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PRITE > Pharmacology PRITE Review (JB PPT) Part 3 > Flashcards

Pharmacology PRITE Review (JB PPT) Part 3 Flashcards

1
Q

Phenytoin side effects?

A

Hirsutism, fetal dysmorphism, gingival hypertrophy
Cerebellar atrophy when taken over a long period of time -> cerebellar symptoms

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2
Q

Phenytoin toxicity?

A

Unsteady gait, slurred speech, nystagmus

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3
Q

Carbamazepine side effects?

A
  • Agranulocytosis, aplastic anemia, thrombocytopenia
  • Heart block
  • Ataxia
  • Rash (benign, SJS)
  • Hyponatremia/water intoxication
  • Neural tube defects
  • Hepatitis
  • Drowsiness
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4
Q

Depakote side effects?

A

Leukopenia
Hyperammonemia
Liver failure
PCOS
Weight gain
Hair loss

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5
Q

True or false - VPA-induced hyperammonemic encephalopathy can occur with acute and chronic use, with therapeutic VPA levels, and in the absence of hepatotoxicity.

A

True

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6
Q

Rx VPA-induced hyperammonemia?

A
  • Stop VPA (effective first-line)
  • Lactulose (enhances removal of NH3 from blood to the gut)
  • Levocarnitine
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7
Q

Lithium therapeutic window?

A

0.7-1.2

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8
Q

Lithium toxicity (per PRITE)?

A

ST depression, QTc prolongation
Tremor, ataxia, dysarthria
Nephrotoxicity
Status epilepticus

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9
Q
A
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9
Q

What AED(s) can cause acute dose-related tremor?

A

VPA

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10
Q

What AED(s) can cause acute dose-related paresthesia?

A

Topiramate, zonisamide

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11
Q

What AED(s) can cause acute dose-related diplopia, blurred vision, visual distortion?

A

Carbamazepine, lamotrigine

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12
Q

What AED(s) can cause acute dose-related mental slowing?

A

Topiramate

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13
Q

What AED(s) can cause acute dose-related mood/behavioral changes?

A

Levetiracetam, ezogabine, perampanel

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14
Q

What AED(s) can cause acute dose-related changes in libido?

A

Carbamazepine, phenytoin, phenobarbital

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15
Q

What AED(s) can cause chronic ostemalacia/osteoporosis?

A

Carbamazepine
Barbiturates
Phenytoin
Oxcarbazepine
VPA

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16
Q

What AED(s) can cause chronic altered connective tissue metabolism/growth (facial coarsening, hirsutism, gingival hyperplasia, contractures)?

A

Phenytoin
Phenobarbital

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17
Q

What AED(s) can cause chronic cerebellar degeneration?

A

Phenytoin

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18
Q

What AED(s) can cause sexual dysfunction in the long-term?

A

Phenytoin
Carbamazepine
Phenobarbital
Primidone

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18
Q

What AED(s) can cause chronic neuropathy?

A

Phenytoin
Carbamazepine

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19
Q

Symptoms caused by DA reuptake inhibition?

A

Psychomotor activation, psychosis

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20
Q

Symptoms caused by 5HT2 agonism?

A

Sexual dysfunction, activation

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21
Q

Symptoms caused by 5HT3 agonism?

A

Nausea

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22
Q

Symptoms caused by 5HT reuptake inhibition?

A

GI disturbances, activation

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23
Q

Symptoms caused by NE reuptake inhibition?

A

Dry mouth, urinary retention, activation, tremor, CV issues

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24
Q

Symptoms caused by alpha antagonism?

A

Postural hypotension, dizziness, reflex tachycardia

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25
Q

Symptoms caused by alpha-1 antagonism?

A

Priapism

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26
Q

Symptoms caused by ACh antagonism?

A

Blurred vision, dry mouth, constipation, sinus tachycardia, urinary retention, memory dysfunction

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27
Q

Symptoms caused by H1 antagonism?

A

Sedation, drowiness, weight gain

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28
Q

Which SSRI does not have an increased risk of seiziures?

A

Escitalopram

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29
Q

Which antidepressant should be avoided in patients with liver disease and alcoholics?

A

Duloxetine

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30
Q

List the 4 dopaminergic pathways and the associated symptoms in schizophrenia.

A
  1. Mesolimbic (VTA to NA) - excessive dopamine > positive symptoms
  2. Mesocortical (VTA to PFC) - decreased dopamine > negative symiptoms
  3. Nigrostriatal (SN to striatum) - blockade of DA > EPS/TD
  4. Tuberoinfundibular pathway (hypothalamus) - blockade of DA - hyperPRL
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31
Q

Antipsychotic effects attributed to D2 receptor antagonism?

A

+ symptom alleviation
EPS
Endocrine effects

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32
Q

Antipsychotic effects attributed to 5HT2A receptor antagonism?

A

Negative symptom alleviation
Less EPS

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33
Q

Antipsychotic effects attributed to high 5HT2A/D2 bindingn affinity ratio?

A

Better antipsychotic activity, lower EPS than D2 antagonism alone

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34
Q

Antipsychotic effects attributed to 5HT1A agonism?

A

Antidepressant and anxiolytic activity, improved cognition, reduced EPS, body weight changes

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35
Q

Antipsychotic effects attributed to 5HT1D antagonism?

A

Antidepressant activity

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36
Q

Antipsychotic effects attributed to 5HT2C antagonism?

A

+ symptom alleviation
Weight gain

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37
Q

Antipsychotic effects attributed to alpha-1 antagonism?

A

Sedation, hypotension, weight gain

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38
Q

Antipsychotic effects attributed to H1 antagonism?

A

Sedation, weight gain

39
Q

Antipsychotic effects attributed to M1 antagonism?

A

Memory impairment, GI symptoms, dry mouth, blurry vision, less EPS

40
Q

Antipsychotic effects attributed to mixed 5HT/NE reuptake inhibition

A

Antidepressant and anxiolytic activity, less weight gain

41
Q

Blockade of which receptor causes EPS and PRL elevation?

A

D2

42
Q

Blockade of which receptor causes cognitive deficits, dry mouth, constipation, increased HR, urinary retention, blurred vision?

A

M1

43
Q

Blockade of which receptor causes sedation, weight gain, dizziness?

A

H1

44
Q

Blockade of which receptor causes hypotension?

A

A1

45
Q

Blockade of which receptor is possibly anti-EPS?

A

5HT2A

46
Q

Blockade of which receptor causes satiety blockade?

A

5HT2C

47
Q

Why do we think typicals cause more EPS than atypicals?

A

More rapid dissociation from D2 receptors

48
Q

3 most cholinergic and sedating antipsychotics?

A

Thioridazine
Chlorpromazine
Clozapine

49
Q

Highest EPS risk antipsychotic?

A

Haloperidol

50
Q

Least EPS risk antipsychotic?

A

Clozapine

51
Q

What is poikilothermia?

A

Inability to maintain constant body temperature (side effect of AP)

52
Q

Which antipsychotic can cause cataracts?

A

Quetiapinehi

53
Q

Which antipsychotic can cause retinal pigmentation?

A

Thioridazine (and chlopromazine but it is mild)

54
Q

Adding ___ to clozapine increases the risk of developing NMS, seizures, and delirium.

A

Lithium

55
Q

True or false - agranulocytosis in clozapine is dose-dependent.

A

False

56
Q

MOA clozapine-induced myocarditis?

A

Acute IgE mediated hypersensitivity reaction

57
Q

When should A1C and lipids be monitored in atypical antipsychotics?

A

Baseline
3 months
Annually

58
Q

WBC and ANC threshold to start clozapine?

A

WBC >3500
ANC>1500 (or >1000 if BEN)

59
Q

Clozapine monitoring frequency?

A

First 6 months - weekly
6-12 months - Q2 weeks
12+ months - monthly

60
Q

How long do you need to continue weekly labs after stopping clozapine due to SE?

A

1 month (after achieving normal labs)

61
Q

Amantadine can be used for which EPS?

A

Parkinsonism (dopaminergic agent)

62
Q

How do mood stabilizers cause SIADH?

A

Increase secretion of ADH by the hypothalamusH

63
Q

How do antipsychotics cause SIADH?

A

Serotonin effects on 5HT2 and 5HT1C lead to increased ADH
Psychogenic polydipsia leads to hyponatremia

64
Q

How do antidepressants cause SIADH?

A

Increased secretion of ADH from hypothalamus
Potentiates effect of ADH in the kidneys
Lowers the threshold for the release of ADH

65
Q

Which TCA can cause QT

A

Imipramine

66
Q

What drug has a block box warning for aplastic anemia and agranulocytosis?

A

Carbamazepine

67
Q

Which drugs have a black box warning for SJS?

A

Carbamazepine, lamotrigine

68
Q

Which drugs have a block box warning for hepatotoxicity?

A

VPA, naltrexone

69
Q

Most common side effect of donepezil/ACh inhibitors?

A

Diarrhea/GI

70
Q

Rx adrenergic toxidrome

A

Rx symptoms (agitation - benzos, psychosis - haloperidol, HTN - phentolamine, SVTs - beta-blockers)

71
Q

Rx anticholinergic toxidrome

A

Rx symptoms (agitation - benzos, Precedex), if life threatening, give cholinesterase inhibitors physostigmine

72
Q

Rx benzodiazepine toxidrome

A

Flumazenil

73
Q

Rx cholinergic toxidrome

A

Atropine (reduces symptoms of cholinergic excess) + pralidoxime (regenerates ACherase)

74
Q

Rx TCA toxidrome

A

Activated charcoal

75
Q

Rx NMS

A

Bromocriptine/amantadine (DA agonist), dantroline (muscle relaxant)

76
Q

Toxidrome - agitation, hallucinations, abnormal movements, tachycardia, mydriasis, dry membranes, hyperthermia, decreased bowel sounds, urinary retention, flushed/dry skin

A

Anticholinergics

77
Q

Toxidrome - hypersalivation, lacrimation, urinary/fecal incontinence, GI cramping, emesis, bradycardia, diaphoresis, miosis, pulmonary edema, weakness, paralysis, muscle fasciculations

A

Cholinergics

78
Q

Antidote for acetaminophen?

A

NAC

79
Q

Antidote for methanol/ethylene glycol?

A

Ethanol/fomepizole

80
Q

Antidote for irone?

A

Deferoxamine

81
Q

Antidote for CO?

A

100% O2, hyperbaric O2

Damages globus pallidus

82
Q

Antidote for methemoglobinemia?

A

Methylene blue

83
Q

Antidote for cyanide?

A

hydroxocobalamin, sodium nitrite, sodium thiosulfate

84
Q

Antidote for beta-blockers?

A

Glucagon, high dose inuslin

85
Q

Antidote for CCBs?

A

High dose insulin

86
Q

In acetaminophen OD, when does tylenol level peak? When does liver toxicity peak?

A

4 hours; 72-96 hours

87
Q

Clue to methanol ingestion?

A

Visual blurring, central scotoma, afferent pupillary defect, pancreatitis

Neurotoxic - damages putamen

88
Q

Clue to ethylene glycol ingestion?

A

Calcium oxalate crystals in urine; CN palsies, tetany, hematuria, AKI

89
Q

Clue to isopropyl alcohol ingestion?

A

NO increased AG or metabolic acidosis

90
Q

What happens to glutamate and GABA in alcohol intoxication?

A

Inhibitory state - decreased glutamate, increased GABA

91
Q

Caffeine MOA

A

Antagonist at adenosine receptor - increases DA

92
Q

Remission specifiers for SUD in DSM5 - early, sustained

A

3, 12 months

93
Q

Too much or too little vitamin ___ can cause polyneuropathy

A

B6 (pyridoxine)

94
Q

Vitamin ____ deficiency can cause pellagra (dermatitis, diarrhea, dementia)

A

B3, niacin

95
Q

Distinguish between B12 and folate deficiency

A

B12 - increased MMA
B12/folate - increased homocysteine

96
Q

False positive UTox for benzos?

A

Sertraline

PRITE (3 decks)

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