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82 Cards in this Set
- Front
- Back
what can be used to decrease aqueous humor synthesis in glaucoma?
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alpha-agonists (due to vasoconstriction)
-eipnephrine - mydriasis, stinging; do NOT used for closed-angle -brimonidine - no pupillary/vision changes beta-blockers (timolol, betaxolol, carteolol) - no pupillary/vision changes Acetazolamide - due to decreased HCO3 - no pupillary/vision changes |
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what can be used to increase outflow of aqueous humor in glaucoma?
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cholinomimetics - contracts ciliar mm which opens trabecular meshwork; can cause miosis & cyclospasm
*direct - pilocarpine, carbachol *indirect - physostigmine, echothiophate Latanoprost (PGF [2-alpha] is a prostaglandin) - darkens color of iris (browning) **give pilocarpine for emergency |
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what to give for glaucoma emergency?
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pilocarpine (cholinomimetic) - very good at opening meshwork in canal of schlemm
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what opioid effects do not develop tolerance?
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miosis & constipation
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how do opioids modulate synaptic transmission?
-channels? -change in neutotransmitters? -receptors? |
modulate synaptic transmission
-open K+ channels, close Ca2+ channels --> decreased synaptic transmission -inhibit release of: ACh, NE, 5-HT, glutamate, substance P -mu receptor = morphine; delta receptor = enkephalin; kappa receptor = dynorphin |
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clinical use or opioid analgesics?
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pain
cough suppression (dextromethorphan) diarrhea (loperamide & diphenoxylate) acute pulmonary edema maintenance programs (methadone) |
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toxicity of opioids?
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addiciton
respiratory depression constipation miosis (pinpoint pupils) additive CNS depression w/other drugs |
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what opioids can be used for cough? for diarrhea?
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cough - dextromethorphan
diarrhea - loperamide, diphenoxylate |
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what is butorphanol?
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partial agonist of mu opioid receptor
agonist at kappa receptor used for pain, less resp depression than full agonists can precipitate withdrawl if accustomed to a full agonist |
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what is tramadol?
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very weak opioid agonist
-inhibits serotonin & NE reuptake used for: chronic pain toxicity: similar to opoids; decreased SEIZURE threshold "tram it all" in - works on multiple neurotransmitters (5HT & NE reuptake inhibiton) |
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1st line tx for partial seizures?
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Carbamazepine
(both simple & complex) (also 1st line for trigeminal neuralgia) |
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1st line tx for tonic-clonic (generalized) seizures?
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Phenytoin, Carbamazepine, Valproic acid
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1st line tx for absent (generalized) seizures?
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ethosuximide
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1st line therapy for status epilepticus?
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acute - benzodiazepines (diazepam or lorazepam)
prophylaxis - phenytoin |
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Phenytoin?
-MOA: -Partial: -Generalized: -Notes: |
-MOA: increase Na+ channel inactivation
-Partial: simple, complex -Generalized: 1st line for tonic-clonic & status epilepticus (prophylaxis) -Notes: fosphenytoin for parenteral use |
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Carbamazepine?
-MOA: -Partial: -Generalized: -Notes: |
-MOA: increase Na+ channel inactivation
-Partial: 1st line for simple & complex -Generalized: 1st line for tonic-clonic -Notes: 1st line for trigeminal neuralgia |
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Lamotrigine?
-MOA: -Partial: -Generalized: -Notes: |
-MOA: blocks voltage-gated Na+ channels
-Partial: simple, complex -Generalized: tonic-clonic -Notes: |
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Gabapentin?
-MOA: -Partial: -Generalized: -Notes: |
-MOA: primarily inhibits HVA Ca2+ channels (tho designed as GABA analog)
-Partial: simple, complex -Generalized: tonic-clonic -Notes: also used for peripheral neuropathy, bipolar disorder *HVA = high voltage activation Ca channels |
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Topiramate?
-MOA: -Partial: -Generalized: -Notes: |
-MOA: blocks Na+ channels, increases GABA action
-Partial: simple, complex -Generalized: tonic-clonic -Notes: - |
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Phenobarbital?
-MOA: -Partial: -Generalized: -Notes: |
-MOA: increase GABA-A action
-Partial: simple, complex -Generalized: tonic-clonic -Notes: 1st line in pregnant women & children |
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Valproic acid?
-MOA: -Partial: -Generalized: -Notes: |
-MOA: increase Na+ channel inactivation; increase GABA concentration
-Partial: simple, complex -Generalized: 1st line for tonic-clonic; works for absence -Notes: also used for myoclonic seizures |
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Ethosuximide?
-MOA: -Partial: -Generalized: -Notes: |
-MOA: blocks thalamic T-type Ca2+ channels
-Partial: - -Generalized: 1st line for absence -Notes: - |
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Benzodiazepines (lorazepam, diazepam) for seizures?
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first line for acute status epilepticus
also used for seizures of eclampsia increases GABA-A action |
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1st line for seizures of eclampsia?
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MgSO4
also use benzodiazepines (lorazepam, diazepam) |
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Tigabine?
-MOA: -Partial: -Generalized: -Notes: |
-MOA: inhibits GABA reuptake
-Partial: simple, complex -Generalized: - -Notes: - |
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Vigabatrin?
-MOA: -Partial: -Generalized: -Notes: |
-MOA: irreversibly inhibits GABA transaminase --> increased GABA
-Partial: simple, complex -Generalized: - -Notes: |
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Levetiracetam?
-MOA: -Partial: -Generalized: -Notes: |
-MOA: unknown, may modulate GABA & glutamate release
-Partial: simple, complex -Generalized: tonic-clonic -Notes: |
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epilepsy drug toxicity - siADH?
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Carbamazepine
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epilepsy drug toxicity - Steven-Johnson syndrome?
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Carbamazepine
Ethosuximide Lamotrigine |
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epilepsy drug toxicity - teratogenesis?
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Carbamazepine
Phenytoin (fetal hydantoin syndrome) Valproic Acid (neural tube defects) |
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epilepsy drug toxicity - hepatotoxicity?
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Carbamazepine
Valproic Acid - rare but fatal; check LFTs |
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epilepsy drug toxicity - agranulocytosis?
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Carbamazepine
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epilepsy drug toxicity - aplastic anemia?
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Carbamazepine
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epilepsy drug toxicity - inductin of cytochrome P-450?
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Carbamazepine
Phenobarbital Phenytoin |
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epilepsy drug toxicity -
sedation, tolerance, dependence |
Benzodiazepines
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epilepsy drug toxicity - ?
Diplopia, ataxia, blood dyscrasias, liver toxicity, teratogenesis, induction of cytochrome P-450, Stevens-Johnson syndrome |
Carbamazepine
also - agranulocytosis, aplastic anemia, siADH |
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epilepsy drug toxicity - ?
GI distress, fatigue, headache, urticaria, Stevens-Johnson syndrome |
Ethosuximide
EFGH - Ethosuximide, Fatigue, GI, Headache |
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epilepsy drug toxicity - ?
Sedation, tolerance, dependence, induction of P450 |
Phenobarbital
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epilepsy drug toxicity - gingival hyperplasia?
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Phenytoin
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epilepsy drug toxicity - ?
Nystagmus, diplopia, ataxia, sedation, hirsutism, megaloblastic anemia, teratogenesis, SLE-like syndrome, induction of P450 |
Phenytoin
also gingival hyperplasia |
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epilepsy drug toxicity - hirsutism?
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Phenytoin
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epilepsy drug toxicity - ?
GI distress, tremor, weight gain, neural tube defects |
Valproic acid
also rare but fatal hepatotoxicity, check LFTs |
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epilepsy drug toxicity - ?
Steven's Johnson syndrome |
Lamotrigine
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epilepsy drug toxicity - ?
Sedation, ataxia |
Gabapentin
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epilepsy drug toxicity - ?
sedation, mental dulling, kidney stones, weight loss |
Topiramate
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short acting benzodiazepines?
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TOM
Triazolam Oxaxepam Midazolam -highest addictive potential |
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what binds the GABA-A receptor? mechanism?
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GABA-A is a ligand-gated chloride channel
Benzodiazepines - increases GABA binding freq Barbituates - increase durationof binding; at high doses directly agonizes Ethanol |
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how to tx benzodiazepine OD?
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flumazenil (competitive antagonist)
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Nonbenzodiazepine hypnotics?
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Zolpidem (Ambien), zaleplon, eszopiclone
short duration; act via BZ1 receptor; reversed by flumazenil |
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what is MAC? formula?
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minimum alveolar concentration = conc at which 50% of population is anesthetized
increased lipid solubility = increased potency = 1/MAC |
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anesthetics - effect of increased blood solubility?
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slower onset of action; more gas required to saturate blood
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anesthetics - what does an increased arterio-venous concentration gradient indicate?
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slower onset of action
-increased solubility w/increased gas required to saturate tissues |
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anesthetics - effect of increased lipid solubility?
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increased potency, decreased MAC
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anesthetics - which have rapid induction & recovery times?
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drugs w/decreased solubility in blood
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anesthetics - effects of inhaled anesthetics?
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myocardial & respiratory depression
nausea/emesis increased cerebral blood flow decreased cerebral metabolic demand |
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inhaled anesthetics toxicity - hepatotoxicity?
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Halothane
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inhaled anesthetics toxicity - nephrotoxicity?
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methoxyflurane
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inhaled anesthetics toxicity - proconvulsant?
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enflurane
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inhaled anesthetics toxicity - expansion of trapped gas?
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nitrous oxide
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IV anesthetics - used for rapid induction & short procedures?
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Propofol
potentiates GABA-A less postoperative nausea than thiopental Thiopental (barbituates) -high potentcy -high lipid solubility -rapid entry into brain, effect terminated by rapid redistribution into tissue & fat -decreased cerebral blood flow |
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IV anesthetics - used for endoscopy; adjunctively w/gaseous anestheics & narcotics?
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Midazolam (benzodiazepines)
may cause severe postoperative respiratory depression decreased BP amnesia |
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IV anesthetics - PCP analog that acts as dissociative stimulant?
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Ketamine (arylcyclohexylamines)
-block NMDA receptors CV stimulant cause: disorientation, hallucination, bad dreams increase cerebral blood flow |
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Local anesthetics - names? mechanism?
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Lidocain
Mepivocain Bupivicaine block Na channels by binding to specific receptors on INNER portion (preferentially bind active, so most effective in rapid firing) tertiary amine local anesthetics penetrate membrane in uncharged form, bind to ion channels as charged form |
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Local anesthetics - what needs to be considered in infected tissue?
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infected tissue is acidic
alkaline anesthetics become charged, can't pennetrate membrane more anesthetic needed in this case |
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Local anesthetics - order of nerve blockade? sensation?
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small-diameter > large diamter
myelinated > unmyelinated pain (first) > temp > touch > pressure (last) size factor predominates small myelinated > small unmyelinated > large myelinated > large unmyelinated |
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Local anesthetics - why give w/epinephrine (vasoconstrictor)?
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decrease bleeding
increase anesthesia by decreasing systemic concentration don't do this with cocain; in digits, penis, (eye?), other areas w/single blood supply |
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Local anesthetics toxicity - severe cardiovascular toxicity?
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bupivicaine
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Local anesthetics toxicity - general?
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CNS excitation
severe cardiovascular toxicity (bupivicaine) HTN Hypotension Arrythmias (cocaine) |
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Local anesthetics toxicity - arrhythmias?
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Cocaine
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depolarizing blockade of NMJ?
complications, phases, antidotes? |
Succinylcholine - hypercalcemia & kyperkalemia are complications
Phase I (prolonged depolarization) - no antidote; potentiated by cholinesterase inhibitors Phase II (repolarized but blocked) - antidote consits of cholinesterase inhibitors (neostigmine) |
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nondepolarizing blockade of NMJ?
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tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, rocuronium
compete w/ACh for receptors reversal - neostigmine, edrophonium, other cholinesterase inhibitors |
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how to tx malignant hyperthermia? MOA?
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Dantrolene
prevents Ca2+ release from sarcoplasmic reticulum of skeletal mm also used to tx neuroleptic malignant syndrome |
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Parkinson's tx - agonize dopamine receptors?
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Bromocriptine (ergot)
Pramipexole Ropinirole (non-ergot) *non ergots are preferred |
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Parkinson's tx - increase dopamine?
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Amantadine (may increase dopamine release)
toxicity = ataxia L-dopa/carbidopa - converted to dopamine in CNS |
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Parkinson's tx - prevent breakdown of dopamine?
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Selegiline - selective MAO type B inhibitor
Entacopone, tolcapone (COMT inhibitors - prevent L-dopa degradation) |
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Parkinson's tx - curb excess cholinergic activity?
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Benztropine
-antimuscarinic, improves tremor & rigidity but has little effect on bradykinesia "Park your mercedes-Benz" |
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Parkinson's tx - mneumonic?
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BALSA
Bromocriptine Amantadine Levodopa (w/carbidopa) Selegiline (& COMT inhibitors) Antimuscarinics |
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How to tx essential or familial tremors?
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beta-blocker
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how to tx Alzheimer's?
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Memantine - NMDA receptor antagonist; prevents excitotoxicity (mediated by Ca2+)
Donepezil, galantamine, rivastigmine - Acetylcholinesterase inhibitors |
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treating Huntington's - do what to neurotransmitters? drugs?
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Huntington's has increased dopamine w/decreased GABA & ACh, need to fix this
Reserpine + tetrabenazine - amine depleting Haloperidol - dopamine receptor antagonist |
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how to tx acute migraines, cluster headache attacks?
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Sumatriptan
-5HT (1B/1D) agonist -vasoconstriction, inhibition of trigeminal activation, & vasoactive peptide release -half life < 2 hours toxicity: coronary vasospasm, mild tingling -contraindicated in pts w/CAD or prinzmetal's angina |
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what pts is sumatriptan contraindicated in?
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Coronary Artery Dz
Prinzmetal's angina sumatriptan causes vasoconstriction (via 5HT agonism) |