Pharmaceuticals (121-140)

Question 1

Melatonin (N-acetyl-5-methoxytryptamine)

Answer 1

C: endogenous hormone

A: antioxidant, immunomodulating, antineoplastic

I: jet lag, shift work, insomnia, SAD, not directly sedative

SE: hyperprolactinemia (rare)

CI: daytime usage

Intx: unsure?

Question 2

Zolpidem

Answer 2

C: Nonbenzo Sedative

A: structurally similar to benzos and works on its receptors

I: short-term insomnia tx

SE: impaired memory, complex sleep issues, SI

CI: abrupt withdrawal

Intx: alcohol, CNS depressants, CYP3A4 inducers/inhibitors

Question 3

Pitocin

Answer 3

C: synthetic oxytocin

A: stimulates uterine contraction and lactation (nasal)

I: induction of labor, incomplete abortion, postpartum hemorrhage

SE: uterine rupture, water intoxication, fetal death, hemorrhage, arrhythmias

CI: fetal distress, abnormal baby position at birth

Intx: vasoconstrictive agents that increase BP

Question 4

Carisoprodol

Answer 4

C: muscle relaxant

A: unknown

I: muscle spasms, myalgia

SE: aggitation, dizziness, vertigo

CI: porphyrias

Intx: CYP2C19 inhibitos, SJW, alcohol, CNS depressants

Question 5

Cyclobenzaprine

Answer 5

C: muscle relaxant

A: antispasmodics

I: skeletal muscle spasms

SE: drowsiness, seizures, arrhythmias, normal SNS sx

CI: arrhythmias, acute MI, CHF, heart block

Intx: MAOIs, anticholinergics

Question 6

Methylphenidate

Answer 6

C: Sympathomimetic

A: unknown

I: narcolepsy, ADHD, weight loss

SE: hallucainations, zombie-like effects, glassy eye appearance, sudden cardiac death - stop usage if serious side effects

CI: CVD, atherosclerosis, caution with mental health disorders

Intx: MAOIs, other sympathomimetics

Question 7

Dextroamphetamine

Answer 7

C: Stimulant - controlled substance

A: sympathomimetic - increases DA and NE/Epi release and blocks reuptake

I: fatigue, ADD, narcolepsy, excess appetite

SE: hallucainations, zombie-like effects, glassy eye appearance, sudden cardiac death - stop usage if serious side effects

CI: CVD, atherosclerosis, caution with mental health disorders

Intx: MAOIs, other sympathomimetics

Question 8

Haloperidol

Answer 8

C: antipsychotic

A: works on DA and serotonin

I: psychosis, tourette

SE: extrapyramidal sx, qt prolongation

CI: CNS depression, coma, PD

Intx: drugs that increase QT prolongation, cardiac arrhythmias, and extrapyramidal sx

Question 9

Aripiprazole

Answer 9

C: Antipsychotic

A: Antagonizes dopamine in brain

I: schizo, BPD1, MDD as adjunctive tx

SE: anticholinergic sx and QT prolongation

CI: hypersens rxn

Intx: lowers seizure threshold, drugs that increase CNS depression and extrapyramidal s/e

Question 10

Risperidone

Answer 10

C: 2nd generation antipsychotic

A: DA and 5HT antagonist

I: psychosis and schizo

SE: increased risk of torsade de pointe and QT prolongation, anticholinergic side effects, tardice dyskinesia, extrapyramidal s/e, ortho hypo

CI: caution in CVD, seizure, PD, low BP

Intx: CNS depressants, anti-HTN, DA agonist (levodopa), CYP3a4 inhibitors/inducers, drugs that cause QT prolongation

Question 11

Phenelzine

Answer 11

C: MAOIs

A: inhibits MAO from breaking down Epi, NE, DA, sero = antidepressant

I: Depression and severe anxiety

SE: HTN, ortho hypo, sexual dysfxn

CI: pheochromocytoma, CHF, HTN

Intx: MANY

Question 12

Amitriptyline

Answer 12

C: Tricyclic Antidepressants

A: inhibits catecholamine reuptake = sedative, anticholinergic, antihistamine, antidepresant

I: depression, enuresis, chronic pain, OCD

SE: anticholinergic effects, qt prolongation

CI: recent MI, seizure hx

Intx: MANY

Question 13

Fluoxetine

Answer 13

C: SSRI

A: inhibits serotinin reuptake

I: depression, panic, bulimia, OCD

SE: insomnia, tremor, SI, HI, serotonin syndrome

CI: liver failure, mania, seizure

Intx; MANY

Question 14

Escitalopram

Answer 14

C: SSRI

A: inhibits serotonin reuptake

I: MDD, GAD

SE: insomnia

CI: MAOi

Intx: phenelzine

Question 15

Bupropion

Answer 15

C: Antidepressant

A: inhibits reuptake of NE, 5HT, and DA

I: Depression, stop smoking, SAD

SE: agitation, insomnia, mania, seizure risk because lowers threshold

CI: seizure and eating disorders, head trauma hx

Intx: buspirone, dextromethorphan, SJS, TCA, trazodone

Question 16

Trazodone

Answer 16

C: SARI antidepressant

A: 5HT receptor antagonist

I: depression, aggression, panic, anxiety

SE: sedation, ortho hypo, anticholinergic sx, increased SI

CI: recent MI

Intx: MANY

Question 17

Venlafaxine

Answer 17

C: SNRI

A: serotonin, NE, Da reuptake inhibition

I: depression, anxiety, panic

SE: insomnia

CI: MAOI usage

Intx: phenelzine

Question 18

Lithium

Answer 18

C: Antimanic agent

A: increases presynaptic degradation and decreases neuronal synapses release of 5hT, DA and NE

I: Manic-depression, BPD

SE: third, polyuria, hypothyroid - VERY NARROW THERAPEUTIC WINDOW - sluggish, tremor, confusion

CI: renal dysfunction, CHD

Intx: DO not combine with first generation antipsychotics, caffeine

Question 19

Alprazolam (short acting) and Diazepam (long acting)

Answer 19

C: benzo

A: increases GABA

I: anxiety, panic

SE: impaired sleep quuality, poor concentration, addictive potential and withdrawal sx possible

CI: acute glaucoma

Intx: CNS depressants - antihistamines, barbiturates, alcohol, MAOIs, opioids, CYP3A4 inducers/inhibitors

Question 20

Buspirone

Answer 20

C: Anxiolytic

A: serotonin, Da, NE receptor agonist without muscle relaxation as seen in other benzos

I: anxiety

SE: nervousness, restlessness

CI: liver/kidney issues

Intx: CYP3A4 inducers/inhibitors, SJW, Trazodone, TCAs

Question 21

Nicotine - transdermal patch

Answer 21

C: stimulant

A: binds to acetylcholine receptors

I: smoking cessation

SE: burning/sensitivity where patch is located

CI: serious arrthymias, angina, recent MI

Intx: nicotine influences drug clearance