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Neuro Modulators Flashcards

1
Q

What are the Amphetamine-based stimulants?

A

Amphetamine
Dextroamphetamine
Methylphenidate

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2
Q

What are the indications for amphetamine?

A

ADHD

Narcolepsy

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3
Q

How does amphetamine treat narcolepsy?

A

Keeps the CNS running at a high rate of activity

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4
Q

What is the MOA of amphetamine?

A

Stimulates CNS via a sympathomimetic mechanism involved the enhanced release and reduced reuptake of norepinephrine and dopamine

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5
Q

What are the common side effects of amphetamine?

A 
Photosensitivity
Visual disturbance
Elevated BP
Infection
Headache
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6
Q

What are the serious side effects of amphetamine?

A 
Dependency
Abuse
Psychosis
Growth suppression
Heart failure
Steven's-Johnson syndrome
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7
Q

Amphetamines increase the release of what at the synaptic cleft?

A

Biogenic amines

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8
Q

Why are photosensitivity and visual disturbance common with amphetamine use?

A

Can cause mydriasis

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9
Q

What is the effect produced by the interaction of CAIs and amphetamine?

A

Renal excretion decreased in alkaline urine

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10
Q

What is the effect produced by the interaction of sympathomimetics and amphetamine?

A

Hypertensive crisis

Arrhythmia

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11
Q

What is the effect produced by the interaction of ophthalmic beta-blockers and amphetamine?

A

Hypertensive crisis

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12
Q

What is the effect produced by the interaction of NSAIDs and amphetamine?

A

Caffeine-based additive effects

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13
Q

When would be a situation in which it might be common to see an issue with amphetamine and sympathomimetic interactions?

A

A narcoleptic being treated for glaucoma (glaucoma drugs are often sympathomimetics

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14
Q

When is amphetamine contraindicated?

A

With glaucoma

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15
Q

What is the biogenic amine theory for antidepressants?

A

There is a deficiency in monoamines (norepinephrine and serotonin)

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16
Q

SSRIs are designed not to influence which monoamine?

A

Norepinephrine

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17
Q

Which monoamine is acted on my SNRIs?

A

Both norepinephrine and serotonin

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18
Q

What kind of antidepressant is imiparmine?

A

TCAD

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19
Q

What is MAO responsible for?

A

Biogenic amine degradation

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20
Q

What are the 6 SSRI antidepressants?

A 
Escitalopram
Sertaline
Fluoxetine
Paroxetine
Fluvoxamine
Citalopram
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21
Q

Which SSRI is the “s” enantiomer of citalopram?

A

Escitalopram

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22
Q

The majority of SSRI antidepressants end in what suffix?

A

-ine

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23
Q

What is the indication for Excitalopram (SSRI)?

A

Major depressive disorder

Generalized anxiety disorder

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24
Q

What is the MOA of escitalopram?

A

SSRI

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25
Q

What are the common side effects of escitalopram?

A

Dizziness

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26
Q

What are the distinguishing side effects of escitalopram?

A

Suicidal risk
Serotonin syndrome
Neuroleptic malignant syndrome
Siezures

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27
Q

What is neuroleptic malignant syndrome?

A

High levels of serotonin in the body - life threatening

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28
Q

Why might escitalopram cause dry eye?

A

Fight and flight turns off all the body’s glands, except the sweat glands, causing a lack of tear production

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29
Q

What are the effects of an interaction between NSAIDs and Escitalopram? (Omega-3s as well)

A

Hemorrhage risk

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30
Q

What are the effects of an interaction between ophthalmic beta blockers and escitalopram?

A

Reduced beta-blocker metabolism

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31
Q

What are the three SNRI antidepressants?

A

Duloxetine
Venlofoxine
Desvenlofoxine

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32
Q

SNRIs aren’t selective for which monoamine?

A

Serotonin

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33
Q

What is the MOA for duloxetine?

A

SNRI

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34
Q

What are the common side effects of Duloxetine?

A 
Blurred vision
Headache
Dizziness
Sweating
ED
HTN
Orthrostatic hypotension
Syncope
Yawning
Constipation
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35
Q

What are the distinguishing adverse effects of duloxetine?

A

Serotonin syndrome

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36
Q

What are the possible hypersensitivity reactions to duloxetine?

A

Angioedema

Steven’s-Johnson syndrome

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37
Q

What are the ocular side effects of duloxetine?

A

Glaucoma

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38
Q

Angioedema from Duloxetine can masquerade as what?

A

Preseptal cellulitis

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39
Q

What is the effect of an interaction between opioids and duloxetine?

A

Additive

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40
Q

What is the effect of an interaction between NSAIDs/omega-3/6s and duloxetine?

A

Hemorrhage

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41
Q

What is the effect of an interaction between beta-blockers and duloxetine?

A

Reduced beta-blocker metabolism, causing a toxic build up of beta-blockers

42
Q

What cautions come with duloxetine?

A

Bleeding risk

Angle closure glaucoma

43
Q

What are the three atypical antidepressants?

A

Trazadone
Nefazadone
Bupropion

44
Q

What is the MOA of trazodone?

A 
Selective Serotonin (5-HT) Reuptake inhibitor (SSRI)
Adrenergic alpha-1blocker and 5-HT_2A/C blocker
45
Q

What are the common adverse effects of trazodone?

A

Headache
Dizziness
Blurred vision
Ocular irritation

46
Q

What are the distinguishing side effects of trazodone?

A

Suicidal ideation

5-HT syndromw

47
Q

What are the effects of cyclosporine/macrolides/azoles when they interact with Trazodone?

A

QT prolongation and impaired hepatic metabolism - rising levels of trazodone

48
Q

What are the effects of NSAIDs when they interact with trazodone?

A

Hemorrhage

49
Q

What causes mania?

A

Excess of norepinephrine, serotonin, and dopamine

50
Q

What are the indications for Quetiapine?

A

Schizophrenia

Bipolar disorder

51
Q

What is the MOA of quetiapine?

A

Antagonizes D2 receptors and 5-HT receptors

Ancillary effects may arise from antagonism of H1 and alpha 1

52
Q

What is H1?

A

Histamine receptor

53
Q

What is 5-HT2?

A

Serotonin type 2 receptors

54
Q

What is D2?

A

Dopamine type 2 receptors

55
Q

Which generation anti-psychotic is quetiapine?

A

2nd generation

56
Q

What does quetiapine antagonize?

A

Both dopamine and serotonin

57
Q

What are the ocular side effects of Quetiapine?

58
Q

What are the muscular side effects of quetiapine?

A

Extrapyramidal symptoms

59
Q

What are the interactions of Macrolides/azoles, CsA with quetiapine?

A

Prolonged QT segment

60
Q

What is the effect of classic anti-histaminics interacting with quetiapine?

A

Additive CNS depression

61
Q

What are the 1st generation antipsychotics?

A

Haloperidol
Chlorpromazine
Thioridazine

62
Q

First generation antipsychotics are selective for what?

63
Q

Which is the more potent 1st generation antipsychotic?

A

Haloperidol

64
Q

What are the ocular side effects to 1st generation antipsychotics?

A

Cataracts

Retinopathy

65
Q

Chlorpromazine and thioridazine have additional ocular side effects beyond the usual cataracts. What are they?

A

Night blindness

Salt and pepper fundus

66
Q

What are the common adverse effects of lithium?

A

Blurred vision

67
Q

What are the severe adverse effects of lithium?

A

Seizures
Bradycardia
Idiopathic intracranial hypertension
Diabetes IN

68
Q

Why should NSAIDs be taken in conjunction with Lithium?

A

NSAIDs increase lithium level by reducing renal excretion

69
Q

What is the effect of the interaction of Lithium with either NSAIDs or tetracyclines?

A

Increased lithium levels

70
Q

What is the effect of the interaction of caffeine or CAIs with lithium?

A

Reduced lithium because of diuresis (caffeine is a diuretic)

71
Q

Alzheimer’s patients have a significant loss of what in the temporal lobe?

A

Cholinergic neurons

72
Q

Most of the drugs used to treat Alzheimer’s are what?

A

Acetylcholinesterase inhibitors (AChE)

73
Q

Why has Tacrine been largely discontinued to treat Alzheimer’s?

A

Severe hepatotoxicity

74
Q

Most of the Alzheimer therapy drugs have which suffix?

75
Q

What is the indication for Donepezil?

A

Alzheimer Dementia

76
Q

What is the MOA of Donepezil?

A

Indirect acting - reversibly binds to and inactivates ACh-ase

77
Q

What are the common adverse effects of Donepezil?

A

Headache
Dizziness
Arthridis

78
Q

What are the serious side effects of Donepezil?

A 
Seizures
Dream disturbances
Hemolytic anemia
AV block
Bradycardia
Syncope
79
Q

What is the effect of a cholinergic agent interacting with Donepezil?

80
Q

If an anticholinergic interacts with Donepezil, what happens?

A

An antagonistic effect

81
Q

Donepezil and NSAIDs put you at risk of what?

A

Hemorrhage

82
Q

What are the two anti-parkinson therapies?

A

Carbidopa + Levodopa

Bromocriptine

83
Q

What is Sinemet?

A

Levodopa + cabidopa for Parkinson’s disease

84
Q

What is the MOA for levodopa?

A

Dopamine precursor that crosses the BBB and enhances dopamine synthesis

85
Q

What is the MOA for carbidopa?

A

Inhibits dopa decarboxylose, preventing it from degrading levodopa to dopa

86
Q

The majority of drugs in the anziolytics and hypnotics category act where?

A

GABAa receptor - the CNS’s major inhibitory neurotransmitter

87
Q

What is the most common type of anxiolytic/hypnotic?

A

Benzodiazepines

88
Q

Is a high therapeutic index good or bad?

89
Q

Which is short acting, alprazolam, or midazolam?

90
Q

What is the MOA of Alprazolam?

A

Selectively binds the BZD site on GABAa receptors, enhancing GABA effects, leading to Cl influx and hyperpolarization

91
Q

Does Alprazolam actually stimulate the receptor?

A

No, it enhances GABA effects

92
Q

What are the common adverse effect of Alprazolam?

A 
Diplopia
Drowsiness
Anterograde amnesia
Confusion
Dizziness
Hypotension
93
Q

What are the possible hypersensitivity reactions to Alprazolam?

A

Stevens-Johnson syndrome

Angioedema

94
Q

How does Alprazolam interact with cyclosporine/azoles/erythromycins?

A

Reduces alprazolam metabolism

95
Q

What happens with chlorpheniramin, diphendydramine/opioids interact with Alprazolam?

A

Additive effect

96
Q

Alprazolam essentially does what to the CNS?

A

Depresses it

97
Q

What are the contraindications for Alprazolam?

A

Unstable Myasthenia Gravis

98
Q

What is the indication for Zolpidem?

A

Insomnia (it is Ambien)

99
Q

What is the MOA of Zolpidem?

A

Selective agonist of GABAa-BZD-1 receptor

100
Q

What are the adverse effects of Zolpidem?

A 
Headache
Sinusitis
Pharyngitis
Anmesia
Suicidal ideation
Aggression
Hallucinations
101
Q

What happens if you take cyclosporine/azoles with Zolpidem?

A

Zolpidem metabolizm is reduced, leading to a build up

102
Q

What happens if you take Zolpidem with opioids or antihistaminics?

A

Additive effect

Systemic Pharm (15 decks)

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