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DSM V reviews > PMHNP Certificate Study Guide Pharmacology > Flashcards

PMHNP Certificate Study Guide Pharmacology Flashcards

1
Q

The movement of the drug into the bloodstream.

A

Absorption

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2
Q

The movement of the drug through the bloodstream and to target receptors.

A

Distribution

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3
Q

The transformation or breakdown of the drug in preparation for elimination from the body

A

Metabolism

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4
Q

The precirculation process (uptake and conversion) by which the substrates (changed drug) are significantly reduced by the cytochrome P450 (CYP450) enzyme in the liver after enteric absorption.

A

First Pass Effect

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5
Q

The process by which substances (drugs, substrates, toxins) leave the body (feces, urine, skin).

A

Excretion

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6
Q

The time needed to clear 50% of the drug from the plasma

A

Half Life

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7
Q

How many half lives does it take to clear a drug from circulation completely?

A

5

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8
Q

How many half lives does it take to create a “steady state” for medications?

A

5

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9
Q

Speeds up the metabolic rate, decreasing serum level of the drug

A

Inducing

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10
Q

Slows down the metabolic rate, increasing the serum level of the drug

A

Inhibiting

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11
Q

A special medication consideration for young children especially during periods of rapid growth and development

A

metabolize (CYP450, 2C9, 2C19, 2D6, and 3A4) more rapidly, thereby causing lower drug concentrations (available free drug) in the systemic circulation (subtherapeutic dose).

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12
Q

A special medication consideration for the elderly?

A

Elderly patients metabolize (CYP450, 1A2) more slowly, thereby causing higher concentrations (available free drug) in the systemic circulation (increased risk of toxicity).

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13
Q

These type of metabolizers have two defective genes and complete absence of the enzyme, for example, CYP2D6.

A

Poor metabolizers

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14
Q

These type of metabolizers have variant genes that are less effective in producing the catalyst.

A

Slow metabolizers

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15
Q

These type of metabolizers have two functional “wild-type” genes. This is normal drug metabolism.

A

Extensive

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16
Q

These type of metabolizers have more than two copies of the gene and excessive production of the enzyme.

A

Ultra Rapid

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17
Q

Liver disease affecting enzyme activity (first-pass effect) can have an inhibitory effect which in turn

A

increasing the risk of drug toxicity

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18
Q

Renal insufficiency (or acute kidney injuries) can also lead to this problem due to reduced glomerular filtration rate (GFR).

A

increased serum concentrations

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19
Q

Low muscle mass, reduced protein, and increased fat stores can lead to what problem with medications?

A

increased drug concentrations and risk of toxicity

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20
Q

Intracellular volume can effect drug metabolism. How does it effect pregnant women and the elderly?

A

Reduced in the elderly requiring a decreased dose, but increased in pregnancy which can necessitate an increased dose.

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21
Q

the study of drug action on the body, specifically the relationship between drug concentration and effect (dose and response).

A

Pharmacodynamics

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22
Q

The process of becoming desensitized and therefore less responsive to a particular dose of medication over time, necessitating increases; may eventually lead to “poop-out” effect.

A

Tolerance

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23
Q

Rapidly diminishing responsiveness to increasing doses of the medication, aka “poop-out” effect.

A

Tachyphylaxis

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24
Q

The activation of a receptor by a chemical to produce a biological response.

A

Agonist

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25
Q

A chemical that binds to a receptor but does not fully activate the receptor and the biological response may be muted

A

Partial agonist

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26
Q

An agent that binds to the same receptor as an agonist, but induces an opposite biological response.

A

Inverse Agonist

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27
Q

The blocking of the receptor to inhibit the biological response. This also blocks endogenous agonists from binding.

A

Antagonist

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28
Q

The substrate may block the various ion channels (potassium, sodium, calcium, chloride) rather than receptor sites and exert either an inhibitory or excitatory effect across the cell membrane.

A

Ion Channel Blockers

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29
Q

Patients should be informed that standard practice typically recommends lifelong treatment for

A

bipolar, schizophrenia, refractory depression, and anxiety.

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30
Q

In general what should antipsychotics be monitored for…

A

significant decrease in the absolute neutrophil count (agranulocytosis), can prolong the QTc interval, and can precipitate the syndrome of inappropriate antidiuretic hormone (SIADH).

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31
Q

This medication requires requires explicit registration in the Risk Evaluation and Mitigation Strategies (REMS) database.

A

Clonazapine

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32
Q

For SSRIs, SNRIs, and MAOIs you should intermittently monitor…

A

sodium

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33
Q

Tobacco products are known

A

CYP450 inducers.

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34
Q

The shorter the half-life, the more difficult

A

it is to wean

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35
Q

Medications with longer half-lives often have less

A

intense withdrawal symptoms

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36
Q

First generation antipsychotics are what kind of neurotransmitter disrupter?

A

Dopamine Antagonists

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37
Q

Which receptor do first generation antipsychotics block?

A

D2

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38
Q

Chlorpromazine AKA

A

Thorazine; 1st gen antipsychotic

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39
Q

Fluphenazine AKA

A

Prolixin; 1st gen antipsychotic

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40
Q

Haloperidol AKA

A

Haldol; 1st gen antipsychotic

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41
Q

Perphenazine AKA

A

Trilafon; 1st gen antipsychotic

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42
Q

Thioridazine AKA

A

Mallaril; 1st gen antipsychotic

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43
Q

What are the general side effects of first generation antipsychotics?

A

sedation, orthostasis, anticholinergic effects, QTc prolongation, EPS, TD, agranulocytosis

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44
Q

What mood stabilizer do you avoid if you have renal disease?

A

Lithium

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45
Q

What mood stabilizer do you avoid if you have hepatic disease or female of child-bearing age

A

Valproate

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46
Q

Which two atypical antipsychotics do you avoid if you have a history of extrapyramidal side effects?

A

aripiprazole and risperidone

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47
Q

Which three atypical antipsychotics do you avoid if you are obese?

A

olanzapine, quetiapine, and risperidone

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48
Q

Valproic acid AKA

A

(Depakene); antileptic also used for mood stabilizer

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49
Q

What is the dosing for Valporic Acid (Depakene)?

A

60 mg/kg/d in divided doses

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50
Q

When do you get a trough for Valporic Acid (Depakene)?

A

serum trough level 12 hours from the previous dose,

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51
Q

What is the half life of Valporic Acid (Depakene)?

A

half-life 13 hours

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52
Q

During titration of Valporic Acid (Depakene) how often do you check a trough?

A

during titration check twice weekly, then monthly.

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53
Q

What is the therapeutic range for Valporic Acid (Depakene)?

A

Therapeutic range: 50 to 125 mcg/mL (evaluate for signs of toxicity and improvement of manic symptoms).

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54
Q

If a patient develops an abnormal mental status on Valporic Acid (Depakene) what do you check for?

A

If patient develops altered mental status, evaluate for hyperammonemia.

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55
Q

If a patient is outside the therapeutic range for Depakene but remains asymptomatic what should you do?

A

Do not treat if asymptomatic

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56
Q

Valporic Acid (Depakene) effect on pregnant women, breastfeeding, and children

A

FDA approved in children for seizure disorders, teratogenic, excreted in breast milk

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57
Q

What kind of monitoring do you do for someone on Valporic Acid (Depakote) besides a trough?

A

Mental status changes, complete blood count (thrombocytopenia), and liver function (transaminitis)

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58
Q

Aripiprazole AKA

A

(Abilify); atypical antipsychotic

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59
Q

Which atypical antipsychotic is least likely to exhibit class effects

A

Aripiprazole (abilify)

60
Q

What are the class side effects for atypical antipsychotics?

A

sedation, orthostasis, anticholinergic effects, EPS, TD, agranulocytosis

61
Q

Asenapine AKA

A

(Saphris); Atypical antipsychotic

62
Q

Brexpiprazole AKA

A

(Resulti); Atypical antipsychotic

63
Q

Cariprazine

A

(Vraylar); atypical antipsychotic

64
Q

Clozapine AKA

A

(Clozaril); Atypical Antipsychotic

65
Q

Iloperidone AKA

A

(Fanapt); Atypical Antipsychotic

66
Q

Which atypical antipsychotic is the most likely culprit for agranulocytosis?

A

Clozapine (Clozaril)

67
Q

Lurasidone AKA

A

(Latuda); Atypical Antipsychotic

68
Q

Olanzapine AKA

A

Zyprexa; Atypical Antipsychotic

69
Q

Paliperidone AKA

A

(Invega); Atypical Antipsychotic

70
Q

Pimavanserin AKA

A

(Nuplazid); Atypical Antipsychotic

71
Q

Quetiapine AKA

A

(Seroquel); Atypical Antipsychotic

72
Q

Risperidone AKA

A

Risperidal; Atypical Antipsychotic

73
Q

Ziprasidone AKA

A

Geodon; Atypical Antipsychotic

74
Q

Lithium (Eskalith) what is the dosing?

A

900 to 1800 mg/d in divided doses,

75
Q

When do you get a lithium trough?

A

serum lithium trough level 12 hours from the previous dose

76
Q

What is the half life of lithium?

A

half-life 20 hours,

77
Q

How often do you check a lithium trough when titrating?

A

during titration check twice weekly, then every 1 to 2 months when stable.

78
Q

How long does lithium take to be effective?

A

Initial anti-mania: 5 to 7 days, full effect 10 to 21 days.

79
Q

What should you evaluate prior to initiating lithium?

A

Before initiating, evaluate renal function, electrolytes, thyroid function, EKG, pregnancy test

80
Q

How does lithium effect pregnancy and breast milk?

A

contraindicated in the first trimester, associated with Ebstein’s anomaly: right ventricular outflow tract obstruction in the fetus Excreted in breast milk.

81
Q

What is the therapeutic index for lithium? What about in the elderly?

A

0.6 mEq/L in elderly, 0.8 to 1.2 mEq/L.

82
Q

At what age is lithium FDA approved in children?

A

FDA approved in children >7 years of age.

83
Q

Lamotrigine (Lamictal) dosing schedule:

A

25 mg/d × 2 weeks, then 50 mg/d × 2 weeks, then 100 mg/d × 1 week to a maximum daily dose of 400 mg/d.

84
Q

What is the most serious adverse reaction with Lamotrigine (lamictal)?

A

Adverse severe reaction: Stevens–Johnson syndrome

85
Q

What medication can hugely increase the risk of Stevens-Johnson syndrome if taken at the same time as Lamotrigine (lamictal)?

A

(SJS; risk is increased when used in conjunction with valproic acid).

86
Q

How does Lamotrigine (Lamictal) effect pregnancy and breast milk?

A

Can be used in pregnancy with caution if the benefit outweighs risks. Excreted in breast milk; monitor infant for poor sucking, drowsiness, apnea.

87
Q

How does Lamotrigine (Lamictal) effect pregnancy and breast milk?

A

Can be used in pregnancy with caution if the benefit outweighs risks. Excreted in breast milk; monitor infant for poor sucking, drowsiness, apnea.

88
Q

What happens to the half life of Lamotrigine (Lamictal) if taken with valporic acid?

A

Half-life 30 hours (half-life is doubled when used in conjunction with valproic acid),

89
Q

How does smoking effect the half life of Lamotrigine (Lamictal)?

A

smoking induces metabolism and reduces half-life by 50%

90
Q

Carbamazepine AKA

A

(Tegretol); Antiepileptic or mood stabilizer

91
Q

What happens to the half life of Carbamazepine (Tegretol) while on maintenance dosing?

A

Half-life shortens while on maintenance due to auto-metabolic effect.

92
Q

Oxcarbazepine AKA

A

Trileptal; Off label for bipolar

93
Q

Side effects common to TCAs?

A

Side effects common to the class include xerostomia, blurry vision, diaphoresis, orthostatic tachycardia, drowsiness, restlessness, and palpitations.

94
Q

What are the dietary restrictions of MAOIs?

A

Dietary (tyramine) restrictions: Aged cheese, cured meat, smoked meat, fermented foods, fish sauce, alcohol, and soy products.

95
Q

Clomipramine AKA

A

(Anafranil); TCA

96
Q

Desipramine AKA

A

(Norpramin); TCA

97
Q

Amitriptyline AKA

A

(Elavil); TCA

98
Q

Doxepin AKA

A

(Sinequan); TCA

99
Q

Imipramine AKA

A

(Tofranil); TCA

100
Q

Phenelzine AKA

A

Phenelzine (Nardil); MAOI

101
Q

Tranylcypromine sulfate AKA

A

(Parnate); MAOI

102
Q

Selegiline transdermal AKA

A

(Emsam); MAOI

103
Q

Citalopram AKA

A

(Celexa); SSRI

104
Q

S-Citalopram AKA

A

(Lexapro); SSRI

105
Q

Sertraline AKA

A

Zoloft; SSRI

106
Q

Fluoxetine AKA

A

Prozac; SSRI

107
Q

Paroxetine AKA

A

Paxil; SSRI

108
Q

Vortioxetine AKA

A

(Brintellix); SSRI

109
Q

Vilazodone AKA

A

(Viibryd); SSRI

110
Q

Nefazodone AKA

A

(Serozone); SSRI

111
Q

Trazodone AKA

A

(Desyrel); SSRI

112
Q

Levomilnacipran AKA

A

(Fetzima); SNRI

113
Q

Venlafaxine AKA

A

Effexor; SNRI

114
Q

Desvenlafaxine AKA

A

(Pristiq); SNRI

115
Q

Duloxetine AKA

A

Cymbalta; SNRI

116
Q

What is the primary receptor target for SSRI?

A

The primary receptor target is 5-hydroxytryptamine (5-HT)

117
Q

What are the main side effects for an SSRI?

A

insomnia (initially and during titration), drowsiness, nausea, dry mouth, diarrhea, restlessness, inhibited arousal (erectile dysfunction), and anorgasmia.

118
Q

What lab should you monitor for SSRI and SNRI?

A

Monitor sodium levels in the first 2 weeks. SIADH can occur at any time while on any psychotropic medication

119
Q

Which two antidepressants are least likely to cause SIADH?

A

Mirtazapine and buproprion

120
Q

Besides anxiety and depression what are SNRIs first line for?

A

neuropathic pain

121
Q

What are the class side effects for SNRIs?

A

hypertension, insomnia (initially and during titration), drowsiness, nausea, dry mouth, diarrhea, restlessness, inhibited arousal (erectile dysfunction), anorgasmia, and retrograde ejaculation.

122
Q

SNRIs and discontinuation

A

Discontinuation and withdrawal syndromes are usually due to the short half-life of the serotonin component of the medication and occur in up to one-third of patients. Augmenting with a long-acting SSRI can mitigate many of these effects during the discontinuation process

123
Q

dizziness, fatigue, headache, nausea, agitation, anxiety, insomnia, irritability, electric-like shocks (head zaps), and audio visual hallucinations are symptoms of

A

Discontinuation symptoms of SNRIs

124
Q

The concurrent use of benzodiazepines and opioids are an issue because

A

Concomitant use with opioids can lead to elevated opioid levels through the CYP450 3A4 pathway.

125
Q

What benzodiazepines are preferred in patients with hepatic diseases or an alcohol use disorder?

A

Oxazepam, lorazepam, and temazepam

126
Q

What are the class side effects of benzodiazepines?

A

psychomotor slowing, temporary cognitive impairment, and rebound anxiety.

127
Q

When it comes to benzodiazepines: The shorter the half-life,

A

the more likely the patient will experience withdrawal symptoms.

128
Q

Which three benzodiazepines have a short half life?

A

Oxazepam, lorazepam, and temazepam

129
Q

Alprazolam AKA

A

Xanax; Benzodiazepine

130
Q

Chlordiazepoxide AKA

A

Librium; Benzodiazepine

131
Q

Clonazepam AKA

A

Klonipin. Benzodiazepine

132
Q

Diazepam AKA

A

Valium; Benzodiazepine

133
Q

Lorazepam AKA

A

Ativan; Benzodiazepine

134
Q

Oxazepam AKA

A

Serax; Benzodiazepine

135
Q

What BP med can be used for performance anxiety?

A

Beta blockers like propranolol (Inderal)

136
Q

What BP meds can be used for Posttraumatic stress disorder (nightmares), symptomatic support in opioid withdrawal?

A

Alpha blockers/clonidine, prazosin, doxazosin

137
Q

dextroamphetamine AKA,

A

(Adderall); stimulant

138
Q

methylphenidate AKA

A

(Ritalin); stimulant

139
Q

lisdexamfetamine AKA

A

(Vyvanse), stimulant

140
Q

Clonidine AKA

A

Kapvav; alpha agonist

141
Q

guanfacine AKA

A

Intuniv; alpha agonist

142
Q

What are two BP medications that can be used to treat ADHD?

A

Clonidine and Guanfacine

143
Q

Neural tube defects, cleft lip, cleft palate, atrial septal defects are birth defects associated with

A

Antiepileptic drugs (valproic acid, carbamazepine):

144
Q

Ebstein anomaly (especially in the first trimester) are associated with

A

Lithium

145
Q

Floppy baby syndrome, cleft palate are associated with

A

benzodiazepines

DSM V reviews (8 decks)

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