Exam 4 Pharmacology Flashcards
1
Q
mild anxiety tx
A
SSRI > Benzo > TCAD, MAOIs
2
Q
what is difference betwen Phase 1 and phase 2 metabolism
A
phase 1 is slow with long T1/2 that leads to daytime sedation and contraindicated in elderly.
phase 2 are fast with short t1/2 and good for elderly
3
Q
Volatile anesthetic onset and recovery
A
slow
4
Q
Phenobarbital action
A
faciltiates GABA-A channel opening, GABA indpendent.
5
Q
Lamotrigine - class
A
new broad spectrum anti-epileptic that inhibits VSSC and VSCC
6
Q
PTSD tx
A
SSRI not TCAD, MAOI, mirtazapine
7
Q
Psuedoparkinsonism and treatment
A
ESP with traiditional antipsychotics
onset 5-90 days
Tx: anticholinergic
8
Q
when is BZD used in overdoses?
A
CNS stimulant, hallucinogens, dissocitave anesthetics - for agitation support
9
Q
Eszopiclone use
A
sleep maintence
10
Q
BDZ - uses
A
alcohol withdrawal - Chlorodiazopoxide, lorazepam Anxiolytic for GAD, panic Short term insomnia parasomnia in kids Status epileptics - Lorazepam, diazepam
11
Q
Phenytoin uses
A
Due to side effects not first choice in partial or tonic clonic
Add on for partial and tonic clonic
IV form - fosphenytoin used for active seizure
12
Q
Half life of Z drugs
A
longest is Eszopiclone
13
Q
Citalopram - class
A
SSRI
14
Q
Trazodone uses
A
Insomnia to decrease REM but increase SWS
Antidepressant
15
Q
Mirtazapine - class
A
alpha 2 antagonist to increase NE and antagonize 5HT2 and 5TH3
16
Q
Suvorexant
A
Sleep aid that is antagonist to Orexin R (ynthesized in latera hypothalamus) used to reduce sleep latency, increase REM and NREM sleep
Schedule IV, very expensive!
17
Q
lamotrigine ADRs
A
similar to pheytoin but much less
Dizzy, diplopia, skin rash, SJS
18
Q
Halothane
A
volatile anesthetic
19
Q
DDIs of Valproate
A
inhibits metabolism of CP450
20
Q
which antidepressants cause sedation?
A
TCADs, Trazodone, mirtazapine
21
Q
Lithium - class
A
Antimanic - maintenance and prophylaxis
22
Q
Potency of Haloperidol vs. Chlorpamazine
A
Haloperidol is low potency compared to chlorpromazine
23
Q
Levitracetam - ADRs
A
somnolence, dizziness, safe in pregnancy
24
Q
metabolsim of barbiturates
A
cyp450 inducers
25
Alcohol mechanism
Facilitates GABA-a CHannel and antagonizes NMDA-R to cause CNS depression
3
26
Olanzapine - class
Atypical antipsychotic
27
Lithium mechanism
unclear
Enhances 5HT and decreases DA and NE,
interefere with PIP recycling
28
Isoflurane
volatile anesthetic
29
What BZD are used for sleep?
Triazolam, flurazepam, temezapm
30
Mirtazapine Side Effects
NO sexual dysfunction, but weight gain, dry mouth, sedation
31
antidepresants and weight gain
highest with TCADs, mirtazapine, paroxetine
| lowest with buproprion
32
Buprenoprhine
partial mu agonist
33
Ethosuximide -- class
old broad spectrum antiepileptic that blocks T type Calcium Channel
34
Quetapine - class
Atypical antipsychotic
35
Benzos used as antiepileptics
Clonazepam (absence), diazepam (Status epilepticus)
36
Opsthontonus
part of acute dystonia - backward carching of neck
37
Phenelzine - class
MAOi -A to increase 5HT, NE, and DA by preventing degradation
38
Pharmokinetics of Phenytoin
zero order - small dose changes lead to toxicity
39
Oxazepam - class
BDZ
40
Side Effects of TCAD
Major: high Anticholinergic effects, also risk of overdose/death with convulsions, coma, cardiotoxicity (arrhythmia)
weight agin, sexual dysfunction, ortho hypotension, prolonged QT, sedation
41
Escitralopram - class
SSRI
42
Buspirone class
5HT partical agonst used to treat chornic anxiety - some risk of EPS
43
BDZ - short half lives
alprazolam, triazolam, oxazepam, mirazolam
44
BDZ - ind half lives
Lorazepam, temazepam
45
DA:5HT ration for atypical antipsychotics
low compared to typical,
| Aripirazole - slightly higher than others
46
Sevoflurane
volatile anesthetic
47
Chlorpromazine - Class
1st generation antipyschoti, with extremely high DA:5HT ratio
48
Bupropion - class
Atypical Antidepressant by blocking Ne and DA reuptake.
49
what class of drugs has no weight gain side effects for antidepressants?
Bupropion
50
Fluoxetine - class
SSRI
51
BDZ - long half lives
flurazepam, diazepam, chlordiazepoxide
52
Trazodone - class
Mixed serotonin reuptake blocker - blocks 5HT2 R and Alpha1 AR
53
Ethosuximide uses
first line for absence seizures
54
Treatment of ADHD
Amphetamines, myethylphenidates (also TCAD, Alpha agonists, atoxmidine, bupropion)
55
what decreases alcohol consumption
disulfiram (anabuse), naltrexone (opioids antagonist), NMDA receptor blocker, Campral (acamprostate)
56
LSD - mechanism
partial agonist to 5HT 2A Rceptors
| 1
57
Carbamezepine - class
Old partial antiepileptic that works by inhibition VSSC
58
Midazolam
IV benzodiazpam that is used for endoscopy with other gaseous anesthetics
59
methadone
long acting mu agonist used for opioid disorders
60
Phase 2 stage 3 metabolism of benzos
conjugation, glucouronidation in kidney and intestine
| Seen in oxazepam, lorazepam
61
Akathisia and treatment
EPS seen with traditional antipsychotics - onset 6-60 days
Inability to sit still, restlessness
Tx: anticholinergic, BB, benzos
62
which class of drugs have no sexual side effects for antidepressants?
Bupropion and Mirtazapine
63
Levitracetam
Tonic clonic, partical atonic myoclonic
| add pn for absnece
64
Contraindications of Bupropion
Panic disorders
| Eating disorders due to increase seizure risk
65
Side effects of Traditional antipsychotics
```
Hypotension (due to alpha1 affect)
Antimuscarinic
Sedation (h1 antagonist)
Neuroepileptic syndrome
EPS
prolong QT
```
66
alpha 1 (GABA)
in cortex
| sedation, bezos only for anticonvulsant. both have amnesia and CNS depression
67
Side effects of inhated anesthetcis
CV depression, respiratyr depression
68
Propofol use
induction of GA, sedation in ICU, short procedures
69
Alprazolam - class
BDZ
70
Use of TCAD
Resistant MDD or MDD with insomnia
Diabetic peripheral neuropathy
Chronic pain
Migrain Prophylaxis
71
Phase 1 - stage 1metabolism of Benzos
rapid! via CYP450 - oxidation in liver
| seen in Chlordiazepoxide, diazepam, clorazapate, alprazolam
72
Olaxapine-Fluoxetine -class
treats bioplar depression
73
Propofol side effects
profound vasodilation - hypotension
| less postop nausea than thiopental
74
Sertraline - class
SSRI
75
Divaloproex-sodium - class
anti manic
76
Bupropion use
MDD with hypersomnolence, smoking cessation
77
Diazepam - - class
bdz
78
Naloxone
tx for opoid oversode
79
what can treat manic depression?
lithium
| olaxapine-fluoxetine
80
Phenobarbital DDI
CYP450 inducer
contraindicated wither other depressants
schedule II drug
81
Phenelzine - side effects
Major: hypertensive crisis with inhibitng digestion of tyramine
also associated with hypotension, anticholinergic, sexual SE, weight gain
82
Treatment of Social Anxiety
BB, high potent BZD
83
which benzo has highest anteriorgrade amnesia
Temazepam
84
Uses of Venalfaxine
Depression, GAD, panic, PTSD
85
Second gas effect in N2O
in blanced anesthesia, high volume of N2O uptake drives both gases into lung and increase than predicted for second sunstance
86
Benzodiazepams addiction number
3
87
Isoflurane Side effects
Less hepatotoxicity, less renal toxicity than halothane
| pungent odor that cuases coughing
88
BDZ mechanism
facilitates GABA-A by increasing frequency of opening
89
Valproate class
old broad spectrum antiepileptic that inhibits VSSC, T type Ca Cannel, GABA activation (inhibits GABA transaminase)
90
Cannabinoids - mechanism
agonist of CB1 to lead to disinhibiton
| 2
91
Side Effects of Atypical Antipsychotics
Fewer EPS and Anticholinergic
weight gain
orthostatic hypothension
prolong QT interval
92
trismus
part of acute dystonia - jaw spasm
93
Diffusion hypoxia in N2O
when terminate, N20 leaves so rapidly that it dilutes O2 in alveoli
94
Zaleplon - class
Z drug
95
Vereniceline (chantix)
partical agonist of alpha4Beta2 NR
96
Bupropion Side effects
NO weight gain or sexual side effects
NE - tachycardia, anxiety, insomnia
Increased seizure risk (contraindicated in eating disorders)
97
Z drugs uses
First line for sleep agents
98
naltrexone
opioid antagonist - used for alcohol and opioid substance abuse
99
Side Effects of Venalfaxine
more than SSRI
Major: increased diastolic BP, increase HR,
Flu like withdrawal
Sexual dysfunction
100
Halperidol ADR
high Extrapyramidal with low hypotensive and sedation
| high Neuroepileptic Malignant syndrome and Tardive dyskinesia
101
Ethosiximide ADRs
GI distress, HA, dissiness
102
what antieleptics are anti-manic
Carbamazpine and valproate
103
Toxicity of BZD
CNS depression - daytime sedation
ataxia - increased risk in elderly
anterograde amnesia (flunitrazepam - date rape)
Dependence - increase risk with high dose, regular use, abuseive hisotry
Oversode if combined with other CNS depressants - opioids, tCAD, antipsychotic, anti convulsants, anthistamines
104
Risperidone - class
Atypical antipsychotic
105
Zaleplon use
decrease sleep latency, does not prevent nocturnal wakenings - good for use during night wakenings
106
Propofol
IV anesthetic that potentials Cloride current through GABA A channels
107
Midazolam - class
BDZ
108
Side effects of SSRIs
Sexual dysfunction (major)
weight gain
Anticholinergic
Serotonin Syndrome with MAOIs, Opioids, or St johns wort
109
which benzo has highest risk of daytime sedation
flurazepam - especially with liver problems
110
side Effects of Trazodone
Oversedation, orthohypotension, sexual side effects, weight gain, priapism
111
alpha 2-5 (gaba)
in brainstem and limbic
| anxiolytic, myorelaxant, leads to motor incoordiantion, tolerance, decreased REM
112
phase 1 stage 2 metabolism of benzos
slow, but still is active
| Oxidation in liver
113
Phenobartibal toxicity
Respirtaory and CV depression
CNS depression
Tolerance and dependence is high!
114
Eszopiclone -class
Z drug
115
Thiopental
IV barbiturate used for periopertaive anesthesia, conscious sedation for minor procedures
116
which atypical antipsychotic increased risk of agranulocytosis
clozapine
117
N2O potency
low
118
Aripiprazole - classification and mechanism
Atypical antipsychotic - partial DA agonist.
119
Nicotine Mechanism
Agonist of N receptor to lead to excitation of DA neurons
| 4
120
Chlorpromazine ADR
med/low EPS with high sedation and hypotension
| Corneal deposits
121
Zolpidem - class
Z drug
122
Lamotrgine DDIs
valroate increases levels, estrogen decreases levels
123
Neuroepileptic Malignant Syndrome
Risk of high dose of antipsychotics - halperidol
fever, encophalopthy, unstable vitals, increased enzyme, rigidity of muscles.
Tx: Dantrolene
124
what can treat Bipolar prevention?
lithium
125
Lorazepam - class
BDZ
126
Serotonin Syndrome
hyperthermia, muscle rigidity, myoclonus, rapid changes in mental status
127
Treatment of GAD
SSRI, SNRI over MAOI
128
Valproate ADRs
generaly few: GI, weight gain, pancreatitis, hepatotoxiciy in those under 2, Contraindicated in pregnancy to cuse NT defects
129
Concentration affect N2O
since most of inspired air is N2O, total pressure of other air in alveoli is less and uptake is more than predicted
130
Opioid mechanism
u receptor agonist of GABA interneurons to lead to disinhibition
4
131
Phenobarbital uses
sedation, antiepipletic, not antianxiety
132
Venlafaxine - class
SNRI - increases NE and 5HT
133
Amphetamines
Aderall and Vyvanse used for ADHD treatment
134
Mirtazapine - use
Depression with insomnia (no change in REM and increase SWS)
135
Tradive Dyskinesia and treatment
ESP with antipsychotics
onset 3-6 months
involuntary movement of orofacial muscles, choreathetoid movements
Tx: prevention - no real treatment.
136
Topiramate
new drug that acts everywehre exctep TType CA Channel
137
Phenelzine -use
atypical or nonresponstive depression and anxiety
138
OCD tx
SSRI > antispyctoci
139
MDMA mechanism
SERT (soem DAT, NET) reversal to releaset 5HT
| ?? - additicion
140
Ketamine
IV Anesthetic by antagonism of NDMA receptor to induce anesthesia
141
N20 Solubitliy
low (low blood:gas partition)
142
Subozone
buprenorphine with naloxone for opioid addiction
143
Phenbarbital as antiepileptic
used as adjunctive therapy for partial or tonic clonic
| Neonatal status epilepticus
144
Lamotrigine uses
first line for Partial, Tonic clonic, atonic myoclonic
add on for absence
Mainentence for biplar, or bipolar depression
145
Topiramate
used as anjuct for partial seizures
146
N20 Onset and recovery speed
Fast
147
Temazepam - - class
BDZ
148
Side effects of Halothane
1) repiratory depression with or without CV failure
2) heptatoxicity with repeated exposure
3) malignant hypothermia
149
Torticollis
part of acute dystonia - wry neck
150
Ketamine - mechanism
antagonist to NMDA receptor
| 1
151
CLonzapine - class
Atypical antipsychotic
152
Mechanism of 1st gen antipsychotid
Decrease DA in the mesolimbic pathway, with high DA R antagonist and low 5HT R antagonist.
153
Haloperidol - Class
1st generation Antipsychotic
154
Flurazepam - class
BDZ
155
Uses of SSRIs
Depression, GAD, Panic, PTSD, OCD, Bulemia
156
Meth mechanism
DAT (SERT, NET, VMAT) reversal of transporter to cause increase DA release
5
157
Carbamezepine ADRs
Diplopia ataxia, hyponatrema, SJS, blood dyscrasias - agranulocytosis, aplastic anemia, hepatotoxic
158
campral (acamprostate)
GABA mimic to decrease symptoms post alcohol wtihdrawal
159
what treats acute alcohol withdrawal -
Chloradiazepoxide, lorazepam, clondine
160
Lithium DDIs
don't use with diuretics, NSAIDS or drugs that decrease GFR
| competes with Na reabsorption (high sodium diet decreases absorption)
161
what can treat acute mania?
Lithium
antiepileptics - carbamazapiine, valproate
Antipsychotics
Divalproex-sodium
162
Phenelzine - DDIs
do not use with SSRIs, TCADs, st johns work - risk of serotonin syndrome
decongestant - increase risk of hypertensive crisis
163
Levitracetam - class
New broad spectrum anti-epileptic that inhibits VSCC and GABA activation
164
Acute Dystonia And treatment
EPS seen with traditional antipsychotics- acute onset in 1-5 days
Torticollis, trismus, opstotonus
Anticholinergic
165
Phenytoin class
Old partial antiepiletic that inhibits VSSC; also Class 1b antiarrhythmic (zero order)
166
Triazolam - class
BDZ
167
Sevoflurorane Side effects
toxic to kidney due to fluroide release
| Pelaant odor so less coughing than isoflurane
168
Weight gain - atypical antipsychotics
highest in olazapine, clozapine, and quetapine
| lowest in ariprazole
169
Lithium Side Efects
Narrow Therapeutic index
Acute: GI upset
Chornic: hypothyroidism, Diabetes insipidous, oversode - coma, sexisure,
Tremor
170
Divalproex
combined with other antieptileptics as broad spectrum antiepileptic.
171
Valrpaote uses
First line for Tonic clonic, used for atonic myoclonic of absence
add on for partial seizure
antimanic
172
sedation in atypical antiphyschotics
highest in quetapine and olazapine
173
Volatile anesthetic potency
high
174
which Z drug has highest rebound insomnia
eszopiclone
175
Methylphenidates
Ritalin and Cocert - used for ADHD treatment
176
which benzos do not use CYP450 metabolism
Oxazepam, lorazepam
177
Cocaine mechanism
DAT (SERT, NET) inhibition to block reuptake
| secedule 5
178
Side effects of thiopental
rapid onset, decrease cerebral blood flow
179
Flumenizil
antagonist to benzodiazepines to treat benzo overdose not ethanol or barb
180
Pheytoin ADRs
nystagmus, diplopia, sedation, gingival hyperplasia, hirsutism, peripheral neuropathy, SLE-like, SJS, overdose risk
181
Zolpidem use
Reduces latency, reduces wakenings, increase sleep time
182
Uses of Carbamezepine
Partial, tonic clonic
drug of choice for trigeminal neuralgia
antimanic
183
Gabapentin
Binds to VSCC to decrease glutamate release, is GABA analogue
Anti epileptic
few SE or DDIs, safe in pregnancy, treatment of resistant epilpsy.
184
Amitryptiline - class
Tricyclic Antidepressant
185
Paroxetine - class
SSRI
186
Ramelteon
Sleep aid that is a Melatonin Recpetor agonist in Suprachiastmatic nuc of hypothalamus to decrease sleep latency
187
Volatike anesthetic solubility
High blood:gas partition
188
antidepressants and sexual dysfunction
lowest with bupropion and mirtazapine
189
Acute panic Tx
benzo
190
Potency of atypical antipsychotics
all high potency except Clozapine - med an quetapine - low
