PHARM LOTS! Flashcards
1
Q
Common side effect of hypnotic agents
A
Sedation
2
Q
Occurs when sedative hypnotics are used chronically or at high doses
A
Tolerance
3
Q
The most common type of drug interaction of sedative hypnotics with other depressant medications
A
Additive CNS depression
4
Q
Major effect of benzodiazepines on sleep at high doses
A
REM is decreased
5
Q
Neurologic SE of benzodiazepines
A
Anterograde amnesia
6
Q
Reason benzos are used cautiously in pregnancy
A
Ability to cross the placenta
7
Q
Main route of metabolism for benzodiazepines
A
Hepatic
8
Q
Benzodiazepine that undergo extrahepatic conjugation (which are useful in older or hepatically impaired)
A
Lorazepam, oxazepam, and temazepam
9
Q
MOA for benzodiazepines
A
increase the FREQUENCY of GABA-mediated chloride ion channel opening
10
Q
Antidote to benzodiazepine overdose (antagonist that reverses the CNS effects)
A
Flumazenil
11
Q
Benzodiazepine with useful relaxant effects in skeletal muscle spasticity of central origin
A
Diazepam
12
Q
Benzodiazepine that has efficacy against absence seizures and in anxiety states, such as agoraphobia
A
Clonazepam
13
Q
Benzodiazepines that are the most effective in the treatment of panic disorder
A
Alprazolam and Clonazepam
14
Q
Benzodiazepine that is used for anesthesia
A
Midazolam
15
Q
DOC for status epilepticus
A
Diazepam
16
Q
Longer acting benzodiazepines used in the management of withdrawal states of alcohol and other drugs
A
Chlordiazepoxide and Diazepam
17
Q
Agents having active metabolites, long half lives, and a high incidence of adverse effects
A
Diazepam, Flurazepam, chlordiazepoxide, and clorazepate
18
Q
Barbiturates may precipitate this hematologic condition
A
Acute intermittent porphyria
19
Q
Barbiturates decrease the effectiveness of many other drugs via this pharmacokinetics property
A
Liver enzyme INDUCTION
20
Q
Barbiturates MOA
A
Increase the DURATION of GABA-mediated chloride ion channels
21
Q
Barbiturate used for the induction of anesthesia
A
Thiopental
22
Q
Important drug interaction with chloral hydrate
A
May displace coumadin from plasma proteins
23
Q
Site of action for zaleplon and zolpidem
A
Benzodiazepine receptor BZ1 (although are not considered benzodiazepines)
24
Q
Good hypnotic activity with less CNS SE than most benzodiazepines
A
Zolpidem, zaleplon
25
Agent that is a partial agonist for the 5-HT1A receptor
Buspirone
26
Drug of choice for generalized anxiety disorder, NOT effective in acute anxiety
Buspirone
27
Agent that is metabolized to acetaldehyde by alcohol dehydrogenase and microsomal ethanol-oxidizing system (MEOS)
Ethanol
28
Agent with zero-order kinetics
Ethanol, theophylline, tolbutamide, warfarin, aspirin, phenytoin
29
Rate limiting step of alcohol metabolism
Aldehyde dehydrogenase
30
System that increases in activity with chronic exposure and may contribute to tolerance
Microsomal ethanol oxidizing system (MEOS)
31
Enzyme that metabolizes acetaldehyde to acetate
Aldehyde dehydrogenase
32
Agents that inhibit aldehyde dehydrogenase
Disulfiram, metronidazole, certain sulfonylureas and cephalosporins
33
Agent used in the treatment of alcoholism, if alcohol is consumed concurrently, acetaldehyde builds up and results in nausea, headache, flushing, and hypotension
Disulfiram
34
The most common neurologic abnormality in chronic alcoholics
Peripheral neuropathy (also excessive alcohol use is associated with HTN, anemia, and MI)
35
Agent that is teratogen and causes a fetal syndrome
Alcohol
36
Agent that competes for alcohol dehydrogenase in the case of methanol overdose
Ethanol
37
Drug that inhibits alcohol dehydrogenase and is used in ethylene glycol exposure
Fomepizole
38
Most frequent route of metabolism
Hepatic enzymes
39
Mechanisms of action for Phenytoin, Carbamazepine, Lamotrigine
Sodium blockade
40
MOA for benzodiazepines and barbiturates
GABA-related targets
41
MOA for Ethosuximide
Calcium channels
42
MOA for Valproic acid at high doses
Affect calcium, potassium, and sodium channels
43
Drugs of choice for generalized tonic-clonic and partial seizures
Valproic acid, Phenytoin and Carbamazepine
44
DOC for febrile seizures
Phenobarbital
45
Drugs of choice for absence seizures
Ethosuximide and valproic acid
46
Drug of choice for myoclonic seizures
Valproic acid
47
Drugs of choice for status epilepticus
IV diazepam (or lorazapam) followed by phenytoin
48
Drugs that can be used for infantile spasms
Corticosteroids
49
Anti-seizure drugs used also for bipolar affective disorder (BAD)
Valproic acid, carbamazepine, phenytoin and gabapentin
50
Anti-seizure drugs used also for Trigeminal neuralgia
Carbamazepine
51
Anti-seizure drugs used also for pain of neuropathic orgin
Gabapentin
52
Anti-seizure agent that exhibits non-linear metabolism, highly protein bound, causes fetal hydantoin syndrome, and stimulates hepatic metabolism
Phenytoin
53
SE of phenytoin
Gingival hyperplasia, nystagmus, diplopia and ataxia
54
Anti-seizure agent that induces formation of liver drug-metabolism enzymes, is teratogen and can cause craniofacial anomalies and spina bifida
Carbamazepine
55
Agent that inhibits hepatic metabolism, is hepatotoxic and teratogen that can cause neural tube defects and gastrointestinal distress
Valproic acid
56
Laboratory value required to be monitored for patients on valproic acid
Serum ammonia and LFT's
57
SE for Lamotrigine
Stevens-Johnson syndrome
58
SE for Felbamate
Aplastic anemia and acute hepatic failure
59
Anti-seizure medication also used in the prevention of migraines
Valproic acid
60
Carbamazepine may cause
Agranulocytosis
61
Anti-seizure drugs used as alternative drugs for mood stabilization
Carbamazepine, gabapentin, lamotrigine, and valproic acid
62
MOA of general anesthetics
Unclear, thought to increase the threshold for firing of CNS neurons
63
Inhaled anesthetic with a low blood/gas partition coefficient
Nitrous oxide
64
Inversely related to potency of anesthetics
Minimum alveolar anesthetic concentration (MAC)
65
Inhaled anesthetics metabolized by liver enzymes which has a major role in the toxicity of these agents
Halothane and methoxyflurane
66
Most inhaled anesthetics SE
Decrease arterial blood pressure
67
Inhaled anesthetics are myocardial depressants
Enflurane and halothane
68
Inhaled anesthetic causes peripheral vasodilation
Isoflurane
69
Inhaled anesthetic that may sensitize the myocardium to arrhythmogenic effects of catecholamines and has produced hepatitis
Halothane
70
Inhaled anesthetics, less likely to lower blood pressure than other agents, and has the smallest effect on respiration
Nitrous oxide
71
Fluoride released by metabolism of this inhaled anesthetic may cause renal insufficiency
Methoxyflurane
72
Prolonged exposure to this inhaled anesthetic may lead to megaloblastic anemia
Nitrous oxide
73
Pungent inhaled anesthetic which leads to high incidence of coughing and vasospasm
Desflurane
74
DOC for malignant hyperthermia that may be caused by use of halogenated anesthetics
Dantrolene
75
IV barbiturate used as a pre-op anesthetic
Thiopental
76
Benzodiazepine used adjunctively in anesthesia
Midazolam
77
Benzodiazepine receptor antagonist, it accelerates recovery from benzodiazepine overdose
Flumazenil
78
This produces "dissociative anesthesia", is a cardiovascular stimulant which may increases intracranial pressure, and hallucinations occur during recovery
Ketamine
79
Opioid associated with awareness during surgery and post-operative recall, but still used for high-risk cardiovascular surgeries
Fentanyl
80
State of analgesia and amnesia produced when fentanyl is used with droperidol and nitrous oxide
Neuroleptanesthesia
81
Produces both rapid anesthesia and recovery, has antiemetic activity and commonly used for outpatient surgery, may cause marked hypotension
Propofol
82
MOA of local anesthetics (LA's)
Block voltage-dependent sodium channels
83
This may enhance activity of local anesthetics
Hyperkalemia
84
This may antagonize activity of local anesthetics
Hypercalcemia
85
Almost all local anesthetics have this property and sometimes require the administration of vasoconstrictors (ex. Epinephrine) to prolong activity
Vasodilation
86
Local anesthetic with vasoconstrictive property, favored for head, neck, and pharyngeal surgery
Cocaine
87
Longer acting local anesthetics which are less dependent on vasoconstrictors
Tetracaine and bupivacaine
88
These LA's have surface activity
Cocaine and benzocaine
89
Most important toxic effects of most local anesthetics
CNS toxicity
90
Commonly abused LA which has cardiovascular toxicity including severe hypertension with cerebral hemorrhage, cardiac arrhythmias, and myocardial infarction
Cocaine
91
LA causing methemoglobinemia
Prilocaine
92
Structurally related to acetylcholine, used to produce muscle paralysis in order to facilitate surgery or artifical ventilation. Full doses lead to respiratory paralysis and require ventilation
Neuromuscular blocking drugs
93
These drugs strongly potentiate and prolong effect of neuromuscular blockade (NMB)
Inhaled anesthetics, especially isoflurane, aminoglycosides, and antiarrhythmic
94
These prevent the action of ACh at the skeletal muscle endplate to produce a "surmountable blockade," effect is reversed by cholinesterase inhibitors (ex. neostigmine or pyridostigmine)
Nondepolarizing type antagonists
95
Agent with long duration of action and is most likely to cause histamine release
Tubocurarine
96
Non-depolarizing antagonist has short duration
Mivacurium
97
Agent can block muscarinic receptors
Pancuronium
98
Agent undergoing Hofmann elimination (breaking down spontaneously)
Atracurium
99
One depolarizing blocker that causes continuous depolarization and results in muscle relaxation and paralysis, causes muscle pain postoperatively and myoglobinuria may occur
Succinylcholine
100
During Phase I these agents worsen the paralysis by succinylcholine, but during phase II they reverse the blockade produced by succinylcholine
Cholinesterase inhibitors
101
Agents acting in the CNS or in the skeletal muscle, used to reduce abnormally elevated tone caused by neurologic or muscle end plate disease
Spasmolytic drugs
102
Facilitates GABA presynaptic inhibition
Diazepam
103
GABA agonist in the spinal cord
Baclofen
104
Similar to clonidine and may cause hypotension
Tizanidine
105
DOC for malignant hyperthermia by acting on the sarcoplasmic reticulum or skeletal muscle
Dantrolene
106
Agent used for acute muscle spasm
Cyclobenzaprine
107
Antipsychotics, reserpine at high doses, and MPTP (by-product of illicit meperidine analog) and is irreversible
Drug induced Parkinsonism
108
Agent used in drug therapy of Parkinson's instead of Dopamine which has low bioavailability and does not cross the BBB
L-dopa
109
This is combined with L-dopa, inhibits DOPA decarboxylase (active only peripherally) which allows lower effective doses of L-dopa and allows for fewer SE's (GI distress, postural hypotension, and dyskinesias)
Carbidopa
110
Clinical response that may fluctuate in tx of Parkinson's dx
"On-off-phenomenon"
111
Anti-Parkinson's drug which increases intraocular pressure and is contraindicated in closed angle glaucoma
Levodopa
112
Ergot alkaloid that is a partial agonist at D2 receptors in the brain, used for patients who are refractory or cannot tolerate levodopa, causes erythromelalgia
Bromocriptine
113
Non ergot agents used as first-line therapy in the initial management of Parkinson's
Pramipexole and ropinirole
114
Enhances dopaminergic neurotransmission SE's include CNS excitation, acute toxic psychosis and livedo reticularis
Amantadine
115
Inhibitor of MAO type B which metabolizes dopamine, used adjunct to levodopa or as sole agent in newly diagnosed pt's
Selegiline
116
Inhibitors of catechol-O-methyltransferase (COMT), used as adjuncts in Parkinson's dx and cause acute hepatic failure (monitor LFT's)
Entacapone and Tolcapone
117
Agent decreases the excitatory actions of cholinergic neurons. May improve tremor and rigidity but have LITTLE effect on bradykinesia. Atropine-like side effects
Benztropine
118
Agent effective in physiologic and essential tremor
Propranolol
119
Agents used in Huntington's Disease
Tetrabenazine (amine depleting drug), Haloperidol (antipsychotic)
120
Agents used in Tourette's dx
Haloperidol or pimozide
121
Chelating agent used in Wilson's disease
Penicillamine
122
Extrapyramidal dysfunction is more common with these agents, which block this subtype of dopamine receptor
Older antipsychotic agents, D2 receptors
123
Side effects occuring in antipsychotics that block dopamine
EPS, hyperprolactinemia, amennorrhea, galactorrhea, neuroleptic malignant syndrome
124
Antipsychotics that reduce positive symptoms only
Older antipsychotics
125
Newer atypical antipsychotics that also improve some of the negative symptoms and help acute agitation
Olanzapine and aripiprazole
126
Atypical antipsychotic causing high prolactin levels
Risperidone
127
Newer atypical antipsychotic used for bipolar disorder, known to cause weight gain, and adversely affect diabetes
Olanzapine
128
Agent more frequently associated with extrapyramidal side effects that can be treated with benzodiazepine, diphenhydramine or muscarinic blocker
Haloperidol
129
Drug used in neuroleptic malignant syndrome
Dantrolene
130
Agents may exacerbate tardive dyskinesias (may be irreversible and there is no treatment)
Muscarinic blockers
131
Antipsychotics having the strongest autonomic effects
Chlorpromazine or Thioridazine
132
Antipsychotic having the weakest autonomic effects
Haloperidol
133
Only phenothiazine not exerting antiemetic effects, can cause visual impairment due to retinal deposits, and high doses have been associated with ventricular arrhythmias
Thioridazine
134
Agent with greater affinity to 5HT2A receptor; reserved for refractory schizophrenia, and can cause weight gain and agranulocytosis
Clozapine
135
Anti-psychotics shown not to cause tardive dyskinesia
Clozapine and quetiapine
136
Anti-psychotics available in depot preparation
Fluphenazine and haloperidol
137
Reduced seizure threshold
Low-potency typical antipsychotics and clozapine
138
Orthostatic hypotension and QT prolongation
Low potency and risperidone
139
Increased risk of developing cataracts
Quetiapine
140
Major route of elimination for Lithium
Kidneys
141
Patients being treated with lithium, who are dehydrated, or taking diuretics concurrently, could develop
Lithium toxicity, lithium-induced nephrogenic diabetes insipidus
142
Drug increases the renal clearance hence decreases levels of lithium
Theophylline
143
Lithium is associated with this congenital defect
Cardiac anomalies; contraindic: pregnancy&lactation
144
DOC for bipolar affective disorder
Lithium
145
SE of lithium
Tremor, sedation, ataxia, aphasia, thyroid enlargement, and reversible diabetes insipidus
146
Example of three antidepressants that are indicated for obsessive compulsive disorder
Clomipramine, fluoxetine and fluvoxamine
147
Neurotransmitters affected by the action of antidepressants
Norepinephrine and serotonin
148
Usual time needed for full effect of antidepressant therapy
2 to 3 weeks
149
Population group especially sensitive to side effects of antidepressants
Elderly patients
150
All antidepressants have roughly the same efficacy in treating depression, agents are chosen based on these criterion
Side-effect profile and prior pt response
151
Well-tolerated and are first-line antidepressants
SSRI's, bupropion, and venlafaxine
152
Most useful in patients with significant anxiety, phobic features, hypochondriasis, and resistant depression
Monamine oxidase inhibitors
153
Condition will result from in combination of MAOI with tyramine containing foods (ex. wine, cheese, and pickled meats)
Hypertensive crisis
154
MAOI should not be administered with SSRI's or potent TCA's due to development of this condition
Serotonin syndrome
155
Sedation is a common side effect of these drugs, they lower seizure threshold, uses include BAD, acute panic attacks, phobias, enuresis, and chronic pain and their overdose can be deadly
Tricyclic antidepressants (TCA)
156
Three C's associated with TCA toxicity
Coma, Convulsions, Cardiac problems (arrhythmias and wide QRS)
157
Agents having higher sedation and antimuscarinic effects than other TCA's
Tertiary amines
158
TCA used in chronic pain, a hypnotic, and has marked antimuscarinic effects
Amitriptyline
159
TCA used in chronic pain, enuresis, and OCD
Imipramine
160
TCA with greatest sedation of this group, and marked antimuscarinic effects, used for sleep
Doxepin
161
TCA used in obsessive compulsive disorder (OCD), most significant of TCA's for risk of seizure, weight gain, and neuropsychiatric signs and symptoms
Clomipramine
162
Secondary amines that have less sedation and more excitation effect
Nortriptyline, Desipramine
163
Antidepressant associated with neuroleptic malignant syndrome
Amoxapine
164
Antidepressant associated with seizures and cardiotoxicity
Maprotiline
165
Antidepressant having stimulant effects similar to SSRI's and can increase blood pressure
Venlafaxine
166
Antidepressant inhibiting norepinephrine, serotonin, and dopamine reuptake
Venlafaxine
167
Antidepressant also used for sleep that causes priapism
Trazodone
168
Antidepressant which is inhibitor of CYP450 enzymes and may be associated with hepatic failure
Nefazodone
169
Unicyclic antidepressant least likely to affect sexual performance, used for management of nicotine withdrawal, SE's include dizziness, dry mouth, aggravation of psychosis, and seizures
Bupropion
170
Antidepressant with MOA as alpha 2 antagonist, has effects on both 5-HT and NE, blocks histamine receptors, and is sedating
Mirtazapine
171
SE of mirtazapine
Liver toxicity, increased serum cholesterol
172
Except for these agents all SSRI have significant inhibition of CytP450 enzymes
Citalopram and its metabolite escitalopram
173
SSRI with long T1/2 and can be administered once weekly for maintenance, not acute tx
Fluoxetine
174
SSRI indicated for premenstrual dysphoric disorder
Fluoxetine (Sarafem)
175
Some of SSRIs' therapeutic effects beside depression
Panic attacks, social phobias, bulimia nervosa, and PMDD (premenstrual dysphoric disorder), OCD
176
SSRI's less likely to cause a withdrawal syndrome
Fluoxetine
177
Inhibit synaptic activity of primary afferents and spinal cord pain transmission neurons
Ascending pathways
178
Activation of these receptors close Ca2+ ion channels to inhibit neurotransmitter release and pain transmission
Presynaptic mu, delta, and kappa receptors
179
Activation of these receptors open K+ ion channels to cause membrane hyperpolarization
Postsynaptic Mu receptors
180
Tolerance to all effects of opioid agonists can develop except
Miosis, convulsions and constipation
181
All opioids except this agent (which has a muscarinic blocking action) cause pupillary constriction
Meperidine
182
SE of these drugs include dependence, withdrawal syndrome, sedation, euphoria, respiratory depression nausea and vomiting, constipation, biliary spasm, increased ureteral and bladder tone, and reduction in uterine tone
Opioid Analgesics
183
Strong opioid agonists
Morphine, methadone, meperidine, and fentanyl
184
Opioids used in anesthesia
Morphine and fentanyl
185
Opioid used in the management of withdrawal states
Methadone
186
Opioid available trans-dermally
Fentanyl
187
Opioid that can be given PO, by epidural, and IV, which helps to relieve the dyspnea of pulmonary edema
Morphine
188
Use of this opioid with MAOI can lead to hyperpyrexic coma, and with SSRI's can lead to serotonin syndrome
Meperidine
189
Moderate opioid agonists
Codeine, hydrocodone, and oxycodone
190
Weak opioid agonist, poor analgesic, its overdose can cause severe toxicity including respiratory depression, circulatory collapse, pulmonary edema, and seizures
Propoxyphene
191
Partial opioid agonist, considered a strong analgesic, has a long duration of action and is resistant to naloxone reversal
Buprenorphine
192
Opioid antagonist that is given IV and had short DOA
Naloxone
193
Opioid antagonist that is given orally in alcohol dependency programs
Naltrexone
194
These agents are used as antitussive
Dextromethorphan, Codeine
195
These agents are used as antidiarrheal
Diphenoxylate, Loperamide
196
Inhalant anesthetics
NO, chloroform, and diethyl ether
197
Toxic to the liver, kidney, lungs, bone marrow, peripheral nerves, and cause brain damage in animals, sudden death has occurred following inhalation
Fluorocarbons and Industrial solvents
198
Cause dizziness, tachycardia, hypotension, and flushing
Organic nitrites
199
Causes acne, premature closure of epiphyses, masculinization in females, hepatic dysfunction, MI, and increases in libido and aggression
Steroids
200
Readily detected markers that may assist in diagnosis of the cause of a drug overdose include
Changes in heart rate, blood pressure, respiration, body temperature, sweating, bowel signs, and pupillary responses
201
Most commonly abused in health care professionals
Heroin, morphine, oxycodone, meperidine and fentanyl
202
This route is associated with rapid tolerance and psychologic dependence
IV administration
203
Lacrimation, rhinorrhea, yawning, sweating, weakness, gooseflesh, nausea, and vomiting, tremor, muscle jerks, and hyperpnea are signs of this syndrome
Abstinence syndrome
204
Treatment for opioid addiction
Methadone, followed by slow dose reduction
205
This agent may cause more severe, rapid and intense symptoms (abstinence syndrome) to a recovering addict
Naloxone
206
Sedative-Hypnotics action
Reduce inhibition, suppress anxiety, and produce relaxation
207
Additive effects when Sedative-Hypnotics used in combination with these agents
CNS depressants
208
Common mechanism by which overdose result in death
Depression of medullary and cardiovascular centers
209
"Date rape drug"
Flunitrazepam (rohypnol)
210
The most important sign of withdrawal syndrome
Excessive CNS stimulation (seizures)
211
Treatment of withdrawal syndrome involves
Long-acting sedative-hypnotic or a gradual reduction of dose, clonidine or propranolol
212
These agents are CNS depressants
Ethanol, Barbiturates, and Benzodiazepines
213
Withdrawal from this drug causes lethargy, irritability, and headache
Caffeine
214
W/D from this drug causes anxiety and mental discomfort
Nicotine
215
Treatments available for nicotine addiction
Patches, gum, nasal spray, psychotherapy, and bupropion
216
Chronic high dose abuse of nicotine leads to
Psychotic state, overdose causes agitation, restlessness, tachycardia, hyperthermia, hyperreflexia, and seizures
217
Tolerance is marked and abstinence syndrome occurs
Amphetamines
218
Amphetamine agents
Dextroamphetamines and methamphetamine
219
These agents are congeners of Amphetamine
DOM, STP, MDA, and MDMA "ecstasy"
220
Overdoses of this agent with powerful vasoconstrictive action may result in fatalities from arrhythmias, seizures, respiratory depression, or severe HTN (MI and stroke)
Cocaine "super-speed"
221
Most dangerous of the currently popular hallucinogenic drugs, OD leads to nystagmus, marked hypertension, and seizures, presence of both horizontal and vertical nystagmus is pathognomonic
PCP
222
Removal of PCP may be aided
Urinary acidification and activated charcoal or continual nasogastric suction
223
THC is active ingredient, SE's include impairment of judgment, and reflexes, decreases in blood pressure and psychomotor performance occur
Marijuana
