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NCS Prep > NCS Pharmacology > Flashcards

NCS Pharmacology Flashcards

1
Q

Absorption, distribution, metabolism, and excretion all have to do with what pharmacological principle?
a. pharmacokinetics
b. pharmacodynamics
c. dose response

A

a. pharmacokinetics

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2
Q

what organ metabolizes medications for the body

A

the liver

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3
Q

what organ is in charge of medication excretion

A

the kidneys

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4
Q

how does exercise affect pharmacokinetics

A

head increases absorption and can shunt blood away from the liver and kidneys

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5
Q

exercise affects all parts of pharmacokinetics except
a. absorption
b. distribution
c. metabolism
d. excretion

A

b. distribution

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6
Q

the dose response relationship and therapeutic index of a drug is an example of what pharmacological principle
a. pharmacokinetics
b. pharmacodynamics

A

b. pharmacodynamics

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7
Q

what neurotransmitter is associated with Alzheimer’s
a. Acetylcholine
b. Dopamine
c. Norepinephrine
d. GABA

A

a. acetylcholine

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8
Q

what neurotransmitter is associated with psychosis
a. Acetylcholine
b. Dopamine
c. Norepinephrine
d. GABA

A

b. dopamine

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9
Q

what neurotransmitter is associated with depression
a. Acetylcholine
b. Dopamine
c. Norepinephrine
d. GABA

A

c. norepinephrine

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10
Q

what neurotransmitter is associated with anxiety
a. Acetylcholine
b. Dopamine
c. Norepinephrine
d. GABA

A

d. GABA

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11
Q

what neurotransmitter is associated with seizures
a. Acetylcholine
b. Dopamine
c. Norepinephrine
d. GABA

A

d. GABA

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12
Q

what neurotransmitter is associated with spasticity
a. Acetylcholine
b. Dopamine
c. Norepinephrine
d. GABA

A

d. GABA

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13
Q

what neurotransmitter is associated with Parkinsons
a. Acetylcholine
b. Dopamine
c. Norepinephrine
d. GABA

A

b. and d. (ACh and DA do opposite things in the brain)

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14
Q

Bob is a 55yo man recently diagnosed with Parkinsons. his symptoms currently include tremor and some brady/akinesia. what medication is he likely prescribed
A. sinemet
b. parlodel (dopamine agonist)
c. selegiline (MAOB inhibitor)
d. Tasmar (COMT inhibitor)
e. anticholinergic

A

b. dopamine agonist as this is the primary monotherapy for persons with PD under 65 when symptoms are more than just a tremor

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15
Q

Bob is a 55yo man recently diagnosed with Parkinsons. his symptoms currently include tremor and some brady/akinesia. what medication is he likely prescribed
A. sinemet
b. parlodel (dopamine agonist)
c. selegiline (MAOB inhibitor)
d. Tasmar (COMT inhibitor)
e. anticholinergic

A

e. anticholinergic as this is the monotherapy for persons with PD under 70 with only tremor

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16
Q

Bob is a 72yo man recently diagnosed with Parkinsons. his symptoms are significant and include tremor and some brady/akinesia. what primary medication is he likely prescribed
A. sinemet
b. parlodel (dopamine agonist)
c. selegiline (MAOB inhibitor)
d. Tasmar (COMT inhibitor)
e. anticholineric

A

a. sinement

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17
Q

Bob is a 72yo man recently diagnosed with Parkinsons. his symptoms are significant and include tremor and some brady/akinesia. what medication(s) is he not likely to take
A. sinemet
b. parlodel (dopamine agonist)
c. selegiline (MAOB inhibitor)
d. Tasmar (COMT inhibitor)
e. anticholineric

A

b. dopamine agonist and e. anticholinergic as these are for younger persons <66 and <70

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18
Q

Bob is a 65yo man recently diagnosed with Parkinsons. his symptoms currently include tremor but he does not want to start sinemet to hold off on the side effects with prolonged use. which drug(s) is he likely to be prescribed
A. sinemet
b. parlodel (dopamine agonist)
c. selegiline (MAOB inhibitor)
d. Tasmar (COMT inhibitor)
e. anticholineric

A

c. MAOB inhibitor to reduce motor symptoms and delay need for sinemet
e. anticholinergic as <70 and no other symptoms besides tremor

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19
Q

Bob is a 63yo man recently diagnosed with Parkinsons. he is currently taking a dopamine agonist to manage his symptoms. which of the following is the correct list of side effects associated with this medication?
a. GI distress, N/V, postural hypotension, arrhythmia, anxiety/depression/confusion/hallucination, dyskinesia and choreoathetoid movements after 5 years
b. impulse control disorders
c. GI distress
d. liver damage
e. dry mouth and skin, tachycardia, dilated pupils, slowed GI

A

b. impulse control disorders

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20
Q

Bob is a 63yo man recently diagnosed with Parkinsons. he is currently taking a dopamine agonist to manage his symptoms. his wife has noticed that he has started to gamble again and has had increased online shopping habits. what do you tell her
a. this is common with persons with parkinson
b. this is a coping mechanism as he was recently diagnosed
c. this is a side effect of the dopamine agonist
d. he likely was suppressing these habits and the parkinsons is preventing the suppression

A

c. this is a side effect of the dopamine agonist

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21
Q

Bob is a 66yo man recently diagnosed with Parkinsons. he is currently taking sinemet to manage his symptoms. which of the following is the correct list of side effects associated with this medication?
a. GI distress, N/V, postural hypotension, arrhythmia, anxiety/depression/confusion/hallucination, dyskinesia and choreoathetoid movements after 5 years
b. impulse control disorders
c. GI distress
d. liver damage
e. dry mouth and skin, tachycardia, dilated pupils, slowed GI

A

a. GI distress, N/V, postural hypotension, arrhythmia, anxiety/depression/confusion/hallucination, dyskinesia and choreoathetoid movements after 5 years

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22
Q

Bob is a 66yo man recently diagnosed with Parkinsons. he is currently taking amantadine to manage his symptoms. which of the following is the correct list of side effects associated with this medication?
a. GI distress, N/V, postural hypotension, arrhythmia, anxiety/depression/confusion/hallucination, dyskinesia and choreoathetoid movements after 5 years
b. impulse control disorders
c. GI distress
d. liver damage
e. dry mouth and skin, tachycardia, dilated pupils, slowed GI

A

a. GI distress, N/V, postural hypotension, arrhythmia, anxiety/depression/confusion/hallucination, dyskinesia and choreoathetoid movements after 5 years

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23
Q

Bob is a 66yo man recently diagnosed with Parkinsons. he is currently taking anticholinergics to manage his symptoms. which of the following is the correct list of side effects associated with this medication?
a. GI distress, N/V, postural hypotension, arrhythmia, anxiety/depression/confusion/hallucination, dyskinesia and choreoathetoid movements after 5 years
b. impulse control disorders
c. GI distress
d. liver damage
e. dry mouth and skin, tachycardia, dilated pupils, slowed GI

A

e. dry mouth and skin, tachycardia, dilated pupils, slowed GI

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24
Q

Bob is a 66yo man recently diagnosed with Parkinsons. he is currently taking MAOB inhibitors to manage his symptoms. which of the following is the correct list of side effects associated with this medication?
a. GI distress, N/V, postural hypotension, arrhythmia, anxiety/depression/confusion/hallucination, dyskinesia and choreoathetoid movements after 5 years
b. impulse control disorders
c. GI distress
d. liver damage
e. dry mouth and skin, tachycardia, dilated pupils, slowed GI

A

c. GI distress

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25
Q

Bob is a 66yo man recently diagnosed with Parkinsons. he is currently taking COMT inhibitors to manage his symptoms. which of the following is the correct list of side effects associated with this medication?
a. GI distress, N/V, postural hypotension, arrhythmia, anxiety/depression/confusion/hallucination, dyskinesia and choreoathetoid movements after 5 years
b. impulse control disorders
c. GI distress
d. liver damage
e. dry mouth and skin, tachycardia, dilated pupils, slowed GI

A

d. liver damage

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26
Q

Bob is a 72yo man diagnosed with mild cognitive impairment. He asks you why his doctor prescribed him statins. what is your response
a. statins are neuroprotective
b. persons with MCI are not typically physically active so he is trying to minimize comorbidities

A

a. statins are neuroprotective

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27
Q

Bob is a 72yo man diagnosed with Alzheimers. he is currently taking donepezil (cholinesterase inhibitor) to slow the progression of the disease. is this drug associated with significant side effects?

A

yes - nausea, vomiting, weight loss, GI distress, generalized pain, fatigue, dizziness

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28
Q

Bob is a 72yo man diagnosed with Alzheimers. he is currently taking memantine (Namenda) to slow the progression of the disease. is this drug associated with significant side effects?

A

no

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29
Q

Bob is a 72yo man diagnosed with moderate to severe Alzheimers. what medication is likely in his chart

A

memantine (Namenda)

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30
Q

Bob is a 72yo man diagnosed with mild Alzheimers. what medication is likely in his chart

A

cholinesterase inhibitor

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31
Q

what are the cholinesterase inhibitors for Alzheimer’s

A

donepezil (Aricept)
galantamine (Razadyne)
rivastigmine (Exelon - daily transdermal patch)

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32
Q

Bob is having a hard time taking his Alzheimer’s medications regularly. what do you tell the pt and caregiver

A

as the MD about rivastigmine (Exelon - daily transdermal patch)

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33
Q

what are the anticholinergics for Parkinsons

A

trihexyphenidyl, benztropine (Cogentin)

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34
Q

what are the COMT inhibitors for Parkinsons

A

entacapone (Comtan), tolcapone (Tasmar)

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35
Q

what are the MAOB inhibitors for Parkinsons

A

selegiline (Eldepryl, Emsam)

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36
Q

what are the dopamine agonists for parkinsons

A

bromocriptine (Parlodel), pramipexole (Mirapex), ropinirole (Requip)

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37
Q

what medications are prescribed for anxiety

A

benzodiazepines such as Alprazolam (Xanax), chlodiazepoxide (Librium), diazepam (Valium), lorazepam (Ativan)

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38
Q

a patient you have been seeing has started to take a new anti anxiety medication what side effects are you looking for and what concerns do you have for their function/PT implications

A

dizziness, sedation, ataxia difficulty with speed and accuracy
risk for falls

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39
Q

what are the 2 classes of psychosis meds and what do they do

A

typical and atypical
typical treats the positive psychotic symptoms such as presence of hallucinations delusions or paranoia
atypical treats the negative psychotic symptoms such as inability to experience pleasure in normal activity, social interaction, and limited speech

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40
Q

what are the typical antipsychosis meds

A

Chlorpromazine (Thorazine), haloperidol (haldol), fluphenazine (prolixin), thioridazine (Mellaril)

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41
Q

what are the side effects for the typical antipsychosis meds

A

they depend on what kind of drug they are
SE for anticholinergic: dry mouth, blur vision, constipation, urinary retention, tachycardia
SE for antiadrenergic: orthostatic hypotension, dizziness, sedation
SE for histamine: sedation, weight gain

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42
Q

what are the PT implications for typical anti psychosis meds

A

monitor vitals, promote hydration, watch for tartive dyskinesia (repetitive involuntary movement of the face)

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43
Q

what are the atypical antipsychosis meds

A

Clozapine (clozaril), olanzapine (Zyprexa), quetiapine (seroquel), risperidone (risperdal), aripiprazole* (Abilify*)

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44
Q

what are the side effects of the atypical antipsychosis meds

A

SE: weight gain, hyperglycemia, lipid abnormalities (except for Abilify *)

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45
Q

what are the PT implications for the typical antipsychosis meds

A

monitor vitals, promote hydration, watch for tartive dyskinesia (repetitive involuntary movement of the face)

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46
Q

what are the 2 generations of anti depression meds

A

first generation are MAOI and tricyclics
second generation are SSRIs and SNRIs

47
Q

why are second generation anti depression meds prescribed more frequently

A

they are just as effective and have less adverse side effects

48
Q

what is the mechanism of action for tricyclics

A

inhibits the reuptake of norepinephrine and serotonin in the brain

49
Q

what are the tricyclics

A

Amitriptyline (Elavil), desipramine (Norpramin), imipramine (Tofranil)

50
Q

what are the side effects of tricyclics

A

think about what would happen since they block NE aka adrenergic, ACh and histamine
dry mouth, blur vision, constipation, urinary retention, tachycardia; orthostatic hypotension, dizziness; sedation, weight gain

51
Q

why are tricyclic anti depressants potentially so dangerous

A

it has a narrow therapeutic index thus needs close monitoring as there is a risk of adverse effects/poisoning

52
Q

what is the mechanism of action of MAOIs

A

inhibit MAOa and MAOb to prevent breakdown of norepinephrine, dopamine, serotonin

53
Q

what are the MAOI drugs

A

Isocaroxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate)

54
Q

why are MAOIs potentially so dangerous

A

food drug interaction causing increased blood pressure resulting in headache or stroke

55
Q

nkwhat are the side effects of MAOIs

A

think about CNS excitation
restlessness, irritability, sleep loss, orthostatic hypotension, dry mouth

56
Q

what is the most widely used type of anti depression med

A

SSRIs

57
Q

what is the most widely used anti depression med and why

A

citalopram or Celxa as there are less drug drug interactions

58
Q

what are the SSRI drugs

A

Citalopram (Celxa), fluoxetine (prozac), fluvoxamine (luxor), paroxetine (paxil), sertraline (zoloft), escitalopram (lexapro)

59
Q

does SSRI increase your risk for suicide

A

no definite answer

60
Q

what is the mechanism of action for SSRIs

A

serotonin reuptake inhibitor

61
Q

what is the mechanism of action of SNRIs

A

serotonin and norepinephrine reuptake inhibitor

62
Q

what are the SNRIs

A

Venlafazine (Effexor), duloxetine (Cymbalta), desvenlafaxine (Pristiq)

63
Q

what are the PT implications for SNRIs

A

think about the NT it is affecting
monitor cardiovascular changes particularly blood pressure

64
Q

true or false: all seizures are a result of reduced inhibition of a brain area

A

false - it is either reduced inhibition or over excitation

65
Q

how do you describe seizures

A

partial aka focal or generalized
simple aka consciousness intact or complex where there is a loss of consciousness
tonic-clonic, tonic, clonic, absence, atonic, myoclinic

66
Q

what is the most common type of seizure

A

tonic clonic (generalized) seizure

67
Q

what anti seizure medication is the primary and most commonly prescribed drug for all seizures except absence seizures

A

Phentoin aka dilantin

68
Q

what is the mechanism for phentoin aka dilantin

A

blocks sodium current

69
Q

what are the side effects for phentoin

A

this is the most commonly prescribed seizure med because the side effects do not induce CNS depression
rash, excessive hair growth, hepatitis, gingival hyperplasia, coarsening of facial features, hyperglycemia, osteomalacia, arrhythmia, hypotension, excitation of cerebellar vestibular system resulting in nystagmus

70
Q

what is the second most commonly prescribed seizure medication

A

carbamazepine aka tegretol

71
Q

true or false: tegretol aka carbamazepine is effective for generalized seizures

A

false - effective for partial seizures

72
Q

what is the mechanism of action for carbamazepine aka tegretol

A

blocks sodium current

73
Q

what are the side effects of carbamazepine aka tegretol

A

drowsiness, fatigue, vertigo, ataxia, diplopia, hyperirritability, respiratory depression, GI N/V, dry mouth, rash, hypernatremia so heart failure and syncope, hypo or hypertension

74
Q

what are the drugs prescribed as anti seizure medications

A

Phenytoin (dilantin), Carbamazepine (tegretol), Phenobarbital (luminal) (barbiturate), Valproate (depakene), Ethosuzimide (Zarontin), Lamotrigine (Lamictal), Gabapentin (neurontin), Tiagabine (gabitril), Topiramate (topamax), Zonisamide (zonegran), Levetiracetam (keppra)

75
Q

if a patient is taking an antiseizure medication, what drug drug interactions do you have to look out for

A

warfarin, oral contraceptives, calcium channel blockers, some chemo drugs

76
Q

what is status epilepticus

A

when the pt has 30min of continuous seizures or multiple in 30min without regaining consciousness
this is a medical emergency

77
Q

your patient with TBI had a bout of seziures while in the hospital and is now medically managed with an anti seizure medication. they ask you typically how long people have to take it. what do you say

A

you must be seizure free for 2-5 years with normal EEG or neuro exam testing

78
Q

what is the mechanism of action of phenobarbital

A

increases the threshold for neuronal firing and enhances GABA inhibition

79
Q

what is a pro of phenobarbital

A

longer half life so do not need to take as frequently

80
Q

what are the side effects of phenobarbital

A

CNS depression

81
Q

what is the drug of choice for absence seizures

A

valproate aka depakene

82
Q

what is the mechanism of action for valproate aka depakene

A

increases GABA and inhibits its reuptake

83
Q

what are the side effects of valproate aka depakene

A

drowsiness, dizziness, sedation, HA

84
Q

what is the mechanism of action of ethosuzimide aka zarontin

A

blocks calcium channels in the thalamus
blocks current that generates absences seizures

85
Q

what are the side effects of ethosuzimide aka zarontin

A

headache, fatigue, GI distress

86
Q

your patient begins to have absences seizures that originate from the thalamus. what medication is the neurologist likely to prescribe

A

ethosuzimide aka zarontin

87
Q

your patient who is being medicated for partial seizures is not having good management. what medication can be used as an adjucnt

A

lamotrigine aka lamictal
tiagabine aka gabitril

88
Q

what is the mechanism of action for lamotrigine aka lamictal

A

unknown but may block sodium channels

89
Q

what is the mechanism of action for tiagabine aka gabitril

A

inhibition of the uptake of GABA

90
Q

what is the mechanism of action for topiramate aka topamax

A

blocks sodium current and enhances action of GABA

91
Q

what is the mechanism of action for zonisamide aka zonegran

A

inactivates sodium channels and delays reopening

92
Q

what is the mechanism of action for levetiracetam aka keppra

A

mechanism unknown

93
Q

why do a lot of neurologist prescribe keppra

A

fewer drug drug interactions

94
Q

what are the types of agents for spasticity management

A

central agents and peripheral agents

95
Q

what are the central agents for spasticity management

A

diazepam aka valium
baclofen aka lioresal
tizanidine aka zanaflex

96
Q

what are the peripheral agents for spasticity management

A

dantrolene sodium aka dantrium
botox

97
Q

what is the mechanism of action for diazepam aka valium

A

CNS depression
increases response time for muscles by binding to chloride GABA channels

98
Q

what are the side effects of diazepam aka valium

A

drowsiness, fatigue, ataxia

99
Q

what is the mechanism of action for baclofen aka lioresal

A

similar to GABA but does not bind to receptors
influences release of monoamines
CNS depression

100
Q

what are the side effects for baclofen aka lioresal

A

CNS depression, somnolence, ataxia, cardiovascular depression

101
Q

what are the risks for intrathecal baclofen

A

infection, overdose, withdrawal

102
Q

during an intrathecal trial, what is the expected response in order to determine success

A

there should be a 1 point MAS change in 1 hour of bolus administration

103
Q

what is the mechanism of action for tizanidine aka zanaflex

A

alpha 2 adrenergic agonist
increases inhibition of motor neurons

104
Q

what are the side effects of tizanidine aka zanaflex

A

somnolence, asthenia or abnormal weakness, dizziness, dry mouth, hypotension within 1 hour peaking 2-3 hours after administration

105
Q

your patient is taking tizanidine aka zanaflex for spasticity management. knowing the time of effects of the drug, what should you educate the patient about and what should you be looking for?

A

BP will be reduced 1 hour after taking the medication but will peak 2-3 hours after administration
monitor vitals

106
Q

what is the mechanism of action for dantrolene sodium aka dantrium

A

interferes with calcium flux at sarcoplasmic reticulum altering excitation contraction coupling

107
Q

what are the side effects of dantrolene sodium aka dantrium

A

drowsiness, dizziness, generalized weakness

108
Q

your patient has recently been newly prescribed dantrolene sodium aka dantrium for spasticity management. you know this affects specific muscles. what change in muscle function should you expect?
a. this affects LE over UE
b. this affects UE over LE
c. this affects fast twitch over slow twitch
d. this affects slow twitch over fast twitch

A

c. this affects fast twitch over slow twitch

109
Q

what is the mechanism of action for botox

A

blocks ACh release at the neuromuscular junction

110
Q

true or false: botox provides temporary change

A

false - botox creates permanent change however pt often need more than one injection as new junctions grow

111
Q

your patient is going to get a botox injection for the first time. they if this is going to provide permanent effects. what do you tell them?
a. it causes permanent changes with permanent effects
b. it causes permanent changes with temporary effects for 3-8 months
c. it causes permanent changes with temporary effects for 1-2 years
d. it causes permanent changes with temporary effects for 3-8 weeks

A

b. it causes permanent changes with temporary effects for 3-8 months

111
Q

your patient began taking baclofen for spasticity management 2 days ago. they complain that they are not seeing any benefit. what do you tell them?
a. keep taking it as prescribed as new drug takes 4-7 days to show effects
b. keep taking it but double the dose to increase effects
c. return to your doctor and tell them its not working

A

a. keep taking it as prescribed as new drug takes 4-7 days to show effects

112
Q

your patient began taking baclofen for spasticity management 45 days ago. they complain that they are not seeing any benefit. what do you tell them?
a. keep taking it as prescribed as new drug takes 4-7 days to show effects
b. keep taking it but double the dose to increase effects
c. return to your doctor and tell them its not working

A

c. return to your doctor and tell them its not working

NCS Prep (26 decks)

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