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Pharm2 S.Horvath > neuropsych > Flashcards

neuropsych Flashcards

1
Q

which drug is mainly used for trigeminal neuralgia and neuropathic pain

A

carbamazepine

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2
Q

what is the treatment of choice for status epileptics?

A

benzos (midazolam, lorazepam, diazepam)

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3
Q

what is carbamazepine’s relationship to the CYP system

A

CYP3A4 inducer and substrate.

it induced it’s own metabolic,, reduces its own levels. has an active metabolite.

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4
Q

all of the “mazepines” carry a risk of _____

A

hyponatremia

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5
Q

oxycarbazepine has a ___ risk of drug/drug interactions as carbamazepine because it is a ___ inducer of CYP3A4

A

lower, weaker

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6
Q

which “mazepine” has a prodrug

A

eslicarbazepine

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7
Q

which drug can have severe cardiac side effects because it is a 1B anti arrhythmic

A

phenytoin

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8
Q

which drug has very specific fetal abnormalities including celt palate/lip, congenital heart disease, slowed growth rate, mental deficiency

A

phenytoin

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9
Q

which drug is often used in combo with depakote for mood stabilization

A

lamotrigine - lamictal

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10
Q

which drug has higher rates of true psychosis and insomnia than some of our newer safer sz meds

A

lamotrigine

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11
Q

which med is used mainly in kids for absence seizures

A

zonisamide

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12
Q

which med carries the risk of terrible skin damage (stevens johnsons)

A

lamotrigine & carb

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13
Q

which sodium channel med does not affect cyp430

A

lamotrigine

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14
Q

lacosamide is pregnancy category __

A

C

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15
Q

what is the benzo of choice for seizure prophy

A

clobazam (onfi)

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16
Q

which benzo has an incredibly high rate of benzo withdrawal

A

clobazam (onfi)

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17
Q

which benzos are very lipohillic and move into the CNS redials, good for rescue therapy, tx of tremors

A

diazepam, clonazepam, lorazepam

valium, clon, ativan

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18
Q

which benzos are used PRN for anxiety attacks

A

triazolam, alprazolam, temazepam

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19
Q

which drug is a gaba transaminase inhibitor and has the risk of permanent vision loss

A

vigabatrin

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20
Q

which ones are GABA agents

A

depakote lyrica neurontin`

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21
Q

which glutamate blocker is rarely used due to fatal hepatic failure

A

felbamate

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22
Q

which drug used for neuropathy is found to reduce post op pain and opiate requirements

A

gabapentin

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23
Q

which drug has more ataxia type side effects

A

pregabalin

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24
Q

T/F Different forms of valproic acid do not have different effects/side effects

A

TRUE they are just diff salt forms

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25
Q

which TCA is used to treat neuropathies

A

amitriptyline (elavil)

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26
Q

what kind of side effects are concerning with TCA’s

A

anticholinergic and cardiac (1A)

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27
Q

where are 5HT1 receptors located

A

blood vessels and CNS

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28
Q

which drug has diabetes-like side effects

A

lithium

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29
Q

which drug tricks the body into thinking that it is sodium and alters neuronal sodium transport thus slowing down the action potential

A

lithium

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30
Q

what is the MOA of nuplazid

A

5HT2A antagonist

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31
Q

what is the indication of nuplazid

A

single indication for parkinson’s but NOT a dopinergic agent.

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32
Q

T/F Depth of anesthesia plays a major role in post-op delirium

A

FALSE- insufficient evidence to show this

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33
Q

what did the STRIDE trial show

A

limiting the level of sedation provided no significant benefit in reducing incident delirium,….. subgroup showed that lighter sedation levels reduced post op delirium for LESS sick patients.

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34
Q

when is the only time giving benzos for post op delirium is appropriate?

A

etoh withdrawal

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35
Q

T/F PO haldol does not reduce delirium in acutely hospitalized older adults. haldol does not reduce mortality in critically ill adults at high risk of delirium.

A

TRUE!

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36
Q

the MOA of a sodium channel blocker is to stabilize them in the ____ state

A

INACTIVE. slowing down the firing, stop the overstimulation leading to sz, psychosis, mania

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37
Q

how do GABA enhancers work

A

increased chloride movement… continue to suppress firing off, pushing it into a more hyper polarized state.

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38
Q

which drugs are sodium channel blockers?

A

“azepine’s”, phenytoin, lamotrigine, zoninamide, lacosamide

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39
Q

which drugs cause stevens-johnsons

A

carbamazepine and lamotrigine

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40
Q

which “azepine” should you adjust in renal impairment

A

eslicarbazepine

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41
Q

rank the “azepines” in terms of side effects

A

carb>oxy>esli

42
Q

which drug is metabolized with non-linear pharmacokinetics (zero order)

A

phenytoin

43
Q

small dose changes are really important with ____ because of the narrow therapeutic index

A

phenytoin

44
Q

which drug causes gingival hyperplasia?

A

dilantin - overgrowth of the gums

45
Q

dilantin is a CYP ___ and ___

A

inducer and substrate

46
Q

which sodium channel blocker is the safest

A

lacosamide (vimpat)

47
Q

which drug is a gaba reuptake inhibitor and causes emotional lability

A

tiagabine

48
Q

what is the MOA of pregabalin?

A

GABA analogue, binds alpha2 and delta receptor sites - reduced release of excitatory Its via calcium currents

49
Q

___ is a category D-X because it causes lower IQ in children compared to other anti-epileptics

A

VPA

50
Q

which drug can cause hepatotoxicity, thrombocytopenia, and hyperammonemia?

A

VPA

51
Q

how do glutamate blockers work (felbamate, topiramate, perampanel)

A

glutamate is an excitatory type neurotransmitter working at NMDA receptor - so by blocking that, we slow down an excitatory process which can stop a seizure or stop a migraine in the case of topamax

52
Q

which drug is rarely used in the US because of its high risk of plastic anemia and fatal hepatic failure

A

felbamate

53
Q

which drug has a BB warning for serious or life threatening psychiatric and behavioral adverse effects? - aggression hostility, irritability, anger, homicidal ideation, threats

A

perampanel

54
Q

what is the MOA of TCA’s?

A

serotonin and norepi rey-take inhibition , anticholinergic, 1A antiarrhythmic

55
Q

which drug class is often used fo pain, not depression and has anticholinergic and CV side effects (QT)?

A

TCA’s

56
Q

which SSRI has anticholinergic side effects

A

paroxetine (paxil)

57
Q

which serotonin receptors are inhibitory?

A

1,5 (decreasing cMAP)

58
Q

serotonin receptors are primarily ____, but ___ is ion chenneled

A

g-coupled, 5HT3

59
Q

T/F if you hold an SSRI you need to restart ASAP

A

true

60
Q

T/F SSRI’s can cause platelet aggregation, thrombocytopenia, GI upset, hyponatremia

A

TRUE

61
Q

s/s of serotonin syndrome

A

rigidity, elevated temps, accelerated htn , mass confusion

62
Q

duloxetine, venlafaxine, desvenlafaxine, levomilnacipran are all examples of

A

SNRI’s

63
Q

SNRI’s have all the potential serotonin effects with added ___ effects

A

norepi - hypertension

64
Q

an example of a DNRI is ____

A

bupropion (wellbutrin)

65
Q

which drug is used for depression as well as a modulator with ADHD meds to promote attention

A

bupropion

66
Q

mirtazepine, nefazodone, trazodone, vilazodone are examples of

A

5HT2A antagonists

67
Q

what is the main concern with nuedexta (dextromethophan/quinidine)

A

drug interactions! quinidine is a 2D6 inhibitor

68
Q

Which drug is used for pseudobulbar affect (laughing or crying in response to inappropriate stimuli)

A

neudexta

69
Q

which drug has lupus side effects that present as chest pain, costrocondritis

A

neudexta

70
Q

you should not give NSAIDs with ____

A

lithium

71
Q

what is the diff between first and second gen antipsychotics?

A

first gen are very sedating bc they are dopaminergic only blockers

second gen are S2D2 blockers

72
Q

what dopamine pathway do positive symptoms come from?

A

mesolimbic

73
Q

what dopamine pathway do negative symptoms come from?

A

mesocortical

74
Q

what dopamine pathway do EPS, TD symptoms come from?

A

nigrostriatal

75
Q

what dopamine pathway does hyperprolactinemia come from?

A

tuberohypophyseal

76
Q

too little dopamine cause ___

A

parkinsons

77
Q

what is the black box warning with antipsychotics

A

dementia related death and agranulocytosis

78
Q

why do you give carbidopa with levodopa

A

because If we give levodopa alone, the majority of it is broken down before it can even get to the CNS. so by giving carbidopa, we are trying to trick the enzymes into breaking down the carbidopa instead of the levodopa

79
Q

which drug is a COMT inhibitor

A

entacapone. given in combo:

carbidopa/levodopa/entacapone (stalevo)

80
Q

levodopa is a

A

dopamine precursor

81
Q

carbidopa is

A

false dopamine

82
Q

T/F. dopamine analongs have the side effects of too much dopamine. agitation, psychosis, insomnia, hallucinations, hypotension.

A

TRUE

83
Q

which drugs are used second line for movement disorders and parkinsons

A

anticholinergics - benztropine & trihexyphenidyl

84
Q

which drug class is commonly used for restless leg syndrome

A

dopamine agonists. (think parkinson’s is from too little dopamine).. pramipexole, ropinirole, rotigotine, bromoriptine, apomorphine

85
Q

how do MOAB inhibitors work?

A

increase DA availability via enzyme inhibition - therefore more dopamine in circulation to prevent the side effects that come with lack of dopamine

86
Q

which drug is indicated for parkinson’s but is not a dopinergic agent

A

nuplazid

87
Q

which drug is a 5HT2A antagonist

A

nuplazid

88
Q

donepezil, galantamine, and rivastigmine are examples of

A

acetylcholinesterase inhbitors

89
Q

which drug is a NMDA receptor antagonist (slows down excitatory process)

A

namenda

90
Q

do acheEi have fight/flight or rest/digest side effects

A

rest/digest

91
Q

achei ____ succs and ___ roc

A

potentiates with succs, reduced blockade with roc.

92
Q

T/F The 2014 AGS Guidelines for Older Adults stated that post-op delirium may be fatal, is preventable in up to 40% of cases. may be hypo or hyperactive or mixed presentation, and almost 50% not reported (particularly hypoactive)

A

TRUE

93
Q

how does hypoactive delirium present?

A

slow reflexes, slow to respond, mass confusion

94
Q

delirium vs dementia

A

delirium: rapid onset, quick confusion, potential agitation
demential: long term cognitive decline and reduced function

95
Q

which med has a drug interaction with VPA

A

lamotrigine

96
Q

T/F Depth of anesthesia plays a major role in post op delirium

A

FALSE

97
Q

T/F Regional anesthesia plays a major role in reducing post op delirium

A

FALSE

98
Q

T/F Lighter sedation levels benefit post op delirium proven only for less sick patients

A

true

99
Q

T/F Haldol does not reduce mortality in critically ill adults at high risk of delirium

A

TRUE

100
Q

when is the only time you should use benzos post op

A

ETOH withdrawal

Pharm2 S.Horvath (13 decks)

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