pharmacology

Question 1

side effect of antipsychotics - restlessness, urge to move, cannot sit still - dx?

Answer 1

akathisia

Question 2

akathisia - tx?

Answer 2

• try to decrease dose of antipsychotic

- if unable, add B-blocker (propanolol)

Question 3

how is lithium eliminated?

Answer 3

ONLY renally

Question 4

by what mechanisms may lithium levels be affected?

Answer 4

• meds that suppress GFR

- affect Na or K levels

Question 5

withdrawal from which drug can be life threatening?

Answer 5

benzos

Question 6

side effects of haldol/antipsychotics?

Answer 6

• extrapyraidal symptoms
• tardive dyskinesia
• anticholinergic effects
• orthostatic hypoT
• sedation

Question 7

acute cocaine ingestion w/cardiovascular manifestations - treatment?

Answer 7

• benzos + nitroglycerin
• ASA!
• BB CONTRAINDICATED (leads to unopposed a-1 receptor vasoconstriction)
• CCB for persistent CP
• phentolamine for persistent htn
• +/- PCI for MI

Question 8

cholinergic toxicity symptoms?

Answer 8

D - defecation
U - urination
M - miosis
B  -bronchospasm/bradycardia
E - emesis
L - lacrimation
S - salivation

Question 9

cholinergic toxicity - treamtnet?

Answer 9

• atropine (competitive inhibito of acetylcholine)

- pralidoxime (cholinesterase reactivating)

Question 10

anticholinergic toxicity - symtpoms?

Answer 10

• dryness
• flushing
• mydriasis
• urinary retention
• decreased bowel motility

Question 11

opioid overdose - symptoms?

Answer 11

• pinpoint pupils

- resp depression

Question 12

treatment for narcolepsy?

Answer 12

modafinil (novel stimulant)

Question 13

treatment for cataplexy?

Answer 13

SNRI (venlafaxine)
SSRI
TCA

Question 14

St John’s wort - interacts with which meds?

Answer 14

• OCPs
• ARTs
• immunosuppressives
• narcotics
• anticoagulants
• antifungals

Question 15

what class is dobutamine?

Answer 15

beta-1 agonist –> improves cardiogenic shock by increasing LV contractility

Question 16

ehat class is epinephrine?

Answer 16

beta-1 and alpha-1 agonist

Question 17

what to do in MI w/badycardia that does not respond to atropine?

Answer 17

temp pacing

Question 18

typical managmenet of RV MI w/hypotension?

Answer 18

FLUIDS (pre-load dependent)

Question 19

serotonin syndrome - symptoms?

Answer 19

• mental status change
• autonomic dysregulation (sweat, tachy, htn, fever, diarrhea, mydriasis)
• neuromusc hyperactivity (hyperreflexia, tremor, rigid, myoclonus)

Question 20

how treat serotonin syndrome?

Answer 20

• stop serotenergic meds
• supportive care
• sedate w/benzos
• serotonin antagonist if supportive fails

Question 21

neuroleptic malignant syndrome - what is it? in response to which med?

Answer 21

idiosyncatic reaction to domapine antagonists

Question 22

neuroleptic malignant syndroe - symptoms?

Answer 22

• tremor
• hyperreflexia
• myoclonus
• bradykinesia
• “lead pipe” rigidity

Question 23

drugs that most commonly cause SJS?

Answer 23

• abx

- anticonvulsants

Question 24

symptoms of PCP intoixcatiotn?

Answer 24

• agitated, combative
• ataxia
• htn
• tachy
• prominent nystagmus (all directions)

Question 25

how treat acute agitation in PCP intoxication?

Answer 25

benzos

Question 26

treatment for bipolar disorder?

Answer 26

1) antipsychotic
PLUS
2) mood stabilizer (ie lithium, valproate)