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IPAP Pharmacology 2 > DOC, MC, CI for Test 4 > Flashcards

DOC, MC, CI for Test 4 Flashcards

1
Q

(Lecture 1)

An anticonvulsant used in Bipolar Disorder, this is the current DOC in most manic indications

A

Valproic Acid/ Divalproex sodium

Effective as lithium in acute and prophylactic management

PREFERRED FOR RAPID CYCLERS (>4 MANIC EPISODES /YR)

PREGNANCY CAT D

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2
Q 
(Lecture 1)
This class of drugs is used first line in treating:
-Depression
-OCD
-Panic Disorder
-Social Phobia
-PTSD
-Premenstrual Dysphoric Disorder (PDD)
-Generalized Anxiety Disorder
A

Selective Serotonin Reuptake Inhibitors (SSRIs)

(EX: Fluoxetine; Fluvoxamine; Paroxetine; Sertraline; Citalopram; Escitalopram; Vilazodone; Vortioxetine

  • not as lethal in cases of OD as are TCAs
  • ONSET OF ACTION TAKES 3-8 WEEKS (OR LONGER IN SOME CASES)
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3
Q

(Lecture 1)

This drug is used as a first line treatment of PTSD along with SSRIs

A

Venlafaxine (an SNRI)

-WORKS AS AN SSRI AT DOSES ~75mg/day; SNRI AT > 225mg/day

ADE: GI… INCREASE IN BP… ABRUPT DISCONTINUATION can yield withdrawal syndrome similar to SSRI w/d (taper dose)

CI: MAOIs and -triptans (serotonin syndrome)

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4
Q

(Lecture 1)

This drug is a 2nd line agent for MDD

A

Desvenlafaxine (as SNRI)

is an active metabolite of venlafaxine… no advantage over venlafaxine

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5
Q

(Lecture 1)
This drug is considered a 2nd or 3rd line agent used for anxious depression or in SSRI use that is too activating/ causing sexual dysfunction

A

Nefazodone (a Serotonin Receptor Antagonist… inhibits 5HT2 family of receptors)

-BLACK BOX WARNING for risk of liver failure

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6
Q

(Lecture 1)

This MAOI, used for atypical depression in patients refractory to other anti-depressants is considered LAST LINE agent

A

Tranylcypromine

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7
Q

(Lecture 1)
This NDRI is contraindicated for PATIENTS AT RISK FOR SEIZURES, those with a hx of eating disorders, and those withdrawing from alcohol or benzos

A

Bupropion

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8
Q

(Lecture 1)

This anti-depressant is “not likely” to cause sexual dysfunction

A

Bupropion

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9
Q

(Lecture 1)

These 2 anti-depressants are “less likely” to cause weight gain

A

Bupropion
and
Fluoxetine

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10
Q

(Lecture 1)

These 3 are good choices for antidepressants which avoid/reduce somnolence

A

Mirtazapine
Paroxetine
and
Trazodone

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11
Q

(Lecture 1)

These anti-depressants can increase energy

A
  • Bupropion or an SNRI

- Fluoxetine and Sertraline are more activating than other SSRIs

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12
Q

(Lecture 1)
These anti-depressant classes are recommended if the PT is currently experiencing anxiety; this drug can increase anxiety

A
  • SSRI or SNRIs are recommended in anxiety

- Bupropion can increase anxiety

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13
Q

(Lecture 1)

These two anti-depressants can be used in depression plus fibromyalgia or neuropathic pain

A

Duloxetine
or
Venlafaxine

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14
Q

(Lecture 1)

These two anti-depressants have indication for diabetic neuropathy

A

Amitriptyline
and
Imipramine

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15
Q 
(Lecture 2)
This class of drugs is DOC for parkinsonism induced by drugs (anti-psychotics and Metoclopromide (Antiemetic))
A

Anticholinergics

EX: Benztropine (useful for control of EPS other than tardive dyskinesia)
and
Trihexyphenidyl

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16
Q

(Lecture 2)

This drug may be the best choice for patients with mild-moderate Parkinson’s

A

Controlled release Carbidopa/Levodopa
-no measurable effect on “freezing”

(immediate release version for ERRATIC disease)

17
Q 
(Lecture 2)
drug class considered first line mono-therapy in most symptomatic Parkinson's Pts because of less dyskinesias and not oxidizing into free radicals
A

Dopamine Agonists

  • may delay need for Levodopa for several years
  • can cause daytime sleepiness
  • USE WITH CAUTION IN PTS W/ PSYCHOSIS OR DEMENTIA (may worsen sx)
18
Q

(Lecture 2)

IMPROVEMENT OF MOTOR DISABILITY in Parkinson’s is better with which drug?

A

Levodopa

  • greatest effect on bradykinesia and rigidity
  • initial therapy for elderly (>70), dementia, and patients with significant cognitive impairment
  • wearing-off and on-off phenomena
19
Q 
(Lecture 2)
LESSENING OF MOTOR COMPLICATIONS in Parkinson's is better with which class of drugs?
A

Dopamine agonists

EX: Bromocriptine; Pramipexole; Ropinirole; Apomorphine

20
Q

(Lecture 2)

Treatment strategy for Parkinson’s PT with side effect of Dyskinesia?

A
  • Reduce L-Dopa dose

- Add amantadine (NMDA receptor Inhibitor) or an anticholinergic

21
Q

(Lecture 2)

Treatment strategy for Parkinson’s PT with side effect of severe motor fluctuations despite optimal oral therapy?

A

consider SQ apomorphine (a short acting D2 selective Dopamine angonist)
- FOR ACUTE, INTERMITTENT TX OF “OFF” EPISODES
- IF NO DOSING >1 WEEK, RESTART AT 0.2 ml INCREASE
or
Duodopa

22
Q 
(Lecture 2) 
This class of drug is most useful in Parkinson's PTs with tremors, but side effects and CIs are a concern
A

Anticholinergics

23
Q

(Lecture 2)

Stimulation of this family of dopamine receptors improves rigidity and bradykinesia

A

D2

24
Q

(Lecture 2)
These 2 non-ergot D2 and D3 selective dopamine Agonists are used in mild Parkinsons and both have indication for Restless Leg Syndrome

A

Pramipexole
-POSSIBLE NEURO-PROTECTIVE EFFECT
and
Ropinirole

25
Q

(Lecture 2)
This drug is used for prophylaxis of SEVERE N/V with Parkinson’s PTS on APOMORPHINE; used 3 days prior to start - first month of tx

A

TRIMETHOBENZAMIDE

26
Q 
(Lecture 2)
Use of this short-acting D2 selective dopamine agonist in Parkinson is CI'd for 
-IV use 
-PTs with Sulfite sensitivity
-PTs on 5-HT3 Antagonists
A

Apomorphine

27
Q

(Lecture 2)

This Dopamine analog DOES NOT CROSS THE BBB

A

Carbidopa

28
Q

(Lecture 2)

This Dopamine analog HAS THE ABILITY TO CROSS THE BBB and is CONVERTED INTO DOPAMINE IN THE PERIPHERY

A

Levodopa

“HONEYMOON” PTs usually respond well for 3-5 years of tx, then effects start to decline

29
Q

(Lecture 2)

Treatment of “WEARING OFF” phenomenon (sx return before the next dose)

A 
-INCREASE THE FREQUENCY (SHORTEN THE DOSING INTERVAL) of levodopa
or
-add a dopamine agonist
or
-add an MAO-B or COMT inhibitor
30
Q

(Lecture 2)
Treatment of “ON-OFF” phenomenon (unpredictable return of sx w/o regard to dosing interval with severity ranging from akinesia (off) to periods of mobility with dyskinesias (on))

A 
-redistributing dietary protein (high protein diet reduces absorption... keep steady intake)
or
-add a dopamine agonist
or
-add an MAO-B or COMT inhibitor
31
Q

These drugs carry a risk of SEROTONIN SYNDROME

A

-MAO-B (Selegiline and Rasagiline)

-

32
Q

SEROTONIN SYNDROME, a potentially life-threatening rxn) looks like this…

(clinical triad)

A
  • COGNITIVE EFFECTS
  • NEUROMUSCULAR DYSFUNCTION
  • AUTONOMIC DYSFUNCTION
33
Q

This is how you tx SEROTONIN SYNDROME

A
  • W/d offending agents
  • Supportive care
    • Benzos for anxiety/seizures
    • ice/cooling blankets for hyperthermia
    • cyproheptadine (1st gen antihistamine and 5HT1A and 5HT2 antagonist
34
Q

Compared to Selegiline, Rasagiline is…

A
  • 5X MORE POTENT
  • NOT METABOLIZED TO AMPHETIMINE derivative
  • ADDITIONAL TESTING NEEDED to determine HTN CRISIS POTENTIAL
  • WARNING to avoid tyramine foods
35
Q

(Lecture 2)
This NMDA receptor inhibitor was originally designed as an ANTIVIRAL TO TX TYPE A INFLUENZA. It notably carries an ADE of LIVEDO RETICULARIS rashes.

A

Amantadine

36
Q

(Lecture 2)
This COMT Inhibitor used to manage motor fluctuations in Parkinson’s (“wearing-off” effect) and is an adjunct to (must be used with) levodopa/carbidopa is known to CAUSE ORANGE DISCOLORED URINE and does not cross the BBB.

A

Entacapone

(STALEVO is a brand combo agent containing Carbidopa,
Levodopa, and Entacapone)

37
Q

(Lecture 2)

When tx hallucinations in Parkinsons… what 2 strategies should be used?

A
  • stop meds that may contribute to psychosis beginning with anticholinergics
  • Avoid typical antipsychotics, risperidone, and olanzapine
38
Q

(Lecture 2)
If cognitive D/Os occur with Parkinson’s, discontinue/reduce Parkinson’s drugs as tolerated. If antipsychotics are needed, treat with these newer neuroleptics:

A
  • Quetiapine

- Clozapine (best option, but bad side effects of agranulocytosis)

IPAP Pharmacology 2 (2 decks)

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