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seattle
on FreezingBlue Flashcards.
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donepizil
acetylcholinesterase inhibitor used for alzheimer's disease
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symptoms for drugs used for alzheimer's
- do not improve symptoms, will only slow the decline
- if MMSE declines >2-4 points after treatment for one year, consider aternate agent
- GI effects are common
- hypotension, dizzyness, muscle cramping, fatigue, anorexia
- overdose manifested by severe GI upset, bradycardia, muscle weakness including respiratory muscle
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acetylcholinesterase inhibitors used for myasthenia gravis
- edrophonium
- neostigmine
- pyridostigmine
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edrophonium
- extremely short acting
- extremely short duration
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neostigmine
used after anesthesia to reverse muslce relaxants
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pyridostigmine
- useful for chronic treatment
- administer on time
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acetylcholinesterase inhibitors:
myasthenia gravis
adverse effects
- cholinergic therefore think sludge
- bradycardia, hypotension
- antidote: atropine
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another use for Ach inhibitor
distingish between myasthenia crisis and cholinergic crisis
- use edrophonium to distingish
- if cholinergic - will not change anything
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neuromuscular blockers
mechanism of action
block Ach at the neuromuscular junction
- eliminate spontaneous breathing
- decrease oxygen consumption of muscles
pt must be sedated and have pain control
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non-depolarizing agent
tubocurarine
- muscles are paralyzed
- causes major histamine release and ganglionic blockade -
- means: vasodilation increased bp
- bradycardia - major respiratory depression
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succinylcholine
- only depolarizing agent
- rapid onset
- short duration
- can not be reversed
- primary agent for endotracheal intubation
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succinylcholine
adverse effects
- may have long duration - 1-2 hours
- upper body/back pain for 24 hr post op
- malignant hyperthermia (temps up to 109 degrees)
- can cause the release of K+ from tissue therefore always check renal function and K+ prior to use and monitor K+ levels
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neuromuscular blockers
adverse effects
- respiratory arrest
- histamine release: bronchospasm, hypotension, salivary and bronchiole secretions
- ganglionic block - hypotenstion
- vagolytic - bradycardia
- hyperkalemia/malignant hyperthermia - succinylcholine
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parkinson's disease
pathophysilogy
- unknown etiology
- results from the loss of dopaminergic neurons
- symptoms appear after 80% loss of dopaminergic neurons
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levodopa & carbidopa
- peripheral dopa-decarboxylase inhibitor
- prevents metabolism of levodopa in the periphery therefore dopaminergic because more levo stays available
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pramipexole
dopamine agonist
act directly on dopamine adonist receptors
- sometimes is a preferred single drug therapy in early stage PD
- used as adjunct med in late stage PD
- only useful for younger people who can tolerate daytime drowsiness and postural hypotenstion
make most of dopamine you already have - because assumes body is still making it
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central acting anticholinergic
benztropine
- blocks acetylcholine
- restores balance of dopamine/acetylcholine - therefore effective against tremors
- uses:
- parkinson's - effective against tremor
- control of EPS symptoms (except tardive dyskinesia)
- not recommened in elderly - associated with falls
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amantadine
- anticholinergic
- stimulates release of dopamine
- inhibits reuptake of dopamine
- adverse effects:
- insominia, daytime fatigue, livedo reticularis, anticholinergic effects
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barbiturates
- sedation, cognitive dysfunction, paradoxical aggression in children
- vitamin D deficiency
- nystagmus, respiratory depression, coma, hypotenstion, death
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phenytoin/fosphenytoin
- iv route for status epileptcus
- highly protein bound
- gingival hypertrophy, ataxia, nystagmus
- rash, hepatic damage, dysrhythmias, hypotension
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diazepam (valium)
lorazepam
- respiratory depression
- anterograde amnesia
flumazenil - reversal agent used for over sedation of benzo's
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carbamazepine
- bipolar
- can cause absence seizures
- dizziness, somnolence, ataxia, N/V, rash
- hyponatremia, stevens-johnson syndrome
bone marrow suppression
no grapefruit juice
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ethosuximide
- absence seizures only
- nausea, hiccups, drowsiness
stevens-johnson syndrome, lupus, blood dyscrasia
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valproate
- bipolar
- migraines
- hepatic metabolism
- highly protein bound
- hepatic failure resulting in death
- nausea/gi upset, thrombocytopenia, elevation of LFT's
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gabapentin
- monotherapy or adjunct for partial seizures
- migraine headaches
- neuropathic pain
drowsiness, nystagmus
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skeletal muscle relaxants
central acting
peripheral acting
diazepam - potential for dependence, controlled substance
- dantrolene - used as treatment for malignant hyperthermia
- the only agent to act directly on spastic muscles and inhibit their contraction by preventing release of calcium in skeletal muscles
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oxybutynin
control urge to void
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bethanechol
for non-obstructive urinary retention
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extrapyramidal side effects
- dystonia
- akathisia
- pseudoparkinsonism
- tardive dyskinesia
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haldol
- increases EPS
- decreases hypotension, anticholinergic SE
increases risk for seizure
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chlorpromazine
- low-potency
- increased sedation, hypotension, dermatitis, anticholinergic effects but decrease EPS
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antipsychotics - conventional
teach patient
- manage antisludge effects
- take dose at bedtime due to sedation
- skin effects common- avoid sun and avoid direct contact with the medication (dermatitis)
- takes 6 weeks for max effect
- come in for followup
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antipsychotics - atypical
clozapine
- block mainly serotonin
- greater reduction of negative symtoms with less EPS and eventual development of tardive dyskinesia
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