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IPAP > Pharm: This Is the Last One > Flashcards

Pharm: This Is the Last One Flashcards

1
Q

What are the criteria for a Major Depressive Episode?

Define Unipolar Depression?

Define Dysthymia

A

Lasting 2wks w/ five Sxs:
One must be: Depressed, Anhedonia

MDD
One major depressive episode w/ no hypo/mania

Persistent Depressive D/o
Depression lasting 2yrs w/ Sxs free periods lasting less than 2 consecutive months

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2
Q

What are the facts about gender and suicide?

What are the 3 hypothesis behind depression?

A

Female: more likely to attempt, 2-4x higher during menopause
Male: more likely to complete

Biogenic Amine: dec levels of NT in brain

Dysregulation: failure of homeostasis

Neurochemical: 5HT/NE system must be functional for anti-depressant to work

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3
Q

What are the 3 types of depression?

A

Reactive/Secondary- MC; response to grief, illness, drugs/ETOH

Unipolar: genetically determined and unable to experience pleasure/cope w/ life

Bi-Polar Affective: manic-depressive

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4
Q

All medications classified as antidepressants increase concentrations of what 3 NTs?

What are the 3 ways to increase NT levels?

A

Dopamine NorEpi Serotonin

Inhibit reuptake
Block degredation
Inc NT release

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5
Q

Continued use of TCAs/SSRIs/SNRIs cause what physiological changes of the receptors?

What structures project into limbic structures and release serotonin to be taken back up in ? neuron?

A

Down regulation of pre-synaptic autoreceptors, increases firing rate of raphae neurons

Raphe neurons
Presynaptic

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6
Q

What are the Tertiary Amines?

What are the Secondary Amines

A

ADICT
Amitriptyline Doxepin Imipramine Clomipramine Trimipramine

DNP
Desipramine Nortriptyline Protriptyline

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7
Q

Here do the issues of taking TCAs come in?

When are TCAs used in therapy?

A

Blockage of Histamine A-Adrenergic, and Muscarinic receptors AND NorEpi/Serotonin uptake

Seldom 1st line agents
Depression/Anxiety orders
Off label: pain syndrome, migraine prophylaxis

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8
Q

What is the most common drug used in ODs?

What are some of the adverse reactions of using this drug class?

A

TCAs

Seizure Arrhythmias Coma Delerium

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9
Q

What PTs should never receive TCAs?

Time frame of TCAs hence why such a gradual taper up is needed?

A

BPH CVDz Glaucoma SIs

2-4wks

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10
Q

What are the adverse effects of taking TCAs?

What class of TCAs are “worse” w/ high sedation, anticholinergic and alpha blockage effects?

A

Anticholinergic
OHOTN
Drug interactions

Tertiary

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11
Q

What TCAs cause weight gain?

What TCA is used for childhood enuresis and adult MDD?

A

Nortriptyline
Amitriptyline

Imipramine

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12
Q

What TCA is used for depression and insomnia?

What TCA is used for OCD?

A

Doxepin

Clomipramine

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13
Q

What drugs fall under SSRI group?

What are the two “other” SSRIs?

A

PFCS EF
Paroxetine Fluoxetine Citalopram Sertraline Escitalopram Fluvoxamine

Others: Villain Vortex
Vilazodone
Vortioxetine

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14
Q

How long does it take for SSRIs to take effect?

SSRIs are first line choice for Tx of ?

A

3-8wks

PODS PPG
Panic D/o
OCD
Depression
Social Phobia
PTSD
Pre-menstrual dysmorphic d/o
General anxiety d/o
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15
Q

Which SSRI has the longest and shortest T1/2?

Only two SSRIs don’t interact w/ CYP450, which ones?

A

Long: Fluoxetine
Short: Fluvoxamine

Citalopram
Escitalopram
*most commonly prescribed, good for elderly PTs on multiple Rxs

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16
Q

What SSRIs are the most and least CNS activating/sedating?

Which SSRI has the worse weight gain?

A

Most activate: Fluoxetine, Sertraline (avoid in insomnia, take in AM)
Most sedating: Paroxetine, Fluvoxamine (dose in PM)

Paroxetine

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17
Q

What is a very common s/e of taking SSRIs?

What are three rare s/e?

A

Loss of labido (switch to Bupropion or add Silenafil)

Serotonin syndrome
SIADH
EPS s/e- akathisia, dystonia, parkinsonian Sxs (Paroxetine has the most)

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18
Q

What is the triad of Serotonin Syndrome

How is it Tx?

A

Cognitive effects
Neuromuscular dysfunction
Autonomic dysfunction

Support: Benzos
Hyperthermia support
Cyproheptadine- 1st gen anti-histamine and 5HT antagonist

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19
Q

Which SSRi can have abrupt discontinuation due to it’s long T1/2?

Which SSRI has FDA warning due to QTc prolongation and which one does NOT have this warning?

A

Fluoxetine

Citalopram above 40mg
Escitalopram

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20
Q

SSRIs drug interactions include ?

What are the main SNRIs?

What are the others?

A

MAOIs ASA NSAIDs

Duloxetine
Venlafaxine
Desvenlafaxine

Levomilnacipram
Milnacipram

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21
Q

What 3 SNRIs have been linked to increasing Diastolic BP?

What two drug classes should they not be used w/?

A

Venlafaxine
Desvenlafaxine
Duloxetine

MAOIs
Serotogenic agents

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22
Q

Which SNRI has a dose-related effect on NorEpi?

What can Venlafaxine be used for?

A

Venlafaxine: <150mg/day is primarily a serotonin effect

Tx resistant depression
Gen Anxiety d/o
PTSD- 1st line w/ SSRI

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23
Q

What are the benefits of using Venlafaxine?

What is the relation between Venlafaxine dosage and the NT blocked?

A

Safer than TCA for OD
Less activating as Fluoxetine
Unique MOA= use if SSRI have failed

SSRI effect at low dose
SNRI effect at high dose

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24
Q

What are two adverse effects of using Venlafaxine?

Which SNRI is an active metabolite of another?

A

HTN
Serotonin syndrome if used w/ MAOI

Desvenlafaxine

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25
Q

What is Desvenlafaxine used for?

What is Duloxetine best used for?

A

2nd line for MDD

Diabetic neuropathy
Fibromyalgia
MSK pain

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26
Q

What PTs can’t take Duloxetine?

Why would Levomilnacipram be used?

A

Liver/Renal dysfunction

As an isomer of Milnacipran, is a stronger NorEpi inhibitor for Depression

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27
Q

Milnacipran is only approved use is for ?

What are the s/e of using Levomilnacipram?

A

Fibromyalgia, not depression

HypoNa
Inc bleed risk
HTN/OHOTN

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28
Q

What is the site of action of the NDRIs?

What is the uses of Bupropion

A

Noradrenergic and dopamine releasing neuron

MDD
Smoking cessation
Off label for ADHD in kids/adolescents

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29
Q

What are the adverse effects of taking Bupropion?

What is a perk of using this drug over other anti-depressants?

A

Weight loss
Inc seizure risk

Less sex dysfunction

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30
Q

What drug interaction occurs w/ Bupropion?

What meds are fall under the classification of Serotonin Receptor Antagonist?

A

MAOIs, 14 day gap between use

MNT
Mirtazapine
Nefazodone
Trazodone

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31
Q

What are three common effects when taking SRAntagonists?

A

Antagonize serotonin, histamine and A1 receptors

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32
Q

MOA, Use, and Adverse effects of of SRA Trazadone

A

Inhibits serotonin uptake and antogonizes HT, A1 and H1 receptors but less than SSRIs

Sleep aid
Depression in combo w/ SS/NRI
Fewer s/e than TCAs

Drowsiness, OHOTN

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33
Q

MOA, Use, and Adverse of SRA Mirtazapine

A

Inhibits HT, H1, A1/A2 receptors but does NOT inhibit reuptake

MDD, better tolerated than TCAs
Used in combo w/ SSRI if PT has sleep d/o

Lower dose if CrCl <30mL/min
Low dose= sedative
High= insomnia
Constipation

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34
Q

MOA, Use and Adverse of SRA Nefazodone

A

Inhibits HT, A and reuptake of serotonin and NorEpi

Anxious depression
SSRIs causing sex dysfuntion

BBWarning: liver failure

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35
Q

MOA of the class of MAOIs

What are their adverse reactions?

A

Non-selective blocking of enzyme from breaking down NorEpi, Dopamine and Serotonin to inc concentration

Serotonin Syndrome
HTN Crisis
OHOTN
Weight gain
Sex dysfunction
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36
Q

What are MAOIs as a class used for?

What interactions do they have?

A

Atypical depression: Hypersomnia, Hyperphagia, Mood reactivity
PTs refractory to other anti-depressant agents

Increases tyramine, increases release of Epi /NorEpi causing HTN crisis

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37
Q

What MAOI are considered last line?

What interactions do they have?

Antidepressant med can be considered a Tx failure if no improvement is seen in what time frame?

A

Tranylcypromine

Decongestants, Cheese plates/drinks

Lack of reduction of Sxs by more than 50% within 8-12wks

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38
Q

How long do PTs need to wait after d/c antidepressant and starting an MAOI?

Facts about Selegiline

A

2 wks
Except Fluoxetine- wait 6wks

Transdermal patch w/ fewer s/e like weight gain, sex dysfunction due to MAO-B inhibition

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39
Q

What medications can cause major and minor sexual dysfunction?

What two antidepressants are less likely to cause weight gain?

A

Buproprion- more rare Sxs
Mirtazapine- lower than S/NRI
S/NRI- reduce libido, prevent ED/orgasms

Buproprion, Fluoxetine

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40
Q

What antidepressants cause somnolence?

Which ones can increase energy?

A

Paroxetine Mirtazapine TCAs
Trazadone

Burproprion, SNRI
Fluoxetine, Sertraline more activating than other SSRIs

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41
Q

What drug can increase anxiety and what medications are recommended to use?

Which medications can reduce pain?

A

Buproprion can cause, S/NRI if PT experiences anxiety

Duloxetine, Venlafaxine (fibromyalgia + depression)

Amitriptyline and Imipramine- diabetic neuropathy

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42
Q

Which medications are indicated for use in diabetic neuropathy?

Which antidepressant specifically has shown to cause heart defects in fetuses?

A

Amitriptyline, Imipramine

Paroxetine

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43
Q

Define Mania

Define Hypomania

Define Cyclothymic d/o

A

1wk of abnormal and persistently elevated mood

Four days or more without impairing social/occupation and not psychosis

Several hypomania periods, mild depression

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44
Q

Define BP1

Define BP2

A

Recurrent manic/mixed manic more frequent/severe than depression

One or more depressive epidosdes w/ one hypomaniac episode w/ no mania

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45
Q

What is the criteria for rapid cycling for Bipolar D/o

What needs to be assessed in these PTs?

What are thought to be the culprit of causing manic episodes?

A

Four or more episodes of mania, hypomania, mixed or depression withing one year

Thyroid

Over production of NorEpi and Serotonin

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46
Q

What are the 5 classes of drugs used for the management of Bipolar D/o?

A

Lithium

Anticonvulsant (Val-TLC))

Antipsychotics (all atypicals except Clozapine, Iloperiodone)

Benzos (Lorazepam, Diazepam)

Antidepressants (not as monotherapy and not during manic episodes)

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47
Q

MOA and Use of Lithium

A

Neuroprotective, inhibits transduction

Mood stabilizer during mania
Not for rapid cycles

Used in conjunction w/ Anti-psych or Benzo, d/c anti-psych after manic episode stops

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48
Q

What monitoring needs to be done on PTs taking Lithium

What type of conditions can raise Lithium levels in a PT to toxic levels?

A

PET CURE
Pregnancy E+ Thyroid CBC UA Renal function ECG

ACEIs/ARBs
NSAIDs- inhibits prostaglandins
Diuretics
Dehydration/Fever/Vomit
Crash/Na restricted diets
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49
Q

What are the adverse effects of taking Lithium

What is done for PTs taking Lithium that have tremors, hypothyroid, polyuria/dyspia?

A

Sedation
Edema/weight gain
Nephrogenic DI
Dec thyroid funtion

BB
Levothyroxine
Lowest dose possible

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50
Q

How are PTs w/ Lithium toxicity Tx?

When are anticonvulsants preferred for Bipolar PTs?

A

Hydrated
Gastric lavage
>3mEq- dialysis

Rapid cycles
Substance abuse
2* bipolar/mixed mania

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51
Q

What is the DOC for Bipolar PTs that are manic or have >4 manic episodes/year?

What are the adverse effects of taking these medications?

A

Valproic acid
Divalproex sodium

Neurotoxicity
Hair loss
Teratogenic- Cat D, causes Spina Bifida

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52
Q

When is Carbamazepine used for Bipolar?

Prior to Rx this, PTs need to be screened for ?

A

Mania and maintenance when improvement isn’t reached w/ only Lithium

HLA B 1502 enzyme- mutation increases risk of Steven Johnson Syndrome

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53
Q

What are the adverse effect of Carbamzepine

What Bipolar drug is only used for maintenance/depression phase?

A

SIADH HypoNa SJS

Lamotrigine

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54
Q

How does Lamotrigine interact w/ other Bipolar drugs?

When/why are Benzos added to Bipolar medication regimes?

A

Valproic acid- dec metabolism
Carbamazepine- inc metabolism

Agitation, Insomnia, Hyperactivity

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55
Q

Which benzos are used in the acute setting of Bipolar?

Which one is briefly used for behavior Sxs?

A

Lorazepam
Diazepam

Clonazepam

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56
Q

What are the Anti-Pyschs/Neuroleptics used for Bipolar?

A

Haloperidol/Olanzapine- control agitation/psychosis

Aripiprazole/Olanzapine- mono therapy for maintenance

Quetiapine- FDA approval for depression and maintenance

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57
Q

What is the pathyphysiology of Parkinson’s?

A

Unbalanced dopamine/ACh neurons

Dopamine inhibits GABA, ACh excites GABA

Parkinson’s= loss of dopamine neurons, inc of ACh unopposed

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58
Q

Since dopamine can’t cross BBB, what drug is given to Parkinson’s PTs that can cross?

What drugs can cause Parkinsonian like s/e?

What type of infection can cause these S/Sxs?

A

L-Dopa

Anti-psychotics (PCTT-zine, Haldol)
Antiemetic
Metoclopramide

Viral encephalitis

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59
Q

What class of meds are used for Parkinson’s motor disability improvement?

Which ones are used for motor complications?

A

Levodopa

Dopamine agonsits

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60
Q

How is Parkinson’s managed in a young, fit PT w/ no comorbidities and mild Sxs?

A 
MAOI (Rasa/Selegiline)
Dopamine agonist (non-ergot)
L-Dopa (Carel/Beneldopa)
COMT inhibitor (Enta/Tolcapone)
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61
Q

How is Parkinson’s managed in frail PT w/ comorbidities and cognitive impairment?

What is done for PTs w/ dyskinesia, severe motor fluctuations or resistant tremors?

A

L-Dopa (Carel/Beneldopa)
MAOI (Rasa/Selegiline)
COMT (Enta/Tolcapone)

D: reduce L-Dopa, add Amantadine
S: SQ Apomorphine or Duodopa
R: Deep brain stimulation

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62
Q

What drug class is the first line for Parkinson’s w/ Sxs?

This drug has the greatest effect on ? but not on ? Sxs

A

Dopamine agonists

Best: Bradykinesia, Rigidity (Levodopa)
Low: Tremor, Posture instability

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63
Q

What 3 circumstances is Levodopa the initial therapy for Parkinson’s?

What drug class is most useful in Parkinson’s PTs w/ tremors?

A

> 70y/o
Dementia
Cognitive impairment

Anticholinergic

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64
Q

When/why would a NMDA receptor inhibitor be given to a Parkinson’s PT?

A

Dec dyskinesia from Levodopa/Dopamine agonist

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65
Q

What are the Dopamine Agonists?

What are the Dopamine Analogs?

A

RAP Bro
Ropinirole Apomorphine Pramipexole Bromocriptine

Levodopa/Carbidopa

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66
Q

What are the Muscarinic Antagonists/Anticholinergics used in Parkinson’s?

What is the NMDA receptor inhibitor med used?

A

Benztropine, Trihexyphenidyl

Amantadine

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67
Q

What two classes of drugs are used to decrease catabolism in Parkinson’s PTs?

What are the two types of Dopamine agonists?

A

COMT Inhibs: Tol/Enta/capone, Carbi/Levodopa

MAOIs: Sele/Rasagline

Ergot vs Nonergot

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68
Q

What is the first line monotherapy for Parkinson Sxs and why is this important?

Use caution when giving this to ? PT populations

A

Dopamine agonists- delay need for Levodopa (short efficacy) in younger PTs for years.
Less dyskinesia/fluctuations

Psychosis, Dementia

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69
Q

Which two dopamine agonists are non-selective?

What are adverse reactions that can occur w/ use?

A

Bromocriptine- rarely used, semi synthetic ergot derivative

Rotigotine- non-ergot, transdermal

Cardiac/pulmonary fibrosis
OHTON
Hallucinations

70
Q

Which dopamine agonists are selective?

Both of these Non-Ergots have FDA approval for ?

What are the a/e and c/i?

A

Pramipexole
Ropoinirole

RLS

Adverse: OHOTN, hallucination

C/i: psychotic illness, recent MI, active peptic ulcer

71
Q

Pramipexole usages

Possible beneficial effect

A

Monotherapy for mild Parkinson’s
PTs w/ advanced Dz

Neuro-protective- scavenges hydrogen peroxide= enhanced neurotrophic activity

72
Q

Ropinirole usage

What is a benefit of adding this med?

A

Monotherapy w/ mild Parkinson’s

Reduces dosage need of Levodopa needed

73
Q

What is Apomorphine used for?

What needs to be monitored on these PTs?

What happens if the PT misses a week worth of doses?

A

Tx of ‘off’ episodes of Parkinson’s

BP

Restart Tx program w/ BP monitoring

74
Q

What is the most common s/e of taking Apomorphine?

How can this reaction be avoided?

A

N/V

Pre-treat w/ Trimethobenzmide 3 days prior

75
Q

What meds are c/i when using Apomorphine?

What type of PT allergy needs to be pre-screened?

A

5HT3 antagonists- severe HOTN or LoC

Sulfite sensitivity

76
Q

What’s the difference between Carbidopa and Levodopa?

What is the MOA of Carbidopa?

A

Carb- no BB crossing
Levo- crosses BBB, converted to dopamine in periphery

Prevent AAD from reducing L-Dopa into Dopamine in the peripheral tissue where dopamine is not needed

77
Q

How is excess dopamine induced dyskinesia managed?

How is the “wearing-off” effect of Parkinson Tx managed?

A

Dec Levodopa
Add anticholinergic
Add Amantadine

Add MAO-B
Add COMT inhibitor or,
Shorten L-dopa dosing interval

78
Q

How is the “on-off” phenomenon of Parkinson’s Tx?

What caution needs to be taken when giving L-dopa?

A

Add dopamine agonist
Add MAO-B
Add COMT inhib
Inc dietary protein

Levodopa- skin CA precursor, may activate cancer

79
Q

PTs on MAO-B inhibitors need to avoid ? meds

MOA of Selegiline

A

Any that increase risk of Serotonin Syndrome

Irreversibly inhibits dopamine metabolism w/out inhibiting MAO-A= lower HTN crisis risk
Last dose taken in early afternoon (drug is metabolized into amphetamine)

80
Q

When would MAO-B Selegiline be used as monotherapy?

Benefits of Rasagiline use

A

Mild Parkinson’s Dz to delay need fo LDopa

Sx relief and neuroprotection
5x more potent than Selegiline and not metabolized to amphetamine

81
Q

What do PTs taking MAO-B Rasagiline need to avoid?

A

Tyramine containing foods (cheese, meat, beer)

82
Q

MOA of COMT inhibitors?

What are they used for?

What is an adverse event of taking one of these inhibitors?

A

Prevent dopamine breakdown, more Levodopa avail to cross BBB

Manage motor fluctuations during wearing off effect

Entacapone causes orange urine

83
Q

What are some required step when using COMT Inhibitor Tolcapone?

What must Entacapone be used with?

A

Used in PTs that failed Entacapone therapy
Reqs PT signed consent due to hepatotoxicity
Monitor LFTs

Carb/Levodopa- does not cross BBB

84
Q

Anticholinergics are most effective for ? Parkinson’s Sxs?

These are the DOC for ?

These don’t have an effect on ?

A

Tremors, Rigidity

Drug induced parkinsonism

Tardive dyskinesia

85
Q

What is the NMDA inhibitor used in Parkinson PTs?

What is this beneficial at helping?

What is the major adverse reaction from this drug?

A

Amantadine- enhances synthesis and release of dopamine. No effect if dopamine release is already at max

Reduces dyskinesia from Levodopa/Dopamine agonists

Livedo reticularis

86
Q

NMDA inhibitor Amantadine was originally developed to treat ?

Nearly all meds in the management of Parkinson’s will have ? s/e

A

Influenza Type A

Hallucinations

87
Q

Tx for Parkinson drug induced hallucinations are removed in what order?

What drugs need to be avoided or they’ll increase Parkinson Sxs?

A 
Anticholinergics
Amantadine
Selefiline
Dopamine agonist
Levo/Carbidopa

Risperdone
Olanzapine
Typical antipsychotics

88
Q

What two drugs can be used for cognitive d/os in Parkinson PTs?

What are the 5 phases of a Tonic-Clonic seizure

A

Quetiapine
Clozapine

Flexion
Extension
Tremor
Clonic
Postictal
89
Q

Define Tonic

Define Clonic

Define Mycoclonic

A

Flexion/extension

Repetitive jerking movements

Brief jerking movements of entire body or UE

90
Q

What are the 4 situations that a seizure PT may attempt to withdrawal from therapy?

Anticonvulsant meds work in ? three ways?

A

Seizure free for 2-5yrs
Single seizure type
Normal neuro exam/IQ
Normal EEG w/ meds

Enhance GABA
Dec Glutamate
Modify E+ conduction

91
Q

What drugs are broad spectrum and used for focal and generalized onset seizure?

A 
Carbamazepine
Felbamate
Lamotrigine
Levetiracetam
Oxcarbazepine
Phenytoin
Topiramate
Valproate
Zonisamide
92
Q

What drugs are narrow spectrum and only used for focal onset seizures?

A 
Carbamazepine
Gabapentin
Lacosamide
Oxcarbazepine
Phenobarbital
Phenytoin
Pregabalin
Tigabine
Vigabatrin
Valproate
93
Q

What meds are narrow spectrum and only used for absence seizures?

What are the Fast Ca Channel blockers for seizures?

A

Ethosuximide
Valproate

F COP
Fosphenytoin
Carbamazepine
Oxcarbazepine
Phenytoin
94
Q

When is Phenytoin used?

What are the adverse effects

What pregnancy category is it?

A

Status epilepticus in IV/PO form

Sexual dysfunction
Hirsutism
Gingival hyperplasia
Nystagmus

Cat D

95
Q

Phenytoin use will interact w/ ? classes of meds?

What physiological change will alter Phenytoin concentrations in the body?

A

PO anticoagulants
Contraceptives

Protein concentration

96
Q

What is a prodrug for Phenytoin and used for loading or maintenance dosing in place of Pheytoin?

What is Carbamazepine used for?

A

Fosphenytoin

Generalized/Partial seizures
Trigeminal neuralgia
Bipolar

97
Q

What does Carbamazepine use for seizures have so many adverse effects?

What are the serious adverse reactions of using this med?

A

Epoxide intermediate metabolite

Bone marrow suppression
Steven Johnson Syndrome- get HLA-1502 screening prior to use
SIADH

98
Q

What monitoring needs to be done on PTs taking Carbamazepine?

What pregnancy category is it?

What two interactions can increase levels of this med and what med is lowered by Carb?

A

LFTs and CBC- watch out for aplastic anemia

Cat D

Lamotrigine, Valproic acid- increase epoxide levels
Dec efficacy of OCPs

99
Q

How is Oxcarbazepine different than Carbamazepine?

Who is given this drug?

A

No epoxide intermediate

PTs that can’t tolerate Carbamazepine

100
Q

What is the more common reaction to occur when taking Oxcarbazepine

What adverse effect is similar to Carbamazepine

A

HypoNa

Reduces efficacy of OCPs

101
Q

What is preferred for seizure maintenance, Carbamazepine or Phenytoin?

What medication is used for seizures that are historically difficult to control?

A

Carbs
Phenytoin has reputation for causing functional impairment and learning problems

Phenobarbital

102
Q

What are the adverse effects of Phenobarbital?

What interactions does it have?

A

CYP ETOH

Reduces OCP efficacy

103
Q

What medication could be added to Carbamazepine or Phenytoin for generalized seizures or essential tremors?

A

Primidone- s/e same as Phenobarbital

104
Q

What are the two GABA receptor blockers used for seizure?

What are the clinical uses of Gabapentin?

What are the adverse effects?

A

Phenobarbital
Primidone

Neuropathic pain
Spasmolytic
Diabetic neuropathy

Drowsy/fatigue
Weight gain

105
Q

What med is an adjunct for partial onset seizures?

What else can this drug be used for?

What PT education has to happen?

A

Pregabalin

Neuropathic pain, RLS, social phobia

Rapid d/c= N/D/Insomnia

106
Q

What is the DOC and 2nd DOC for absence seizures?

What is the MOA of the Valproic acids and derivative?

A

Ethosuximide- side effect of N/V and needs CBC monitoring
Valproic Acid

Block Ca/Na channels
Inc GABA production
Dec GABA degredation

107
Q

Valproic acid and derivatives are used for ?

What non-epileptic use are they used for?

A

Non convulsive seizures

Manic episodes of Bipolar
Migraine prophylaxis

108
Q

What is the FDA indication on Valproic Acid?

What are the most common and severe adverse reactions?

A

Only for replacement PO dosing, sometimes used absence status epilepticus

Alopecia
Platelet aggregation
Weight gain

Liver failure death

109
Q

Valproic acids are Preg Cat D due to their likelihood of causing?

What is used if PT OD’s on these meds?

A

Spina Bifida

Naloxone

110
Q

What is the MOA of Lamotrigine

What unique setting is this used in?

A

Dec glutamate/aspartate release
Delays repetitive neuron firing
Blocks fast Na channels

Lenox-Gastaut- pediatric onset epilepsy

111
Q

What is the effect of OCPs on Lamotrigine

What is the effect of Valproic Acid on Lamotrigine?

A

Reduces, inc seizures

Dec Lamotrigine metabolism= inc levels in circulation

112
Q

What is the Black Box warning on Lamotrigine?

What is the MOA of Topiramate?

A

Steven Johnson Syndrome

Fast Na channel blocker to enhance GABA, antagonize AMP and wakly inhibit carbonic anhydrase

113
Q

What is Topiramate used for?

What is the unique adverse effect of Topiramate?

A

Adjunct for absence seizures
Lenox-Gastaut
Off label: migraine prophylaxis

Memory impairment
Metabolic acidosis
Encephalopathy- especially w/ Valproic acid

114
Q

Topiramate will interact and decrease what two drugs?

What is Levetiracetam used for?

A

OCPs and Digoxin

+6y/o idiopathic generalized epilepsy
+12y/o myoclonic seizure

115
Q

Use and Adverse of Ezogabine

A

Adjunct partial onset seizure

Urine retention/UTI
QTc prolongation
Vision loss
Psychosis

116
Q

Use and Adverse of Lacosamide

A

Mono/adjunct therapy for partial onset seizure

Prolonged PR interval
AV block
Multi organ hyper sensitivity
Neutropenia

117
Q

Use and adverse of Vigabatrin

A

Adjunct for refractory complex partial seizures
Mono therapy for infantile spasms

Depression
MRI abnormalities
Vision loss, permanent*
Weight gain

118
Q

Use and adverse of Zonisamide

A

Adjunct for partial seizures
Bipolar d/o

Steven Johnson
Sulfonamide agent
Blood issues
Kidney issues
Hyperhydrosis in kids
No G6PD PTs
119
Q

Use and Adverse of Felbamate

Use and Adverse of Tiagabine

A

Partial seizure
Lennox Gastaut

Aplastic anemia
Liver failure

Adjunct for partial seizures

Steven Johnson
Non-convulsive epilepticus

120
Q

What two drugs can be used to Tx of prolonged febrile seizures?

What meds are used for emergency cases of status epilepticus?

A

Phenobarbital
Diazepam

Lorazepam- less lipophilic, stays in CNS longer
Diazepam- rectal gel
Midazolam- preferred for IM

121
Q

What are the urgent meds used for Status Epilepticus

A

Fosphenytoin
Phenytoin- causes arrhythmia, HOTN, extravasation
Phenobarbital

Off label, if PT can’t take above 3 meds:
Valproic acid
Levetiracetam
Lacosamide

122
Q

What meds are used for refractory status epilepticus?

A

Pentobarbital- PT must be on ventilator
Propofol- PT must be on ventilator
Midazolam- HOTN, respiratory depression

123
Q

Which anti-seizure meds need to be used with caution in geriatric PTs and why

What is used for eclampsia Tx and what is used for supplementation?

A 
Lamotrigine- dec clearance
Carbamazepine- dec clearance
Phenytoin- dec protein binding
Valproic- dec protein binding
Diazepam- inc t1/2

Mg sulfate
Folic Acid- prevent neural tube defects

124
Q

What two anti-convuslant meds are not effected by/or cause dec efficacy of birth control?

What birth defects can occur due to Phenytoin, Carbamazepine, Phenobarbital, Valproic acid or Topiramate use during pregnancy?

A

Medroxyprogesterone
Levonorgesterol

Phenytoin: cleft palate, poor cognitive function
Carbamazepine: posterior cleft palate
Pheno: cardiac and cognitive issues
Val: congenital malformation
Top: congenital malformation
125
Q

What 6 anticonvulsants cause the worse sexual dysfunction?

What two cause the least?

A

Carb Phenobarb Pheny Pregablain Top Zoni

Lamo Oxcar

126
Q

What are three issues seen w/ anticonvulsant class usage?

What causes the negative sxs of schizophrenia?

A

Sex dysfunction
Osteopenia
SI

Flat affect, Apathy due to inhibited mesocortical path in prefrontal cortex= no dopamine

127
Q

What causes the Positive Sxs of Schizophrenia?

What causes the adverse effects of Schizophrenia?

A

Delusion, Hallucination from dysfunction in the mesolimbic pathway= uninhibited dopamine release

Parkinsonism, dysfunction in nigrostriatal pathway in corpus striatum= inhibited dopamine release causing inhibited ACh

128
Q

What are the top NTs involved in psychological abnormalities?

A

Dopamine
Serotonin
Glutamate

129
Q

What are the typical antipsychotics?

A 
Chlorpromazine
Fluphenazine
Haloperidol
Loxapine
Mesoridazine
Perphenazine
Thioridazine
Thiothixene
Trigloperazine
130
Q

What are the atypical antipsychotics

A 
Aripiprazole
Asenapine
Clozapine
Illoperidone
Lurasidone
Olanzapine
Paliperidone
Quetiapine
Risperidone
131
Q

What class of anti-psych is recommended to be used first when Dx of Schizo has been given?

How long can it take for max treatment response to occur w/ these drugs?

A

Second unless PT prefers or has had success w/ typicals before

6mon

132
Q

What is the only FDA approved drug for hiccups?

Which anti-psych is most widely used w/ an anti-emetic effect?

A

Chlorpromazine- may cause pigment deposits in retina/cornea

Prochlorperazine

133
Q

What is the most common EPS Sx from using antipsych meds?

What is a common s/e from using antipsychotics that affects men and women?

A

Akathesia
Tx w/ Propanolol

Anorgasmia

134
Q

What is the black box warning on anti-psychs?

What is the MOA of 1st Gen anti-psychs?

A

Inc mortality in elderly PTs w/ dementia related psychosis

Competitively blocks dopamine receptors in, less effective at controlling negative Sxs of Schizo

135
Q

What is the difference between Low Potency and High Potency typical anti-psychs?

A

Low: low affinity for dopamine receptors, less risk of EPS.
Higher adverse reactions

High: higher affinity for dopamine receptors, less adverse reactions

136
Q

If Schizo PT is having pseudo-parkinsonism Sxs due to drugs, what can be given for Tx?

What are the adverse effects of typical anti-psychs?

A

Anticholinergic: Trihexyphenidyl or Benztropine
Antihistamine: Diphenhydramine

QTC prolongation
OHOTN
Weight gain
Anticholinergic
Sedation
137
Q

Define Neuorleptic Malignant Syndrome

What other major s/e is seen w/ typical anti-psych use?

A

Common w/ high potency typical anti-psychs, most severe adverse drug event

Prolactin elevation
F: galactorrhea, menstrual irregularity
M: gynecomastia, sex dysfunction

138
Q

What are the low potency typical anti-psychs?

What are the high potency typicals?

A

Chlorpromazine
Thioridazine

Haloperidol
Fluphenazine
Trifluperazine

139
Q

Low Potency: Thioridazine

A

High anticholinergic effect
Highest occurrence of sedation
BBW: Torsades

140
Q

High Potency: Trifluoperazine

A

General non-psychotic anxiety used after Benzos

Long term use= tardive dyskinesia

141
Q

High Potency: Fluphenazine

A

IM long lasting neuroplastic therapy (PT refusing PO meds)

Reqs bridging meds

142
Q

High Potency: Haloperidol

A

Schizo, Agitation, Tourettes
IM lasts 1mon
IV= Torsades induction

Severe EPS
QTc prolongation

C/i: Parkinsons, CNS depression, comatose PT

143
Q

2nd Gen anti-psychs are dopamine antagonists and block 5HT receptors except for ? drug

These have a similar efficacy for positive Sxs except for which one?

A

Aripiprazole

Clozapine

144
Q

What is an adverse effect of taking atypical anti-psychs?

What three things are monitored in PTs taking atypicals?

A

Metabolic Syndrome- waist circumference taken at baseline

Weight
Hyperglycemia/DM
Lipids

145
Q

What two atypicals are more likely to cause weight gain?

Which one causes the least?

A

Clozapine
Olanzapine

Lurasidone

146
Q

Atypical Antipsych: Clozapine

This is the only atypical that provides what benefit?

A

Most effective
Reserved for 3x failures and resistant to other antipsychs

Reduce risk of suicide
Better improvement of negative Sxs

147
Q

What is the BBW on Clozapine

What monitoring is done?

A

Agranulocytosis

Weekly CBC fist 6mon the Q2wks

148
Q

Why would Olanzapine be preferred over Clozapine?

Olonzapine can also be used in MDD if it’s combined w/ ?

A

No agranylocytosis risk

Fluoxetine

149
Q

What monitoring is done for Olanzapine?

What is the benefit of using Risperidone?

A

Monitor for respiratory depression x 3hrs after administration

More effective against positive Sxs

150
Q

What is the adverse effect of using Risperidone?

Why would you chose Paliperidone over Risperidone?

A

Most prolactin elevation of all the atypicals
Highest EPS of all atypicals

Pal: IM Q3mon, lower EPS/hyperprolactinemia

151
Q

Which atypical med has a risk of causing cataracts?

What is the advantage and disadvantage of using Ziprasidone?

A

Quetiapine- psychosis in Parkinson’s PTs

Lower metabolic syndrome risk
Higher QTc prolongation

152
Q

Which atypical can NOT be used in depression?

This med is only available in ? form

A

Asenapine

Sublingual tablet

153
Q

Which atypical is ONLY used for Schizo?

What are the down sides?

A

Iloperidone

Higher OHOTN and QTc prolongation w/ BID dosing

154
Q

What are the perks of taking Lurasidone?

When would using this one be preferred?

A

Low s/e except medium sedation

Weight management, can’t afford any more weight gain

155
Q

What meds are high potency a/typicals and benzos that can be used for acute agitation and psychosis?

A

Haloperidol
Diazepam/Lorazepam
Midazolam
Atypical: Olanzapine, Ziprasidone

156
Q

Antipsychotics that are PO disintegrating?

Which ones are used in parenteral formulation?

A

Risperidone
Olanzapine

Ziprasidone
Olanzapine

157
Q

What antipsychotics are used as rapid tranquilizers?

Which ones are reserved for non-compliant PTs or for maintenance?

A 
Chlorpromazine
Fluphenazine
Haloperidol
Ziprasidone
Olanzapine

Haloperidol decanoate
Fluphenazine deconate
Risperidone, long acting
Paliperidone

158
Q

Why are Benzos and Barbituates better at sedating than natural GABA?

Which ones are linear w/ inc concentration up to death?

A

Different binding sites but same sites as ETOH

Barbituates

159
Q

What are the short acting Barbituates?

What barbituate is the DOC for seizures?

A 
SPAM
Secobarbital
Pentobarbital
Amobarbital
Methohexital

Phenobarbital

160
Q

Which barbituate is a combo of 4 drugs used as an adjunct in IBS Tx?

What are the adverse effects of barbituates?

A

Donnatal

COW
CNS depression
OD
Withdrawal, worse than opiates

161
Q

What is Methohexital used for?

What is Pentobarbital used for?

Which ones can be used for insomnia?

A

Anesthesia induction/maintenance

Status epilepticus

Pento Amobarbital Seco Thiopental

162
Q

Short acting Benzos

Intermediate Benzos

Long acting Benzos

A

Clorazepate- prodrug
Triazolam
Oxazepam
Midazolam

Temazepam
Estazolam
Alprazolam
Lorazepam

Chlonazepam
Diazepam
Chlordiazepoxide
Flurazepam
Quazepam
163
Q

Which class of benzos causes rapid tolerance and commonly have PTs go through withdrawal?

Where do benzos exert their effects?

A

Short half-life

Central action causing relaxation, no analgesic property

164
Q

Which benzo is preferred in PTs w/ liver Dz?

Which benzos can be used for anxiety?

A

Lorazepam

Clonazepam
Lorazepam
Diazepam

165
Q

What benzos can be used for panic attacks?

Which ones can be used for alcohol withdrawal?

A

Clonzaepam
Alprazolam
Oxazepam

Chlordiazepoxide
Oxazepam
Lorazepam*
Diazepam

166
Q

Which benzos interact w/ CYP3A4 the least?

These same 3 drugs are preferred in ? PT population?

A

Lorazepam
Oxazepam
Temazepam

Geriatrics

167
Q

What is the benzo OD rescue agent?

What medication is used as a second line agent for anxiety when benzos need to be avoided?

A

Flumazenil

Buspirone

168
Q

How does Zolpidem exert its effect?

What are the s/e of Eszopiclone?

A

Acts on benzo receptor enhancing GABA

Metalic taste
SIs

169
Q

Which hypnotic is least likely to cause daytime somnolence?

MOA of Suvorexant

A

Zaleplon

Orexin receptor agonist

170
Q

What is Ramelteon MOA

How effective is this?

A

Melatonin receptor agonist

Improves sleep by 7min

171
Q

What is Tasimelteon used for?

What short, intermediate and long acting Benzos are used for insominia?

A

Melatonin receptor agonist for non-24hr sleep/wake d/o (blind PTs)

Short: Triazolam
Inter: Temazepam, Estazolam
Long: Flurazaepam, Quazepam

172
Q

Which antidepressants are sedating?

What antihistamines can be used for insomnia but who must use caution when using?

A

Doxepin
Mirtazapine
Trazadone

Diphenhydramine
Doxylamine
Elderly- worsened dementia and BPH

IPAP (212 decks)

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