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PANCE > Pharm (exam 1 material) > Flashcards

Pharm (exam 1 material) Flashcards

1
Q

Duloxetine SE

A

Hepatotoxicity

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2
Q

SSRI/SNRIs with highest risk of discontinuation syndrome

A

Paroxetine and venlafaxine

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3
Q

Trazadone SE

A

Priapism, hypotension, sedation

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4
Q

Mirtazapine SE

A

Weight gain

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5
Q

Indication for amitriptyline (NOT MDD)

A

Migraine ppx

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6
Q

S/sx of TCA overdose

A

Sinus tach ECG, seizures, sedation, anticholinergic effects

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7
Q

TCA OD antidote

A

IV sodium bicarb

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8
Q

Names of TCAs I can’t remember

A

Imipramine, clomipramine, doxepin

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9
Q

Names of MOAIs I can’t remember

A

Isocarboxazid, tranylcypromine, phenelzine, selegiline

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10
Q

MOAI interactions/CI

A

Uncontrolled HTN, CHF, pheo, high tyramine foods/ETOH (leads to HTN crisis, delirium)

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11
Q

Earliest indicators of response to MDD tx:

A

Increased pleasure in activities

Improvements in psychomotor retardation

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12
Q

Earliest indicators of response to MDD tx:

A

Increased pleasure in activities

Improvements in psychomotor retardation

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13
Q

What do we screen for before starting an AD?

A

FH (1st deg) of bipolar disorder

AD monotherapy can precipitate mania

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14
Q

When to start screening for depression and with what tool?

A

12yo w/ PHQ-2

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15
Q

Childhood depression: start w/ ______ and add ______ if necessary

A

Psychotherapy, fluoxetine

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16
Q

Switching from one class of ADs to another requires

A

Cross tapering (exception: SSRI to SNRI

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17
Q

When to add an additional AD in a pt. already on one?

A

+ TLC and CBT first

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18
Q

Buspirone indication

A

Augmentation (to AD and CBT) for anxiety

Safe in pregnancy!

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19
Q

BZD antidote

A

Flumazenil

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20
Q

BZD use…

  1. Short term bridging therapy for anxiety + panic attacks
  2. Status epilepticus
  3. Conscious sedation
A
  1. Alprazolam, lorazepam
  2. Lorazepam
  3. Diazepam, midazolam
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21
Q

Withdrawal of what 3 drugs/substances can kill patients

A

BZDs , ETOH, barbituates

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22
Q

BZD BBW

A

Concomitant use with opioids (resp. depression)

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23
Q

BZDs w/ highest abuse potential

A

Alprazolam and diazepam

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24
Q

AD used for OCD

A

Clomipramine (TCA) - cardiac eval first

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25
Q

Lithium MOA

A

Cation transport

Influences reuptake of NE and 5HT

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26
Q

Lithium indications

A

Acute and maintenance of bipolar disorder

Most effective long-term therapy, decreases suicide risk AND short-term mortality

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27
Q

Labs to check w/ lithium

A

Pregnancy test, CBC, BMP (hyponatremia, hypokalemia, hypercalcemia), renal fcn w/ BUN/CR and UA, TSH

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28
Q

What increases risk of lithium toxicity?

A

Renal dysfunction

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29
Q

Difference b/w 1st and 2nd gen APs

A

1st MORE dopamine, 2nd MORE serotonin

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30
Q

AP w/ the highest risk of EPS

A

Haloperidol

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31
Q

QT prolonging meds

A

AD, AP, antiemetics, antiarrhythmics, antimicrobials

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32
Q

Indication for chlorpromazine (1st gen AP)

A

Intractable hiccups

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33
Q

2nd gen APs that are good adjuncts for depression

A

Olanzapine, quetiapine, brex & aripiprazole

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34
Q

Tx for refractory schizoprenia

A

Clozapine

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35
Q

BBW for 2nd gen APs

A

Increased mortality in dementia-related psychosis

Increased suicidality if depression

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36
Q

What must you do before rx an AP in a primary care setting?

A

Consult psych

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37
Q

AP ADRs:

  1. Agranulocytosis
  2. WORST DM and weight gain
  3. Highest risk of QTc prolongation
  4. Anaphylaxis/angioedema/type 1 HST rxn
  5. Compulsive urges (eat, binge, shop, sex)
  6. DRESS
A
  1. Clozapine
  2. Clozapine, olanzapine
  3. Ilioperidone, ziprasidone
  4. Asenapine
  5. Aripirazole
  6. Olanzapine, ziprasidone
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38
Q

Do positive or negative sx assoc. w/ schizophrenia respond better to AP?

A

Positive (e.g. hallucinations, delusions)

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39
Q

Extrapyramidal sx

A 
Acute dystonia (1st few days) = torticollis
Pseudoparkinsonism (1st few weeks) = chorea, athetosis
Akathesia (1st few weeks) = creepy crawlies 
Tardive dyskinesia = loss of muscle control affected face, arms, legs
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40
Q

Which EPS sx is irreversible?

A

Tardive dyskinesia

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41
Q

Tx of EPS

A
  1. Reduce AP
  2. If step 1 ineffective, switch AP
  3. Benztropine (alternative: ER amantadine)
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42
Q

ACUTE phase bipolar tx:

  1. Mania
  2. Depression
A
  1. AP, lithium, VPA

2. AP, lithium

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43
Q

MAINTENANCE phase:

  1. Mania
  2. Depression
  3. Mixed
A
  1. Lithium
  2. Lamotrigine
  3. Lithium +/- VPA, carbamazepine, lamotrigine
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44
Q

1st gen antihistamines

A

Diphenhydramine and doxylamine

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45
Q

Doxylamine indication

A

Nausea in pregnancy (1st line pharm agent, after lifestyle/dietary changes, vitamin B6)

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46
Q

Treatment of non-24hr sleep-wake disorder (blind pt.)

A

Tasimelteon

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47
Q

What type of stimulants are most commonly used for ADHD?

A 
*Long-acting/ER*
Methylphenidate (Ritalin) 
Dexmethylphenidate (Focalin)
Amphetamine/dextroamphetamine (Adderall) 
Lisdexamphetamine (Vyvanse)
48
Q

Stimulant MOA

A

Increase release of catcholamines from CNS synapses which leads to increased NE and DA in the brainstem (thought to increase attention span)

49
Q

MOA of methylphenidate products

A

BLOCKS REUPTAKE of NE and DA

50
Q

MOA of amphetamine products

A

PROMOTES RELEASE of NE and DA

51
Q

Lisdexamphetamine is FDA approved for what non-ADHD condition

A

Binge-eating disorders

52
Q

Interactions/ADRs of stimulants

A
  • Diminish affect of anti-HTN drugs
  • HTN crisis when used with MAOI and linezolid
  • Increase HR and BP (caution w/ sympathomimetics/caffeine)
  • Anxiety
  • Appetite disturbance, wt. loss
  • Sleep disturbance
  • Sow growth rate in kids
  • Precipitate tics in kids
  • Lowers seizure threshold
53
Q

What schedule drug are stimulants

A

II

54
Q

T or F: ECG is indicated in all patients before initiating a stimulant?

A

False - healthy patients do not need one

55
Q

CI to stimulants

A
  • Underlying cardiac dz
  • FH of tics, tourettes
  • Marked anxiety
  • Hyperthyroid
  • Glaucoma
56
Q

Atomoxetine MOA

A

SNRI-like (increases NE)

57
Q

Atomoxetine BBW

A

SI

58
Q

Role for atomoxetine in treating ADHD

A

Pt. intolerant of stimulant, h/o substance abuse, marked anxiety, anorexia

59
Q

What medications are adjunctive to stimulants in treating ADHD?

A

Guanfacine (M/C) and clonidine

60
Q

Fluoxetine and paroxetine inhibit what CYP enzyme

A

2D6 (think metoprolol)

61
Q

Caution when adding SSRIs to other serotonergic drugs such as…..

A

Linezolid, St. John’s wart, dextromethorphan

62
Q

What SSRI poses the greatest risk of QT prolongation?

A

Citalopram

63
Q

Serotonin syndrome vs. neuroleptic syndrome

A 
SS:
- Onset w/in 12 hrs
- Hyperreflexia
- Increase muscle tone 
- Dilated pupils
- Hyperactive bowel sounds
NMS:
- Onset w/in 1-3 days
- Hyporeflexia 
- Lead-pipe rigidity
Both:
- Fever
- Hemodynamic instability (HTN, tachycardia) 
- Hypersalivation, diaphoresis
64
Q

Drugs that cause SS

A

Lithium, VPA, atypical APs, trazadone, buspirone, tramadol, benadryl, meperidine, linezolid, triptans, DM, methadone

65
Q

Drugs that cause NMS

A

Compazine, phenergan, reglan, hydroxyzine OR withdrawal from dopamine agonist

66
Q

Tx of SS and NMS

A

SS: Cyproheptadine (+/- NM blockade, intubation)
NMS: Bromocriptine or amantadine + dantrolene
Both: D/C offending agent, IVF, cooling blanket, lorazepam, +/- ECT

67
Q

Max dose APAP for adults

A

4g/day

68
Q

Antidote to APAP overdose

A

N-acetylcsteine

69
Q

NSAIDs MOA

A

Reversibly inhibits COX 1 and/or COX2

70
Q

NSAIDs should be used cautiously in pt. w/…..

A
  • IBD
  • HTN/HF, CAD, CVD, h/o TIA (avoid altogether in pt. w/ recent CABG)
  • CKD (d/t prostaglandin inhibition -> dec renal BF and incr fluid retention)
  • Asthma
  • PUD
  • Pregnancy
71
Q

NSAID therapy….
1st line drugs:
2nd like drugs:

A

1st line drugs: Ibuprofen, naproxen

2nd like drugs: Meloxicam (safer for GI tract), piroxicam (safer for heart)

72
Q

NSAIDs BBW

A

Increased CV risk

73
Q

Why should we avoid diclofenac?

A

Prothrombotic + hepatotoxic

*topical form better (OA, MSK injuries)

74
Q

Which NSAIDs is most likely to cause nephortoxicity?

A

Ketorolac

75
Q

NSAIDs interfere with the antiplatelet effect of what drug?

A

ASA - if have to be taken concomitantly, take ASA 1 hr before

76
Q

What 3 drugs minimize GI side effects of NSAIDs?

A

Misoprostol
H2 blockers
PPI (preferred)

77
Q

Celecoxib MOA

A

Selectively binds COX 2

78
Q

What’s unique about celecoxib?

A

Selective for COX 2, less GI toxicity, no antiplt effects

79
Q

Indication for….

  1. Cyclobenzaprine
  2. Baclofen
  3. Dantrolene
A
  1. Short-term tx of MSK muscle spasms (acute, painful)
  2. Neuromuscular conditions e.g. cerebral palsy
  3. Malignant hyperthermia
80
Q

Cyclobenzaprine SE

A

QTc prolongation

81
Q

Dantrolene SE

A

Dose-dependent hepatotoxicity

82
Q

Schedule II opioids

A

Codeine, hydrocodone, tapentadol

83
Q

Which opioid should NEVER be used in children <18 or breastfeeding women?

A

Codeine

84
Q

Codeine is a prodrug of what

A

Morphine

85
Q

What CYP enzyme metabolizes codeine

A

2D6

86
Q

What’s the issue with CYP2D6?

A

10% of the population lacks the enzyme (cannot convert to active form)
1-30% are rapid metabolizers (toxicity)

87
Q

Methadone MOA and indication

A

Mu agonist

Pain and opioid rehab clinics

88
Q

What opioid if combined with MAOI could lead to death?

A

Merperidine (serotonergic)

89
Q

c/t other opioids, methadone has a higher risk of

A

Respiratory depression

90
Q

Buprenorphine MOA and indication

A

Partial opioid agonist, opioid antagonist

Pain and opioid rehab clinics (+ Naloxone = Suboxone)

91
Q

Common opioid ADRs

A
  • Euphoria
  • Sedation
  • Miosis
  • Resp distress
  • N/V
  • Constipation
  • Hyperalgesia
  • Withdrawal
  • Urinary retention
92
Q

What medication can be used during opioid weaning for pt. c/o withdrawal sx?

A

Clonidine

93
Q

Naloxone MOA

A

Competitive antagonist CNS opioid receptors

94
Q

Naloxone pearls

A
  • Reverses opioid w/in 1-3 minutes
  • Short half life (60-90 minutes)
  • Initial dose 0.4-2mg
  • Available formulations: intranasal, SQ, IM, IV
95
Q

Which opioid is category B in pregnancy?

A

Oxycodone

96
Q

Triptans MOA

A

Selective agonist for serotonin receptors (causes vasoconstriction)

97
Q

Avoid triptans in pt. w/

A
  • Hemiplegic & basilar migraines
  • Ischemic CVA/HD/vasospastic CAD/PAD, ischemic bowel, uncontrolled HTN, Raynaud’s
  • Severe hepatic impairment
  • WPW
  • Pregnancy
98
Q

Factors that indicate need for migraine ppx

A
  • Recurring migraines >4 per month
  • Use of acute analgesics >2-3x/week
  • CI to or failure or overuse or adverse effects of acute therapies
  • Pt. preference
99
Q

Migraine ppx options

A
  • Propranolol
  • AEDs: topiramate, VPA
  • Amitriptyline
100
Q

What 3 medications can prevent menstrual migraines?

A

Triptans, NSAIDs, OCPs

101
Q

Dementia drugs

  1. Sx treatment
  2. Disease-modifying agent
A
  1. Donepezil

2. Memantidine

102
Q

Donepezil MOA

A

Cholinesterase inhibitor

103
Q

Memantidine MOA

A

NMDA receptor agonist

104
Q

Most effective symptomatic treatment for PD

A

Levodopa

105
Q

Levodopa MOA

A

Naturally occurring amino acid, circulates in plasma to BB (dopamine cannot cross), decarboxylates to dopamine

106
Q

Levodopa ADRs

A
  • Motor fluctuations/on-off syndrome: >5 years
  • Wearing off phenomenon: reemergence of PD sx <4 hrs following a dose
  • N/V, anorexia
  • CNS effects d/t chronic therapy, dose escalation (hallucination, sleep disturbance)
107
Q

Carbidopa MOA

A

Blocks conversion of levodopa to dopamine systemically (inhibits peripheral decarboxylase)
+ minimizes side effects (N/V, orthostatic hypotension)

108
Q

Drugs that should not be used concomitantly with PD meds

A

Anti-HTN, APs (1st gen >), nausea meds (promethazine, prochlorperazine, metochlopramide)

109
Q

What drug is an alternative 1st line OR add-on therapy to levodopa/carbidopa? What about anther adjunct when levodopa efficacy is deteriorating?

A

Non-ergot derivatives (dopamine receptor agonists) e.g. ropinirole, pramipexole
Irreversible MOA-B inhibitors e.g. selegiline, rasagiline

110
Q

Ropinirole indications (besides PD)

A

Restless leg syndrome

111
Q

“Old” AEDs that require monitoring

A

Phenytoin
Carbamazapine
Valproate

112
Q

Non-seizure indications for AEDs:

  1. Gabapentin
  2. Lamotrigine
  3. Topiramate
  4. CBZ
  5. VPA
A
  1. Neuropathy
  2. Mood stabilizer
  3. Migraine ppx, wt. loss
  4. Trigeminal neuralgia, bipolar
  5. Migraine ppx
113
Q

Phenytoin is a CY.P…..

A

Inducer (speeds metabolism, reduces concxn of a drug)

114
Q

Phenytoin ADRs

A 
Gingival hypertrophy
Teratogenicity 
Rash
Drug fever
Hepatotoxicity
*Nystagmus* = supratherapeutic dose
115
Q

CBZ ADRs

A 
BM suppression
Drug fever
SJS 
Vitamin D deficiency
Teratogenicity (neural tube defects)
116
Q

VPA ADRs

A

Teratogenicity (neural tube defects)

Hepatotoxicity

117
Q

Two opioids that are antidiarrheals

A

Diphenoxylate (+ atropine to dec addictive potential) and loperamide (dose not cross BBB -> no addictive potential)

PANCE (4 decks)

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