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RC Nuggets > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Mesocortical pathway

A

Negative symptoms

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2
Q

Mesolimbic pathway

A

Positive symptoms

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3
Q

Tuberoinfundibular pathway

A

Prolactin increase (due to loss of inhibition by dopamine)

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4
Q

Nigrostriatal

A

EPS

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5
Q

Most loose binding @ D2?

A

Clozapine

Seroquel

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6
Q

D2 blockade needed for efficacy?

A

68%

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7
Q

D2 blockade needed for hyperprolactinemia?

A

72%

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8
Q

D2 blockade needed for EPS?

A

80%

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9
Q

Abilify mechanism?

A

Partial agonist 5HT1A

Antagonist 5HT2A

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10
Q

Receptors associated with weight gain?

A

5HT2C

Histamine

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11
Q

Alpha 1 antagonism

A

Tachycardia
Increased salvation
Urinary incontinence
Priapism

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12
Q

Alpha 2 antagonism

A

Sexual dysfunction

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13
Q

Which antipsychotic does not cause QT prolongation?

A

LATUDA

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14
Q

Anticholinergic effect of antipsychotics?

A

Dopamine INHIBITS acetylcholine.

LOW potency APs are more ANTICHOLINERGIC (Clozapine, Seroquel)

The MORE anticholinergic you are, the LESS your risk for NMS

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15
Q

Serious side effect of Flumazenil (benzo intox treatment)?

A

SEIZURE

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16
Q

Lithium tremor

A

Fine, rapid
Increases with fine movements and when maintaining posture

Treat with BETA-BLOCKER

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17
Q

Akathisia most common with which AP?

A

ABILIFY

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18
Q

Which antidepressants don’t cause SIADH?

A

Mirtazapine

Wellbutrin

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19
Q

No anticholinergics for?

A

AKATHISIA

TD

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20
Q

No beta-blockers for?

A

DYSTONIA

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21
Q

Which medication can you not take while on Clozapine?

A

CARBAMAZEPINE

combined myeloproliferative disease

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22
Q

Agranulocytosis

A

1%
1st year of treatment
NOT dose dependent

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23
Q

Myocarditis

A

0.06%

Highest risk during 1st month of treatment

24
Q

Clozapine missed dose

A

> 48 hours, have to re-start progressive dosing but can go faster

25
Q

Clozapine level

A

350-550ng/ml

306-1836nmol/L

26
Q

Clozapine flag

A

GREEN
WBC > 3.5
ANC > 2.0

YELLOW
WBC 3.5 - 2 (fall > 3.0 in 4 weeks and < 4.0)
ANC 2 - 1.5 (fall > 1.5 in 4 weeks and < 2.5)
CBC 2x per week until green
evaluate for flu-like sx

RED
WBC < 2
ANC < 1.5
**STOP RX, confirm results within 24 hours**
Continue CBC weekly x 4 weeks
Patient non-rechallengeable

ISOLATION
WBC < 1
ANC < 0.5

27
Q

Invega loading dose timing?

A

Day 8 (+/- 4 days)

28
Q

Invega monthly dose timing?

A

+/- 7 days

If missed dose 4-6 weeks, can give usual.
More than that, have to re-start with loading dose.
> 6 months, have to re-start at beginning dose.

29
Q

How long Abilify PO needed with Maintena?

A

2 weeks after starting IM

30
Q

Maintena missed dose?

A

More than 5-6 weeks, need PO x 2 weeks again

31
Q

How long Risperdal PO needed with Consta?

A

3 weeks after starting IM

32
Q

Consta missed dose?

A

Missed 2nd dose or > 6 weeks any other dose, need PO x 3 weeks again

33
Q

Benzo taper at what rate?

A

25%/week

34
Q

Latuda needs to be taken with how many calories?

A

350

35
Q

Pregabalin (Lyrica)

A

Better tolerated than Neurontin (Gabapentin)
No medication interactions
Renally excreted

36
Q

Ziprasidone

A 
Anti-histaminic
Give with 500 calories
> 120mg more efficacious
Little weight gain
\++ QT prolongation
Moderate increase in prolactin
37
Q

Which Rx can commonly give alopecia?

A

Epival!

38
Q

Which Rx can give pancreatitis?

A

Epival

39
Q

Epival and Lamictal interaction?

A

Epival INCREASES Lamictal by 50%

Lamictal DECREASES Epival by 25%

Through glucuronidation

40
Q

Lamictal missed dose?

A

> 5 days need to re-start titration

41
Q

OCP decreases the efficacy of which Rx?

A

LAMICTAL

42
Q

Lamictal rash?

A

8% benign

1% severe

43
Q

Normal amount of urine in 24 hours?

A

1-2 liters

44
Q

Lithium common side effects?

A

HYPOthyroidism
HYPERcalcemia via HYPERparathyroidism

Polyuria/polydipsia
Diabetes insipidus (nephrogenic, decreased response to ADH = HYPONATREMIA

Worsening of psoriasis
Leukocytosis

Tremors
Myasthenia gravis symptoms
Exophthalmia

45
Q

Lithium changes in renal morphology?

A

Interstitial fibrosis

SINGLE dose is better

46
Q

What decreases Lithium levels?

A 
Coffee
High salt diet
Pregnancy
Mannitol
Theophylline
Acetazolamide
Spironolactone
47
Q

What increases Lithium levels?

A 
Thiazide diuretics
ACEI
ARBs
NSAID, Coxed
Propranolol
Dehydration
Age
No salt diet
48
Q

Which medications have no interaction with Lithium?

A 
Amiloride
Lasix
ASA
Tylenol
Calcium channel blocker
49
Q

Mild lithium toxicity symptoms?

A

1.5-2.0

Ataxia, tremor, nystagmus, dysarthria

50
Q

Moderate lithium toxicity symptoms?

A 
2-2.5
HYPERreflexia
seizures
delirium
hallucinations
51
Q

What’s not helpful for treating lithium toxicity?

A

ACTIVATED CHARCOAL (not absorbed).

52
Q

How many half-lives needed to get to steady state?

A

5

53
Q

Pharmacokinetics factors?

A

What body does to drug:

  1. Absorption
  2. Distribution
  3. Metabolism
  4. Excretion
54
Q

Pharmacodynamics factors?

A

What drug does to body:

  1. Efficiency (INDEPENDENT OF CONCENTRATION)
  2. Power
  3. Affinity
55
Q

Which medications need 2D6 activation?

A

Tamoxifen
Tramadol
Hydrocodone
Codeine

RC Nuggets (20 decks)

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