Pharm 2 exam 2 Flashcards
1
Q
What drugs notably don’t have a potential for abuse?
A
Antipsychotics
2
Q
Which drug is good for treating nausea?
A
Dronabinol (Cannabinoid)
3
Q
What are the Peripheral Tissue Effects of opioids?
A
– Lowered activity of GI system – Urine retention – Uterine relaxation (bad for labor!)
4
Q
Analgesia is mediated mainly by receptors in ______
A
spinal cord
5
Q
Name drug class: Reduction of Anxiety Sedative and Hypnotic Anterograde Amnesia Anticonvulsant Muscle Relaxant anesthetic
A
Benzodiazepines
6
Q
Tramadol
A
Opiate agonist. Pain management. weak SNRI.
Caution in pts SSRI, tricyclics, or MAOIs
7
Q
Which antidepressant helps with nicotine withdrawal?
A
Bupropion
8
Q
How does someone get Anesthetic-induced corneal syndrome? What happens?
A
Occurs within 6 days to 6 weeks of self-administration of anesthetic (like proparacaine)
Loss of epithelium, inhibition of healing, stromal edema
9
Q
Name drug:
– Anxiety • HTN, tachycardia, paranoia – Depression • Stimulation is followed by period of depression – Can induce seizures as well as arrhythmias
A
Cocaine
10
Q
Modafinil
A
Psychomotor Stimulant, Amphetamine. UNIQUE MOA: Targets DA transporter to prevent DA reuptake.
Tx Narcolepsy
AE: Addiction, dependence and tolerance. – Insomnia, irritability, weakness, dizziness, tremor and hyperactive reflexes – Confusion, delirium, panic states, suicidal tendencies – Heart palpitations, arrhythmias, HTN, angina – Nausea, vomiting, abdominal cramps and diarrhea
11
Q
What is the precursor of glutamate? How is glutamate broken down?
A
Glutamine + glutaminase = glutamate.
glutamine synthetase breaks it down
12
Q
How does a local anesthetic block pain? How does this differ from opioids?
A
They block Na channel to prevent propagation of pain signal.
Opioids block pain in the spinal cord
13
Q
What is the traditional treatment for mania?
A
Lithium
14
Q
How does ethanol affect smooth muscle?
A
It relaxes smooth muscle to cause vasodilation. This can result in hypothermia, esp in cold places
15
Q
Which drug blocks NMDA glutamate receptor to inhibit reuptake of DA, 5-HT, and NE?
A
Phencyclidine (PCP)
16
Q
_____ neurons are the most numerous type
A
Multipolar
17
Q
Paroxetine (Paxil)
A
SSRI. Tx depression. AE: Dry mouth, GI distress, Agitation, insomnia, Sexual dysfunction
18
Q
Phenelzine
A
MAOI. Tx depression. Increase NE 5HT and DA. AE: Orthostatic hypotension, Serotonin syndrome, Sleep disturbances, weight gain, blurred vision, dry mouth, sexual dysfunction
19
Q
What is the pathway of Epinephrine?
A
Tyrosine (tyrosine hydroxylase)> L-Dopa (aromatic AA decarb)> DA (DA beta hydroxylase)> NE > Epi
20
Q
What makes ACh?
A
Acetyl + Choline through enzyme choline acetyltransferase = ACh
21
Q
Methadone
A
Opioid Agonist. Longer duration of action than morphine. Good ORALLY
Helps to lessen withdrawal.
– Analgesia – Drowsiness/sedation – Euphoria – Dysphoria (confusion) – Pupillary constriction – Nausea and vomiting – Respiratory depression – Cough suppression – Decreased BP
– Lowered activity of GI system – Urine retention – Uterine relaxation (bad for labor!)
not for Shock, Bronchial asthma, Head injuries (can increase intracranial pressure), During labor (Obstetrics), Emphysema/asthma because reduces respiratory rate
22
Q
What are the primary amine NTs?
A
Ach, DA, NE, Epi, 5-HT, Histamine
23
Q
Opioids
A
Preanesthetic Medication and Intravenous General Anesthetic.
24
Q
Tranylcypromine
A
MAOI. Tx depression. Increase NE 5HT and DA. AE: Orthostatic hypotension, Serotonin syndrome, Sleep disturbances, weight gain, blurred vision, dry mouth, sexual dysfunction
25
Lithium
```
Tx Mania. MOA unknown.
AE:
Tremor
Ataxia
Aphasia
Mental confusion
Decreased thyroid function
Polydipsia and polyuria
Edema
```
26
Lisdexamfetamine
Psychomotor Stimulant, Amphetamine. MOA: MAO stores this drug in vesicle instead of NE/DA, so these NTs are out in cleft longer)
AE: Addiction, dependence and tolerance. – Insomnia, irritability, weakness, dizziness, tremor and hyperactive reflexes – Confusion, delirium, panic states, suicidal tendencies – Heart palpitations, arrhythmias, HTN, angina – Nausea, vomiting, abdominal cramps and diarrhea
27
Which two drugs are especially good at treating restless legs syndrome?
Pramipexole or ropinirole (DA agonist for parkinson's)
| Pram- Ropi-
28
Benztropine
Anti-parkinson Drugs, Anticholinergic Agents, useful in early stages to reduce tremors. can cause blurry vision, bad for glaucoma pts
29
Barbiturates
Intravenous General Anesthetic. binds to GABA receptor to enhance GABA.
30
Citalopram (Celexa)
SSRI. Tx depression. AE: Dry mouth, GI distress, Agitation, insomnia, Sexual dysfunction
31
Which abused drugs cause excitation of DA neurons
Nicotine, alcohol
32
Temazepam
Benzodiazepine. binds to GABA receptor to enhance GABA; also decreases GABA release. CAN'T OVERDOSE
actions: Reduction of Anxiety, Sedative and Hypnotic, Anterograde Amnesia, Anticonvulsant, Muscle Relaxant, anesthetic
AE: Amnesia, daytime sedation, Disinhibition, Some reports of “bizarre” behavior and hallucinations
33
What receptors does glutamate bind to? Which one has a Mg block inside the channel?
AMPA, NMDA, and kainate. NMDA is blocked by Mg
34
Ketamine
Intravenous General Anesthetic. Unknown MOA
35
Quetiapine (Seroquel)
2nd generation antipsychotic. D2 antagonist (and D3, D4, 5HT blocker) UNIQUE: tx Mania and Bipolar Disorder (good for depression)
36
____ helps ease opiate withdrawal
methadone
37
Thiothixene
1st generation antipsychotic. D2 antagonist.
AE:
Metabolic side effects (weight gain, DBM, etc)
Antiemetic effects
Beta-blocking effect (causes orthostatic hypotension w/ reflex tachycardia and arrhythmias)
Affects Ach (blurred vision, dry mouth)
Extrapyramidal side effects (Acute dystonia, akathisia, Tardive dyskinesia, Parkinson's-like sign)
38
```
Name drug's AE:
Tremor
Ataxia
Aphasia
Mental confusion
Decreased thyroid function
Polydipsia and polyuria
Edema
```
Lithium
39
Dexmethylphenidate
Psychomotor Stimulant, Amphetamine. MOA: MAO stores this drug in vesicle instead of NE/DA, so these NTs are out in cleft longer)
AE: Addiction, dependence and tolerance. – Insomnia, irritability, weakness, dizziness, tremor and hyperactive reflexes – Confusion, delirium, panic states, suicidal tendencies – Heart palpitations, arrhythmias, HTN, angina – Nausea, vomiting, abdominal cramps and diarrhea
40
What a local anesthetic allow you to perform on the cornea?
Debridement • Diagnosis • Techniques
41
After GABA is removed from the synaptic cleft, it it taken up by the ____
Astrocytes
42
Clomipramine
Tricyclic antidepressants. block reuptake of NE and 5HT (but not DA). AE: Dry mouth, Confusion, Weight gain, Blurred vision, Increased IOP, Sedation, Sexual dysfunction
43
Chlorpromazine (Thorazine)
1st generation antipsychotic. D2 antagonist.
AE:
Metabolic side effects (weight gain, DBM, etc)
Antiemetic effects
Beta-blocking effect (causes orthostatic hypotension w/ reflex tachycardia and arrhythmias)
Affects ACh (blurred vision, dry mouth)
Extrapyramidal side effects (Acute dystonia, akathisia, Tardive dyskinesia, Parkinson's-like sign)
44
Proparacaine
Local anesthetic. MOA: target Na channels in axon to prevent pain propagation to spinal cord. Not for prolonged use
45
___ and ___ are responsible for the progression of Alzheimer's
Polymerization of beta amyloid protein forming tau tangles and fibrils
46
The monoamine theory of depression states that…
5-HT and NE are low in depression, but there is little evidence
47
Codeine
Partial Opioid Agonist, antitussive. good ORALLY
48
What can cause a Kayser Fleischer ring on the cornea?
Wilson's Disease (copper metabolism problem that causes movement problems)
49
Both NE and 5-HT are (excitatory/inhibitory) NTs
Excitatory, except alpha 2
50
Escitalopram (Lexapro)
SSRI. Tx depression. AE: Dry mouth, GI distress, Agitation, insomnia, Sexual dysfunction
51
Trihexyphenidyl
Anti-parkinson Drugs, Anticholinergic Agents, useful in early stages to reduce tremors. can cause blurry vision, bad for glaucoma pts
52
What can treat narcolepsy?
Amphetamine, Armodafinil, Modafinil
53
Which ion is especially excitotoxic?
Calcium
54
Zaleplon
Benzodiazepine-like drug. short-term binds to GABA receptor to enhance GABA. Tx insomnia
55
Dextroamphetamine + Amphetamine
Psychomotor Stimulant, Amphetamine. MOA: MAO stores this drug in vesicle instead of NE/DA, so these NTs are out in cleft longer)
Tx: ADHD
AE: Addiction, dependence and tolerance. – Insomnia, irritability, weakness, dizziness, tremor and hyperactive reflexes – Confusion, delirium, panic states, suicidal tendencies – Heart palpitations, arrhythmias, HTN, angina – Nausea, vomiting, abdominal cramps and diarrhea
56
Clonazepam (Klonopin)
Benzodiazepine. binds to GABA receptor to enhance GABA; also decreases GABA release. CAN'T OVERDOSE
actions: Reduction of Anxiety, Sedative and Hypnotic, Anterograde Amnesia, Anticonvulsant, Muscle Relaxant, anesthetic
AE: Amnesia, daytime sedation, Disinhibition, Some reports of “bizarre” behavior and hallucinations
57
Which abused drugs block DA uptake
Cocaine, amphetamine, ecstasy
58
Fentanyl
Opioid Agonist.
– Analgesia – Drowsiness/sedation – Euphoria – Dysphoria (confusion) – Pupillary constriction – Nausea and vomiting – Respiratory depression – Cough suppression – Decreased BP
– Lowered activity of GI system – Urine retention – Uterine relaxation (bad for labor!)
not for Shock, Bronchial asthma, Head injuries (can increase intracranial pressure), During labor (Obstetrics), Emphysema/asthma because reduces respiratory rate
59
Zolpidem
Benzodiazepine-like drug. short-term binds to GABA receptor to enhance GABA. Tx insomnia
60
Name drug:
Low doses produce euphoria and arousal as well as relaxation – Improves attention, learning, problem solving, and reaction time. – High doses cause central respiratory paralysis and severe hypotension (medullary paralysis)
Nicotine
61
Alprazolam (Xanax)
Benzodiazepine. binds to GABA receptor to enhance GABA; also decreases GABA release. CAN'T OVERDOSE
actions: Reduction of Anxiety, Sedative and Hypnotic, Anterograde Amnesia, Anticonvulsant, Muscle Relaxant, anesthetic
AE: Amnesia, daytime sedation, Disinhibition, Some reports of “bizarre” behavior and hallucinations
62
Diazepam (Valium)
Benzodiazepine. TX MUSCLE SPASMS binds to GABA receptor to enhance GABA; also decreases GABA release. CAN'T OVERDOSE
actions: Reduction of Anxiety, Sedative and Hypnotic, Anterograde Amnesia, Anticonvulsant, Muscle Relaxant, anesthetic
AE: Amnesia, daytime sedation, Disinhibition, Some reports of “bizarre” behavior and hallucinations
63
What are opioids used for?
Relief of pain, kinda anesthesia, antidiarrheal, antitussive (codeine), Dyspnea (SOB, tx morphine meperidine), opiate addiction tx (methadone)
64
Thioridazine
1st generation antipsychotic. D2 antagonist.
AE:
Metabolic side effects (weight gain, DBM, etc)
Antiemetic effects
Beta-blocking effect (causes orthostatic hypotension w/ reflex tachycardia and arrhythmias)
Affects Ach (blurred vision, dry mouth)
Extrapyramidal side effects (Acute dystonia, akathisia, Tardive dyskinesia, Parkinson's-like sign)
65
Rotigotine
Anti-parkinson Drugs and restless legs syndrome tx, Dopamine Agonists. Effective past failing point of other drugs. less dyskinesia than levodopa, but anorexia, nausea, vomiting, postural hypotension, and psychiatric reactions are common
66
Anticholinergics
Preanesthetic Medication. Prevent bradycardia and secretion of fluids into the respiratory tract
67
Oxycodone
(OxyContin) Opioid Agonist. Similar to morphine, good ORALLY.
– Analgesia – Drowsiness/sedation – Euphoria – Dysphoria (confusion) – Pupillary constriction – Nausea and vomiting – Respiratory depression – Cough suppression – Decreased BP
– Lowered activity of GI system – Urine retention – Uterine relaxation (bad for labor!)
not for Shock, Bronchial asthma, Head injuries (can increase intracranial pressure), During labor (Obstetrics), Emphysema/asthma because reduces respiratory rate
68
The synapse is ____ wide
20 nm
69
Varenicline
Psychomotor Stimulant. Parasympathetic Agonist. MOA: partial agonist at neuronal nicotinic receptor. Good for reducing rewards of smoking
70
What can treat Tourette tics?
```
haloperidol (1st generation antipsychotic. D2 antagonist)
or clonidine (alpha 2 agonist)
```
71
Which drug is a melatonin receptor agonist?
Ramelteon
72
Bupivacaine
Local anesthetic. MOA: target Na channels in axon to prevent pain propagation to spinal cord. Not for prolonged use.
Longest duration injectible
73
Hydrocodone
Partial Opioid Agonist. Similar to morphine, good ORALLY
74
Buspirone
5HT receptor agonist. Tx anxiety
75
Triazolam
Benzodiazepine. binds to GABA receptor to enhance GABA; also decreases GABA release. CAN'T OVERDOSE
actions: Reduction of Anxiety, Sedative and Hypnotic, Anterograde Amnesia, Anticonvulsant, Muscle Relaxant, anesthetic
AE: Amnesia, daytime sedation, Disinhibition, Some reports of “bizarre” behavior and hallucinations
76
Benzodiazepines
Preanesthetic medication and Intravenous General Anesthetic. Benzodiazepine. binds to GABA receptor to enhance GABA; also decreases GABA release. CAN'T OVERDOSE
77
Midazolam (Versed)
Benzodiazepine. binds to GABA receptor to enhance GABA; also decreases GABA release. CAN'T OVERDOSE
actions: Reduction of Anxiety, Sedative and Hypnotic, Anterograde Amnesia, Anticonvulsant, Muscle Relaxant, anesthetic
AE: Amnesia, daytime sedation, Disinhibition, Some reports of “bizarre” behavior and hallucinations
78
Heroin
Opioid Agonist.
– Analgesia – Drowsiness/sedation – Euphoria – Dysphoria (confusion) – Pupillary constriction – Nausea and vomiting – Respiratory depression – Cough suppression – Decreased BP
– Lowered activity of GI system – Urine retention – Uterine relaxation (bad for labor!)
not for Shock, Bronchial asthma, Head injuries (can increase intracranial pressure), During labor (Obstetrics), Emphysema/asthma because reduces respiratory rate
79
Aripiprazole (Abilify)
2nd generation antipsychotic. D2 antagonist (and D3, D4, 5HT blocker). UNIQUE: tx Mania and Bipolar Disorder
80
Nortriptyline
Tricyclic antidepressants. block reuptake of NE and 5HT (but not DA). AE: Dry mouth, Confusion, Weight gain, Blurred vision, Increased IOP, Sedation, Sexual dysfunction
81
Antacids
Preanesthetic Medication
82
Desflurane
Inhaled General Anesthetic. interacts with ion channel proteins
83
Chlordiazepoxide (Librium)
Benzodiazepine. binds to GABA receptor to enhance GABA; also decreases GABA release. CAN'T OVERDOSE
actions: Reduction of Anxiety, Sedative and Hypnotic, Anterograde Amnesia, Anticonvulsant, Muscle Relaxant, anesthetic
AE: Amnesia, daytime sedation, Disinhibition, Some reports of “bizarre” behavior and hallucinations
84
Chronic use of ___ actually depletes DA
Cocaine
85
Donepezil (Aricept)
Alzheimer's treatment (and myasthenia gravis tx), Cholinesterase inhibitor.
AE: tremors, nausea, anorexia, bradycardia, diarrhea, myalgia
86
(drug class) produces dyskinesias less frequently than levodopa, but other side effects more common
DA agonists (in parkinson's)
87
Procaine (Novocain)
Local anesthetic. MOA: target Na channels in axon to prevent pain propagation to spinal cord. Not for prolonged use
88
What glutamate channels let Na through? Which one does Na, K, and Ca?
AMPA, NMDA, and kainate, but NMDA lets the other ions through
89
Mepivacaine
Local anesthetic. MOA: target Na channels in axon to prevent pain propagation to spinal cord. Not for prolonged use
90
For preanesthetic meds, what reduces anxiety. Causes sedation. Prevents allergic reactions. Reduces gastric acidity. Prevents vomiting. And reduces pain?
Benzodiazepines reduce anxiety. Barbiturates cause sedation. Antihistamines revent allergic reactions. Rantidine reduces gastric acidity. Antiemetics prevent vomiting. Opioids reduce pain
91
Levorphanol
Opioid Agonist.
– Analgesia – Drowsiness/sedation – Euphoria – Dysphoria (confusion) – Pupillary constriction – Nausea and vomiting – Respiratory depression – Cough suppression – Decreased BP
– Lowered activity of GI system – Urine retention – Uterine relaxation (bad for labor!)
not for Shock, Bronchial asthma, Head injuries (can increase intracranial pressure), During labor (Obstetrics), Emphysema/asthma because reduces respiratory rate
92
Opening GABA channels lets ___ to flow ___ the cell
Cl flows into the cell (hyperpolarizing it)
93
What can treat ADHD?
Amphetamines. Especially Dextroamphetamine (w/ wo/ Amphetamine), Methylphenidate
94
What can treat alcohol or opiate addiction?
Benzodiazepines
95
Lorazepam
Benzodiazepine. binds to GABA receptor to enhance GABA; also decreases GABA release. CAN'T OVERDOSE
actions: Reduction of Anxiety, Sedative and Hypnotic, Anterograde Amnesia, Anticonvulsant, Muscle Relaxant, anesthetic
AE: Amnesia, daytime sedation, Disinhibition, Some reports of “bizarre” behavior and hallucinations
96
Estazolam
Benzodiazepine. binds to GABA receptor to enhance GABA; also decreases GABA release. CAN'T OVERDOSE
actions: Reduction of Anxiety, Sedative and Hypnotic, Anterograde Amnesia, Anticonvulsant, Muscle Relaxant, anesthetic
AE: Amnesia, daytime sedation, Disinhibition, Some reports of “bizarre” behavior and hallucinations
97
Nitrous oxide
Inhaled General Anesthetic. interacts with ion channel proteins
98
Biperiden
Anti-parkinson Drugs, Anticholinergic Agents, useful in early stages to reduce tremors. can cause blurry vision, bad for glaucoma pts
99
AE of SSRIs?
Dry mouth, GI distress, Agitation, insomnia, Sexual dysfunction
100
What do extrapyramidal side effects cause?
Acute dystonia (spasms)
akathisia (squirm)
Tardive dyskinesia (facial movements)
Parkinson's-like signs.
These can arise from 1st gen antipsychotics
101
Which drug is a 5HT agonist and causes symp ANS activation?
Lysergic acid diethylamide (LSD)
102
Desipramine
Tricyclic antidepressants. block reuptake of NE and 5HT (but not DA). AE: Dry mouth, Confusion, Weight gain, Blurred vision, Increased IOP, Sedation, Sexual dysfunction
103
For infected/inflamed patients, what should you change about your injection anesthetics?
You'll likely need to use a larger dose because infection and/or inflammation is usually associated with acidosis. This ionizes drugs making them harder to enter cells.
104
Caffeine
Psychomotor stimulant. Methylxanthine. MOA: Blockade of adenosine receptors in CNS. indirectly increases DA. Simulates HCl secreation
AE: – Insomnia, anxiety, agitation – Emesis and convulsions at higher doses. Tolerence
Theophylline and theobromine are also metabolites of caffeine
105
Which NT Is only found in the CNS?
GABA
106
___ is the only illicit drug that can cause death by dose AND from hyperthermia (because it impairs sweating and cutaneous vasodilation)
Cocaine
107
Bipolar neurons are commonly ____neruons
Interneurons
108
Greatest effect of opioid analgesics are at ___ receptors
Mu
109
Amantadine
Anti-parkinson Drugs, Induces DA release. MOA unknown. Effective until "critical point"
110
AE MAOIs?
- Orthostatic hypotension
- Serotonin Syndrome (acute HTN, cardiac problems, NE release makes Ser Syn worse. avoid tyramine to improve)
- Sleep disturbances, weight gain, blurred vision, dry mouth, sexual dysfunction
111
First generation antipsychotics characteristics:
(Thio- -azine Halo-)
Very good at treating positive signs of schizophrenia
D2 antagonists
Affects movement (bad)
112
Eszopiclone
(Lunesta) Benzodiazepine-like drug. short-term binds to GABA receptor to enhance GABA. Tx insomnia
113
How do you reverse the effects of Barbiturates?
You can't! there is no barbiturate blockers, unlike Flumazenil for os
114
Mirtazapine
alpha 2 blocker, enhances 5HT and NE neurotransmission. Atypical antidepressant. Also is a sedative
115
```
Name drug class MOA:
increase in K conductance and a decrease in Ca conductance through inhibition of adenylyl cyclase and a decrease in the concentration of cAMP.
```
Opioids
116
Which drug causes a phase I block? What is it?
Succinylcholine (Depolarizing agent). The muscle fiber can't repolarize
117
Pentobarbital (Nembutal)
Barbiturate. binds to GABA receptor to enhance GABA.
ACTIONS: CNS depression (for anesthesia)Suppress CO2 response, Induce CYP450 (decrease conc of other drugs including this class), Sedative and Hypnotic, anticonvulsant (not as common), anesthetic
AE: Addiction, Sedation, Hypotension, Lethal overdose
118
Cisatracurium
Muscle relaxant, nondepolarizing Agent. less likely to produce toxic metabolite, Most commonly used in clinical practice.
MOA: Nicotinic antagonist
AE: Hyperkalemia, increased IOP, muscle pain
Tx: Surgical relaxation, Endotracheal Intubation, Control of ventilation (reduce chest wall resistance), Treatment of convulsions
119
What is akathisia?
Pacing/squirming. It's an extrapyramidal side effect. This can arise from 1st gen antipsychotics
120
Trazodone
weak 5HT reuptake inhibitor. Atypical antidepressant
121
Which GABA receptor is useful for drug targets?
GABAa, (ionotropic)
122
Which drug is only available in combination with sodium fluorescein?
Benoxinate
123
Succinylcholine
Muscle relaxant, Depolarizing Agent. Very short duration of action.
MOA: nicotinic agonist that doesn't easily break down.
Causes flaccid paralysis because muscle can't repolarize (phase I block)
Prolonged exposure causes difficulty in depolarization (phase II block)
AE: Cardiac arrhythmias, Hyperkalemia, increased IOP, muscle pain.
Succinylcholine can be antagonized with nondepolarizing blocker
124
Tetracaine
Local anesthetic. available in gel for minor surgical procedures
MOA: target Na channels in axon to prevent pain propagation to spinal cord
125
Cocaine causes ____ of normal pupil ( _____ in Horner's)
Cocaine causes dilation of normal pupil ( no dilation in Horner's syndrome)
126
```
Name drug class:
CNS depression (for anesthesia)
Suppress CO2 response
Induce CYP450 (decrease conc of other drugs including this class)
Sedative and Hypnotic
anticonvulsant (not as common)
anesthetic
```
Barbiturates
127
Buprenorphine
Mixed Opiate Agonist-Antagonist. Show agonist activity in drug naïve patients or antagonist activity in patients with opioid dependence
128
___% of pts don't respond to a particular antidepressant
40%
129
What is Tardive dyskinesia?
Involuntary, tic-like movements of lips, jaw, tongue, and may include trunk and limbs. This can arise from 1st gen antipsychotics
130
Unipolar neurons tend to be ____ neurons
Sensory
131
Doxepin
Tricyclic antidepressants. block reuptake of NE and 5HT (but not DA). AE: Dry mouth, Confusion, Weight gain, Blurred vision, Increased IOP, Sedation, Sexual dysfunction
132
Olanzapine
2nd generation antipsychotic. D2 antagonist (and D3, D4, 5HT blocker)
133
Duloxetine (Cymbalta)
SNRI. Tx depression (associated with chronic pain). AE: LESS SEVERE Dry mouth, Confusion, Weight gain, Blurred vision, Increased IOP, Sedation, Sexual dysfunction
134
Rocuronium
Muscle relaxant, nondepolarizing Agent. highly dependant on liver metabolism
MOA: Nicotinic antagonist
AE: Hyperkalemia, increased IOP, muscle pain
Tx: Surgical relaxation, Endotracheal Intubation, Control of ventilation (reduce chest wall resistance), Treatment of convulsions
135
Oxazepam
Benzodiazepine. binds to GABA receptor to enhance GABA; also decreases GABA release. CAN'T OVERDOSE
actions: Reduction of Anxiety, Sedative and Hypnotic, Anterograde Amnesia, Anticonvulsant, Muscle Relaxant, anesthetic
AE: Amnesia, daytime sedation, Disinhibition, Some reports of “bizarre” behavior and hallucinations
136
Nicotine
Psychomotor Stimulant. Parasympathetic Agonist. MOA: causes ganglionic stimulation/blockade at low/high doses
CNS: Low doses produce euphoria and arousal as well as relaxation – Improves attention, learning, problem solving, and reaction time. – High doses cause central respiratory paralysis and severe hypotension (medullary paralysis)
PNS: – Low doses • Increase blood pressure and heart rate • Decreased coronary blood flow • Increase bowel motor activity – High doses • Decreased blood pressure • Activity of GI tract and bladder cease
AE: Irritability and tremors – Intestinal cramps, diarrhea – Increased heart rate and blood pressure
137
Baclofen
Muscle relaxant, Centrally Acting Spasmolytic Drugs.
MOA: GABAb agonist.
tolerance can develop.
tx: lower back pain, reducing cravings in alcoholics, in migraine patients
138
To cross the BBB, drugs need to be charged or uncharged?
Uncharged
139
Benoxinate (Fluress)
Local anesthetic. Less toxic than other topicals. Only available in combination with sodium fluorescein (Fluress)
MOA: target Na channels in axon to prevent pain propagation to spinal cord.
Not for prolonged use
140
Galantamine
Alzheimer's treatment (and myasthenia gravis tx), Cholinesterase inhibitor.
AE: tremors, nausea, anorexia, bradycardia, diarrhea, myalgia
141
D_ is also present on the axon terminals
D2
142
Theophylline
Psychomotor stimulant. Methylxanthine. MOA: Blockade of adenosine receptors in CNS. indirectly increases DA. Simulates HCl secreation. found in tea
AE: – Insomnia, anxiety, agitation – Emesis and convulsions at higher doses. Tolerence
143
Name drug:
– Low doses • Increase blood pressure and heart rate • Decreased coronary blood flow • Increase bowel motor activity – High doses • Decreased blood pressure • Activity of GI tract and bladder cease
Nicotine
144
Pramipexole
Anti-parkinson Drugs and restless legs syndrome tx, Dopamine Agonists. Effective past failing point of other drugs. less dyskinesia than levodopa, but anorexia, nausea, vomiting, postural hypotension, and psychiatric reactions are common
145
Valproic acid
Tx mania (and epilepsy). Targets voltage-gated Na channels
146
```
Name drug class AE:
Amnesia
Daytime sedation
Disinhibition
Some reports of “bizarre” behavior and hallucinations
```
Benzodiazepines
147
____ generation antipsychotics have a higher risk of metabolic side effects (like diabetes, hypercholesterolemia, weight gain)
Second gen (Ari- -apine -idone)
148
When should you NOT give opiates?
– Shock
– Bronchial asthma
– Head injuries (can increase intracranial pressure)
– During labor (Obstetrics)
– Emphysema/asthma because reduces respiratory rate
149
Venlafaxine (Effexor)
SNRI. Tx depression (associated with chronic pain). AE: LESS SEVERE Dry mouth, Confusion, Weight gain, Blurred vision, Increased IOP, Sedation, Sexual dysfunction
150
Sertraline
SSRI. Tx depression. AE: Dry mouth, GI distress, Agitation, insomnia, Sexual dysfunction. UNIQUE: undergoes extensive 1st pass metabolism
151
What are the 4 stages of anesthesia?
Stage 1 Analgesia
Stage 2 Excitement (delirium/violent)
Stage 3 Surgical anesthesia (eye and pupil movement stop)
Stage 4 Medullary paralysis (can be hard to come out of, death)
152
Dextroamphetamine
(Dexedrine) Psychomotor Stimulant, Amphetamine. MOA: MAO stores this drug in vesicle instead of NE/DA, so these NTs are out in cleft longer)
Tx: ADHD
AE: Addiction, dependence and tolerance. – Insomnia, irritability, weakness, dizziness, tremor and hyperactive reflexes – Confusion, delirium, panic states, suicidal tendencies – Heart palpitations, arrhythmias, HTN, angina – Nausea, vomiting, abdominal cramps and diarrhea
153
Ziprasidone
2nd generation antipsychotic. D2 antagonist (and D3, D4, 5HT blocker)
154
What can Wilson's Disease cause?
Tremor, rigidity, hypokinesia, dysphagia, and Kayser Fleischer ring
155
Clorazepate
Benzodiazepine. binds to GABA receptor to enhance GABA; also decreases GABA release. CAN'T OVERDOSE
actions: Reduction of Anxiety, Sedative and Hypnotic, Anterograde Amnesia, Anticonvulsant, Muscle Relaxant, anesthetic
AE: Amnesia, daytime sedation, Disinhibition, Some reports of “bizarre” behavior and hallucinations
156
Amitriptyline
Tricyclic antidepressants. block reuptake of NE and 5HT (but not DA). AE: Dry mouth, Confusion, Weight gain, Blurred vision, Increased IOP, Sedation, Sexual dysfunction
157
Oxymorphone
Opioid Agonist.
– Analgesia – Drowsiness/sedation – Euphoria – Dysphoria (confusion) – Pupillary constriction – Nausea and vomiting – Respiratory depression – Cough suppression – Decreased BP
– Lowered activity of GI system – Urine retention – Uterine relaxation (bad for labor!)
not for Shock, Bronchial asthma, Head injuries (can increase intracranial pressure), During labor (Obstetrics), Emphysema/asthma because reduces respiratory rate
158
Which abused drugs should epileptics not take?
Bupropion (weak SNRI)
159
What is a benzodiazepine antagonist?
Flumazenil
160
Tremors (other movement disorder) can be treated with …..
Propranolol (beta blocker)
161
Dronabinol
Hallucinogens. Cannabinoid that decreases inhibition of presynaptic cannabinoid receptors
tx nausea
162
Secobarbital
Barbiturate. binds to GABA receptor to enhance GABA.
ACTIONS: CNS depression (for anesthesia)Suppress CO2 response, Induce CYP450 (decrease conc of other drugs including this class), Sedative and Hypnotic, anticonvulsant (not as common), anesthetic
AE: Addiction, Sedation, Hypotension, Lethal overdose
163
Alzheimer's is from damage to the ____ in the brain
Neocortex
164
What are the 4 GABA binding sites?
GABA, Barbiturate, Benzodiazepine, Ethanol
165
What drugs are bad for glaucoma pts?
Cholinergic receptor blockers (trihexyphenidyl, benztropine, and biperiden) -tropine -den -dyl
166
Apomorphine
Anti-parkinson Drugs and restless legs syndrome tx, Dopamine Agonists. Effective past failing point of other drugs. less dyskinesia than levodopa, but anorexia, nausea, vomiting, postural hypotension, and psychiatric reactions are common
167
AE of Tricyclic antidepressants? Which drug class has similar but less severe AE?
Antagonize muscarinic, histamine, and adrenergic receptors causing:
Dry mouth, Confusion, Weight gain, Blurred vision, Increased IOP, Sedation, Sexual dysfunction
SNRIs have similar but less severe side effects.
168
Propofol
Intravenous General Anesthetic. Unknown MOA
169
What are the CNS effects of opioid stimulation?
– Analgesia – Drowsiness/sedation – Euphoria – Dysphoria (confusion) – Pupillary constriction – Nausea and vomiting – Respiratory depression – Cough suppression – Decreased BP
170
What is the pathway for GABA?
Glutamine (glutaminase)> Glutamate (glutamic acid decarboxylase)> GABA
171
_______(anesthesia agent) are not very good for pain. Pt can come out of sleep because of pain!
Inhalation agents are not very good for pain
172
Which antidepressant is also a sedative?
Mirtazapine (Alpha 2 blocker), Trazodone and Nefazodone.
Also Tricyclic antidepressants
173
Activation of ___ opioid receptors causes less Ca influx into the presynaptic nerve terminal, decreasing number of vesicles that can release NT. It basically decreases NT release
Kappa
174
Which drug is found in tea?
theophylline
175
What is the functional duration of short, intermediate, and long duration benzodiazepines?
5 hours
15 hours
2 days
176
Antihistamines
Preanesthetic Medication. Prevention of allergic reactions
177
Phencyclidine
(PCP) Hallucinogens. MOA: block NMDA glutamate receptor to inhibit reuptake of DA, 5-HT, and NE.
Effects: insensitivity to pain WITHOUT loss of consciousness (separation of mind and body), numbness of extremities, staggered gait, slurred speech, and muscular rigidity
alters perception wo/ reward and euphoria
AE: High doses can cause anesthesia, stupor, or coma where the eyes stay open
Flashbacks and psychosis
178
Flurazepam
Benzodiazepine. binds to GABA receptor to enhance GABA; also decreases GABA release. CAN'T OVERDOSE
actions: Reduction of Anxiety, Sedative and Hypnotic, Anterograde Amnesia, Anticonvulsant, Muscle Relaxant, anesthetic
AE: Amnesia, daytime sedation, Disinhibition, Some reports of “bizarre” behavior and hallucinations
179
Risperidone
2nd generation antipsychotic. D2 antagonist (and D3, D4, 5HT blocker)
180
Which drugs alter perception wo/ reward or euphoria? Can cause flashbacks and psychosis?
Lysergic acid diethylamide (LSD) and
| Phencyclidine (PCP)
181
What can cause the development of extrapyramidal side effects?
Psychosis drug treatment (1st gen)
182
Carbamazepine
Tx mania (and epilepsy). Targets voltage-gated Na channels.
183
Imipramine
Tricyclic antidepressants. block reuptake of NE and 5HT (but not DA). AE: Dry mouth, Confusion, Weight gain, Blurred vision, Increased IOP, Sedation, Sexual dysfunction
184
What are the 3 stages of anesthesia?
Induction, maintenance, and recovery
185
Hydromorphone (Dilaudid)
Opioid Agonist.
– Analgesia – Drowsiness/sedation – Euphoria – Dysphoria (confusion) – Pupillary constriction – Nausea and vomiting – Respiratory depression – Cough suppression – Decreased BP
– Lowered activity of GI system – Urine retention – Uterine relaxation (bad for labor!)
not for Shock, Bronchial asthma, Head injuries (can increase intracranial pressure), During labor (Obstetrics), Emphysema/asthma because reduces respiratory rate
186
Cocaine
Psychomotor Stimulant.and topical anesthetic (alpha agonist). MOA: Monoamine reuptake inhibitor (NE, 5HT, DA especially). Chronic depletes DA
Effect: • Increases mental awareness and induces euphoria • Produce hallucinations and delusions • Increases motor activity. Produces fight/flight response from increased NE
187
Selegiline
MAO-B Inhibitor. Tx depression AND Parkinson's Disease. Increase (a little NE) 5HT and DA. AE: Orthostatic hypotension, Serotonin syndrome, Sleep disturbances, weight gain, blurred vision, dry mouth, sexual dysfunction
188
Acamprosate
Tx alcohol dependence. unknown MOA
189
Which antidepressant class is especially effective at treating chronic pain with depression?
SNRIs
190
Which antidepressant class has the longest half life?
SSRIs (24 hours or more)
191
Lidocaine
Local anesthetic. Only FDA approved topical lidocaine formulation for ophthalmic procedures
MOA: target Na channels in axon to prevent pain propagation to spinal cord.
Not for prolonged use
192
Armodafinil
Psychomotor Stimulant, Amphetamine. UNIQUE MOA: Targets DA transporter to prevent DA reuptake.
Tx Narcolepsy
AE: Addiction, dependence and tolerance. – Insomnia, irritability, weakness, dizziness, tremor and hyperactive reflexes – Confusion, delirium, panic states, suicidal tendencies – Heart palpitations, arrhythmias, HTN, angina – Nausea, vomiting, abdominal cramps and diarrhea
193
What drug class shows amphetamine-like metabolites?
MOA inhibitors
194
Which amphetamines have a more unique MOA?
Armodafinil and Modafinil (-finil)
195
Dantrolene
Muscle relaxant, Direct-acting Muscle Relaxant.
MOA: blocks Ca channel in sarcoplasmic reticulum of skeletal muscle
Does not affect cardiac nor smooth muscle
196
Which SSRI has once a week dosing?
Fluoxetine, 50 hr half life with potent metabolites
197
How long does it take for an antidepressant to take effect?
2 to 12 weeks!
198
What benzodiazepine is a muscle relaxant?
Diazepam (Valium)
199
Activation of ____ opioid receptors leads to opening of K channels producing hyperpolarization , lowering AP frequency.
Mu or Delta
200
What is Dynorphin?
A natural opiate. Protein that is synthesized within the cell body of a neuron
201
Which amphetamine slowly enters the brain?
Methylphenidate (ritalin)
202
Ropinirole
Anti-parkinson Drugs and restless legs syndrome tx, Dopamine Agonists. Effective past failing point of other drugs. less dyskinesia than levodopa, but anorexia, nausea, vomiting, postural hypotension, and psychiatric reactions are common
203
Ramelteon (Rozerem)
Melatonin receptor agonist. other hypnotic. Tx insomnia
204
What are the body's natural opiates called?
Dynorphins, enkephalins, and endorphins
205
What opioid do you want to avoid for patients taking SSRIs, tricyclics or MAOIs?
Tramadol
206
Some think that Schizophrenia is from too ____ activity of the mesolimbic DA system.
much
207
What evidence casts doubt on the monoamine theory of depression?
Chemical effect of antidepressants is very fast, but clinical effect is delayed by a few weeks, indicating possible "downstream effect"
208
What is the "first choice" drugs for depression?
Tricyclic antidepressants and SSRIs (especially)
209
Bupropion (Wellbutrin, Zyban)
weak SNRI. Atypical antidepressant. Helps with nicotine withdrawal. NOT for seizure pts.
210
What ADHD tx is preferred in children?
Methylphenidate (ritalin)
211
Rasagiline
Anti-Parkinson Drugs, MAOIs, inhibits DA-specific MAO-B
212
Name drug class:
– Analgesia – Drowsiness/sedation – Euphoria – Dysphoria (confusion) – Pupillary constriction – Nausea and vomiting – Respiratory depression – Cough suppression – Decreased BP
Opioid
213
What drug only treats anxiety and does not induce sedation?
Buspirone
214
Amphetamine
Psychomotor Stimulant, Amphetamine. MOA: MAO stores this drug in vesicle instead of NE/DA, so these NTs are out in cleft longer)
Effects: Increased alertness, decreased fatigue, depressed appetite and insomnia, stimulates adrenergic system.
Tx: ADHD to increase DA. and Narcolepsy
AE: Addiction, dependence and tolerance. – Insomnia, irritability, weakness, dizziness, tremor and hyperactive reflexes – Confusion, delirium, panic states, suicidal tendencies – Heart palpitations, arrhythmias, HTN, angina – Nausea, vomiting, abdominal cramps and diarrhea
215
Flumazenil
Benzodiazepine blocker. reverses anesthesia
216
Which injection anesthetic has the longest duration? Shortest?
Bupivacaine (12 hours).
| Procaine (45 min)
217
Ethanol displays ___ order kinetics
Zero order kinetics
218
Levodopa/Carbidopa
Anti-parkinson Drugs, DA precursor, effective up to a certain point (several years).
AE: affects NE and DA neurons in all of the brain. Also anorexia, tachycardia, nausea, hypotension.
Carbidopa prevents L-Dopa from being processed by NE neurons in PNS, making more L-Dopa available to the brain
219
Phenobarbital
Barbiturate. binds to GABA receptor to enhance GABA.
ACTIONS: CNS depression (for anesthesia)Suppress CO2 response, Induce CYP450 (decrease conc of other drugs including this class), Sedative and Hypnotic, anticonvulsant (not as common), anesthetic
AE: Addiction, Sedation, Hypotension, Lethal overdose
220
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Name drug class withdrawal response:
Irritability, insomnia, nausea, vomiting, diarrhea, chills alternating with flushing, sweating, muscle cramps, pupil dilation
```
Opioids
221
Tizanidine
Muscle relaxant, Centrally Acting Spasmolytic Drugs
MOA: Alpha-2 agonist
AE: Drowsiness
also effective for migraine
222
What is good for reducing rewards of smoking?
Varenicline
223
Which drug causes a phase II block? What is it?
Succinylcholine (Depolarizing agent). Prolonged exposure causes desensitized repolarization
224
Which abused drugs disinhibit DA neurons
Opioids, benzodiazepines
225
Atracurium
Muscle relaxant, nondepolarizing Agent. metabolite can cause seizures
MOA: Nicotinic antagonist.
AE: Hyperkalemia, increased IOP, muscle pain, cardiovascular effects.
Tx: Surgical relaxation, Endotracheal Intubation, Control of ventilation (reduce chest wall resistance), Treatment of convulsions
226
What are the uses of neuromuscular blocking drugs?
Surgical relaxation, Endotracheal Intubation, Control of ventilation (reduce chest wall resistance), Treatment of convulsions
227
Memantine
Alzheimer's tx, NMDA receptor antagonist (blocks glutamate), reduces cytotoxic Ca. Less toxic than cholinesterase inhibitors.
AE (don't memorize): – Confusion – Anxiety – Chills – Cough – Dry Mouth
228
Isoflurane
Inhaled General Anesthetic. interacts with ion channel proteins
229
Meperidine (Demerol)
Opioid Agonist. Analgesic, sedative, respiratory depressant. NO miotic effect
Weak antitussive and antidiarrheal properties
Slower development of tolerance and dependence than morphine.
– Analgesia – Drowsiness/sedation – Euphoria – Dysphoria (confusion) – Nausea and vomiting – Respiratory depression – Cough suppression – Decreased BP
– Lowered activity of GI system – Urine retention – Uterine relaxation (bad for labor!)
not for Shock, Bronchial asthma, Head injuries (can increase intracranial pressure), During labor (Obstetrics), Emphysema/asthma because reduces respiratory rate
230
Methylphenidate
(Ritalin) Psychomotor Stimulant, Amphetamine. MOA: MAO stores this drug in vesicle instead of NE/DA, so these NTs are out in cleft longer)
Tx: ADHD
UNIQUE enters brain slowly
AE: Addiction, dependence and tolerance. – Insomnia, irritability, weakness, dizziness, tremor and hyperactive reflexes – Confusion, delirium, panic states, suicidal tendencies – Heart palpitations, arrhythmias, HTN, angina – Nausea, vomiting, abdominal cramps and diarrhea
231
_____ have fewer and less severe side effects than tricyclic antidepressants and MAOIs
SSRIs
232
What drugs can cause blurry vision?
Cholinergic receptor blockers (trihexyphenidyl, benztropine, and biperiden) -tropine -den -dyl
233
What is the pathway of 5-HT?
Tryptophan (Tryptophan hydroxylase)> 5-HTP (aromatic AA decarboxylase)> 5-HT
234
Sevoflurane
Inhaled General Anesthetic. interacts with ion channel proteins
235
Morphine
Opioid Agonist. Analgesic, sedative, respiratory depressant, antitussive, antidiarrheal, miotic.
not for Shock, Bronchial asthma, Head injuries (can increase intracranial pressure), During labor (Obstetrics), Emphysema/asthma because reduces respiratory rate
236
Entacapone
Anti-Parkinson Drugs, COMT Inhibitor to allow for more L-Dopa.
AE: Diarrhea, abdominal pain, orthostatic hypotension, sleep disturbances
237
How is physical dependence on opioids?
Very common but requires chronic use
238
Tetrahydrocannabinol (THC)
Hallucinogens. MOA: Decreases inhibition on presynaptic cannabinoid receptors
Effects: euphoira, drowsiness/relaxation, Depresses short-term memory and mental activity, impairs motor ability. APPETITE STIMULATION, visual hallucinations, delusions, enhancement of sensory activity, NOVELTY
AE: heavy users feel bored when not taking drug. – Reddening of the conjunctiva – Increased progression of HIV – Increased heart rate – Decreased blood pressure
Bad glaucoma treatment
239
Nefazodone
weak 5HT reuptake inhibitor. Atypical antidepressant
240
What is the future treatment strategy for Alzheimer's? what is done currently?
Reduce presence and aggregation of beta amyloid protein .
| Current: Cholinesterase inhibitors and Glutamatergic antagonists
241
Haloperidol (Haldol)
1st generation antipsychotic. D2 antagonist. UNIQUE: tx for Tourette tics
AE:
Metabolic side effects (weight gain, DBM, etc)
Antiemetic effects
Beta-blocking effect (causes orthostatic hypotension w/ reflex tachycardia and arrhythmias)
Affects Ach (blurred vision, dry mouth)
Extrapyramidal side effects (Acute dystonia, akathisia, Tardive dyskinesia, Parkinson's-like sign)
242
Naltrexone
Tx alcohol dependence. opiate antagonist. Used w/ psychotherapy support
243
Rivastigmine
Alzheimer's treatment (and myasthenia gravis tx), Cholinesterase inhibitor.
AE: tremors, nausea, anorexia, bradycardia, diarrhea, myalgia
244
It is very hard or impossible to overdose on…
Benzodiazepines (by themselves)
245
Protriptyline
Tricyclic antidepressants. block reuptake of NE and 5HT (but not DA). AE: Dry mouth, Confusion, Weight gain, Blurred vision, Increased IOP, Sedation, Sexual dysfunction
246
```
Name drug class AE:
Addiction
Sedation
Hypotension
Lethal overdose
```
Barbiturates
247
Naloxone
(Narcan) Opioid antagonist. Tx opiate overdose (that is not a coma). IV ONLY
Coma = Pinpoint pupils, respiratory depression, coma
248
Lysergic acid diethylamide
(LSD) Hallucinogens. MOA: 5HT agonist and symp ANS activation
alter perception wo/ reward and euphoria
AE: Hyperreflexia, nausea and muscular weakness. TRUE dependence is rare.
Flashbacks and psychosis
249
What are the symptoms of Alzheimer's Disease?
Impairment of memory and judgement, Impairment of abstract thinking, Changes in personality
250
Vecuronium
Muscle relaxant, nondepolarizing Agent. highly dependant on liver metabolism
MOA: Nicotinic antagonist
AE: Hyperkalemia, increased IOP, muscle pain
Tx: Surgical relaxation, Endotracheal Intubation, Control of ventilation (reduce chest wall resistance), Treatment of convulsions
251
Nalbuphine
Mixed Opiate Agonist-Antagonist. Show agonist activity in drug naïve patients or antagonist activity in patients with opioid dependence
252
Antiemetics
Preanesthetic Medication. Prevent nausea and possible aspiration of stomach contents
253
Fluoxetine
SSRI. Tx depression. AE: Dry mouth, GI distress, Agitation, insomnia, Sexual dysfunction UNIQUE: very long half-life (dose once/week), especially good with bipolar
254
Articaine
Local anesthetic. MOA: target Na channels in axon to prevent pain propagation to spinal cord. Not for prolonged use
255
The resting membrane potential of a neuron is ___
-65 mV
256
What drug can induce psychotic behavior?
Ldopa
257
Disulfiram
Tx alcohol dependence. inhibits aldehyde dehydrogenase
258
Clozapine
2nd generation antipsychotic. D2 antagonist (and D3, D4, 5HT blocker)
259
Etomidate
Intravenous General Anesthetic. Unknown MOA
260
fluphenazine
1st generation antipsychotic. D2 antagonist.
AE:
Metabolic side effects (weight gain, DBM, etc)
Antiemetic effects
Beta-blocking effect (causes orthostatic hypotension w/ reflex tachycardia and arrhythmias)
Affects ACh (blurred vision, dry mouth)
Extrapyramidal side effects (Acute dystonia, akathisia, Tardive dyskinesia, Parkinson's-like sign)
261
Which Alzheimer's drugs have less side effects?
Memantine (NMDA antagonist, prevents influx of Ca)
