Exam 4

Question 1

Blocks the reuptake of Norepi

T x: 1 st - Fibromyalgia, Neuropathic 2nd - Depression
C ardiac toxicity (arrhythmias by overdose)
A nticholinergic (blurry vision/dry mouth)
S econd line drug, decrease seizure threshold

Orthostatic Hypotension

__________: BBW - Suicide in children/Maximal effects up to months
__________
__________: Yawngasm

Answer 1

Desipramine

Doxepin

Clomipramine

Pramine & Doxepin

Question 2

Serotonin SSRI - 1st Line Depression

Blocks reuptake of serotonin ONLY

S-erotonin syndrome (Agitation and Tremors)
S-exual dysfunction
S-uicidal risk (BBW in children)
S-edation

WD: taper dose off
*Neonatal effects: abistenece syndrome (Newborn experience withdrawal symptoms)

Most commonly used for depression
__________
__________
__________

Answer 2

Feluoxetine

Escitalopram

Sertraline

FES

• tine
• lopram
• line

Feluox, Escibar, and Sertra experience the S’s

Question 3

Serotonin SNRI - 1st Line Depression

Blocks reuptake of Norepi and Serotonin

S-exual dysfunction - Anorgasm
S-uicidal risk (BBW in children)

WD: taper dose off

Similar effect to SSRI’s but MORE adverse

__________
__________

Answer 3

Venlafaxine

Duloxetine

Question 4

Atypical Drug

Tx: Depression and Smoking cessation
Stimulant Activity - No weight gain
Increase sexual desire

___________ will make you well
_____ will help stop smoking

Answer 4

Bupronion

Wellbutrin

Zyban

(Bedica)

Question 5

Atypical Drug

RELEASE Norepi and Serotonin

Tx: Depression

Less Sexual Dysfunction
Drowsiness and weight gain

__________

Answer 5

Mirtazapine

Mirtal

Question 6

Monoamine oxidase inhibitor - MAOI

Block MAOI

3rd line depression - This drug are not used often due to their adverse effects

Severe Adverse Effects:
CNS: Anxiety, Mania
HTN CRISIS! - when given with norepi releasing drugs

__________

Answer 6

Phenelzine

Question 7

Mood Stabilizer

Bipolar - reduce fluctuations of mania and depression symptoms

Therapeutic doses:

• Teratogenesis - developmental abnormalities in fetus
• Fine hand Tremors
• Polyuria

Excessive Doses:

• COARSE hand tremors
• confusion/incoordination
• seizures
• LOW therapeutic index = need to monitor _______ levels
• Low plasma sodium –> increase _______ toxicity

__________

Other Mood stabilizer drugs:
__________
__________

Answer 7

Lithium

Valproic Acid - want to obtain baseline tests of live function.
Carbamazepine

Question 8

Not an approved use for depression

Serotonin Sydrome! (Agitation and Tremors)

Monoamine theory of depression: a decrease in norepi and serotonin in brain = cause depression overtime

Answer 8

St. John’s Wort

Question 9

Serotonin Syndrome - Think Harmful

H - \_\_\_\_\_\_\_\_\_ 
A - Agitation
R - Reflexes (hyperrefelxia) 
M - \_\_\_\_\_\_\_\_\_ (twitching)
F - Fast heart rate and fever 
U - \_\_\_\_\_\_\_\_\_
L - \_\_\_\_\_\_ of GI control

Answer 9

Hyperthermia

Myoclonus

Unconsciousness

Loss

Question 10

Antiparkinson’s

Crosses BBB
*Loss of impulse control
Dark urine/sweat
Dyskinesias (involuntary movement)

Food decreases absorption
“wearing off” – lasts few hr
“unpredictable off” – not working @ high drug level
“failure of on” – never kicks in

__________
Don’t use to treat alone

Answer 10

Levodopa

Question 11

Antiparkinson’s

DA receptor agonist – directly stim DA receptors

1st line drugs, but not as efficacious as Levodopa + Carbidopa

AE:
Nausea, dizzy, drowsy, insomnia, constipation, weak, hallucinations
-impulse control disorder

Answer 11

Pramipexole

Question 12

Antiparkinson’s

Inhibit of MAO-B in brain

1st line (prolongs levodopa - unpredictable on/off are less)

Mild Parkinson’s

Metabolizes into amphetamine (cause insomnia)

Answer 12

Selegiline

Question 13

Antiparkinson’s

2nd line (short-term & limited in use)

livedo reticularis (excess DA causing vasodilation of veins)

Answer 13

Amantadine

Question 14

Antiparkinson’s

Inhib COMT in brain (catechol-o-methyl transferase)

Used ONLY w/ levodopa

Orthostatic hypoTN
Colored urine

Answer 14

Entacapone

Tolcapone (can cause liver damage)

Question 15

Antiparkinson’s

Blocks muscarinic receptor
• Reduce Ach
Antimuscarinic – dry mouth, blurry, urinary ret, tachy, constip.

Tx: Reduce tremors

*more severe CNS adverse effects in elderly

Answer 15

Benztropine

centrally acting antimuscarinic

Question 16

Types of seizures

_______ (Aka Focal, local seizures):

• _______ partial: Do not have impaired consciousness
o Motor, sensory, psychic symptoms

• _______ partial: Consciousness impaired
o Simple partial onset followed by impaired consciousness
• Partial evolving to generalized seizures
o Tonic, clonic, or tonic-clonic

Answer 16

Partial

Simple

Complex

Question 17

ANTICONVULSANTS

Types of seizures

\_\_\_\_\_\_\_\_\_\_\_ 
(Convulsive or nonconvulsive) 
*involve muscle movement or not
•	Myoclonic seizures 
•	Clonic seizures
•	Tonic seizures 
•	Tonic-clonic seizures 
•	Atonic seizures

Answer 17

Generalized

Question 18

ANTICONVULSANTS

ANTICONVULSANTS

Therapeutic considerations

• Eliminate or reduce seizures
• Match seizure type with drug
• Evaluate drug effectiveness (proper drug, proper dose)
• Measure _____ drug levels (variations among different people)
• Withdraw drug (If brain rewires, and restores normal function)
• Increased risk of suicidality in the young (all anticonvulsants)
• Drug groups (Traditional vs. Newer)

Answer 18

plasma

Question 19

ANTICONVULSANTS

Traditional vs Newer

Equal Effectiveness
More experience with traditional
Newer = border uses 
Traditional = Complex 
More adverse effects with traditional 

Pregnancy
Traditional = more dangerous
Newer = Generally safer

Traditional is less expensive

Answer 19

Study

Question 20

ANTICONVULSANTS

Reduce neuronal excitability

↓ Vit D and bone mineral density

Gingival hyperplasia

**worsens absence seizures

Answer 20

Phenytoin - Traditional

Question 21

ANTICONVULSANTS

First line drug for all partial and generalized seizures

Increase GABA
Blocks Ca channels

HIGH fetal abnormalities

Rare but serious liver toxicity

Can increase plasma levels of phenytoin

Answer 21

Valproic acid - Traditional

Question 22

ANTICONVULSANTS

Inhib seizure spread

***partial seiz ONLY

Hyponatremia

Stevens-Johnson rash

Answer 22

Oxcarbazepine

Question 23

ANTICONVULSANTS

*avoid grapefruit juice

Seizure, BP Disorder, Trigerminal neuralgia

Answer 23

Carbamazepine

Question 24

ANTICONVULSANTS

Tx: absence seiz ONLY

Answer 24

Ethosuximide

Question 25

ANTICONVULSANTS

Tx: seizure - used with other drugs

Also Tx neuropathic pain, migraines, fibromyalgia

Answer 25

Gabapentin

Gaba = fibromyalgia, neuropathic pain

Question 26

ANTICONVULSANTS

Tx: seizure - partial and generalized

Also Tx neuropathic pain, wt loss, *binge-eating disorder

Answer 26

Topiramase

Question 27

ANTICONVULSANTS

Tx: seizure

Also Tx fibromyalgia, neuropathic pain

Answer 27

Pregabalin

Gaba = fibromyalgia, neuropathic pain

Question 28

ANTICONVULSANTS

Given IV for status epilepticus (tonic-clonic for 20-30min)

^ Convulsive Status Epileptic ^

Answer 28

Diazepam, Lorazepam

Question 29

Indications: ADHD, narcolepsy

**give before 4pm

Answer 29

Stimulants

Question 30

Stimulants

The term __________ refers to not a single compound but a 50/50 mix of dextroamphetamine and levamphetamine (racemic mixture).

*High abuse potential – Schedule II Controlled Substance

Alertness, decrease fatigue, increase mood
Increase HR

• Tolerance and physical dependence can develop. Abstinence syndrome occurs with abrupt withdrawal
• Paranoid psychosis
• Acute tox: halluc, delusions, dizzy, confusion, palpitations, dysrhy.

Answer 30

amphetamine

Question 31

Stimulants

caffeine!
Cross placenta > small risk of birth defects

Peripheral vasodilation
CNS vasoconstriction

Answer 31

Methylxanthines