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E 1.3 Review > Pharma > Flashcards

Pharma Flashcards

1
Q

Succinylcholine is in what class?

A

Neuromuscular Blockers: causes paralysis

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2
Q

What is the MOA of Succinylcholine?

A

*DEPOLARIZING neuromuscular blocker. Diffuses away from NMJ on its own, without needing a reversal agent.
*Cannot reverse action
*Strong ACh agonist, so causes sustained depolarization–> prevent muscle contraction

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3
Q

What is the clinical use of succinylcholine?

A

*Maintain paralysis in surgery
*Paralyze vocal chords to allow intubation. Used along with Etomidate
*Always give with hypnotics or sedatives

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4
Q

What are the side effects of succinylcholine?

A

*Fasciculations (muscle twitching)
*Increased blood K+ levels (dangerous in pts with existing hyperkalemia,
e.g. pts on dialysis)
*Malignant hyperthermia (symptoms are high fever and muscle rigidity due to muscle breakdown due to ryanodine Ca channel abnormal)
*Cardiac arrhythmias, muscle pain, increased intracranial, intraocular, intragastric
pressure

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5
Q

What is the class of Rocuronium and Vecuronium?

A

Neuromuscular blocker: causes paralysis

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6
Q

What is the MOA of Rocuronium and Vecuronium?

A

*Non-depolarizing neuromuscular blockers
*Work as competitive antagonists at the ACh receptor
*Often reversed by a reversal agent: AChE

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7
Q

What are the side effects of Rocuronium and Vecuronium?

A

*Maintain paralysis in surgery
*Paralyze vocal chords to allow intubation

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8
Q

What is the MOA of Dantrolene?

A

*Skeletal muscle relaxant that impairs calcium release from the sarcoplasmic reticulum
*Malignant hyperthermia

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9
Q

What class does pyridostigmine belong?

A

*Acetylcholinesterase inhibitor

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10
Q

What is the MOA of pyridostigmine?

A
  • inhibit the enzyme acetylcholinesterase from breaking down the neurotransmitter acetylcholine into choline and acetate,[2] thereby increasing both the level and duration of action of acetylcholine in the central nervous system
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11
Q

What are the side effects of pyridostigmine?

A

hypersalivation, sweating, diarrhea, nausea, vomiting, cramps

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12
Q

What class does glatiramer acetate belong?

A

MS disease modifying treatments

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13
Q

What is the MOA of glatiramer acetate?

A

scrambled myelin peptide disrupts T cell responses

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14
Q

What are the side effects of glatiramer acetate?

A

flush/anxiety, chest pain, lipoatrophy

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15
Q

What class does teriflunomide belong?

A

MS disease modifying treatments

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16
Q

What is the MOA of teriflunomide?

A

*pyrimidine synthesis inhibitor

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17
Q

What are the side effects of teriflunomide?

A

transient hair loss, category X pregnancy
(charcoal elimination)

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18
Q

What class does fingolimod (Siponimod) belong?

A

MS disease modifying treatments

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19
Q

What is the MOA of fingolimod (Siponimod)?

A

S1P receptor modulator, sequesters lymphocytes in LN

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20
Q

What are the side effects of fingolimod (Siponimod)?

A

HA, elevated LFTs, HSV/shingles infection, rare cryptococcal mgn, macular edema, *FDO symptomatic, bradycardia

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21
Q

What class does cladribine belong?

A

MS disease modifying treatments

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22
Q

What is the MOA of cladribine?

A

*purine analog, interferes with DNA synthesis

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23
Q

What are the side effects of cladribine?

A

*bone marrow suppression, increased risk of cancer and fetal harm

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24
Q

What class does alemtuzumab belong?

A

MS disease modifying treatments

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25
What is the MOA of alemtuzumab?
*anti-CD52
26
What are the side effects of alemtuzumab?
Infusion reactions, infections, autoimmune disease (eg ITP, anti-GBM), cancer
27
What is the clinical use of pyridostigmine?
*Myasthenia gravis *Reverse effects of non-depolarizing neuromuscular blockers
28
What class does dimethyl fumarate belong?
MS disease modifying treatments
29
What is the MOA of dimethyl fumarate?
anti-inflammatory (Nrf2)
30
What are the side effects of dimethyl fumarate?
flushing, GI s/e
31
What class does ocrelizumab belong?
MS disease modifying treatments
32
What is the MOA of ocrelizumab?
anti-CD20
33
What are the side effects of ocrelizumab?
Infusion reactions
34
What class does natalizumab belong?
MS disease modifying treatments
35
What is the MOA of natalizumab?
alpha-4 integrin inhibitor
36
What are the side effects of natalizumab?
Infusion reactions, fatigue, PML
37
What is the indication of Flumazenil?
*overdose/reversal of benzodiazepines *used for benzodiazepine overdose ONLY in inpatient medical settings
38
What is the MOA of flumazenil?
antagonist at GABA-A/benzodiazepine receptor
39
How is Flumazenil administered?
IV
40
What are the side effects of Flumazenil?
BLACK BOX WARNING: seizures
41
What is the indication for disulfiram (Antabuse)?
*relapse prevention/maintenance for alcohol *aversion therapy
42
What is the MOA of disulfiram?
*inhibits aldehyde dehydrogenase causing increase in acetaldehyde --> trigger catecholamine release --> sweating, flushing, n/v, palpitations
43
How is disulfiram administered?
PO (by mouth)
44
What are the side effects of disulfiram?
Never used in the setting of alcohol intoxication or without full consent
45
What is the indication for Acamprosate (Campral)
*relapse prevention/maintenance for alcohol
46
What is the MOA of acamprosate?
*unknown *modulates NMDA receptors to restore equilibrium
47
What is the indication for Chlordiazepoxide and diazepam?
Alcohol withdrawal and anxiety
48
What class are diazepam, chlordiazepoxide, oxazepam, and lorazepam in?
Benzodiazepines
49
What is the MOA of Chlordiazepoxide and diazepam,lorazepam?
*GABA-A receptor agonists, increase frequency of Cl- channel opening
50
How are Chlordiazepoxide and diazepam,lorazepam administered?
PO, IM, IV
51
What are the side effects of Chlordiazepoxide and diazepam,lorazepam?
Increased risk of respiratory depression when combined with opioids
52
What is the indication for phenobarbital?
withdrawal of alcohol
53
What class is phenobarbital in?
Barbiturates
54
What is the MOA of phenobarbital?
GABA-A receptor agonists, increase duration of Cl- channel opening; used for CNS depression
55
What are the side effects of phenobarbital?
Deadly if taken with alcohol as it can cause respiratory depression
56
What is the indication for Naloxone (Narcan)?
Overdose/reversal of opioids
57
What is the MOA of Naloxone?
*Mu-opioid receptor antagonist *short-acting opioid antagonist (blocks opioid receptors)
58
How is Naloxone administered?
IN, IM, SC, IV
59
What is the indication for Naltrexone (Vivitrol)?
*Opioid and EtOH relapse prevention *NOT used for withdrawal *maintenance, prevent relapse
60
What is the MOA of Naltrexone?
*Mu-opioid receptor antagonist *Contraindicated in liver failure *long-acting opioid antagonist
61
How is Naltrexone administered?
PO, IM
62
What are the side effects of Naltrexone?
*Black box warning: hepatoxicity *Needs induction process to avoid precipitating withdrawal
63
What is Buprenorphine (Subutex) or Buprenorphine + Naloxone (Suboxone) indication?
Relapse prevention/maintenance
64
What is the MOA of buprenorphine?
*Mu-opioid partial agonist *long duration of action
65
What is the administration of buprenorphine?
sublingual
66
What are the side effects of buprenorphine?
*Needs induction process to avoid precipitating withdrawal *Black box warning: increased risk of respiratory depression with combine with alcohol/BZD
67
What is the indication of Methadone?
*Relapse prevention/Maintenance *Only available in federally-qualified programs
68
What is the MOA of Methadone?
*Mu-opioid receptor agonist *long-acting oral opiate to reduce cravings
69
What is the administration of Methadone?
PO, Liquid
70
What are the side effects of Methadone?
Black box warning: increased risk of respiratory depression when combined with alcohol/BZD
71
What is the indication for Clonidine?
*Opioid withdrawal *Manages symptoms of acute and post-acute opiate withdrawal
72
What is the MOA of Clonidine?
Alpha-2 adrenergic agonist
73
What is the route of Clonidine?
PO, Patch
74
What are the side effects of Clonidine?
Hypotension
75
What is the indication for nicotine replacement?
Cessation & relapse prevention
76
What is the MOA of nicotine replacement?
Nicotinic receptor agonist
77
What is the indication for Bupropion (Wellbutrin)?
Cessation & relapse prevention; depression (antidepressant)
78
What is the MOA of bupropion?
Norepinephrine-DA reuptake inhibition
79
What is the indication for Varenicline?
Cessation & relapse prevention
80
What is the MOA of Varenicline?
Nicotinic receptor partial agonist
81
What are the side effects of Varenicline?
Nausea, vivid dreams, HA, rash *Black box warning for depression and suicidality removed in 2016
82
MOA of Alcohol
GABA-A receptor agonist; increased duration of Cl- channel opening
83
Symptoms of Alcohol Intoxication
Slurred speech; Incoordination; Ataxia
84
What class is Lithium, Lithium Carbonate, Lithium Citrate in?
Mood Stabilizers
85
What is the MOA of lithium meds?
Inositol pathway, increasing 5-HT synthesis and decreases NE release
86
What is the indication for Lithium?
Acute and maintenance bipolar
87
What are the SE of lithium?
*Tremor, polydipsia, polyuria, acne, metallic taste, rash *Lithium toxicity, tremor, ataxia, confusion, GI; hypothyroidism, renal injury, Ebstein
88
Contraindications for lithium?
renal failure, dehydration, hyponatremia
89
What class is Valproic acid, divalproex sodium, Sodium valproate?
Mood stabilizers
90
What is the MOA of Valproic acid, divalproex sodium, Sodium valproate?
multiple; including voltage-gated sodium channel inhibition and effects on GABA
91
What is the indication for Valproic acid, divalproex sodium, Sodium valproate?
Acute and Maintenance bipolar, epilepsy, migraine, impulsivity, agitation in TBI
92
What are the side effects of Valproic acid, divalproex sodium, Sodium valproate?
*sedation, weight gain *Black box warning: hepatotoxicity, pancreatitis, teratogenicity (not for women of reproductive age)
93
What are the contradictions of Valproic acid, divalproex sodium, Sodium valproate?
hepatic impairment, urea cycle, mitochondrial disorders, pregnancy
94
What is the class of Carbamazepine?
Mood disorder
95
What is the MOA of carbamazepine?
multiple: including voltage-gated calcium channel inhibition and 5-HT release
96
What is the indication for Carbamazepine?
Maintenance bipolar, epilepsy, trigeminal neuralgia
97
What are the side effects of Carbamazepine?
Sedation, dizziness, constipation, dry mouth *Black box: bone marrow suppression, Steens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN)
98
What are the contraindications of carbamazepine?
hepatic impairment, urea cycle and mitochondrial disorders, pregnancy
99
What is the class for Lamotrigine?
Mood disorders
100
What is the MOA of Lamotrigine?
multiple: including voltage-gated calcium channel inhibition adn 5-HT release
101
That are the indications for Lamotrigine?
Maintenance bipolar, epilepsy
102
What are the side effects of Lamotrigine?
dizziness, headache, GI, rash
103
What class is Fluoxetine, Sertraline, Citalopram, Escitalopram, Paroxetine, Fluvoxamine, Vortioxetine, Vilazodone?
SSRI: Selective Serotonin Reuptake Inhibitors (SSRIs)
104
What is the MOA of Fluoxetine, Sertraline, Citalopram, Escitalopram, Paroxetine, Fluvoxamine, Vortioxetine, Vilazodone?
Inhibits presynaptic reuptake of 5-HT
105
What is the indication of Fluoxetine, Sertraline, Citalopram, Escitalopram, Paroxetine, Fluvoxamine, Vortioxetine, Vilazodone?
Depressive and anxiety disorders
106
What are the side effects of Fluoxetine, Sertraline, Citalopram, Escitalopram, Paroxetine, Fluvoxamine, Vortioxetine, Vilazodone?
GI (nausea, diarrhea), sleep disturbance, sexual dysfunction, easy bruising , dry mouth
107
What is the specific indication for Fluoxetine and Escitalopram?
FDA approved medication for depression in teens
108
What is the class of Venlafaxine, Duloxetine, Desvenlafaxine, Levomilnacipran?
SNRI: Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
109
What is the MOA of Venlafaxine, Duloxetine, Desvenlafaxine, Levomilnacipran?
Inhibit presynaptic reuptake of 5-HT and NE
110
What are the indications of Venlafaxine, Duloxetine, Desvenlafaxine, Levomilnacipran?
depressive and anxiety disorders, chronic pain syndromes
111
What are the side effects of Venlafaxine, Duloxetine, Desvenlafaxine, Levomilnacipran
GI (nausea, diarrhea), sleep disturbance, sleep dysfunction, HTN, jitteriness, dry mouth
112
What are the specific indications for Duloxetine?
*Diabetic neuropathic pain *GAD in children 7-17
113
What are the specific indications for Desvenlafaxine, Levomilnacipran?
MDD only
114
What is the SE of Bupropion?
jitteriness, fewer sexual SE
114
What is the class for bupropion?
Anti-depressants ; NE dopamine reuptake inhibitor (also approved for smoking cessation, ADHD)
115
What the is MOA of Trazodone?
5-HT, H-1 and alpha-1 receptor antagonist
116
What is the indication for Trazodone?
insomnia, anti-depressant
117

E 1.3 Review (4 decks)

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