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PPT > PPT Exam 2 (P2 Fall) > Flashcards

PPT Exam 2 (P2 Fall) Flashcards

1
Q

Fatal, genetic disease that causes progressive breakdown of nerve cells in the brain

A

Huntington’s Disease

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2
Q

Approximately # Americans and # individuals globally are affected by Huntington’s disease.

A

30,000
80,000

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3
Q

T/F: Huntington’s is more common in males.

A

False, affects both sexes equally

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4
Q

Typical disease onset in Huntington’s disease

A

30 - 50 years old

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5
Q

Huntington’s is most prevalent in, which two countries?

A

Europe and North America

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6
Q

Cause of Huntington’s disease

A

The Huntington protein is expressed in higher concentration in the brain

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7
Q

What happens to GABA and Dopaminergic function in Huntington’s disease?

A

GABA = diminished, Dopaminergic = enhanced

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8
Q

What are the 3 main characteristics of Huntington’s disease?

A
  1. Abnormally choreoathetoid movements (dancelike movements) of limbs
  2. Rhythmic movements of the tongue and face
  3. Mental deterioration (psychosis and dementia)
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9
Q

Only drug approved for chorea in Huntington’s disease

A

Tetrabenazine

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10
Q

Tetrabenazine is known as a ________ depletor

A

monoamine

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11
Q

Tetrabenazine believes to act as a __________ of the _____(receptor)_____

A

reversible inhibitor; VMAT2

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12
Q

net result of Tetrabenazine

A

reduce dopamine release from nerve terminals

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13
Q

AE of Tetrabenazine

A
  1. Drowsiness / Sedation / Fatigue / Insomnia
  2. Hypotension
  3. Extrapyramidal reaction
  4. anxiety
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14
Q

What are the 3 additional treatment options for Huntington’s disease, besides Tetrabenazine?

A

Antipsychotics (Haloperidol), BNZs (Diazepam), Drugs that inhibit glutamate neurotoxicity

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15
Q

Gradually progressive dementia affecting cognition, behavior, and functional status - no cure exists

A

Alzheimer’s disease

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16
Q

Approximately # Americans have Alzheimer’s and by 2050 projected #

A

5.4 million
13.2 million

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17
Q

T/F: cognitive decline is gradual over the course of Alzheimer’s

A

true

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18
Q

T/F: Alzheimer’s is fatal

A

true

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19
Q

What two components are considered the pathologic hallmarks of A.D.?

A

Amyloid plaques, Neurofibrillary tangles

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20
Q

Amyloid plaques are extracellular accumulations of, what?

A

A beta protein

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21
Q

Intracellular component composed of the microtubule-associated protein Tau

A

neurofibrillary tangles

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22
Q

Aggregation of ________ is an important event in Alzheimer’s pathogenesis.

A

A beta

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23
Q

3 Main symptoms of Alzheimer’s

A
  1. Memory loss
  2. Aphasia
  3. Apraxia
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24
Q

Donepezil, Rivastigmine, and Galantamine are are drugs used to treat…. ?

A

Alzheimer’s disease

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25
Q

Donepezil, Rivastigmine, and Galantamine work by _______ ________ centrally active acetylcholinesterase (AChE)

A

reversibly inhibiting

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26
Q

EXELON Patch is a transdermal formulation of which drug?

A

rivastigmine

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27
Q

4 common AE with Central Acetylcholinesterase inhibitors

A

NVD, anorexia

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28
Q

Donepezil, rivastigmine, and galantamine are NOT associated with, which AE?

A

hepatotoxicity

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29
Q

Memantine MOA

A

noncompetitive glutamate receptor (NMDA) antagonist

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30
Q

AE of Memantine

A

Confusion
Dizziness
Drowsiness
Headache
Insomnia

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31
Q

Namzaric is a combination of which two drugs?

A

Memantine ER + donepezil

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32
Q

A new combination of, which two drugs, was shown to reduce emotional liability as noted by decreased outbursts of laughing or crying

A

dextromethorphan and quinidine

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33
Q

ALS is also called

A

Lou Dehrig’s disease

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34
Q

How many people in the US are diagnosed with ALS each year?
How many people are estimated to be living with ALS at any given time?

A

5,000
16,000

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35
Q

Riluzole treats

A

ALS / Lou Gehrig’s

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36
Q

Riluzole MOA

A

glutamate anT

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37
Q

Which channels does Riluzole inactivate?

A

sodium channels

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38
Q

Riluzole AE

A

dizziness
drowsiness
NVD
vertigo

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39
Q

autoimmune disease characterized by the demyelination and axonal damage in the CNS

A

Multiple Sclerosis (MS)

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40
Q

symptoms of MS

A

ataxia
fatigue
pain
spasticity
problems with speech, vision, and bladder function

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41
Q

MS affects more men or women?

A

women, 1 in 200

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42
Q

cytokine in the interferon family, used to tx relapsing-remitting and secondary-progressive forms of MS

A

interferon beta-1b

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43
Q

Dalfampridine blocks which channel and tx which disease?

A

K+
MS

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44
Q

Fingolimod reduces __________ ? to tx MS

A

lymphocyte migration

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45
Q

Mitoxantrone, an antineoplastic agent, treats ?

A

MS

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46
Q

5 treatment options for MS

A

Interferon beta-1b
Dalfampridine
Fingolimod
Mitoxantrone
Prednisone

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47
Q

the most common form of psychosis
characterized by + and - symptoms & impaired cognition

A

schizophrenia

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48
Q

Schizophrenia’s symptoms result from excessive or insufficient neuronal activity in the ____ & ____ neuronal pathways of brain dopamine system

A

mesolimbic, mesocortical

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49
Q

Older ‘typical’ drugs TX Schizophrenia

A

-phenothiazines: Chlorpromazine, Thioridazine, Fluphenazine
-butyrophenone: Haloperidol
-thioxanthene: thiothixene

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50
Q

newer ‘atypical’ antipsychotics: TX schizophrenia

A

Aripiprazole, Clozapine, Olanzapine, Risperidone, Quetiapine

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51
Q

Does typical or Atypical antagonize 5-HT more than D2?

A

atypical

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52
Q

Aripiprazole MOA

A

partial agonist at D2, antagonist at 5-HT

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53
Q

true or false: some atypical antipsychotic drugs have affinity for D3 and D4 receptors

A

true

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54
Q

which two typical antipsychotics are considered low potency?

A

Chlorpromazine & thioridazine

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55
Q

which typical antipsychotic is considered high potency?

A

haloperidol

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56
Q

most common AE of typical antipsychotics

A

EP symp., tardive dyskinesia, hyperproloactinemia

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57
Q

supersensitivity of dopamine receptors, manifestation?

A

tardive dyskinesia

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58
Q

which atypical antipsychotic has AE of:
agranulocytosis and neutropenia?

A

Clozapine

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59
Q

which atypical antipsychotic has AE of:
weight gain + Diabetes

A

Clozapine & Olanzapine

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60
Q

which atypical antipsychotic has AE of:
Hyperprolactinemia

A

risperidone

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61
Q

Which medication requires patients to receive regular blood tests?

A

Clozapine

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62
Q

Potential Drug Interactions of atypical antipsychotics

A

potentiate CNS depressants
block dopamine agonist effects
modify cardiovascular drug effects
Additive effects: sedatives, anticholinergics, antihistaminics & a-adrenergic blockers

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63
Q

true or false: antidepressants act immediately

A

false
1-3 weeks for effect

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64
Q

what class does Sertraline belong to?

A

SSRIs

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65
Q

name the three discussed SSRIs

A

fluoxetine, paroxetine, sertraline

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66
Q

t1/2 of fluoxetine

A

2.5 days
due to active metabolite

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67
Q

therapeutic uses of SSRIs

A

anxiety, depression, OCD, PTSD

68
Q

AE of SSRIs: 4 common, 1 specific to males

A

-dizziness, insomnia, nausea, nervousness
-male sexual dysfunction

69
Q

MOA of venlafaxine

A

SNRI
inhibits reuptake of both 5-HT & NE

70
Q

SNRI MOA

A

Moderately, Selective, Blockade of SERT & NET

71
Q

therapeutic use of SNRIs

A
  1. depression
  2. chronic pain
  3. fibromyalgia
  4. menopausal symptoms
72
Q

which antidepression class can cause cardiac conduction disturbances?

A

SNRI

73
Q

two discussed SNRIs

A

duloxetine
venlafaxine

74
Q

Desipramine, Imipramine, Amitryptyline

A

Tricyclic Antidepressants (TCAs)

75
Q

MOA: TCAs

A

block reuptake of 5-HT &/or NE

76
Q

TCAs are also potent ANTAGONISTS at, which receptors?

A

alpha-adrenergic
cholinergic
histaminergic

77
Q

therapeutic use of TCAs

A

depression
OCD
chronic pain

78
Q

which two classes of Antidepressants can be used for OCD?

A

SSRI, TCA

79
Q

which two classes of Antidepressants can be used for chronic pain?

A

SNRIs, TCAs

80
Q

which medication may have AE of both dry mouth and constipation?
Sertraline
Imipramine
Venlafaxine
Trazodone

A

Imipramine
(TCA - anticholinergic effects due to potent antagonist at cholinergic receptors)

81
Q

name the MAOI

A

Selegline
Phenelzine
Tranylcypromine

82
Q

MOA: selegline

A

inhibit MAO B

83
Q

MOA: phenelzine

A

inhibit MAO A & B

84
Q

MAOI use:

A

2nd option for depression

85
Q

which two antidepressant classes, when taken together, are most likely to cause serotonin syndrome?

A

MAOI & SSRI

86
Q

symptoms of serotonin syndrome

A

muscle rigidity/tremor/myoclonus
hyperthermia
hypertension - tachycardia

87
Q

Hypertensive crisis can occur with:

A

MAOI + sympathomimetic amines
MAOI + food containing Tyramine

88
Q

Trazadone & Nefazodone MOA

A

antagonist at 5-HT2

89
Q

main AE of Trazadone

A

sedation

90
Q

Maprotiline inhibits both: ? –> increases ?

A

NET & DAT
synaptic NE and dopamine (DA)

91
Q

Maprotiline is most common use

A

psychotic depression

92
Q

which medication is a WEAK blocker of DAT, NET, & SERT?

A

bupropion

93
Q

Bupropion MOA at nicotinic cholinergic receptors?

A

noncompetitive antagonist

94
Q

use of bupropion

A

depression
ADHD
smoking cessation

95
Q

Which antidepressant has this MOA:
non-competitive glutamate NMDA antagonist

A

Esketamine
(like memantine)

96
Q

use of Esketamine

A

resistant depression

97
Q

true or false: Maprotiline comes as a nasal spray

A

false, esketamine does
(use nasal spray in conjunction w/ oral - under health care supervision)

98
Q

AE of esketamine

A

sedation & dissociation

99
Q

Which antidepressant must be administered at the medical office in the form of a nasal spray?

A

esketamine

100
Q

When given in combination with SSRI or SNRI, this ingredient of St. John’s Wort can be used off-label for depression

A

Hypericin

101
Q

true or false: men are more likely to be affected by depression than women

A

false
women twice as likely

102
Q

first-line treatment options for anxiety

A

SSRI, SNRI

103
Q

second-line treatment option for anxiety

A

BNZ, Buspirone, Imipramidine, Pregabalin

104
Q

Mood Stabilizing Agents

A

Lithium, Carbamazepine, Valproic Acid

105
Q

mood stabilizing agents are used to treat ?

A

bipolar disorder (manic-depressive illness)

106
Q

MOA: lithium

A

may affect
-ion transport (Na)
-serotonin system
-phosphatidyl inositol (PI) cascade/signaling in brain

107
Q

true or false: lithium has a wide TI

A

false
narrow TI

108
Q

most common AE of Lithium

A

tremor

109
Q

What drug treats tremor caused by lithium?

A

Propranolol

110
Q

What medication has an AE of polyuria and polydipsia?

A

Lithium

111
Q

Which medication is contraindicated in pregnancy, renal disease, and cardiovascular disease?

A

Lithium

112
Q

CNS Stimulants

A

Dextroamphetamine + amphetamine
Dextroamphetamine
Methylphenidate
Modafinil

113
Q

use of CNS stimulants

A

ADHD, Narcolepsy

114
Q

MOA of CNS stimulants

A

increase catecholamines
inhibit dopamine reuptake

115
Q

Which drug class are sympathomimetic agents?

A

CNS stimulants

116
Q

true or false: bradycardia is an AE of methylphenidate?

A

false,
tachycardia

117
Q

true or false: chest pain is an AE of Modafinil?

A

true

118
Q

What are opioids derived from?

A

opium poppy (papaver somniferum)

119
Q

What type of receptor is common to all opioid receptors?

A

G-coupled

120
Q

Which receptor subtype has the greatest affinity from Endorphins?

A

Mu

121
Q

Which receptor subtype has the greatest affinity from Enkephalins?

A

Delta

122
Q

Which receptor subtype has the greatest affinity from Dynorphins?

A

Kappa

123
Q

Mu, Delta, and Kappa opioid receptors all share these two functions

A

spinal analgesia
modulation of hormone & neurotransmitter release

(Delta’s only two functions)

124
Q

Which opioid receptor has functions of sedation and inhibition of respiration?

A

Mu

125
Q

Which opioid receptor has function of psychotomimetic effects?

A

kappa

126
Q

pimary opioid receptor

A

mu

127
Q

Pre-synaptic MOA for opioids

A

close Ca2+
inhibit neurotransmitter release (glutamate, ACh, NE, 5-HT, substance P)

128
Q

Post-synaptic MOA for opioids

A

open K+ –> hyperpolarization –> inhibition of postsynaptic neurons

129
Q

CNS Effects: analgesia

A

reduce pain, sensory & affective (emotional)

130
Q

True or False: sleep is induced more easily in young, healthy individuals than elderly

A

false
more in elderly

131
Q

true or false: Respiratory depression with CNS depressants is dose related

A

true

132
Q

Do opioids cause miosis or mydriasis?

A

miosis

133
Q

true or false: opioids decrease the tone of the large trunk muscles affecting ventilation

A

false, intensify the tone

134
Q

true or false: opioids can cause nausea & vomiting

A

true

135
Q

Do opioids cause an (increase or decrease) in biliary sphincter tone and pressure in the biliary tract?

A

increase

136
Q

Opioids: increase or decrease in renal function?

A

decrease
due to less renal blood flow

137
Q

Why do opioids cause prolongation of labor?

A

decreased uterine tone

138
Q

Which of the following are decreased with opioid use?
ADH
Prolactin release
Luteinizing hormone release

A

Luteinizing hormone release

139
Q

What dermal side effects are seen with opioid use?

A

flushing, itching, rash

140
Q

What opioid is suggested with obstetric labor? Why?

A

meperidine - less respiratory depression

141
Q

Which drug & route would be used for acute pulmonary edema?

A

IV morphine

142
Q

Mechanism for relief of acute pulmonary edema?

A

reduced anxiety
decreased cardiac preload and afterload

143
Q

relating to surgery, opioids are used as…

A

Preanesthetic - before surgery
(sedative, anxiolytic, and analgesic properties)

144
Q

Which effects of opioids have minimal or no degree of tolerance to be developed with use?

A

constipation
convulsions
miosis

145
Q

Which effect of opioids has a moderate degree of tolerance to be developed with use?

A

bradycardia

146
Q

What opioid combination should be avoided?

A

full Agonist + partial agonist

147
Q

What 5 contraindications are there with opioid therapy?

A

Pregnancy
Pulmonary (impaired function)
Head injury
Hepatic (impairment)
Renal (impairment)
Endocrine (disorders)
(Pregnant People’s Heads Have Red Ends)

148
Q

What drug groups are contraindicated with Opioids?

A

Sedative-hypnotics
Antipsychotic tranquilizers

149
Q

What is the concern of taking opioids with sedative-hypnotics?

A

increased respiratory depression

150
Q

What is the concern of taking opioids with antipsych tranquilizers?

A

increased sedative
variable resp.dep.
increased cardiovascular effects

151
Q

true or false: opioids should be used as a rationale for withholding adequate pain control

A

FALSE
SHOULD NOT

152
Q

What medication is used for acute opioid overdose?

A

Naloxone

153
Q

what class is Naloxone?

A

nonselective, short-acting, antagonist
(IM or IV or nasal spray)
(30-60 min duration)

154
Q

What medication is used to prevent relapse in opioid addiction?

A

Naltrexone

155
Q

What drug class is Naltrexone?

A

Selective, long-acting antagonist

156
Q

What is the t1/2 of Naltrexone?

A

10 h

157
Q

What are high-potency opioids?

A

Morphine
Methadone
Meperidine
Fentanyl
Alfentanil
(more meth means fun afternoon)

158
Q

Which high-potency opioid has a duration of action of 2 to 4 hours?

A

Meperidine

159
Q

true or false: fentanyl is 100x more potent than morphine

A

true

160
Q

What high potency opioid is metabolized to an active metabolite?

A

meperidine

161
Q

Which high-potency opioid is used for brief, painful procedures?

A

Alfentanil

162
Q

Which Moderate opioid is low potency?

A

codeine
(cough medicine)

163
Q

Which moderate opioids are moderate potency?

A

hydrocodone, oxycodone

164
Q

What is tramadol used for? risks?

A

Chronic pain
risk of: Serotonin syndrome

165
Q

true or false: mixed agonist-antagonists have greater addictive potential and risk for respiratory depression

A

false

166
Q

Which mixed opioid is not a kappa agonist, only mu agonist?

A

buprenorphine

167
Q

what are the mixed agonist-antagonist opioids?

A

Buprenorphine, Butorphanol, Nalbuphine, Pentazocine

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