Exam 2: Step 3 Name that Drug (Toxicities, Special Features) Flashcards
what drug has high efficacy against psychosis but NOT first line because of risk of agranulocytosis?
clozapine
what drug has moderate efficacy against psychosis without risk of agranulocytosis, but highest risk of metabolic side effects?
olanzapine
which atypical antipsychotic is useful for elderly patients because it is non-sedating?
risperidone
“rise” and shine
which atypical antipsychotic has risk of QT prolongation?
which opioid has risk of QT prolongation?
ziprasidone
methadone
What are the extrapyramidal side effects that can be caused by D2 antagonists?
“muscle, rustle, hustle”
acute dystonia - 4 hours
akisthesia - 4 days
akinesia - 4 weeks
What is the late side effect of D2 antagonists?
tardive dyskinesia
What is the drug of choice for absence seizures?
ethosuximide
what would you give a depressed patient for migraine ppx?
amytryptaline (a TCA)
would would you give a hypertensive patient for migraine ppx, as long as they don’t have asthma?
propranolol
what combination of drugs could cause serotonin syndrome?
SSRI + MAOI
SSRI/SNRI + St. John’s Wort
SSRI + promethazine
which benzodiazepine is approved as a short term sleep aid?
triazolam
which benzodiazepine is used to induce anesthesia?
midazolam
which benzodiazepines are also useful as anticonvulsants because of their long half life?
diazepam, clonazepam
what two drugs bind directly to the alpha-1 subunit of GABA to cause sedation?
zolpidem
eszopicline
what can be used for maintenance treatment of generalized anxiety d/o without causing sedation?
buspirone
Besides lithium, name 3 drugs approved for treatment of bipolar disorder.
valproic acid
lamotrigine
olanzapine
what antidepressant can you prescribe to a 10 year old?
fluoxetine
what antidepressant(s) can you prescribe to a 14 year old?
fluoxetine or escitalopram
which anxiolytic cannot be taken with MAOI due to risk of serotonin syndrome?
buspirone
increases serotonin
which anticonvulsant can treat bipolar disorder and trigeminal neuralgia?
carbamazepine
Name two drugs that can treat HIT.
fondiparinux
argatroban
which anticonvulsant can cause Toxic Epidermal Necrolysis, especially in Han Chinese and South Asians with a genetic mutation?
carbamazepine
what is the antidote for heparin?
protamine sulfate
what drug can treat acute dystonic side effect of an antipsychotic (D2 blocker)?
benztropine
which antidepressant has a risk of seizures?
bupropion
which class of antidepressants has the highest risk of death by overdose and should not be given to patients with suicidal ideation?
TCA
Name 2 antipsychotics with the highest risk of weight gain & diabetes.
olanzapine
clozapine
which antipsychotic has the lowest side effect profile?
aripirazole
which antidepressant does not have a risk of sexual side effects?
buproprion
your patient has depression with insomnia and anorexia, what might you prescribe?
mirtazapine
what drugs could you try for a patient that needs long term treatment of insomnia?
ramelteon - best for falling asleep
zolpidem
eszopiclone - best for staying asleep
which benzodiazepine is useful for acute panic attack because of its short half life?
midazolam
alprazolam
what drug treats benzodiazepine or barbiturate overdose?
flumazenil
which anticonvulsant/antimigraine has side effects of weight loss and cognitive impairment?
topiramate
This therapy is approved for treatment of migraine in someone with 15 or more headaches per month. Treatment is repeated every 12 weeks.
onabotulinum toxin injection
what are 3 common adjuvant therapies for migraine?
caffeine
metoclopramide
NSAID
_________ must be given right at the start of a migraine, where as ________ is effective even if taken later and has fewer side effects.
ergots
triptans
which drug for migraines is effective in 80% of patients but has a high rebound rate?
triptans
which antidepressant class can have the following cardiac toxicities: arrhythmia tachycardia palpitations orthostatic hypotension conduction block
TCAs
Treatment of arrhythmia secondary to TCA overdose is ______.
lidocaine
Which TCA (of the two we learned) is a secondary amine and has fewer side effects and a higher TI?
desipramine
If a patient eats tyramine while taking an _________ (class of antidepressant), he is at risk for acute hypertensive crisis.
MAOI
If MAOIs are taken with _________ or _________ (both opioids) the patient may experience severe serotonin syndrome.
meperidine
dextromethorphan
If MAOIs are taken with ___________ drugs, the patient may have headache and increased BP.
sympathomimetics
L-DOPA, bupropion, amphetamines, pseudoephedrine
Due to risk of serotonin syndrome, we must allow 2-5 weeks after discontinuing _______ before starting ___________.
MAOI
SSRI, SNRI, or TCA
Which antidepressant is useful for smoking cessation?
bupropion
You do not want to give an antihypertensive that causes increased sodium excretion to a patient who is taking __________.
Lithium
What drugs are useful for treating an acute manic emergency?
antipsychotics (haloperidol)
benzodiazepines IV
valproate (not as rapid as the above)
Because its adverse affects include agitation, anxiety, insomnia and
seizures, ___________ is not a good antidepressant for someone with anxiety.
bupropion
Which anticonvulsant has significant anti depressive activity but carries a risk of Stevens Johnson Syndrome?
lamotrigine
This drug commonly causes tremor, polydipsia and polyuria, or nephrogenic diabetes insipidus as a side effect.
lithium
Which drug has a black box warning for thrombosis, HTN, and atherogenesis?
celecoxib
Which drugs have a black box warning for hematoma after spinal anesthesia/puncture?
enoxaparin
fondaparinux
rivaroxaban
dabigatran
Chronic high dose intake of NSAIDS is associated with analgesic ____________>
nephropathy
What drug can be given with NSAIDS to prevent GI toxicity?
misoprostol
At toxic levels, which drug causes tinnitus and acidosis?
aspirin
If coadministered, which drug will decrease the cardio protective effect of aspirin?
ibuprofen
Which drug causes potentially fatal hepatotoxicity at doses >15 grams?
acetaminophen
Alcohol induces CYP2E1, which increases toxicity of ___________.
acetaminophen
An acetaminophen overdose is treated with _______________.
N-acetylcysteine (Mucomyst)
Monitor _________ for patients on heparin (but not enoxaparin or fondiparinux).
PTT
Monitor _________ for patients on warfarin.
PT/INR
why? highly variable person-to-person pharmacokinetics!
What is the antidote for warfarin?
vitamin K
Which anticoagulants are safe in pregnancy?
enoxaparin
fondaparinux
(heparin has something in the preservative)
Which drug has a BBW for risk of MI/stroke/death in those who are CYP2C19 poor metabolizers with acute coronary syndrome or PCI?
Clopidogrel
Which drug has a BBW for severe bleeding in people <60 kilograms?
Prasugrel
Which drug has a BBW for intracranial hemorrhage in people >75 years old?
Prasugrel
Which drug has a BBW for thrombosis/MI/death in patients likely to undergo CABG?
Prasugrel
Most serious complication of alteplase is______.
hemorrhagic stroke (1-2%)
What drug(s) chelate iron?
deferoxamine (SQ or IV)
deferasirox (oral)
FDA released a warning of next-morning impairment with use of which drug?
zolpidem
This drug class should not be mixed with alcohol or given to a pt with respiratory disease.
benzodiazepines
Which benzodiazepines are associated with higher abuse?
alprazolam & diazepam
due to fast absorption and high rate of entry into CNS
Don’t give triptans to someone with ________
CAD.
Don’t give w/ MAOIs
Which migraine tx has worse side effect profile and a risk of dependence?
ergotamine
Which opioid -
does not depress myocardium
does not release histamine
can be given epidural
fentanyl
Which opioid has HIGH first pass metabolism and needs dose adjustment for patients with renal failure?
morphine
Which opioid is going to be ineffective as an analgesic in people with CYP2D6 polymorphism?
codeine
Which two opioids are not analgesics?
dextromethorphan (antitussive)
loperamide (antidiarrheal)
also codeine if you have the CYP polymorphism!
Which two opioids cannot be combined with an MAOI or SSRI due to risk of serotonin syndrome?
meperidine
tramadol
Which opioid is thought to have lower dependence/abuse since MOA is on the kappa opioid receptor instead of MOR?
pentazocine
What opioids have seizures as a potential adverse effect?
codeine
meperidine
tramadol
Which opioid is INACTIVATED by CYP2D6, therefore those with a polymorphism are at risk of overdose?
methadone
Which opioid does NOT cause miosis (pinpoint pupils)?
meperidine
causes mydriasis (dilated pupils)
Salivation Lacrimation Urination Defecation GI distress Emesis [SLUDGE] are symptoms of \_\_\_\_\_\_\_\_\_.
sarin poisoning
A fast acting drug in this class is used to diagnose myasthenia gravis.
Anticholinesterase
the drug is edrophonium, not on our list
Treatment for sarin poisoning is two step:
1) ASAP injection of____________.
2) ______________.
1) atropine
2) pralidoxime
If you want to reverse the skeletal muscle block of vecuronium, you can give __________.
neostigmine
This muscle blocker can produce malignant hyperthermia, hyperkalemia, cardiac arrhythmia, etc.
succinylcholine
“succ sucks”
use for emergency intubation only
1 complaint from patients on _______ (drug class) is constipation.
opioids
oral iron
This anticoagulant is metabolized (inactivated) by CYP3A4 and transported by P-gp, making drug-drug interactions common.
Rivaroxaban
This drug, given to assist with smoking cessation, has a BBW for neuropsychiatric symptoms including suicidal ideations.
Varenicline
Acetaminophen is formulated hydrocodone (Vicodin) or oxycodone (Percocet), increasing the risk of _____________.
liver toxicity
Opioid overdose is treated with __________.
Naloxone
