Pharmacology Flashcards
1
Q
Primary metabolite of norepinephrine
A
Vanillymandelic acid
2
Q
Age of FDA approval for irritability associated with ASD?
A
5-16 years old
3
Q
Decrease in [neurotransmitter] is linked to episodic violence
A
Serotonin
4
Q
Prednisone is the inducer of CYP ____, leading to decreased efficacy of diazepam
A
2C19
5
Q
Erythromycin leads to diazepam toxicity due to CYP ____ induction
A
3A4
6
Q
Genetic variability in CYP ____ could lead to more rapid metabolism of codeine to morphine
A
2D6
7
Q
Best class of meds for kleptomania
A
SSRIs
8
Q
Evidenced based med for clozapine induced sialorrhea
A
Glycopyrrolate (antimuscarinic)
9
Q
T/F: Can botulinum toxin injections be used for clozapine induced sialorrhea?
A
True
10
Q
Lipid profile f/u after starting zyprexa timeline
A
Obtain baseline, 3 months, and then annually
11
Q
Inhibiting CYP2D6 would ____ (inc/dec) concentration of atomoxetine
A
Increase
12
Q
Fluoxetine inhibits these CYP isoenzymes (4)
A
1A2, 2C, 2D6, 3A4
(1,2,2,3)
13
Q
T/F: Lithium must be discontinued during pregnancy.
A
False, must weigh risk (fetal abnormalities) vs. benefit (preventing decompensation)
14
Q
T/F: Recent MI is a relative contraindication to ECT.
A
True
15
Q
T/F. ECT has absolute contraindications.
A
False. ECT only has relative contraindications.
16
Q
Patient with SSRI withdrawal while tapering paroxetine should have paroxetine replaced with ____
A
Fluoxetine. Due to its longer half-life.
17
Q
T/F: Topiramate causes greater cognitive impairment than gabapentin and lamotrigine
A
True
18
Q
How should sertraline be adjusted after pt has shunts placed for portal hypertension secondary to liver dz
A
DECREASE the dose
19
Q
Persistent pulmonary hypertension of the newborn is associated with this class of medications (2)
A
SSRIs and SNRIs
20
Q
Neonatal abstinence syndrome is associated with this class of meds
A
Opioids
21
Q
Risk for neural tube defects with VPA is as high as ___% in the first trimester
A
5
22
Q
T/F: Cholinesterase inhibitors (donepezil, galantamine, rivastigmine) can lead to worsening bronchoconstriction in asthma, COPD
A
True
23
Q
Benzo with half life of 100 hours, and therefore with high risk of daytime sedation
A
Flurazepam
24
Q
Clozapine should be stopped and G-CSF or Gm-CSF therapy should begin once ANC falls below _______
A
1500/mm^3
25
Theophylline and haldol are metabolized by CYP ___
1A2
26
Fluvoxamine will ***inhibit/induce*** CYP 1A2
Inhibit
27
Citalopram, escitalopram, venlafaxine, and sertraline all ***weakly/strongly*** inhibit CYP 2D6
Weakly
28
Brexanolone treats this dx
Post partum depression
29
Brexanolone MOA
GABA modulator
30
If pt is started on brexanolone, what must provider do immediately?
Start continuous pulse ox
31
Risks when first starting brexanolone (2)
Sedation and sudden loss of consciousness
32
Physostigmine indication
Anticholinergic toxicity
33
Doxepin absolute contraindications (2)
urinary retention
narrow angle glaucoma
34
Acetylsalicylic acid (aspirin) can **increase/decrease** blood concentration of valproic acid
Increase
35
Carbamazepine can **increase/decrease** blood concentration of valproic acid
decrease
36
SSRI with biggest risk of fetal cardiac abnormalities
Paroxetine
37
Metronidazole can lead to increase in Qtc prolongation with antipsychotic use due to ____ inhibition
P450
38
How can disulfiram potentially lead to psychosis?
Inhibition of dopamine beta-hydroxylase --> increases dopamine concentration --> increased neurotransmission in mesolimbic system
39
How long to monitor patient after ketamine administration
2 hours
40
EEG changes in a pt who has a sz on olanzapine
Nonspecific changes
41
Increased beta waves on EEG can indicate use of these types of meds
benzos and barbituates
42
Must have special precautions with this drug for narcolepsy due to reputation as the "date rape drug"
Sodium Oxybate (salt of GHB)
42
Decreased alpha waves seen in pts taking these types of meds
Opioids
43
Addition of metoclopramide to an antipsychotic can lead to to this adverse reaction
NMS
44
Lithium and haldol together can lead to adverse reaction that resembles _____
NMS
45
Lithium and haldol combo can lead to this change in Qtc
Qtc prolongation
46
CYP ___ is responsible for 90% of metabolism for caffeine
1A2
47
CYP 3A4 is responsible for ____(substance) metabolism
cocaine
48
Valproic Acid MOA
Increases levels of GABA in the brain and blocks voltage-gated Na+ channels
49
Combo of dextromethorphan and SSRI can lead to ___
Serotonin syndrome
50
Treatment for intrathecal baclofen withdrawal
Oral baclofen and IV benzos
51
Baclofen works on this GABA receptor
GABA B
52
PPIs induce CYP 3A which **increases/decreases** plasma levels of diazepam
Increases
53
Atropine and pralidoxime are used in ____ poisoining
Organophosphate
54
This intervention should be done FIRST in patients with clozapine induced sialorrhea
Behavioral measures
| sugar-free gums, pillows, lateral decubitus position, towel for pillow
55
Women are **more/less** likely to have side effects from antipsychotic medication
More
56
Women are **more/less** likely to be sensitive to prolactin increases/weight gain with antipsychotic use
More
57
Lithium is theorized to inhibit _____ which is involved in second messenger systems.
inositol monophosphatase
58
Diabetes insipidus secondary to long term lithium use is due to the decrease in ______ channels along the collecting duct's cell surface.
Aquaporin
59
Tranylcypromine falls under this class of medications
MAO-I's
60
Acidification of urine to treat PCP intoxication is contraindicated in patients with ______.
Rhabdomyolysis
| Can precepitate myoglobin in kidneys and lead to acute renal failure
61
Risk of Ebstein's Abnormality increases when Lithium is taken in the ___ trimester
First
62
It is recommended to reduce of lamotrigine to ____ if co-administered with valproic acid
Half
63
In patients with psychogenic polydipsia, can switch antipsychotic from 1st generation to a ______ to help resolve polydipsia
2nd Gen antipsychotic
64
Those who are positive for HLA-B*1502 and HLA-A3101 genes are more susceptible to carbamazepine induced _______
SJS/TEN
65
Mirtazapine's blockade at _____ is associated with its appetite stimulating effects
5HT3
66
Clozapine is associated with a __ to __% incidence of agranulocytosis
1 to 2%
67
Non-specific lab findings associated with Serotonin Syndrome (4)
increased WBC count, elevated creatinine protein kinase (indicative of rhabdomyolysis), elevated creatinine, and elevated LFTs
68
When should AIMS be performed
Every 3-6 months
69
Antipsychotic with the lowest risk of hyperprolactinemia
Quetiapine
70
A CBC and a ____ should be obtained prior to starting clozapine
EKG
71
Aromatic hydrocarbons in cigarette smoke induce the CYP___ enzyme, leading to faster metabolism of clozapine.
1A2
72
After a patient on clozapine stops smoking, may have to consider **increasing/decreasing** the dose
decreasing
73
In patients with aneurysms, vascular malformations, or increased intracranial pressure during ECT, they are at greater risk due to ____.
increased blood flow during the induction of the seizure
73
# ID the therapy type.
Therapy in which instruments are used to measure autonomic parameters in patients who are provided with "real-time" feedback from the instrumentation about their bodily physiologic processes.
Biofeedback
| feedback enables patients to control their own physiologic functions
74
To minimize cognitive effects and memory impairment from ECT, electrodes should be placed here
Right unilateral placement
75
This mood stabilizer should be discontinued before ECT
Lithium
| It can prolong a seizure
76
This antipsychotic should be discontinued before ECT
Clozapine
| causes late appearing seizures
77
TMS is applied to this area of the brain
Left dorsolateral prefrontal cortex
78
NeuroStar TMS is indicated for the treatment of major depressive disorder in adult patients who have failed to achieve satisfactory improvement from ____ prior antidepressant(s) at or above the minimal effective dose and duration in the current episode.
One
79
On average depressed patients require __ to __ ECT treatments to treat depression
6,12
80
Mirtazapine's antidepressant effects are primarily due to _____ antagonism.
Alpha 2
81
Inducers of CYP3A4:
STart the PHunny RIFle CARl!
St. John's Wort, Phenytoin, Rifampin, Carbamazepine
82
Inhibitors of CYP3A4:
MYCINful PARtner inhibits my happiness. He's an AZOLE.
Paroxetine, -mycins (erythromycin, clarithromycin), -azoles (ketoconazole, itraconazole)
83
T/F: Inhibition of CYP3A leads to toxicity of morphine
True
84
Up to ___% of patients taking lithium experience hypothyroid symptoms
50%
85
Bupropion is an *inhibitor/inducer* of CYP2D6
Inhibitor
86
Dystonic reactions from antipsychotics are more likely to occur in this demographic
Young antipsychotic naive males
87
How does carbamazepine affect hepatic metabolism of birth control?
Increases metabolism therefore decreases effectiveness.
88
Myocarditis secondary to clozapine use is likely to happen within the first ___ weeks.
12
89
Z drugs (non-benzo sedative hypnotics) are metabolized primarily by the CYP___ enzyme
3A4
90
Pimavanserin selectively targets serotonin ____ receptors
5-HT2A
91
T/F: Valproic acid can increase risk of Autism with in utero exposure
True
92
Metabolic effects of TCAs
Low HDL levels
93
After stopping the medication, supportive measures should be taken first for the treatment of neuroleptic malignant syndrome, including ___, cooling, and cardiac support
Fluids
| Medications like dantroline are considered second line
94
Phenelzine + Pseudoephedrine can lead to _____
A hypertensive crisis
95
CYP ___ is involved in the involved in the N-demethylation of cocaine to norcaine
3A4
96
SSRI that most strongly inhibits CYP 2D6
Fluoxetine
97
An antidepressant that works via serotonin 1A receptor agonism
Gepirone
98
# [](http://)
Must obtain this prior to starting gepirone
EKG
| due to ability to prolong Qtc
99
The two TCAs least likely to cause orthostatic hypotension
Nortriptyline, desipramine
100
Lithium Interactions: "No ACE in the Hole"
NSAIDs, Ace Inhibitors, HCTZ
101
Cardiac conditions that should be stabilized first including unstable hypertension, decompensated ___, valvular disease, and unstable angina prior to ECT.
heart failure
102
Varenicline is a nicotinic receptor partial ___
Agonist
103
Lithium can cause this electrolyte abnormality due to Nephrogenic Diabetes Insipidis
Hypernatremia (due to water loss)
104
Due to increased CYP 1A2 activity with cigarette smoke, the blood levels of these two SGAs are reduced
Olanzapine, Clozapine
105
The mainstay of treatment of lithium-induced NDI is___, a potassium-sparing diuretic that reduces lithium uptake in the cells of the collecting duct
Amiloride
106
T/F: ECT can paradoxically increase seizure threshold
True
107
___ prevention involves reducing deficits caused by an illness to obtain the highest possible level of functioning.
Tertiary (taking pills as the doc prescribes)
108
Naltrexone is an opioid _____
Antagonist
109
Memantine is also used for Alzheimer's dementia, but works by binding to ____ receptors.
N-methyl-d-aspartate (NMDA)
110
Sumatriptan is contraindicated in pts with these conditions (2)
ischemic heart disease, hypertension
111
Two medications that are not contraindicated with MAOI use
Lithium, phentolamine
112
Antipsychotics and methylphenidate will **inc/dec** levels of TCAs
INCREASE
113
most of the benzodiazepine immunoassays are designed to detect ____
oxazepam
114
Two Vitamins that could be supportive in Tardive Dyskinesia
Vitamin B6 (pyridoxine) and Vitamin E
115
A TCA with dopamine receptor blockage (potential to cause Tardive Dyskinesia)
Amoxapine
116
Olanzapine and clozapine, have the most effect on ____, which may be independent of the weight gain.
triglycerides
117
Studies have shown a small but significant increase in the risk of PPHN (Persistent Pulmonary Hypertension of the Newborn) associated with ___ use during the second and early third trimesters
SSRI
