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pharmacology Flashcards

1
Q

all atypical anti-psychotics are antagonists for D2 receptors

A

false, aripiprazole is partial agonist

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2
Q

what are the extrapyramidal side effects associated with anti-psychotic drugs

A

1) parkinsonism, bradykinesia
2) acute dystonia
3) akathisia

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3
Q

what is tardive dyskinesia

A
  • Affect on the CNS:
    1) orthostatic hypotension, impotence and failure in ejaculation
    2) anti-cholinergic effects
  • Affects on the endocrine
    1) hyperprolactinemia which can cause ammoniuria, galactorrhea, infertility and impotence
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4
Q

which drugs should not be used with antipsychotics?

A

anti-Parkinson’s drugs , because they potentiate the extra-pyramidal side effects

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5
Q

read slide 12 of anti-psychotic drugs

A

ok

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6
Q

what are the 3 classes of phenothiazine

A

1) fluphenazine, perphenazine(piperazine)
2) chlorpromazine(aliphatic chain)
3) thioridazine(piperidine)

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7
Q

which side chain anti-psychotic drugs are the most potent?

A

piperazine (fluphenazine ,perphenazine)

however they have the highest incidence of extra pyramidal side effects

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8
Q

typical antipsychotics alleviate what type of symptoms in schizophrenia

A

positive, ex: hallucinations and delusions

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9
Q

chlorpromazine is the drug of choice in?

A

intractable hiccups

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10
Q

which anti-psychotic agent is the least potent?

A

thioridazine, it has has the least severe extrapyramidal side effects

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11
Q

which drug is used for borderline personality disorder

A

thiothixene (thioxanthene)

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12
Q

which drugs are used for the initial stabilization of a psychotic patient?

A

butyrophenones( haloperidol)

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13
Q

what is the function of pimozide

A

1) prevents acute exacerbations in chronic schizophrenia

2) suppresses motor and vocal tics in Tourette syndrome

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14
Q

what is the function of loxapine ?

A

treatment of schizoaffective disorders, because it major metabolite is an antidepressant ; amoxapine

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15
Q

clozapine is reserved for the treatment of what ?

A

it is reserved for the treatment of refractory severe psychosis

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16
Q

atypical antipsychotics are used for the treatment of ?

A

1) psychotic disorders 2)mania 3)bipolar disorders

4) autism

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17
Q

true or false

atypical anti-psychotics are used to alleviate only positive and negative symptoms of schizophrenia

A

false, also cognitive

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18
Q

what are the side effects of atypical agents

A

less extrapyramidal and anticholinergic side effects. however, more weight gain leading to type II diabetes and can cause cardiac QT interval prolongation leading to cardiac arrhythmias

note: Clozapine can cause agranulocytosis

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19
Q

true or false

levodopa is pharmacologically inert

A

true

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20
Q

true or false

levodopa doesn’t relieve dementia, causes postural hypotension , and it inhibits the release of prolactin

A

true

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21
Q

what is the effect of levodopa on the urine and on the and the dip stick test for ketoacidosis ?

A

the urine is red and turns black on exposure to air or alkali
it gives a false positive test

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22
Q

what drugs are contraindicated with levodopa

A

1)vit b6 pyridoxine
2)reserpine
3)anticholinergics
4)anti psychotics
5)MAO-I ;can cause hypertensive crisis
and hyperpyrexia

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23
Q

what is the side effect caused by tolcapone

A

acute liver failure

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24
Q

when is amantadine used ?

A

in early Parkinson’s or as an adjunct to levodopa

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25
Q

uses of Bromocriptine, Pramipexole, and Ropinirole

A

restless leg syndrome

Parkinson’s

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26
Q

which of the anti-Parkinson’s drugs is More effective in relieving tremor than either rigidity or bradykinesia

A

MOA-I, levodopa is the opposite

note: MOA-I causes cycloplegia

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27
Q

is COX1 or COX2 responsible for the anti pyritic , anti-inflammatory and anti- analgestic effect of NSAIDs ?

A

COX-2

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28
Q

what are the side effects of NSAIDS?

A

1) acute renal failure
2) skin rash or hypersensitivity
3) gastric distress, worsened by ethanol and SSRI
4) bronchospasm in NSAID -sensitive asthmatics

note: they are also contraindicated in 1) pregnancy;3rd trimester 2) in influenza like diseases; causes Reyes syndrome 3) alcohol use and peptic ulcers 4) bleeding disorders

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29
Q

in asthmatics you should use ——— to relieve pain ?

A

acetaminophen

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30
Q

true or false
the major difference between NSAIDs is not in the anti-inflammatory , anti pyretic and analgesic activity but in the pharmacokinetic activity

A

true

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31
Q

true or false

aspirin causes nephrotoxicity

A

false

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32
Q

Olsalazine, mesalamine ,Sulfasalazine are used for

A

ulcerative colitis, crohn disease, RA

note: they are reversible inhibitors and they do not inhibit platelet aggregation

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33
Q

indomethacin is used for ?

A

1) gout

2) closure of patent ductus arteriosus

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34
Q

the most frequent side effect of indomethacin is ?

A

severe frontal headache

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35
Q

contraindications of indomethacin

A

1) peptic ulcer

2) should be used with caution with elderly, epileptic patients and patients with psychosis or Parkinson’s

36
Q

COX-2 selective inhibitors ?

A

they cause a prothrombic state but they do not cause GI irritation

37
Q

true or false acetaminophen is an anti inflammatory, anti pyretic, analgesic drug

A

false, it doesn’t have an anti-inflammatory action

not: it is a weak inhibitor of cyclooxygenases

38
Q

uses of acetaminophen

A

1) when aspirin is contraindicated

2) it is the drug of choice in pregnancy

39
Q

overdose of acetaminophen can lead to

A

hepatotoxicity(due to accumulation of NAPQI which can be aggravated by ethanol, it is treated with acetylcysteine

40
Q

for mild to moderate nociceptive pain it is better to use

A

NSAIDs

41
Q

neuropathic pain responds best to

A

anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors

42
Q

can opioids cause orthostatic hypotension

A

yes

43
Q

what are the actions of opioids which act on the mu receptor ?

A

supra spinal analgesia
euphoria
dependence
respiratory depression

44
Q

what are the actions of opioids which act on the kappa receptor ?

A

spinal analgesia
miosis
sedation

45
Q

what are the actions of opioids which act on the delta receptor ?

A

involved in affective behaviors

46
Q

which opioid drugs are used to treat diarrhea and cough

A

diarrhea: loperamide
cough: codeine and Dextromethorphan (morphine doesn’t work)

47
Q

Morphine and related compounds act at all opiate receptors, but with the highest affinity at

A

u receptors

48
Q

morphine is metabolized by:

A

glucuronide conjugation

49
Q

true or false

opioids decrease biliary pressure

A

false, they increase biliary pressure

50
Q

opioids are contraindicated in patients with

A

1) patients with head injury

2) patients with lung diseases as it causes respiratory depression

51
Q

opioid action is potentiated by ?

A

phenothiazines
MOA-I
tricyclic antidepressants

52
Q

what are the analogues of meperidine ?

A

Fentanyl
Sufentanil

at toxin levels they can cause CNS excitement (unlike morphine)

53
Q

describe meperidine

A

1) higher bioavailability (doesn’t undergo first pass metabolism )
2) postural hypotension
3) spasmogenic like morphine, but less intense in relation to its analgesia
4) respiratory depression
5) no anti tussive and constipation action

note: meperidine reacts with MOA-I causing
excitation, delirium, hyperpyrexia, convulsions, and severe respiratory depression.

54
Q

what metabolite accumulates in meperidine

A

normeperidine , which causes CNS excitation

55
Q

methadone and LAAM uses

A

used for 1)analgesia 2)used to treat opioid withdrawal symptoms

note: they cause constipation and biliary spasm

56
Q

pentazocine ?

A

is a μ-receptor antagonist and a δ- and κreceptor agonist.

note: May block the analgesia produced by morphine
note: can cause Tolerance, dependence, and withdrawal

57
Q

Buprenorphine?

A

is a partial agonist at μ receptors.

58
Q

which opioid antagonist has the highest duration of action

A

nalmefene

59
Q

which drugs are used to treat opioid poisoning

A

naloxone , nalmefene

note: naltrexone is used to treat drug and alcohol addiction

60
Q

tramadol is used for

A

neuropathic pain

note: It is equal to or less effective than codeine plus aspirin or to codeine plus acetaminophen.

61
Q

ziconotide is used for

A

severe chronic pain

note: it has sever side effects described as drunken-like. also it is related to bacterial meningitis

62
Q

true or false

It is possible for a person to exhibit signs of dependence following withdrawal of a drug, yet not crave the drug.

A

true

63
Q

true or false

Tolerance develops more slowly to meperidine than morphine

A

true

64
Q

true or false if I abused a short acting highly potent drug the withdrawal will be be more intense and for a short duration

A

true

65
Q

which drugs are used for the treatment of heroin withdrawal

A

methadone and Buprenorphine

66
Q

true or false

alcohol will cause hyperthermia

A

false, it will cause hypothermia

note: diuresis will also occur due to decrease ADH release

67
Q

liver cirrhosis caused by alcoholism can lead to

A

1) hypertension in liver BV
2) gastric and esophageal varices
3) ascites
4) hepatic encephalopathy

68
Q

describe fetal alcohol syndrome

A

abnormal facial features, growth deficiencies, vision and hearing deficits mental disorders(difficulty in learning, memory problems, poor attention span, and
poor communication skills).

69
Q

true or false

Benzodiazepines are cross tolerant with alcohol and will alleviate withdrawal symptoms

A

true

note: but they do not have the same stimulating
effects on the central nervous system (CNS) as alcohol.

70
Q

arrhythmias are treated with——
tremor are treated with ———
hallucinations and paranoia are treated with ——–
Delirium tremens are treated with ———

A

lidocaine
propranolol
phenothiazine or haloperidol
diazepam

71
Q

naltrexone’s are contraindicated in ?

A

liver failure or acute hepatitis

72
Q

methanol ingestion causes ?

A

Metabolic acidosis and organ damage
Methanol can cause blindness by damaging the optic nerve.

note: methanol is metabolized to formaldehyde then it is metabolized to formic acid

73
Q

what are the withdrawal symptoms of Benzodiazepines

A

anxiety, insomnia, convulsion ( in severe withdrawal)

74
Q

true or false
— Tolerance develops to the sedative and hypnotic effects of barbiturates but No tolerance develops to the anticonvulsant actions of barbiturates.

A

true

75
Q

true or false
Chronic toxicity of cocaine and amphetamines produces anxiety and confusion, leading to paranoia and psychosis, which is indistinguishable from schizophrenia

A

true

note: amphetamines are used to treat ADHD and narcolepsy

76
Q

true or false

cocaine and amphetamines can cause hypopyrexia

A

false, they cause hyperpyrexia

77
Q

drug used for intoxication of cocaine and amphetamines

A

chlorpromazine

78
Q

true or false

tolerance develops to both cocaine and amphetamines

A

false, only for amphetamines

79
Q

Synesthesia’s and “flashbacks” are unique features of?

A

Psychedelic Hallucinogens

80
Q

Marijuana and Hashish are used as

A

Antiemetic in cancer chemotherapy patients

81
Q

true or false

Benzodiazepines have a higher therapeutic index compared to barbiturates

A

true

note: but barbiturates do not only facilitate the GABA receptor but they also have an additional GABA agonist effect of their own

82
Q

remember
Diazepam has a direct muscle relaxant effect in addition to CNS
actions.
Alprazolam has an additional antidepressant effect.
Triazolam may result in rebound anxiety following cessation of
administration.

A

ok

83
Q

The only peripheral effects of Benzodiazepines

A

coronary vasodilation after certain
benzodiazepines are injected intravenously (IV)
and neuromuscular block after very high doses

84
Q

Flumazenil is used for

A

overdose or poisoning with benzodiazepines

85
Q

Eszopiclone , Zaleplon, and Zolpidem are used for

A

They are used exclusively to treat insomnia.

86
Q

barbiturates induce ?

A

cytochrome P-450 microsomal enzyme activity and δ-aminolaevulinic acid (δ-ALA) synthetase

note: therefore barbiturates are contraindicated inpatients with acute intermittent porphyria, porphyria variegate, or a positive family history of these porphyria’s.

CNS (11 decks)

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