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Pharmacology > Exam 4 endocrine + Psych > Flashcards

Exam 4 endocrine + Psych Flashcards

1
Q

Neurotransmitters in major depressive disorder

A

Serotonin, NE, dopamine

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2
Q

Treatment phases of depression

A

Acute: 6-12 weeks
Continuation: 9 months-1 year

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3
Q

SSRI

A

Fluoxetine, citalopram, sertraline, fluvoxamine, paroxetine, escitalopram
Effective after 4-6 weeks
May decrease REM sleep
SE: Sexual dysfunction
Abrupt withdrawal causes flu like symptoms, insomnia, GI effects, anxiety

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4
Q

Only SSRI approved for children

A

Fluoxetine (Prozac)

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5
Q

SNRIs

A

Venlafaxine, desvenlafaxine, duloxetine, levomilnacipran
For more resistant depression
Takes 4-6 weeks
Higher rates of anticholinergic effects

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6
Q

TCAs

A

-triptyline and -amine
Worse SE than SSRI
Active at ACh and H receptors–anticholinergic effects

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7
Q

MAOI

A

Phenlzine
Decrease degradation of nE, serotonin, and dopamine
Potential for life threatening hypertension
Last line treatment

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8
Q

Neurotransmitters involved in anxiety disorders

A

NE, serotonin, GABA

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9
Q

Antidepressants for anxierty

A

SSRI or SNRI or imipramine (TCA)

1st line tx of anxiety

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10
Q

Benzodiazepines

A

Alprazolam (Xanax), clonazepam, diazepam, lorazepam (Ativan), oxazepam
bind to GABA A
Indicated for short term management (2-4 weeks) as well as exacerbations
Long term tx not recommended
SE: drowsiness and psychomotor impairment
Flumazenil for OD

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11
Q

Azapirones

A

Buspirone
Partial agonist at 5-HT1a receptor and inhibits uptake of dopamine, serotonin and NE
Used as adjunct therapy
No hypnotic, muscle relaxant or anticonvulsant properties
Not useful for immediate relief
Minimal abuse potential

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12
Q

Benzodiazepines for insomnia

A

Blocks thalamic, hypothalamic and limbic arousal
Tempazepam + Lorazpem–intermediate acting for sleep maintenance
Flurazepam–long acting and rapid onset for sleep initiation

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13
Q

Benzodiazepine receptor agonists

A

Eszoplicone, zolpidem (ambien), zaleplon
Induces sleepiness but not anxiolysis or muscle relaxation
Can increase sleep walking, eating and driving

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14
Q

Suvorexant

A

Blockage of orexin neuropeptides and results in severe sleepiness
Sleep induction and maintenance achieved

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15
Q

Ramelteon

A

Melatonin receptor agonists

Shortens latency to sleep onset

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16
Q

1st line therapy for insomnia

A

Benzo, benzo agonist, ramelteon

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17
Q

Ropinirole or pramipexole

A

Dopaminergic agent for restless leg syndrome

Quicker onset than dopamine agonists–useful for relief of sleep onset insomnia

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18
Q

Anticonvulsants for restless leg

A

Off label use

Considered when dopamine agonists have failed

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19
Q

Narcolepsy triad

A

Excessive daytime sleepiness, cataplexy, sleep related hallucinations, sleep paralysis

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20
Q

Modafenil and Armodafinil

A

Psychostimulant
Increase release of NE in hippocampus, thalamus and amygdala
Tx of narcolepsy

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21
Q

Methylphenidate

A

amphetemaines
tx of narcolepsy
Stimulants CNS activity and blocks reuptake of NE

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22
Q

Mirtazapine

A

Similar to TCA
Causes sedation
Alpha 2 antagonist/mixed serotonin blockers
Increases appetite and decreases insomnia

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23
Q

Trazodone

A

Serotonin 2A antagonist and serotonin reuptake inhibitor
Highly sedating
Often used to treat insomnia in low doses

24
Q

Atarax and Visatril

A

Hydroxyzines
For anxiety
H1 receptor antagonist with low antihistaminic properties
SE: dry mouth and drowsiness

25
Q

1st line tx for insomnia

A

Zaleplom: help patient fall asleep
Temazepam: stay asleep through night
Antidepressant: for chronic insomnia
Diphenhydramine: pregnancy

26
Q

1st line tx for restless legs

A

Dopaminergic agonist at low dose

27
Q

2nd line tx for restless legs

A

Anticonvulsant or opioid

28
Q

Sulfonylureas

A

Tolbutamide, chlorpropramide, tolazamide, gluburide, glipizide, glimepiride
Binds to beta cell receptors causing Ca channels to open and release of inuslin
SE: hypoglycemia

29
Q

Biguanides

A

Metformin
Not hypoglycemic
Used in conjunction with diet
Inhibits hepatic glucose production and improves peripheral sensitivity to insulin
CI: renal issues, HF, pregnancy, alcoholics, >80, children
SE: GI upset

30
Q

Thiazolidinediones

A 
Rosiflitazone + Ploglitazone
Decreases insulin resistance 
Binds to nuclear steroir hormone 
SE: weight gain, edema, hepatic toxicity, hypoglycemia
CI: HF patient , liver failure
31
Q

Alpha glucosidase inhibitors

A

Acarbose + Miglitol
Decreases absorption of carbs at brush border of intestine
Given as adjunct therapy
CI: bowel disease

32
Q

Meglitinide Analogs

A

Repaglinide + Nateglinide
Rapid acting insulin secretagogues stimulates release of insulin in response to meal
CI: type 1 DM, DKA, Severe infecton, surgery, trauma, pregnancy, BF

33
Q

DPP4 inhibitors

A

-gliptin
Increases amoint of circulating incretins and increases GLP-1
SE: URI, UTI, HA

34
Q

GLP-1 receptor agonists (incretins)

A 
-Glutide and exenatide
Used as adjunct therap 
Stimulates glucose dependent secretion of insulsin from pancreas while decreasing release of glucagon and slows gastric emptying 
Avoids hypoglycemia 
SE: GI distress
35
Q

Amylin analog

A

Pramlintide
Synthetic of amylin–co-secreted with insulin in response to food, delays fastric emptying
Type 1 and type 2 DM
SE: nausea

36
Q

Sodium glucose co transporter 2 inhibitors

A

-Gliflozin
Induces glycosuria
CI: type 1 DM, DKA, severe kidney disease

37
Q

Rapid acting insulin

A

Lispro (Humalog)
Onset <30 mins
Duration 3-5 hours

38
Q

Short acting insulin

A

Regular insulin (Humulin R, Novolin R)
Onset 30 mins
Duration 6-8 hours

39
Q

Intermediate acting insulin

A

NPH (Humulin N, Novolin N)
Onset 1-4 hours
Durating 14-26 hours

40
Q

Long acting insulin

A

Glargine (Lantus) + Detemir
Onset 2-4 hours
Duration 24 hours

41
Q

Dawn phenomenon

A

Early morning increase in blood sugar between 2 and 8 am–give insulin

42
Q

Somogyi effect

A

Hypoglycemia in the middle of the night leading to rebound hyperglycemia in early morning
-Do not increase insulin

43
Q

General stepwise tx for type 2 DM

A

Metformin first, titrate up, add sulfonylureas, add TZDs

44
Q

3 drugs diabetics should be on

A

Glucose lowering agent, statin, ACEI

45
Q

S/S hypothyroidism

A

fatigue, constipation, weight gain, bradycardia, peripheral edema
Dx: increased TSH and decreased T4

46
Q

Tx of hypothyroidism

A

Levothyroxine, liothyronine, liotrix
Give on empty stomach–interact with everthing; do not give with PPI
MOA: increases basal metabolic rate, increases utilization of glycogen, promotes gluconeogenesis
Start with lowest dose; titrate up every 4-6 weeks

47
Q

Most common cause of hyperthyroidism

A

Graves disease–autoimmune

Autoantibodies act like TSH

48
Q

S/S hyperthyroidism

A

Palpitations, sweating, heat intolerance, weight loss, increased BP, increased HR, exophthalmos

49
Q

3 main tx for hyperthyroidism

A

Antithyroid drugs, radioactive iodine, surgery

50
Q

Antithyroid drugs

A

Methimazole + Propylthiouracil

Inhibits iodine organification; blocks conversion of T4 to T3

51
Q

Ajunct therapy for hyperthyroidism

A

Beta blockers for palpitations (propranolol and atenolol)
Iodine containing compounds (tx of thyrotoxic storm)
Lithium
Glucocorticoids

52
Q

Tx of exophthalmos

A

Anti-inflammatory drugs, immunosuppressive drugs, surgery

53
Q

Goal of diabetic therapy

A

A1C < 6.5

54
Q

Most common type 2 DM regimen

A

2/3 dose in morning, 1/3 dose in evening
Morning dose is 2/3 intermediate acting and 1/3 short acting
Evening dose is 1/2 intermediate acting and 1/2 short acting

55
Q

Length of tx for hypothyroidism

A

Usually lifelong

56
Q

Length of tx for hyperthyroidism

A

Usually 1-2 years max

57
Q

Hyperthyroidism for pregnant woman

A

Methimazol except during first trimester of pregnancy

Pharmacology (56 decks)

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