CHE 360 Midterm #2

GABA

the neurotransmitter gamma-aminobutyric acid, binds to a channel protein in the synaptic cleft. Which in turn allows more chloride ions into the cell. Known as an inhibitory neurotransmitter

Hyperpolarization

Is caused by GABA and takes place in the post-synaptic membrane inhibiting post-synaptic neuron firing

GABA stimulation in the limbic system of the brain_____

reduces anxiety

GABA stimulation in the cortical areas of the brain _____

promotes sleep

GABA stimulation in the hippocampus and cerebral cortex induces _____

amnesia

GHB

a GABA analog

Large doses of ____ can result in sedation

GHB

Off label use vs anxiety disorders

Reduce adrenergic stimulation and tachycardia. Completely different mode of action, not involving GABA receptors

An anti-anxiety drug which does not have sedative effects

Buspirone/Buspar

The manufacture claims it is not physically addictive, unlike benzodiazepines

Buspirone/Buspar

Sometimes prescribed for pre-operative anxiety. Including dentistry

Diazepam/Valium

Is currently being used as an anti-seizure medication; including IV for status epilepticus

diazepam/Valium

Ambien

zolpidem

What does zolpidem (Ambien) treat?

insomnia

What does Lorazepam (Ativan) do?

Anxiety - Alcohol withdrawal (DT's) - Status epilepticus (continuous seizures) - Chemotherapy-associated nausea

What does midazolam (Versed) do?

Causes hypnotic sedation

What does Eszopiclone (Lunesta) do?

insomnia

What does carbamazepine do?

unknown for mood disorder but for seizure it blocks Na channels, dec calcium concentration, and modulate presynaptic asparate and glutamate release

What are the adverse effects that Benzodiazepines cause?

psychological dependence,

Partial Seizures: Simple

Consciousness preserved; limited to one part of the body (e.g. convulsions of a single limb)

Partial Seizures: Complex

Impaired consciousness that is preceded, accompanied, or followed by psychological symptoms

tonic-clonic seizure

generalized seizure in which the patient loses consciousness and has jerking movements of paired muscle groups

What are the three major classes of anxiolytic CNS depressants?

GHB, Barbiturates, Benzodiazepines

Fioricet contains a barbiturate drug that is

Used for tension headaches and migraines

Which of the following is NOT a side-effect of benzodiazepine drugs:
Day time sleeping
Habit-forming
Amnesia
Respiratory depression

respiratory depression

Midazolam (Versed) is a benzodiazepine that is

given IV before surgery (or colonoscopy etc) to produce sedation and amnesia.

Lorazepam (Ativan) is a benzodiazepine that is:

used to treat a wide variety of conditions, including anxiety, alcoholism withdrawal, and chemotherapy-related nausea

Eszoplicone (Lunesta) is a non-benzodiazepine drug that is

heavily marketed for insomnia

Tonic-clonic seizures are characterized by:

Periods of twitching followed by periods of muscle rigidity

Gabapentin (along with several other anti-seizure medications) is characterized by:

High frequency of off-label prescriptions

Valproic acid (along with several other anti-seizure medications) is characterized by:

low therapeutic index

In addition to treating seizures, topiramate is FDA-approved for

migrain prevention

Levatiracetam (Keppra) is primarily an

Anti-seizure medication

________ is an example of a benzodiazepine that is commonly used for insomnia.

Temazepam

________ is a benzodiazepine that can be used IV for status epilepticus.

Diazepam

GABA receptors cause ________ of post-synaptic neurons, inhibiting them from firing.

hyperpolarization

________ is a widely prescribed non-benzodiazepine drug that is now available as a generic, and seems to have fewer withdrawal symptoms than benzodiazepines.

Zolpidem

How are anti-emetic drugs related to some antipsychotic drugs? How are they different? What special feature of the CTZ relates to this?

Anti-emetic drugs block dopamine stimulation also, but they do so in the CTZ (chemoreceptor trigger zone), not the mesolimbic region. The CTZ is not protected by the blood-brain barrier, so drugs can have access to it without affecting the whole brain

SNRI stands for

serotonin and norepinephrine reuptake inhibitors

_____________________ is an older "typical" antipsychotic drug that is used to treat schizophrenia, and is sometimes used IV or IM to treat episodes of aggressive behavior in hospital patients.

Haloperidol or Holdol

____________________ is an "atypical" antipsychotic drug that is used to treat schizophrenia, which often causes weight gain as a side-effect

Olanzapine, Zyprexa, Quetiapine, Seroquel

Name an antidepressant from the newer SNRI class

Duloxetine, Venlafaxine, Effexor,
Cymbalta

What form of a drug (amine or ammonium ion) would be preferred for IV administration? Why?

Ammonium ion would be preferred: it is more polar, thus more soluble in blood, so more immediately available. Also, it would avoid the possibility of a thrombus forming around crystals of insoluble drug

________ is a widely prescribed non-benzodiazepine drug that is now available as a generic, and seems to have fewer withdrawal symptoms than benzodiazepines.

Ambien

What is the prefex for an ACE inhibitor?

pril

Amphetamine is used to treat

ADHD

Methylphenidate is used to treat

ADHD

Tiotropium bromide and ipratropium bromide are used primarily to treat

COPD

Bethanecol is used to treat

postsurgical difficulty with urination

Tolterodine or oxybutynin are used primarily to treat

Incontinence

Mometasone is used primarily to treat

Asthma

Atenolol is used primarily to treat

Hypertension

Phenytoin is used primarily to treat

Seizures

Levodopa and carbidopa are used primarily to treat

Parkinson's disease

Aprazolam is used primarily to treat

Anxiety

Clonidine is used primarily to treat

Hypertension

Zolpidem is used primarily to treat

insomnia

Tolterodine and oxybutynin are classed as

muscarinic antagonists

Serevent is classed as a(n

beta2 agonist

Bethanecol is classed as a(n)

muscarinic agonist

Timolol is classed as a(n)

non-specific beta blocker

Doxazosin and tamsulosin are classed as

alpha blockers

Atropine is used to treat

Organophosphate poisoning

Discuss the differences between warfarin (Coumadin) and heparin in terms of routes of administration, half life, adverse effects.

Coumadin is given as a pill, takes a day or more before it affects clotting and has a longer half-life; heparin must be given IV and has an immediate effect which wears off within a couple of hours. Both can cause hemorrhage and have low TI's, but since the effect of coumadin is delayed, can be altered by diet (deep green vegetables can lessen its effectiveness) and is often taken long-term at home, ongoing monitoring of clotting times is needed

Angiotensin II receptor blockers generically all have names that end in ____

Sartan

Name a drug that increases production of red blood cells: _______

EPO

____ is a drug taken sublingually to produce nitric oxide to stop an angina attack

Nitroglycerin

Hypokalemia is a common side-effect of primary (loop or early distal) diuretics such as: _______ (use generic name).

HCTZ, hydrochlorothiazide

Beta-1 blockers treat angina primarily by

slow down heart

Which of the following is NOT an effective treatment for CHF (congestive heart failure)?

Anticoagulants

Digoxin treats CHF (congestive heart failure) primarily by

Increasing the force of heart contractions

A known side-effect of acetaminophen in susceptible individuals is

Liver damage at high dosages

Coumadin works as an anticoagulant by inhibiting use of this molecule:

Vitamin K

Which one of the following drugs is used to break down existing clots in an MI or stroke?

tPA (tissue plasminogen activator)

Which one of the following drugs works by inhibiting platelet aggregation?

Clopidrogrel (Plavix)

Aspirin works as an anticoagulant by inhibiting formation of this molecule

Thromboxane A2

Spironolactone is used to treat severe CHF, as well as to treat hypertension. It is an example of a(n)

K-sparing diuretic

Valsartan is an example of a(n)

Angiotensin II receptor blocker

What are the three anxiety Disorders?

Acute anxiety attacks, Situational anxiety, Generalized Anxiety disorder

GABA-activated chloride channel proteins binds where?

gamma aminobutyric acid binds to channel, outside cell, in synaptic cleft

Does GABA allow one or more Chloride ion(s) into the cell?

Allows more chloride ions into cell

GABA causes _________ of post-synaptic membrane. Which Inhibits ______-synaptic neuron firing

hyperpolarization, post

GABA stimulates different parts of the Brain, in the limbic System what does it stimulate?

reduces anxiety

GABA in the cortical areas of the brain does what?

Promotes Sleep

GABA in the hippocampus and cerebral cortex it induces _____

Amnesia

This drug is Legal but is rarely prescription for narcolepsy.

GHB

A Major side-effect is respiratory depression.

Barbiturates

Occasionally still used to treat seizures

Phenobarbitol

used to induce anaesthesia

sodium pentothal (Thiopental)

combination of butalbital, aspirin & caffeine

Fiorinal

are prescribed in Oregon for physician-assisted suicide

Secobarbital, Pentobarbital

This enhanced the effect of GABA on its receptors

Benzodiazepines

Withdrawal may induce paranoia, delirium, or anxiety attacks

benzodiazepines

often a small dose will reduce anxiety, while larger doses will induce sleep

benzodiazepines

Other uses: alcohol withdrawal (DT's), seizures

benzodiazepines

It is used to treat anxiety and panic attacks. It is very habit forming

Alprazolam

Wider range of uses: - Anxiety - Alcohol withdrawal (DT's) - Status epilepticus (continuous seizures) - Chemotherapy-associated nausea

Lorazepam

Given IV before surgery

Midazolam

is a short half life benzodiapines

Midazolam

Produces sedation and amnesia

midazolam