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Pharm Flashcards

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1
Q

Compare barbiturates vs bezodiazepines

A

Barbiturates:

  • deadly via decreased heart and respirations
  • no antidote
  • highly addictive

Benzos:

  • plateau so not as deadly, though can become deadly with opioids and alcohol
  • antidote
  • addictive but less so than barbiturates
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2
Q

Xanax

A

alprazolam

benzo

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3
Q

Ambien

A

zolpidem

non-benzo

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4
Q

Low-potency benzos with long half-life

A

diazepam

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5
Q

Valium

A

diazepam

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6
Q

Low-potency benzos with short half-life

A

temazepam

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7
Q

High-potency benzos with long half-life

A

clonazepam

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8
Q

High-potency benzos with short half-life

A

alprazolam

lorazepam

traizolam

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9
Q

Ativan

A

lorazepam

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10
Q

What drug accentuates GABA activity by increasing the FREQUENCY of Cl- channel opening in response to GABA?

A

benzos

local hyperpol–> cell doesn’t fire

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11
Q

Uses for benzos

A

anxiety

sedative

anticonvulsant

amnesia/anesthesia
–> some anterograde amnesia

skeletal muscle relaxant

alcohol withdrawal

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12
Q

Rohypnol

A

date-rape drug

benzo

anterograde amnesia

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13
Q

Most common benzo side effect

A

drowsiness

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14
Q

Who is susceptible/resistant to benzos

A

susceptible: elderly
resistant: alcoholics, barbiturate abusers

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15
Q

Abrupt d/c of long-term benzo use leads to

A

rebound insomnia

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16
Q

What benzos also used for insomnia?

A

triazolam

temazepam

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17
Q

What drug a/w respiratory depression and arrest when used for sedation in non-critical care settings?

A

IV midazolam (versed)

benzo

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18
Q

What benzo used for preop sedation, general anesthesia, anxiety and amnesia?

A

midazolam (versed)

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19
Q

What drug is used only for insomnia that is safe in pregnancy?

A

zolpidem (Ambien)

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20
Q

What drug binds BZ1 receptors of GABAa and is mainly for sleep maintenance?

A

zolpidem (ambien)

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21
Q

What drug can cause complex sleep behaviors (sex while asleep, sleep-driving, sleep-walking, etc) after taking?

A

zolpidem (ambien)

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22
Q

What drug is an antagonist of benzo-binding sites on GABAa?

A

flumazenil

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23
Q

What drug is used to manage benzo overdose and reverse benzo-induced sedation?

A

flumazenil

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24
Q

What drug is a/w seizures with long-term sedation or concomitant TCA use?

A

flumazenil

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25
Q

Barbiturate used to control tonic-clonic seizures

A

phenobarbital (long-acting)

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26
Q

Barbiturate that is short-acting sedative/anesthetic but has been replaced by Propofol and banned in US d/t lethal injections

A

thiopental

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27
Q

What drugs increase the duration of GABA-gated Cl- channel opening?

A

barbiturates

hyperpol–>reduce cell firing

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28
Q

Why are barbiturates so deadly?

A

at high doses, open Cl- channels without need for GABA–> can’t be controlled

CNS depression–> low BP and respiratory rate

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29
Q

What drugs are inducers of CYP450?

A

barbiturates

–>increase metabolism of drugs

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30
Q

What drug is a non-benzo anxiety med that acts on serotonin receptors and lacks tolerance, dependence and withdrawal?

A

buspirone

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31
Q

Can you have additive CNS depression with buspirone and other sedative drugs?

A

no

minimal psychomotor impairment

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32
Q

What drug is used for sleep disorders and activates MT1/2 in SCN in CNS?

A

ramelteon (melatonin analog)

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33
Q

Can you have abuse, withdrawal or dependency with ramelteon?

A

no

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34
Q

What drug blocks binding of orexins and is used with difficulty falling asleep?

A

suvorexant

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35
Q

What drug antagonizes H2 receptors, inhibits reuptake of serotonin and norepi, and is used for sleep maintenance and tmt of resistant MDD?

A

doxepin

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36
Q

Do antihistamines act on anxiety?

A

no, only cause sedation

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37
Q

When to use benzos in GAD?

A

use acutely until SSRIs kick in

reserve for pts without hx abuse disorder

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38
Q

What drug has been shown to reduce anxiety in GAD without risk of dependence?

A

buspirone

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39
Q

How to treat separation anxiety?

A

CBT

SSRI

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40
Q

Can you still get constipation and dilated pupils with opioid tolerance?

A

yes

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41
Q

What are examples of opioid antagonists?

A

naloxone (narcan)

naltrexone (prevents euphoria, decrease cravings)

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42
Q

What are the 3 major classes of opioid receptors?

A

mu

kappa

delta

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43
Q

What is the most serious adverse effect of opioids?

A

respiratory depression

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44
Q

Side effects of opioids

A

main: resp depression

constipation
urinary retention
orthostatic hypotension
emesis
birth defects
increase ICP
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45
Q

What G protein receptor is involved in opioid signaling?

A

Gi

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46
Q

Pure opioid agonists act at what receptors?

A

mu and kappa

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47
Q

Pentazocine acts on what opioid receptors?

A

antagonist at mu

agonist at kappa

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48
Q

Butorphanol acts on what opioid receptors?

A

partial agonist at mu

agonist at kappa

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49
Q

Buprenorphine acts on what opioid receptors?

A

partial agonist at mu

antagonist at kappa

***used to treat addicts (Subloxone)

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50
Q

What responses does the mu opioid receptor cause?

A 
analgesia (+ kappa)
respiratory depression
sedation (+ kappa)
euphoria
physical dependence 
decreased GI motility/constipation (+kappa)
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51
Q

What responses does the kappa opioid receptor cause?

A

analgesia
sedation
constipation

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52
Q

Why are oral doses of opioids larger than iv doses?

A

significant first-pass metabolism

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53
Q

Why give kids less dose of opidoids?

A

blood brain barrier not fully developed

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54
Q

What responses to opioids are affected with tolerance?

A

analgesia
euphoria
sedation
respiratory depression

NOT constipation or miosis

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55
Q

Are withdrawal from opioids dangerous/fatal?

A

NO (3Bs are fatal)

unpleasant so withdraw gradually

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56
Q

Why do you avoid anticholinergic drugs (atropine, antihistamines, TCAs) with opioids?

A

exacerbate constipation and urinary retention

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57
Q

Triad of opioid overdose

A

coma

respiratory depression

pinpoint pupils

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58
Q

What opioid is 100x more potent than morphine, has same adverse effects and multiple formulations?

A

fentanyl

think prince and tom petty

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59
Q

What opioid is more potent than morphine and used for induction and maintenance of anesthesia?

A

alfentanil

remifentanil

sufentanil

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60
Q

What is an IV opioid with rapid onset and brief duration (used for postop analgesia)?

A

remifentanil

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61
Q

What opioid used to be used for migraines is in decline d/t short half life (frequent dosing), adverse reactions and toxic metabolite build-up? Also abused by healthcare workers d/t lack of pinpoint pupils (anticholinergic effect)?

A

meperidine (demerol)

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62
Q

What drug is an NMDA receptor antagonist, similar to morphine, long duration of action but causes disproportionate number of deaths via torsades?

A

methadone

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63
Q

What drug has higher lipid solubility vs morphine and gives a greater high when injected?

A

heroin

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64
Q

What drug is used for mod-severe pain, similar SA c/t morphine, reversed by naloxone and more water soluble (can be diluted in smaller volume for injection)?

A

hydromorphone (Dilaudid)

oxymorphone, levorphanol

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65
Q

What drug is the prototype for moderate-severe opioid agonist, given PO, can be converted to morphine–>analgesia, and formulated alone or with nonopioid analgesics? Also used as cough suppressant.

A

codeine

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66
Q

What drug is similar to codeine and metabolized by CYP3A4?

A

oxycodone (OxyContin)

67
Q

What drug is similar to codeine but only available in combo with other drugs?

A

hydrocodone

w/ acetaminophen–> Vicodin

68
Q

What drug is a mu opioid antagonist that can’t cross BBB, used for opioid-induced constipation?

A

methylnaltrexone

69
Q

What drug is a mu opioid agonist that can’t cross BBB, used for acute and chronic diarrhea?

A

loperamide

70
Q

Large quantities of this drug (used for a high or alleviate withdrawal sx) can cause?

A

torsades de pointes d/t QT prolongation

71
Q

What opioid is safe for use in renal and hepatic insufficiency?

A

fentanyl

72
Q

Interaction of opioids with CNS depressants

A

increased respiratory depression and sedation

73
Q

Interaction of agonist-antagonist opioids with pure opioids

A

precipitation of withdrawal reaction

74
Q

Interaction of opioids with anticholinergic drugs

A

increased constipation and urinary retention

75
Q

Interaction of opioids with hypotensive agents

A

increased hypotension

76
Q

Interaction of opioids with monoamine oxidase inhibitors

A

hyperpyrexic (F) coma

77
Q

What is an ingredient in vaping that is the primary cause of lung injuries and is used as thickening agent?

A

vitamin E acetate

78
Q

Does vaping contain nicotine?

A

yes

79
Q

What is an orally administered synthetic 9-THC that acts mainly on CB1 and produces analgesia, appetite enhancement, muscle relaxation, psychological effects and hormonal actions?

A

dronabinol

80
Q

Dronabinol indications

A

anorexia in AIDS pts
chemotherapy-induced N/V

off-label: OSA

81
Q

What is a THC capsule approved for chemo-induced N/V?

A

nabilone

82
Q

Adverse effects of THC/marijuana

A

judgement and coordination–> increase risk for accidents

sedation, bloodshot eyes, depression, dizziness, tachy, hypotension, hallucinations, dry mouth

83
Q

What kind of pain is cannibis preferred for?

A

neuropathic and chronic pain

84
Q

Contraindications for cannabis use

A

hx psychosis

current or past substance abuse disorder

heart or lung disease

85
Q

What is CBD useful to treat?

A

epilepsy

Dravet syndrome (myoclonic seizure)

Lennox-Gastaut syndrome (tonic seizures)

86
Q

What is the difference between stimulant and non-stimulant meds for ADHD?

A

stimulants are amphetamine derivatives

87
Q

Side effects of stimulants

A

dyspepsia, GI distress

headache

decreased appetite
–> weight loss, reduced growth

insomnia

anxiety

irritability/agression/agitation

elevated BP/HR

88
Q

Rare effects of stimulants

A

priapism

seizures

sudden cardiac death

stroke and MI in adults

chemical leukoderma w/ Daytrana patch

89
Q

What drugs are controlled substances?

A

stimulants

onset of activity 24 hours

90
Q

What amphetamine stimulants are immediate release tablets?

A

dextroamphetamine

dextroamphetamine (adderall)

methamphetamine (desoxyn)

91
Q

What amphetamine stimulants are immediate release liquid?

A

dextroamphetamine sulfate (procentra)

92
Q

What amphetamine stimulants are immediate release capsules?

A

amphetamine sulfate (evekeo)

93
Q

What amphetamine stimulants are extended release capsules?

A

dextroamphetamine (adderall xr)

dextroamphetamine

lisdexamfetamine (vyvanse)

amphetamine mixed salt (mydayis)

94
Q

What amphetamine stimulants are extended release liquids?

A

amphetamine (dyanavel xr)

95
Q

What are methylphenidate-based stimulates that are immediate release tablets?

A

dexmethylphenidate

methylphenidate (ritalin)

96
Q

What are methylphenidate-based stimulates that are immediate release liquids?

A

methylphenidate (methylin)

97
Q

What are methylphenidate-based stimulates that are sustained tablets?

A

methylphenidate (ritalin-SR)

98
Q

What are methylphenidate-based stimulates that are extended release tablets?

A

methylphenidate HCL (concerta)

methylphenidate ER

99
Q

What are methylphenidate-based stimulates that are extended release capsules?

A

methylphenidate (aptensio XR)

dexmethylphenidate hcl (focalin xr)

methylphenidate hcl (metadate cd)

methylphenidate hcl er (ritalin LA)

100
Q

What are methylphenidate-based stimulates that are extended release transdermal patch?

A

daytrana (methylphenidate transdermal)

101
Q

What are methylphenidate-based stimulates that are extended release chewable tablets?

A

methylphenidate hcl (quillichew)

102
Q

What are methylphenidate-based stimulates that are extended release liquids?

A

methylphenidate (quillivant xr)

103
Q

MOA of non-stimulant meds for ADHD

A

inhibit NE pre-synaptic uptake

agonist of CNS alpha 2 adrenergic receptors

104
Q

What drugs are useful for patients intolerant of stimulant effects?

A

non-stimulants

1-4 week onset of activity

nonscheduled

105
Q

Capsule non-stimulant

A

atomoxetine (straterra ER)

106
Q

Non-stimulant meds that are antihypertensives

A

clonidine ER

guanfacine ER

both tablets

risk of rebound HTN

107
Q

What are stimulant users at risk of?

A

future substance abuse

psychosis

108
Q

Non-IR stimulant with formulation of amphetamine

A

adzenys XR-ODT

3:1 d to l isomer

qd, dissolves on tongue

109
Q

Which ADHD stimulant is a pro-drug?

A

Lisdexamfetamine

110
Q

Abstinence syndrome

A

sx that occur with withdrawal of a drug in a dependent person

111
Q

What classifies drug dependence?

A

signs and sx caused by withdrawal from chronic use or abrupt lowering of dose

AKA physical dependence

112
Q

Define designer drug

A

synthetic derivative of a drug with a slightly modified structure

no major change in action

113
Q

Describe sensitization

A

increase in response with repetition of same dose of drug

shifts left vs tolerance shifts right

114
Q

Most commonly abused prescription depressants

A

alprazolam (xanax)

zolpidem

zaleplon

115
Q

Most commonly abused prescription stimulants

A

adderal

methylphenidate

116
Q

NMDA antagonist that reduces desire to drink alcohol

A

acamprosate

117
Q

What can caffeine be used for?

A

improve alertness

migraine ha

ha after epidural anesthesia

asthma

ADHD

memory

118
Q

What drugs are abused but aren’t necessarily adductive?

A

LSD

PCP/angel dust

Ketamine (special k)

119
Q

How long does 1 oz of alcohol take to metabolize?

A

1 hour

so 6oz–> 6 hrs

120
Q

Drugs for tmt of acute methanol or ethylene glycol poisoning

A

ethanol

fomepizole

121
Q

Drugs for prevention of alcohol abuse

A

acamprosate

disulfiram (antabuse)

naltrexone

122
Q

Drugs for tmt of acute alcohol withdrawal syndrome

A

diazepam (valium)

lorazepam (ativan)

oxazepam

thiamine (Vit B1)

123
Q

Naltrexone MOA

A

alcohol and opiate dependence

mu opioid antagonist

reduces craving and short-term rate of relapse

124
Q

Acamprosate MOA

A

weak NMDA antagonist and GABAa agonist

reduces short and long-term relapse rates

125
Q

Disulfiram MOA

A

irreversibly inhibits ADH–> causes extreme discomfort in pts who drink alcohol

126
Q

Describe Neuroleptic Malignant Syndrome (NMS)

A

after antipsychotic use (new or increased dose)

can be hours–>30 days until onset of sx

Malignant FEVER:
~Myoglobinuria (muscle damaged, releases myoglobin, can cause acute renal failure)
~Fever
~Encephalopathy
~Vitals unstable
~increased Enzymes, specifically CK
~muscle Rigidity
127
Q

Tmt for Neuroleptic Malignant Syndrome (NMS)

A

dantrolene: binds ryanodine receptor, decreases calcium release to relax muscles

bromocriptine (dopamine agonist)

D/C CAUSATIVE AGENT

128
Q

Typica/First Gen Antipsychotics

A 
Haloperidol
Pimozide
Trifluoperazine
Fluphenazine
Thioridazine
Chlorpromazine

-azine

129
Q

What antipsychotic to use in delirium?

A

haloperidol (haldol)

130
Q

High potency first gen antipsychotics

A

Hal Tries to Fly HIGH

Haloperidol

Trifluoperazine

Fluphenazine

more neuro SE like EPS

131
Q

Low potency first gen antipsychotics

A

Cheating Thieves are low

Chlorpromazine

Thioridazine

132
Q

MOA of first gen psychotics

A

block D2 receptors–> increase CAMP

decrease dopamine, also block these receptors:
muscarinic (ACh)
histamine
alpha-1

133
Q

SE of first gen anitpsychotics

A 
EPS
hyperprolactinemia
metabolic syndrome (obesity, DM, hyperlipidemia)
antimuscarinic (dry mouth, constipation)
antihistamine (sedation)
alpha: orthostatic hypotension
QT prolongation
corneal deposits (chlorpromazine)
retinal deposits (thioridazine)
NMS
134
Q

Sx of hyperprolactinemia

A

galactorrhea

oligomenorrhea

gynecomastia

135
Q

What antipsychotic causes corneal deposits

A

chlorpromazine (1st)

136
Q

What antipsychotic causes retinal deposits

A

thioridazine (1st)

137
Q

Describe hours-days sx of EPS

A

acute dystonia

  • ->muscle spasm, rigidity/stiffness
  • ->oculogyric crisis

tmt: benztropine (blocks muscarinic receptors to decrease ACh which increases dopamine) and diphenhydramine

138
Q

Describe days-months sx of EPS

A

akathisia (restlessness)
–>tmt: propranolol or other B blocker, benztropine, benzos

parkinsonism (bradykinesia)

  • -> d/t decreased dopamine
  • -> tmt: benztropine, amantadine
139
Q

Describe months-years sx of EPS

A

Tardive dyskinesia
–>choreathetosis, smaking gums, etc

tmt: clozapine, valbenazine, deutetrabenazine (VMAT 2 inhibitors)

140
Q

What is EPS

A

d/t decreased dopamine, decreased modulation of movement via basal ganglia

141
Q

Atypical/2nd generation antipsychotics

A 
Aripiprazole
Asenapine
Clozapine
Olanzapine
Quetiapine
Iloperidone
Paliperidone
Risperidone
Lurasidone
Ziprasidone
  • idone
  • piprazole
  • apine
142
Q

MOA of -idone atypical antipsychotics

A

block serotonin (2A) and dopamine (D2) receptors

143
Q

MOA of -piprazole atypical antipsychotics

A

partial serotonin and dopamine agonist

144
Q

What drug to use for tmt-resistant schizoprhenia or schizoaffective disorder

A

clozapine

145
Q

What drug to use for suicide prevention in schizophrenia

A

clozapine

146
Q

universal SE of atypical antipsychotics

A

prolonged QT

fewer EPS and anticholinergic c/t typical antipsychotics

147
Q

SE of atypical -apines (antipsychotics)

A

metabolic syndrome: weight gain, DM, hyperlipidemia

olanzapine
clozapine

O–>obesity

148
Q

SE of clozapine

A

2nd gen/atypical antipsychotic:

Agranulocytosis (monitor WBC)

Seizures (dose related)

must watch bone marrow CLOZely with CLOZapine

149
Q

SE of risperidone

A

2nd gen/atypical antipsychotic:

hyperprolactinemia
–>galactorrhea, amenorrhea, gynecomastia

150
Q

Long-acting injectables to treat non-adherence of antipsychotics

A

Risperidone
Olanzapine
Aripiprazole
Paliperidone

151
Q

What is the most common drug-induced cause of hyperprolactinemia?

A

antipsychotics (fluphenzine, haloperidol, risperidone)

152
Q

Tmt of EPS

A

benztropine (antimuscarinic)

diphenhydramine (antihistamine)

153
Q

Tmt of tardive dyskinesia

A

VMAT 2 inhibitors (-benazine)

154
Q

Difference between typical and atypical antipsychotics

A

typical: EPS, side effects, act only on dopamine D2 receptor
atypical: more serotonin (2a) receptor activity vs dopamine, less EPS and anticholinergic effects

155
Q

What can cause drug rxn w/ eosinophilia and systemic sx (DRESS)?

A

olanzapine

156
Q

Cause sedation and anticholinergic SE the most

A

chlorpromazine

thioridazine

cariprazine

clozapine (other -apines)

157
Q

Cause orthostatic hypotension SE the most

A

chlorpromazine

thioridazine

clozapine

cariprazine

158
Q

Antipsychotic least likely to cause weight gain

A

ziprasidone

159
Q

Antidepressant used for nicotine withdrawal

A

bupropion

160
Q

Antidepressant used for enuresis/bedwetting

A

imipramine

161
Q

Antidepressant used for diabetic peripheral neuropathy

A

duloxetine

162
Q

Antidepressant used for fibromyalgia

A

duloxetine

163
Q

Antidepressant used for chronic musculoskeletal pain

A

duloxetine

164
Q

Antidepressant used for stress incontinence

A

duloxetine

Psych (12 decks)

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