Pharm Exam 1 Drugs Flashcards by Sarah Hoffman

Q

Fluoxetine

A

depression, (depression in kids), anxiety

SSRI - blocks serotonin reuptake pump = increase amount of serotonin at synapse

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Q

Sertraline

A

depression/anxiety

SSRI - blocks serotonin reuptake pump = increase amount of serotonin at synapse

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Q

Paroxetine

A

depression, anxiety

SSRI - blocks serotonin reuptake pump = increase amount of serotonin at synapse

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Q

Citalopram / Escitalopram

A

depression/anxiety

SSRI - blocks serotonin reuptake pump = increase amount of serotonin at synapse

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Q

Venlafaxine / Desvenlafaxine

A

depression/anxiety

SNRI - inhibitor of NE > serotonin reuptake

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Q

Duloxetine

A

depression/anxiety, diabetic peripheral neuropathy, fibromyalgia, chronic msk pain
SNRI - inhibitor of NE > serotonin reuptake

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Q

vilazodone

A

depression/anxiety

SSRI + 5HT1 receptor agonist - inhibits serotonin reuptake + agonist of 5HT1 receptor

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Q

vortioxetine

A

depression/anxiety

SSRI + 5HT1 receptor agonist - inhibits serotonin reuptake + agonist of 5HT1 receptor

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Q

bupropion

A

depression

dopamine > NE reuptake inhibitor

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Q

trazadone

A

depression

5HT1 antagonist, SSRI, H1 and a1-adrenergic receptor antagonist

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Q

mirtazapine

A

depression

NE, serotonin, H1 receptor antagonist

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Q

amitriptyline

A

depression, neuropathic pain, migraine prophylaxis

tertiary TCA - increase serotonin, NE + a1, histaminic, muscarinic receptors

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Q

nortriptyline

A

depression, neuropathic pain

secondary TCA - increase serotonin, NE + H1, muscarinic, a-adrenergic receptors

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Q

phenelzine

A

depression + hyperphagia or hypersomnia

MAO-A inhibitor - increase serotonin & NE by inhibiting its breakdown by MAO-A

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Q

selegiline

A

depression, *PD

MAO-B inhibitor - increases dopamine by inhibiting its breakdown

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Q

buspirone

A

anxiety

unknown MOA

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Q

pregabalin

A

anxiety

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Q

alprazolam

A

anxiety
benzo - binds BZD receptors on postsynaptic GABA neuron = potentiates endogenous GABA = hyperpolarization and stabilization

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Q

clonazepam

A

anxiety, seizure disorders
benzo - binds BZD receptors on postsynaptic GABA neuron = potentiates endogenous GABA = hyperpolarization and stabilization

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Q

lorazepam

A

anxiety, status epilepticus
benzo - binds BZD receptors on postsynaptic GABA neuron = potentiates endogenous GABA = hyperpolarization and stabilization

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Q

diazepam

A

anxiety
benzo - binds BZD receptors on postsynaptic GABA neuron = potentiates endogenous GABA = hyperpolarization and stabilization

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Q

midazolam

A

anxiety
benzo - binds BZD receptors on postsynaptic GABA neuron = potentiates endogenous GABA = hyperpolarization and stabilization

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Q

lithium

A

mania/bipolar

influences reuptake of serotonin +/- NE

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Q

haloperidol

A

emergency sedation of severely agitated or delirious patients
1st gen antipsychotic - antagonist at dopaminergic receptors, + a, histaminic, muscarinic antagonism

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chlorpromazine

intractable hiccups | 1st gen antipsychotic - antagonist at *dopaminergic* receptors, + a, histaminic, muscarinic antagonism

clozapine

*refractory schizophrenia*, psychosis, bipolar disorder | 2nd gen antipsychotic - Antagonist at 5HT2 & D4, D2 receptors (too much serotonin)

risperidone

schizophrenia, psychosis, bipolar disorder | 2nd gen antipsychotic - *serotonergic* >> dopamine antagonist

olanzapine

schizophrenia, psychosis, bipolar disorder, *depression adjunct* 2nd gen antipsychotic - *serotonergic* >> dopamine antagonist

quetiapine

schizophrenia, psychosis, bipolar disorder, *depression adjunct* 2nd gen antipsychotic - *serotonergic* >> dopamine antagonist

ziprasidone

schizophrenia, psychosis, bipolar disorder | 2nd gen antipsychotic - *serotonergic* >> dopamine antagonist

aripiprazole

schizophrenia, psychosis, bipolar disorder, *depression adjunct*, children w irritability w autistic disorder 2nd gen antipsychotic - agonist at D2 & 5HT1 receptors, antagonist at 5HT2

paliperidone

schizophrenia, psychosis, bipolar disorder | 2nd gen antipsychotic - *serotonergic* >> dopamine antagonist

asenapine

schizophrenia, psychosis, bipolar disorder | 2nd gen antipsychotic - *serotonergic* >> dopamine antagonist

iloperidone

schizophrenia, psychosis, bipolar disorder | 2nd gen antipsychotic - *serotonergic* >> dopamine antagonist

lurasidone

schizophrenia, psychosis, bipolar disorder | 2nd gen antipsychotic - *serotonergic* >> dopamine antagonist

brexpiprazole

schizophrenia, psychosis, bipolar disorder, *depression adjunct* 2nd gen antipsychotic - agonist at D2 & 5HT1 receptors, antagonist at 5HT2

IM antipsychotics

``` risperidone olanzapine aripiprazole paliperidone (ROAP) ```

antipsychotics for depression adjunct

aripiprazole, brexpiprazole, quetiapine, olanzapine

antipsychotics associated with diabetes & wt gain

clozapine, olanzapine

antipsychotics with QTc interval prolongation

iloperidone, ziprasidone

short acting/IR stimulants

Methylphenidate, dexmethylphenidate, amphetamine-dextroamphetamine, dextroamphetamine

intermediate stimulants

methylphenidate | dextroamphetamine

long-acting/ER stimulants

methylphenidate, dexmethylphenidate, amphetamine-dextroamphetamine, lisdexamphetamine

trade names for long acting methylphenidate

concerta, metadata CD, Ritalin LA, aptension XR, adhansia XR, jornay PM (dosed at night) chewable tab powder

methylphenidate

ADHD, narcolepsy | stimulant - blocks reuptake of NE + dopamine to increase its concentration

amphetamine

ADHD, narcolepsy | stimulant - promote release of NE + dopamine

dexmethylphenidate

ADHD, narcolepsy | stimulant - blocks reuptake of NE + dopamine to increase its concentration

dexamphetamine

ADHD, narcolepsy | stimulant - promote release of NE + dopamine

lisdexamphetamine

binge eating disorder in adults | long-acting stimulant

atomoxetine

ADHD | SNRI - inhibitor of NE and serotonin

guanfacine

ADHD | a2 adrenergic agonist = ability to control/inhibit inappropriate behaviors and increase focus

clonidine

ADHD | a2 adrenergic agonist

diphenhydramine

hypnotics/sleep aid | 1st gen antihistamines - anticholinergic effects

doxepin

sleep maintenance hypnotic , (depressant) | tertiary TCA - increase serotonin, NE + a1, histaminic, muscarinic receptors

benzodiazepines for sleep

``` triazolam estazolam temazepam flurazepam quazepam (Quit Fucking Trying To Escape) ```

benzodiazepines MOA

binds BZD receptors on postsynaptic GABA neuron to potentiate its endogenous GABA = hyperpolarization and stabilization

benzodiazepines use

anxiety, hypnotic

Zaleplon

hypnotic | NBRA - agonist on GABAa receptors close to or coupled with BZD1 receptors (not BZD2)

zolpidem

hypnotic | NBRA - agonist on GABAa receptors close to or coupled with BZD1 receptors (not BZD2)

eszopiclone

hypnotic | NBRA

melatonin

hypnotic | melatonin receptor agonist - acts on MT1 & MT2 to induce sleepiness and regulation of circadian rhythms

ramelteon

for difficulty falling asleep (good for elderly patients) | melatonin receptor agonist - acts on MT1 & MT2 to induce sleepiness and regulation of circadian rhythms

tasimelteon

non-24 hour sleep-wake disorder | melatonin receptor agonist - acts on MT1 & MT2 to induce sleepiness and regulation of circadian rhythms

modafinil / armodafinil / solriamfetol / pitolisant

excessive daytime sleepiness (narcolepsy, OSA) | *start with modafinil, armodafinil!!!

acetaminophen

analgesic + antipyretic | unknown MOA

carboxylic acid NSAID

aspirin

aspirin

anti-thrombotic (not used for pain)

propionic acid NSAIDs

ibuprofen naproxen *start here

ibuprofen

analgesic, antipyretic, dysmenorrhea, anti-inflammatory | reversibly** inhibits COX1 +/- COX2

naproxen

analgesic, antipyretic, dysmenorrhea, anti-inflammatory | reversibly** inhibits COX1 +/- COX2

acetic acid NSAIDs

ketorolac diclofenac (indomethacin)

enolic acid NSAIDs

piroxicam | meloxicam

piroxicam

analgesic, antipyretic, dysmenorrhea, anti-inflammatory | reversibly** inhibits COX1 +/- COX2

meloxicam

analgesic, antipyretic, dysmenorrhea, anti-inflammatory | reversibly** inhibits COX1 +/- COX2

ketorolac

analgesic, antipyretic, dysmenorrhea, anti-inflammatory reversibly** inhibits COX1 +/- COX2 *only commonly used IV/IM

diclofenac

analgesic, antipyretic, dysmenorrhea, anti-inflammatory reversibly** inhibits COX1 +/- COX2 *topical uses (systemic should not be used - Paxton)

celecoxib

anti-inflammatory (RA, OA, spondyloarthropathies, localized MSK, gout) selectively binds COX2

cyclobenzaprine

``` muscle relaxant (antispasmodic for MSK stuff same as for amitriptyline - serotonin/NE, a1, H1, muscarinic ```

clarisoprodol

muscle relaxant (antispasmodic for MSK stuff) MOA- who cares, DON'T USE schedule IV

tizanidine

``` muscle relaxant (antispasmodic for MSK stuff) unknown MOA ```

baclofen

muscle relaxant (antispastic for MS, SC injury)

dantrolene

muscle relaxant (antispastic for MS, SC injury), malignant hyperthermia

mild-moderate agonist opioids

codeine | hydrocodone

strong agonist opioids

``` morphine oxycodone oxymorphone hydromorphone methadone meperidine fentanyl ```

codeine

analgesia mild-moderate agonist (phenanthrene) opioid prodrug that is metabolized to morphine via 2D6

hydrocodone

analgesia | mild-moderate agonist (phenanthrene) opioid

morphine

``` analgesia, acute pulmonary edema SOB strong agonist (phenanthrene) opioid ```

oxycodone

strong agonist (phenanthrene) opioid

oxymorphone

strong agonist (phenanthrene) opioid

hydromorphone

strong agonist (phenanthrene) opioid

methadone

``` mostly used in pain/opioid rehab clinics strong agonist (phenylhepatylamines/diphenylheptanes) ```

meperidine

``` short-term acute pain strong agonist (phenylpiperidine) ```

fentanyl

``` transdermal patch for chronic pain in *opioid tolerant patients* strong agonist (phenylpiperidine) ```

tramadol

Last line for acute/chronic pain to avoid a stronger opioid | weak mu-agonist + SSRI (metabolized through 2D6)

tapentadol

similar to tramadol, but stronger

buprenorphine

binds with high affinity to mu-opioid receptor

opioids that are 3A4 substrates

oxycodone, hydrocodone, fentanyl, buprenorphine, tramadol

opioids that are 2D6 substrates

codeine | tramadol

opioids that are more predictable in pts with 2D6 polymorphisms

hydromorphone, oxymorphone, morphine

opioid clinical use

analgesia pulmonary edema (IV morphine) cough - dont use for this diarrhea?

naloxone

opioid reversal | structure is similar to oxymorphone - competitive antagonist CNS opioid receptors & no opioid agonist effects

Excedrin

caffeine + APAP + ASA | for abortive tension-type HA

sumatriptan

abortive migraine HA, cluster HA | fastest acting triptan - selective agonist for serotonin receptors in cranial arteries = vasoconstriction

zolmitriptan

abortive migraine HA | fast acting triptan - selective agonist for serotonin receptors in cranial arteries = vasoconstriction

frovatriptan

abortive migraine HA | longest acting triptan - selective agonist for serotonin receptors in cranial arteries = vasoconstriction

dihydroergotamine

for pts who have not responded to triptans | ergots (do not combine ergots with triptans!)

metoclopramide, prochlorperazine, promethazine

adjuncts for N/V during migraine

propranolol | metoprolol

prophylaxis for migraine HAs | B-blocker

divalproex

prophylaxis for migraine HAs

Valproate

prophylaxis for migraine HAs

OCPs

can help prevent menstrual migraines - add triptans or NSAIDs

erenumab

prophylaxis migraine when oral preventive meds arent enough/not tolerated CGRP antagonist - prevents vasodilation

fremanezumab

prophylaxis migraine when oral preventive meds arent enough/not tolerated CGRP antagonist - prevents vasodilation

galcanequmab

prophylaxis migraine when oral preventive meds arent enough/not tolerated CGRP antagonist - prevents vasodilation

cefaly

a ridiculous nerve stimulator that goes on your forehead, looks absurd, but prevents your migraines...maybe

botox

migraine prevention

donepezil

mild-moderate dementia | cholinesterase inhibitor - increase cholinergic transmission

galantamine

mild-moderate dementia | cholinesterase inhibitor - increase cholinergic transmission

rivastigmine

mild-moderate dementia | cholinesterase inhibitor - increase cholinergic transmission

memantine

moderate-severe dementia | NMDA receptor antagonist

levodopa

PD 1st line | goes from plasma to BBB and gets decarboxylated to DOPAMINE!

carbidopa

PD "body guard" to add to levodopa | decarboxylase inhibitor that blocks the breakdown of levodopa before it gets to the BBB (more levodopa in BBB)

entacapone

PD "body guard" (not used as frequently d/t fatal liver injury) prevents o-methylation of levodopa

ropinirole

PD 1st line, RLS | dopamine receptor agonist

rotigotine

PD 1st line, RLS | dopamine receptor agonist

pramipexole

PD 1st line, RLS | dopamine receptor agonist

rasagiline

PD 2nd line (along with selegiline) | MAOB-inhibitor - increases dopamine by inhibiting it breakdown

benztropine

PD 2nd line (good for mild tremor in early dz, or with drooling), treatment of EPS* anticholinergic

amantadine

PD 2nd line | NMDA receptor antagonist (interferes with excessive glutamate neurotransmission)

when to start dopamine agonist vs levodopa for PD

dopamine agonist if <65 | levodopa if >65 or if sx seriously threaten pts life

primavanserin

PDD (Parkinson's disease dementia) antipsychotic (inverse agonist + antagonist at serotonin receptors) make for PDD Qt prolonger!

carbamazepine

partial seizures, tx of chronic pain syndromes, acute manic or mixed episodes of bipolar I depression Na+ channel AED

oxcarbazepine/eslicarbazepine

mono or adjunct in partial seizures | Na+ channel AED

phenytoin /fosphenytoin

generalized tonic-clonic + complex partial seizures (no longer 1st line), prevention of "early" seizures following TBI/NS Na+ channel AED

lamotrigine

newly diagnosed absence seizures, LGS, maintenance of bipolar disorder Na+ channel AED

lacosamide

monotherapy or adjunctive in partial-onset seizures | Na+ channel AED

zonisamide

adjunct for focal seizures | Na+ channel AED (sulfonamide derivative)

rufinamide

LGS syndrome | Na+ channel AED

ezogabine

adjunctive for partial-onset seizures | K+ channel AED

ethosuximide

absence (petit mal) seizures | Ca+ channel AED

gabapentin

*adjunct* for partial seizures, *postherpetic neuropathy*, RLS Ca+ channel AED

pregabalin

fibromyalgia, management of peripheral neuropathies, RLS, GAD (off-label) Ca+ channel AED + substance P !!

phenobarbital

partial + secondarily generalized seizures | GABA receptor AED

clobazam

LGS | BZD that increases GABAergic tone (AED)

clonazepam

adjunct for LGS, adjunct for myoclonic & atonic seizures | BZD that increases GABAergic tone (AED)

tiagabine

adjunct for partial seizures | GABA AED

Vigabatrin

infantile spasms r/t truberous sclerosis | AED

perampanel

adjunct for partial-onset seizures | AED- glutamate receptor antagonist

valproate

mania associated with bipolar disorder, migraine prophylaxis AED- Na+ blocker, Ca+ current blocker, *increases GABA*

topiramate

migraine prophylaxis, chronic weight management | Na+ blocker , GABA enhancer, NMDA receptor antagonizer

felbamate

LGS | AED - unknown MOA

levetiracetam

prevention of early seizures following TBI/NS | AED- unknown MOA

brivaracetam

adjunctive tx of partial onset seizures | AED - unknown MOA

cannabidiol

seizures associated with dravet syndrome or LGS | unknown MOA