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Pharmacology Flashcards

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1
Q

Primary metabolite of norepinephrine

A

Vanillymandelic acid

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2
Q

Age of FDA approval for irritability associated with ASD?

A

5-16 years old

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3
Q

Decrease in [neurotransmitter] is linked to episodic violence

A

Serotonin

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4
Q

Prednisone is the inducer of CYP ____, leading to decreased efficacy of diazepam

A

2C19

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5
Q

Erythromycin leads to diazepam toxicity due to CYP ____ induction

A

3A4

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6
Q

Genetic variability in CYP ____ could lead to more rapid metabolism of codeine to morphine

A

2D6

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7
Q

Best class of meds for kleptomania

A

SSRIs

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8
Q

Evidenced based med for clozapine induced sialorrhea

A

Glycopyrrolate (antimuscarinic)

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9
Q

T/F: Can botulinum toxin injections be used for clozapine induced sialorrhea?

A

True

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10
Q

Lipid profile f/u after starting zyprexa timeline

A

Obtain baseline, 3 months, and then annually

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11
Q

Inhibiting CYP2D6 would ____ (inc/dec) concentration of atomoxetine

A

Increase

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12
Q

Fluoxetine inhibits these CYP isoenzymes (4)

A

1A2, 2C, 2D6, 3A4
(1,2,2,3)

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13
Q

T/F: Lithium must be discontinued during pregnancy.

A

False, must weigh risk (fetal abnormalities) vs. benefit (preventing decompensation)

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14
Q

T/F: Recent MI is a relative contraindication to ECT.

A

True

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15
Q

T/F. ECT has absolute contraindications.

A

False. ECT only has relative contraindications.

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16
Q

Patient with SSRI withdrawal while tapering paroxetine should have paroxetine replaced with ____

A

Fluoxetine. Due to its longer half-life.

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17
Q

T/F: Topiramate causes greater cognitive impairment than gabapentin and lamotrigine

A

True

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18
Q

How should sertraline be adjusted after pt has shunts placed for portal hypertension secondary to liver dz

A

DECREASE the dose

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19
Q

Persistent pulmonary hypertension of the newborn is associated with this class of medications (2)

A

SSRIs and SNRIs

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20
Q

Neonatal abstinence syndrome is associated with this class of meds

A

Opioids

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21
Q

Risk for neural tube defects with VPA is as high as ___% in the first trimester

A

5

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22
Q

T/F: Cholinesterase inhibitors (donepezil, galantamine, rivastigmine) can lead to worsening bronchoconstriction in asthma, COPD

A

True

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23
Q

Benzo with half life of 100 hours, and therefore with high risk of daytime sedation

A

Flurazepam

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24
Q

Clozapine should be stopped and G-CSF or Gm-CSF therapy should begin once ANC falls below _______

A

1500/mm^3

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25
Q

Theophylline and haldol are metabolized by CYP ___

A

1A2

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26
Q

Fluvoxamine will inhibit/induce CYP 1A2

A

Inhibit

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27
Q

Citalopram, escitalopram, venlafaxine, and sertraline all weakly/strongly inhibit CYP 2D6

A

Weakly

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28
Q

Brexanolone treats this dx

A

Post partum depression

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29
Q

Brexanolone MOA

A

GABA modulator

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30
Q

If pt is started on brexanolone, what must provider do immediately?

A

Start continuous pulse ox

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31
Q

Risks when first starting brexanolone (2)

A

Sedation and sudden loss of consciousness

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32
Q

Physostigmine indication

A

Anticholinergic toxicity

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33
Q

Doxepin absolute contraindications (2)

A

urinary retention
narrow angle glaucoma

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34
Q

Acetylsalicylic acid (aspirin) can increase/decrease blood concentration of valproic acid

A

Increase

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35
Q

Carbamazepine can increase/decrease blood concentration of valproic acid

A

decrease

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36
Q

SSRI with biggest risk of fetal cardiac abnormalities

A

Paroxetine

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37
Q

Metronidazole can lead to increase in Qtc prolongation with antipsychotic use due to ____ inhibition

A

P450

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38
Q

How can disulfiram potentially lead to psychosis?

A

Inhibition of dopamine beta-hydroxylase –> increases dopamine concentration –> increased neurotransmission in mesolimbic system

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39
Q

How long to monitor patient after ketamine administration

A

2 hours

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40
Q

EEG changes in a pt who has a sz on olanzapine

A

Nonspecific changes

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41
Q

Increased beta waves on EEG can indicate use of these types of meds

A

benzos and barbituates

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42
Q

Must have special precautions with this drug for narcolepsy due to reputation as the “date rape drug”

A

Sodium Oxybate (salt of GHB)

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42
Q

Decreased alpha waves seen in pts taking these types of meds

A

Opioids

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43
Q

Addition of metoclopramide to an antipsychotic can lead to to this adverse reaction

A

NMS

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44
Q

Lithium and haldol together can lead to adverse reaction that resembles _____

A

NMS

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45
Q

Lithium and haldol combo can lead to this change in Qtc

A

Qtc prolongation

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46
Q

CYP ___ is responsible for 90% of metabolism for caffeine

A

1A2

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47
Q

CYP 3A4 is responsible for ____(substance) metabolism

A

cocaine

48
Q

Valproic Acid MOA

A

Increases levels of GABA in the brain and blocks voltage-gated Na+ channels

49
Q

Combo of dextromethorphan and SSRI can lead to ___

A

Serotonin syndrome

50
Q

Treatment for intrathecal baclofen withdrawal

A

Oral baclofen and IV benzos

51
Q

Baclofen works on this GABA receptor

A

GABA B

52
Q

PPIs induce CYP 3A which increases/decreases plasma levels of diazepam

A

Increases

53
Q

Atropine and pralidoxime are used in ____ poisoining

A

Organophosphate

54
Q

This intervention should be done FIRST in patients with clozapine induced sialorrhea

A

Behavioral measures

sugar-free gums, pillows, lateral decubitus position, towel for pillow

55
Q

Women are more/less likely to have side effects from antipsychotic medication

A

More

56
Q

Women are more/less likely to be sensitive to prolactin increases/weight gain with antipsychotic use

A

More

57
Q

Lithium is theorized to inhibit _____ which is involved in second messenger systems.

A

inositol monophosphatase

58
Q

Diabetes insipidus secondary to long term lithium use is due to the decrease in ______ channels along the collecting duct’s cell surface.

A

Aquaporin

59
Q

Tranylcypromine falls under this class of medications

A

MAO-I’s

60
Q

Acidification of urine to treat PCP intoxication is contraindicated in patients with ______.

A

Rhabdomyolysis

Can precepitate myoglobin in kidneys and lead to acute renal failure

61
Q

Risk of Ebstein’s Abnormality increases when Lithium is taken in the ___ trimester

A

First

62
Q

It is recommended to reduce of lamotrigine to ____ if co-administered with valproic acid

A

Half

63
Q

In patients with psychogenic polydipsia, can switch antipsychotic from 1st generation to a ______ to help resolve polydipsia

A

2nd Gen antipsychotic

64
Q

Those who are positive for HLA-B*1502 and HLA-A3101 genes are more susceptible to carbamazepine induced _______

A

SJS/TEN

65
Q

Mirtazapine’s blockade at _____ is associated with its appetite stimulating effects

A

5HT3

66
Q

Clozapine is associated with a __ to __% incidence of agranulocytosis

A

1 to 2%

67
Q

Non-specific lab findings associated with Serotonin Syndrome (4)

A

increased WBC count, elevated creatinine protein kinase (indicative of rhabdomyolysis), elevated creatinine, and elevated LFTs

68
Q

When should AIMS be performed

A

Every 3-6 months

69
Q

Antipsychotic with the lowest risk of hyperprolactinemia

A

Quetiapine

70
Q

A CBC and a ____ should be obtained prior to starting clozapine

A

EKG

71
Q

Aromatic hydrocarbons in cigarette smoke induce the CYP___ enzyme, leading to faster metabolism of clozapine.

A

1A2

72
Q

After a patient on clozapine stops smoking, may have to consider increasing/decreasing the dose

A

decreasing

73
Q

In patients with aneurysms, vascular malformations, or increased intracranial pressure during ECT, they are at greater risk due to ____.

A

increased blood flow during the induction of the seizure

73
Q

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.

A

Biofeedback

feedback enables patients to control their own physiologic functions

74
Q

To minimize cognitive effects and memory impairment from ECT, electrodes should be placed here

A

Right unilateral placement

75
Q

This mood stabilizer should be discontinued before ECT

A

Lithium

It can prolong a seizure

76
Q

This antipsychotic should be discontinued before ECT

A

Clozapine

causes late appearing seizures

77
Q

TMS is applied to this area of the brain

A

Left dorsolateral prefrontal cortex

78
Q

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.

A

One

79
Q

On average depressed patients require __ to __ ECT treatments to treat depression

A

6,12

80
Q

Mirtazapine’s antidepressant effects are primarily due to _____ antagonism.

A

Alpha 2

81
Q

Inducers of CYP3A4:
STart the PHunny RIFle CARl!

A

St. John’s Wort, Phenytoin, Rifampin, Carbamazepine

82
Q

Inhibitors of CYP3A4:
MYCINful PARtner inhibits my happiness. He’s an AZOLE.

A

Paroxetine, -mycins (erythromycin, clarithromycin), -azoles (ketoconazole, itraconazole)

83
Q

T/F: Inhibition of CYP3A leads to toxicity of morphine

A

True

84
Q

Up to ___% of patients taking lithium experience hypothyroid symptoms

A

50%

85
Q

Bupropion is an inhibitor/inducer of CYP2D6

A

Inhibitor

86
Q

Dystonic reactions from antipsychotics are more likely to occur in this demographic

A

Young antipsychotic naive males

87
Q

How does carbamazepine affect hepatic metabolism of birth control?

A

Increases metabolism therefore decreases effectiveness.

88
Q

Myocarditis secondary to clozapine use is likely to happen within the first ___ weeks.

A

12

89
Q

Z drugs (non-benzo sedative hypnotics) are metabolized primarily by the CYP___ enzyme

A

3A4

90
Q

Pimavanserin selectively targets serotonin ____ receptors

A

5-HT2A

91
Q

T/F: Valproic acid can increase risk of Autism with in utero exposure

A

True

92
Q

Metabolic effects of TCAs

A

Low HDL levels

93
Q

After stopping the medication, supportive measures should be taken first for the treatment of neuroleptic malignant syndrome, including ___, cooling, and cardiac support

A

Fluids

Medications like dantroline are considered second line

94
Q

Phenelzine + Pseudoephedrine can lead to _____

A

A hypertensive crisis

95
Q

CYP ___ is involved in the involved in the N-demethylation of cocaine to norcaine

A

3A4

96
Q

SSRI that most strongly inhibits CYP 2D6

A

Fluoxetine

97
Q

An antidepressant that works via serotonin 1A receptor agonism

A

Gepirone

98
Q

Must obtain this prior to starting gepirone

A

EKG

due to ability to prolong Qtc

99
Q

The two TCAs least likely to cause orthostatic hypotension

A

Nortriptyline, desipramine

100
Q

Lithium Interactions: “No ACE in the Hole”

A

NSAIDs, Ace Inhibitors, HCTZ

101
Q

Cardiac conditions that should be stabilized first including unstable hypertension, decompensated ___, valvular disease, and unstable angina prior to ECT.

A

heart failure

102
Q

Varenicline is a nicotinic receptor partial ___

A

Agonist

103
Q

Lithium can cause this electrolyte abnormality due to Nephrogenic Diabetes Insipidis

A

Hypernatremia (due to water loss)

104
Q

Due to increased CYP 1A2 activity with cigarette smoke, the blood levels of these two SGAs are reduced

A

Olanzapine, Clozapine

105
Q

The mainstay of treatment of lithium-induced NDI is___, a potassium-sparing diuretic that reduces lithium uptake in the cells of the collecting duct

A

Amiloride

106
Q

T/F: ECT can paradoxically increase seizure threshold

A

True

107
Q

___ prevention involves reducing deficits caused by an illness to obtain the highest possible level of functioning.

A

Tertiary (taking pills as the doc prescribes)

108
Q

Naltrexone is an opioid _____

A

Antagonist

109
Q

Memantine is also used for Alzheimer’s dementia, but works by binding to ____ receptors.

A

N-methyl-d-aspartate (NMDA)

110
Q

Sumatriptan is contraindicated in pts with these conditions (2)

A

ischemic heart disease, hypertension

111
Q

Two medications that are not contraindicated with MAOI use

A

Lithium, phentolamine

112
Q

Antipsychotics and methylphenidate will inc/dec levels of TCAs

A

INCREASE

113
Q

most of the benzodiazepine immunoassays are designed to detect ____

A

oxazepam

114
Q

Two Vitamins that could be supportive in Tardive Dyskinesia

A

Vitamin B6 (pyridoxine) and Vitamin E

115
Q

A TCA with dopamine receptor blockage (potential to cause Tardive Dyskinesia)

A

Amoxapine

116
Q

Olanzapine and clozapine, have the most effect on ____, which may be independent of the weight gain.

A

triglycerides

117
Q

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

A

SSRI

Adult Psych Boards (18 decks)

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