Pharm drugs - PP1, Exam 3

Carbamazepine (Tegretol) → Antiepileptic Drugs → Sodium Channel Blockers

-Use: Focal seizures, bipolar disorder

-Action: Delays sodium channel recovery

-Side Effects: Vertigo, rash, hematologic issues

- Avoid grapefruit juice, monitor sodium, avoid diuretics

phenytoin (Dilantin) -> IV (large vein, slow rate, monitor heart) & PO (sedation, gingival, hyperplasia) 

Use: Epilepsy prevention

Action: slows action potentials
SE: -

Client Ed: avoid in pregnancy, interacts with warfarin steroids

*: 10 - 20 mg/L, lateral nystagmus normal, >30 mg/L = coma, ataxia 

phenobarbital → other AEDs - CNS sedatives / benzodiazepines → oral, IV, IM, PR

Use: partial/ tonic- clonic seizures, insomnia, coma

Action: enhances GABA

SE: drowsiness, imbalance, depression, rash

Client Ed: no alcohol, caution in COPD

*: drug level 10 - 40 mcg/ mL / No reversal agent, abuse potential

valproic acid (Depakote) → mixed mechanism → oral, IV

Use: Seizures, bipolar disorder

Action: increase GABA, blocks Na/K/Ca channels

SE: hepatotoxicity, suicidality, SJS

Client Ed: avoid in liver disease, <2 y.o., pregnancy

*: drug level 50 - 100 mcg/mL

Gabapentin → other AEDs → oral

Use: seizures , pain

Action: inhibits excitatory transmitters

SE: drowsiness, suicidality

Client Ed: avoid alcohol, CNS depressants

*: no interaction with valproate, lithium, carbamazepine

pregabalin → Other AEDs → oral (no crush)

Use: neuropathic pain, seizures

Action: blocks Ca channels

SE: Angioedema, dizziness

Client Ed: habit-forming, XR = no crush

topiramate (tompamax) → other AEDs → oral

Use: epilepsy, migraines

Action: blocks sodium channels 

SE: paresthesia, memory issues

Client Ed: not for pregnancy, monitor kidney labs 

Diazepam, Midazolam → other AEDs - CNS sedatives / benzodiazepines

Use: anxiety, seizures

Action: GABA enhancement 

SE: sedation, respiratory depression

Client Ed: avoid in other CNS depressants, taper slowly 

*: 

morphine (oral, IV, IM, PR, intrathecal, Epidural, sublingual), codeine (oral), fentanyl (IV, transdermal patch, sublingual, buccal, intranasal), tramadol (oral) → opioids

Use: treat moderate to severe acute and chronic pain by activating opioid receptors in the brain to block pain signals

Action: Mu/ Kappa receptor activation

SE: analgesia, sedation, constipation
-fentanyl = 50 - 100x stronger than morphine
-tramadol = partial agonist, not fully reversed by naloxone

Client Ed: 

*: monitor respiration, avoid alcohol

naproxen, sumatriptan, Ubrogepant → non-opioid pain meds,

-naproxen = NSAID, blocks prostaglandins -> oral

-sumatriptan = serotonin agonist for acute migraines - interacts with SSRIs -> oral, intradermal, subQ

-Ubrogepant = CGRP antagonist, fewer side effects -> oral

Use: 

Action: 

SE: GI upset, dizziness, drug interactions 

Client Ed:

cyclobenzaprine → muscle relaxants → oral

Use: muscle spasms

Action: Reduces motor neuron activity (usually in brain stem), eases muscle tension/ spasm.

SE: drowsiness, dry mouth

Client Ed: avoid alcohol, not for pregnancy

baclofen → muscle relaxants → oral, intrathecal

Use: spasticity (MS, TBI)

Action: GABA agonist, constipation

SE: Sedation, constipation

Client Ed: avoid abrupt withdrawal, no high fat meals 

anesthesia (local) - lidocaine -> tropical, subQ, IV

Use: local anesthesia usually with epinephrine, except fingers, nose, penis, toes)

Action: sodium channel blocker 

SE: 

Client Ed:

Propofol, Vecuronium, Isoflurane → general anesthetics 

-propofol = GABA-A enhancer -> IV

-Vecuronium = muscle relaxant - acetylcholine blocker (locks motor movement - paralytic) -> IV

-isoflurane =  ileus postoperatively -> inhaled 

Use:  

Action: 

SE: 

Client Ed:

*: monitor heart, reps, sedation level