drug adverse effects and ADME

Question 1

which benzodiazepines have short half-lives? what is the consequence?

Answer 1

no problem with cumulative effects with multiple doses

estazolam, oxazepam, lorazepam

Question 2

what are the contraindications for benzodiazepines and their receptor agonists?

Answer 2

COPD, depression, hepatic disease, closed-angle glaucoma

Question 3

which insomnia drugs are Cat X, C?

Answer 3

X: benzodiazepines
C: benzodiazepine receptor agonists

Question 4

what are two adverse effects of ramelteon?

Answer 4

URTI, naso-pharyngitis

Question 5

what two drugs used in insomnia are associated with suicidal ideation?

Answer 5

doxepin, suvorexant

Question 6

who shouldn’t anti-histamines be given to for insomnia?

Answer 6

elderly: excessive sedation, urinary retention, falls

Question 7

who needs a dose adjustment with suvorexant?

Answer 7

obese women: lower dose recommended

Question 8

what anti-migraine drugs are contraindicated in pregnancy? late pregnancy?

Answer 8

ergots

late: NSAID’s

Question 9

which triptan is most responsible for adverse effects? what are they primarily?

Answer 9

sumatriptan

CNS effects

Question 10

what are triptans contraindicated with and why?

Answer 10

any sort of vascular disease

may cause coronary and peripheral vasospasm

Question 11

which triptans are interact with MAOI’s?

Answer 11

zolmi-, riza-, and sumatriptan

Question 12

which triptan has increased levels when taken with CYP3A4 inhibitors?

Answer 12

elitriptan

Question 13

which triptans interact with propranolol, resulting in increased levels?

Answer 13

eli-, zolmi-, and rizatriptan

Question 14

when are ergots contraindicated, 2 populations?

Answer 14

pregnancy/lactation, vasospastic predisposing conditions

Question 15

which drug used in migraines may cause hyperprolactinemia, gynecomastia?

Answer 15

metoclopramide

Question 16

which drug used in migraines may cause Parkinson-like syndrome?

Answer 16

chlorpromazine

Question 17

which migraine prophylaxis drugs can cause increased weight?

Answer 17

valproate and amytryptiline

Question 18

which migraine prophylaxis drug can cause increased aggression?

Answer 18

amytryptiline

Question 19

which migraine prophylaxis drug is Cat X and potentially hepatotoxic?

Answer 19

valproate

Question 20

what are two contraindications for using muscarinic atnagonists?

Answer 20

glaucoma

sulfit preservative allergies

Question 21

what two drugs are associated with increased hair growth?

Answer 21

prostaglandin analogs

phenytoin

Question 22

contacts can’t be worn with which glaucoma drugs?

Answer 22

beta-blockers

Question 23

which drugs can cause dysgeusia (bitter taste)? what is another common adverse effect?

Answer 23

carbonic anhydrase inhibitors

bacterial keratitis due to contamination of multi-dose vial

Question 24

which non-antibiotic drugs are sulfonamides?

Answer 24

carbonic anhydrase inhibitors

Question 25

what glaucoma drugs are associated with decreased night vision?

Answer 25

muscarinic agonists

Question 26

what drugs have additive effects with carbamate/phosphate insecticides?

Answer 26

AChE inhibitors

Question 27

which AED's are CYP inducers?

Answer 27

phenytoin and carbamazepine

Question 28

which AED's require serum drug level monitoring to guide therapy?

Answer 28

carbamazepine, phenytoin, valproate, gabapentin, ethosuximide

Question 29

what are the 4 common adverse effects with AED's?

Answer 29

1. suicidal ideation 2. CNS effects 3. dermatologic toxicity 4. hematologic toxicity

Question 30

which AED's are weak carbonic anhydrase inhibitors? what is the adverse outcome?

Answer 30

zonisamide and topiramate | renal stones and metabolic acidosis

Question 31

what drug has 0-order elimination? what are two other drugs like that?

Answer 31

phenytoin | alcohol and high dose aspirin

Question 32

what drug is associated with gingival hyperplasia? what other somewhat similar adverse effect is it associated with?

Answer 32

phenytoin | hypertrichosis/hirsutism

Question 33

what are the BBB for the following drugs: carbamazepine, felbamate, lamotrigine

Answer 33

carbamazepine: agranulocytosis; felbamate: aplastic anemia, BM suppression, hepatic disease; lamotrigine: SJS/TEN

Question 34

which AED's are Cat X? Cat D?

Answer 34

Cat X: valproate | Cat D: carbamazepine, phenytoin, others

Question 35

which AED may cause thrombocytopenia? what can it cause in children?

Answer 35

valproate | hepatotoxicity