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Pharm 2/4 Cram Flashcards

1
Q

TCAs

A

3: ADICT
Amitriptyline Doxepine Imipramine Clomipramine Trimipramine

2: DNP
Desipramine Nortriptyline Protriptyline

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2
Q

MOA of TCAs

How long for them to create an effect?

What are they used for

A

Block reuptake of S, H, A, NorEpi and Monoamines

2-4wks

Depression Anxiety
Off label: Pain syndrome, Migraine prophylaxis

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3
Q

S/e of TCAs

C/i in ? PTs

If d/c suddenly, what Sxs are experienced?

A

Most common used in OD

SI CVDz Glaucoma BPH

Flu-like

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4
Q

SSRIs

A

PFCS EF
Paroxetine Fluoxetine Citalopram Sertraline Escitalopram Fluvoxamine

Other: Vilazodone Vortioxetine

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5
Q

MOA of SSRI

How long do they take to create an effect?

Uses of SSRIs?

A

Inhibit serotonin reuptake w/out affecting reuptake of NorEpi or Dopamine in presynaptic neuron

3-8wks

PAP PODS
PMDD Anxiety PTSD Panic OCD Depression Social

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6
Q

SSRI w/ longest t1/2

SSRI w/ shortest t1/2

A

Fluoxetine

Fluoxemine

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7
Q

All SSRIs interact w/ CYP450 except for ?

Which SSRIs are most and least activating?

A

Citalopram
Escitalopram

Fluoxetine Sertraline
Fluvoxamine Peroxetin

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8
Q

Which SSRI has the worst weight gain?

What s/e is common for SSRIs and what are 3 less common s/e?

A

Paroxetine

Sex dysfuntion- switch to Bupropion or add Sildenafil
Serotonin syndrome
EPS
SIADH

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9
Q

Which SSRI has the worst EPS Sxs?

How is Serotonin Syndrome treated?

A

Paroxetine

Benzo
Cooling bath
Cyproheptadine

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10
Q

Which SSRI can be d/c abruptly w/out fear of s/e?

SSRIs have ? drug interactions?

A

Fluoxetine

NSAID
ASA
MAOI

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11
Q

Use for Fluoxetine

Use for Sertraline

Use for Paroxetine

A

PTSD MDD PMDD

PTSD MDD

PTSD, MDD Panic, Hot flashes

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12
Q

What SSRI can’t be used in kids or pregnancy?

Use for Fluvoxamine

A

Paroxetine- inc S/is
Cardiac septal defect

OCD

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13
Q

SSRI w/ QTC prolongation warning?

Alternate med that doesn’t have as much prolongation effect?

A

Citalopram

Escitalopram

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14
Q

Use of Vortioxetine

What happens if it’s d/c quickly?

A

MDD

HA, Muscle tension

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15
Q

SNRIs

A

Duloxetine
Venlafaxine
Desvenlafaxine

Levomilnacipran
Milnacipran

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16
Q

MOA of SNRIs

Adverse effect of these?

A

Inhibit reuptake of 5HT and NorEpi

Inc DBP

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17
Q

MOA of Venlafaxine

Uses

Adverse

A

Dose related effect Serotonin or NorEpi

TRD GAD PTSD
Unique MOA for use when SSRIs have failed

GI BP Withdrawal

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18
Q

Use of Desvenlafaxine

Adverse

A

2nd line for MDD

GI BP Withdrawal

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19
Q

MOA of Duloxetine

Uses

Adverse

C/i

A

SNRI w/ dose dependent NE reuptake inhibition

TRDs Diabetic neuropathy
MSK pain Fibromyalgia

HTN Sweating

Liver/Renal insufficiency

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20
Q

MOA of Levomilnacipram

Use

Adverse

A

Stronger NorEpi inhibitor

Depression only

HypoNa
BP
Bleed risk

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21
Q

Milnacipram is only approved for use of ?

A

Fibromylagia

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22
Q

NDRI

Use

Adverse

C/i

A

Buproprion

Smoking, Ped ADHD, MDD

Seizure, Dec weight

Seizure, Eating d/o, Withdrawal

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23
Q

SRAntagonists

A

Mirtazapine
Nefazodone
Trazadone

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24
Q

MOA of Trazadone

Use

Adverse

A

Less inhibition than SSRIs

Depression
Sleep aid w/ SSRI

Drowsy

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25
MOA of Mirtazapine Use Adverse
No reuptake inhibtion MDD Sleep w/ SSRI Sedative Modify if CrCl <30ml
26
MOA of Nefazodone Use Adverse
Inhibit NASH Anxious depression BBW: Liver failure
27
MAOIs MOA of class Use Adverse
PST Phenelzine Selegiline Tranylcypromine Stop degradation of DNA Atypical depression: hypersomnia, hyperphagia mood reactivity Inc tyramine= HTN crisis
28
Which MAOI is a MAO-B inhibitor What two drugs cause less sex dysfunction
Selegiline Transdermal Buproprion Mirtazapine
29
What two antidepressants don't cause weight gain? Which ones cause somnolence?
Buproprion Fluoxetine TCA Mirtazapine Paroxetine Trazodone
30
What antidepressants cause increased energy? Which ones increase anxiety?
Buproprion Fluoxetine Sertraline Buproprion
31
Which antidepressants can cause a reduction of pain?
Duloxetine or Venlafaxine for depression and fibromyalgia Amytriptyline and Imipramine for diabetic neuropathy
32
Anticonvulsants used for Bipolar? Which antipsychotics can be used?
``` Val TLC Valproic Avid Topiramate Lamotrigine Carbamezapine ``` All atypicals except: Closapine, Iloperiodone
33
MOA of Lithium Use
Neuroprotection, reduced transduction Manic depression as a mood stabilizer, use antipsychotic/benzo as bridge
34
Pre-Lithium lab work S/e of Lithium
CURE PET CBC UA Renal E+ Pregnancy ECG Thyroid Dec thyroid funciton Nephrogenic DI Edema/weight gain
35
What drugs/situations can cause Lithium to increase to toxic levels? How is this toxicity Tx?
ACE/ARB NSAID Diuretics Na restriction/crash diet Hydrate, Gastric lavage, +3mEq= dialysis
36
Use of Valproic acid Adverse
Acute/prophylactic management DOC manic episodes Preferred for rapid cyclers Neurotoxic Alopecia Spina bifida- Preg Cat D
37
Use for Carbamzaepine Screening req'd prior to use Adverse
Acute mania/maintenance Added to Lithium when complete therapy isn't reached 1502 SJS Agranulocytois SIADH HypoNa
38
What 3 benzos can be used in Bipolar? Antipsychotics/Neuroleptics that can be used?
Lorazepam Diazepam Clonazepam- for behavior sx relief Haldol/Olanzapine- agitation or psychosis Aripirazole/Olanzapine- mono therapy maintenance Quetiapine- depression and maintenance
39
What two TCAs cause weight gain? What TCA can be used for childhood enuresis or adult MDD
Nortryptiline Amytiptiline Imipramine
40
What TCA is for depression and insomnia? What TCA is used for OCD?
Doxepin Clomipramine
41
Drugs that can induce Parkinson Sxs? What Dz can cause these Sxs?
Antipsychotics Antiemetics Metoclopramide Viral encephalitis
42
Parkinson Tx for young PTs Parkinson Tx for older PTs
MAOI Dopamine agonist LDopa COMT inhibitor LDopa MAOI COMT inhibitor
43
Parkinson PT have dyskinesia during Tx is corrected by ? PT have severe motor fluctuations depsite max PO therapy is managed w/ ? PTs w/ severely resistant tremors or severe motor fluctuations is managed w/ ?
Reduce L-Dopa, add Amantadine Apomorphine or Duodopa Deep brain stimulation
44
What is the first line agent for Parkinson PTs w/ Sxs? ? med has the greatest effect on bradykinesia What class is most useful for PT tremors
Dopamine agonist L-dopa Anticholinergics
45
If Parkinson is experiencing Sxs/dyskinesia caused by L-dopa/Dopamine agonists can be given? What dopamine agonists are used for Parkinson's?
NMDA receptor inhibitor ``` BroRAP Bromocriptine Ropinirole Apomorphine Pramipexole ```
46
Dopamine analogs used in Parkinsons? What are the muscarinic antagonists used?
Levodopa Carbidopa Benztropine Trihexyphenidyl
47
What are the COMT inhibitors used in Parkinson to decrease catabolism? What MAO-Bs are used?
TEC Tolcapone Entacapone C/L/E combo Selegilline Rasagilline
48
MOA of dopamine agonists Use caution when using these in ? PT populations?
Direct acting on post-synaptic dopamine receptors Pyschosis Dementia
49
What are the two non-selective dopamine agonists? What are s/e of these?
Bromocriptine- semisynthetic ergot derivative Rotigotine- non-ergot transdermal CV/Pulm fibrosis Halllucinations Cramps
50
What are the two selective dopamine agonists? These two have an FDA approval for use in ?
Pramipexole Ropinirole RLS
51
What are c/i for using dopamine agonists? Use of Pramipexole Use of Ropinirole
Psychotic illness, recent MI, active peptic ulcer Monotherapy for mild/adv Parkinsons w/ neuroprotective ability Monotherapy for mild dz
52
MOA of Apomorphine Use Adverse C/i
Dopamine receptor agonist Tx of "off" episodes N/V in 98% of PTs, pre-Tx w/ Trimethobenzamide 5-HT3 antagonist: -setron IV use Sulfite sensitivity
53
MOA of Carbidope MOA of Levodopa
AAAD inhibitor that doesn't cross BBB, preventing peripheral conversion of levodopa to dopamine Dopamine precursor that crosses BBB Improvement on disability and MORTALITY Best for: bradykinesia, rigidity Less: tremor, instability
54
S/e of dopamine analogs How are "wearing off" phenomenons managed?
Dyskinesia- tx w/ dec levodopa dose or add anticholinergic (B/T) or Amantadine Add dopamine agonist Add MAO-B inhibitor Add COMPT inhibitor Shorten dosing interval
55
How are Parkinson "on-off" phenomenons managed? Levodopa is a precursor to ? and can activate this
Add dopamine agonist Add MAO-B inhibitor Add COMPT inhibitor High protein diet to reduce Levodopa absorption Skin melanin Malignant melanoma
56
What are MAO-B inhibitors used for in Parkinsons? PTs need to avoid meds that can cause ?
Sx control of mild/mod Dz Serotonin Syndrome
57
MOA for Selegilline Use Adverse
Irreversible inhibition of doapmine metabolism w/ inhibiting MAO-A for a lower risk of HTN crisis Monotherapy for mild Dz Conjucntion w/ Ldopa Metabolized into amphetamine
58
MOA of Rasagiline Difference about this one Adverse
Unknown, Sx relief and neuroprotection 5x more poetent but not metabolized to amphetamine Avoid tyramine
59
MOA of COMT inhibitors Use Adverse
Prevent dopamine breakdown to inc L-Dopa crossing BBB Wearing off effect Other Tx failure Orange urine (Entacapone)
60
Adverse on Tolcapone Use of Entacapone
Hepatoctoxic- written/signed consent from PT. Get LFTs at baseline Used in Entacapone failure Must be used w/ Levodpoa/Carbidopa No BBB crossing
61
What is the triple combo pill for COMT inhibition? Anticholinergic use in Parkinson is best for? and the DOC for? Use of Benztropine
Stalevo- Carbidopa, Levodopa, Entacapone Tremor, rigidity Drug induced parkinsonism EPS d/o control
62
MOA of Amantadine Use Adverse
Inc synthesis and release of dopamine Reduces dyskinesia Livedo reticularis CNS
63
Most parkinson PTs will experience hallucinations, d/c drugs in ? order What two antipsychotics are used in Parkinson PTs?
``` Anticholinergic Amantadine Selegiline Dopamine agonist Levo/Carbidopa ``` Quetiapine Cloxapine
64
When can a seizure PT attempt to withdraw pharmaceutical therapy? MOA of anticonvulsants
Seizure free 2-5yrs Single seizure type Normal neuro exam/IQ Normal EEG w/ meds Enhance GABA Reduce excitation of glutamate Modify conduction of Ca/Na
65
MOA of Phenytoin Use Adverse
Fast Na blocker Tonic clonic Simple/complex Status epilepticus Sex dysfuntion Hirsutism Gingival hyperplasia Dose related: nystagumus blurred vision, thick tongue
66
What drugs does phenytoin interact w/? What dietary changes affect Phenytoin?
Anticoagulants inc Phenytoin concentration Reduce OCP efficacy Dec protein causes inc in free drug
67
MOA of Fospenytoin Use Advantage
Phenytoin prodrug, fast Na blocker Status epilepticus Parenteral for loading/maintenance in leu of Phenytoin Preferred for parenteral use, mixed w/ NS/D5W
68
MOA of Carbamzepine Use Adverse
Fast Na blocker Only PO form available Tonic clonic Simple, complex partial ``` Rash HypoNa BOMS Bone marrow suppression Osteomalacia Multi organ hypersensitivity SJS ```
69
What monitoring is need when taking Carbamazepine MOA of Oxcarbazepine Use
CBC LFT- monitor for aplastic anemia and agranulocytosis 1502 pre-screen Fast Na blocker Less potent, no epoxide metabolite For PTs can't tolerate Carbamazepine General tonic-clonic Trigeminal neuralgia Bipolar
70
Adverse events of Oxcarbenzapine use What drug interactions does it have?
HypoNa more likely Reduces OCP, CCBs
71
What two anticonvulsants increase GABA Cl influx When are they used?
Primidone- metabolized into phenobarbital, alternate for general tonic-clonic sezure Essential tremors Phenobarbital- tonic clonic, simple, partial or complicated seizures
72
Adverse effects of Phenobarbital Adverse of Primidone
Sex dysfunction Ataxia, sedation
73
Adverse effects of Benzos What 3 anticonvulsants inhibit voltage gated Ca channels?
Sedation High dose= ataxia, behavior changes Pregabalin Ethosuximide Gabapentin
74
Gabapentin use and adverse Pregabalin use and adverse
Partial onset seizure Spasmolytic Diabetic neuropathy Adv: Drowsy, fatigue, weight gain ``` Partial onset seizure RLS Neuropathic pain Social phobia Spinal injury Adv: Dizzy, weight gain, Angioedema, Inc creatine kinase ```
75
What is the DOC and second line choice for absence seizures? What is the adverse and required monitoring for this drug?
Ethosuximide 2nd: Valproic acid Transient leukopenia GI Monitor CBC- neutropenia, leukopenia
76
MOA of Valproic Acid and derivatives Use Adverse
Block T-type Ca and Na channels Inc GABA production Dec GABA degredation Generalized non-convulsive seizure 2nd choice for absence seizures Parenteral use Alopecia Interferes w/ platelet aggregation BBW: liver failure, monitor LFTs
77
Why are Valproic acid and derivative Preg Cat X? If a PT ODs, what can be used to reverse?
Spina bifida Naloxone
78
MOA of Lamotrigine Uses Adverse
Dec glutamate/aspartate release Delays repetitive firing Blocks fast Na channels General tonic clonic Lenox Gataut Bipolar 1 SJS BBW: rashes
79
MOA of Topiramate Use Adverse
"Dope-a-max" Fast Na blocker Inc GABA activity Absence seizures Lenox Gastaut Sex dysfunction Memory impairment Metabolic acidosis
80
MOA of Levetiracetam Use
Prevents hypersynchornization of firing and propogation of seizure activity Tonic clonic in PT +6y/o Myoclonic seizure in PTs +12y/o Lenox Gastaut
81
Use and adverse of anticonvuslants
``` F: mono, LG adjunct; ALF E: n/a; SUPVQ L: mono; PAMN T: n/a; SJS, non-SE V: refractory/infant; DMV Z: Bipolar; Sufa FRAN ```
82
What is used to Tx eclampsia? What meds need to be avoided in pregnancy and why?
Mg Sulfate Folic acid supplementation Pheytoin- cleft palate, poor cognitive funtion Carbamazepine- posterior cleft palate Phenobarbital- cardiac malformation, poor cognitive function Valproic acid/Topiramate- congenital malformations
83
What anticonvulsants have the highest incidence of sexual dysfunction What two improve sex dysfunction
PC PT PZ Phenobarbital Carbamazepine Phenytoin Topiramate Pregabalin Zonisamide Lamotrigine Oxcarbazepine
84
What are the 3 groups of Sxs seen in Schizo PTs?
Pos: presence of seomthing that shouldn't be there Neg: absence of something that should be there Cognitive- poor function, impaired attention
85
What are the theorized origins of the 3 groups of issues seen in Schizo PTs?
Neg- prefrontal cortex, blocked by 5HT Pos: nucleus accumbus, excess dopamine Parkinson: corpus striatum, no dopamine leaves ACh uninhibited
86
What are the 3 main NTs involved w/ Schizo? What is the strongest link of predictability?
D, S, Glutamate 1st degree relative w/ Schizo
87
What are the 3 goals of Schizo management? Typical/First gen antipsychs end w/ while atypical/Second gen end w/ ?
Control Sxs Minimize adverse effect Prevent relapse 1st: zine/xene/Haldol/Loxapine 2nd: zole, pine, one
88
How long can it take for max treatment response to be reached w/ Schizo drugs? Once response is observed, what is the next step?
6mon Maintain for 6mon
89
What is the most widely used anti-emetic for Schizo PTs? Only FDA drug approved for hiccups?
Prochlorperazine Chlorpromazine
90
General adverse effects of taking antipsychotics? Why do these have BBWs?
Dystonia Tardive dyskinesia Akathesia- MC, tx w/ Propranolol Sex dyfuntion Inc mortality in elderly w/ dementia related psychosis
91
What is the MOA of 1st Gen antipsychotics This class has less effect on controlling ? Sxs
Competitive dopamine receptor blocker and block HAM receptors Negative Sxs
92
What is the difference between Low and High affinity Typical Antipsych meds? What drugs can be used in these PTs if they develop Pseudo Parkinson Sxs?
Low- low affinity, less risk of EPS High- high affinity, higher rate of EPS Anticholinergics: Trihexy/Benz Antihistamine: Diphenhydramine
93
What are the adverse effects of taking typical antipsych meds?
Worse neg/cognitive Sxs Prolong QTc POHTN Weight gain (inc w/ low potency)
94
# Define Neuroleptic Malignant Syndrome What is an adverse effect impacting both genders of PTs?
Most common drug event from high potency typical antipsychs Agitation confusion LoC HTN/Tachy Prolactin elevation
95
Use of Chlorpromazine Adverse
Intractable hiccups Pigment deposits on retina/cornea Long use= inc risk for tardive dyskinesia
96
Use Thioridazine What is the BBW for this med
High anticholinergic effect w/ HIGHEST occurrence of sedation Torsades
97
Use of Trifluoperazine Adverse
General non-psychotic anxiety only after trying Benzos first Persistant tardive dyskinesia
98
What drug is preferred for non-psychotic anxiety in Schizo PTs? Use Fluphenazine decanoate
Benzos IM injection for Schizo need long neuroleptic therapy, reqs bridging
99
Use of Haloperidol Benefit of this med Adverse C/i
Schizo Acute agitation Tic/Tourettes Less sedation than other anti-psych meds Severe EPS IV form causes Torsades Parkinsons, Comatose
100
MOA of Atypical Antipsychs This class has similar efficacy for positive Sxs except for ?
Dopamine antagonists Block S Clozapine
101
What is a potential adverse effect of the atypical antipsych class? Which two are more likely to cause weight gain and which one causes the least?
Metabolic Syndrome Measure waist at baseline Most: Clozapine, Olanzapine Least: Lurasidone
102
What atypical antipsych is the most effective and reserved for PTs that are resistant to other antipsychs? This med is the only atypical shown to reduce the risk of ?
Clozapine Reduce risk of suicide
103
What are additional benefits that come from using Clozapine Adverse What is the BBW and monitoring needed?
Low EPS, Tardive dyskinesia Improved negative Sxs No prolactin elevation Fatal myocarditis Inc seizure Agranulocytosis Weekly CBC for first 6mon, then every 2wks
104
Olanzapine benefit Use Adverse What is required after giving a PT a dose of Olanzapine
No agranylocytosis Acute agitation of Schizo/Bipolar Long term schizo tx Weight gain, HOTN Monitor for respiratory depression x 3hrs
105
Benefit of Risperidone Risperidone is the worse of all the atypicals for ? Sx What is a better version of Risperidone?
Best for Pos Sx Tx Peds 10-17 Hyperprolactinemia Higher risk of EPS of all atypicals Paliperidone- active metabolite
106
Quetiapine is a good choice for ? PT population What is an adverse effect
Psychosis in Parkinson PTs Sedation OHOTN Cataracts
107
Advantage of using Ziprasidone Disadvantage of this one
Lower metabolic syndrome and prolactin Higher QTc risk and cataracts
108
Aripiprazole has a unique FDA approved use for ? Asenapine is used for This one is only available in ? form
Depression w/ SSRI Schizo/Bipolar Sublingual tab
109
Iloperidone Use Adverse Lurasidone Use
Schizo only Inc risk OHOTN, QTc prolongation, Esophogeal dysmotility Schizo/Bipolar
110
MOAs of Atypicals
``` Cloza: D blocker, S antagonist Olan: D blocker, S antagonist Risper: D/S antagonist Pali: Riper metabolite Quet: NT antagonist, least D antagonist Zipra: D/S antagonist, S/NE inhibitor Aripip: partial D/S agonist Asen: mixed D/S antagonist Iloperi: mixed D/S antagonist Lura: mixed D/S antagonist ```
111
What drugs are used for acute agitation/psychosis in pyschosis PTs? Only antipsychotics that are PO disintegrating?
Benzos: D/L Haldol Atypicals: Olanzapine, Ziprasidone Midazolam Risperidone Olanzapine
112
Only antipsychs that are in parenteral formulation Which ones are rapid tranquilizers
Olanzapine Ziprasidone ``` Chlopromazine Haldol Fluphenazine Olanzapine Ziprasidone ```
113
Which antipsychs are used for non-compliant PTs? What med can be used to augment antipsych action?
Haldol deconoate Fluphnazine decanoate Risperidone Paliperidone Lithium
114
What anticonvulsants can be used in acute psychosis episodes? What class is used for pregnant PTs who suffer from EPS? Which ones need to be avoided during pregnancy
Carbamazepine Valproic acid Atypicals Low potency typicals- worsen constipation
115
Why are benzo/barbituates so potent? Their receptor strength is equivalent to ?
Binding site is more potent than GABA site ETOH
116
What are the short acting barbituates used for anesthesia? What is Donnatal and what is it used for?
SPAM Seco, Pento, Amobarbital, Methohexital Trio combo: Scopalamin Atropine Phenobarbital IBS
117
Withdrawal from Barbituates is worse than? What needs to be done if PT ODs?
Opiates Mechanical ventilate GI lavage Dialysis
118
What short acting Barbituates are used for anesthesia, status epileptics or insomnia? Phenobarbital MOA and usage
Methohexital- anesthesia Pentobarbital- epilepticus SAPI- insomnia, not Methohexital Inc GABE Cl influx Any seizure type
119
Short, Med, Long Benzos
Short: TOMC; Triazolam Oxeaepam Midazolam Clorazepate Med: TEAL; Temazepam Estazolam Alprazolam Lorazepam Long: CDC FQ; Chlordiazepoxide Diazepam Clonezepam Flurazepam Quazepam
120
What class of Benzo will have more hangover Sxs Which class will quickly develop tolerance, dependence and frequently experience withdrawal?
Long half life Short half life
121
Benzos do not offer ? services What benzos are used for anxiety
Analgesic Antipsychotic ANS affect Med/long life benzo- Clonazepam, Lorazepam, Diazepam
122
What benzos can be used for panic attacks? Which one is preferred in liver Dz/alcoholics due to liver bypassing effects?
Clonazepam Oxazepam Alprazolam Lorazepam COL*D
123
Which benzos can be used during alcohol withdrawals? Which ones can be used for insomnia
Chlordiazepoxide Oxazepam Lorazepam* Diazepam FETT Q Flurazepam Estazolam Temazepam Triazolam Quazepam
124
What type of benzo is needed to keep PTs asleep through the night? Which class only puts them to sleep?
Long acting Short acting
125
What are 3 adverse effects from using Benzos? Which benzos have minimal interaction w/ CYP3A4
Hangover Rebound insomnia Anterograde amnesia LOT Lorazepam Oxazepam Temazepam
126
What are the only benzos that can be used in geriatric PTs? What is the rescue agent for Benzo ODs? Use of Buproprion
Lorazepam Oxazepam Temezaepam Flumazenil- competitive antagonist, poor at reversing respiratory depression Anxiety No abuse potential Preferred when Benzos have to be avoided
127
Zolpidem Eszopiclone
MOA: enhances GABA Adv: metallic taste, SI, abnormal thought CAUTION- lasts 50% longer in elderly PT Highest risk for hangover
128
Zaleplon Suvorexant Ramelteon Tasimelteon
Short term insomnia Tx Least likely to cause somnolence Orexin receptor antagonist Melatonin receptor agonist Inc sleep x 7.3min Blind PT sleep aid, fake melatonin
129
What are the 7 non-benzo hypnotics?
``` Zolpidem Zaleplon Buspirone Esxopiclone Ramelteon SuVorexant Tasimeltion ```
130
Short, Med, Long benzo for insomnia Antidepressants for insomnia
Triazolam Temazepam Estazolam Flurazepam Quazepam Doxepin Mirtazapine Trazadone
131
DOC for acute management of Anxiety D/o DOC/1st, 2nd line and other options for GAD
Benzo, high potency w/ rapid onset are preferred SSRI or SNRI 2nd: Buspirone, Pregabalin Other: Quetiapine
132
First line agent for Panic D/o Which Benzos can be used?
SSRI/SNRI Clonazepam* Alprazolam
133
First line for Social anxiety d/o Second line? If Benzo is used, which ones can be used?
SSRI or SNRI Gaba/Pregabalin Clonazepam* Alprazolam
134
What can be used for performance anxiety? What is the first choice for OCD
Propranolol SSRI (no SNRI) TCA Comipramine can be used w/ SSRI combo
135
First line for PTSD? Which antipsychs can be used?
SSRI SNRI Quetiapine Olanzapine Risperidone
136
What med is used for PTSD nightmares? What is used for uncontrollable anxiety w/ PTSD?
Prazosin Benzo
137
What med are used for impulsiveness, hyperarousal and flashbacks? What is the most severe form of ethanol withdrawal?
Tiagabine Topiramate Divalproex Delirium tremens
138
What two benzos can b used for propylene glycol poisoning? Which one is most frequently used for outpatient alcohol detox?
Lorazepam Diazepam Chlordiazepoxide
139
What is an adverse event that occurs in alcoholics? What is the Tx?
Wernicke encephalopathy Folic acid and B12
140
What are the first line meds for alcohol dependence? Which ones are second line choices?
Naltrexone Acamprostate ``` Disulfiram Topiramate Gabapentin Baclofen SSRI ```
141
MOA of Naltrexone What does it cause to happen for the PT? Adverse
Naloxone derivative that is competitive antagonist at opioid receptors, best on mu receptor Reduces alcohol dependence, cravings and consuption Dep- blocks all opioids Liver toxicity, 5x inc of enzymes
142
MOA of Acamprosate Use Adverse
GABA mimetic to antagonize glutamate Safe for PTs w/ liver dz Abstinence from ETOH TID dosing N/V/D Renal excretion
143
Disulfiram What happens when this reaction occurs?
Only motivated PTs Inhibits ALDH blocking ETOH metabolism ACh accumulation causing N/V/HA, Tachy/HOTN
144
What needs to be checked prior to starting PT on ADHD meds What stimulants are used for ADHD What non-stimulants can be used?
BP HR Ht/Wt Dextroamphetamine Amphetamine Methylphenidate Lisdexamfetamine Guanfacine Atomoxetine Clonidine
145
What is the first line Tx for ADHD? What is the MOA of amphetamines as a class
Behavior intervention Inc D/NorEpi release and decrease uptake
146
What are the 3 clinical uses of amphetamines What is the most common pysch dz dx'd in kids?
ADHD Narcolepsy Obesity ADHD
147
What is the largest determinant of which amphetamine is chosen for ADHD Tx? When are non stimulants moved up for use as first line
Duration Concern for abuse PT/Fam request of no stimulant PT has condition that doesn't tolerate stimulants (CDz, glaucoma, no appetite)
148
What is not a controlled substance and was the first non-stimulant approved for ADHD use MOA Use Adverse
Atomoxetine Block NEpi uptake ADHD in PTs +6y/o Worsens aggressive behavior
149
Clonidine MOA Use Adverse
Central A2 agonist Alternative for kids who are intolerant to stimulants, especially w/ Tics Impulsions/Tourettes Sedation Worse depression
150
What drug class is not effective in ADHD What class has shown efficacy against ADHD?
SSRI TCA- Imipramine, Deipramine
151
What are the drugs classified as "other" stimulants
Caffeine Armodafinil Modafinil Ecstasy
152
Modafinil/Armodafinil MOA Use Adverse
Dec GABA transmission Obstructive apnea Narcolepsy Shift work d/o Rhinitis and dec appetite
153
What effect does caffeine have in neonates? When is this used in medicine
Inc respiratory drive and force Migraine Apnea of prematurity
154
What is the MOA of MDMA What are the BMIs for over weight, obese and severely obese?
Hallucinogenic amphetamine Over: 25-29 Obese: 30+ Severe: 40+
155
What is the mainstay of obesity Tx? When are PTs candidates for bariatric surgery? When are they candidates to receive pharmaceutical help w/ weight loss?
Behavior modification 35+ w/ comorbidity 40+ >27 w/ comorbidity >30
156
If PT has not loss ? weight, stop any weight loss meds they are on What drug is given to reduce fat absorption and diegestion?
5% by 12wks Orlistat
157
What drugs can be given for obesity to reduce appetite?
``` Sympathomimetics -phetamine Diethylpropion Phentermine Phendimetrazine Bupropion ``` Serotonergic- Topiramate Antidiabetic- Metformin GLP-1 meds
158
Phen/Top Caution/C/i
Phe- appetite suppression Top- promotes satiety by GABA stimulation Taper to avoid seizures Cat X
159
Naltrex/Bupropion Adverse Avoid in
Nalt: opioid antagonist Bupro: D/NorEpi inhibitor SI, Seizure Opiods, seizure, HTN
160
MOA of Liraglutide Adverse Preg Cat
GLP-1 agonist Pancreatitis Sx hypoglycemia Cat x
161
Benzos used for pre-anesthetics Which opiates are used?
Diazepam Lorazepam Midazolam ``` Meperidine Morphine Fentanyl Remifentanyl Sufentanyl ```
162
What anticholinergics can be used for pre-anesthetic situations? What is the only antihistamine used in a pre-anesthetic setting?
Atropine Glygopyrrolate Scopolamine Diphenhydramine
163
What 2 neuromuscular blockers are used for pre-anesthetics? What are the 4 phases of anesthesia
Cisatracurium Succinylcholine 1: analgesia 2: hyperexcitable 3: surgical anesthesia 4: medullary paralysis- OD
164
What two classes of drugs are used to maintain anesthesia after admin of IV agent What are the adverse reactions to these meds?
NO gas Halogenated liquids: NO HIDES-ane Nephrotoxicity (S/E-ane) Hematotoxicity- NO dec methonine, causing megaloblastic anemia Malignant hyperthermia- inhaled agents or succinylcholine
165
What is the reversal/rescue agent for malignant hyperthermia? What drug is preferred for outpatient surgical procedures
Dantrolene- reduced Ca release Desflurane
166
What drug is used for Peds anesthesia and risk of use What drugs are used as IV agents for surgery that prevent derlirium and combative behavior
Suvoflurane, potentiall nephrotoxic Barbituate/Benzo Ketamine Etomidate Propofal- induction/maintenance
167
What two neuromuscluar blockers are used for intubation and relaxation? What barbituate is used for induction and maintenance of anesthesia?
Succinylcholine Rocuronium Vecuronium Methohexital
168
Which 3 benzos are available in IV Ketamine site of action Etomidate and Propofol site of action
DLM Midazolam- rapid, shorter elimination time Causes amnesia K: NMDA receptor E/P: GABA
169
What is the adverse effect of ketamine use? Which med is used in IV form for sedation in critical care as a continuous infusion?
Inc ICP Propofol
170
What is the adverse effects of Propofol PTs can't receive this med if they're allergic to ?
Inc TG Nutrition Bacterial infection Egg licithin Soybean oil
171
What meds induce anesthesia? What meds maintain anesthesia?
``` Isoflurane Desflurane Halothane IV: BBKEP Methohexital Ketamine Propofol ``` Propofol Methohexidal Ketamine Dexmedetomidine
172
What happens during Propofol infusion syndrome
``` Brady Metabolic acidosis CV collapse Rhabdo Renal failure ```
173
DOC for rapid intubation What is an adverse effect Adverse
Succinylcholine Malignant hyperthermia HyperK Malignant hyperthermia Hx
174
What NMBA is the DOC in PTs w/ renal/liver Dz Depolarizing, Non-depolarizing belong to what 3 groups?
Cistracurium Depol- ultra short (Succ) Non-depol- int (ACRV) Non-depol-long (Pan)
175
What is the longest lasting NMBA What is the adverse effect of this drug What drugs does it interact w/
Atracurium Metabolized into laudanosin, can cause seizures ACh inhibitors Aminoglycoside ABX CCBs
176
What two factors determine onset and duration of local anesthetics? Adverse effects of using local anesthetics
Tissue pH pKa of drug- closer to body pH= faster onset Methemoglobinemia- Fe3 can't bind O2 Seizure Arrhythmia
177
Epidural insert local anesthetic below ? Intrathecal insert meds beneath ?
Ligamentum flavum Arachnoid membrane of brain/spine
178
Uses of Benzo, Chloropro, Co, and Procaine Which amide is used during labor?
Ben: topical Chloro: local, nerve, epidural Co: topical Pro: local, nerve block, spinal Bupivacaine- no motor block, usually used as epidural
179
Preferred use for Lidocaine, Lido/pro, TAC, and LET gel
Lido: intact skin for neuralgia Lido/Prilo: intact skin for local TAC: uncomplicated lacerations LET: laceration on face/scalp
180
What 3 foods can lower cholesterol?
Garlic- inhibit synthesis Red yeast rice- inhibit HMG CoA, lowers LDL/TG, inc HDL Omega 3 fatty acid
181
What are the adverse effects of using red yeast rice?
Myopathy | Hepatotoxicity
182
What dietary supplements can be used for performance enhancers
Adaptogens- promotes homeostasis Steroid enhancer- DHEA AA Whey protein
183
3 supplements for HA Two for sedative/hyponotics
Caffeine Mg Peppermint oil Valerian, Melatonin
184
What two supplements can be used for depression? Too much garlic can cause ?
St John wart- serotonin syndrome Ginkgo Platelet dysfunction
185
Use of Omega 3 fatty acids What is the adverse effects
Hyperlipidemia- lowers TG, may raise LDL Burping fish taste, inc bleeding risk when used w/ anticoag or antiplatelet agent
186
What is Asian ginseng used for? What is an adverse effect?
ED/Sexual arousal Athletic performance Insomnia
187
Use of Kratom Use of Valerian and adverse
Opioid like effect Insominia anxiety depression stress Hepatotoxicity, Benzo like withdrawal
188
Adverse of using Melatonin Caution using St John wart in ? Risk of ?
Lowers seizure threshold Pregnancy, Bipolar, Schizo Serotonin syndrome
189
Use of Ginkgo biloba Adverse
Cognitive function/dementia Anxiety Schizo Antidepressant induced sex dysfunction Seizure Neurotoxicity Seizure
190
Use of Black Cohosh Adverse Dont' use in ?
Estrogen like effect for menopause Liver toxicity Muscle damage Pregnant/Liver Dz
191
What is Dong Quia used for? Adverse
Menopause, Premature ejaculation Cancer
192
Use of cranberry Use of Echinacea
UTI prophylaxis Flu/Cold Tx
193
Use of Saw Palmetto
5-a-reductase and prevents DHT in vitro | BPH
194
Use of ginger What are the secondary Sxs of Parkinsons?
Morning sickness N/V Cognitive dysfunction Autonomic dysfunction Speech disturbance Micrographia
195
5 meds that can cause Parkinsonism Sxs Improving motor disability is better done w/ ? while lessening motor complications is better done w/ ?
``` Prochloroperazine Chlorpromazine Trifluoperazine Thioridazine Haldol ``` ``` Levodopa Dopamine agonist (BroRAP) ```
196
When is L-dopa the initial therapy? What class of drug is NOT used for OCD?
>70, Dementia, Cognitive impairment SNRI
197
What antipsych is only a partial agonist? What med is used for the depression phase of Bipolar?
Aripramide Lamotrigine
198
What are 4 meds that can be used in L Gataut? What meds can cause SJS?
TTL Barbituates 5 more
199
What two antidepressants don't require tapering before d/c Valproic acid, Carb, Lamotrigine are more effective than Lithium in ? 4 scenarios
Fluoxetine Buproprion 2* bipolar Mixed mania Rapid cyclers Substance abuse

IPAP (212 decks)

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