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Pharmacology (Dale Turley) > Exam 5 > Flashcards

Exam 5 Flashcards

1
Q

Bupropion adverse reactions ?

A 
tachycardia
photosensitivity
hyper/hypoglycemia
anorexia
weight loss
nausea 
dry mouth
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2
Q

Bupropion contrindications ?

A

Current or history of seizures
Anorexia
bulimia

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3
Q

Bupropion interactions ?

A

First pass effect – avoid drugs with hepatic metabolism with similar competitive effects

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4
Q

Bupropion information ?

A

Advise patient and family that may take 2 to 4 weeks of treatment for optimal results

Some improvement 7-10 days

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5
Q

Mirtazapine adverse reactions ?

A

Flu-like symptoms

Higher risk of inducing seizure (no history)

Sedation
Weight gain
Constipation
Dry mouth
Vomiting
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6
Q

Mirtazapine interactions ?

A

MAOI’s

CNS depressants

drugs affecting CYP-450 system

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7
Q

Amitriptyline adverse reactions ?

A

Anticholinergic effects-blurred vision, confusion, dry mouth, hot dry skin, urinary retention

Orthostatic hypotension, tachycardia, arrhythmias (torsade de pointes)

Prolonged QT interval

GI distress, jaundice, metallic taste

Confusion, hallucinations, SI

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8
Q

Amitriptyline interactions ?

A 
Many
Watch other anticholinergics
Alcohol
SSRI’s
Cimetidine
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9
Q

TCA’s in the elderly cause _________________ , especially ___ in elderly male!!

A

arrhythmias, CHF, MI

BPH

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10
Q

Class of meds tend to cause more sedation and orthostatic hypotension ?

A

Tricyclic Antidepressants


Amitriptyline (Elavil) + 8 others

Named because of their three ringed structure
1957 – used to elevate mood
Considered second-line due to side effects

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11
Q

Amitriptyline considerations ?

A

Second-line therapy

Effective with severe depression, anxiety and OCD

Overdose - fatal arrhythmias

Taper dose discontinuance

Monitor blood counts and SI

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12
Q

Monoamine Oxidase Inhibitor (MAOI)

 pharmacokinetics ?

A

Major first pass effects

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13
Q

Phenelzine adverse reactions ?

A

Dilated pupils

HTN crisis

Serotonin syndrome

Sexual dysfunction
Weight gain

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14
Q

Phenelzine drug-drug interactions ?

A

Foods high in tyramine / caffeine = HTN crisis

Ct John’s wort + MAOI’s = Serotonin Syndrome / Fatalities

Amphetamines
Antidiabetic drugs
SSRI’s, TCA’s
Alcohol

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15
Q

MAOI’s must be stopped for ________ before starting other anti-depressants

A

10-14 days

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16
Q

Monoamine Oxidase Inhibitor (MAOI)

 may cause ?

A

serotonin syndrome

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17
Q

Hypertensive crisis can be caused by ingesting foods rich in ________ , white taking MAOI’s.

A

tyramine

cheese, beer and wine and also caffeine

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18
Q

Trazodone pharmacokinetics ?

A

Peak plasma level in 1 hour on empty stomach

Absorbed well, 2/3 patients get relief in several weeks, usually by end of second week

Metabolized live
Excreted urine
Half-life 5-9 hours

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19
Q

Trazodone adverse reactions ?

A

Orthostatic hypotension 4-6 hours after dose

Nausea / vomiting

Priapism

drowsiness

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20
Q

What what when taking Trazodone ?

A

Watch with digoxin and Coumadin (protein bound drugs)

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21
Q

Trazodone interactions ?

A

Strong sedating effect

Used at bedtime for depression and insomnia

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22
Q

Haloperidol / Chlorpromazine pharmacokinetics ?

A

Absorbed well orally

Onset ½ to 1 hour

Highly metabolized by lever and GI mucosa

Excreted by kidneys

Half life 30 hours

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23
Q

Haloperidol / Chlorpromazine adverse reactions ?

A 
Dizziness
Hypotension
Photosensitivity
Hyperglycemia
Impaired thermoregulation
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24
Q

Haloperidol / Chlorpromazine adverse reactions cont.. ?

A

Decreased libido

Urinary retention

Extrapyramidal symptoms

Impaired memory

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25
Q

Haloperidol / Chlorpromazine contrindication ?

A

Parkinsonism

Blood dyscrasias

Liver impairment

Cardiac disease

Rey’s syndrome

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26
Q

________ only atypical with clear evidence in tx of resistant-schizophrenia

A

Clozapine

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27
Q

Introduced in the 1990’s with breakthrough in treating
Schizophrenia

Ability to NOT cause extrapyramidal side effects

Some may cause elevated prolactin levels

A

Antipsychotics (Second Generation)

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28
Q

Antipsychotics (Second Generation) examples ?

A

Aripiprazole (Abilify)

Olanzapine (Zyprexa)

Quetiapine (Seroquel)

Risperidone (Risperdal)

Clozapine (Clozaril)

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29
Q

Antipsychotics (Second Generation) pharmacokinetics ?

A

Metabolized liver
Excreted 50% urine, 50% feces
Half-Life 4-66 hours

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30
Q

Antipsychotics (Second Generation) BBW ?

A

May increase mortality in elderly with dementia-related psychosis

Increased risk of agranulocytosis, seizures and myocarditis / Cardiomyopathy

Severe neutropenia

Orthostatic hypotension, bradycardia, syncope

31
Q

Methylphenidate interactions and adverse effects ?

A

Not with MAOI’s
Ay cause “Tourette like” syndrome
Hypoglycemia
Arrhythmias

32
Q

Methylphenidate pharmacokinetics ?

A

Metabolized CYP-450
Excreted urine, small amt feces
Half-life 3.5 hrs

33
Q

Methylphenidate facts ?

A

Get echo after 5 years use

Watch weights loss, insomnia, agitation, HTN

May cause dependency

34
Q

Methylphenidate (Concerta)

/ Atomoxetine facts ?

A

Newer generation of medications

Reduced dosage BID

Higher incidence of “Tourette” like syndrome

Addictive properties

Abuse / Black market

35
Q

Benzodiazepines
 pharmacokinetics ?

A

Most lipid soluble and thus taken orally

Popular PO anxiolytic

Traditional drug for treatment of seizures however replaced by lorazepam

Active metabolites

Absorption
-Well absorbed orally
diazepam onset 30-60 min
-Peak effects usually occur in 1 to 2 hours (valium slow)
-Duration last 2 to 3 hours
-Given IM midazolam and lorazepam onset 1 to 5 min

Active metabolites increase the effective half-life

36
Q

what benzos are all injectable ?

A

Midazolam (Versed)

Diazepam (Valium)

Lorazepam (Ativan)

37
Q

__________ only available in injectable (only water soluble) can be given intranasal

A

Midazolam

38
Q

_______ poorly absorbed via IM injection

A

Diazepam

39
Q

Benzodiazepines
 what is better than injectable ?

A

Oral

40
Q

Benzodiazepines adverse effects ?

A

Respiratory depression

Retrograde amnesia (why midazolam used preoperatively)

Orthostatic hypotension
Constipation, nausea, vomiting, diarrhea
CNS effects of ataxia, drowsiness, dizziness, slurred speech, confusion, somnolence

41
Q

Benzodiazepines prescribing considerations ?

A

DEA schedule IV controlled substance

Beers Criteria in elderly

Addictive property

Not a primary therapy

Not effective comorbid depression

Lethal when used with alcohol or other CNS depressants

Impaired driving / cognitive skills 1mg alprazolam = BAC 0.15

42
Q

Benzo OD tx. ?

A

Flumazeril (Romazicon)

43
Q

Benzodiazepines BBW ?

A

watch for seizures with chronic use and withdrawal, prepare seizure management

44
Q

Flumazeril (Romazicon)

dosing ?

A

0.2 mg IV q min x 1 to 5 doses

45
Q

Selective serotonin reuptake
inhibitors (SSRIs) examples ?

A

fluoxetine (Prozac

paroxetine (Paxil)

sertraline (Zoloft)

citalopram (Celexa)

Escitalopram (Lexapro)

46
Q

Selective serotonin reuptake
inhibitors (SSRIs) BBW ?

A

Increased suicide risk in children, adolescents, and young adults w/ major depressive or other psychiatric disorders

**suicide risk in kids **

47
Q

Selective serotonin reuptake
inhibitors (SSRIs) pharmacokinetics ?

A

Significant first pass metabolism by liver

Excreted by Kidneys

Half-life 24 hours average

Prozac half-life 4-6 days, effects up to 14 days
MUCH LONGER HF

48
Q

Selective serotonin reuptake
inhibitors (SSRIs) adverse reactions ?

A

Aggitation, insomnia, headache, nervousness, sedation, tremor

Serotonin syndrome

  • Nausea / Vomiting
  • Anorgasmia in both men and women
  • Ejaculatory disturbances in men
49
Q

Serotonin Syndrome ?

A

Myoclonus (intermittent jerking or twitching)

Hyperreflexia (greater in upper limbs)

Increased heart rate
Shivering
Sweating
Dilated pupils

50
Q

Serotonin Syndrome , other information ?

A

abnormalities such as hyperactive bowel sounds, high blood pressure and hyperthermia

temperature as high as 40°C (104°F)

Mental changes include hypervigilance or insomnia and agitation

include metabolic acidosis, rhabdomyolysis, seizures and renal failure

Seen in OD and MDMA’s (Ecstasy)

**almost like encephalopathy with a fever

check a CK-MM ( if this is high then check CR) **

51
Q

Venlafaxine pharmacokinetics ?

A

Metabolized Liver

Excreted Urine

52
Q

Venlafaxine PO dosing ?

A

Start: 37.5-75 mg PO qd, incr. by 75 mg/day q4-7 days

Max: 225 mg/day

Info: give w/ food; may open cap, but do not cut/crush/chew/dissolve contents

53
Q

Venlafaxine taper dose by no more than ?

A

75 mg/wk to D/C

**dont abrutply stop it cause they will get the worse flu like sxs. they ever had **

54
Q

Venlafaxine BBW ?

A

Increased suicidality risk in children, adolescents, and young adults w/ major depressive or other psychiatric disorders

55
Q

Trazodone (DESYRYL) 
 pharmacokinetics ?

A

Metabolized liver

Excreted in urine

56
Q

Trazodone (DESYRYL) 
50 mg ?

A

light orange circle

57
Q

Trazodone (DESYRYL) 100 mg ? 


A

white circle

58
Q

Trazodone (DESYRYL) 
150 mg ?

A

light orange bar

59
Q

Trazodone (DESYRYL) 
PO dosing ?

A

Start: 25-50 mg PO bid-tid, may incr. by 50 mg/day q3-4 days

Max: 400 mg/day if outpatient
600 mg/day if inpatient

Info: taper dose gradually to D/C

**start low and go slow **

60
Q

Trazodone (DESYRYL) 
BBW ?

A

Increased suicidality risk in children, adolescents, and young adults w/ major depressive or other psychiatric disorders

61
Q

Bupropion (Wellbutrin SR, Zyban) 
 PO dosing ?

A

Start: 150 mg PO qam,
Increase after 3 days

Max: 400 mg/day

Info: do not cut/crush/chew tab

62
Q

Bupropion (Wellbutrin SR, Zyban) 
BBW ?

A

Monitor for serious neuropsychiatric events including behavior change, hostility, agitation, depression, and suicidality

Worsening of preexisting psychiatric con’d
-pts taking bupropion for smoking cessation and after discontinuation

63
Q

Bupropion (Wellbutrin SR, Zyban) 
BBW pt. 1 ?

A

Some cases possibly complicated by nicotine withdrawal symptoms

Reported in patients who continue to smoke while taking bupropion

Weigh bupropion risks vs. benefits of smoking cessation

64
Q

Bupropion (Wellbutrin SR, Zyban) 
 PO dosing smoking cessation ?

A

Start: 150 mg PO qd x3 days

Max: 300 mg/day

Info: separate doses by at least 8h

last dose no later than 6pm

stop smoking after 5-7 days of tx

do not cut/crush/chew tab

65
Q

Mirtazapine (Remeron) PO dosing ?

A

Start: 15 mg PO qhs; Info: taper dose gradually to D/C

66
Q

Mirtazapine (Remeron) BBW ?

A

Increased suicidality risk in children, adolescents, and young adults w/ major depressive or other psychiatric disorders

67
Q

Duloxetine (Cymbalta)


 pharmacokinetics ?

A

Metabolized by Liver

Excreted in Urine

68
Q

Duloxetine (Cymbalta) PO dosing ?

A

Start: 15 mg PO qhs

Info: taper dose gradually to D/C

69
Q

Duloxetine (Cymbalta) BBW ?

A

Increased suicidality risk in children, adolescents, and young adults w/ major depressive or other psychiatric disorders

70
Q

Lithium side effects related to serum level ?

A

Nausea / Vomiting

Tremor

Muscle weakness

Hyper-reflexia

Drowsiness

Increased thirst and urinary
frequency

Hypokalemia

71
Q

Lithium levels > 4 = ?

A

Impaired renal function

Decreased consciousness, seizures, or life-threatening dysrhythmias, regardless of lithium levels

**difference is how fast it is metabolized off **

72
Q

Levels are _____ mEq/L, significant confusion is noted, or the expected time to reduce levels to ____ mEq/L is more than 36 hours

A

> 5.0

< 1.0

**difference is how fast it is metabolized off **

73
Q


Lithium Toxicity
 treatment ?

A

Supportive therapy is the mainstay treatment

Protect airway

Seizure control with benzo’s

Gastric lavage if < 1 hour

IV Fluid therapy (Watch CHF patients)

Monitor electrolytes

Dialysis if needed

Lithium OD are bad as soon as you lavage then get them to the ICU

Pharmacology (Dale Turley) (31 decks)

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