Final exam Review

Answer 1

D1 receptors activate (+Gs) adenylyl cyclase = excitatory

D2 receptors inhibit (Gi) adenylyl cyclase, activate K+ currents (increase K+ conductance and supress Ca2+

currents (supress Ca2+ conductance)

The actions of dopamine in the brain are mediated by a family of dopamine receptors.

*D1 and D2 receptors are abundant in the striatum and are the most important receptor sites with regard to the causes and treatment of Parkinson’s disease.

Question 2

which Parkinsons drug can cause: uncontrollable somnolence. (which requires discontinuation of the medication).

Answer 2

NONERGOT DOPAMINE AGONISTS

Pramipexole

Ropinirole

Rotigotine

Question 3

Nonergot dopaminergic agonist. FDA-approved as rescue therapy for the acute treatment of “off” episodes of akinesia in patients on dopaminergic therapy. Administered SC.

Answer 3

APOMORPHINE

Question 4

name that drug

similar to zolpidem in its hypnotic actions.

Causes fewer residual effects on psychomotor and cognitive functions compared to zolpidem or the benzodiazepines. (This may be due to its rapid elimination, with a half-life of approximately 1 hour.)

Metabolized by aldehyde oxidase and CYP3A4.

Answer 4

ZALEPLON

act only on the BZ1 subtype of benzodiazepine receptors; these are GABAA receptors that contain α1 subunits.

***use if a pt has anxiety+insomnia and wants “minimal daytime sedative effects”

Question 5

ANTIEPILEPTIC DRUG with an AE of

Gingival hyperplasia

Answer 5

Phenytoin

Question 6

ANTIEPILEPTIC DRUG with an AE of

Rash, Stevens-Johnson syndrome. Should be discontinued at the first sign of rash.

*black box warning*

Answer 6

Lamotrigine

Question 7

The drugs of choice for absence seizures are

Answer 7

ethosuximide and valproate.

Question 8

List the 3 CYP450 inducers in the list of anti-epileptics which would naturally mean these 3 carry the hightest risk of Newborn Hemmorrhagic Disease

Answer 8

Phenobarbital

Phenytoin

Carbamazepine

Question 9

fetal exposure to older antiepileptic drugs, particularly ________and _______, is associated with congenital anomalies.

_____________ is associated with the highest risk of congenital malformations, and with developmental delay.

Answer 9

valproate and phenobarbital,

valproate

Question 10

whats protocol for treating status epilepticus

Answer 10

Question 11

Myoclonic Seizures DOC

Answer 11

Valproate is the drug of choice.

Question 12

Na+ channel inhibitor

AE: hepatoxicity (measure LFTs)

CI in pregnancy

used for Migraine prophylaxis, Myoclonic seizures, bipolar

Question 13

Tx for Febrile Convulsions

Answer 13

diazepam given IV or as a rectal solution.

Question 15

pt was on Fluoxetime (SSRI) for depression but now has sexual dysfunction, which antidepressant is KNOWN well for NOT being associated with sexual AE and whyyyy

Answer 15

bc its not serotinergic

BUPROPION

NDRI Norepi Dopamine Reuptake inhibitor==> more release of both

Question 16

FLUID rentions and weight gain are an AE effect of this drug, therefore it is CI in pts with class III or IV CHF

• FDA requires Hepatotox monitoring
• this drug specifically shows significant improvements in LIPID PROFILE

__name that drug__

Answer 16

PIOGLITAZONE

Question 17

AE of Benztropine

Park your Mercedes-Benz.

Answer 17

Dry mouth, urinary retention, pupil dilation, hallucination

(Antimuscarinic; improves tremor and rigidity but has little effect on bradykinesia in Parkinson disease).

Question 18

livedo reticularis is an AE of what drug

Answer 18

Amantadine (antiviral)—Parkinsons drug

livedo reticularis (purple discoloration of skin in a lace lke pattern). goes away when discontinued

Question 19

Amitriptyline

nortriptyline

Phenelzine

imipramine

Clozapine

Citalopram

which ANTIDEPRESSANT above for a pt with Coronary Vasucular disease history: MI & Second Degree heart blocks

what class are each of these?

Answer 19

CItalopram (SSRI)-no CYP interactions

Phenelzine-(MAO-I: Hydrazine)-for refractory depression

Amitriptyline, nortriptyline, imipramine = TCA; Tri-C’s: Convulsions, Coma, Cardiotoxicity (arrhythmia due to Na+ channel inhibition) SO NO IN THIS PT

Clozapine-NERP, its an atypical antipsychotic

Question 20

tx for Ethylene glycol/methanol intoxication

Answer 20

Fomepizole (alcohol dehydrogenase inhibitor)

Question 21

talk about GABA and Glutamate and their activation/inhibition in relation to their effects on Epilepsy

Answer 21

if you inhibit the GABAa receptor and activate the Glutamate receptor –> + Trigger a seizure

vice versa

if you inhibit the Glutamate receptor and activate Gaba-nergic transmission –> inhibit a seizure

Question 22

SSRI’s are DOC for how many anxiety disorders, list them

Answer 22

GAD

Panic disorder (for long term)

Social anxiety disorder

OCD

PTSD

but NOT Performance anxiety —use Propanolo for that!

Benzo’s are used in ACUTE situations UNTILS SSRI’s kick in

Question 23

Nystagmus is a clinical manigestation of which Psychedelic Agent

Answer 23

PCP/Phencyclidine/angel dust

Question 24

_____________ & ___________reduce arterial pressure mainly by myocardial depression (reduced cardiac output), with little effect on peripheral vascular resistance

In contrast, _________, ____________, ______________produce greater vasodilation and have minimal effect on cardiac output.

which group of drugs may be better choices for patients with impaired myocardial function?

Answer 24

Halothane and enflurane

isoflurane, desflurane and sevoflurane (SID)

Isoflurane, desflurane and sevoflurane may be better choices for patients with impaired myocardial function.

Question 25

• ____________sensitizes the myocardium to circulating catecholamines, which may lead to ventricular arrhythmias

. This effect is less marked for isoflurane, sevoflurane and desflurane. (SID)

Answer 25

Halothane

Question 26

which one of the following RAISES ICP and which one LOWERS ICP?

Propofol

Etomidate

Ketamine

Barbituate

Answer 26

which one of the following RAISES ICP and which one LOWERS ICP?

Propofol, Etomidate & Barbituate LOWERS ICP

Ketamine RAISES ICP

Question 27

which IV anesthetic has ANTIEMETIC properties

Answer 27

Propofol

Question 28

the ONLY IV anesthetic to possess both analgesic properties and CV stimulation is….

Answer 28

KETAMINE

PCP analogs that act as dissociative anesthetics. Block NMDA receptors

Question 29

IV anesthetic Used for induction of anesthesia and short surgical procedures.

what patient population should be concerned if taking these?

Answer 29

Barbiturates (Thiopental) & (Methohexital)

Asthmatics bc AE = coughing, chest wall spasm, laryngospasm, bronchospasm

Question 30

TINNITUS is a classic AE of what type of Drug Toxicity

Answer 30

MILD Salicylate Aspirin Tox (150-200mg)

Question 31

Bipolar disorder (manic depression) tx: list most common ones

Answer 31

lithium

valproic acid

carbamazepine

atypical antipsychotics.

Question 32

Focal to massive hepatic necrosis, list the drugs that can cause this (hepatotoxicity)

think “HAVAc”

Answer 32

Halothane

Amanita phalloides (death cap mushroom)

Valproic acid

Acetaminophen

Question 33

Agranulocytosis is an AE of which

Answer 33

Clozapine (Atypical antipsychotic)

Carbamazepine (antiepileptic)

Propylthiouracil (PTU)-a thioamide

Methimazole (a thioamide)

Colchicine

Ganciclovir

Question 34

if a pt is experiencing alcohol WITHDRAWAL,

what is (are) the DOC

• how about if they are old people or have liver failure , which meds would you use and hwhy
• which of these are long, intermediate and short acting?*

Answer 34

BENZO’s

the following 2 bc of their long t1/2s

Diazepam (long acting)

Chlordiazepoxide (long acting)

if they are old or have a jacked up liver

use (bc they skip first pass met in liver)

Lorazepam (long acting)

Oxazepam (short acting)