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Pharmacology > Exam 3 > Flashcards

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

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2
Q

What is normeperidine?

A

Toxic metabolite resulting from merperidine w/ prolonged use

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3
Q

What is propofol and its MOA?

A

IV anesthetic

Agonizes GABA

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4
Q

What are AE of propofol?

A

Respiratory depression and hypotension

Propofol infusion syndrome —> metabolic acidosis, cardiac and renal failure, rhabdo

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5
Q

When is methylnaxtrexone contraindicated?

A

GI obstruction b/c it is used for opioid induced constipation

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6
Q

What two side effects of opioids do you not develop tolerance to?

A

Constipation and miosis

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7
Q

What drugs are used for cancer pain w/ opioids?

A 
Biphosphanates (for bone pain)
Other antidepressants
Antiseizure drugs
TCAs
Glucocorticoids
CNS stimulants
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8
Q

What are first line of attack for migraines?

A

Serotonin receptor antagonists = triptans

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9
Q

Second line attack for migraine termination

A

Ergotamine (ergot alkaloid)

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10
Q

What is ergotism?

A

Ischemia d/t peripheral vasoconstriction and can lead to necrosis
Happens if you OD on ergotamine

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11
Q

what is naltrexone used for?

A

Block euphoric effects of opioids and alcohol abuse

more effective for alcohol than opioids*

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12
Q

what receptors to triptans agonize?

A

5HT 1B/1D receptors –> vasoconstriction

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13
Q

which drug blocks 5HT 1F receptors = block of trigeminal ganglia pain transmission?

A

lasmiditan

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14
Q

what patients can you use lasmiditan with?

A

CAD patients b/c it doesn’t cause vasoconstriction

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15
Q

CGRP receptor antibodies drug

A

erenumab

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16
Q

what can pass through the BBB?

A

Small lipid soluble, non-protein bound or if they have a transport system

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17
Q

levodopa MOA

A

Prodrug that is converted to DA in CNS presynaptic nerve terminals

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18
Q

can DA pass the BBB?

A

NO - requires cotransporter and competes with amino acids (don’t take with protein)

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19
Q

what drug increases % levodopa to CNS by 5x

A

Carbidopa

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20
Q

what drugs helps manage dyskinesias w/ levadopa

A

amantadine

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21
Q

what does MAO-B break down?

A

DA

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22
Q

what does MAO-A break down

A

NE & 5-HT (serotonin)

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23
Q

what drug Helps levodopa avoid COMT to get into the BBB

A

COMT inhibitors - entacapone

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24
Q

Centrally acting anticholinergics for Parkinsons

A

benzotropine

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25
Q

4 nonergot alkaloid dopamine agonists & receptors they bind to

A

amorphine
rotigotine
ropinirole
pramipexole

bind to D2 and D3 receptors - used for mild or w/ levodopa for severe

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26
Q

3 AchE inhibitors

A

donezapil (reversible)
rivastigmine (irrreversible)
galantamine (reversible)

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27
Q

what is memantine used for

A

alzheimers - to slow cognitive decline

prevents excess NMDA activation from glutamate (excitatory) leak in pathologic state

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28
Q

what pts would you not use AchEs with?

A

COPD/asthma

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29
Q

3 AEs of mitoxantrone

A

Myelosuppression
Cardiotoxicity irreversible
Fetal injury

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30
Q

first gen/traditional anti-seizure drugs

A 
Phenytoin* (Traditional)
Carbamazepine* (traditional)
Valproate* (traditional)
Ethosuximide* (traditional)-For absence seizures only
Phenobarbital* (traditional)
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31
Q

second gen antiseizure drugs

A 
Oxcarbazepine* (new gen)
Gabapentin* (new gen)
Lamotrigine* (new gen)
levetiracetam* (new gen)
pregabalin* (new gen)
topiramate* (new gen)
tiagabine* (new gen)
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32
Q

drugs of choice for status epilepticus

A 
benzodiazepines 
Lorazepam (DOA = 72 hours) or diazepam (shorter DOA)
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33
Q

which antiseizure drugs bind to Na+ channels in inactivated state to prolong inactivation?

A

phenyotin + fosphenytoin
carbamazepine
lamtotrigine

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34
Q

which antiseizure drugs act on GABA?

A 
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
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35
Q

which antiseizure drugs act on Calcium?

A

ethosuximide - traditional - suppresses Ca

pregabalin - new gen - binds Ca presynaptically

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36
Q

which is the most effective aid to smoking cessation

A

Varenicline:
Partial nicotinic receptor agonist
Promotes DA release
Higher affinity for N receptors than nicotine —> when nicotine is used, DA release doesn’t occur

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37
Q

what kind of drug is bupropion?

A

atypical antidepressant:

Results in CNS stimulation and appetite reduction → reduces cravings

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38
Q

3 drugs for abstinence of opioids

A

methadone
Buprenorphine
naltrexone

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39
Q

antidote for benzos

A

flumazenil

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40
Q

low potency first generation antipsychotic drug

A

chlorpromazine

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41
Q

high potency second gen antipsychotic

A

haloperidol

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42
Q

what receptors do Conventional First Generation Antipsychotics block

A

D2 receptors

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43
Q

what receptors do Atypical Second Generation Antipsychotics (SGA) block

A

Blocks D1, D2, D4 and 5-HT2 receptors

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44
Q

most effective antipsychotic for schizophrenia

A

clozapine

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45
Q

what NTs does depression impact

A

deficiency of NE, 5HT or both

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46
Q

which syndrome has gradual onset

A

Neuroleptic malignant Syndrome

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47
Q

SSRI prototype

A

Fluoxetine

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48
Q

SNRI prototype

A

Venlafaxine

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49
Q

what does tyramine do

A

Stimulates NE release

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50
Q

what is the advantage of Selegiline as a transdermal MAOI?

A

Lowers HTN risk w/ tyramine since it bypasses intestines/liver first pass effect → doesn’t inhibit MAO as much in these areas

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51
Q

what two antiseizure drugs are also used for bipolar disorder

A

valproate & carbamazepine

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52
Q

what drug is a benzo like drug that acts as a GABA agonist?

A

Zolpidem (ambien)

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53
Q

what kind of drug is Ramelton

A

melatonin agonist

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54
Q

what drug is an orexin antagonist?

A

Suvorexant

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55
Q

what pts would you use Suvorexant with caution?

A

OSA & COPD

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56
Q

what is Buspirone used for and what receptors does it mainly bind to?

A

anxiety

Binds to 5HT receptors

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57
Q

3 CNS stimulants for ADHD

A

Amphetamines
Methylxanthines (caffeine)
modafinil

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58
Q

3 ways to minimize poison absorption

A

charcoal
Polyethylene glycol
gastric lavage

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59
Q

MOA for methylxanthines for asthma

A

Block adenosine receptors → relax bronchial smooth muscle

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60
Q

what are the most effective drug for long term control of airway inflammation

A

glucocorticoids

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61
Q

3 glucocorticoids for airway inflammation

A

Beclomethasone*
Budesonide*
Fluticasone*

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62
Q

2 leukotriene receptor antagonists for airway inflammation

A

zileuton

Montelukast

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63
Q

mast cell stabilizer

A

cromolyn

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64
Q

what is cromolyn used for

A

Used for exercise asthma (nebulizer) and allergic rhinitis (intranasal)

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65
Q

what is the MOA of omalizumab

A

Forms complex with IgE that prevents its binding w/ receptors on mast cells → decreased mediator release

66
Q

what kind of drug is roflumilast

A

monoclonal antibody, Phosphodiesterase 4 inhibitor

67
Q

MOA of roflumilast

A

Inhibits PDE4 (enzyme that breaks down camp) → suppresses cytokines and decreases WBC infiltration

68
Q

what is Symbicort made up of?

A

budenoside/formoterol

used for asthma

69
Q

what is advair made up of?

A

fluticasone propionate/ salmeterol

used for asthma*

70
Q

what is combivent made up of?

A

albuterol/ipratropium

used for COPD

71
Q

2 Sympathomimetics for decongestion (a1 agonists)

A

Phenylephrine

pseudoephedrine

72
Q

what receptors do Phenylephrine & pseudoephedrine agonise?

A

A1 –> local vasoconstriction

73
Q

cough expectorant

A

guaifenesin

74
Q

2 mucolytics

A

inhaled hypertonic saline & acetylcysteine via inhalation

75
Q

most effective cough suppressant

A

codeine

76
Q

non opioid antitussive

A

Dextromethorphan

77
Q

what 3 drugs decrease production of aqueous humor in glaucoma patients

A

Beta Blockers: Timolol
A2 Agonist: Brimonidine
Cardiac Anhydrase Inhibitors: Dorzolamide

78
Q

what drug increases the outflow of aqueous humor

A

Prostaglandin Analogues: Latanoprost

79
Q

what is H1 Receptor Blockers azelastine used for?

A

allergic conjunctivitis

80
Q

what does vascular endothelial growth factor do?

A

helps body grow new blood vessels (helpful in trauma or coronary blockage)

81
Q

when do you want to inhibit VEFG?

A

age related macular degeneration

82
Q

what is bevacizumab?

A

VEFG inhibitor

83
Q

3 drugs used for acne

A

Antibiotics Benzoyl peroxide*
Retinoids: Tretinoin
Azelaic Acid

84
Q

topical drug for psoriasis

A

coal tar

85
Q

systemic drug for psoriasis

A

methotrexate

86
Q

what is a topical immunosuppressant for eczema?

A

tacrolimus

second line treatment

87
Q

MOA of topical minoxidil

A

aka rogaine
vasodilator
only for male pattern baldness

88
Q

what is otitis externa and how do you treat it?

A

painful, itchy infection of outer ear (swimmer’s ear)

tx: acetic acid (vinegar)

89
Q

what is otitis media and how do you treat it?

A

infection, fluid, inflammation of middle ear

tx: amoxicillin

90
Q

what drug has redistribution from CNS but not rapidly metabolized & DOA = 3-5 mins

A

propofol

91
Q

MAC

A

minimum concentration in the lungs that will = immobility to painful stimuli in 50% of population

92
Q

what is malignant hyperthermia a rare side effect of

A

inhaled anesthetics

93
Q

Which ester cannot be given topically?

A

Chloroprocaine - IV only

94
Q

Which local anesthetic has higher allergic reaction rates

A

Esters

95
Q

What are the 3 effects of agonizing kappa receptors

A

Slow GI motility
Sedation
Analgesia

96
Q

Pure opioids (5)

A 
Morphine
Fentanyl
Merperidine
Codeine
Methadone
97
Q

Do you need higher or lower doses of morphine to cross the BBB

A

Higher

98
Q

When is preventative therapy indicated for migraines?

A

More than 3 attacks per month, high severity or if abortive drugs don’t work

99
Q

What is an example of a preventative therapy for migraine

A

CGRP receptor antibodies = erenumab

100
Q

Possible effects of adaptation

A

Increased therapeutic effects
Decreased side effects
Tolerance and physical dependence

101
Q

Drugs that augment levodopa (2)

A

Carbidopa (decarboxylase inhibitor)

Entacapone (COMT inhibitor)

102
Q

What is benzotropine used for?

A

Second line drug for Parkinson’s tremor

103
Q

Characteristics of new gen antiseizure drugs

A 
Well tolerated
No CYP450 impact
Safer in pregnancy
More expensive 
Less complex PK
104
Q

Which drug for muscle spasticity acts peripherally and can result in muscle weakness

A

Dantrolene

105
Q

What drug reduces unpleasant feelings associated with abstinence and reduces desire to drink

A

Acamprosate

106
Q

What is the most effective aid for smoking cessation

A

Varenicline

107
Q

MOA of varenicline?

A

Partial nicotinic receptor agonist —> promotes DA release —> higher affinity for N receptors than nicotine
If nicotine is used, DA doesn’t get released

108
Q

When is a amorphine used

A

Rescue treatment in hypomobility episodes of advanced PD

109
Q

What are the AEs of lithium

A 
N/V
Thirst, polyuria 
Lethargy, slurred speech, fine hand tremor
Renal toxicity
Hypothyroidism and goiter
Teratogenesis
110
Q

Live vaccines

A

Polio can be live
MMR
Varicella
Rotavirus can be live

111
Q

Which delivers the highest concentration of drug to the lung

A

Nebulizer

112
Q

3 types of drugs used for bronchodilaton

A

B2 agonists
Methylxanthines
Anticholinergics

113
Q

What drug is most effective for acute bronchospasm

A

Albuterol

114
Q

What are 2 LABA

A

Formoterol

Salmeterol

115
Q

What B2 agonists can be taken PO

A

Albuterol

Terbutaline

116
Q

SAMA

A

Ipatropium

117
Q

LAMA

A

Tiotripium

118
Q

What is the most effective drug for long term control of inflammation

A

Glucocorticoids

119
Q

IgE antibody antagonist

A

Omalizumab

120
Q

IL5 receptor antagonist MOA

A

IL-5 is responsible for differentiation/maturation of eosinophils

121
Q

IL4 receptor

A

Il4 = inflammatory cytokine expressed on many immune type cells

122
Q

what drug is used for severe bronchitis primary COPD

A

roflumilast

123
Q

2 drugs for skin

A

glucocortoicodis - hydrocortisone

keratolytic - salicylic acid

124
Q

metabolism of phenytoin

A

Doses need to be therapeutic at only slightly smaller than doses need to saturate hepatic enzymes - liver has limited capacity to metabolize it

125
Q

phenytoin AE

A
  • CV = dysrhythmias / hypotension with IV injection → dilute and infuse slowly
  • necrosis w/ IV extravasation
126
Q

if Gaba is enhanced, there is an influx of what electrolyte

A

chloride – hyperpolarization of postsynaptic neuron → harder to elicit an AP → depression CNS activity

127
Q

what drug is associated with Methemoglobinemia

A

topical benzocaine

128
Q

meperidine dosing info

A

Keep use <48 hours and dose <600mg / 24 hours to avoid build up

129
Q

what drugs do you avoid with meperidine

A

Avoid with MAOIs, TCAs and SSRIs

130
Q

major AE of levodopa

A

dyskinesias

orthostatic hypotension

131
Q

what do carbidopa and encapone do to the AEs of levodopa

A

Indirectly decrease AE of levodopa b/c we can use lower doses of levodopa

*do not block aEs on their own!

132
Q

how are MS immunomodulators delivered?

A

SQ

133
Q

patient education points when starting a new anti-seizure drug

A

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
Q

AE of baclofen

A

CNS depression (b/c it mimics GABA!)

135
Q

what schedule is zolpidem (benzo like drug)

A

schedule IV

136
Q

what schedule are most opioids

A

schedule II

137
Q

what is treatment for acute alcohol OD

A

Endotracheal tube + mechanical ventilation

Fluid, electrolytes, glucose

138
Q

tx for acute withdrawl of alcohol

A

benzos

139
Q

which effects of nicotine do you not get tolerance to

A

CV effects: vasoconstriction, tachycardia, increased contractility

140
Q

why would you take an EKG before haloperidol admin

A

it prolongs QT interval

141
Q

other uses of chlorpromazine

A 
Suppression of emesis
Relief of intractable hiccups
Control of severe behavioral problems in children
Dysrhythmias 
Neuralgias
142
Q

pt education for depression meds

A

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
Q

AEs of TCAs

A 
Orthostatic hypo
Anticholinergic effects
Sedation
Cardiac toxicity = dysrhythmias and heart block
Seizure risk
Suicide risk
144
Q

AEs of MAOIs

A

CNS stimulation

Orthostatic hypotension

145
Q

AE of lithium

A

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
Q

Lithium drug interactions

A

Diuretics (Na+ loss)
NSAIDs increase lithium levels
Anticholinergics =urinary hesitancy
ACE inhibitors (Na+ loss)

147
Q

does buspirone have any GABA effects?

A

No

binds to 5HT

148
Q

what schedule is modafinil

A

IV

149
Q

live vaccines

A

MMR
varicella
polio (oral)
rotavirus

150
Q

PO vaccines

A

polio

rotavirus

151
Q

when is activated charcoal most effective

A

Most effective within 30 minutes → 90% of dose becomes inactivated
After 60 minutes → 37% inactivated

152
Q

why is theophylline not normally prescribed

A

Due to serious AE + low TI + highly variable metabolism → need to monitor plasma levels

153
Q

how do glucocorticoids suppress inflammation

A

Decreased synthesis and release of inflammatory mediators
Decreased infiltration of inflammatory cell
Decreased edema of airway mucosa

154
Q

safest anti inflammatory

A

cromolyn b/c of rare AE

155
Q

how long does it take for IgE levels to return to pre-tx levels after omalizumab

A

1 year

156
Q

what drugs for allergic rhinitis can result in rebound congestion when used for too many days

A

Phenylephrine

pseudoephedrine

157
Q

why is codeine (antitussive) schedule v

A

Formulated w/ other meds to decrease abuse potential (schedule V)
Acetaminophen, aspirin, promethazine, etc.

158
Q

what topical formation is good for eczema

A

ointment

159
Q

what topical treatment is helpful for inflamed or dry skin

A

creams

160
Q

what do you give in severe asthma exacerbation

A

Nebulized high dose SABA & ipratropium

Pharmacology (6 decks)

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