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Pharmacology > Exam 2: Step 3 Name that Drug (Toxicities, Special Features) > Flashcards

Exam 2: Step 3 Name that Drug (Toxicities, Special Features) Flashcards

1
Q

what drug has high efficacy against psychosis but NOT first line because of risk of agranulocytosis?

A

clozapine

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2
Q

what drug has moderate efficacy against psychosis without risk of agranulocytosis, but highest risk of metabolic side effects?

A

olanzapine

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3
Q

which atypical antipsychotic is useful for elderly patients because it is non-sedating?

A

risperidone

“rise” and shine

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4
Q

which atypical antipsychotic has risk of QT prolongation?

which opioid has risk of QT prolongation?

A

ziprasidone

methadone

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5
Q

What are the extrapyramidal side effects that can be caused by D2 antagonists?

A

“muscle, rustle, hustle”

acute dystonia - 4 hours
akisthesia - 4 days
akinesia - 4 weeks

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6
Q

What is the late side effect of D2 antagonists?

A

tardive dyskinesia

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7
Q

What is the drug of choice for absence seizures?

A

ethosuximide

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8
Q

what would you give a depressed patient for migraine ppx?

A

amytryptaline (a TCA)

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9
Q

would would you give a hypertensive patient for migraine ppx, as long as they don’t have asthma?

A

propranolol

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10
Q

what combination of drugs could cause serotonin syndrome?

A

SSRI + MAOI
SSRI/SNRI + St. John’s Wort
SSRI + promethazine

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11
Q

which benzodiazepine is approved as a short term sleep aid?

A

triazolam

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12
Q

which benzodiazepine is used to induce anesthesia?

A

midazolam

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13
Q

which benzodiazepines are also useful as anticonvulsants because of their long half life?

A

diazepam, clonazepam

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14
Q

what two drugs bind directly to the alpha-1 subunit of GABA to cause sedation?

A

zolpidem

eszopicline

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15
Q

what can be used for maintenance treatment of generalized anxiety d/o without causing sedation?

A

buspirone

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16
Q

Besides lithium, name 3 drugs approved for treatment of bipolar disorder.

A

valproic acid
lamotrigine
olanzapine

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17
Q

what antidepressant can you prescribe to a 10 year old?

A

fluoxetine

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18
Q

what antidepressant(s) can you prescribe to a 14 year old?

A

fluoxetine or escitalopram

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19
Q

which anxiolytic cannot be taken with MAOI due to risk of serotonin syndrome?

A

buspirone

increases serotonin

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20
Q

which anticonvulsant can treat bipolar disorder and trigeminal neuralgia?

A

carbamazepine

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21
Q

Name two drugs that can treat HIT.

A

fondiparinux

argatroban

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22
Q

which anticonvulsant can cause Toxic Epidermal Necrolysis, especially in Han Chinese and South Asians with a genetic mutation?

A

carbamazepine

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23
Q

what is the antidote for heparin?

A

protamine sulfate

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24
Q

what drug can treat acute dystonic side effect of an antipsychotic (D2 blocker)?

A

benztropine

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25
Q

which antidepressant has a risk of seizures?

A

bupropion

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26
Q

which class of antidepressants has the highest risk of death by overdose and should not be given to patients with suicidal ideation?

A

TCA

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27
Q

Name 2 antipsychotics with the highest risk of weight gain & diabetes.

A

olanzapine

clozapine

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28
Q

which antipsychotic has the lowest side effect profile?

A

aripirazole

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29
Q

which antidepressant does not have a risk of sexual side effects?

A

buproprion

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30
Q

your patient has depression with insomnia and anorexia, what might you prescribe?

A

mirtazapine

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31
Q

what drugs could you try for a patient that needs long term treatment of insomnia?

A

ramelteon - best for falling asleep

zolpidem

eszopiclone - best for staying asleep

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32
Q

which benzodiazepine is useful for acute panic attack because of its short half life?

A

midazolam

alprazolam

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33
Q

what drug treats benzodiazepine or barbiturate overdose?

A

flumazenil

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34
Q

which anticonvulsant/antimigraine has side effects of weight loss and cognitive impairment?

A

topiramate

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35
Q

This therapy is approved for treatment of migraine in someone with 15 or more headaches per month. Treatment is repeated every 12 weeks.

A

onabotulinum toxin injection

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36
Q

what are 3 common adjuvant therapies for migraine?

A

caffeine
metoclopramide
NSAID

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37
Q

_________ must be given right at the start of a migraine, where as ________ is effective even if taken later and has fewer side effects.

A

ergots

triptans

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38
Q

which drug for migraines is effective in 80% of patients but has a high rebound rate?

A

triptans

39
Q 
which antidepressant class can have the following cardiac toxicities:
arrhythmia
tachycardia
palpitations
orthostatic hypotension
conduction block
A

TCAs

40
Q

Treatment of arrhythmia secondary to TCA overdose is ______.

A

lidocaine

41
Q

Which TCA (of the two we learned) is a secondary amine and has fewer side effects and a higher TI?

A

desipramine

42
Q

If a patient eats tyramine while taking an _________ (class of antidepressant), he is at risk for acute hypertensive crisis.

A

MAOI

43
Q

If MAOIs are taken with _________ or _________ (both opioids) the patient may experience severe serotonin syndrome.

A

meperidine

dextromethorphan

44
Q

If MAOIs are taken with ___________ drugs, the patient may have headache and increased BP.

A

sympathomimetics

L-DOPA, bupropion, amphetamines, pseudoephedrine

45
Q

Due to risk of serotonin syndrome, we must allow 2-5 weeks after discontinuing _______ before starting ___________.

A

MAOI

SSRI, SNRI, or TCA

46
Q

Which antidepressant is useful for smoking cessation?

A

bupropion

47
Q

You do not want to give an antihypertensive that causes increased sodium excretion to a patient who is taking __________.

A

Lithium

48
Q

What drugs are useful for treating an acute manic emergency?

A

antipsychotics (haloperidol)
benzodiazepines IV
valproate (not as rapid as the above)

49
Q

Because its adverse affects include agitation, anxiety, insomnia and
seizures, ___________ is not a good antidepressant for someone with anxiety.

A

bupropion

50
Q

Which anticonvulsant has significant anti depressive activity but carries a risk of Stevens Johnson Syndrome?

A

lamotrigine

51
Q

This drug commonly causes tremor, polydipsia and polyuria, or nephrogenic diabetes insipidus as a side effect.

A

lithium

52
Q

Which drug has a black box warning for thrombosis, HTN, and atherogenesis?

A

celecoxib

53
Q

Which drugs have a black box warning for hematoma after spinal anesthesia/puncture?

A

enoxaparin
fondaparinux
rivaroxaban
dabigatran

54
Q

Chronic high dose intake of NSAIDS is associated with analgesic ____________>

A

nephropathy

55
Q

What drug can be given with NSAIDS to prevent GI toxicity?

A

misoprostol

56
Q

At toxic levels, which drug causes tinnitus and acidosis?

A

aspirin

57
Q

If coadministered, which drug will decrease the cardio protective effect of aspirin?

A

ibuprofen

58
Q

Which drug causes potentially fatal hepatotoxicity at doses >15 grams?

A

acetaminophen

59
Q

Alcohol induces CYP2E1, which increases toxicity of ___________.

A

acetaminophen

60
Q

An acetaminophen overdose is treated with _______________.

A

N-acetylcysteine (Mucomyst)

61
Q

Monitor _________ for patients on heparin (but not enoxaparin or fondiparinux).

A

PTT

62
Q

Monitor _________ for patients on warfarin.

A

PT/INR

why? highly variable person-to-person pharmacokinetics!

63
Q

What is the antidote for warfarin?

A

vitamin K

64
Q

Which anticoagulants are safe in pregnancy?

A

enoxaparin
fondaparinux
(heparin has something in the preservative)

65
Q

Which drug has a BBW for risk of MI/stroke/death in those who are CYP2C19 poor metabolizers with acute coronary syndrome or PCI?

A

Clopidogrel

66
Q

Which drug has a BBW for severe bleeding in people <60 kilograms?

A

Prasugrel

67
Q

Which drug has a BBW for intracranial hemorrhage in people >75 years old?

A

Prasugrel

68
Q

Which drug has a BBW for thrombosis/MI/death in patients likely to undergo CABG?

A

Prasugrel

69
Q

Most serious complication of alteplase is______.

A

hemorrhagic stroke (1-2%)

70
Q

What drug(s) chelate iron?

A

deferoxamine (SQ or IV)

deferasirox (oral)

71
Q

FDA released a warning of next-morning impairment with use of which drug?

A

zolpidem

72
Q

This drug class should not be mixed with alcohol or given to a pt with respiratory disease.

A

benzodiazepines

73
Q

Which benzodiazepines are associated with higher abuse?

A

alprazolam & diazepam

due to fast absorption and high rate of entry into CNS

74
Q

Don’t give triptans to someone with ________

A

CAD.

Don’t give w/ MAOIs

75
Q

Which migraine tx has worse side effect profile and a risk of dependence?

A

ergotamine

76
Q

Which opioid -

does not depress myocardium
does not release histamine
can be given epidural

A

fentanyl

77
Q

Which opioid has HIGH first pass metabolism and needs dose adjustment for patients with renal failure?

A

morphine

78
Q

Which opioid is going to be ineffective as an analgesic in people with CYP2D6 polymorphism?

A

codeine

79
Q

Which two opioids are not analgesics?

A

dextromethorphan (antitussive)

loperamide (antidiarrheal)

also codeine if you have the CYP polymorphism!

80
Q

Which two opioids cannot be combined with an MAOI or SSRI due to risk of serotonin syndrome?

A

meperidine

tramadol

81
Q

Which opioid is thought to have lower dependence/abuse since MOA is on the kappa opioid receptor instead of MOR?

A

pentazocine

82
Q

What opioids have seizures as a potential adverse effect?

A

codeine

meperidine

tramadol

83
Q

Which opioid is INACTIVATED by CYP2D6, therefore those with a polymorphism are at risk of overdose?

A

methadone

84
Q

Which opioid does NOT cause miosis (pinpoint pupils)?

A

meperidine

causes mydriasis (dilated pupils)

85
Q 
Salivation
Lacrimation
Urination
Defecation
GI distress
Emesis 
[SLUDGE]  are symptoms of \_\_\_\_\_\_\_\_\_.
A

sarin poisoning

86
Q

A fast acting drug in this class is used to diagnose myasthenia gravis.

A

Anticholinesterase

the drug is edrophonium, not on our list

87
Q

Treatment for sarin poisoning is two step:

1) ASAP injection of____________.
2) ______________.

A

1) atropine

2) pralidoxime

88
Q

If you want to reverse the skeletal muscle block of vecuronium, you can give __________.

A

neostigmine

89
Q

This muscle blocker can produce malignant hyperthermia, hyperkalemia, cardiac arrhythmia, etc.

A

succinylcholine

“succ sucks”
use for emergency intubation only

90
Q

1 complaint from patients on _______ (drug class) is constipation.

A

opioids

oral iron

91
Q

This anticoagulant is metabolized (inactivated) by CYP3A4 and transported by P-gp, making drug-drug interactions common.

A

Rivaroxaban

92
Q

This drug, given to assist with smoking cessation, has a BBW for neuropsychiatric symptoms including suicidal ideations.

A

Varenicline

93
Q

Acetaminophen is formulated hydrocodone (Vicodin) or oxycodone (Percocet), increasing the risk of _____________.

A

liver toxicity

94
Q

Opioid overdose is treated with __________.

A

Naloxone

Pharmacology (6 decks)

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