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IPAP > Pharm 2/4 Cram > Flashcards

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
Q

MOA of Mirtazapine

Use

Adverse

A

No reuptake inhibtion

MDD
Sleep w/ SSRI

Sedative
Modify if CrCl <30ml

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26
Q

MOA of Nefazodone

Use

Adverse

A

Inhibit NASH

Anxious depression

BBW: Liver failure

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27
Q

MAOIs

MOA of class

Use

Adverse

A

PST
Phenelzine
Selegiline
Tranylcypromine

Stop degradation of DNA

Atypical depression: hypersomnia, hyperphagia mood reactivity

Inc tyramine= HTN crisis

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28
Q

Which MAOI is a MAO-B inhibitor

What two drugs cause less sex dysfunction

A

Selegiline Transdermal

Buproprion
Mirtazapine

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29
Q

What two antidepressants don’t cause weight gain?

Which ones cause somnolence?

A

Buproprion
Fluoxetine

TCA Mirtazapine Paroxetine Trazodone

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30
Q

What antidepressants cause increased energy?

Which ones increase anxiety?

A

Buproprion
Fluoxetine
Sertraline

Buproprion

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31
Q

Which antidepressants can cause a reduction of pain?

A

Duloxetine or Venlafaxine for depression and fibromyalgia

Amytriptyline and Imipramine for diabetic neuropathy

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32
Q

Anticonvulsants used for Bipolar?

Which antipsychotics can be used?

A 
Val TLC
Valproic Avid
Topiramate
Lamotrigine
Carbamezapine

All atypicals except: Closapine, Iloperiodone

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33
Q

MOA of Lithium

Use

A

Neuroprotection, reduced transduction

Manic depression as a mood stabilizer, use antipsychotic/benzo as bridge

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34
Q

Pre-Lithium lab work

S/e of Lithium

A

CURE PET
CBC UA Renal E+ Pregnancy ECG Thyroid

Dec thyroid funciton
Nephrogenic DI
Edema/weight gain

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35
Q

What drugs/situations can cause Lithium to increase to toxic levels?

How is this toxicity Tx?

A

ACE/ARB
NSAID
Diuretics
Na restriction/crash diet

Hydrate, Gastric lavage, +3mEq= dialysis

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36
Q

Use of Valproic acid

Adverse

A

Acute/prophylactic management
DOC manic episodes
Preferred for rapid cyclers

Neurotoxic
Alopecia
Spina bifida- Preg Cat D

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37
Q

Use for Carbamzaepine

Screening req’d prior to use

Adverse

A

Acute mania/maintenance
Added to Lithium when complete therapy isn’t reached

1502

SJS
Agranulocytois
SIADH
HypoNa

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38
Q

What 3 benzos can be used in Bipolar?

Antipsychotics/Neuroleptics that can be used?

A

Lorazepam
Diazepam
Clonazepam- for behavior sx relief

Haldol/Olanzapine- agitation or psychosis
Aripirazole/Olanzapine- mono therapy maintenance
Quetiapine- depression and maintenance

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39
Q

What two TCAs cause weight gain?

What TCA can be used for childhood enuresis or adult MDD

A

Nortryptiline
Amytiptiline

Imipramine

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40
Q

What TCA is for depression and insomnia?

What TCA is used for OCD?

A

Doxepin

Clomipramine

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41
Q

Drugs that can induce Parkinson Sxs?

What Dz can cause these Sxs?

A

Antipsychotics
Antiemetics
Metoclopramide

Viral encephalitis

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42
Q

Parkinson Tx for young PTs

Parkinson Tx for older PTs

A

MAOI
Dopamine agonist
LDopa
COMT inhibitor

LDopa
MAOI
COMT inhibitor

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43
Q

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/ ?

A

Reduce L-Dopa, add Amantadine

Apomorphine or Duodopa

Deep brain stimulation

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44
Q

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

A

Dopamine agonist

L-dopa

Anticholinergics

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45
Q

If Parkinson is experiencing Sxs/dyskinesia caused by L-dopa/Dopamine agonists can be given?

What dopamine agonists are used for Parkinson’s?

A

NMDA receptor inhibitor

BroRAP
Bromocriptine
Ropinirole
Apomorphine
Pramipexole
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46
Q

Dopamine analogs used in Parkinsons?

What are the muscarinic antagonists used?

A

Levodopa
Carbidopa

Benztropine
Trihexyphenidyl

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47
Q

What are the COMT inhibitors used in Parkinson to decrease catabolism?

What MAO-Bs are used?

A

TEC
Tolcapone Entacapone C/L/E combo

Selegilline
Rasagilline

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48
Q

MOA of dopamine agonists

Use caution when using these in ? PT populations?

A

Direct acting on post-synaptic dopamine receptors

Pyschosis
Dementia

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49
Q

What are the two non-selective dopamine agonists?

What are s/e of these?

A

Bromocriptine- semisynthetic ergot derivative
Rotigotine- non-ergot transdermal

CV/Pulm fibrosis
Halllucinations
Cramps

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50
Q

What are the two selective dopamine agonists?

These two have an FDA approval for use in ?

A

Pramipexole
Ropinirole

RLS

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51
Q

What are c/i for using dopamine agonists?

Use of Pramipexole

Use of Ropinirole

A

Psychotic illness, recent MI, active peptic ulcer

Monotherapy for mild/adv Parkinsons w/ neuroprotective ability

Monotherapy for mild dz

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52
Q

MOA of Apomorphine

Use

Adverse

C/i

A

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

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53
Q

MOA of Carbidope

MOA of Levodopa

A

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

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54
Q

S/e of dopamine analogs

How are “wearing off” phenomenons managed?

A

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

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55
Q

How are Parkinson “on-off” phenomenons managed?

Levodopa is a precursor to ? and can activate this

A

Add dopamine agonist
Add MAO-B inhibitor
Add COMPT inhibitor
High protein diet to reduce Levodopa absorption

Skin melanin
Malignant melanoma

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56
Q

What are MAO-B inhibitors used for in Parkinsons?

PTs need to avoid meds that can cause ?

A

Sx control of mild/mod Dz

Serotonin Syndrome

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57
Q

MOA for Selegilline

Use

Adverse

A

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

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58
Q

MOA of Rasagiline

Difference about this one

Adverse

A

Unknown, Sx relief and neuroprotection

5x more poetent but not metabolized to amphetamine

Avoid tyramine

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59
Q

MOA of COMT inhibitors

Use

Adverse

A

Prevent dopamine breakdown to inc L-Dopa crossing BBB

Wearing off effect
Other Tx failure

Orange urine (Entacapone)

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60
Q

Adverse on Tolcapone

Use of Entacapone

A

Hepatoctoxic- written/signed consent from PT. Get LFTs at baseline
Used in Entacapone failure

Must be used w/ Levodpoa/Carbidopa
No BBB crossing

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61
Q

What is the triple combo pill for COMT inhibition?

Anticholinergic use in Parkinson is best for? and the DOC for?

Use of Benztropine

A

Stalevo- Carbidopa, Levodopa, Entacapone

Tremor, rigidity
Drug induced parkinsonism

EPS d/o control

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62
Q

MOA of Amantadine

Use

Adverse

A

Inc synthesis and release of dopamine

Reduces dyskinesia

Livedo reticularis
CNS

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63
Q

Most parkinson PTs will experience hallucinations, d/c drugs in ? order

What two antipsychotics are used in Parkinson PTs?

A 
Anticholinergic
Amantadine
Selegiline
Dopamine agonist
Levo/Carbidopa

Quetiapine
Cloxapine

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64
Q

When can a seizure PT attempt to withdraw pharmaceutical therapy?

MOA of anticonvulsants

A

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

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65
Q

MOA of Phenytoin

Use

Adverse

A

Fast Na blocker

Tonic clonic
Simple/complex
Status epilepticus

Sex dysfuntion
Hirsutism
Gingival hyperplasia
Dose related: nystagumus blurred vision, thick tongue

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66
Q

What drugs does phenytoin interact w/?

What dietary changes affect Phenytoin?

A

Anticoagulants inc Phenytoin concentration
Reduce OCP efficacy

Dec protein causes inc in free drug

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67
Q

MOA of Fospenytoin

Use

Advantage

A

Phenytoin prodrug, fast Na blocker

Status epilepticus
Parenteral for loading/maintenance in leu of Phenytoin

Preferred for parenteral use, mixed w/ NS/D5W

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68
Q

MOA of Carbamzepine

Use

Adverse

A

Fast Na blocker

Only PO form available
Tonic clonic
Simple, complex partial

Rash 
HypoNa
BOMS
Bone marrow suppression
Osteomalacia
Multi organ hypersensitivity
SJS
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69
Q

What monitoring is need when taking Carbamazepine

MOA of Oxcarbazepine

Use

A

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

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70
Q

Adverse events of Oxcarbenzapine use

What drug interactions does it have?

A

HypoNa more likely

Reduces OCP, CCBs

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71
Q

What two anticonvulsants increase GABA Cl influx

When are they used?

A

Primidone- metabolized into phenobarbital, alternate for general tonic-clonic sezure
Essential tremors

Phenobarbital- tonic clonic, simple, partial or complicated seizures

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72
Q

Adverse effects of Phenobarbital

Adverse of Primidone

A

Sex dysfunction

Ataxia, sedation

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73
Q

Adverse effects of Benzos

What 3 anticonvulsants inhibit voltage gated Ca channels?

A

Sedation
High dose= ataxia, behavior changes

Pregabalin
Ethosuximide
Gabapentin

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74
Q

Gabapentin use and adverse

Pregabalin use and adverse

A

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
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75
Q

What is the DOC and second line choice for absence seizures?

What is the adverse and required monitoring for this drug?

A

Ethosuximide
2nd: Valproic acid

Transient leukopenia
GI

Monitor CBC- neutropenia, leukopenia

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76
Q

MOA of Valproic Acid and derivatives

Use

Adverse

A

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

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77
Q

Why are Valproic acid and derivative Preg Cat X?

If a PT ODs, what can be used to reverse?

A

Spina bifida

Naloxone

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78
Q

MOA of Lamotrigine

Uses

Adverse

A

Dec glutamate/aspartate release
Delays repetitive firing
Blocks fast Na channels

General tonic clonic
Lenox Gataut
Bipolar 1

SJS
BBW: rashes

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79
Q

MOA of Topiramate

Use

Adverse

A

“Dope-a-max”
Fast Na blocker
Inc GABA activity

Absence seizures
Lenox Gastaut

Sex dysfunction
Memory impairment
Metabolic acidosis

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80
Q

MOA of Levetiracetam

Use

A

Prevents hypersynchornization of firing and propogation of seizure activity

Tonic clonic in PT +6y/o
Myoclonic seizure in PTs +12y/o
Lenox Gastaut

81
Q

Use and adverse of anticonvuslants

A 
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
Q

What is used to Tx eclampsia?

What meds need to be avoided in pregnancy and why?

A

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
Q

What anticonvulsants have the highest incidence of sexual dysfunction

What two improve sex dysfunction

A

PC PT PZ
Phenobarbital Carbamazepine Phenytoin Topiramate Pregabalin Zonisamide

Lamotrigine Oxcarbazepine

84
Q

What are the 3 groups of Sxs seen in Schizo PTs?

A

Pos: presence of seomthing that shouldn’t be there

Neg: absence of something that should be there

Cognitive- poor function, impaired attention

85
Q

What are the theorized origins of the 3 groups of issues seen in Schizo PTs?

A

Neg- prefrontal cortex, blocked by 5HT

Pos: nucleus accumbus, excess dopamine

Parkinson: corpus striatum, no dopamine leaves ACh uninhibited

86
Q

What are the 3 main NTs involved w/ Schizo?

What is the strongest link of predictability?

A

D, S, Glutamate

1st degree relative w/ Schizo

87
Q

What are the 3 goals of Schizo management?

Typical/First gen antipsychs end w/ while atypical/Second gen end w/ ?

A

Control Sxs
Minimize adverse effect
Prevent relapse

1st: zine/xene/Haldol/Loxapine
2nd: zole, pine, one

88
Q

How long can it take for max treatment response to be reached w/ Schizo drugs?

Once response is observed, what is the next step?

A

6mon

Maintain for 6mon

89
Q

What is the most widely used anti-emetic for Schizo PTs?

Only FDA drug approved for hiccups?

A

Prochlorperazine

Chlorpromazine

90
Q

General adverse effects of taking antipsychotics?

Why do these have BBWs?

A

Dystonia
Tardive dyskinesia
Akathesia- MC, tx w/ Propranolol
Sex dyfuntion

Inc mortality in elderly w/ dementia related psychosis

91
Q

What is the MOA of 1st Gen antipsychotics

This class has less effect on controlling ? Sxs

A

Competitive dopamine receptor blocker and block HAM receptors

Negative Sxs

92
Q

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?

A

Low- low affinity, less risk of EPS
High- high affinity, higher rate of EPS

Anticholinergics: Trihexy/Benz
Antihistamine: Diphenhydramine

93
Q

What are the adverse effects of taking typical antipsych meds?

A

Worse neg/cognitive Sxs
Prolong QTc
POHTN
Weight gain (inc w/ low potency)

94
Q

Define Neuroleptic Malignant Syndrome

What is an adverse effect impacting both genders of PTs?

A

Most common drug event from high potency typical antipsychs
Agitation confusion LoC HTN/Tachy

Prolactin elevation

95
Q

Use of Chlorpromazine

Adverse

A

Intractable hiccups

Pigment deposits on retina/cornea
Long use= inc risk for tardive dyskinesia

96
Q

Use Thioridazine

What is the BBW for this med

A

High anticholinergic effect w/ HIGHEST occurrence of sedation

Torsades

97
Q

Use of Trifluoperazine

Adverse

A

General non-psychotic anxiety only after trying Benzos first

Persistant tardive dyskinesia

98
Q

What drug is preferred for non-psychotic anxiety in Schizo PTs?

Use Fluphenazine decanoate

A

Benzos

IM injection for Schizo need long neuroleptic therapy, reqs bridging

99
Q

Use of Haloperidol

Benefit of this med

Adverse

C/i

A

Schizo
Acute agitation
Tic/Tourettes

Less sedation than other anti-psych meds

Severe EPS
IV form causes Torsades

Parkinsons, Comatose

100
Q

MOA of Atypical Antipsychs

This class has similar efficacy for positive Sxs except for ?

A

Dopamine antagonists
Block S

Clozapine

101
Q

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?

A

Metabolic Syndrome
Measure waist at baseline

Most: Clozapine, Olanzapine
Least: Lurasidone

102
Q

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 ?

A

Clozapine

Reduce risk of suicide

103
Q

What are additional benefits that come from using Clozapine

Adverse

What is the BBW and monitoring needed?

A

Low EPS, Tardive dyskinesia
Improved negative Sxs
No prolactin elevation

Fatal myocarditis
Inc seizure

Agranulocytosis
Weekly CBC for first 6mon, then every 2wks

104
Q

Olanzapine benefit

Use

Adverse

What is required after giving a PT a dose of Olanzapine

A

No agranylocytosis

Acute agitation of Schizo/Bipolar
Long term schizo tx

Weight gain, HOTN

Monitor for respiratory depression x 3hrs

105
Q

Benefit of Risperidone

Risperidone is the worse of all the atypicals for ? Sx

What is a better version of Risperidone?

A

Best for Pos Sx Tx Peds 10-17

Hyperprolactinemia
Higher risk of EPS of all atypicals

Paliperidone- active metabolite

106
Q

Quetiapine is a good choice for ? PT population

What is an adverse effect

A

Psychosis in Parkinson PTs

Sedation OHOTN Cataracts

107
Q

Advantage of using Ziprasidone

Disadvantage of this one

A

Lower metabolic syndrome and prolactin

Higher QTc risk and cataracts

108
Q

Aripiprazole has a unique FDA approved use for ?

Asenapine is used for

This one is only available in ? form

A

Depression w/ SSRI

Schizo/Bipolar

Sublingual tab

109
Q

Iloperidone Use

Adverse

Lurasidone Use

A

Schizo only

Inc risk OHOTN, QTc prolongation, Esophogeal dysmotility

Schizo/Bipolar

110
Q

MOAs of Atypicals

A 
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
Q

What drugs are used for acute agitation/psychosis in pyschosis PTs?

Only antipsychotics that are PO disintegrating?

A

Benzos: D/L
Haldol
Atypicals: Olanzapine, Ziprasidone
Midazolam

Risperidone
Olanzapine

112
Q

Only antipsychs that are in parenteral formulation

Which ones are rapid tranquilizers

A

Olanzapine
Ziprasidone

Chlopromazine
Haldol
Fluphenazine
Olanzapine
Ziprasidone
113
Q

Which antipsychs are used for non-compliant PTs?

What med can be used to augment antipsych action?

A

Haldol deconoate
Fluphnazine decanoate
Risperidone
Paliperidone

Lithium

114
Q

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

A

Carbamazepine
Valproic acid

Atypicals

Low potency typicals- worsen constipation

115
Q

Why are benzo/barbituates so potent?

Their receptor strength is equivalent to ?

A

Binding site is more potent than GABA site

ETOH

116
Q

What are the short acting barbituates used for anesthesia?

What is Donnatal and what is it used for?

A

SPAM
Seco, Pento, Amobarbital, Methohexital

Trio combo: Scopalamin Atropine Phenobarbital
IBS

117
Q

Withdrawal from Barbituates is worse than?

What needs to be done if PT ODs?

A

Opiates

Mechanical ventilate
GI lavage
Dialysis

118
Q

What short acting Barbituates are used for anesthesia, status epileptics or insomnia?

Phenobarbital MOA and usage

A

Methohexital- anesthesia
Pentobarbital- epilepticus
SAPI- insomnia, not Methohexital

Inc GABE Cl influx
Any seizure type

119
Q

Short, Med, Long Benzos

A

Short: TOMC; Triazolam Oxeaepam Midazolam Clorazepate

Med: TEAL; Temazepam Estazolam Alprazolam Lorazepam

Long: CDC FQ; Chlordiazepoxide Diazepam Clonezepam Flurazepam Quazepam

120
Q

What class of Benzo will have more hangover Sxs

Which class will quickly develop tolerance, dependence and frequently experience withdrawal?

A

Long half life

Short half life

121
Q

Benzos do not offer ? services

What benzos are used for anxiety

A

Analgesic
Antipsychotic
ANS affect

Med/long life benzo- Clonazepam, Lorazepam, Diazepam

122
Q

What benzos can be used for panic attacks?

Which one is preferred in liver Dz/alcoholics due to liver bypassing effects?

A

Clonazepam
Oxazepam
Alprazolam

Lorazepam
COL*D

123
Q

Which benzos can be used during alcohol withdrawals?

Which ones can be used for insomnia

A

Chlordiazepoxide
Oxazepam
Lorazepam*
Diazepam

FETT Q
Flurazepam Estazolam Temazepam Triazolam Quazepam

124
Q

What type of benzo is needed to keep PTs asleep through the night?

Which class only puts them to sleep?

A

Long acting

Short acting

125
Q

What are 3 adverse effects from using Benzos?

Which benzos have minimal interaction w/ CYP3A4

A

Hangover
Rebound insomnia
Anterograde amnesia

LOT
Lorazepam Oxazepam Temazepam

126
Q

What are the only benzos that can be used in geriatric PTs?

What is the rescue agent for Benzo ODs?

Use of Buproprion

A

Lorazepam Oxazepam Temezaepam

Flumazenil- competitive antagonist, poor at reversing respiratory depression

Anxiety
No abuse potential
Preferred when Benzos have to be avoided

127
Q

Zolpidem

Eszopiclone

A

MOA: enhances GABA

Adv: metallic taste, SI, abnormal thought
CAUTION- lasts 50% longer in elderly PT
Highest risk for hangover

128
Q

Zaleplon

Suvorexant

Ramelteon

Tasimelteon

A

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
Q

What are the 7 non-benzo hypnotics?

A 
Zolpidem
Zaleplon
Buspirone
Esxopiclone
Ramelteon
SuVorexant
Tasimeltion
130
Q

Short, Med, Long benzo for insomnia

Antidepressants for insomnia

A

Triazolam

Temazepam
Estazolam

Flurazepam
Quazepam

Doxepin Mirtazapine Trazadone

131
Q

DOC for acute management of Anxiety D/o

DOC/1st, 2nd line and other options for GAD

A

Benzo, high potency w/ rapid onset are preferred

SSRI or SNRI
2nd: Buspirone, Pregabalin
Other: Quetiapine

132
Q

First line agent for Panic D/o

Which Benzos can be used?

A

SSRI/SNRI

Clonazepam* Alprazolam

133
Q

First line for Social anxiety d/o

Second line?

If Benzo is used, which ones can be used?

A

SSRI or SNRI

Gaba/Pregabalin

Clonazepam* Alprazolam

134
Q

What can be used for performance anxiety?

What is the first choice for OCD

A

Propranolol

SSRI (no SNRI)
TCA Comipramine can be used w/ SSRI combo

135
Q

First line for PTSD?

Which antipsychs can be used?

A

SSRI SNRI

Quetiapine Olanzapine Risperidone

136
Q

What med is used for PTSD nightmares?

What is used for uncontrollable anxiety w/ PTSD?

A

Prazosin

Benzo

137
Q

What med are used for impulsiveness, hyperarousal and flashbacks?

What is the most severe form of ethanol withdrawal?

A

Tiagabine Topiramate Divalproex

Delirium tremens

138
Q

What two benzos can b used for propylene glycol poisoning?

Which one is most frequently used for outpatient alcohol detox?

A

Lorazepam
Diazepam

Chlordiazepoxide

139
Q

What is an adverse event that occurs in alcoholics?

What is the Tx?

A

Wernicke encephalopathy

Folic acid and B12

140
Q

What are the first line meds for alcohol dependence?

Which ones are second line choices?

A

Naltrexone
Acamprostate

Disulfiram
Topiramate
Gabapentin
Baclofen
SSRI
141
Q

MOA of Naltrexone

What does it cause to happen for the PT?

Adverse

A

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
Q

MOA of Acamprosate

Use

Adverse

A

GABA mimetic to antagonize glutamate
Safe for PTs w/ liver dz

Abstinence from ETOH

TID dosing
N/V/D
Renal excretion

143
Q

Disulfiram

What happens when this reaction occurs?

A

Only motivated PTs
Inhibits ALDH blocking ETOH metabolism

ACh accumulation causing N/V/HA, Tachy/HOTN

144
Q

What needs to be checked prior to starting PT on ADHD meds

What stimulants are used for ADHD

What non-stimulants can be used?

A

BP HR Ht/Wt

Dextroamphetamine
Amphetamine
Methylphenidate
Lisdexamfetamine

Guanfacine
Atomoxetine
Clonidine

145
Q

What is the first line Tx for ADHD?

What is the MOA of amphetamines as a class

A

Behavior intervention

Inc D/NorEpi release and decrease uptake

146
Q

What are the 3 clinical uses of amphetamines

What is the most common pysch dz dx’d in kids?

A

ADHD
Narcolepsy
Obesity

ADHD

147
Q

What is the largest determinant of which amphetamine is chosen for ADHD Tx?

When are non stimulants moved up for use as first line

A

Duration

Concern for abuse
PT/Fam request of no stimulant
PT has condition that doesn’t tolerate stimulants (CDz, glaucoma, no appetite)

148
Q

What is not a controlled substance and was the first non-stimulant approved for ADHD use

MOA

Use

Adverse

A

Atomoxetine

Block NEpi uptake

ADHD in PTs +6y/o

Worsens aggressive behavior

149
Q

Clonidine MOA

Use

Adverse

A

Central A2 agonist

Alternative for kids who are intolerant to stimulants, especially w/ Tics
Impulsions/Tourettes

Sedation
Worse depression

150
Q

What drug class is not effective in ADHD

What class has shown efficacy against ADHD?

A

SSRI

TCA- Imipramine, Deipramine

151
Q

What are the drugs classified as “other” stimulants

A

Caffeine
Armodafinil
Modafinil
Ecstasy

152
Q

Modafinil/Armodafinil MOA

Use

Adverse

A

Dec GABA transmission

Obstructive apnea
Narcolepsy
Shift work d/o

Rhinitis and dec appetite

153
Q

What effect does caffeine have in neonates?

When is this used in medicine

A

Inc respiratory drive and force

Migraine
Apnea of prematurity

154
Q

What is the MOA of MDMA

What are the BMIs for over weight, obese and severely obese?

A

Hallucinogenic amphetamine

Over: 25-29
Obese: 30+
Severe: 40+

155
Q

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?

A

Behavior modification

35+ w/ comorbidity
40+

> 27 w/ comorbidity
30

156
Q

If PT has not loss ? weight, stop any weight loss meds they are on

What drug is given to reduce fat absorption and diegestion?

A

5% by 12wks

Orlistat

157
Q

What drugs can be given for obesity to reduce appetite?

A 
Sympathomimetics
-phetamine
Diethylpropion
Phentermine
Phendimetrazine
Bupropion

Serotonergic-
Topiramate

Antidiabetic-
Metformin
GLP-1 meds

158
Q

Phen/Top

Caution/C/i

A

Phe- appetite suppression
Top- promotes satiety by GABA stimulation

Taper to avoid seizures
Cat X

159
Q

Naltrex/Bupropion

Adverse

Avoid in

A

Nalt: opioid antagonist
Bupro: D/NorEpi inhibitor

SI, Seizure

Opiods, seizure, HTN

160
Q

MOA of Liraglutide

Adverse

Preg Cat

A

GLP-1 agonist

Pancreatitis
Sx hypoglycemia

Cat x

161
Q

Benzos used for pre-anesthetics

Which opiates are used?

A

Diazepam
Lorazepam
Midazolam

Meperidine
Morphine
Fentanyl
Remifentanyl
Sufentanyl
162
Q

What anticholinergics can be used for pre-anesthetic situations?

What is the only antihistamine used in a pre-anesthetic setting?

A

Atropine
Glygopyrrolate
Scopolamine

Diphenhydramine

163
Q

What 2 neuromuscular blockers are used for pre-anesthetics?

What are the 4 phases of anesthesia

A

Cisatracurium
Succinylcholine

1: analgesia
2: hyperexcitable
3: surgical anesthesia
4: medullary paralysis- OD

164
Q

What two classes of drugs are used to maintain anesthesia after admin of IV agent

What are the adverse reactions to these meds?

A

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
Q

What is the reversal/rescue agent for malignant hyperthermia?

What drug is preferred for outpatient surgical procedures

A

Dantrolene- reduced Ca release

Desflurane

166
Q

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

A

Suvoflurane, potentiall nephrotoxic

Barbituate/Benzo
Ketamine
Etomidate
Propofal- induction/maintenance

167
Q

What two neuromuscluar blockers are used for intubation and relaxation?

What barbituate is used for induction and maintenance of anesthesia?

A

Succinylcholine
Rocuronium
Vecuronium

Methohexital

168
Q

Which 3 benzos are available in IV

Ketamine site of action
Etomidate and Propofol site of action

A

DLM
Midazolam- rapid, shorter elimination time
Causes amnesia

K: NMDA receptor
E/P: GABA

169
Q

What is the adverse effect of ketamine use?

Which med is used in IV form for sedation in critical care as a continuous infusion?

A

Inc ICP

Propofol

170
Q

What is the adverse effects of Propofol

PTs can’t receive this med if they’re allergic to ?

A

Inc TG
Nutrition
Bacterial infection

Egg licithin
Soybean oil

171
Q

What meds induce anesthesia?

What meds maintain anesthesia?

A 
Isoflurane
Desflurane
Halothane
IV: BBKEP
Methohexital
Ketamine
Propofol

Propofol
Methohexidal
Ketamine
Dexmedetomidine

172
Q

What happens during Propofol infusion syndrome

A 
Brady
Metabolic acidosis
CV collapse
Rhabdo
Renal failure
173
Q

DOC for rapid intubation

What is an adverse effect

Adverse

A

Succinylcholine

Malignant hyperthermia
HyperK

Malignant hyperthermia Hx

174
Q

What NMBA is the DOC in PTs w/ renal/liver Dz

Depolarizing, Non-depolarizing belong to what 3 groups?

A

Cistracurium

Depol- ultra short (Succ)
Non-depol- int (ACRV)
Non-depol-long (Pan)

175
Q

What is the longest lasting NMBA

What is the adverse effect of this drug

What drugs does it interact w/

A

Atracurium

Metabolized into laudanosin, can cause seizures

ACh inhibitors
Aminoglycoside ABX
CCBs

176
Q

What two factors determine onset and duration of local anesthetics?

Adverse effects of using local anesthetics

A

Tissue pH
pKa of drug- closer to body pH= faster onset

Methemoglobinemia- Fe3 can’t bind O2
Seizure
Arrhythmia

177
Q

Epidural insert local anesthetic below ?

Intrathecal insert meds beneath ?

A

Ligamentum flavum

Arachnoid membrane of brain/spine

178
Q

Uses of Benzo, Chloropro, Co, and Procaine

Which amide is used during labor?

A

Ben: topical
Chloro: local, nerve, epidural
Co: topical
Pro: local, nerve block, spinal

Bupivacaine- no motor block, usually used as epidural

179
Q

Preferred use for Lidocaine, Lido/pro, TAC, and LET gel

A

Lido: intact skin for neuralgia
Lido/Prilo: intact skin for local
TAC: uncomplicated lacerations
LET: laceration on face/scalp

180
Q

What 3 foods can lower cholesterol?

A

Garlic- inhibit synthesis

Red yeast rice- inhibit HMG CoA, lowers LDL/TG, inc HDL

Omega 3 fatty acid

181
Q

What are the adverse effects of using red yeast rice?

A

Myopathy

Hepatotoxicity

182
Q

What dietary supplements can be used for performance enhancers

A

Adaptogens- promotes homeostasis
Steroid enhancer- DHEA
AA
Whey protein

183
Q

3 supplements for HA

Two for sedative/hyponotics

A

Caffeine
Mg
Peppermint oil

Valerian, Melatonin

184
Q

What two supplements can be used for depression?

Too much garlic can cause ?

A

St John wart- serotonin syndrome
Ginkgo

Platelet dysfunction

185
Q

Use of Omega 3 fatty acids

What is the adverse effects

A

Hyperlipidemia- lowers TG, may raise LDL

Burping fish taste, inc bleeding risk when used w/ anticoag or antiplatelet agent

186
Q

What is Asian ginseng used for?

What is an adverse effect?

A

ED/Sexual arousal
Athletic performance

Insomnia

187
Q

Use of Kratom

Use of Valerian and adverse

A

Opioid like effect

Insominia anxiety depression stress
Hepatotoxicity, Benzo like withdrawal

188
Q

Adverse of using Melatonin

Caution using St John wart in ?

Risk of ?

A

Lowers seizure threshold

Pregnancy, Bipolar, Schizo

Serotonin syndrome

189
Q

Use of Ginkgo biloba

Adverse

A

Cognitive function/dementia
Anxiety
Schizo
Antidepressant induced sex dysfunction

Seizure Neurotoxicity Seizure

190
Q

Use of Black Cohosh

Adverse

Dont’ use in ?

A

Estrogen like effect for menopause

Liver toxicity
Muscle damage

Pregnant/Liver Dz

191
Q

What is Dong Quia used for?

Adverse

A

Menopause, Premature ejaculation

Cancer

192
Q

Use of cranberry

Use of Echinacea

A

UTI prophylaxis

Flu/Cold Tx

193
Q

Use of Saw Palmetto

A

5-a-reductase and prevents DHT in vitro

BPH

194
Q

Use of ginger

What are the secondary Sxs of Parkinsons?

A

Morning sickness
N/V

Cognitive dysfunction
Autonomic dysfunction
Speech disturbance
Micrographia

195
Q

5 meds that can cause Parkinsonism Sxs

Improving motor disability is better done w/ ? while lessening motor complications is better done w/ ?

A 
Prochloroperazine
Chlorpromazine
Trifluoperazine
Thioridazine
Haldol
Levodopa
Dopamine agonist (BroRAP)
196
Q

When is L-dopa the initial therapy?

What class of drug is NOT used for OCD?

A

> 70, Dementia, Cognitive impairment

SNRI

197
Q

What antipsych is only a partial agonist?

What med is used for the depression phase of Bipolar?

A

Aripramide

Lamotrigine

198
Q

What are 4 meds that can be used in L Gataut?

What meds can cause SJS?

A

TTL

Barbituates
5 more

199
Q

What two antidepressants don’t require tapering before d/c

Valproic acid, Carb, Lamotrigine are more effective than Lithium in ? 4 scenarios

A

Fluoxetine
Buproprion

2* bipolar
Mixed mania
Rapid cyclers
Substance abuse

IPAP (212 decks)

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