delerium+psychosis. visual hallusinations, fluctua consciousness, impaired memory, agitatiion. Give her drug that blocks DA Rs in limbic system and relieves sx.
Name drugs in this class and major ADV
Typical antipsychotics: relieve pos symtptoms and block D2 Rc in limbic sys (also bind musc, hista, adrene Rc)
rx: Haloperidol, Fluphenzine (both hi potency); chlorpromazine, thioridazine?(low potency)
- ADV: sedation, anticholinergic effects,
- extrapyramidal effects (acute dystonia(muscle spasm),akinesia(cant move voluntarily),akathisia(muscle restlessness),tardive dyskinesia
- galactorrhea and amenorrhea
- neuroleptic malignant syndrome(rigid, change in mental status, hi temp,ans instability)--tx w/ dantrolene and DA antag
32 yr pt w/ paranoid schizo, cant care for himself over past 2months, auditory hallu tell him CIA is after him, flat/blunt affect. currently on typical antipshycotics but u want to switch to something that will tx pos and neg symptoms but may cause agranulocytosis.
Switch to atypical antipsychotic Clozapine (agranulocytosis) so monitor WBCs. Causes fewer extrapyramidal and anticholinergic sx than typicals
name the 6 atypical antipsychotics
Clozapine, Olanzapine, Quetiapine, risperidone, ziprazidone,aripriprazole
- MECH: block 5HT and DA Rc
- USE: Tx pos and negative Sx of schizo, Delirium(Olanzapine, Quetiapine, risperidone, )
- ADV: weight gain, diabetes(both esp olanzapine), agranulocytosis(clozapine)
43 yr F experiencing alcohol withdrawal symptoms bc she stopped drinking 2days ago: seizures (w/o prior hx), agitated, sweating, confused, tachy, HTN,bilateral hand tremors, hi fever. What do u give her?
Describe BZDs. Name a least one drug from each caterogry (short-, medium-, long- acting)
- medium: lorazepam
- long: diazepam
- MECH: inc GABAa Rc activity-->Cl- enterss--> dec activity of neurons at limbic,thalamic,hypothalamic areas
- USE: alcohol withdrawal, seizures, status epilepticus (911!), panic, insomnia
- ADV: sedation, withdrawal if stopped abruptly (vomit, tachy,anxious,altered mental status)
- OVERDOSE: cardiac and resp depression,tx w/ flumazenil (BZD antag)
- c/i: alcohol, other depressants, liver dx
What drug indirectly potentiates GABA Rc and is commonly used for anesthesia induction?
- Barbituates: -pental
- USES: sedative (anxiety and insommnia),anesthesia induction, manage seizures(pheno-), neonatal hyperbilirubinemia
- ADV: sedation, withdrawal if stopped abruptly
- OVERDOSE: cardiac and resp depression, tx w/ mech ventilation,hemodialysis,alakalinization of urine
- c/i: preggers,liver dx,porphyrias,alchol,BZDs and other depressants
Which drug is used to treat grand mal seizures( gen tonic-clonic), blocks Na channels? WHat are it's ADV? Is it save for women trying to get pregnant?
- ADV: severe birth defects--prenatal growth issues, cardiac and palate congenital malformations
What is phenytoin used to treat? What is it used as prophylaxis against?
- grand mal seizeures, partial seizures.
- status epilepticus prophylaxis
MECH of Lamotrigine?
block Na channels and inhib release of glu from nervous tissue
What is the 1st line for absence seizures and describe the drugs features??
What's second line?
- Ethosuximide: dec T-type Ca channels current
- Valproic acid: unclear...inc GABA conc?
- USES: grand mal, myoclonic, absence, mania in bipolar
- ADV: liver tox, neural tube defects/teratogen
Drugs to treat trigeminal neuralgia (like in MS)?
Phenytoin, Carbamezapine(adv: low WBC)
MECH and 3 ADV of Carbamezapine
- inhib flow of Na ions thru channel
- liver tox, agranulocytosis,aplastic anemia
23yr w/ complex partial seizure comes fro follow up bc he didnt like phenytoin and stopped it. currently on carbamezapine. seizures increased so you want to add another drug which inhib GABA reuptake at cleft and has little ADV other than N/D, drowsy. which rx?
Tiagabine: used IN COMBINATION WITH OTHER DRUGS.
name 2 other antiepileptic drugs like Tiagabine
Vigabatrin(inhib GABA breakdown, ADV: sedation, psych disturbances), Levetiracetam(adjunct, unk mech)
Name the drug of choice for rapid muscle paralysis for endotracheal intubation during surgery. what are ADV? what is c/i to use with it?
- Succinylcholine: depol neurmusc blocker
- Watch out for bradycardia, cardia arryth,hyperkalemia
- c/i: halothane -->malignant hyperthermia(rigid, hi temp), tx w/ dantrolene
8 yr boy with CF and pheumonia needs short acting neuromusc blockade for short procedure to get biopsies and mucous samples. you need an agent that is also easily reversible. what are your options and best answer?
Options: vecuronium,pancuronium, atracurium,cisatra-, tubocurarine,mivacurium,rapacurium,
- best choice: pancuronium: comp binds nicotinic Rc, neuron stays inactivated--no muchle contraction
- ADV: hypotension
- reverse with anticholinesterase..like neostigmine