Pharm 2

Question 1

How does smoking affect drug metabolism?

Answer 1

Tobacco induces CYP 1A2 which lower drug plasma level of particular drugs.

Question 2

What 6 drugs are classically affected by concurrent smoking? And how?

Answer 2

Tobacco induces CYP 1A2 which lower drug plasma level of:

1. Clozapine
2. Olanzapine
3. Haldol
4. Amitriptyline
5. Imipramine
6. Fluvoxamine

(Among others)

Question 3

What is the predominant MOA of Buspirone?

Answer 3

Serotonin 1A agonist.

Question 4

TCAs can be categorized as tertiary or secondary amines….during drug metabolism a tertiary amine TCA becomes a secondary amine…

What three TCAs start as secondary amines?

Answer 4

• Nortriptyiline
• Desipramine
• Protryptyline

Question 5

Which TCA gets metabolized into a potent Dopamine blocking product that can lead to antipsychotic- like effects?

Answer 5

Amoxapine

Question 6

TCAs are most heavily metabolized by which liver enzyme?

Answer 6

Cytochrome P450 2D6.

CYP 2D6

Question 7

TCAs effect what change that correlates most closely with the TIME it takes for clinical effect.

Answer 7

TCAs lead to a decrease (by down regulation) in B-adrenergic receptor and 5-HT receptors, which correlates with the time it takes for clinical effect.

Question 8

What two TCAs are considered LEAST sedating?

What three TCAs are considered MOST sedating?

Answer 8

LEAST SEDATING

• Desipramine
• Protriptyline

MOST SEDATING:

• Doxepin
• Amitriptyline
• Trimipramine

Question 9

What can be a potential problem with combining Carbamazepine and Oral Contraceptive pill?

Answer 9

Carbamazepine is a P450 inducer, thus can lower OCP, causing failure of contraception.

Question 10

What are the SE of Lithium toxicity?

Answer 10

1. Tremor and ataxia
2. N/V
3. Renal toxicity, polyuria (from antagonism of ADH)
4. seizure
5. hyper-reflexia
6. Nystagmus
7. Muscle weakness
8. Non specific T wave changes
9. Lethargy, coma