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BB EOYS12 Flashcards

1
Q

A 45-year-old man is admitted to the intensive care unit following a head injury. His history is significant for alcohol use disorder and 5 mg of diazepam is administered intravenously every 2 hours as ordered. After administering a dose, you observe the patient’s respiratory rate change from 20 breaths/min to 6 breaths/min. Which drug should be readily available to treat this complication?

A. Fentanyl
B. Fluorouracil
C. Naloxone
D. Flumazenil

A

A 45-year-old man is admitted to the intensive care unit following a head injury. His history is significant for alcohol use disorder and 5 mg of diazepam is administered intravenously every 2 hours as ordered. After administering a dose, you observe the patient’s respiratory rate change from 20 breaths/min to 6 breaths/min. Which drug should be readily available to treat this complication?

A. Fentanyl
B. Fluorouracil
C. Naloxone
D. Flumazenil

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2
Q

Phenelzine belongs to which drug class

SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)

A

Phenelzine belongs to which drug class

MOAI (irreversible)

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3
Q

Tranylcypromine belongs to which drug class

SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)

A

Tranylcypromine belongs to which drug class

SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)

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4
Q

Eating a food like cheese contains tyramine, which inhibits which of the following

Phenelzine

A
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5
Q

Which of the following are antagonists to alpha 1 adrenoreceptors and create side effects like postural hypotension

SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)

A

Which of the following are antagonists to alpha 1 adrenoreceptors and create side effects like postural hypotension

SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)

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6
Q

Moclobemide belongs to which drug class?

SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)

A

Moclobemide belongs to which drug class?

SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)

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7
Q

Describe the mechanism of action of agomelatin

Binds to MT1 and MT2 receptors only
Binds to MT1 and MT2 receptors; 5HT agonist
Binds to MT1 and MT2 receptors; 5HT antagonist
5HT agonist
5HT antagonist

A

Describe the mechanism of action of agomelatin

Binds to MT1 and MT2 receptors only
Binds to MT1 and MT2 receptors; 5HT agonist
Binds to MT1 and MT2 receptors; 5HT antagonist
5HT agonist
5HT antagonist

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8
Q

Which combination of food and drug can result in an idiosyncratic reaction leading to hypertensive crises?

A. Ergotamine and cheese
B. Selegiline and beer
C. Phenelzine and red wine
D. Tranylcypromine and caffeine

A

Which combination of food and drug can result in an idiosyncratic reaction leading to hypertensive crises?

A. Ergotamine and cheese
B. Selegiline and beer
C. Phenelzine and red wine
D. Tranylcypromine and caffeine

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9
Q

Reboxetine is a drug used to treat depression that has the mechanism of action of which of the below?

noradrenaline reuptake inhibitor (NARI)
serotonergic reuptake inhibirot (SARI)
noradrenergic and specific serotonergic antidepressant (NaSSA)

A

noradrenaline reuptake inhibitor (NARI)

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10
Q

Which of the following binds to Monoamine oxidase A to cause inhibition?

Tranylcypromine
Moclobemide
Phenelzine
Selegiline

A

Which of the following binds to Monoamine oxidase A to cause inhibition?

Tranylcypromine
Moclobemide - reversible inhibitor; others all bind to MOA-B
Phenelzine
Selegiline

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11
Q

GI side effects are most common to which drug class

SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)

A

SSRI

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12
Q

Which drugs would you prescribe for treatment resistant:

  • Schizophrenia [1]
  • Depression [1]
A

Schizophrenia: Clozapine
Depression: Esketamine

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13
Q

Weight gain due to TCA use is due to antagonist effect at which receptor?

Alpha 1 adrenoreceptors
Alpha 2 adrenoreceptors
Muscarinic receptors
H1 receptors

A

Weight gain due to TCA use is due to antagonist effect at which receptor?

Alpha 1 adrenoreceptors
Alpha 2 adrenoreceptors
Muscarinic receptors
H1 receptors

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14
Q

Haloperidol is a typical anti-pyschotic used in SCH. Name one more [1]

A

chlorpromazine, thioridazine,
fluphenazine, , flupenthixol

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15
Q

Which of the following causes an increase in photosensitivity?

thioridazine
flupenthixol
chlorpromazine
fluphenazine
haloperidol

A

thioridazine
flupenthixol
chlorpromazine
fluphenazine
haloperidol

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16
Q

Olanzapine is a atypical antipsychotic. State which disease that prescribing this drug can cause [1]

A

Diabetes ( & metabolic syndrome)

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17
Q
A
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18
Q

Which is most toxic in an overdose?

SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)

A

Which is most toxic in an overdose?

SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)

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19
Q

Describe the MoA of TCAs [2]

A
  • Inhibit reuptake of amines on the presynaptic terminal, so 5HT or NA cannot be taken back into neuron
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20
Q

Important AEs of TCAs? [4]

A
  • Dangerous (cardiotoxic) in overdose
  • Anti-cholinergic: dry mouth; blurred vision, constipation, urinary retention, aggravation of narrow angle glaucoma, fatigue, postural hypotension, dizziness, loss of libido, arrhythmias
  • Antihistaminic: sedation, weight gain.
  • Block alpha 1 adrenoreceptors: orthostatic hypotension - blood pressure drops on standing, cardiac effects

As a result aren’t the first choice!

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21
Q

Phenelzine, tranylcypromine belong to which drug class? [1]

A

Irreversible MONOAMINE OXIDASE INHIBITORS

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22
Q

Describe the MoA of monoamine oxidase inhibitors such Phenelzine, tranylcypromine [1]

Which type of food interact with MOIs? [1]

A

Irreversible inhibition of the enzyme monoamine oxidase [1]

Interactions with tyramine-containing food (mature cheese, pickled fish and meat, red wine, beer, broad bean pods, yeast extract)- restrictions continue at least 2 weeks after discontinuation

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23
Q

Moclobemide belongs to which drug class? [1]

A

REVERSIBLE MONOAMINE OXIDASE INHIBITOR

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24
Q

Describe MoA of Agomelatine [2]

Why is this potentially a really good drug? [2]

A

MoA:
* Agonist at melatonin MT1 & MT2 receptors: important for sleep control
* Antagonist of 5-HT2 receptors

Benefits of Agomelatine:
* improves sleep quality
* less sexual dysfunction than SSRIs;
* anxiolytic effects
* no ‘discontinuation syndrome’

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25
Apart from inhibiting the reuptake of amines, which other receptors do TCAs bind to? [3] Why is this problematic? [1]
Bind to: * H1 receptors * muscarinic receptors * α1 and α2 adrenoceptors Causes wide ranging side effects
26
What is the benefit of using SSRIs (citalopram, fluoxetine, paroxetine) with regards to AEs [3]
No anticholinergic activity No cardiotoxic effects Safe in overdose
27
AEs of SSRIs?
· Nausea vomiting · Dry mouth · Headache · Asthenia · Dizziness · Anorexia · Weight loss · Nervousness · Tremor · Convulsions · Sexual dysfunction
28
What are the different targets for reverible MAOIs compared to irreversible MOAIs? [2] Describe the benefits of reversible MAOIs compared to irreversible MAOs [2]
Drug targets: * Reversible MAOI targets: **MOA-A** * Irreversible MAOI targets: **MAOA & MAOB** Differences: * Reversible is **safer** than irreversible MAOIs * **Can switch drug classes quicker**
29
# Depression drugs Name a noradrenaline reuptake inhibitor used for depression treatment [1]
Reboxetine
30
# Depression Drugs Name a serotonergic antagonist and reuptake inhibito (SARI) [1]
**Trazodone**
31
# Depression drugs Name a noradrenergic and specific serotonergic antidepressant (NaSSA) [1]
Mirtazapine
32
Explain why there is a delayed action for anti-depressant drug action for TCAs [4]
The immediate increase in synaptic concentration of amines may lead to activation of **somatic neuronal autoreceptors** The activated autoreceptors **decrease firing of the neurones** During the first weeks of treatment the **autoreceptors desensitize** The neurones will **return** **subsequently** to the **normal** firing rate The **inhibition** of **reuptake** continues and the **level of amines continues to be high**, resulting in full efficacy
33
Name two risks of using antidepressant drugs used in bipolar disorder to treat periods of depression? [2]
can **precipitate manic episodes** or mixed affective states **induce an increased frequency** in **mood change cycles**
34
Name 4 non-pharmacological approaches for mood disorders
**Electroconvulsive therapy** (treatment-refractory severe depression with suicide risk) **Cognitive behavioural therapy** (CBT) (can augment the effects of pharmacological treatment) **Vagal nerve stimulation** (especially in chronic depression) **Deep brain stimulation (DBS);** subcallosal cingulate white matter – Brodmann area 25)
35
Which area is the DBS target for treating depression? [1] What the is the Broadmann area? 21 22 23 24 25
Which area is the DBS target for treating depression: **subgenual cingulate cortex** What the is the Broadmann area? 21 22 23 24 **25**
36
Name two new therapeutic developments for depression [2] What types of depression do they speficifically treat? [2] What are their MoAs? [2]
**Esketamine**: * NMDA glutamate receptor antagonist * **treatment-resistant depression** **Brexanolone**: * **progesterone**-related compound, **positive modulator of GABAA receptors** * approved for **post-partum depression**
37
Most common AE of SSRI? [1]
**gastrointestinal symptoms** are the most common side-effect:
38
30% schizophrenic patients do not respond to treatment. Which drug would you provied for those who have drug resistance? [1]
**Clozapine**
39
The drugs used to treat schizophrenia are [] receptor [antagonists / agonists] [2] They can be divided into typical and atypical drug treatments; what are the difference between them?
The drugs used to treat schizophrenia are **D2 (dopamine) receptor antagonists** **Typical**:’ are older and cause generalised dopamine receptor blockade. **Atypical**: are more **selective** in their dopamine blockade and also block **serotonin 5-HT2A receptors**.
40
Atypical antipsychotic drugs target which receptor/s D1 receptors D2 receptors D1 & D2 receptors D1 & 5-HT2 receptors D2 & 5-HT2 receptors
Atypical antipsychotic drugs target which receptor/s D1 receptors D2 receptors D1 & D2 receptors D1 & 5-HT2 receptors **D2 & 5-HT2 receptors**
41
Clozapine blocks [] receptors with high affinity Aripiprazole is a partial [] at presynaptic D2 receptors but an [] at D2 postsynaptic receptors
**Clozapine** blocks **D4** receptors with high affinity **Aripiprazole** is a partial **agonist** at **presynaptic** **D2** receptors but an **antagonist** at **D2 postsynaptic receptors**
42
Atypical anti-psychotics target which receptors? [2]
Antagonists at: * D2 receptors * 5-HT2A receptors
43
Name 3 extrapyramidal effects that occur due to antipsychotic drugs. [3] Why do these occur? [1]
Extrapyramidal effects (EPS): * **acute dystonias** * **parkinsonism** * **tardive dyskinesia** Approx. **60% D2 receptor occupancy** required for **antipsychotic** efficacy; if **>80% D2 receptors are blocked**, then potential for **EPS**
44
Which anti-psychotics can be adminstered by IM injections? [2]
**fluphenazine** decanoate **haloperidol** decanoate
45
Explain what tardive dyskinesia is and the length of the AE [2]
Involuntary movements of the lips, jaw, face; grimacing, constant chewing, tongue thrusting; rapid involuntary limb movements typical antipsychotics, taken for longer than a few months/years In some patients it may be possible to overcome it
46
Describe what neuroleptic malignant syndrome is a combination of [6]
Due to typical anti-psychotics hyperpyrexia muscle rigidity tremor confusion autonomic instability
47
The cingulate gyrus and parrahippocampal gyrus are continuous via a bundle of white matter called the []
The cingulate gyrus and parrahippocampal gyrus are continuous via a bundle of white matter called the **cingulum**
48
Label A-E
A: **cingulate gyrus** B: **corpus callosum** C: **fornix** D: **parahippocampal gyrus** E: **subcallosal area**
49
Label A-F
A: **Fornix** B: **Cingulate cortex** C: **Thalamus** D: **Mamilllary body** E: **Hippocampus** F: **Amygdala**
50
Label A-C
A: **Anterior commissure** B: **Amygdala** C: **Hippocampal**
51
Label 14-17
14 Pulvinar of thalamus 15 Mamillary body 16 Optic tract 17 Anterior commissure
52
Label 18-22
18 **Fornix** 19 Longitudinal stria 20 **Dentate gyrus** 21 **Hippocampal** fimbria 22 Pes **hippocampi**
53
What are primary reinforcers?
Gene specified goals for action (for rewarding or punishment) A Primary Reinforcer is a stimulus that is biologically important to an organism, such as food, water, sleep, shelter, safety, pleasure, and sex
54
What is the role of the insula? [1]
Recieves data from cortex and amygdala. Has to make exec **decision** on whether the experience was **worth remembering.**
55
What is this structure? [1]
Nucleus accumbens
56
State the main function of the: Hippocampus [1] Parahippocampal gyrus [1] Amygdala: [1] Septal nucleus [1] Cingulate cortex [1]
**Hippocampus** = Memory acquisition and recall, formation of long-term memory. **Formation of memory** not storage **Parahippocampal gyrus**: storage and conversion of new experiences into memories **Amygdala** = Emotional content of stimuli: fear, anxiety and danger **Septal nucleus** = Pleasure and reward **Cingulate cortex** = Affective significance
57
Describe the route of Papez's circuit
Cingulate cortex --> parahippocampal cortex --> hippocampus --> fornix --> mamillary bodies --> hypothalamus -> anterior thalamus --> cingulate cortex.
58
Name the extremely fast response to an unexpected loud noise in babeies? [1]
**Acoustic startle reflex / Moro reflex**
59
What is the difference in role between anterior and posterior cingulate cortex? [1]
**Anterior cingulate cortex:** * monitors quality of pain continously; activates strategies to remove pain * Evaluates the degree of pain / ppleasure experienced **Posterior cingulate cortex:** * Recalling **emotional memories** - NOT involved in non-emotional memories
60
Describe the pathway in which amygdala controls the startle reflex [4]
Sensory information feeds into the **basolateral amygdala** Feeds into the **central amygdala** Central amygdala sends **output to the central gray area** of the midbrain Information is relayed to the **nucleus** in the **pons** responsible **for the startle reflex**
61
What is 8? Corpus Callosum Hippocampus Subthalamic nuclei Nucleus accumbens Putamen
What is 8? Corpus Callosum Hippocampus Subthalamic nuclei **Nucleus accumbens** Putamen
62
What is 8? Anterior commissure Fornix Lateral ventricle Putamen Nucleus accumbens
What is 8? Anterior commissure **Fornix** Lateral ventricle Putamen Nucleus accumbens
63
What is 5? Hypothalamus Fornix Amygdala Hippocampus Thalamus
What is 5? Hypothalamus Fornix Amygdala **Hippocampus** Thalamus
64
What is 13? Hypothalamus Fornix Amygdala Hippocampus Thalamus
What is 5? Hypothalamus Fornix **Amygdala** Hippocampus Thalamus
65
What is 3? Hypothalamus Fornix Amygdala Hippocampus Thalamus
What is 3? **Hypothalamus** (mamilliary body) Fornix Amygdala Hippocampus Thalamus
66
What is 10? Hypothalamus Fornix Amygdala Hippocampus Thalamus
What is 10? Hypothalamus **Fornix** Amygdala Hippocampus Thalamus
67
Label A-D
A:Cingulate cortex nuclei B: Anterior thalamic C:Mammillary bodies D: hippocampus

Yr 2 EOYS (58 decks)

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