Exam 3 Flashcards
1
Q
What is an adverse effect of nalbuphine and butorphanol?
A
Increase cardiac work —> can increase HR and contractility
Avoid in MI pts
2
Q
What is normeperidine?
A
Toxic metabolite resulting from merperidine w/ prolonged use
3
Q
What is propofol and its MOA?
A
IV anesthetic
Agonizes GABA
4
Q
What are AE of propofol?
A
Respiratory depression and hypotension
Propofol infusion syndrome —> metabolic acidosis, cardiac and renal failure, rhabdo
5
Q
When is methylnaxtrexone contraindicated?
A
GI obstruction b/c it is used for opioid induced constipation
6
Q
What two side effects of opioids do you not develop tolerance to?
A
Constipation and miosis
7
Q
What drugs are used for cancer pain w/ opioids?
A
Biphosphanates (for bone pain) Other antidepressants Antiseizure drugs TCAs Glucocorticoids CNS stimulants
8
Q
What are first line of attack for migraines?
A
Serotonin receptor antagonists = triptans
9
Q
Second line attack for migraine termination
A
Ergotamine (ergot alkaloid)
10
Q
What is ergotism?
A
Ischemia d/t peripheral vasoconstriction and can lead to necrosis
Happens if you OD on ergotamine
11
Q
what is naltrexone used for?
A
Block euphoric effects of opioids and alcohol abuse
more effective for alcohol than opioids*
12
Q
what receptors to triptans agonize?
A
5HT 1B/1D receptors –> vasoconstriction
13
Q
which drug blocks 5HT 1F receptors = block of trigeminal ganglia pain transmission?
A
lasmiditan
14
Q
what patients can you use lasmiditan with?
A
CAD patients b/c it doesn’t cause vasoconstriction
15
Q
CGRP receptor antibodies drug
A
erenumab
16
Q
what can pass through the BBB?
A
Small lipid soluble, non-protein bound or if they have a transport system
17
Q
levodopa MOA
A
Prodrug that is converted to DA in CNS presynaptic nerve terminals
18
Q
can DA pass the BBB?
A
NO - requires cotransporter and competes with amino acids (don’t take with protein)
19
Q
what drug increases % levodopa to CNS by 5x
A
Carbidopa
20
Q
what drugs helps manage dyskinesias w/ levadopa
A
amantadine
21
Q
what does MAO-B break down?
A
DA
22
Q
what does MAO-A break down
A
NE & 5-HT (serotonin)
23
Q
what drug Helps levodopa avoid COMT to get into the BBB
A
COMT inhibitors - entacapone
24
Q
Centrally acting anticholinergics for Parkinsons
A
benzotropine
25
4 nonergot alkaloid dopamine agonists & receptors they bind to
amorphine
rotigotine
ropinirole
pramipexole
bind to D2 and D3 receptors - used for mild or w/ levodopa for severe
26
3 AchE inhibitors
donezapil (reversible)
rivastigmine (irrreversible)
galantamine (reversible)
27
what is memantine used for
alzheimers - to slow cognitive decline
| prevents excess NMDA activation from glutamate (excitatory) leak in pathologic state
28
what pts would you not use AchEs with?
COPD/asthma
29
3 AEs of mitoxantrone
Myelosuppression
Cardiotoxicity irreversible
Fetal injury
30
first gen/traditional anti-seizure drugs
```
Phenytoin* (Traditional)
Carbamazepine* (traditional)
Valproate* (traditional)
Ethosuximide* (traditional)-For absence seizures only
Phenobarbital* (traditional)
```
31
second gen antiseizure drugs
```
Oxcarbazepine* (new gen)
Gabapentin* (new gen)
Lamotrigine* (new gen)
levetiracetam* (new gen)
pregabalin* (new gen)
topiramate* (new gen)
tiagabine* (new gen)
```
32
drugs of choice for status epilepticus
```
benzodiazepines
Lorazepam (DOA = 72 hours) or diazepam (shorter DOA)
```
33
which antiseizure drugs bind to Na+ channels in inactivated state to prolong inactivation?
phenyotin + fosphenytoin
carbamazepine
lamtotrigine
34
which antiseizure drugs act on GABA?
```
valproate = traditional - enhances GABA
phenobarbital = traditional - potentiates GABA
gabapentin = new generation = enhance GABA release
topiramate = new gen = potentiate GABA
tigabine = new gen - inhibits GABA reuptake
```
35
which antiseizure drugs act on Calcium?
ethosuximide - traditional - suppresses Ca
| pregabalin - new gen - binds Ca presynaptically
36
which is the most effective aid to smoking cessation
Varenicline:
Partial nicotinic receptor agonist
Promotes DA release
Higher affinity for N receptors than nicotine —> when nicotine is used, DA release doesn’t occur
37
what kind of drug is bupropion?
atypical antidepressant:
| Results in CNS stimulation and appetite reduction → reduces cravings
38
3 drugs for abstinence of opioids
methadone
Buprenorphine
naltrexone
39
antidote for benzos
flumazenil
40
low potency first generation antipsychotic drug
chlorpromazine
41
high potency second gen antipsychotic
haloperidol
42
what receptors do Conventional First Generation Antipsychotics block
D2 receptors
43
what receptors do Atypical Second Generation Antipsychotics (SGA) block
Blocks D1, D2, D4 and 5-HT2 receptors
44
most effective antipsychotic for schizophrenia
clozapine
45
what NTs does depression impact
deficiency of NE, 5HT or both
46
which syndrome has gradual onset
Neuroleptic malignant Syndrome
47
SSRI prototype
Fluoxetine
48
SNRI prototype
Venlafaxine
49
what does tyramine do
Stimulates NE release
50
what is the advantage of Selegiline as a transdermal MAOI?
Lowers HTN risk w/ tyramine since it bypasses intestines/liver first pass effect → doesn’t inhibit MAO as much in these areas
51
what two antiseizure drugs are also used for bipolar disorder
valproate & carbamazepine
52
what drug is a benzo like drug that acts as a GABA agonist?
Zolpidem (ambien)
53
what kind of drug is Ramelton
melatonin agonist
54
what drug is an orexin antagonist?
Suvorexant
55
what pts would you use Suvorexant with caution?
OSA & COPD
56
what is Buspirone used for and what receptors does it mainly bind to?
anxiety
| Binds to 5HT receptors
57
3 CNS stimulants for ADHD
Amphetamines
Methylxanthines (caffeine)
modafinil
58
3 ways to minimize poison absorption
charcoal
Polyethylene glycol
gastric lavage
59
MOA for methylxanthines for asthma
Block adenosine receptors → relax bronchial smooth muscle
60
what are the most effective drug for long term control of airway inflammation
glucocorticoids
61
3 glucocorticoids for airway inflammation
Beclomethasone*
Budesonide*
Fluticasone*
62
2 leukotriene receptor antagonists for airway inflammation
zileuton
| Montelukast
63
mast cell stabilizer
cromolyn
64
what is cromolyn used for
Used for exercise asthma (nebulizer) and allergic rhinitis (intranasal)
65
what is the MOA of omalizumab
Forms complex with IgE that prevents its binding w/ receptors on mast cells → decreased mediator release
66
what kind of drug is roflumilast
monoclonal antibody, Phosphodiesterase 4 inhibitor
67
MOA of roflumilast
Inhibits PDE4 (enzyme that breaks down camp) → suppresses cytokines and decreases WBC infiltration
68
what is Symbicort made up of?
budenoside/formoterol
| used for asthma
69
what is advair made up of?
fluticasone propionate/ salmeterol
| used for asthma*
70
what is combivent made up of?
albuterol/ipratropium
| used for COPD
71
2 Sympathomimetics for decongestion (a1 agonists)
Phenylephrine
| pseudoephedrine
72
what receptors do Phenylephrine & pseudoephedrine agonise?
A1 --> local vasoconstriction
73
cough expectorant
guaifenesin
74
2 mucolytics
inhaled hypertonic saline & acetylcysteine via inhalation
75
most effective cough suppressant
codeine
76
non opioid antitussive
Dextromethorphan
77
what 3 drugs decrease production of aqueous humor in glaucoma patients
Beta Blockers: Timolol
A2 Agonist: Brimonidine
Cardiac Anhydrase Inhibitors: Dorzolamide
78
what drug increases the outflow of aqueous humor
Prostaglandin Analogues: Latanoprost
79
what is H1 Receptor Blockers azelastine used for?
allergic conjunctivitis
80
what does vascular endothelial growth factor do?
helps body grow new blood vessels (helpful in trauma or coronary blockage)
81
when do you want to inhibit VEFG?
age related macular degeneration
82
what is bevacizumab?
VEFG inhibitor
83
3 drugs used for acne
Antibiotics Benzoyl peroxide*
Retinoids: Tretinoin
Azelaic Acid
84
topical drug for psoriasis
coal tar
85
systemic drug for psoriasis
methotrexate
86
what is a topical immunosuppressant for eczema?
tacrolimus
| second line treatment
87
MOA of topical minoxidil
aka rogaine
vasodilator
only for male pattern baldness
88
what is otitis externa and how do you treat it?
painful, itchy infection of outer ear (swimmer’s ear)
| tx: acetic acid (vinegar)
89
what is otitis media and how do you treat it?
infection, fluid, inflammation of middle ear
| tx: amoxicillin
90
what drug has redistribution from CNS but not rapidly metabolized & DOA = 3-5 mins
propofol
91
MAC
minimum concentration in the lungs that will = immobility to painful stimuli in 50% of population
92
what is malignant hyperthermia a rare side effect of
inhaled anesthetics
93
Which ester cannot be given topically?
Chloroprocaine - IV only
94
Which local anesthetic has higher allergic reaction rates
Esters
95
What are the 3 effects of agonizing kappa receptors
Slow GI motility
Sedation
Analgesia
96
Pure opioids (5)
```
Morphine
Fentanyl
Merperidine
Codeine
Methadone
```
97
Do you need higher or lower doses of morphine to cross the BBB
Higher
98
When is preventative therapy indicated for migraines?
More than 3 attacks per month, high severity or if abortive drugs don’t work
99
What is an example of a preventative therapy for migraine
CGRP receptor antibodies = erenumab
100
Possible effects of adaptation
Increased therapeutic effects
Decreased side effects
Tolerance and physical dependence
101
Drugs that augment levodopa (2)
Carbidopa (decarboxylase inhibitor)
| Entacapone (COMT inhibitor)
102
What is benzotropine used for?
Second line drug for Parkinson’s tremor
103
Characteristics of new gen antiseizure drugs
```
Well tolerated
No CYP450 impact
Safer in pregnancy
More expensive
Less complex PK
```
104
Which drug for muscle spasticity acts peripherally and can result in muscle weakness
Dantrolene
105
What drug reduces unpleasant feelings associated with abstinence and reduces desire to drink
Acamprosate
106
What is the most effective aid for smoking cessation
Varenicline
107
MOA of varenicline?
Partial nicotinic receptor agonist —> promotes DA release —> higher affinity for N receptors than nicotine
If nicotine is used, DA doesn’t get released
108
When is a amorphine used
Rescue treatment in hypomobility episodes of advanced PD
109
What are the AEs of lithium
```
N/V
Thirst, polyuria
Lethargy, slurred speech, fine hand tremor
Renal toxicity
Hypothyroidism and goiter
Teratogenesis
```
110
Live vaccines
Polio can be live
MMR
Varicella
Rotavirus can be live
111
Which delivers the highest concentration of drug to the lung
Nebulizer
112
3 types of drugs used for bronchodilaton
B2 agonists
Methylxanthines
Anticholinergics
113
What drug is most effective for acute bronchospasm
Albuterol
114
What are 2 LABA
Formoterol
| Salmeterol
115
What B2 agonists can be taken PO
Albuterol
| Terbutaline
116
SAMA
Ipatropium
117
LAMA
Tiotripium
118
What is the most effective drug for long term control of inflammation
Glucocorticoids
119
IgE antibody antagonist
Omalizumab
120
IL5 receptor antagonist MOA
IL-5 is responsible for differentiation/maturation of eosinophils
121
IL4 receptor
Il4 = inflammatory cytokine expressed on many immune type cells
122
what drug is used for severe bronchitis primary COPD
roflumilast
123
2 drugs for skin
glucocortoicodis - hydrocortisone
| keratolytic - salicylic acid
124
metabolism of phenytoin
Doses need to be therapeutic at only slightly smaller than doses need to saturate hepatic enzymes - liver has limited capacity to metabolize it
125
phenytoin AE
- CV = dysrhythmias / hypotension with IV injection → dilute and infuse slowly
- necrosis w/ IV extravasation
126
if Gaba is enhanced, there is an influx of what electrolyte
chloride -- hyperpolarization of postsynaptic neuron → harder to elicit an AP → depression CNS activity
127
what drug is associated with Methemoglobinemia
topical benzocaine
128
meperidine dosing info
Keep use <48 hours and dose <600mg / 24 hours to avoid build up
129
what drugs do you avoid with meperidine
Avoid with MAOIs, TCAs and SSRIs
130
major AE of levodopa
dyskinesias
| orthostatic hypotension
131
what do carbidopa and encapone do to the AEs of levodopa
Indirectly decrease AE of levodopa b/c we can use lower doses of levodopa
*do not block aEs on their own!
132
how are MS immunomodulators delivered?
SQ
133
patient education points when starting a new anti-seizure drug
Might need to try different drugs to see what works → trial period → shouldn’t drive
Blood levels for drugs might be monitored - low TI
Avoid alcohol or other CNS depressants, tell provider about other OTC drugs
Suicide risk on initial therapy
134
AE of baclofen
CNS depression (b/c it mimics GABA!)
135
what schedule is zolpidem (benzo like drug)
schedule IV
136
what schedule are most opioids
schedule II
137
what is treatment for acute alcohol OD
Endotracheal tube + mechanical ventilation
| Fluid, electrolytes, glucose
138
tx for acute withdrawl of alcohol
benzos
139
which effects of nicotine do you not get tolerance to
CV effects: vasoconstriction, tachycardia, increased contractility
140
why would you take an EKG before haloperidol admin
it prolongs QT interval
141
other uses of chlorpromazine
```
Suppression of emesis
Relief of intractable hiccups
Control of severe behavioral problems in children
Dysrhythmias
Neuralgias
```
142
pt education for depression meds
Max responses to drug response can take up 3 months
Continue tx 4-9 months to prevent relapse then can d/c but taper over a few weeks w/ other life interventions occuring
Early in tx: all antidepressants can increase suicide ideation (SI) at beginning of therapy
143
AEs of TCAs
```
Orthostatic hypo
Anticholinergic effects
Sedation
Cardiac toxicity = dysrhythmias and heart block
Seizure risk
Suicide risk
```
144
AEs of MAOIs
CNS stimulation
| Orthostatic hypotension
145
AE of lithium
N/V diarrhea
Thirst, polyuria (blocks ADH)
Lethargy, slurred speech, fine hand tremor
Renal toxicity (monitor BUN/Cr)
Hypothyroidism and goiter
Teratogenesis (avoid in 1st trimester unless benefits outweigh risks)
146
Lithium drug interactions
Diuretics (Na+ loss)
NSAIDs increase lithium levels
Anticholinergics =urinary hesitancy
ACE inhibitors (Na+ loss)
147
does buspirone have any GABA effects?
No
| binds to 5HT
148
what schedule is modafinil
IV
149
live vaccines
MMR
varicella
polio (oral)
rotavirus
150
PO vaccines
polio
| rotavirus
151
when is activated charcoal most effective
Most effective within 30 minutes → 90% of dose becomes inactivated
After 60 minutes → 37% inactivated
152
why is theophylline not normally prescribed
Due to serious AE + low TI + highly variable metabolism → need to monitor plasma levels
153
how do glucocorticoids suppress inflammation
Decreased synthesis and release of inflammatory mediators
Decreased infiltration of inflammatory cell
Decreased edema of airway mucosa
154
safest anti inflammatory
cromolyn b/c of rare AE
155
how long does it take for IgE levels to return to pre-tx levels after omalizumab
1 year
156
what drugs for allergic rhinitis can result in rebound congestion when used for too many days
Phenylephrine
| pseudoephedrine
157
why is codeine (antitussive) schedule v
Formulated w/ other meds to decrease abuse potential (schedule V)
Acetaminophen, aspirin, promethazine, etc.
158
what topical formation is good for eczema
ointment
159
what topical treatment is helpful for inflamed or dry skin
creams
160
what do you give in severe asthma exacerbation
Nebulized high dose SABA & ipratropium
