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1
Q

Neurotransmitter Function
* Acetylcholine ->
* Dopamine ->
* Endorphin ->
* GABA ->
* Glutamate ->
* Serotonin ->
* Epi/Norepi ->

A
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2
Q

Wt loss med indications

A
  • BMI ≥ 30
  • BMI ≥ 27 + 1 WT-related comorbidity (HTN, Dyslipidemia, DM)
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3
Q

Short-Term Anorexiants

A
  • Phentermine (Adipex-P)(C-IV)
  • Diethylpropion (Tenuate)(C-IV)
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4
Q

Long-Term Anorexiants

A
  • Phentermine/Topiramate (Qsymia)(C-IV)
  • Lorcaserin (Belviq)(C-IV)
  • Naltrexone/Bupropion (Contrave)
  • Liraglutide (Saxenda)/Semaglutide(Wegovy)
  • Orlistat (Xenical Rx only)(Alli OTC)
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5
Q

Phentermine (Adipex-P) & Diethylpropion (Tenuate):
Take _____ to prevent insomnia

A

in the morning

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5
Q

CI to CNS Sympathomimetics

  • Phentermine, Diethylpropion
  • Phentermine/Topiramate
A
  • Uncontrolled HTN
  • Hyperthryoidism
  • Glaucoma
  • Anxiety, Agitation, Psychosis
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6
Q

Diethylpropion (Tenuate)
- MOA?
- ADR?
- DOA?

A
  • MOA: Sympathomimetic effect in CNS -> decr appetite
  • SE: Tachy, agitation, incr BP, Insomnia, tremor, psychotic ss
  • DOA: 12wk, used to jumph start diets
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6
Q

Lorcaserin (Belviq)
- MOA?
- SE?

A
  • MOA: Activates serotonin receptors (5-HT2c) -> satiety
  • SE: Nausea, Fatigue, Hypoglycemia, Blood Dyscrasias

  • 17lb/yr wt loss
    • SEROTONIN SYNDROME RISK
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7
Q

Naltrexoe/Bupropion CI

A
  • Seizures
  • Uncontrolled HTN
  • Opiods
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8
Q

Diabetics should be started on a _____ dose of Liraglutide/Semaglutide if taking for wt loss

Higher or Lower?

A

LOWER

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9
Q

Orlistat brand names
- Rx only =
- OTC =

A
  • Rx only = Xenical
  • OTC = Alli
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10
Q

Orlistat
- MOA?
- SE?
- Considerations?

A
  • MOA: inhibits fat absorption from food
  • SE: abd pain, bowel uregency, bowel incontinence, freq shitting
  • MAX 30% daily kcal from fat
  • take MULTIVITAMIN bc decr vit/mineral absorption
  • Some drugs may not be absorbed as well in the GI tract
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11
Q

List the WT LOSS Meds by least to most effective (lb/yr lost)

A
  • Orlistat (Xenica, Alli) -> 13 lb/yr
  • Lorcaserin (Belviq) -> 17 lb/yr
  • Naltrexone/Bupropion (Contrave) -> 17 lb/yr
  • Liraglutide/Semaglutide -> 21 lb/yr
  • Phentermine/Topiramate -> 32 lb/yr
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12
Q

If there is little to no WT LOSS after 12wk -> consider _____

A

discontinuing med

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13
Q

OTC wt loss supplements dont work very well and incr your risk for _____

A

CVD

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14
Q

Seizure vs Epilepsy

A
  • Seizure = brief disturbance in brain electrical activity (SINGULAR INCIDENT)
  • Epilepsy = neurological condition with RECURRENT seizures
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15
Q

Define these siezures:
- Partial Seizure
- Grand mal Seizure
- Petite mal or absence Seizure

A
  • Partial Seizure = Focal onset (+ Aware or Impaired awareness)
  • Grand mal = Generalized onset + Impaired awareness + Motor
  • Petite mal or Absence Seizure = Generalized onset + Impaired Awareness + Non-motor
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16
Q

Mechanisms of Anticonvulsants

A
  • inhibit voltage-gated Na & Ca channels
  • enhance inhibitory effects of GABA
  • decr excitatory effect of Glutamate
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17
Q

Overall SE of Anticonvulsants

A
  • CNS depression -> dizzy, sleepy, slow, fatigue
  • SUICIDE
  • Avoid using with meds that decr Seziure Threshold (Bupropion, Tramadol, Varenicline, Lithium, B-lactam ABX)
  • Decr Ca & Vit D -> +/- supplememts
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18
Q

1st Line Tx options for Generalized Onset Sz:
- Motor (Grand Mal)?
- Non-motor (Absence/Petit Mal)?

A

MOTOR (GRAND MAL)
- Lamotrigine
- Levetiracetam
- Valproic acid

NON-MOTOR (ABSENCE/PETIT MAL)
- Ethosuximide
- Valproid acid

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19
Q

1st line tx options for ALL FOCAL Sz?

Same for focal motor and non-motor (partial sz) & focal = to bilateral tonic-clonic

A
  • Carbamazepine, Oxcarbazepine
  • Lamotrigine
  • Levetiracetam
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20
Q

What is Status Epilepticus?

A

Seziure lasting >5min or continguous seizures w/o full recovery of consciousness b/w Sz

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21
Q

Status Epileptical Tx
1. Initial?
2. Maintenance?
3. Refractory?

A

INITIAL Tx
- Lorazepam (Ativan) IV
- Midazolam (Versed) IM
- Diazepam (Valium) IV

MAINTENANCE Tx
- Fosphenytoin (Cerebyx)
- Valproid Acid (Depacon)
- Levetiracetam (Keppra)
- Phenobarbital (Luminal)

REFRACTORY Tx
- ADD alt from #2
- Pentobarbital (Nembutal)
- Medazolam (Versed) Infusion
- Propofol (Diprivan)

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22
Q

6 types of Na CBs used as Anticonvulsants

A
  1. Phenytoin (Dilantin), Fosphenytoin (Cerebyx)
  2. Carbamazepine (Tegretol), Oxcarbazepine (Trileptal), Eslicarbazepine (Aptiom)
  3. Lamotrigine (Lamictal)
  4. Topiramate (Topamax)
  5. Zonisamide (Zonegran)
  6. Rufinamide (Banzel)
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23
Phenytoin (Dilantin) vs Fosphenytoin (Cerebyx)
* Fosphenytoin is more water soluble and can be infused at a faster rate
24
________ is more water soluble and can be infused at a faster rate | Phenytoin (Dilantin) or Fosphenytoin (Cerebyx)?
Fosphenytoin (Cerebyx) ## Footnote 100-150mg/min
25
Chronic Phenytoin use may lead to - ____ Syndrome - ____ and ____ toxicity
- DRESS Syndrome = drug rxn with systemic SS & Eosinophilia (TOO MANY) - Neuro & Cardiac toxicity
26
Pt taking Phenytoin presents with gingival hyperplasia, peeling rash, and blisters of mouth and eyes. What is this complication?
Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)
27
Carbamazepine (Tegretol), Oxcarbazepine (Trileptal), and Eslicarbazepine (Aptiom) have a BBW for?
- Agranulocytosis - Aplastic anemia
28
Which of the following is a weaker inducer that causes less drug-drug interxns, is not an autoinducer, and has NO monitoring req? - Carbamazepine (Tegretol) - Oxcarbazepine (Trileptal) - Eslicarbazepine (Aptiom)
Oxcarbazepine (Trileptal)
29
Which of the following is an autoinducer, req monitoring (4-12mcg/mL), and may cause SJS/TEN? - Carbamazepine (Tegretol) - Oxcarbazepine (Trileptal) - Eslicarbazepine (Aptiom)
- Carbamazepine (Tegretol)
30
Lamotrigine (Lamictal) - MOA: Na CB & ____ inhibitor - _______ incr it's [conc] by 100% - _______ & _____ decr it's [conc] by 40%
- MOA: Na CB & **Glutamate** inhibitor - **Valproic acid** -> incr [conc] by 100% - **Phenytoin & Carbamazepine** -> decr [conc] by 40%
31
Which Na CB Anticonvulsant also enhances GABA, is a Glutamate inhibitor, and may cause **HYPERAMMONEMIA, WT LOSS, METABOLIC ACIDOSIS, & KIDNEY STONES**
**TOPIRAMATE (TOPAMAX)**
32
Which Na CB Anticonvulsant is this? - Also blocks Ca channels - SE: decr concentration, WT loss, Hyperammonenmia, Metabolic Acidosis, Kidney stones - AVOID IN PTS WITH SULFA ALLX
**ZONISAMIDE (ZONEGRAN)**
33
Which Na CB Anticonvulsant is this? - prolongs the inactive state of Na channels - SE: EKG CHANGES, GI, Change in vision, Tremor, Rash - **adjunct in Tx in Lennox-Gastaut Syndrome (LGS)**
RUFINAMIDE (BANZEL)
34
4 GABA Enhancing Anticonvulsants
1. Valproic acid (Depacon), Divalproex (Depakote) 2. Benzos (Ativan, Versed, Valium, Klonopin, Onfi) 3. Tiagabine (Gabitril) 4. Phenobarbital (Luminal), Pentobarbital (Nembutal), Primidone (Mysoline)
35
Which GABA Enhancing Anticonvulsant causes **HYPERAMMONEMIA, HAIR LOSS, WT GAIN, HEPATOTOXICITY?**
Valproic Acid (Depacon) & Divalproex (Depakote)
36
Give ____ to Tx HYPERAMMONEMIA d/t Valproic Acid (Depacon) or Divalproex (Depakote)
Levocarnitine (Carnitor)
37
ALL Benzo Anticonvulsants are schedule (C-___)
C-IV
38
Which GABA Enhancing Anticonvulsant may incr risk for **INFX**?
Tiagabine (Gabitril) | SE: INFX, GI, Tremors, Rash
39
Is Phenobarbital (Luminal) or Pentobarbital (Nembutal) higher up on the drug schedule? | which is more controlled?
**Pentobarbital (Nembutal) = C-II** Phenobarbital (Luminal) = C-IV
40
Is Phenobarbital (Luminal) hepatotoxic or nephrotoxic? is monitoring required>
Hepatotoxic (inducer) Monitor: 10-40mcg/mL
41
Perampanel (Fycompa) - MOA? - Use? - SE?
- MOA: Glutamate Inhibitor (AMPA Receptor ANTAGONIST) - Use: Anticonvulsant - SE: Psychosis, Irritable, Agitation, WT Gain
42
2 Ca Channel Blocking Anticonvulsants
* Ethosuximide (Zarontin) * Gabapentin (Neurontin), Pregabalin (Lyrica)
43
Gabapentin was designed to mimic the neurotransmitter GABA. HOWEVER, it does NOT bind to GABA receptors. It works as an Anticonvulsant bc it inhibits the alpha-2-delta subunit of ____ channels
Calcium
44
Ethosuximide (Zarontin) - MOA - SE
- MOA: T-type CCB - SE: Psychosis, Irritable, Agitation, WT Gain
45
Which is a controlled substance in ALL states *except OHIO*? - Gabapentin (Neurontin) - Pregabalin (Lyrica)
Pregabalin (C-V) | Gabapentin is only controlled in OHIO (C-V)
46
Which 2 Anticonvulsants bind to the SVZA protein in the brain
Levetiracetam (Keppra) & Brivaracetam (Briviact)
47
Lacosamide (Vimpat) - Anticonvulsant of Unknown Mechanism - MOA? - SE? - Class schedule?
- MOA: Modulates Na Channels - SE: EKG Changes, Vision Changes, GI - (C-V)
48
What is the ONLY weed-like Med that is FDA approved for seizures? - Schedule?
Cannabidiol (Epidiolex) - (C-V)
49
Z-Hypnotics: Eszopiclone (Lunesta), Zolpidem (Ambien), Zaleplon (Sonata) You must commit to ____ - ____Hr of sleep
7-8Hr
50
"Z" Hypnotics and Benzos should only be used for ____ for sleeping DOs
90 days or less
51
Which Antidepressant can be used as a sleep aid and causes HypoTN and Priapism?
Trazodone
52
4 Antidepressants that can be used as sleep aids
1. Trazodone (Desyrel) 2. Amitriptyline (Elavil) 3. Mirtazapine (Remeron) 4. Doxepin (silenor)
53
Which OTC/Herbal Sleep aid causes **HEPATOTOXICITY?**
VALERIAN ROOT
54
Is melatonin better for sleep induction or regulation of sleep-wake cycle?
regulation of sleep-wake cycle? ## Footnote it does NOT induce sleep
55
Modafinil and Armodafinil MOA
Decr dopamine reuptake -> incr Dopamine avail (Non-CNS stimulant)
56
Sodium Oxybate (Xyrem) - MOA? - Must give 2nd dose when ______ - schedule?
- MOA: Mimics GABA -> CNS Depression - Give 2nd dose a few hrs into sleep - C-III. C-I if used illicitly as date-rape drug
57
Tx for Migraines 1. ACUTE? 2. 6/4/3 days & NO/MOD/SEVERE Disability?
1. OTC -> Triptans -> Ergots 2. Migraine Prophylaxis, Triptans or Ergots PRN
58
When can you ADD biologics for migraines?
* 4-7 migraine days + MOD Disability * 8-14 days with NO Disability + Poor response to 2 prophylaxis Tx
59
Which 2 classes of Migraine meds cause Tingling/Numbness & Warm/Cold Sensations
Triptans Ergots

Pharmacology (14 decks)

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