pharm test

acetylcholinesterase inhibitor used for alzheimer's disease

• 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

• edrophonium
• neostigmine
• pyridostigmine

• extremely short acting
• extremely short duration

used after anesthesia to reverse muslce relaxants

• useful for chronic treatment
• administer on time

• cholinergic therefore think sludge
• bradycardia, hypotension
• antidote: atropine

distingish between myasthenia crisis and cholinergic crisis

• use edrophonium to distingish
• if cholinergic - will not change anything

block Ach at the neuromuscular junction

• eliminate spontaneous breathing
• decrease oxygen consumption of muscles

pt must be sedated and have pain control

• muscles are paralyzed
• causes major histamine release and ganglionic blockade -

• means: vasodilation increased bp
• bradycardia - major respiratory depression

• only depolarizing agent
• rapid onset
• short duration
• can not be reversed
• primary agent for endotracheal intubation

• 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

• respiratory arrest
• histamine release: bronchospasm, hypotension, salivary and bronchiole secretions
• ganglionic block - hypotenstion
• vagolytic - bradycardia
• hyperkalemia/malignant hyperthermia - succinylcholine

• unknown etiology
• results from the loss of dopaminergic neurons
• symptoms appear after 80% loss of dopaminergic neurons

• peripheral dopa-decarboxylase inhibitor
• prevents metabolism of levodopa in the periphery therefore dopaminergic because more levo stays available

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

• 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

• anticholinergic
• stimulates release of dopamine
• inhibits reuptake of dopamine

• adverse effects:
• insominia, daytime fatigue, livedo reticularis, anticholinergic effects

• sedation, cognitive dysfunction, paradoxical aggression in children
• vitamin D deficiency
• nystagmus, respiratory depression, coma, hypotenstion, death

• iv route for status epileptcus
• highly protein bound
• gingival hypertrophy, ataxia, nystagmus
• rash, hepatic damage, dysrhythmias, hypotension

• respiratory depression
• anterograde amnesia

flumazenil - reversal agent used for over sedation of benzo's

• bipolar
• can cause absence seizures
• dizziness, somnolence, ataxia, N/V, rash
• hyponatremia, stevens-johnson syndrome

bone marrow suppression

no grapefruit juice

• absence seizures only
• nausea, hiccups, drowsiness

stevens-johnson syndrome, lupus, blood dyscrasia

• bipolar
• migraines
• hepatic metabolism
• highly protein bound
• hepatic failure resulting in death
• nausea/gi upset, thrombocytopenia, elevation of LFT's

• monotherapy or adjunct for partial seizures
• migraine headaches
• neuropathic pain

drowsiness, nystagmus

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

control urge to void

for non-obstructive urinary retention

• dystonia
• akathisia
• pseudoparkinsonism
• tardive dyskinesia

block dopamine receptors

• uses:
• schizophrenia

• increases EPS
• decreases hypotension, anticholinergic SE

increases risk for seizure

• low-potency
• increased sedation, hypotension, dermatitis, anticholinergic effects but decrease EPS

• 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

• block mainly serotonin
• greater reduction of negative symtoms with less EPS and eventual development of tardive dyskinesia