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Top 200 > P3 Quiz 3 > Flashcards

P3 Quiz 3 Flashcards

1
Q

Aripiprazole

A

Abilify

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2
Q

Benztropine

A

Cogentin

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3
Q

Carbamazepine

A

Tegretol, Carbatrol, Equetro

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4
Q

Carbidopa with levodopa

A

Sinemet

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5
Q

Desvenlafaxine

A

Pristiq

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6
Q

Divalproex

A

Depakote

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7
Q

Donepezil

A

Aricept

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8
Q

Lamotrigine

A

Lamictal

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9
Q

Levetiracetam

A

Keppra

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10
Q

Lithium carbonate

A

Lithonate, Lithotabs, Lithobid

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11
Q

Lurasidone

A

Latuda

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12
Q

Memantine

A

Namenda

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13
Q

Mirtazapine

A

Remeron

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14
Q

Oxcarbazepine

A

Trileptal and Oxtellar XR

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15
Q

Paroxetine

A

Paxil

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16
Q

Phenobarbital

A

Phenobarbital

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17
Q

Phenytoin

A

Dilantin Kapseals

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18
Q

Quetiapine

A

Seroquel

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19
Q

Pramipexole

A

Mirapex

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20
Q

Risperidone

A

Risperdal

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21
Q

Topiramate

A

Topamax

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22
Q

Venlafaxine

A

Effexor

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23
Q

Aripiprazole class

A

Antipsychotic

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24
Q

Aripiprazole common FDA indications

A

Bipolar disorder, manic or mixed episodes, acute treatment: Adults, 10-15 mg po daily
Schizophrenia: Adults, 10-15 mg po daily
Depression, adjunctive with antidepressant: 2-4 mg po daily
Tourette syndrome: Children ≥6 y of age and <50 kg, 2 mg po daily, may titrate to 5-10 mg po daily; Children ≥6 y of age and ≥50 kg, 2 mg po daily, may titrate to 10-20 mg po daily
Irritability with autistic disorder: Children ≥6 y of age, 2 mg po daily × 7 d, then 5 mg po daily, may titrate to 15 mg/d

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25
Q

Aripiprazole MOA

A

Aripiprazole is an atypical antipsychotic agent (quinolinone derivative). It exhibits partial agonist activity at dopamine D2 and D3 receptors and serotonin 5-HT1A receptors and antagonist activity at 5-HT2A receptors.

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26
Q

Aripiprazole BBW

A

Dementia, suicidality

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27
Q

Aripiprazole DDI

A

CYP3A4/5 inducers- increase aripiprazole metabolism reduces aripiprazole efficacy
CYP3A4/5 , 2D6 inhibitors- decreased aripiprazole metabolism increases risk of aripiprazole toxicity

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28
Q

Aripiprazole common AE

A

Akathisia, anxiety, extrapyramidal effects, headache, increased appetite, somnolence, weight gain, hyperglycemia

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29
Q

Aripiprazole rare but serious AE

A

Slowed or difficult breathing when used in combination with opioids, compulsive behaviors, neuroleptic malignant syndrome, pancytopenia, QT prolongation, seizures, suicidal thoughts, tardive dyskinesia

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30
Q

Benztropine class

A

Antiparkinsonian, anticholinergic

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31
Q

Benztropine FDA indication

A

Extrapyramidal disease, medication-induced movement disorder: Adults, 1-4 mg po daily or bid
Parkinsonism: 1-2 mg/d po

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32
Q

Benztropine MOA

A

Benztropine possesses anticholinergic and antihistamine effects. May inhibit reuptake and storage of dopamine.

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33
Q

Benztropine MOA

A

Benztropine possesses anticholinergic and antihistamine effects. May inhibit reuptake and storage of dopamine.

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34
Q

Benztropine MOA

A

Benztropine possesses anticholinergic and antihistamine effects. May inhibit reuptake and storage of dopamine.

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35
Q

Benztropine MOA

A

Benztropine possesses anticholinergic and antihistamine effects. May inhibit reuptake and storage of dopamine.

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36
Q

Benztropine contraindications

A

Hypersensitivity to benztropine, patients <3 y of age

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37
Q

Benztropine DDI

A

Amantadine- Increased CNS toxicity
Phenothiazines- enhanced anticholinergic effects, decreased phenothiazine concentrations
Haloperidol- excessive anticholinergic effects
Thiazides- Anticholinergic agents may increase the serum concentration of thiazides
Potassium- anticholinergic agents may enhance the ulcerogenic effect of potassium

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38
Q

Benztropine common AE

A

Constipation, Nausea

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39
Q

Benztropine rare but serious AE

A

Anhidrosis, drug-induced psychosis, heat stroke, increased body temperature, tachycardia, visual hallucinations

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40
Q

Carbamazepine class

A

Anticonvulsant

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41
Q

Carbamazepine common FDA indications

A

Epilepsy, partial, generalized, and mixed types: Adults, 200 mg po bid, may titrate to 1200 mg po daily; Children <6 y of age, 10-20 mg/kg/d po in 2-4 divided doses, may titrate to 250-350 mg/d po (or 35 mg/kg/d); Children 6-12 y of age, 100 mg po bid, may titrate to 800 mg po daily
Trigeminal neuralgia: 100 mg po q12h, may titrate to 1200 mg po daily for pain control

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42
Q

Carbamazepine MOA

A

Carbamazepine acts presynaptically to block firing of action potentials, which decreases the release of excitatory neurotransmitters, and postsynaptically by blocking high-frequency repetitive discharge initiated at cell bodies.

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43
Q

Carbamazepine BBW

A

Agranulocytosis, aplastic anemia, dermatologic reactions (especially in asians), screen for HLA-B*1502

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44
Q

carbamazepine contraindications

A

Hypersensitivity to carbamazepine, history of bone marrow depression, MAOIs, nefazodone

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45
Q

Carbamazepine DDI

A

Acetaminophen- hepatotoxicity
CYP3A4/5 inducers- reduced carbamazepine efficacy
CYP3A4/5 inhibitors- decreased carbamazepine metabolism increases toxicity
CYP1A2, 2B6, 2C19, 2C8, 2C9, 3A4/5 and P-gb substrates- decreases substrate activity
Ergocalciferol- increased catabolism of vitamin D
Diuretics- increased risk of hyponatremia
Hormonal contraceptives- carbamazepine may render contraceptives less effective
MAOIs- increased risk of ergotism
Nefazodone- inhibit carbamazepine metabolism, induction of nefazodone metabolism
Warfarin- decreased anticoagulant efficacy

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46
Q

Carbamazepine common AE

A

Hyponatremia, dizziness, nausea

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47
Q

Carbamazepine rare but serious AE

A

Cardiac dysrhythmia, hepatitis, nephrotoxicity, pancreatitis, pancytopenia, Stevens-Johnson syndrome, syncope, toxic epidermal necrolysis, suicidal thoughts and behaviors

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48
Q

Carbidopa/levodopa class

A

Antiparkinsonian

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49
Q

Carbidopa/levodopa FDA indications

A

Parkinson disease: Immediate release, 25 mg/100 mg po tid, increasing dose to therapeutic response; extended release, 50 mg/200 mg po bid, separate doses by at least 6 h; extended-release capsules, 23.75 mg/95 mg po tid × 3 d, then may increase to 36.25 mg/145 mg po tid; patients generally treated with 400-1600 mg of levodopa per d; max 200 mg of carbidopa and 2000 mg of levodopa

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50
Q

Carbidopa/Levodopa MOA

A

When levodopa is administered orally, it is rapidly decarboxylated to dopamine in extracerebral tissues so that only a small portion of a given dose is transported unchanged to the CNS. For this reason, when given alone, large doses of levodopa are required for adequate therapeutic effect. However, these doses often result in nausea and other adverse reactions. Carbidopa inhibits decarboxylation of circulating levodopa, preventing nausea and allowing more levodopa to reach the CNS. Carbidopa does not cross the blood-brain barrier and does not affect the metabolism of levodopa within the CNS.

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51
Q

Carbidopa/levodopa contraindications

A

Hypersensitivity to carbidopa or levodopa, narrow-angle glaucoma, concurrent MAOI or linezolid

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52
Q

Carbidopa/levodopa DDI

A

D2 receptor antagonists (isoniazid, metoclopramide)- reduced therapeutic effect of levodopa
Linezolid- unknown, serotonin toxicity with severe HTN
MAOIs- severe HTN
Phenytoin, papaverine, iron salts- reversal of the effects of levodopa in Parkinson disease
Antihypertensive- risk of hypotension

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53
Q

Carbidopa/Levodopa common AE

A

Dyskinesia

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54
Q

Carbidopa/Levodopa rare but serious AE

A

Orthostatic hypotension, neuroleptic malignant syndrome, hallucinations, sleep attacks, compulsive behaviors

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55
Q

Desvenlafaxine class

A

SNRI

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56
Q

Desvenlafaxine FDA indications

A

Depression- 50 mg QD

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57
Q

Desvenlafaxine MOA

A

Desvenlafaxine is a potent reuptake inhibitor of serotonin and norepinephrine but lacks effects on muscarinic, α-adrenergic, or histamine receptors.

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58
Q

Desvenlafaxine BBW

A

Suicidality; not for use in children; not for bipolar disorder

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59
Q

Desvenlafaxine contraindications

A

Hypersensitivity to desvenlafaxine or venlafaxine; MAOI use

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60
Q

Desvenlafaxine DDI

A

Anticoagulants, antiplatelets, NSAIDs- increased risk of bleeding
Triptans, SSRIs, tramadol= increased risk of serotonin syndrome
Linezolid, metoclopramide, MAOI- increased risk of serotonin syndrome

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61
Q

Desvenlafaxine common AE

A

Diaphoresis, dizziness, headache, nausea, xerostomia

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62
Q

Desvenlafaxine rare but serious AE

A

GI hemorrhage, serotonin syndrome, suicidal thoughts

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63
Q

Divalproex class

A

Anticonvulsant

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64
Q

Divalproex common FDA indications

A
  1. ) Absence seizure, simple and complex: 15 mg/kg/d po, may titrate to 60 mg/kg/d; delayed-release products are dosed bid, extended-release 24 h products are dosed daily
  2. ) Complex partial epileptic seizure: 10-15 mg/kg/d po, may titrate to 60 mg/kg/d; delayed-release products are dosed bid, extended-release 24 h products are dosed daily
  3. ) Manic bipolar disorder: 25 mg/kg/d po, may titrate to 60 mg/kg/d; delayed-release products are dosed bid, extended-release 24 h products are dosed daily
  4. ) Migraine prophylaxis: Extended release 24 h, 500 mg po daily for 1 wk, then 1 g po daily; delayed release 250 mg po bid, increasing to 500 mg po bid
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65
Q

Divalproex MOA

A

Divalproex is composed of sodium valproate and valproic acid. Valproic acid is a carboxylic acid compound whose anticonvulsant activity might be mediated by an inhibitory neurotransmitter, GABA. Valproic acid might increase GABA levels by inhibiting GABA metabolism or enhancing postsynaptic GABA activity. Valproic acid also limits repetitive neuronal firing through voltage- and usage-dependent sodium channels.

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66
Q

Divalproex BBW

A

Hepatotoxicity, patients with mitochondrial disease, teratogenicity, pancreatitis

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67
Q

Divalproex Contraindications

A

Hypersensitivity to divalproex, hepatic disease, urea cycle disorders

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68
Q

Divalproex DDI

A

Aspirin, macrolides- increased valproic acid concentrations
Carbamazepine, ethosuximide, lamotrigine, rufinamide, TCAs- divalproex inhibits metabolism of these drugs, increasing toxicity
Acyclovir, carbapenems, protease inhibitors, rifampin, risperidone- decreased valproic acid conc and loss of anticonvulsants
Phenytoin, phenobarbital- altered levels of these and valproic acid levels
Olanzapine, oxcarbazepine- decreased olanzapine and oxcarbazepine concentrations
Warfarin- increased warfarin effect
Topiramate- increased hyperammonemia

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69
Q

Divalproex AE

A

Abdominal pain, alopecia, asthenia, diarrhea, diplopia, dizziness, headache, nausea, somnolence, tremor, vomiting

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70
Q

Divalproex rare but serious AE

A

Hepatitis, palpitation, pancreatitis, tachycardia, thrombocytopenia, suicidal ideation or behavior

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71
Q

Donepezil class

A

Central cholinesterase inhibitor

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72
Q

Donepezil common FDA indications

A

Alzheimer disease, dementia (mild-moderate): 5 mg po daily hs, may titrate to max 10 mg/d
Alzheimer disease, dementia (moderate-severe): 5 mg po daily qhs, may titrate to 10 mg/d at 4-6 wk to max 23 mg/d (immediate-release tablet) or 10 mg/d (disintegrating tablet)

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73
Q

Donepezil MOA

A

Donepezil enhances the action of acetylcholine by reversibly inhibiting acetylcholinesterase (AChE), the enzyme responsible for its hydrolysis. It has a high degree of selectivity for AChE in the CNS, which might explain the relative lack of peripheral side effects.

74
Q

Donepezil DDI

A

Tolterodine, oxybutynin- decreased efficacy of donepezil

Ramelteon- increased ramelteon exposure

75
Q

Donepezil common AE

A

Asthenia

76
Q

Donepezil rare but serious AE

A

Atrioventricular block, GI bleeding, torsades de pointes

77
Q

Lamotrigine class

A

Phenyltriazine anticonvulsant

78
Q

Lamotrigine common FDA indications

A

Bipolar I disorder: Adults 25 mg daily × 2 wk, then 50 mg po daily × 2 wk, then 100 mg po daily × 1 wk, then 200 mg po daily; may titrate to 400 mg po daily; regimens containing valproic acid, 25 mg po qod × 2 wk, then 25 mg po daily × 2 wk, then 50 mg po daily × 1 wk, then 100 mg po daily; regimens without valproic acid but containing carbamazepine, phenytoin, phenobarbital, primidone, rifampin, lopinavir/ritonavir: 50 mg po daily × 2 wk, then 50 mg po bid × 2 wk, then 100 mg po bid × 1 wk, then 300 mg/d po in divided doses × 1 wk, then 400 mg/d po in 2 divided doses

Partial seizure, adjunct or monotherapy, tonic-clonic seizure, Lennox-Gastaut syndrome, adjunctive: Adults and Children ≥12 y of age, immediate release, 100-500 mg/d po in 2 divided doses, extended release, 200-600 mg po daily; Children 2-12 y of age: immediate release, 1-15 mg/kg/d po in 1 or 2 divided doses, max 400 mg/d; dose initiation for combination regimens as noted above; dose titration required

79
Q

Lamotrigine MOA

A

Lamotrigine is a phenyltriazine derivative unrelated to other marketed antiepileptic drugs (AEDs). Lamotrigine inhibits voltage-dependent sodium channels, thereby stabilizing neuronal membranes and reducing the release of excitatory neurotransmitters such as glutamate and aspartate.

80
Q

Lamotrigine BBW

A

Serious skin reactions

81
Q

Lamotrigine DDI

A

Enzyme inducers, rifampin, carbamazepine- decreased lamotrigine efficacy
Escitalopram- increased risk of myclonus
Estrogen based birth controls- decreased lamotrigine concentrations
Risperidone- increased risperidone concentrations

82
Q

Lamotrigine common AE

A

Rash, ataxia, somnolence, headache, diplopia, rhinitis, nausea, vomiting, insomnia

83
Q

Lamotrigine rare but serious AE

A

Stevens-Johnson syndrome, anemia, leukopenia, disseminated intravascular coagulation, thrombocytopenia, liver failure, aseptic meningitis, suicidal thoughts

84
Q

Levetiracetam class

A

Anticonvulsant

85
Q

Levetiracetam common FDA indications

A
  1. ) Myoclonic seizure, adjunct: Children ≥12 y of age and Adults, initial, 500 mg po bid, titrate to target dose of 3000 mg/d
  2. ) Partial seizure, adjunct: Children ≥16 y of age and Adults, immediate release, initial, 500 mg po bid, max 3000 mg/d; extended release, initial, 1000 mg po qd, max 3000 mg/d; Children 4-15 y of age, immediate release, initial, 10 mg/kg po bid, max 60 mg/kg/d; Children 6 mo to 3 y of age, initial 10 mg/kg po bid, max 50 mg/kg/d; Children 1-5 mo of age, 7 mg/kg po bid, max 42 mg/kg/d
  3. ) Tonic-clonic seizure, primary generalized, adjunct: Children ≥16 y of age and Adults, initial, 500 mg po bid, titrate to target dose of 3000 mg/d; Children 6-15 y of age, initial, 10 mg/kg po bid, titrate to target dose of 60 mg/kg/d
86
Q

Levetiracetam MOA

A

Levetiracetam is a pyrrolidine derivative that is structurally unrelated to other AEDs. Its mechanism of action is unclear and does not relate to any known mechanisms of neuronal excitation or inhibition. The action of levetiracetam in animal models of seizures and epilepsy is unique from other AEDs.

87
Q

Levetiracetam DDI

A

Carbamazepine- increased carbamazepine toxicity

88
Q

Levetiracetam common AE

A

Asthenia, fatigue, headache, somnolence, vomiting, increased BP

89
Q

Levetiracetam rare but serious AE

A

Pancytopenia, hepatotoxicity, suicidal thoughts, suicide, Stevens-Johnson syndrome

90
Q

Lithium class

A

Antimanic

91
Q

Lithium common FDA indications

A

Bipolar disorder, maintenance therapy: Adults and Children >12 y of age, extended release, 900-1800 mg/d po in 2-3 divided doses; immediate release, initial 300 mg po daily, may titrate to 900-1800 mg po in 3-4 divided doses
Bipolar disorder, manic episode: Adults and Children >12 y of age, extended release, 1800 mg/d po in 2-3 divided doses; immediate release, 600 mg po tid

92
Q

Lithium MOA

A

Lithium’s mechanism of antimanic effect is unknown; it alters the actions of several second-messenger systems (eg, adenylate cyclase and phosphoinositol). Alters cation transport across cell membrane in nerve and muscle cells and influences reuptake of serotonin and/or norepinephrine; second-messenger systems involving the phosphatidylinositol cycle are inhibited.

93
Q

Lithium BBW

A

Lithium levels required

94
Q

Lithium contraindications

A

Severe debilitation, dehydration, or sodium depletion; significant cardiovascular disease; significant renal impairment; concomitant diuretic therapy

95
Q

Lithium DDI

A

Acetazolamide, sodium bicarbonate- decreased lithium conc
ACEIs, ARBs, diuretics, NSAIDs- increased risk of lithium toxicity
Agents that prolong QTc interval- additive cardiotoxicity
Antipsychotics drugs, clozapine- increased risk of AE and EPS
MAOIs- increased risk of malignant hyperpyrexia
SSRIs, linezolid- increased lithium concentrations and/or increased risk of serotonin syndrome

96
Q

Lithium common AE

A

Cardiac dysrhythmias, fine tremor, hypothyroidism, leukocytosis, thrombocytosis, xerostomia

97
Q

Lithium rare but serious AE

A

Hypotension, nephrotoxicity, seizure, hypercalcemia, hyperparathyroidism

98
Q

Lurasidone class

A

Second generation (atypical) antipsychotics

99
Q

Lurasidone common FDA label indication

A

Depressive episodes associated with bipolar disorder: Adults, 20 mg po daily, may titrate to max 120 mg po daily
Schizophrenia: Adults, 40 mg po daily, may titrate to max 160 mg/d

100
Q

Lurasidone MOA

A

Lurasidone is an atypical antipsychotic agent (benzisothiazole-derivative). It exhibits relatively high affinity for dopamine D2 receptor and serotonin 5-HT7 and 5-HT2A receptors.

101
Q

Lurasidone BBW

A

Dementia (increased mortality), suicidality

102
Q

Lurasidone contraindications

A

Hypersensitivity, concurrent CYP3A4/5 inducers and inhibitors

103
Q

Lurasidone DDI

A

CYP3A4/5 moderate inducers- increased lurasidone metabolism reduces efficacy
CYP3A4/5 inhibitors- decreased lurasidone metabolism increased risk of toxicity

104
Q

Lurasidone common AE

A

Akathisia, extrapyramidal effects, headache, nausea, somnolence

105
Q

Lurasidone rare but serious AE

A

Abnormal dreams, angioedema, bradycardia, neuroleptic malignancy syndrome, pancytopenia, seizures, suicidal thoughts, stroke, tardive dyskinesia

106
Q

Memantine class

A

NMDA receptor antagonist

107
Q

Memantine common FDA indication

A

Alzheimer disease: Immediate release, 5 mg po daily, may titrate dose no more than once per week to target dose of 10 mg po bid; extended release, 7 mg po daily, may titrate dose no more than once per week to target dose of 28 mg po daily

108
Q

Memantine MOA

A

Activation of NMDA receptors by glutamate is believed to contribute to the symptomatology of Alzheimer disease. Memantine is believed to act as an uncompetitive (open-channel) NMDA receptor antagonist that binds preferentially to the NMDA receptor-operated cation channels. There is no evidence that memantine prevents or slows neurodegeneration in patients with Alzheimer disease.

109
Q

Memantine DDI

A

Urinary alkalinizers- reduced memantine clearance

110
Q

Memantine common AE

A

None known

111
Q

Memantine rare but serious AE

A

Stevens-Johnson syndrome, DVT, hepatitis, liver failure, cerebrovascular accident, grand mal seizure, transient ischemic attack, acute renal failure

112
Q

Mirtazapine class

A

antidepressant, alpha2 antagonist

113
Q

Mirtazapine common FDA indications

A

Depression: 15 mg po daily hs, may titrate to response in 15 mg increments q1-2wk to 45 mg po daily hs

114
Q

Mirtazapine BBW

A

Suicidality, not for use in children

115
Q

Mirtazapine contraindications

A

Hypersensitivity to mirtazapine; concurrent use or use within 14 d of MAOI, linezolid, IV methylene blue use

116
Q

Mirtazapine DDI

A

CYP2D6, 3A4/5, and 1A2 inducers- decreased mirtazapine efficacy
CYP2D6, 3A4/5, and 1A2 inhibitors- increased mirtazapine toxicity
Fluoxetine, fluvoxamine, linezolid, MAOIs, olanzapine, tramadol, venlafaxine- increased risk of serotonin syndrome

117
Q

Mirtazapine common AE

A

Constipation, increased appetite, somnolence, xerostomia, increased serum cholesterol, weight gain

118
Q

Mirtazapine rare but serious AE

A

Neutropenia, suicidal thoughts, QTc prolongation, torsades de pointes

119
Q

Oxcarbazepine class

A

Dibenzapine carboxamide, anticonvulsant

120
Q

Oxcarbazepine common FDA indication

A

Partial seizure: Adults, 300 mg po bid, may titrate to 1200-2400 mg/d po (depending on formulation); Children 4-16 y of age, 8-10 mg/kg/d po in 2 divided doses, may titrate to 600 mg/d po; Children <4 y of age and <20 kg, 16-20 mg/kg/d po in 2 divided doses, may titrate to a max 60 mg/kg/d

121
Q

Oxcarbazepine DDI

A

CYP3A4/5 inducers- reduces oxcarbazepine efficacy
CYP3A4/5 inhibitors- increases oxcarbazepine toxicity
CYP3A4/5 substrates- decreases substrate concentration
CYP2C19 substrates- increase substrate activity
Carbamazepine, phenobarbital, valproic acid, verapamil- decreased oxcarbazepine concentrations
Oral contraceptives- decreased contraceptive efficacy

122
Q

Oxcarbazepine common AE

A

Somnolence, HA, diplopia, dizziness

123
Q

Oxcarbazepine rare but serious AE

A

Anaphylaxis, angioedema, Stevens-Johnson syndrome, suicidal thoughts, pancytopenia

124
Q

Paroxetine class

A

SSRI

125
Q

Paroxetine FDA indications

A

Depression: Adults, immediate release, 20 mg po daily, may titrate to 50 mg po daily; Adults, controlled release, 25 mg po daily, may titrate to 62.5 mg po daily; Children ≥8 y of age, 10-20 mg po daily
Generalized anxiety disorder: Adults, 20 mg po daily
Social anxiety disorder: Adults, 20 mg po daily; Children ≥8 y of age, 10 mg po daily
OCD: Adults, 20 mg po daily, may titrate to 60 mg po daily; Children ≥8 y of age, 10 mg po daily, may titrate to 30 mg daily
Panic disorder: Immediate release, 10 mg po daily, may titrate to 60 mg po daily; controlled release, 12.5 mg po daily, may titrate to 75 mg po daily
Posttraumatic stress disorder (PTSD): Adults, 20 mg po daily, may titrate to 50 mg po daily
Premenstrual syndrome: 12.5 mg po daily or × 14 d prior to expected start of menses, may titrate to 25 mg po daily
Vasomotor symptoms of menopause: 7.5 mg po daily at bedtime

126
Q

Paroxetine BBW

A

Suicidality

127
Q

Paroxetine contraindications

A

Hypersensitivity to paroxetine; concomitant use of thioridazine or MAOIs, pregnancy

128
Q

Paroxetine DDI

A

CYP2D6 inhibitors- increases risk of paroxetine toxicity
Antiplatelet drugs, NSAIDs- increased risk of bleeding
Triptans, dextroamphetamine, tramadol, linezolid, MAOIs, opioids- increased risk of serotonin syndrome
Clozapine- increased clozapine conc
Agents that increase QTc interval- increased risk of QTc prolongation

129
Q

Paroxetine common AE

A

Abnormal ejaculation, asthenia, constipation, diarrhea, headache, insomnia, nausea, somnolence

130
Q

Paroxetine rare but serious AE

A

Serotonin syndrome, suicidal thoughts

131
Q

Phenobarbital class

A

Long-acting barbiturate, C-IV

132
Q

Phenobarbital common FDA indications

A

Epilepsy: Adults, 50-100 mg po bid-tid; Children, 15-50 mg po bid-tid (tablet) or 3-6 mg/kg/d po (solution)
Daytime sedation: Adults, 30-120 mg po divided into 2-3 doses, may titrate to 400 mg/d; Children, 6 mg/kg/d po divided into 3 doses

133
Q

Phenobarbital MOA

A

Phenobarbital produces different degrees of depression within the CNS, from sedation to general anesthesia. It has been demonstrated to depress monosynaptic responses in the CNS only transiently, but synaptic recovery is delayed and a decrease in postsynaptic resistance is observed at some synapses.

134
Q

Phenobarbital contraindications

A

Hypersensitivity to barbiturates; marked liver function impairment; respiratory disease with evidence of dyspnea or obstruction; history of sedative or hypnotic addiction; personal or family history of acute intermittent porphyria

135
Q

Phenobarbital DDI

A

Substrates of CYP1A2, 2A6, 2B6, 2C8, 2C9, and 3A4/5- reduces substrate efficacy
CYP2C19 inducers- reduces phenobarbital efficacy
CYP2C19 inhibitors- increased phenobarbital toxicity
Barbiturates, benzodiazepines, opioids- additive CNS respiratory depression
Phenytoin- alter phenobarbital concentrations
Valproic acid- decreased valproic acid efficacy

136
Q

Phenobarbital common AE

A

None Known

137
Q

Phenobarbital rare but serious AE

A

Barbiturate withdrawal, bradyarrhythmia, megaloblastic anemia, respiratory depression, Stevens-Johnson syndrome

138
Q

Phenytoin class

A

hydantoin anticonvulsant

139
Q

Phenytoin common FDA indication

A

Seizure, generalized tonic-clonic, complex partial, or following neurosurgery, treatment, and prophylaxis: Adults, 100 mg po tid, may titrate to 200 mg po tid; doses up to 300 mg may be given once daily if capsule dosage form used; Children, 5 mg/kg/d po divided into 2-3 doses, may titrate to 300 mg/d

140
Q

Phenytoin MOA

A

Phenytoin is a hydantoin that suppresses the spread of seizure activity mainly by inhibiting synaptic posttetanic potentiation and blocking the propagation of electric discharge. Phenytoin might decrease sodium transport and block calcium channels at the cellular level to produce these actions.

141
Q

Phenytoin BBW

A

Hypotension and arrhythmias with IV administration

142
Q

Phenytoin contraindications

A

Hypersensitivity to phenytoin, sinus bradycardia, AV block

143
Q

Phenytoin DDI

A

CYP2C19, CYP2C9 inducers- reduces phenytoin efficacy
CYP2C19, CYP2C9 inhibitors- increases risk of phenytoin toxicity
Substrates of CYP2B6, 2C19, 2C8, 2C9, and 3A4/5- reduce efficacy of substrates
Acetaminophen- increased risk of hepatotoxicity
Carbamazepine, valproic acid- altered concentrations

144
Q

Phenytoin common AE

A

gingival hyperplasia

145
Q

Phenytoin rare but serious AE

A

Hepatotoxicity, pancytopenia, systemic lupus erythematosus, Stevens-Johnson syndrome, suicidal behavior, withdrawal seizures

146
Q

Pramipexole class

A

Dopamine agonist, antiparkinson

147
Q

Pramipexole common FDA indications

A

Parkinson disease: Immediate release, 0.125 mg po tid, may titrate to 0.5-1.5 mg po tid; ER, 0.375 mg po daily, may titrate to 4.5 mg po daily
Restless leg syndrome: Immediate release only, 0.125 mg po daily taken 2-3 h prior to bedtime, may titrate to 0.5 mg po daily

148
Q

Pramipexole MOA

A

Pramipexole is a nonergot-derived dopamine subtype selective agonist that exerts activity in the CNS at D2 and D3 receptors but has no activity at the D1 receptor. D2 receptors are thought to play an important role in improving the akinesia, bradykinesia, rigidity, and gait disturbances of Parkinson disease.

149
Q

Pramipexole DDI

A

Cimetidine-increased pramipexole concentrations

Antipsychotics- may reduce the effectiveness of antipsychotic or dopamine agonist

150
Q

Pramipexole common AE

A

Asthenia, dream disorder, dyskinesia, extrapyramidal movements, nausea, somnolence

151
Q

Pramipexole rare but serious AE

A

Blackouts, heart failure, impulsive behavior, melanoma

152
Q

Quetiapine class

A

Antipsychotic (atypical)

153
Q

Quetiapine FDA indication

A

Bipolar disorder or schizophrenia, therapy initiation: Adults, immediate release, 50 mg po bid × 1 d, increase 50 mg/d × 3 d, may titrate to 800 mg/d; Adults, extended release, 300 mg po hs × 1 d, then 600 mg po hs × 1 d, may titrate to 800 mg/d; Children 10-17 y of age, immediate release, 50 mg po × 1 d, then 100 mg po × 1 d, then 200 mg po × 1 d, then 300 mg po × 1 d, then 400 mg po × 1 d, may titrate to 600 mg/d
Bipolar disorder or schizophrenia, maintenance: Adults, immediate release: 400-800 mg/d po; Adults, extended release, 400-800 mg/d po; Children 10-17 y of age, regular release, titrate to lowest effective dose
Major depressive disorder, adjunct to antidepressants: Adults, extended release, 50 mg po daily hs, may titrate to 300 mg/d

154
Q

Quetiapine MOA

A

Quetiapine is an antagonist at multiple neurotransmitter receptors in the brain. It antagonizes serotonin 5-HT1A and 5-HT2, dopamine D1 and D2, histamine H1, and adrenergic α1 and α2 receptors. Efficacy in schizophrenia and bipolar disorder is due to the antagonism of a combination of D2 and 5-HT2 receptors.

155
Q

Quetiapine BBW

A

Mortality in elderly with dementia, suicidality, not approved for children <10 y of age

156
Q

Quetiapine DDI

A

CYP3A4/5 inducers- reduced quetiapine effectiveness
CYP3A4/5 inhibitors- increases quetiapine toxicity
Agents that prolong QTc interval- increased risk of QTc prolongation

157
Q

Quetiapine common AE

A

Agitation, headache, HTN, somnolence, weight gain, xerostomia

158
Q

Quetiapine rare but serious AE

A

Neuroleptic malignant syndrome, neutropenia, pancreatitis, sudden cardiac death, syncope, tardive dyskinesia, slowed or difficult breathing when used in combination with opioids

159
Q

Risperidone class

A

Benzisoxazole, antipsychotic

160
Q

Risperidone common FDA indications

A

Autistic disorder, irritability: Children ≥5 y of age and weighing <20 kg, 0.25 mg po daily, titrate to response; Children ≥5 y of age and weighing >20 kg, 0.5 mg po daily, titrate to response
Acute manic or mixed episodes of bipolar I disorder: Adults, 2-3 mg po daily, may titrate to 6 mg/d or 25-50 mg IM every 2 wk; Children ≥10 y of age, 0.5 mg po daily, may titrate to 6 mg/d
Schizophrenia: Adults, 1 mg po bid, may titrate to 18 mg/d or 25-50 mg IM every 2 wk; Children ≥13 y of age, 0.5 mg po daily, may titrate to 6 mg/d

161
Q

Risperidone MOA

A

Risperidone is a potent serotonin-5-HT2 antagonist with weaker dopamine-D2 antagonism. Whereas typical antipsychotics are dopamine antagonists, the additional serotonin antagonism increases efficacy for negative symptoms of schizophrenia and reduces the likelihood of extrapyramidal symptoms.

162
Q

Risperidone BBW

A

Mortality in elderly with dementia, DRESS

163
Q

Risperidone contraindications

A

Hypersensitivity to risperidone, agents that increase QTc interval

164
Q

Risperidone DDI

A

CYP2D6, P-glycoprotein inhibitors- increases toxicity
P-glycoprotein inducers- reduces risperidone efficacy
Agents that prolong QTc interval
Valproic acid- increased valproic acid concentrations
Anticholinergics- additive anticholinergic activity

165
Q

Risperidone common AE

A

Extrapyramidal symptoms, insomnia, anxiety, fatigue, metabolic changes (hyperglycemia, dyslipidemia, weight gain, DM)

166
Q

Risperidone rare but serious AE

A

Neuroleptic malignant syndrome, pancreatitis, stroke, pancytopenia, sudden cardiac death, syncope, tardive dyskinesia, priapism, slowed or difficult breathing when used in combination with opioids, seizure, suicidal ideation or behavior

167
Q

Topiramate class

A

Anticonvulsant

168
Q

Topiramate common FDA indication

A

Partial or tonic-clonic seizure, monotherapy or adjunct: Children 2-16 y of age, 1-3 mg/kg/d (max 25 mg) po daily × 1 wk, may titrate to 5-9 mg/kg/d; Children ≥17 y of age and Adults, 25 mg po bid × 1 wk, may titrate to max of 200 mg po bid
Migraine prophylaxis: Immediate release only, initial 25 mg po daily × 1 wk, may titrate to max of 50 mg po bid

169
Q

Topiramate MOA

A

The exact mechanisms by which topiramate exerts its anticonvulsant and migraine prophylaxis effects are unknown. Electrophysiologic and biochemical evidence suggests that topiramate blocks voltage-dependent sodium channels, augments the activity of the neurotransmitter gamma-aminobutyrate at some subtypes of the GABA-A receptor, antagonizes the AMPA/kainate subtype of the glutamate receptor, and inhibits the carbonic anhydrase enzyme, particularly isozymes II and IV.

170
Q

Topiramate contraindications

A

Hypersensitivity, alcohol use for the ER formulation (within 6 h prior to and 6 h after administration)

171
Q

Topiramate DDI

A

Amitriptyline- may increase amitriptyline concentrations
Oral contraceptives- reduces contraceptive efficacy
CNS depressants- additive CNS derpression

172
Q

Topiramate common AE

A

Ataxia, loss of appetite, dizziness, impaired psychomotor performance, somnolence, fatigue, nystagmus, low serum bicarbonate

173
Q

Topiramate rare but serious AE

A

Erythema multiforme, Stevens-Johnson syndrome, hypohidrosis, increased body temperature, metabolic acidosis, liver failure, glaucoma, myopia, suicidal ideation, visual field defects

174
Q

Venlafaxine class

A

antidepressant, SNRI

175
Q

Venlafaxine common FDA indication

A

Generalized anxiety disorder: Extended release, 37.5-75 mg po daily, may titrate to 225 mg/d
Depression: Immediate release, 37.5-75 mg po daily in 2-3 divided doses, may titrate to 375 mg/d; extended release, 37.5-75 mg po daily, may titrate to 375 mg/d
Panic disorder: Extended release, 37.5 mg po daily × 7 d, then 75 mg po daily, then may titrate to 225 mg/d
Social anxiety disorder: Extended release, 37.5 mg po daily, may titrate to 75 mg po daily

176
Q

Venlafaxine MOA

A

Potent reuptake inhibitor of serotonin and norepinephrine but lacks effects on muscarinic, α-adrenergic, or histamine receptors.

177
Q

Venlafaxine BBW

A

Suicidal ideation

178
Q

Venlafaxine contraindications

A

Hypersensitivity, MAOIs

179
Q

Venlafaxine DDI

A

Agents that prolong QTc interval
Anticoagulants, antiplatelets, NSAIDs
CYP3A4/5, 2D6 inhibitors- increased venlafaxine tox
CYP3A4/5 inducers- reduces venlafaxine efficacy
Dextroamphetamine, SSRIs, SNRIs, sumatriptan, tramadol, trazodone, zolmitriptan, MAOIs- increased risk of serotonin syndrome

180
Q

Venlafaxine common AE

A

Dizziness, headache, insomnia, nausea, somnolence, xerostomia, weakness

181
Q

Venlafaxine rare but serious AE

A

GI hemorrhage, hepatotoxicity, serotonin syndrome, suicidal thoughts

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