Pharm review ppt

Drug class of lorazepam

Benzodiazepine

Drug class of alprazolam

Benzodiazepine

Drug class of midazolam

Benzodiazepine

Drug class of zolpidem

Benzodiazepine receptor agonist (Z-drug)

Drug class of phenobarbital

Barbiturate

Primary neurotransmitter affected by benzodiazepines

GABA

Do benzodiazepines work without GABA present?

No, GABA must already be present.

Mechanism of benzodiazepines

Positive allosteric modulators of GABA-A receptors that increase chloride influx.

Effect of chloride entering neurons

Hyperpolarization and inhibition of neuronal firing.

Primary effect of GABA

Inhibitory neurotransmitter in the CNS.

Clinical use of alprazolam

Acute anxiety and panic attacks.

Clinical use of midazolam

Anesthesia and procedural sedation.

Clinical use of lorazepam

Status epilepticus and anxiety.

Clinical use of zolpidem

Insomnia.

Clinical use of phenobarbital

Status epilepticus and anesthesia induction.

Benzodiazepines are used for which withdrawal syndrome?

Alcohol withdrawal.

Herbal product that interacts with GABA

Valerian.

Adverse effect common to all sedative-hypnotics

Sedation.

Which sedative causes impaired motor coordination?

Benzodiazepines and barbiturates.

Which sedatives commonly cause dependence?

Benzodiazepines and barbiturates.

Which sedative may cause complex sleep behaviors?

Zolpidem.

Which sedatives may cause birth defects?

Benzodiazepines and barbiturates.

Which sedatives cause respiratory depression with alcohol?

All sedative-hypnotics.

Antidote for benzodiazepines and zolpidem

Flumazenil.

Withdrawal from benzodiazepines may cause

Seizures.

Withdrawal from barbiturates may cause

Seizures.

Withdrawal from zolpidem commonly causes

Insomnia.

Which sedatives induce liver enzymes?

Barbiturates.

Which sedatives interact with alcohol?

All sedative-hypnotics.

Sedating prescription antihistamine

Hydroxyzine.

Common OTC sedating antihistamine

Diphenhydramine.

Drug class of suvorexant

Orexin receptor antagonist.

Mechanism of suvorexant

Blocks orexin receptors that promote wakefulness.

Unique adverse effects of suvorexant

Sleep paralysis and sleep-related behaviors.

Melatonin mechanism

Mimics endogenous melatonin to promote sleep.

Light has what effect on melatonin?

Suppresses melatonin release.

Common melatonin adverse effects

Nightmares and daytime drowsiness.

Definition of nociceptor

Pain-sensing primary afferent neuron.

Primary afferent pain neurotransmitters

Substance P and glutamate.

Descending pain pathway neurotransmitters

Norepinephrine and serotonin.

Afferent means

Arrives at the CNS.

Efferent means

Exits the CNS.

Drug class of morphine

Mu opioid agonist.

Drug class of oxycodone

Mu opioid agonist.

Drug class of codeine

Mu opioid agonist and cough suppressant.

Drug class of naloxone

Opioid antagonist.

Drug class of nalbuphine

Mixed opioid agonist-antagonist.

Drug class of buprenorphine

Partial mu agonist.

Drug class of dextromethorphan

Opioid-like cough suppressant.

Does dextromethorphan act on opioid receptors?

No.

Primary opioid receptor responsible for analgesia

Mu receptor.

Kappa receptor stimulation commonly causes

Dysphoria and hallucinations.

Major therapeutic uses of opioids

Pain relief, anesthesia, opioid use disorder.

Do opioids reduce inflammation?

No.

Classic opioid overdose triad

Respiratory depression, pinpoint pupils, unconsciousness.

Fatal adverse effect of opioids

Respiratory depression.

Most common chronic opioid adverse effect

Constipation.

Naloxone is used for

Opioid overdose reversal.

Buprenorphine advantage

Less respiratory depression than full agonists.

Nonselective NSAIDs

Aspirin and ibuprofen.

Selective COX-2 inhibitor

Celecoxib.

Primary uses of NSAIDs

Pain, inflammation, fever.

Low-dose aspirin prevents

Thrombosis.

Primary uses of acetaminophen

Pain and fever.

Do NSAIDs inhibit prostaglandin synthesis?

Yes.

Does acetaminophen reduce inflammation?

Very little; acts mainly in the brain.

Migraine drug to know

Sumatriptan.

Mechanism of triptans

Serotonin receptor agonists that inhibit CGRP and substance P.

Major acetaminophen toxicity

Liver toxicity.

Less common acetaminophen toxicity

Kidney toxicity.

Common triptan adverse effects

Chest tightness and abnormal skin sensations.

COX-1 protects

Stomach, kidneys, platelets.

COX-2 primarily produces

Inflammatory prostaglandins.

NSAID adverse effects

GI ulcers, kidney injury, bronchospasm, premature ductus arteriosus closure.

Drug of choice for status epilepticus

Lorazepam.

Phenobarbital mechanism

Enhances GABA.

Gabapentin clinical uses

Partial seizures and chronic pain.

Gabapentin major advantage

Few drug interactions and well tolerated.

Mechanism of phenytoin

Blocks sodium channels.

Mechanism of divalproex

Blocks sodium channels and increases GABA.

Divalproex also prevents

Migraines.

Major adverse effect of phenytoin

Gingival overgrowth.

Signs of phenytoin toxicity

Nystagmus and unsteady gait.

Major adverse effects of divalproex

Liver toxicity, weight gain, GI upset, birth defects.

Drug for absence seizures

Ethosuximide.

Mechanism of ethosuximide

Blocks T-type calcium channels.

Four cardinal signs of Parkinson disease

Tremor, rigidity, bradykinesia, postural instability.

Cause of Parkinson disease

Loss of dopamine-producing neurons.

Most effective Parkinson medication

Levodopa/carbidopa.

Purpose of carbidopa

Prevents peripheral metabolism of levodopa.

Major levodopa adverse effects

Nausea, orthostatic hypotension, dyskinesia.

Unique levodopa adverse effect

On-off effect.

Main pathology of Alzheimer's disease

Loss of cholinergic neurons.

Acetylcholinesterase inhibitor

Donepezil.

Mechanism of donepezil

Inhibits acetylcholinesterase, increasing acetylcholine.

Common donepezil adverse effects

GI upset and insomnia.

Mechanism of memantine

NMDA (glutamate) receptor antagonist.

Positive schizophrenia symptoms

Hallucinations, delusions, bizarre behavior, disorganized thinking.

Negative schizophrenia symptoms

Flat affect, lack of motivation, social withdrawal, reduced speech.

Typical antipsychotic example

Haloperidol.