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term 4 > 5drugsmental > Flashcards

5drugsmental Flashcards

1
Q

treatment of depression unresponsive to other
antidepressants (antidepressant)

what else is it used for

A

MAOI(selegine)

selegine also used for PD to selectively inhibit MAO-B that is selective to dopamine

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2
Q

uses for sellegine

A

-refractory depression
-early parkinsons disease
*can give intradermal which will avoid the cheese run

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3
Q

MAOI adverse effects

A

serotonin rxn(irreversible inhibitojn)
cheese rxn

NE inc causes drowsiness/ insomnia

SERT inc causes weight gain, dec sex

orthostatic hon

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4
Q

sx of serotonin rxn and tx

A

hyperthermia
sweating
monoclonus/jerking muscles

discontinue drug, sedate with benzodiazepines, and give serotonin agonist= cryptoheptidine

applicable to MAOI OD

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5
Q

sx of cheese rxn
what causes it
treatment

A

no degradation of tyramine by MAO causes release of catecholamines = tachy, htn, arrhythmia, seizures, stroke

-can be caused by cheese, wines with tyrosine. can also be causes by OTC cold meds(pseudoephedrine, and phenylpropanolamine)

tx with phentolamine or prazosin (for the HTN) or labetolol

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6
Q

TCA MOA

A

blocks NERT and SERT (reuptakers) which also causing block of a1, H1, M

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7
Q

TCA AE

A

inc serotonin effects(dec sex)
inc NE effects

anticholinergic (blurry, dry, delirium, glaucoma aggravation)

antihistaminic(sedation and weight gain/increases appetite)

blocks cardiac fast sodium channels(arrhythmia)

blocks alpha1 receptors(ortho hypo)

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8
Q

TCA arrhythmia antidote/ OD

A

sodium carbonate

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9
Q

SSRI AE and overdose

A

nausea from inc serotonin in the gut

weight gain

dec sex

NO: ortho hypo, dry, blurry

OD=seizure

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10
Q

which SSRIs have the lowest potential of other drug interactions

A

estatalopram
citalopram
sertraline

all can cause serotonin synd if paired with MAOI

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11
Q

SARI names, MOA

A

N/T-zodone

blocks SERT and NERT and antagonizes 5HT2 receptors to avoid unwanted effects of inc serotonin

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12
Q

AE of the SARIs

A

nefazodone causes hepatotoxiciity

trazodone ALSO BLOCKS a1 and H1…extremly sedating, ortho hypo, and PRIAPISM

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13
Q

SNRI MOA and time for use

A

blocks SERT and NERT
without the TCA side effects or the drug interactions with SSRIs

-try these is SSRIs dont work

venlafaxine will strongly inhibit SERT and in high doses can block NERT

Duoloxitine will inhibit both at any dose

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14
Q

Mirtazapine MOA and time for use

A

NaSSA
-Antagonist at serotonin Rs
-Antagonist at H1
-Antagonist of presynaptic alpha 2 receptors for serotonin and NE(normally when activated tells the neuron to stop releasing)

can be useful if there is also insomnia

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15
Q

ketamine MAO and time for use

A

noncompetitive antagonism at NMDA

refractory or suicidal depression

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16
Q

abnormal discontinuation syndrom sx and which drugs most likely cause this

A

flu like sx
electric shock sensation, insomnia

most likely caused by short half life drugs such as paroxetine and venlafaxitine…NOT from fluoxetine

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17
Q

tx chronic neuropathic pain

A

SNRI and TCA

ex.diabetic neuropathy

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18
Q

lithium use and MOA

A

tx bipolar

inhibits inositol synthesis(needed for the Gq, PLC, IP3/DAG) by uncompetitive inhibition of inositol phosphatase. no PIP2 so neuron cant fire.

alternatives are: valproate and carbamazepine, lamotrigine(anti epileptic), atypical antipsychotics(QORA)

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19
Q

lithium AE and OD

A

tremor, GI distress, seizures, hypothyroid, nephrogenic DI, alopecia

if used in pregnancy associated with congenital cardiac abnormalities

with OD: perfuse diahrea/vomitting, tremor, convulsions, coma

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20
Q

tx if lithium induces nephrogenic DI

A

discontinue lithium and give amiloride

if can discontinue, add thiazides or NSAIDs(reduces the renal clearance of lithium..also ACE)

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21
Q

what needs to be monitored with lithium

A

lithium serum levels
thyroid function
renal function

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22
Q

what needs to be monitored with valporate

A

liver function and CBC

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23
Q

what needs to be monitored with carbamazipine

A

CBC

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24
Q

dual antagonism of atypical antipsychotics

A

Dual antagonism at 5-HT2A and D2 receptors

less EPR, less prolactin inc

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25
Q

atypical least likely to cause EPR

A

Clozapine and quetiapine

in general atypical are less likely to cause EPR, prolacticemia, and can improve negative sx

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26
Q

partial agonist at D2 and 5HT1A
receptors and an antagonist at 5HT2A receptors.

A

aripiprazole

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27
Q

an inverse agonist at the 5HT2A
receptors with no significant affinity for dopamine
receptors

A

Pimavanserin

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28
Q

high affinity for D1, D4, 5HT2,
muscarinic and alpha-adrenergic receptor, but it is
also a D2 blocker.

A

clozapine

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29
Q

blocks 5HT2 to a greater extent
than it does D2

A

risperidone

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30
Q

which antipsychotics are not also antiemetics(blockade D2 receotrs in chemo center in medulla)

A

aripiprazole and thioridazole

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31
Q

why does thioridazine and chlorpromazine have the less likelihood of causing EPR

A

they have strong anticholinergic activity

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32
Q

what are the EPRs and how do you treat them

A

Parkinsonism: tx with antimuscarinics like trihexpheydil or benztropine. Can use diphenhydramine or amantidine

Dystonia: tx with benztropine, trihexyphenidyl, or diphenhydramine

Akathesia: clonazepam or propranolol

tardative dyskinesia: discontinue any anticholinergics, add VMAT inhibitors(tetrabenzine or valbenzine) then switch them over to clozapine

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33
Q

May be due to dopamine receptor up-regulation

A

tardative dyskenesia

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34
Q

NEUROLEPTIC MALIGNANT SYNDROME sx and tx

A

possible side effect of antipsychotics

sx- rigidity and hyperthermia, autonomic instability, elevated CK

tx-dantrolene, bromocriptine

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35
Q

which antipsychotics have the biggest risk for seizures

A

Chlorpromazine and clozapine

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36
Q

which antipsychotic required monitoring and of what

A

need to monitor blood counts with clozapine bc it causes agranulocytosis

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37
Q

which antipsychotic has the cardiac problems

what is the other side effect for this drug

A

thiordazine

also causes retinal deposits

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38
Q

causes deposits in the cornea
and lens

A

chlorpromazine
classic antipsychotic

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39
Q

which antipsychotics have the highest and the lowest metabolic dysfunction

A

highest: clozapine and olanzipine

lowest: aripiprazole, quietazole, haloperidol

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40
Q

antipsychotics black box warning

A

increased risk of death when given to elders for dementia related psychosis

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41
Q

tic tx

A

antipsychotic

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42
Q

approved for treatment of hallucinations
and delusions associated with Parkinson’s disease
psychosis

A

Pimavanserin

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43
Q

antipsychotics for pregnancy

A

clozapine is safest, others are class C

atypical have increased risk of weight gain and hyperglycemia in pregnancy

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44
Q

aspirin OD sx and tx

A

sailyic ACID OD = tinnitus, hyperventilation, vertigo, respiratory alkalosis/metabolic acidosis, impair renal, inc ketones and lactic acid(blocks oxidative phosphorylation and krebbs)…respiratory failure

tx: sodium bicarbonate

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45
Q

acetometaphan OD sx and tx

A

hepatic necrosis**, renal necrosis, hypoglycemia coma

inc NAPQI damage hepatocyte, depletes glutathione

tx: n-acetylcystein

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46
Q

beta blocker OD sx and tx

A

Brady, heart block, QT prolongation, hypotension

glucagon tx

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46
Q

CCB OD sx and tx

A

esp nifedipine causing dec SA and AV conduction

tx: atropine, isoproterenol for Brady

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46
Q

anticholinergic od
which drugs involved
tx

A

antihistamines OD is seizure
TCA OD is cardiac toxic

overall anticholinergic effects: tachy and dilated pupils

tx: physostigmine but not for TCA bc will agricvate cardio more..benzo good

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47
Q

amphetamine OD
which drugs included
tx

A

meth, cocaine, MDMA, pseudoepherdrine

hyperventilation, htn, sweating

tx: benzo or nitroprusside/ phentolamine. if arrythmias proposal

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47
Q

opioid OD sx and txx
what drugs are in this category

A

heroin, morphin, codeine, oxycodone
pinpoint pupils

naloxone nalfemene

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48
Q

Nitrate od and tx

A

od: hemolytic anemia / methylglobinemia
-inhibits ETC

tx: methylene blue

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49
Q

theophylline OD tx

A

beta blockers proprolol or phenobarbital is seizing

think caffeine

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50
Q

sulfa drug od sx and tx

A

hypoglycemia

tx: octreotide and glucose infusion

51
Q

what should be used in cases of QRS-interval prolongation
after a massive diphenhydramine overdose

A

sodium bicarbonate

52
Q

ethanol od tx

A

thiamine then glucose

53
Q

NEUROLEPTIC MALIGNANT SYNDROME can be caused from and tx

A

can be caused from antipsychotic OD

tx: Bromocriptine or dantrolene maybe benzo

54
Q

methanol intoxo sx and tx

A

methanol”windshield wiper fluid”,
acidosis and blindness

ethanol or Fomepizole

may need to treat the metabolic acidosis with sodium bicarbonate

55
Q

abdominal
cramps, diarrhea, excessive salivation, sweating, urinary frequency, and
increased bronchial secretions

tx

A

organophosphate poisoning- anticholinesterase

atropine

56
Q

warfarin rodent bait od tx

A

Vit K1

57
Q

cyanide od tx

A

sodium nitrate
sodium thiosulfate
hydroxocobalamin

58
Q

ethylene glycol intoxo sx and tx

A

ethylene glycol “antifreeze”
causes calcium crystal

Fomepizole

59
Q

binds to cytochrome c oxidase in mitochondria

A

cyanide

60
Q

delta-ALA dehydratase and ferrochelatase are inactivated by

A

Lead

61
Q

lead od sx and tx

A

PICA abdominal colic/ bloody diahrea, CNS problems, anemia!

Chelation therapy: IV EDTA ± IM dimercaprol.

62
Q

Severe gastrointestinal discomfort, vomiting, “ricewater” stools, capillary damage
with dehydration and shock. anemia

tx

A

arsenic poisoning

Chelation with unithiol IV or succimer
-can also give this in mercury poisoning

63
Q

vomiting, bloody diarrhea, fever, lethargy and gray cyanosis

tx

A

iron poisoning

Deferoxamin

64
Q

regenerates acetyl choline esterase

A

pralidoxime

64
Q

heparin od tx

A

protamine

64
Q

insulin OD

A

octreotide

65
Q

all addictive drugs activate
the what system

A

mesolimbic

66
Q

which addiction drugs inc dopamine indirectly by blocking GABA

A

opioids, cannabis, benzes, alcohol

66
Q

which addiction drugs directly stimulate dopamine

which block ore reverse DAT

A
  1. nic and alc
  2. coc, amphetamines(coc actually blocks all of it SERT NET DAT) (amphetamines are MAOI and release catecholamines-mama is more specific for SERT)
66
Q

CNS depressants

A

ethanol, barbs, benzes

66
Q

ethanol withdrawal tx

A

Diazepam and chlordiazepoxide (benzos with long half life but if elderly give medium acting Lorazepam and oxazepam )

67
Q

alcohol addition tx and MOA

A

-naltrexone- block Mu allowing inc in GABA and dec Dop
-acamprostate- NMDA-R antag, blocking hyper glutamate
-disulfiram- block alcohol dehydrogenase
-topiramate- antagonizes glutamate

68
Q

agonists at the GABAa
receptor

A

Benzes

-this will inhibit GABA and inc Dop

69
Q

tremors, anxiety,
perceptual disturbances, dysphoria, psychosis,
and seizures

A

benzo withdrawal

70
Q

management of benzo withdrawl

A

long acting benzo- diazepam

71
Q

block presynaptic adenosine
receptors which causes

A

Methylxanthines: caffeine, theophylline, theobromine

what normally blocks NE is now blocked so there is an inc in NE

72
Q

interfere
with the VMAT, depleting synaptic vesicles

A

amphetamines

73
Q

increased appetite,
sleepiness, exhaustion, and mental depression

A

amphetamine withdrawal

74
Q

VARENICLINE

A

Partial agonist at nicotinic receptors in the CNS.
* Reduces the reward of smoking.

75
Q

opioid withdrawal sx

A

dysphoria, lacrimation, rhinorrhea and
yawning

76
Q

opioid withdrawal tx

A

long acting opioid agonists:
Methadone or buprenorphine.

naltrexone is used AFTER withdrawal for abstinence compliance as it is a mu antagonist

77
Q

what are the medical cannabis names

what are they used for

A

Nabilone- chemo N/V
Dronabinol- chemo N/V, anorexia
* Cannabidiol (CBD)- seizures

78
Q

MESCALINE

MAO

A

psychedelics

agonist effects at 5-HT2 receptors…no motor changes

79
Q

PHENCYCLIDINE MAO

A

competitive antagonism at NMDA receptors and Blocks reuptake of norepinephrine and dopamine

80
Q

natural remedies for cholesterol/htn

A

garlic, coenzyme Q

81
Q

natural remedies for OA

A

condrotin sulfate
glucosamine

82
Q

natural remedies for 1.BPH

2.hepatits

  1. performance enhancer
  2. anxiety
A

saw palmetto

mik thistle

ma haung

kava, ginseng

83
Q

D2 conductance

A

dec adenyl cyclase
dec Ca2+
inc K

Parkinson drugs want to stimulate D2

84
Q

what are the peripheral side effects of Levodopa

how about CNS effects

A

nausea, vomiting, go bleeding, cardiac arrhythmias, tachy, hypotension

cns: hallucination, depression, insomnia

85
Q

For PD patients with severe off-periods who are unresponsive to other measures, what can you try.

what are the other measures

A

apomorphine

dopamine agents(non ergot) or COMT-I
-usually first try capone

86
Q

levodopa contraindications

A

dont give with B6 bc it will inc peripheral conversion

with MAOI can induce hypertensive crisis

dont give in close angle glaucoma

dont give to psychotic patients or with antipsychotic drugs

watch out for the cardiac patients and with GI ulcers

87
Q

Used increasingly as initial treatment for PD,
particularly for younger patients

A

the non ergot dopamine agonists

Pramipexole & Ropinirole (patch)

dont use the ergot bromocriptine anymore

87
Q

trimethobenzamide when to use it

A

use it before giving apomorphine to minimize nausea

87
Q

bromocriptine AEq

A

pulmonary
infiltrates, pleural and retroperitoneal
fibrosis, and erythromelalgia

87
Q

Pramipexole AE

A

same as the Levodopa ones but also can cause 1. painless digital vasopasms 2. increased compulsive behaviors 3. severe solomnence-discontinue meds

same applies for Ropinirole

88
Q
A
88
Q

apomorphine AE

A

nausea, QT prolongation, drowisness, swerating, hypotension

88
Q

amantadine AE

A

toxic dose = psychosis as with any parkinsons drug

Livedo reticularis -rash

dry mouth
ortho hypo
urine retention, confusion, hallucinations

88
Q

antimuscarinics used for parkinsons

for what aspect

A

BENZTROPINE & TRIHEXYPHENIDYL

for the rigidity and tremors, drooling

88
Q

Metabolized to methamphetamine and
amphetamine: may cause insomnia if taken
late in the day

A

selegine/ rasagilline

88
Q
A
89
Q

BENZTROPINE & TRIHEXYPHENIDYL AE

A

mood changes, xerostomia,
pupillary dilation, confusion, hallucinations,
and urinary retention

dont use in glaucoma, prostatic hypertrophy, or pyloric stenosis

90
Q

receptor functions as a chloride
channel

what is the shape

What bind

A

GABAa

has a pentameric
structure 2alpha 2beta 1gamma

GABA binds between alpha and beta
Benzos/NBBRA bind bw alpha and gamam(positive allosteric modulator of GABA)

barbs bind at different alpha site

91
Q

metabolites are
then conjugated to
form glucuronides that
are excreted

exceptions

A

benzos

urine

LOT- no P450 metabolism

92
Q
A
93
Q

benzos for:
1.muslcular disorders
2.sleep disorders

A

diazepam

Temaz
Triaz

94
Q

Benzodiazepines may cause paradoxical effects

A

Anxiety, irritability, hostility and rage, paranoia,
depression and suicidal ideation

also can happen with barbs

95
Q

5-HT1A PARTIAL AGONISTS

A

BUSPIRONE

antianziety only with long onset of action

96
Q

RAMELTEON MAO

AE

A

agonist to melatonin receptor

AE: endocrine changes, decreases in testosterone &
increases in prolactin

97
Q

blocks neuropeptides

A

SUVOREXANT & LEMBOREXANT

blocks orexin A and B

98
Q

SUVOREXANT & LEMBOREXANT AE and contraindication

A

Adverse effects include daytime somnolence and
worsening of depression/suicidal ideation

contraindicated in narcolepsy

99
Q

effective in the management of
nightmares and sleep disturbances associated
with PTSD

A

PRAZOSIN

100
Q

which antihistamines are used for sleep and which used for anxiety

A

sleep: doxepin

anxiety: HYDROXYZINE

101
Q

what is responsible for the optic nerve damage in alcoholics

A

formic acid which is a metabolite

also applicable to methanol nerve damage

102
Q

Motor dysfunction may involve chewing
movements, diarrhea, urination and LOC

A

Focal Impaired Awareness Seizures
usually in the temporal lobe

103
Q

principle MOA for anti seizure drugs

A

Blockade of Voltage-Gated Ion Channels(Na T-type Ca)

Modulation of Synaptic Transmission

104
Q

which anti epileptics block voltage gated Na channels

use?

A

phenytoin, carbamazepine, lamotrigine, zonisamide

potentially valproate, phenobarbital, topiramate

used for tonic clonic

105
Q

antiepileptic:
which drugs induce GABA presynaptically which postsynaptically

which drugs block glutamate presynaptically, which postsynaptically

A

GABA post: barb, benzo, topi
GABA pre: Tiagabine( by blocking reuptake), Vigabatrin (inhibits GABA aminotransferase/ degradation)

glutamate post: phenobarbital, topimarate(blocks Na)
glutamate pre: pregabalin and pregabalin(block Ca)

106
Q

which antiepiletics block t type Ca channels

what are they used for

A

used for absence seizures

valporate(use for atypical absence or if also tonic clonics)
ethansuxamide

107
Q

binds to synaptic vesicle
glycoprotein 2A (SV2A)

function

A

Reduce Glutamatergic
Neurotransmission Presynaptically- vesicle dont pop

Levetiracetam

108
Q

which ant epileptics induce P450

A

carbamazepine, phenytoin, phenobarbital

109
Q

valproate AE

A

hepatotoxic

inhibit metabolism of drugs/ inhibit P450

110
Q

phenytoin AE

A

gingival, hirtuism, rash
**zero order kinetics

111
Q

carbamazepine AE

A

anemia, agranulocytosis
rash

112
Q

which anti epileptics have the highest SJS risk

A

carbamazepine, phenytoin, lamotrigine
-back box warnings
phenobarbital too but no black box

also risk for toxic epidermal necrosis

113
Q

vigabatrin AE

A

visual

114
Q

anti epileptics while pregnant

A

valproate is the worst for malformations and can be combated with folic acid to decrease neural tube defects

will also increase via K degradation causing newborn hemorrhagic disease and can be combated with vitamin K

term 4 (13 decks)

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