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P&T > CNS review > Flashcards

CNS review Flashcards

1
Q

3 1st generation AEDs that are enzyme inducers

A

Phenytoin, Phenobarbital and Carbamazepine

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2
Q

MOA of oxcarbazepine

A

Stabilizes inactivated Na channels

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3
Q

The major inhibitory transmitter in the brain

A

GABA

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4
Q

Treatment options for status epilepticcus `

A

IV benzodiazepine, phenytoin or phenobarbital

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5
Q

The major excitatory neurotransmitter in the brain

A

Glutamate

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6
Q

What is special about the metabolism of phenytoin

A

saturable metabolism

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7
Q

What is special about the metabolism of carbamazepine

A

autoinduction

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8
Q

Type of receptor that GABA-A receptor is

A

inotropic Cl channel

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9
Q

Major toxicities of phenytoin

A

nystagmus, ataxia, gingival hyperplasia, osteomalacia

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10
Q

Amount of oxcarbazepine that can induce OC metabolism

A

> 1200 mg/day

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11
Q

Toxicities of oxcarbazepine

A

dizziness, diplopia, ataxia, hyponatremia

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12
Q

toxicity with lacosamide

A

diplopia, HA, dizziness, nausea

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13
Q

The most studied AED in pregnancy

A

Lamotrigine

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14
Q

MOA of carbamazepine

A

Stabilizes inactivated Na Channels

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15
Q

AED that was recently moved to pregnancy category D due to risk of low birth weights

A

topiramate

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16
Q

Amount of topiramate that induces OC metabolism

A

> 200 mg/day

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17
Q

Toxicities with lamotrigine

A

sedation, diplopia, ataxia, nausea, rash

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18
Q

Toxicities associated with topiramate

A

difficulty concentrating, kidney stones, weight loss

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19
Q

MOA of zonisamide

A

Stabilizes inactivated Na channels and acts on Ca channels

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20
Q

Toxicities associated with zonisamide

A

somnolence, dizziness, kidney stones, weight lossq

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21
Q

MOA of rufinamide

A

Stabilizes inactivated Na channels

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22
Q

MOA of phenobarbital

A

GABA-A agonist

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23
Q

Toxicities with phenobarbital

A

sedation, paradoxical hyperactivity, osteomalacia

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24
Q

Seizure that involves brief episodes of staring, unable to respond

A

absence/ patit mal

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25
Q

Black box warning for vigabatrin

A

irreversible visual field loss

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26
Q

MOA of vigabatrin

A

Irreversible inhibitor of GABA transaminase

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27
Q

SSRI that has potential for QTc prolongation

A

Citalipram

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28
Q

MOA of ethosuximide

A

Inhibits T-type Ca channels

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29
Q

Drug of choice for absence seizures

A

ethosuximide

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30
Q

MOA of tiagabine

A

decreases GABA reuptake into neurons and glial cells

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31
Q

MOA of valproic acid

A

Inhibits T-type Ca channels, weak effect of Na channels and increases GABA activity

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32
Q

1st generation AED that is an enzyme inhibitor

A

valproic acid

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33
Q

Type of receptor that GABA-B is

A

metaboltropic

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34
Q

Toxicities associated with gabapentin

A

fatigue, ataxia, dizziness

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35
Q

Major toxicities of carbamazepine

A

diplopia, dizziness, leukopenia, osteomalacia

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36
Q

MOA of pregabalin

A

Binds to alpha2-delta site of Ca channels

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37
Q

Toxicities associated with pregabalin

A

dizziness, ataxia, weight gain

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38
Q

MOA of levetiracitam

A

Binds to synaptic vesicle protein (SV2A)

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39
Q

Toxicities associated with ezogabine

A

dizziness, fatigue, diplopia, ataxia, urinary retention

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40
Q

What is notable about gabapentins metabolism

A

saturable absorption

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41
Q

QIDS score that indicates very severe depression

A

> 20

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42
Q

MOA of ezogabine

A

potassium channel stabilizer

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43
Q

MOA of phenytoin

A

Stabilizes inactivated Na channels

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44
Q

MOA of perampanel

A

noncompetitive AMPA receptor antagonist

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45
Q

Black box warning with parampanel

A

suicidality and homocidality

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46
Q

MOA of topiramate

A

Stabilizes inactivated Na channels, GABA agonist and glutamate antagoinist

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47
Q

SSRI that is pregnancy category D

A

Paroxetine

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48
Q

Black box warning with ezogabine

A

bluish discoloration of the skin and ocular toxicity

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49
Q

QIDS score that indicates severe depression

A

16-20

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50
Q

Issue with felbamate that limits its use

A

hepatotoxicity

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51
Q

Seizure in 1 hemisphere in which consciousness is not impaired

A

Simple partial seizure

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52
Q

MOA of ketamine

A

NMDA antagonist

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53
Q

QIDS score that indicates mild depression

A

6-10

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54
Q

SSRI that has the highest rate of diarrhea

A

Sertraline

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55
Q

Location where norepinephrine is synthesized

A

locus ceruleus

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56
Q

Presynaptic NE autoreceptor that is important in feedback inhibition

A

Alpha2

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57
Q

The hormonal influence on seizures in women who are menstrating

A

Catamenial influence

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58
Q

Seizure in 1 hemisphere in which consciousness and memory are impaired

A

Complex partial seizure

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58
Q

Precursor for NE

A

Tyrosine

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59
Q

Precursor for serotonin

A

tryptophan

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60
Q

Length of an untreated major depressive episode

A

> 6 months

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61
Q

Length of a typical treated major depressive episode

A

4-5 months

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62
Q

toxicities associated with valproic acid

A

weight gain, hair loss, tremor, thrombocytopenia

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63
Q

QIDS16 score that indicates remission

A
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64
Q

A diminished interest in activities

A

anhedonia

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65
Q

2nd line antidepressant pharmacotherapy options

A

TCAs, trazadone, nefazadone

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66
Q

QIDS score that indicates normal

A

0-5

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67
Q

QIDS score that indicates moderate depression

A

11-15

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68
Q

QIDS16 score that indicates a response

A

6-8

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69
Q

Return of symptoms meeting full criteria within 6-12 months of full and sustained remission from the index episode

A

Relapse

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70
Q

1st line options for antidepressant pharmacotherapy

A

SSRIs, SNRIs, buproprion, mirtazepine

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71
Q

Occurrence of a new episode following 6-12 months of full and sustained remission from the index episode

A

Reoccurance

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72
Q

3rd line antidepressant pharmacotherapy options

A

MAOIs

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73
Q

MOA of lacosamide

A

Stabilized inactivated Na channels

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74
Q

MOA of lamotrigine

A

Stabilizes inactivated Na channels and decreases glutamate release

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75
Q

SSRI with highest rate of sexual dysfunction

A

Paroxetine

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76
Q

Toxicities associated with levetiracitam

A

somnolence, dizziness, behavioral changes

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77
Q

5 most common residual symptoms of depression

A

insomnia, fatigue, pain, difficulty concentrating, lack of interest

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78
Q

MOA of Gabapentin

A

Binds to alpha2-delta site of Ca channels, decreasing neurotransmitter release

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79
Q

4 most common triggers of seizures

A

lack of sleep, stress, acute infections, missed medications

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80
Q

MOA of vilazodone

A

SSRI and partial 5HT1A receptor agonist

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81
Q

MOA of trazadone

A

weak SSRI and 5HT2A and 5HR2C antagonist

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82
Q

Black box warning for nefazodone

A

rare hepatic failure

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83
Q

Non-selective serotonin antagonist that is used to treat serotonin syndrome

A

Cyproheptidine

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84
Q

MOA of buproprion

A

Inhibits DA and NE reuptake

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85
Q

MOA of mirtazapine

A

alpha2-adrenergic antagonist, 5HT2A and 5HT3 antagonist and H1 antagonist

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86
Q

5 tertiary amine TCAs

A

amitriptyline, trimipramine, imipramine, clomipramine, doxepin

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87
Q

3 secondary amine TCAs

A

desipramine, nortriptyline, protriptyline

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88
Q

5 patient populations to use caution when using TCAs

A
  1. underlying CV disease (QT prolongation)
  2. seizures
  3. glaucoma
  4. urinary retention
  5. elderly
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89
Q

3 major groups of SEs with TCAs (tertiary > secondary amines)

A
  1. anticholinergic SEs
  2. orthostatic hypotension
  3. sedation
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90
Q

Antagonist of what receptor leads to orthostatic hypotension

A

alpha adrenergic receptor

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91
Q

3 non-selective MAO-A and MAO-B irreversible inhibitors

A

phenelzine,, tranylcypromine, isocarboxazid

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92
Q

A selective MAO-A irreversible inhibitor

A

Selegiline

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93
Q

Dietary restriction associated with MAO-Is

A

tyramine containing foods

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94
Q

Drug used to treat hypertensive crisis created by food or drug interactions with MAO-Is

A

phentolamine

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95
Q

4 major groups of SEs associated with MAO-Is

A
  1. orthostatic hypotension
  2. CNS stimulation (anxiety, insomnia)
  3. weight gain
  4. sexual dysfunction
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96
Q

Wash out period needed when switching from MAO-I to another antidepressant or vice versa

A

2 weeks

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97
Q

Length of time to see effect in GAD

A

2-4 weeks until effect, 4-6 weeks until max effect

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98
Q

Wash out period needed when switching between fluoxitine and another antidepressant

A

5 weeks

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99
Q

A transcription factor, whose levels are increased by antidepressants that leads to an increase in the neuronal growth factor BDNF

A

CREB

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100
Q

Area of the brain that processes threatening or taumatic stimuli

A

Hippocamous

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101
Q

1st line pharmacologic treatments in anxiety disorder

A

SSRIs and SNRIs

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102
Q

MOA of buspirone

A

5HT1A receptor partial agonist

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103
Q

Difference in dose of SRIs between treatment of depression and anxiety

A

use 1/2 the starting dose in anxiety

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104
Q

GABA-A receptor subunits that are required for BZD binding

A

alpha and beta

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105
Q

GABA-A receptor subunits that are required for GABA binding

A

alpha and gamma

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106
Q

3 preferred BZDs in liver disease

A

Lorazepam, oxazaepam and temazepam

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107
Q

Length of time of excessive anxiety/worry to qualify as generalized anxiety disorder

A

> 6 months

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108
Q

GAD-7 Score that qualifies as mild GAD

A

5-9

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109
Q

GAD-7 score that qualifies as moderate GAD

A

10-14

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110
Q

Transtheoretical model for change phase that a patient is i when they are ready to quit within the next 30 days

A

Preparation

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110
Q

Transtheoretical model for change phase that a patient is i when they are ready to quit within the next 30 days

A

Preparation

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111
Q

GAD-7 score that qualifies as severe GAD

A

> 15

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112
Q

Minimum length of treatment for GAD

A

12 months

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113
Q

Length of time of persistent worry about another panic attack to qualift as panic disorder

A

1 month

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114
Q

SSRI that is 2nd line for panic disorder

A

citalipram

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115
Q

Treatments that are NOT effective for panic disorder

A

propanolol, buspirone, antihistamines, antipsychotis

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116
Q

Time it takes to see max effect during treatment of manic disorder

A

6-12 weeks

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117
Q

Length of treatment for panic disorder

A

12-24 months

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118
Q

Length of fear of social situation to qualify as social anxiety disorder

A

> 6 months

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119
Q

Treatment options for performance only SAD

A

propranolol, atenolol

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120
Q

Treatments that are not effective for general SAD

A

TCAs, buspirone monotherapy, atenolol

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121
Q

Length of medication trial in SAD

A

8-12 weeks

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122
Q

Length of treatment for SAD

A

usually long-term

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123
Q

Therapies that are not effective in PTSD

A

buspirone, buproprion, desimpramine

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124
Q

Time until treatment effect is seen in PTSD

A

8-12 weeks

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125
Q

Length of therapy in PTSD

A

Minimum 12 months after response

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126
Q

1st line options for OCD

A

SSRIs, clmipramine

127
Q

Length of delay in treatment effect in OCD

A

10-12 weeks

128
Q

Length of treatment for OCD

A

1-2 years, usually lifelong

129
Q

3 best options for treating anxiety in pregnancy

A

citalopram, fluoxetine, sertraline

130
Q

BZD to use if absolutely necessary in pregnancy

A

clonazepam and lorezapam

131
Q

Timing of bright light therapy for advanced sleep phase sleeping disorder

A

PM

132
Q

Timing of bright light therapy for advanced sleep phase sleeping disorder

A

PM

134
Q

Transthoretical model for change that a patient is in when they are thinking about quitting in the next 6 months

A

Contemplation

135
Q

BZD antagonist that can reverse effects in overdose

A

flumazenil

136
Q

SSRI that has been shown to be safetly used post-MI

A

Sertraline

137
Q

GABA receptor subtype that Z-hypnotics preferentially bind to that creates sedative effects but no anxiolytic effects

A

Alpha-1

138
Q

Area of the hypothalamus that controls circadian rhythm

A

suprahiasmatic nucleus

139
Q

Where melatonin is synthesized

A

pineal gland

140
Q

AA precursor of melatonin

A

tryptophan

141
Q

MOA of ramelteon

A

M1 and M2 melatonin receptor agonist

142
Q

Timing of melatonin therapy in advanced sleep phase disorder

A

dawn

143
Q

Transtheoretical model of change stage that a patient is in when they are not yet ready to quit

A

Pre-contemplation

144
Q

Location of the hypothalamus where histamine is produced

A

tuberomemmillary nucleus

145
Q

Transthoretical model for change that a patient is in when they are thinking about quitting in the next 6 months

A

Contemplation

146
Q

Inhibitory dopamine receptors

A

Type2 (D2, D3 and D4)

147
Q

Hoehn and Yahr Parkinson’s stage when motor dysfunction is bilateral with postural abnormalities

A

Stage IV

148
Q

BZD antagonist that can reverse effects in overdose

A

flumazenil

149
Q

TCA that is FDA approved for insomnia characterized by sleep maintenance issues

A

doxepin (silenor)

150
Q

MOA of suvorexant

A

Orexin receptor (OX1 and OX2) antagonist

151
Q

Transtheoretical model for change that patients are in when they are 6 or more months after their quit date and are now considered a former user

A

Maintenance

152
Q

Peptide neurotransmitters implicated in wakefulness that are lost in patients with narcolepsy

A

Orexins A and B

153
Q

FDA approved medications for sleep onset

A

BZDs
Z-hypnotics
Remelteon

154
Q

Max trial of antidepressants that should be tried with no response

A

9 weeks

155
Q

FDA approved medications for sleep maintenance

A

BZDs
Z-hypnotics
Silenor

156
Q

3 sleep medications/classes that should not be taken with high fat meals due to decreased absorption

A

z-hypnotics
ramelteon
silenor

156
Q

The best established pathway for reinforcement

A

dopaminergic projection from the ventral tagmental are (VTA) to the nucleus accumbens

157
Q

Preferred class of sleep drugs in the elderly

A

Z-hypnotics

160
Q

MOA of tolcapone

A

COMT inhibitor in the periphery and CNS

161
Q

Transtheoretical model of change phase that patients are in when they are actively trying to quit and are still within 6 months of their quit date

A

Action

162
Q

GABA receptor subtype that Z-hypnotics preferentially bind to that creates sedative effects but no anxiolytic effects

A

Alpha-1

163
Q

5 A’s for clinicians when dealing with substance abuse

A 
Ask
Advise
Assess
Assist
Arrange
164
Q

1st line therapy for alcohol withdraw

A

BZDs

165
Q

4 vitamins given to patients with alcohol withdraw

A

Thiamine (B1)
Folic Acid
Phosphate
Magnesium

166
Q

The only 2 treatments that were found to be effective for alcohol dependance

A

Acamprosate

Naltrexone

167
Q

MOA of disulfiram in treatment of alcohol dependance

A

increases acetyl aldehyde, creating a terrible rxn when patients drink

168
Q

Hoehn and Yahr Parkinson’s stage when motor dysfunction is bilateral but there are no postural abnormalities

A

Stage II

169
Q

Initial symptoms that anticholinergics help to treat in Parkinson’s disease

A

tremor and rigidity

170
Q

Hoehn and Yahr Parkinson’s stage when the disease is fully developed and the patient is bed or chair bound

A

Stage V

171
Q

Treatment for the physical symptoms of cocaine intoxicatoin

A

phentoamine

172
Q

Ferritin level that worents ferrous sulfate supplementation in RLS

A
173
Q

1st line sleep therapy in children

A

Non-drug therapy

174
Q

MAO of pramiprexole

A

D2 and D3 agonist

175
Q

Area of the brain in which DA is too high, creating the positive symptoms in schizophrenia

A

mesolimbic pathway

176
Q

MOA of naltrexone

A

opioid receptor antagonist

177
Q

Timing of bright light therapy in delayed sleep phase type sleep disorder

A

30-60 min in the AM

178
Q

MOA of phentolamine

A

alpha-1 blocker

179
Q

1st line treatment for Parkinson’s disease for a patient

A

Amantadine and MAO-B-Is

180
Q

MOA of naloxone

A

mu-receptor antagonist

181
Q

Hoehn and Yahr Parkinson’s stage when motor dysfunction is unilateral

A

Stage I

182
Q

MOA of carbidopa

A

peripheral dopa decarboxylase inhibitor

183
Q

Location in the brain where dopamine is synthesized

A

substantia nigra

184
Q

MOA of entacapone

A

COMT inhibitor in the periphery

185
Q

High potency FGAs

A

Trifluoperazine, Fluphenazine, Haloperidol

186
Q

2 anticholinergic medications that can be used to treat Parkinson’s disease

A

trihexyphenidyl

benztropine

187
Q

2 MAO-B inhibitors used to treat Parkinson’s disease

A

Selegilline

Rasagiline

188
Q

MAO of bromocriptine

A

D2 agonist and mild D3 antagonist

189
Q

MAO of Ropinerole

A

D2 and D3 agonist

190
Q

2 DA agonist used to treat Parkinson’s Disease that may cause peripheral edema

A

amantadine

pramiprexole

191
Q

MOA of apomorphine

A

D2 and D3 agonist and D4 antagonist

192
Q

1st line treatment for Parkinson’s disease for a patient

A

Dopamine agonist

193
Q

MOA of all SGAs and FGAs

A

D2 receptor antagonists

194
Q

1st line treatment for Parkinson’s disease in a patient that has some cognitive impairment

A

Carbidopa/levodopa

195
Q

Inability to sit still

A

choreiform

196
Q

1st line treatment for Parkinson’s disease for a patient

A

Anticholinergics or MAO-B-I

197
Q

2 antipsychotics that have been studied in Parkinson’s disease

A

Clozapine and quetiapine

198
Q

MOA of caffeine

A

Adenosine A1 and A2 receptor antagonist

199
Q

Low potency FGAs

A

Chlorpromazine, Thioridazine

200
Q

MOA of guanfacine and clonidine

A

alpha-2 adrenergic agonists

201
Q

Area of the hypothalamus that controls circadian rhythm

A

suprahiasmatic nucleus

202
Q

Area of the brain in which DA is too low, creating the negative symptoms in schizophrenia

A

Mesocortical pathway

203
Q

Schizophrenia + bipolar disorder

A

Schizoaffective disorder

204
Q

2 TCAs that are preferred in the treatment of ADHD with depression

A

Imipramine and desipramine

205
Q

Medium potency FGAs

A

Loxapine, Perphenazine, Thiothixene

206
Q

Low potency SGAs

A

Clozapine, Quetiapine

207
Q

High potency SGAs

A

Risperidone, Paliperidone

208
Q

Receptor that SGAs block that gives them additional efficacy on negative symptoms

A

5HT2A

209
Q

SGA that has the highest risk of akathisia (inner restlessness)

A

Aripiprazole

210
Q

Antagonism of what receptor by antipsychotics causes anticholinergic SEs

A

M1

211
Q

Antagonism of this receptor leads to sedation created by antipsychotics

A

H1

212
Q

Antagonism of this receptor leads to hypotension created by antipsychotics

A

alpha-1

213
Q

Antipsychotics that have the highest risk of DIMD

A

high potency, slow dissociation (FGAs)

214
Q

Antipsychotics that have the highest risk of anticholinergic SEs and sedation

A

low potency

215
Q

Antipsychotics that have the highest risk of hypotension

A

low potency and Iloperidone

216
Q

Antipsychotics with the highest risk of hyperprolactinemia

A

FGAs, risperidone and paliperidone

217
Q

Antagonism of this receptor leads to weight gain associated with antipsychotics

A

H1

218
Q

Antagonism of these 3 receptors is associated with lipid and glucose changes associated with antipsychotics

A

H1, M3, 5HT2C

219
Q

SGAs that have the highest risk of metabolic issues

A

clozapine and olanzapine

220
Q

SGAs that have the lowest risk of metabolic issues

A

ziprasidone, lurasidone, aripiprazole

221
Q

Antipsychotics that have the highest risk of neuroleptic malignant syndrome

A

high potency

222
Q

3 antipsychotics that are the most important not to abruptly discontinue

A

clozapine, quetiapine, iloperidone

223
Q

Antipsychotic that has the highest risk of QT prolongation

A

Thioridizone

224
Q

Antipsychotic that has the highest risk of seizures

A

clozapine

225
Q

Antipsychotic that has the lowest seizure risk

A

quetiapine

226
Q

Special dietary restriction with asenapine

A

no food or drink within 10-15 min

227
Q

Dietary restriction with ziprasidone

A

must take with > 500 cal

228
Q

Dietary restriction with lurasidone

A

must take with >300 cal

229
Q

Antipsychotic medications that are both anti-manic and anti-depressive

A

quetiapine
lorasidone
olanzepine + fluoxitine

230
Q

Order of increasing risk of mood switching for antidepressants used in bipolar disorder

A

bupropriod

231
Q

AEDs used to treat bipolar disorder that are mainly anti-manic with slight anti-depressive effects

A

valproic acid
carbamazepine
oxcarbazepine

232
Q

AED that is used in bipolar disorder that has mainly antidepressive effects

A

Lamotrigine

233
Q

Treatment that tends to be the most effective for classic euphoric mania

A

Lithium

234
Q

Treatment that tends to be the most effective for dysphoric mania

A

AEDs

235
Q

What qualifies a HA as chronic

A

Occurs more days in a month than not

236
Q

Best acute treatment for a cluster HA

A

100% O2 inhalation

237
Q

Best treatment for an ice-pick HA (stabbing pain for a short period of time)

A

Indomethacin

238
Q

Drug of choice for prophylactic treatment of tension type HAs

A

amitriptylline

239
Q

MOA of triptans

A

5HT1B/1D receptor agonists

240
Q

5 medications that are FDA approved for prophylaxis of migraines

A 
valproic acid
topiramate
propranolol
timolol
anabotulinum toxin A
241
Q

SGA that is a D2 receptor partial agonist

A

Aripiprazole

242
Q

Classification when schizophrenia symptoms have lasted less than 6 months

A

Schizophreniform disorder

243
Q

Antipsychotic that has superior efficacy in treating positive symptoms

A

Clozapine

244
Q

Issue with tolcapone that limits its use

A

Increases risk of hepatic failure

245
Q

Where melatonin is synthesized

A

pineal gland

246
Q

AA precursor of melatonin

A

tryptophan

247
Q

Excitatory dopamine receptors

A

Type 1 (D1 and D5)

248
Q

Hoehn and Yahr Parkinson’s stage when movement dysfunction is bilateral and there are mild postural abnormalities

A

Stage III

249
Q

MOA of ramelteon

A

M1 and M2 melatonin receptor agonist

250
Q

Timing of melatonin therapy in delayed sleep phase sleep disorder

A

At dusk, about 5 hours before bedtime

251
Q

Timing of melatonin therapy in advanced sleep phase disorder

A

dawn

252
Q

Transtheoretical model of change stage that a patient is in when they are not yet ready to quit

A

Pre-contemplation

253
Q

Location of the hypothalamus where histamine is produced

A

tuberomemmillary nucleus

256
Q

TCA that is FDA approved for insomnia characterized by sleep maintenance issues

A

doxepin (silenor)

257
Q

MOA of rotigotine transdermal patch

A

D1, D2 and D3 agonist

258
Q

MOA of suvorexant

A

Orexin receptor (OX1 and OX2) antagonist

259
Q

Transtheoretical model for change that patients are in when they are 6 or more months after their quit date and are now considered a former user

A

Maintenance

260
Q

FDA approved medications for sleep maintenance

A

BZDs
Z-hypnotics
Silenor

261
Q

Preferred class of sleep drugs in the elderly

A

Z-hypnotics

262
Q

Peptide neurotransmitters implicated in wakefulness that are lost in patients with narcolepsy

A

Orexins A and B

263
Q

3 sleep medications/classes that should not be taken with high fat meals due to decreased absorption

A

z-hypnotics
ramelteon
silenor

264
Q

Transtheoretical model of change phase that patients are in when they are actively trying to quit and are still within 6 months of their quit date

A

Action

265
Q

5 A’s for clinicians when dealing with substance abuse

A 
Ask
Advise
Assess
Assist
Arrange
266
Q

1st line sleep therapy in children

A

Non-drug therapy

267
Q

The best established pathway for reinforcement

A

dopaminergic projection from the ventral tagmental are (VTA) to the nucleus accumbens

268
Q

Timing of bright light therapy in delayed sleep phase type sleep disorder

A

30-60 min in the AM

269
Q

Timing of melatonin therapy in delayed sleep phase sleep disorder

A

At dusk, about 5 hours before bedtime

270
Q

FDA approved medications for sleep onset

A

BZDs
Z-hypnotics
Remelteon

272
Q

Effect mediated by the mu opioid receptor

A

analgesia, sedation, inhibition of respiration and slowed GI transit

273
Q

Effects mediated by the kappa opioid receptor

A

analgesia, dysphoria, slowed GI transit

273
Q

G alpha receptor type for opioid receptors

A

Gi

274
Q

MOA of morphine

A

mu-opioid receptor agonist

275
Q

Inactive metabolite of morphine that has neuroexcitatory properties

A

morphine-3-glucuronide

276
Q

Active metabolite of morphine that is more potent than the parent

A

Morphine-6-glucuronide

277
Q

MOA of methadone

A

Mu and delta opioid receptor agonist, NMDA receptor antagonist, SNRI

277
Q

MOA of fentanyl

A

mu-opioid receptor agonist

278
Q

MOA of oxycodone

A

mu-opioid receptor agonist and kappa agonist

279
Q

MOA of hydrocodone

A

mu-opioid receptor agonist

280
Q

MOA of codeine

A

mu-opioid receptor agonist

281
Q

MOA of tramadol

A

5HT/NE reuptake inhibitor and metabolite is a weak mu-opioid agonist

282
Q

MOA of pentazocaine

A

partial mu-agonist and k-agonist

283
Q

MOA of butorphanol

A

partial mu-agonist and kappa-agonist

284
Q

MOA of nalbuphine

A

mu antagonist and kappa agonist

285
Q

MOA of buphenorphine

A

partial mu agonist and possible k antagonist

286
Q

The primary agent use for opioid overdose

A

naloxone

287
Q

Effects mediated by the delta opioid receptor

A

analgesia

296
Q

MOA of methylnaltrexone

A

peripherally acting mu-opioid receptor antagonist

297
Q

FDA approved indication for methylnaltrexone

A

refractory opioid-induced constipation in patients with advanced illness receiving palliative care

298
Q

2 effects of opioids that patients do not gain tolerance to

A

GI effects and pupillary constriction

299
Q

MOA of aspirin

A

irreversible inhibition of COX via acetylation

300
Q

Intrathercal spinal infusion of cone snail venom that is reserved for severe neuropathic pain and blocks presynaptic N-type Ca channels

A

Zoconitide

301
Q

MOA of epinephrine that makes it useful when combined with local anesthetics

A

vasoconstrictor

302
Q

Main MOA of local anesthetics

A

Block Na channel function

303
Q

Alkaloid derived from plants of Solanaceae that activates TRPVI receptor of C fiber sensory neurons and then desensitizes it, depleting Substance P

A

Capsaicin

304
Q

Normal processing of a stimulus

A

nociceptive

305
Q

nociceptive pain due to damage to bone, muscle, ligament or skin

A

somatic

306
Q

nociceptive pain due to damage to solid or hollow organs (liver, heart, spleen, kidney, GI tract)

A

Visceral

307
Q

Abnormal processing on pain stimuli

A

neuropathic

308
Q

Only FDA indication of lidocaine patches

A

Post herpetic neuralgia

309
Q

The drug of choice for trigeminal neuralgia

A

Carbamazepine

310
Q

MOA of ketamine, used for neuropathic pain

A

NMDA receptor antagonist

311
Q

Opioid that is the most effective in neuropathic pain

A

methadone

312
Q

4 1st line agents for neuropathic pain

A

TCAs
Gabapentin/pregabalin
lidocaine patch
SNRIs

313
Q

NSAID that has the lowest CV risk

A

naproxen

314
Q

Most common therapy given to patients experiencing opioid-inducted constipation

A

Senna + docusate

315
Q

Opioid with the worst nausea SE

A

Codeine

316
Q

2 Opioids that it is most common to have a true allergy to

A

codeine + morphine

317
Q

2 drugs that are the most common options to switch to if a patient has a true allergy to morphine

A

fentanyl or methadone

318
Q

Dose of naloxone that should be given to a patient with a respiratory rate of

A

0.04 mg (diluted) IVP over 15 sec q1-3min

319
Q

Dose of naloxone that should be given to a patient in respiratory arrest

A

0.4-2 mg

320
Q

Opioid that should specifically be avoided in renal disease

A

Morphine

321
Q

4 pain medications that can contribute to serotonin toxicity

A

fentanyl, methadone, meperidine, tramadol

322
Q

MOA of tapntadol

A

weak mu agonist and NE reuptake inhibitor

323
Q

Active metabolite of hydrocodone

A

hydromorphone

324
Q

MOA of meperidone

A

strong mu agonist and NMDA agonist

325
Q

Neurotoxic metabolite of hydromorphone

A

H3G

326
Q

Non-active, non–toxic CYP3A4 metabolite of oxycodone

A

noroxycodone

327
Q

Active CYP2D6 metabolite of oxycodone

A

oxymorphone

328
Q

Cut off for non-opioid naive patients

A

> 60mg/day MEQ for past 7 days

P&T (18 decks)

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