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Pharmacy School Spring P2 > Final exam review > Flashcards

Final exam review Flashcards

1
Q

What does chronic activation of the monoamine receptors do?

A

-increases BDNF signaling
-downregulates the HPA axis

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2
Q

What medication is MAO-B selective?

A

Selegiline

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3
Q

What medication is MAO-A selective?

A

Moclobemide

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4
Q

What are the non-selective MAO inhibitors?

A

Phenelezine, Tranylcypromine

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5
Q

What must be present for a diagnosis of depression?

A

Depressed mood OR loss of interest or pleasure in doing things

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6
Q

What is SIGE CAPS?

A

S- Sleep (insomnia/hypersomnia)
I- Interest Decreased
G- Guilt/worthlessness
E- Energy loss/fatigue
C- Concentration difficulties
A- Appetite change (increase/decrease)
P- Psychomotor agitation/retardation
S- Suicidal Ideation

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7
Q

What are the SSRI medications?

A

fluoxetine, escitalopram, citalopram, paroxetine, fluvoxamine, sertraline

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8
Q

What SSRI has the most weight gain, sedation, and anticholinergic effects?

A

Paroxetine (Paxil)

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9
Q

What SSRI has more GI upset than other antidepressants?

A

Sertraline (Zoloft)

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10
Q

What SSRI has QTc prolongation (high doses)?

A

citalopram

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11
Q

What SSRI has weight loss and a long T 1/2 (96-144 hours)?

A

fluoxentine

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12
Q

What class effect adverse effects are there for the SSRIs?

A

sexual dysfunction, increased risk of bleeding (platelet inhibition), Hyponatremia (more likely in elderly)

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13
Q

What SNRI has an FDA warning for hepatotoxicity and needs slow titration due to nausea side effect?

A

Duloxetine
-obtain LFTs every 6 months or if symptomatic

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14
Q

What SSRIs/SNRIs are 2D6 inhibitors?

A

Fluoxetine, Paroxetine, Sertraline, Duloxetine, Venlafaxine (higher doses)

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15
Q

What SNRI has a fibromyalgia indication?

A

Milnacipran

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16
Q

What SNRI must be adjusted for renal impairment or strong 3A4 inhibitors?

A

Levomilnacipran

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17
Q

What SNRI has a dose-limiting side effect of nausea but no major CYP reactions?

A

Desvenlafaxine

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18
Q

What are the SNRI class effects?

A

blood pressure elevation, nausea
-can be useful in fibromyalgia, musculoskeletal pain, neuropathic pain

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19
Q

What are the TCA class effects?

A

CNS: sedation, confusion, lower seizure threshold
Cardiovascular: tachycardia, orthostatic hypotension
Anticholinergic: blurred vision, urinary retention, constipation
Other: weight gain, sexual dysfunction, narrow therapeutic index
Caution: serotonin syndrome, hypertensive crisis

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20
Q

What MAO inhibitor does not require the tyramine diet?

A

Selegiline 6mg/24 hour patch

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21
Q

What class of antidepressants requires a 2 week washout period before switching to another class (5 weeks for fluoxetine)?

A

MAO inhibitors

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22
Q

What are the bupropion clinical pearls?

A

-2D6 inhibitor, CI in seizure and eating disorders

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23
Q

What medications can be combined with SSRIs/SNRIs?

A

Bupropion, Mirtazapine

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24
Q

What are the mirtazapine clinical pearls?

A

warnings: agranulocytosis, increased cholesterol
-sedation, increased appetite (doses < 15 mg/day)

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25
Q

What are the SSRI + 5HT1A partial agonists?

A

Vilazodone, Vortioxetine
-do not use these with SSRIs/SNRIs
-nausea

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26
Q

What are the FDA approved augmentation agents for depression?

A

Aripiprazole, Brexpiprazole, Cariprazine, Quetiapine

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27
Q

What is the criteria needed for Bipolar I disorder?

A

at least 1 or more manic episodes

28
Q

What is the criteria needed for Bipolar II disorder?

A

hypomanic episodes that generally last 4 or more days

29
Q

What are the adverse effects/toxicities associated with Lithium?

A

polyuria, polydipsia (diabetes inspidus), hypothyroidism, acne, GI toxicity, ataxia, seizure, lethargy, confusion, agitation, dry mouth, weight gain, ECG changes, coarse/fine hand tremor, teratogenic (cardiac structural abnormality in 1st trimester)

30
Q

What drugs can decrease renal clearance of Lithium (increase lithium levels)?

A

ACEis, ARBS, NSAIDS, thiazide diuretics, dehyrdration

31
Q

What drugs can increase renal clearance of Lithium (decrease lithium levels)?

A

osmotic diuretics, +/- loop diuretics, caffeine

32
Q

What drugs can increase excretion of Lithium (decrease lithium levels)?

A

sodium bicarbonate, high Na intake

33
Q

What adverse effects/toxicities are associated with valproate/valproic acid/divalproex?

A

Thrombocytopenia, hyperammonemia, N/V/D, teratogenicity (neural tube defects and lower IQ in offspring), PCOS, increased appetite-weight gain, anoxeria, dyspepsia, ulceration, platelet dysfunction

34
Q

What drug interactions are important to consider for valproate?

A

Lamotrigine -increased risk for SJS

35
Q

What are important clinical pearls for carbamazepine (tegretol) in bipolar disorder treatment?

A

thrombocytopenia/hematologic effects

36
Q

What are important clinical pearls for oxcarbazepine (trileptal) in bipolar disorder treatment?

A

CYP3A4 inducer (no auto-induction), hyponatremia

37
Q

What are important clinical pearls for lamotrigine in bipolar disorder treatment?

A

-1st line treatment for depressive symptoms of bipolar; not useful for acute treatment or manic/hypomanic symptoms

38
Q

What are important clinical pearls for topiramate in bipolar disorder treatment?

A

weight loss, heat intolerance/hypohydrosis, metabolic acidosis, kidney stones, possible teratogen (cardiac structural effects), DRESS warning

39
Q

What are the FDA-approved antipsychotics for bipolar disorder treatment?

A

quetiapine, lurasidone, olanzapine/fluoxetine

40
Q

What antipsychotics are commonly used off-label for bipolar disorder treatment?

A

aripiprazole, brexpiprazole

41
Q

What clinical pearls are important to consider for use of atypical antipsychotics in bipolar disorder treatment?

A

all monitoring parameters for metabolic syndrome and movement side effects apply when used for bipolar disorder!

42
Q

What are the known/possible teratogenic medications for bipolar disorder treatment?

A

Lithium, Valproic acid, carbamazepine, topiramate

43
Q

What is periphery pain circuit system?

A

peripheral nociceptors —–> peripheral neurons ——> dorsal root ganglion ——> dorsal horn (spinal cord) ——> spinothalamic tract (ascending input) ——-> brain + nocicpetion-inhibiting neurons —–> descending modulation —–> dorsal horn (spinal cord)

44
Q

What channels and receptors are involved in temperature sensitive pain signaling?

A

Transient receptor potential cation channel (TRP)
heat sensitive: TRPV (Vanniloid)
cold sensitive: TRPM (Melastatin)

45
Q

What channels and receptors are involved in acid sensitive pain signaling?

A

Acid sensing ion channel (ASIC)
-activated by H+
-conduct Na

46
Q

What channels and receptors are involved in chemical irritant sensitive pain signaling?

A

-Histamine, Bradykinin

47
Q

What ion channels are responsible in conduction of pain signals from the periphery to the spinal cord?

A

Nav1.8 (action potential signaling along axon), Glutamate receptors, AMPA receptos, NMDA receptors

48
Q

What are the three fibers involved in transducing pain signals?

A

AB fibers- fastest, non-noxious, responds to touch, pressure
ADelta fibers- first pain sensation, cold, myelinated, fast
C-Fibers - second pain sensation, dull, aching, unmyelinated, slow

49
Q

What role does substance P play in peripheral sensitization?

A
  1. vasodilation
  2. degranulation of mast cells
  3. release of histamines
  4. inflammation and prostaglandins
    leads to increase in pain receptors and sensitization of area
50
Q

What are the two pathways thought to lead to neuropathic pain sensitization (spinal cord)?

A

spinal sensitization - increased AMPA and NMDA expression/sensitivity, glutamate
Spontaneous afferent activity- enhanced expression of Na channels, increased cellular excitability and action potential

51
Q

What type of receptors play a role in pain in the brain circuitry?

A

Mu opioid receptors
-abundant & play a role in modulation of pain signals

52
Q

What are the types of opioid receptors?

A

GPCRs
Mu -what morphine brings to
Kappa -is dysphoric, can offset euphoria of Mu receptors
Delta -no FDA approved due to seizures, can help pain, alcoholism, hyperalgesia, hibernation receptor
Nociceptan/orphanin FQ receptor

53
Q

What does CYP3A4 do in opioid metabolism?

A

CYP3A4 (four) makes opioids start with nor (less active metabolites)

54
Q

What is the endogenous opioid for Mu opioid receptors?

A

Endorphins

55
Q

What is the endogenous opioid for Kappa Opioid receptors?

A

Dynorphins

56
Q

What is the endogenous opioid for Delta Opioid receptors?

A

Enkephalins

57
Q

What is the endogenous opioid for Orphanin-Receptor-Like Subtype 1 (ORL1), Nociceptin?

A

Nociceptin/Orphanin FQ

58
Q

What role does VTA and NAc play in addiction?

A

Ventral tegemental area- source of dopamine
Nucleus accumbens -pleasure, valuation

59
Q

What are the analgesic adjuvants?

A

gabapentinoids, serotonin norepinephrine re-uptake inhibitors, tricyclic antidepressants, skeletal muscle relaxants, anti-epileptics, topical agents

60
Q

What are the non-opioid options for pain treatment?

A

acetaminophen, NSAIDs

61
Q

What is the pediatric dosing for tylenol?

A

10-15 mg/kg PO Q4H PRN
MAX: 75mg/kg/day or 3-4 g/day

62
Q

What is the pediatric dosing for Ibuprofen?

A

5-10mg/kg/day PO q4-6h PRN
MAX: 40mg/kg/day or 2400 mg whichever is less;;l

63
Q

What are the clinical pearls for ketorolac (Teradol)?

A

-max duration is 5 days (parenteral + oral formulations) due to high risk for GI bleed

64
Q

What is the recommended dosing for the Gabapentinoids?

A

Gabapentin (Neurontin)- 100-300 mg po tid MAX 3600mg/day)
Pregabalin (Lyrica) - 75 mg po bid MAX 600 mg/day (schedule V)

65
Q
A

Pharmacy School Spring P2 (11 decks)

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