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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
Symptoms caused by NE reuptake inhibition?
Dry mouth, urinary retention, activation, tremor, CV issues
24
Symptoms caused by alpha antagonism?
Postural hypotension, dizziness, reflex tachycardia
25
Symptoms caused by alpha-1 antagonism?
Priapism
26
Symptoms caused by ACh antagonism?
Blurred vision, dry mouth, constipation, sinus tachycardia, urinary retention, memory dysfunction
27
Symptoms caused by H1 antagonism?
Sedation, drowiness, weight gain
28
Which SSRI does not have an increased risk of seiziures?
Escitalopram
29
Which antidepressant should be avoided in patients with liver disease and alcoholics?
Duloxetine
30
List the 4 dopaminergic pathways and the associated symptoms in schizophrenia.
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
31
Antipsychotic effects attributed to D2 receptor antagonism?
+ symptom alleviation EPS Endocrine effects
32
Antipsychotic effects attributed to 5HT2A receptor antagonism?
Negative symptom alleviation Less EPS
33
Antipsychotic effects attributed to high 5HT2A/D2 bindingn affinity ratio?
Better antipsychotic activity, lower EPS than D2 antagonism alone
34
Antipsychotic effects attributed to 5HT1A agonism?
Antidepressant and anxiolytic activity, improved cognition, reduced EPS, body weight changes
35
Antipsychotic effects attributed to 5HT1D antagonism?
Antidepressant activity
36
Antipsychotic effects attributed to 5HT2C antagonism?
+ symptom alleviation Weight gain
37
Antipsychotic effects attributed to alpha-1 antagonism?
Sedation, hypotension, weight gain
38
Antipsychotic effects attributed to H1 antagonism?
Sedation, weight gain
39
Antipsychotic effects attributed to M1 antagonism?
Memory impairment, GI symptoms, dry mouth, blurry vision, less EPS
40
Antipsychotic effects attributed to mixed 5HT/NE reuptake inhibition
Antidepressant and anxiolytic activity, less weight gain
41
Blockade of which receptor causes EPS and PRL elevation?
D2
42
Blockade of which receptor causes cognitive deficits, dry mouth, constipation, increased HR, urinary retention, blurred vision?
M1
43
Blockade of which receptor causes sedation, weight gain, dizziness?
H1
44
Blockade of which receptor causes hypotension?
A1
45
Blockade of which receptor is possibly anti-EPS?
5HT2A
46
Blockade of which receptor causes satiety blockade?
5HT2C
47
Why do we think typicals cause more EPS than atypicals?
More rapid dissociation from D2 receptors
48
3 most cholinergic and sedating antipsychotics?
Thioridazine Chlorpromazine Clozapine
49
Highest EPS risk antipsychotic?
Haloperidol
50
Least EPS risk antipsychotic?
Clozapine
51
What is poikilothermia?
Inability to maintain constant body temperature (side effect of AP)
52
Which antipsychotic can cause cataracts?
Quetiapinehi
53
Which antipsychotic can cause retinal pigmentation?
Thioridazine (and chlopromazine but it is mild)
54
Adding ___ to clozapine increases the risk of developing NMS, seizures, and delirium.
Lithium
55
True or false - agranulocytosis in clozapine is dose-dependent.
False
56
MOA clozapine-induced myocarditis?
Acute IgE mediated hypersensitivity reaction
57
When should A1C and lipids be monitored in atypical antipsychotics?
Baseline 3 months Annually
58
WBC and ANC threshold to start clozapine?
WBC >3500 ANC>1500 (or >1000 if BEN)
59
Clozapine monitoring frequency?
First 6 months - weekly 6-12 months - Q2 weeks 12+ months - monthly
60
How long do you need to continue weekly labs after stopping clozapine due to SE?
1 month (after achieving normal labs)
61
Amantadine can be used for which EPS?
Parkinsonism (dopaminergic agent)
62
How do mood stabilizers cause SIADH?
Increase secretion of ADH by the hypothalamusH
63
How do antipsychotics cause SIADH?
Serotonin effects on 5HT2 and 5HT1C lead to increased ADH Psychogenic polydipsia leads to hyponatremia
64
How do antidepressants cause SIADH?
Increased secretion of ADH from hypothalamus Potentiates effect of ADH in the kidneys Lowers the threshold for the release of ADH
65
Which TCA can cause QT
Imipramine
66
What drug has a block box warning for aplastic anemia and agranulocytosis?
Carbamazepine
67
Which drugs have a black box warning for SJS?
Carbamazepine, lamotrigine
68
Which drugs have a block box warning for hepatotoxicity?
VPA, naltrexone
69
Most common side effect of donepezil/ACh inhibitors?
Diarrhea/GI
70
Rx adrenergic toxidrome
Rx symptoms (agitation - benzos, psychosis - haloperidol, HTN - phentolamine, SVTs - beta-blockers)
71
Rx anticholinergic toxidrome
Rx symptoms (agitation - benzos, Precedex), if life threatening, give cholinesterase inhibitors physostigmine
72
Rx benzodiazepine toxidrome
Flumazenil
73
Rx cholinergic toxidrome
Atropine (reduces symptoms of cholinergic excess) + pralidoxime (regenerates ACherase)
74
Rx TCA toxidrome
Activated charcoal
75
Rx NMS
Bromocriptine/amantadine (DA agonist), dantroline (muscle relaxant)
76
Toxidrome - agitation, hallucinations, abnormal movements, tachycardia, mydriasis, dry membranes, hyperthermia, decreased bowel sounds, urinary retention, flushed/dry skin
Anticholinergics
77
Toxidrome - hypersalivation, lacrimation, urinary/fecal incontinence, GI cramping, emesis, bradycardia, diaphoresis, miosis, pulmonary edema, weakness, paralysis, muscle fasciculations
Cholinergics
78
Antidote for acetaminophen?
NAC
79
Antidote for methanol/ethylene glycol?
Ethanol/fomepizole
80
Antidote for irone?
Deferoxamine
81
Antidote for CO?
100% O2, hyperbaric O2 Damages globus pallidus
82
Antidote for methemoglobinemia?
Methylene blue
83
Antidote for cyanide?
hydroxocobalamin, sodium nitrite, sodium thiosulfate
84
Antidote for beta-blockers?
Glucagon, high dose inuslin
85
Antidote for CCBs?
High dose insulin
86
In acetaminophen OD, when does tylenol level peak? When does liver toxicity peak?
4 hours; 72-96 hours
87
Clue to methanol ingestion?
Visual blurring, central scotoma, afferent pupillary defect, pancreatitis Neurotoxic - damages putamen
88
Clue to ethylene glycol ingestion?
Calcium oxalate crystals in urine; CN palsies, tetany, hematuria, AKI
89
Clue to isopropyl alcohol ingestion?
NO increased AG or metabolic acidosis
90
What happens to glutamate and GABA in alcohol intoxication?
Inhibitory state - decreased glutamate, increased GABA
91
Caffeine MOA
Antagonist at adenosine receptor - increases DA
92
Remission specifiers for SUD in DSM5 - early, sustained
3, 12 months
93
Too much or too little vitamin ___ can cause polyneuropathy
B6 (pyridoxine)
94
Vitamin ____ deficiency can cause pellagra (dermatitis, diarrhea, dementia)
B3, niacin
95
Distinguish between B12 and folate deficiency
B12 - increased MMA B12/folate - increased homocysteine
96
False positive UTox for benzos?
Sertraline

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