SSRIs, MAOIs, Antiemetics, ECTs

Gastrin

Which GI hormone is produced by G cells in stomach, stimulated by food in stomach, and increases gastric acid and pepsin secretion?

Secretin, Cholecystokinin, Gastric inhibitory peptide

Which GI hormones are produced in the small intestine?

Cholecystokinin and gastric inhibitory peptide

Which GI hormones are stimulated by food in the duodenum?

Somatostatin

Which GI hormone is produced by D cells in pancreatic islets, stomach, and SI; stimulated by food in the gut, gastrin, CCK; and decreases ALL GI function (universal shut off)?

Anticholinergics, cricoid pressure, pregnancy

What decreases barrier pressure?

Metoclopramide

What increase barrier pressure?

Succs

What has no effect on barrier pressure?

25mL and <2.5

What volume and pH is enough to cause aspiration pneumonia?

H1

Which histamine receptor activates phos. C?

H2

Which histamine receptor increases intracellular cAMP?

H3

Which histamine receptor is responsible for negative feedback inhibiting more histamine release?

H4

Which histamine receptor is involved with mast cells and eosinophils (allergy and inflammation)?

H2

Which histamine receptor causes mild bronchodilation, pulmonary constriction, and increase in gastric acid?

H1

Which histamine receptor causes smooth muscle broncho constriction?

Diphenhydramine

Which H1 blocker has antimuscarinic effects and the dose is 25-50mg?

Promethazine

Which H1 blocker has antidopaminergic blocking properties and the dose is 12.5-50mg?

H2 blocker

Which histamine blocker competitively inhibits binding and results in reduced gastric output and acidity?

H2 blocker

What med class is used to treat gastric ulcers, GERD, H-pylori, reduce gastric volume?

Hepatotoxicity, nephritis, thrombocytopenia, lethargy, and hallucinations in elderly

What are long term use SE of H2 blockers?

Arrhythmias

What SE is mainly involved with rapid injection of H2 blockers?

Renal

How are H2 blockers eliminated?

Cimetidine

Which H2 blocker slows metabolism of lidocaine, propranolol, theophylline, phenobarbital, warfarin, and phenytoin?

Cimetidine and Ranitidine

Which H2 blockers have inhibitory effects of P450 system?

Antacids

What drug class are used to pretreat in OB or for a full stomach and have an immediate effect but increase gastric volume?

15-30 min

How long before induction should antacids be given?

Reglan

Which drug increases LES tone, speeds gastric emptying, decreases gastric volume, and blocks dopamine receptors in CRTZ?

Reglan

What drug is a cholinomimetic which facilitates AcH transmission at M-receptors and central dopamine blockers?

Reglan

Which drug is contraindicated in complete bowel obstruction, can cause HTN crisis in pheochromocytoma patients, and lead to tardive dyskinesia and NMS d/t dopamine antagonism?

PPIs

What drug class is used to treat peptic ulcers, GERD, and Zollinger-Ellison's?

PPIs

What drug class interferes with P450 therefore decreases Plavix effectiveness and clearance of diazepam, warfarin, and phenytoin?

5 HT3 blocker

What drug class are ondansetron, granisetron, tropisetron, dolasteron fall into?

5 HT3 blockers

What drug class selectively blocks with NO effect on dopamine receptors because the receptors are outside the BBB?

GI tract

Where are serotonin 5-hydroxytryptamine (5-HT) largely present?

5HT3 blockers

What drug class can causes HA, prolonged QT, and metabolized in the liver?

Butyrophenones

What drug class does Droperidol, Compazine, and Promethazine fall into?

Droperidol

Which drug blocks dopamine receptors and carries a black box warning for prolonged QT with high doses?

Substance P

What is a neuropeptide that interacts at NK1 receptors?

Aprepitant (Emend)

What drug is a NK1 antagonist that inhibits substance P at central and peripheral receptors and can reduce PONV when used with Zofran?

At induction

When should you give decadron?

Scopolamine and hydoxyzine

Which drugs target the vestibular apparatus in the inner ear?

Zofran (5-HT3)

What drug acts in two areas: CRTZ and peripheral receptors in GI?

SSRIs

What drug class does fluoxetine, sertraline, and paroxetine fall into and are considered the first line agents for depression?

HA, agitation, insomnia

SE of SSRIs include?

TCAs

What drug class is used to treat depression and chronic pain syndrome by working at nerve synapses by blocking neuronal reuptake of catecholamines and serotonin?

Desipramine and nortriptyline

Which two TCA meds have fewer SE and are less sedating?

Amitriptyline

Which TCA has more sedative properties and the most profound anticholinergic effects?

TCAs

Which drug class includes anticholinergic type SE and cardiac effects which includes tachycardia, T-wave flattening/inversion, and prolongation of PRI/QRS/QT?

Doxepin

Which TCA med has the fewest cardiac effects?

TCAs and MAOIs

The most important interaction between anesthetic agents and WHAT DRUG CLASSES causes an exaggerated response to INDIRECT-acting vasopressors and sympathetic stimulation?

Direct/selective

Would you use indirect/nonselective or direct/selective acting cardiac meds for patients on TCAs/MAOIs?

MAOIs

What drug class does Isocarboxazid (Marplan), Phenelzine (Nardil), and Selegiline fall into?

MAOIs

What drug class blocks the oxidative delaminating of natural occurring amines?

MAOIs

What drug class carries the following SE risks: ortho hypotension, agitation, tremor, seizures, urinary retention, and HTN crisis d/t excess of tyramine?

Phenelzine

Which MAOI can prolong succs?

Opioids and meperidine

What drugs should NOT be used with MAOIs d/t risk of hyperthermia, seizures, and coma?

Benzos

For mild serotonin syndrome what meds do you use for treatment?

Cyproheptadine

For moderate serotonin syndrome what med do you use to treat?

SSRIs, SNRIs, MAOIs, MDMA

What can cause serotonin syndrome?

Serotonin syndrome

What syndrome has these key features: akathisia, mydriasis, tremor, AMS, clonus, and muscle rigidity?

Halogenated anesthetic and succs

What can cause malignant hyperthermia?

Hypercarbia, tachycardia, acidosis, muscle rigidity

What are the key features of malignant hyperthermia?

Dopamine depletion in basal ganglia

What causes NMS?

Dopamine antagonists

What drug class do these meds fall into (metoclopramide, haloperidol, chlorpromazine, risperidone) and should be avoided in patients with Parkinson's?

NE, Epi, Phenylephrine

Which vasopressors are direct acting meaning they stimulate the receptor directly?

Dopamine, dobutamine, ephedrine

Which vasopressors are indirect acting?

NO

If catecholamine reserve is depleted, will indirect vasopressor agents be effective?

NE

With mania, what is there an excess activity of in the brain?

True

True or false: The MOA of lithium is poorly understood.

T-wave changes, leukocytosis, vasopressin resistant DI

What are the SE of lithium?

Confusion, sedation, weakness, tremor, slurred speech

What are the toxicity s/s of lithium?

Wide QRS, AV block, hypotension, seizures

What are HIGH toxicity s/s of lithium?

Lithium

What psych drug decreases MAC, prolongs NMS blockers, and can lead to sodium depletion?

Loop and thiazide diuretics

Which drugs decrease lithium excretion and can lead to toxicity?

PNS then SNS tone

The initial phase to ECTs involve an increase in WHAT and then followed by an increase in WHAT?

Methohexital (Brevital)

Which med is the gold standard for rapid recovery in ECTs?

Barbiturates

What drug class does Brevital fall into?

Brevital, Precedex, Esmolol, Clonidine

Which drugs have no effect on seizure duration for ECTs?

HYPERventilate

What should you do just prior to ECT to help prolong seizure duration?

Increase duration

The following meds do what to seizure duration: etomidate, ketamine, aminophylline, and caffeine?

Decrease duration

The following meds do what to seizure duration: propofol, versed, Ativan, fentanyl, lidocaine?

Etomidate

Which induction agent is associated with an increase risk of PONV and post-ECT HTN?