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Pharmacology > Antipsychotics, antidepressants, opioids, drugs of abuse, endocrine > Flashcards

Antipsychotics, antidepressants, opioids, drugs of abuse, endocrine Flashcards

1
Q

target action of typical antipsychotics

A

D2 receptors in caudate putamen, nucleus accumbens, cerebral cortex, hypothalamus

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2
Q

dopaminergic tract-regulating mentation and mood

A

meso-cortical, meso-limbic

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3
Q

dopaminergic tract-extrapyramidal function

A

nigrostriatal

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4
Q

dopaminergic tract-control of prolactin relace

A

tuberoinfundibular

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5
Q

dopaminergic tract-eating behavior

A

medullary-periventricular

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6
Q

dopaminergic tract-anticipatory motivational phase of copulatory behavior

A

incertohypothalamic

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7
Q

antipsychotic of choice for drug resistance

A

clozapine

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8
Q

caused by supersensitivity of dopamine receptors

A

tardive dyskinesia

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9
Q

tx for acute dystonia

A

diphenhydramine

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10
Q

tx for parkinsonism

A

benztropine

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11
Q

tx for rabbit syndrome

A

benztropine

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12
Q

tx for tardive dyskinesia

A

nonerome

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13
Q

tx for akathisia

A

decrease dose, diphenhydramine

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14
Q

tx for neuroleptic malignant syndrome

A

withdraw drug, dantrolene, diazepam, dopamine agonist

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15
Q

typical antipsychotic; SE: corneal and lens deposits, neuroleptic malignant syndrome, contact dermatitis

A

chlorpromazine

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16
Q

typical antipsychotic; SE: retinal deposits, cardiotoxicity, w/ strongest autonomic effects, fatal ovedose

A

thoridazine

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17
Q

typical antipsychotic known for major EPS, also used for Huntington’s and Tourette’s, least sedating among typicals

A

haloperidol/droperidol

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18
Q

only antipsychotic that reduces the risk of suicide

A

clozapine

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19
Q

weight gain attributed to atypical antipsychotics

A

probably from H1 and 5-HT2 blockade

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20
Q

atypical antipsychotic also used for manic episodes; SE: cataracts, hypnagogic hallucinations, priapism

A

quetiapine

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21
Q

only antipsychotic approved in the youth

A

risperidone

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22
Q

atypical antipsychotic; SE: QT prolongation, increased mortality in elderly with dementia-related psychosis

A

ziprasidone

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23
Q

least sedating among atypical anti-psychotics

A

aripiprazole

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24
Q

atypical antipsychotics with no atropine like effects, do not cause hypergly, hyperprolactinemia or weight gain

A

ziprasidone, aripiprazole

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25
Q

features of neuroleptic malignant syndrome

A

FEVER: fever, encephalopathy, vitals unstable, elevated CPK, rigidity`

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26
Q

MOA of lithium

A

decreases cAMP, inhibits inositol-1-phosphatase

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27
Q

SE of lithium; Tx

A

LITH: leukocytosis, insipidus, teratogen (Ebstein’s anomaly), thyroid enlargement, tremors, heart (bradycardia); also acneiform skin eruptions; hemodialysis

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28
Q

threshold for lithium toxicity

A

2 mEq/L

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29
Q

NTs responsible for mood

A

NE and serotonin

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30
Q

back-up drug for MDD

A

TCAs: imipramine (clomipramine, desipramine, amitryptyline, nortryptiline)

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31
Q

toxic dose of TCAs; lethal dose

A

7mg/kg; 15 mg/kg

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32
Q

ECG findings in TCA overdose

A

abnormal QRS morphology, prolonged QRS, abnormal R and S waves in AVR

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33
Q

features of TCA overdose; Tx

A

coma, convulsions, cardiotoxicity; bicarbonate (for QRS>100msec)

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34
Q

first line for MDD

A

SSRI (fluoxetine, paroxetine, citalopram, escitalopram, sertraline, fluvoxamine)

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35
Q

notable SE of SSRIs

A

erectile dysfunction

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36
Q

tx for serotonin syndrome

A

cyproheptadine

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37
Q

inhibits neuronal reuptake of serotonin and NE

A

SNRIs (venlafaxine, duloxetine, desvenlafaxine)

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38
Q

SNRI with hepatotoxicity SE

A

duloxetine

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39
Q

SNRI with cardiotoxicity and CYP450 inhibitio

A

venlafaxine

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40
Q

weak 5-HT reuptake inhibitors that blocks 5-HT2 receptors to make serotonin available to other receptors, SE: priapism; SE: hepatotoxicity

A

trazodone and nefazodone; trazodone; nefazodone

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41
Q

tetracyclic antidepressant which causes amenorrhea-galactorrhea syndrome and lowers seizure threshold

A

amoxapine

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42
Q

tetracyclic antidepressant which can be used as appetite stimulant; can cause nightmares

A

mirtazapine

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43
Q

tetracyclic antidepressant which can also be used for smoking cessation; also causes priapism, aggravation of psychosis, lower seizure threshold

A

bupropion

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44
Q

inhibits monoamine oxidase type A and B, increases NE and serotonin

A

MAOIs (phenelzine, tranylcypromine, selegiline)

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45
Q

causes hypertensive crisis when taken with tyramine (indirect acting sympathomimetic in cheese)

A

MAOIs

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46
Q

features of serotonin syndrome

A

FAT CHD; fever, agitation, tremors, clonus, hyperreflexia, diaphoresis

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47
Q

features of malignant hyperthermia

A

FCHART; fever, acidosis, rhabdomyolysis, trismus, clonus, HPN

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48
Q

precipitating drugs for serotonin syndrome

A

SSRIs, MAOIs, TCAs, meperidine, MDMA, St. John’s wort

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49
Q

opioids with shortest and longest half-lives

A

remifentanil; buprenorphine

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50
Q

mu opioid receptor (function, affinity)

A

inhibition of respiration, endorphins

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51
Q

delta opioid receptor (function, affinity)

A

dev’t of tolerance, enkephalin

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52
Q

kappa opioid receptor (function, affinity)

A

slowed GI transit, dynorphin

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53
Q

opioid analgesic which may be given trandermally or via lollipop

A

fentanyl

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54
Q

most potent opioid

A

ohmefentanyl

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55
Q

opioid of choice for relief in pancreatitis and labor pains

A

meperidine

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56
Q

opioid which causes serotonin syndrome w/ SSRIs or MAOIs

A

meperidine

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57
Q

agonist of mu and kappa receptors

A

meperidinethadone

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58
Q

opioid used for opioid dependence/withdrawal, can cause drug-induced hyperthyroidism, currently being investigated as a novel treatment for leukemia

A

methadone

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59
Q

partial opioid agonist; SE: hypogonadism, hearing loss

A

hydrocodone/oxycodone

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60
Q

partial opioid agonist which depresses medullary cough center through sigma receptor stimulation

A

dextrometorphan/ codeine

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61
Q

weak opioid agonist withdrawn due to fatal cardiotoxicity

A

propoxyphene

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62
Q

opioid which is a strong agonist of kappa receptors but weak antagonist of mu receptors

A

nalbuphine, buprenorphine, butorphanol, pentazocine

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63
Q

effects resistant to naloxone reversal

A

nalbuphine, buprenorphine, butorphanol, pentazocine

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64
Q

systemic opioid antagonist

A

naloxone

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65
Q

systemic opioid antagonist which also reduces alcohol dependence

A

naltrexone

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66
Q

dual-acting opioid analgesic, weak agonist of mu receptor, also inhibits reuptake of serotonin and NE, lowers seizure threshold and may cause serotonin syndrome

A

tramadol

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67
Q

CI of tramadol use

A

epilepsy

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68
Q

triad of opioid overdose

A

PRC: pupillary constriction, respiratory depression, coma

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69
Q

NT believed to cause addiction

A

excessive dopaminergic stimulation

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70
Q

antidepressants with limited benefit against amphetamine withdrawal symptoms

A

amineptine, mirtazapine

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71
Q

congeners of amphetamines

A

dimethoxymethylamphetamine (DOM), methylene dioxyamphetamine (MDA), methylene dioxymethamphetamine (MDMA/ ecstacy)

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72
Q

electrolyte imbalance which may be caused by ecstacy

A

profound hyponatremia

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73
Q

“speed”, “superspeed”

A

methamphetamine, cocaine

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74
Q

causes crack lung (hemorrhagic alveolitis), mydriasis, HPN, vasoconstriction, psychomotor agitation, hyperthermia, dyspnea, bowel ischemia, thrombus formation

A

cocaine overdose

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75
Q

presents with agitation, hypertension, tachycardia, delusions, hallucinations, hyperthermia, seizures

A

methamphetamine overdose

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76
Q

teratogenic, causes cystic cortical lesions on CT

A

cocaine

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77
Q

psychotomimetic effect

A

phencyclidine/ ketamine

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78
Q

most dangerous hallucinogenic agent

A

phencyclidine

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79
Q

“angel dust”

A

phencyclidine

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80
Q

causes nystagmus, hypertension and seizures; tx

A

phencyclidine; IV diazepam/lorazepam

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81
Q

no actions on dopaminergic neurons unlike most drugs of abuse

A

phencyclidine

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82
Q

psychedelic effects

A

lysergic acid diethylamide (LSD), mescaline, psilocybin

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83
Q

purified more potent form of marijuana

A

hashish

84
Q

reddened conjunctiva

A

marijuana

85
Q

increases IGF-1 in liver and cartilage; used for short stature syndromes (Turner, Noonan, Prader-Willi), AIDS wasting, failure to thrive

A

somatropin

86
Q

somatostatin analog, suppresses GH, IGF-1, serotonin and GI peptides; used for acromegaly, pituitary GH-secreting adenoma, carcinoid, gastrinoma, glucagonoma, variceal bleeding

A

octreotide/lanreotide

87
Q

syndrome of ovarian enlargement, ascites, hypovolemia, possible shock

A

ovarian hyperstimulation syndrome

88
Q

FSH analog, used for controlled ovarian hyperstimulation, infertility due to hypogonadism in male

A

follitropin alfa, menotropins (hMG)

89
Q

LH analog, used for ovulation induction and hypogonadotropic hypogonadism

A

choriogonadotropin alfa, hCG, menotropins (hMG), lutropin

90
Q

GnRH analog

A

leuprolide (gonadorelin, goserelin, histrelin, nafarelin, triptorelin)

91
Q

effect of leuprolide

A

increased LH and FSH with intermittent admin; dec with prolonged continuous admin; may temporarily exacerbate precocious puberty or prostate CA

92
Q

GnRH antagonist

A

ganirelix, cetrorelix, abarelix, degarelix

93
Q

does not cause tumor flare-ups when used for tx of advanced prostate CA

A

ganirelix, cetrorelix, abarelix, degarelix (GnRH antagonist)

94
Q

drug against hyperprolactinemia, pituitary adenoma (prolactin-secreting), acromegaly, Parkinson’s which may cause erythromelalgia and Raynaud’s phenomenon

A

bromocriptine (pergolide, cabergoline, quinagolide)

95
Q

may cause fluid retention (water intoxication), placental/uterine rupture

A

oxytocin

96
Q

CI for oxytocin

A

fetal distress, prematurity, CPD, predisposition for uterine rupture

97
Q

increases F VIII activity in patients w/ mild hemophilia A

A

desmopressin

98
Q

used for central DI, vW disease, variceal bleeding, primary nocturnal enuresis

A

desmopressin

99
Q

ADH antagonist used for SIADH, hyponatremia

A

conivaptan, tolvaptan, lixivaptan

100
Q

tyrosine residues are iodinated to form MIT or DIT

A

iodine organification

101
Q

T4

A

levothyroxine

102
Q

T3

A

liothyronine

103
Q

T4 must be lowered in patients with

A

CV disease or longstanding hypothyroidism

104
Q

Tx for myxedema coma

A

IV loading dose of levothyroxine (300-400mcg) followed by 50-100 mcg daily, IV hydrocortisone if w/ adrenal or pituitary insufficiency

105
Q

inhibits thyroid peroxidase

A

thioamides (PTU, methimazole)

106
Q

inhibits thyroid peroxidase and peripheral conversion of T4 and T3, DOC for thyroid storm and pregnant patients; SE: fulminant hepatitis; thrice daily dosing

A

PTU

107
Q

inhibits thyroid peroxidase, can cause cholestatic jaundice and cutis aplasia; once daily dosing

A

methimazole

108
Q

onset of action of thioamides

A

3-4 weeks

109
Q

tx for agranulocytosis

A

d/c PTU/methimazole, administer recombinant G-CSF (Vilgrastine); prophylactic antibiotics

110
Q

emits beta rays causing destruction of thyroid parenchyma; CI

A

radioactive iodine; pregnant and nursing mothers

111
Q

inhibits iodine organification and hormone release; reduces size and vascularity of thyroid

A

potassium iodide/lugol’s solution

112
Q

used as preparation for thyroidectomy or radiation prophylaxis

A

potassium iodide

113
Q

should not be used alone (escape in 2-8 weeks)

A

potassium iodide

114
Q

fetal exposure causes fetal goiter

A

potassium iodide

115
Q

ingestion of iodine causes hypothyroidism due to negative feedback

A

Wolff-Chaikoff effect

116
Q

ingestion of iodine causes hyperthyroidism (e.g. endemic goiter)

A

Jod-Basedow phenomenon

117
Q

utility of beta blockers in thyroid dse

A

inhibits peripheral conversion

118
Q

used to treat thyrotoxicosis-related arrhythmias

A

esmolol

119
Q

causes clinical improvement without altering thyroid hormone levels

A

propranolol

120
Q

inhibit peripheral conversion of T4 to T3

A

PTU, propranolol, hydrocortisone

121
Q

granulocyte count in thyroid storm

A

<500 cells/mm3

122
Q

high dose of methimazole increasing risk for throid storm

A

> 40mf/d

123
Q

done to prevent Jod-Basedow effect

A

administer PTU before SSKI

124
Q

Tx for thyroid storm

A

PTU, SSKI, Propranolol, Hydrocortisone

125
Q

Drugs which cause drug-induced hyperthyroidism

A

Clofibrate, amiodarone, methadone

126
Q

drug which can cause either hyper or hypothyroidism

A

amiodarone

127
Q

difference of 21 and 11 B-hydroxylase deficiency

A

21-hypotension, 11-hypertension (due to accumulation of 11-B deoxycortisol)

128
Q

glucocorticoid with highest anti-inflamm property

A

betamethasone

129
Q

glucocorticoid with highest salt-retaining potency

A

fludrocortisone

130
Q

low potency hydrocortisone

A

desonide (“di sanay”)

131
Q

medium potency hydrocortisone

A

fluticasone, mometasone (fruity moment)

132
Q

high potency hydrocortisone

A

desoximetasone, clobetasol (di saucy kubeta)

133
Q

glucocorticoid used for prevention of organ transplant rejection, beain swelling, post-chemo vomiting, lowering ICP secondary to brain tumors

A

prednisone

134
Q

SE: steroid rage (behavioral changes), osteoporosis, glucose intolerance, growth inhibition

A

prednisone

135
Q

GC which hastens fetal lung maturation

A

betamethasone

136
Q

mineralocorticoid used for chronic adrenal insufficiency, CAH, adrenal replacement post-adrenalectomy; additive hypoK with loop and thiazide diuretics

A

fludrocortisone/deoxycorticosterone

137
Q

corticosteroid antagonist which inhibits desmolase, blocking conversion of cholesterol to pregnenolone, used for breast Ca and Cushing’s

A

aminoglutethimide

138
Q

azole antifungal which can inhibit cholesterol side chain cleavage, preventing steroid synthesis; used for adrenal CA, breast and prostate CA, hirsutism

A

ketoconazole

139
Q

selective inhibitor of 11-hydroxylation used for diagnosis and Tx of Cushing’s

A

metyrapone

140
Q

DOC for pregnants w/.Cushing’s

A

metyrapone

141
Q

ethinyl estradiol use increases risk of ____; prevent by combining w/ ____

A

endometrial CA and breast CA; progestin

142
Q

synthetic estrogen used for atrophic vaginitis, HRT, metastatic prostate CA

A

DES

143
Q

notable SE of progestings

A

HPN, decreased HDL, weigh gain, reversibly dec in bone mineral density

144
Q

type of OCPs with constant dosage throughout menstrual cycle

A

monophasic

145
Q

type of OCPs with change/s in dosage throughout menstrual cycle; mimics hormonal changes in menstrual cycle

A

biphasic/triphasic

146
Q

association of combined OCPs and breast CA

A

lifetime risk will not change, but there is earlier onset

147
Q

IM depot preparation of progestin-only contraceptive

A

medroxyprogesterone acetate (depo-provera)

148
Q

used for emergency contraception

A

levonorgestrel

149
Q

estrogen agonists in some tissues but partial agonists or antagonists in other tissues

A

selective estrogen receptor modulators

150
Q

estrogen antagonist in breast and CNS, agonist in uterus, liver and bone; used in ER+, PR+ breast CA; decreases risk of_____ and ____, increased risk of ______

A

Tamoxifen; osteoporosis and atherosclerosis; endometrial CA

151
Q

estrogen antagonist in breast, uterus and CNS, agonist in liver and bone; used in osteoporosis and breast CA prevention

A

Raloxifene

152
Q

partial agonist of estrogen in pituitary, increases FSH and LH; used for induction of labor; notable SE

A

Clomiphene; ovarian enlargement, multiple pregnancies (CLONE ME PHLEASE), increase risk of low-grade ovarian CA with long term use

153
Q

SERM inhibiting aromatase used for precocious puberty and tamoxifen resistant breast CA

A

anastrozole

154
Q

SERM used for endometriosis, fibrocystic disease (cyclical painful breast mass), hemophilia

A

danazol

155
Q

medical abortifacient which may cause sepsis due to Clostridium sordelli

A

Mifepristone

156
Q

sex hormone-binding globulin is increased by; decreased by

A

estrogen, thyroid hormone, cirrhosis; androgen, growth hormone, obesity

157
Q

site of conversion of testosterone to DHT; enzyme involved

A

prostate, penis scrotum; 5 alpha reductase

158
Q

androgen agonist aside from testosterone; increases muscle bulk and RBC production but can cause paradoxical feminization

A

oxandrolone

159
Q

androgen antagonist; administered with leuprolide to prevent acute flare-up of prostate cancer

A

flutamide

160
Q

androgen antagonist used for surgical castration

A

nilutamide

161
Q

androgen antagonist with progestational effect; orphan drug status

A

cyproterone

162
Q

inhibits 5-alpha reductase, used for BPH, male pattern baldness and hirsutism; controversial use in prevention of prostate CA

A

finasteride/ dutasteride

163
Q

all insulin preparations contain

A

zinc

164
Q

glucose transporter for basal uptake of glucose

A

GLUT 1

165
Q

glucose transporter for transport across blood brain barrier

A

GLUT 1

166
Q

glucose transporter for regulation of insulin release and glucose homeostasis

A

GLUT 2

167
Q

glucose transporter for uptake into neurons

A

GLUT 3

168
Q

glucose transporter for insulin mediated uptake of glucose

A

GLUT 4

169
Q

transporter for absorption of fructose

A

GLUT 5

170
Q

glucose transporter found in all tissues

A

GLUT 1

171
Q

rapid acting insulin

A

lispro, aspart, glulisine

172
Q

short acting insulin

A

regular

173
Q

intermediate acting insulin

A

NPH, lente

174
Q

ultra long acting insulin

A

glargine, detemir, lantus

175
Q

MEN 1

A

Wermer syndrome; parathyroid adenoma/hyperplasia, pancreatic tumor, pituitary tumor

176
Q

MEN 2A

A

Sipple syndrome; pheochromocytoma, parathyroid hyperplasia, medullary thyroid CA

177
Q

MEN 2B

A

pheochromocytoma, neuroma/ganglioma, medullary thyroid CA

178
Q

long acting insulin

A

ultralente

179
Q

group of drugs which can block signs and symptoms of hypoglycemia

A

B-blockers

180
Q

counter-regulatory hormones of insulin

A

GH, cortisol, glucagon, epinephrine

181
Q

tx for somogyi effect

A

decrease evening dose of insulin

182
Q

tx for dawn phenomenon

A

increase evening dose of insulin

183
Q

tx for waning of insulin dose

A

increase evening dose of insulin

184
Q

period in type 1 DM when exogenous insulin reqts decrease due to an increase in endogenous production of insulin

A

honeymoon period

185
Q

depolarizes pancreatic B cell and triggers insulin release

A

insulin secretagogue

186
Q

insulin secretagogue; 1st gen sulfonylurea, causes disulfiram reaction, weight gain, highest risk for hypoglycemia

A

chlorpropramide, tolbutamide, tolazamide

187
Q

insulin secretagogue; 2nd gen sulfonylurea, causes less hypoglycemia than 1st gen, cholestatic jaundice

A

glipizide, glimepiride, glibenclamide (risk for cholestatic jaundice), gliclazide

188
Q

insulin secretagogue; effective for postprandial hyperglycemia, least hypoglycemic among secretagogues, can cause URTI, used in diabetics with sulfa allergies

A

repaglinide, nateglinide, mitiglinide

189
Q

insulin secretagogue; least hypoglycemic, may be used in CKD patients

A

nateglinide

190
Q

activates AMP-stimulated protein kinase leading to inhibition of hepatic and renal gluconeogenesis; associated with lactic acidosis; DOC for obese diabetics and DM prevention among high risk

A

metformin

191
Q

increases tissue sensitivity to insulin by activating PPAR-y receptor; also for DM prevention; can cause fluid retention, CHF, hepatotoxicity, macular edema, dyslipidemia; CI in pregnant and CHF pts

A

pioglitazone (thiazolinediones)-pampaPOGI ng insulin

192
Q

slows down glucose absorption causing reduction in postprandial hyperglycemia (not fasting); causes GI disturbance(flatulence), minor glucose-lowering defect

A

alpha glucosidase inhibitors (e.g. acarbose, miglitol, voglibose)

193
Q

amylin analog which suppresses glucagon release, delays gastric emptying, reduces appetite (anorectic effect)

A

pramlintide

194
Q

activates GLP-1 receptors to augment glucose-stimulated insulin release

A

exenatide (incretin modulator)

195
Q

inhibits dipeptyl peptidase-4, degrading GLP-1 and other incretins

A

sitagliptin

196
Q

antiobesity drug inhibiting GI and pancreatic lipases; causes rebound weight gain upon discontinuation; CI in pregnancy

A

Orlistat

197
Q

antiobesity drug inhibiting NE and serotonin reuptake, reduces appetite (anorectic effect); withdrawn due to increased CV risk

A

sibutramine

198
Q

antiobesity drug inhibiting cannabinoid-1 receptors, reduces appetite (anorectic effect); withdrawn due to increased suicidal risk

A

rimonabant

199
Q

bangkok pills; increased risk for ____

A

ephedrine, fenfluramine, phentermine; valvular heart dse

200
Q

increases heart rate and force of contraction hence useful for B-blocker overdose

A

glucagon

201
Q

present w/ decreased aa in blood, anemia, diarrhea, weight loss and necrolytic migratory erythema

A

glucagonoma

202
Q

recombinant PTH used for osteoporosis; must be administered in _______ to stimulate bone formation

A

teriparatide; low intermittent dosing

203
Q

used for rickets and osteomalacia commonly added to dairy products

A

ergocalciferol/ cholecalciferol

204
Q

indication for active vitamin D (calcitriol)

A

secondary hyper PTH in CKD, hypocalcemia in hypoparathyroidism, psoriasis, liver dse

205
Q

inhibits bone resorption, used in Paget’s dse of bone, hypercalcemia, osteoporosis, tumor marker for medullary thyroid CA

A

calcitonin/ salcatonin

206
Q

suppresses activity of osteoclasts, used in Paget’s dse of bone, hypercalcemia, osteoporosis, causes esophagitis (100%) so take with large quantities of water

A

alendronate, pamidronate, zoledronic acid

207
Q

phosphate binding resin used to treat hyperphosphatemia in CKD, vit D intoxication and hypoparathyroidism

A

sevelamer

Pharmacology (7 decks)

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