Pharm 2 Exam 4

Question 1

SSRIs MOA + Uses (Fluoxetine)

Answer 1

• MOA: selectively blocks reuptake of serotonin in the synaptic gap
• Takes several weeks to become therapeutic (teach pt’s correct expectations)
• Do NOT abruptly stop
• Uses: Major depression, OCD, bulimia nervosa, panic disorder, PTSD, anxiety

Question 2

SSRI (Fluoxetine) ADEs

Answer 2

• Sexual dysfunction
• CNS stimulation (take in the AM)
• Weight changes
• Serotonin syndrome (confusion, anxiety, sweating - early sx)
• Withdrawal syndrome
• Hyponatremia
• Rash, GI distress
• Sleepiness
• Bruxism (clenching and grinding teeth)

Question 3

SSRI Interactions

Answer 3

• MAOIs, TCAs, and St. John’s wort can increase risk of serotonin syndrome
• Can increase warfarin levels and suppress platelet aggregation

Question 4

SNRIs (Venlafaxine)

Answer 4

• Selectively blocks serotonin and norepinephrine
• Same uses
• Don’t stop abruptly
• ADEs: HA, nausea, agitation, anxiety, sleep disturbances
• Monitor for hyponatremia especially in elder adults, weight loss, and increased diastolic pressure

Question 5

Atypical Antidepressants (Buproprion)

Answer 5

• Uses: Depression, SAD, smoking cessation
• ADEs: HA, dizziness, dry mouth, constipation, GI distress, restlessness, insomnia
• Interacts with MAOIs

Question 6

Tricyclic Antidepressants (Imipramine, Amitriptyline) MOA + Uses

Answer 6

• Blocks reuptake of serotonin and norepinephrine
• Depression, depressive episodes of bipolar disorder, neuropathic pain
• Not first line for depression

Question 7

TCAs ADEs

Answer 7

• Narrow therapeutic window
• Orthostatic hypotension, anticholinergic effects, sedating (take at bedtime), cholinergic toxicity resulting in cardiac effects (get baseline EKG), decreases seizure threshold, excessive sweating
• Overdose is just 8 times daily dose - careful with SI patients

Question 8

TCA Interactions & Cautions

Answer 8

• MAOIs or St. John’s wort increases risk of serotonin syndrome
• Antihistamines or anticholinergics
• CNS depressants
• Caution with patients with: CAD, DM, liver, kidney, or respiratory disorders, BPH, urinary retention or obstruction, hyperthyroidism

Question 9

MAOIs (Nardil - phenelzine)

Answer 9

• Block MAO enzyme in the brain increasing dopamine, serotonin, and norepinephrine
• Used in depression and bulimia nervosa
• LOTS of interactions

Question 10

Benzodiazepines

Answer 10

• MOA: enhance action of GABA in CNS
• ADEs: CNS depression, anterograde amnesia, paradoxical response (stimulation), resp depression, physical dependence, acute toxicity.
• Antidote : flumazenil (Romazicon)

Question 11

Benzo Interactions

Answer 11

• CNS depressants such as alcohol
• Contraindicated in pregnancy, sleep apnea, resp depression, history of substance abuse
• Older adults might need decreased doses

Question 12

Non-Benzodiazepines MOA + Uses (Ambien)

Answer 12

• MOA: enhance the action of GABA in the CNS resulting in prolonged sleep duration and decreased awakenings
• Uses: management of insomnia

Question 13

Non-Benzos ADEs + Interactions

Answer 13

• Main ADE: daytime sleepiness
• Interacts with: CNS depressants (avoid alcohol)
• Caution with pregnancy & breastfeeding, older adults, impaired kidney, liver, or resp function

Question 14

Atypical Anxiolytics (BuSpar - buspirone)

Answer 14

• MOA: binds to serotonin and dopamine receptors
• Uses: panic disorder, social anxiety disorder, OCD, PTSD
• Meant for short term but can be used long term
• No sedation or CNS depression, or withdrawal
• Tolerated better with less ADEs

Question 15

Atypical Anxiolytics (BuSpar) ADEs and Interactions

Answer 15

• Dizziness, lightheadedness, nausea, HA, agitation
• Interacts with erythromycin, ketoconazole, St. John’s wort, and grapefruit juice = all increase effects; MAOIs
• Use caution with liver and renal failure pt’s

Question 16

CNS stimulants (Ritalin - methylphenidate) MOA + Uses

Answer 16

• MOA: raise levels of serotonin, norepinephrine, and dopamine in CNS
• Uses: ADHD & Conduct disorder

Question 17

CNS stimulants ADEs & Interactions

Answer 17

• ADEs: CNS stimulation (last dose before 4pm), weight loss, cardiovascular effects, psychotic manifestations, withdrawal medications, hypersensitivity reactions
• Contraindications: High potential for substance use disorder, CV disorders, severe anxiety, and psychosis
• Interacts with MAOIs, caffeine, phenytoin, warfarin, phenobarbital, OTC cold medicines

Question 18

Norepinephrine selective reuptake inhibitors (Srattera- atomoxetine)

Answer 18

• MOA: blocks reuptake of norepinephrine
• Used for ADHD
• ADEs: appetite suppression, weight loss, growth suppression, GI effects, SI, hepatotoxicity
• Interacts with MAOIs, Paxil, Prozac, Quinidine

Question 19

TCAs for ADHD (desipramine)

Answer 19

• MOA: block reuptake of norepinephrine and serotonin
• Can also be used for autism spectrum disorder, depression, panic, OCD

Question 20

Alpha-2 adrenergic agonists for ADHD (guanfacine)

Answer 20

• MOA: activate presynaptic alpha-2 adrenergic receptors
• ADEs: CNS effects, CV effects, weight gain
• Interacts with CNS depressants, antihypertensives, high-fat foods

Question 21

Atypical Antipsychotics for ADHD (risperidone)

Answer 21

• MOA: blocks serotonin, dopamine, norepinephrine, histamine, and acetylcholine receptors
• Used for conduct disorder, autism spectrum disorder, PTSD, relief of psychotic manifestations

Question 22

1st generation Antipsychotics (Chlorpromazine - Thorazine) MOA + Uses

Answer 22

• MOA: block dopamine, acetylcholine, histamine, norepinephrine in brain and periphery
• Used for: treatment of acute and chronic psychotic disorders, manic bipolar disorders, schizophrenia spectrum, tourette’s

Question 23

1st generation Antipsychotics ADEs

Answer 23

• Extra-pyramidal side effects such as movement disorders
• neuroleptic malignant syndrome
• Anticholinergic effects, neuroendocrine effects, seizures, skin effects, orthostatic hypotension, sedation, sexual dysfunction, agranulocytosis, severe dysrhythmias

Question 24

2nd generation Antipsychotics MOA + Uses (Risperidone - Risperdal)

Answer 24

• MOA: mainly block serotonin and dopamine (to a lesser degree). Also blocks Ach, Norepi, histamine
• Used for: schizophrenia spectrum, psychotic episodes induced by levodopa, relief of psychotic manifestations

Question 25

2nd gen Antipsychotics ADEs

Answer 25

• DM and poor glucose level control
• Weight gain, hypercholesterolemia, orthostatic hypotension, anticholinergic effects, mild EPS
• Agitation, dizziness, sedation, sleep disruption

Question 26

Lithium Carbonate for Bipolar (Lithane)

Answer 26

• MOA: produces neurochemical changes in the brain, including serotonin receptor blockade
• Used to control acute mania, prevention of the return of mania/depression, decreases incidence of suicide

Question 27

Lithium carbonate ADEs

Answer 27

• GI distress (n/v, ab pain)
• Fine hand tremors
• Polyuria, thirst
• Weight gain, renal toxicity, hypothyroidism with goiter
• Bradydysrhythmias, hypotension, and electrolyte imbalances

Question 28

Dopamine Replacement for PD (Levodopa/Carbidopa - Sinemet)

Answer 28

• Most effective treatment but usually beneficial effects wear off in 5 years
• “Off times” increase closer to 5 year mark

Question 29

Levodopa/Carbidopa - Sinemet ADEs

Answer 29

• N/V, drowsiness
• Dyskinesias
• Orthostatic hypotension
• CV effects (beta-1 stimulation)
• Psychosis

Question 30

Dopamine Agonists (Ropinirole- Requip)

Answer 30

• Used in early stages of PD; given with Sinemet in later stages
• ADEs: Sleepiness, orthostatic hypotension, psychosis, impulse control disorder, dyskinesia, nausea

Question 31

COMT Inhibitors (Entacapone, Tolcapone)

Answer 31

• MOA: inhibits breakdown of Levodopa/Carbidopa
• ADEs: same as dopamine agonists; GI symptoms
• Use caution with impaired hepatic function