Pharm 2 Final

• Amphetamines


  Increase norepinephrine and dopamine
• Amphetamines

  • Acute toxicity, give in morning
• Methylphenidate


  First line treatment, patch on hip, remove after 9 hours
• Methylxanthines


  Caffeine, acute toxicity
• Modafinil


  Interacts with oral contraceptives and cyclosporine
• Atomoxetine


  Non-stimulant, no abuse, inhibits norepinephrine reuptake
• Atomoxetine


  Interacts with MAOI and CYP2D6
• ADHD treatments for children

  • Alpha 2-adrenergic agonist: Guanfacine, Clonidine
  • Antidepressants (2nd line): desipramine, imipramine, bupropion
• Esters (local anesthetics)


  Procaine, chlorprocaine, tetracaine, allergic reaction common
• Amides (local anesthetics)


  Lidocaine, bupivacaine, prilocaine, ropivacaine, systemic toxicity
• Local anesthetics


  • Spinal headaches and methemoglobinemia
• Topical local anesthetics


  • Systemic toxicity (tinnitus and metallic taste)
• Infiltration local anesthetics


  • Give epinephrine, not in distal areas
• Epidural anesthesia


  Into epidural space, lidocaine, bupivacaine
• Intrathecal anesthesia


  Into subarachnoid space, lidocaine, bupivacaine, tetracaine
• Moderate anesthetics


  Benzodiazepine, Propofol with opiate
• Inhalation general anesthetics


  Nitrous oxide, enflurane, desflurane, Malignant Hyperthermia (antidote: dantrolene)
• Parenteral general anesthetics


  Propofol, etomidate, ketamine (hallucinations)
• Succinylcholine


  Depolarizing neuromuscular blocking drug, 1st: autonomic activity 2nd: pain and sensory function 3rd: motor activity, Order of functions lost, reoccurs in reverse in recovery
• Succinylcholine antidote


  Neostigmine, pyridostigmine, edrophonium
• Succinylcholine

  • Malignant Hyperthermia (antidote: dantrolene)
• Labor pain management


  • Nitrous oxide
  • Fentanyl (first one most effective, rest after are less effective)
  • Butorphanol tartrate
  • Naloxone
• Labor pain management

  • Adverse: hypotension, spinal headache, limited movement, bowel and bladder incontinence
• Clomiphene


  Blocks estrogen receptors in uterus and brain (false signal of low estrogen), start on 5th day after menses
• Oxytocin


  Uterine stimulant, can give for postpartum hemorrhage, adverse: water retention
• Methylergonovine


  Uterine stimulant, can give for postpartum hemorrhage, adverse: hypertension
• Dinoprostone


  Cervical ripening, gel: lie supine for 30 min, insert: supine for 2hrs, can give for induction or abortion
• Misoprostol


  Alternative to Dinoprostone, PO or vaginal
• Terbutaline


  Uterine relaxant, suppress labor not prevent
• Nifedipine


  Uterine relaxant, suppress for 48hrs, safer than Terbutaline, hypotension can occur in hypovolemic
• Indomethacin


  Uterine relaxant, extremely early labor, increase risk of neonatal complications
• Magnesium sulfate


  For pregnancy induced hypertension, suppress contractions, high infant mortality
• Nitroglycerin


  Uterine relaxant, transdermal patch, similar to Terbutaline
• Isotonic fluids


  • LR, 0.9% NaCl, D5W, for rehydration, resuscitation, mild hyponatremia, fluid replacement, risk: fluid overload
• Hypotonic fluids


  • 0.45% NS, 0.33% NS, for dehydration from GI loss, cells dehydrated, DKA, risk: cell lysis, worsen edema, hyponatremia, hypovolemia, hypotension
• Hypertonic fluids


  • 3% NS, D5NS, D5 1/2 NS, D5LR, for cerebral edema, hyponatremia, risk: fluid overload, pulmonary edema
• Albumin


  Volume expander
• Blood products


  Increase colloid osmotic pressure, only fluid that can carry oxygen
• Potassium


  Normal range: 3.5-5.3, hypokalemia causes: thiazide diuretic, loop diuretic, insulin, PO K, IV K, hyperkalemia causes: dextrose and insulin, Na Polystyrene sulfate, calcium gluconate
• Sodium


  Normal range: 135-145, mild hyponatremia: PO NaCl or fluid restriction, severe hyponatremia: IV NS or LR