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
2
Q
Approximately # Americans and # individuals globally are affected by Huntington’s disease.
A
30,000
80,000
3
Q
T/F: Huntington’s is more common in males.
A
False, affects both sexes equally
4
Q
Typical disease onset in Huntington’s disease
A
30 - 50 years old
5
Q
Huntington’s is most prevalent in, which two countries?
A
Europe and North America
6
Q
Cause of Huntington’s disease
A
The Huntington protein is expressed in higher concentration in the brain
7
Q
What happens to GABA and Dopaminergic function in Huntington’s disease?
A
GABA = diminished, Dopaminergic = enhanced
8
Q
What are the 3 main characteristics of Huntington’s disease?
A
- Abnormally choreoathetoid movements (dancelike movements) of limbs
- Rhythmic movements of the tongue and face
- Mental deterioration (psychosis and dementia)
9
Q
Only drug approved for chorea in Huntington’s disease
A
Tetrabenazine
10
Q
Tetrabenazine is known as a ________ depletor
A
monoamine
11
Q
Tetrabenazine believes to act as a __________ of the _____(receptor)_____
A
reversible inhibitor; VMAT2
12
Q
net result of Tetrabenazine
A
reduce dopamine release from nerve terminals
13
Q
AE of Tetrabenazine
A
- Drowsiness / Sedation / Fatigue / Insomnia
- Hypotension
- Extrapyramidal reaction
- anxiety
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
15
Q
Gradually progressive dementia affecting cognition, behavior, and functional status - no cure exists
A
Alzheimer’s disease
16
Q
Approximately # Americans have Alzheimer’s and by 2050 projected #
A
5.4 million
13.2 million
17
Q
T/F: cognitive decline is gradual over the course of Alzheimer’s
A
true
18
Q
T/F: Alzheimer’s is fatal
A
true
19
Q
What two components are considered the pathologic hallmarks of A.D.?
A
Amyloid plaques, Neurofibrillary tangles
20
Q
Amyloid plaques are extracellular accumulations of, what?
A
A beta protein
21
Q
Intracellular component composed of the microtubule-associated protein Tau
A
neurofibrillary tangles
22
Q
Aggregation of ________ is an important event in Alzheimer’s pathogenesis.
A
A beta
23
Q
3 Main symptoms of Alzheimer’s
A
- Memory loss
- Aphasia
- Apraxia
24
Q
Donepezil, Rivastigmine, and Galantamine are are drugs used to treat…. ?
A
Alzheimer’s disease
25
Donepezil, Rivastigmine, and Galantamine work by _______ ________ centrally active acetylcholinesterase (AChE)
reversibly inhibiting
26
EXELON Patch is a transdermal formulation of which drug?
rivastigmine
27
4 common AE with Central Acetylcholinesterase inhibitors
NVD, anorexia
28
Donepezil, rivastigmine, and galantamine are NOT associated with, which AE?
hepatotoxicity
29
Memantine MOA
noncompetitive glutamate receptor (NMDA) antagonist
30
AE of Memantine
Confusion
Dizziness
Drowsiness
Headache
Insomnia
31
Namzaric is a combination of which two drugs?
Memantine ER + donepezil
32
A new combination of, which two drugs, was shown to reduce emotional liability as noted by decreased outbursts of laughing or crying
dextromethorphan and quinidine
33
ALS is also called
Lou Dehrig's disease
34
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?
5,000
16,000
35
Riluzole treats
ALS / Lou Gehrig's
36
Riluzole MOA
glutamate anT
37
Which channels does Riluzole inactivate?
sodium channels
38
Riluzole AE
dizziness
drowsiness
NVD
vertigo
39
autoimmune disease characterized by the demyelination and axonal damage in the CNS
Multiple Sclerosis (MS)
40
symptoms of MS
ataxia
fatigue
pain
spasticity
problems with speech, vision, and bladder function
41
MS affects more men or women?
women, 1 in 200
42
cytokine in the interferon family, used to tx relapsing-remitting and secondary-progressive forms of MS
interferon beta-1b
43
Dalfampridine blocks which channel and tx which disease?
K+
MS
44
Fingolimod reduces __________ ? to tx MS
lymphocyte migration
45
Mitoxantrone, an antineoplastic agent, treats ?
MS
46
5 treatment options for MS
Interferon beta-1b
Dalfampridine
Fingolimod
Mitoxantrone
Prednisone
47
the most common form of psychosis
characterized by + and - symptoms & impaired cognition
schizophrenia
48
Schizophrenia's symptoms result from excessive or insufficient neuronal activity in the ____ & ____ neuronal pathways of brain dopamine system
mesolimbic, mesocortical
49
Older 'typical' drugs TX Schizophrenia
-phenothiazines: Chlorpromazine, Thioridazine, Fluphenazine
-butyrophenone: Haloperidol
-thioxanthene: thiothixene
50
newer 'atypical' antipsychotics: TX schizophrenia
Aripiprazole, Clozapine, Olanzapine, Risperidone, Quetiapine
51
Does typical or Atypical antagonize 5-HT more than D2?
atypical
52
Aripiprazole MOA
partial agonist at D2, antagonist at 5-HT
53
true or false: some atypical antipsychotic drugs have affinity for D3 and D4 receptors
true
54
which two typical antipsychotics are considered low potency?
Chlorpromazine & thioridazine
55
which typical antipsychotic is considered high potency?
haloperidol
56
most common AE of typical antipsychotics
EP symp., tardive dyskinesia, hyperproloactinemia
57
supersensitivity of dopamine receptors, manifestation?
tardive dyskinesia
58
which atypical antipsychotic has AE of:
agranulocytosis and neutropenia?
Clozapine
59
which atypical antipsychotic has AE of:
weight gain + Diabetes
Clozapine & Olanzapine
60
which atypical antipsychotic has AE of:
Hyperprolactinemia
risperidone
61
Which medication requires patients to receive regular blood tests?
Clozapine
62
Potential Drug Interactions of atypical antipsychotics
potentiate CNS depressants
block dopamine agonist effects
modify cardiovascular drug effects
Additive effects: sedatives, anticholinergics, antihistaminics & a-adrenergic blockers
63
true or false: antidepressants act immediately
false
1-3 weeks for effect
64
what class does Sertraline belong to?
SSRIs
65
name the three discussed SSRIs
fluoxetine, paroxetine, sertraline
66
t1/2 of fluoxetine
2.5 days
due to active metabolite
67
therapeutic uses of SSRIs
anxiety, depression, OCD, PTSD
68
AE of SSRIs: 4 common, 1 specific to males
-dizziness, insomnia, nausea, nervousness
-male sexual dysfunction
69
MOA of venlafaxine
SNRI
inhibits reuptake of both 5-HT & NE
70
SNRI MOA
Moderately, Selective, Blockade of SERT & NET
71
therapeutic use of SNRIs
1. depression
2. chronic pain
3. fibromyalgia
4. menopausal symptoms
72
which antidepression class can cause cardiac conduction disturbances?
SNRI
73
two discussed SNRIs
duloxetine
venlafaxine
74
Desipramine, Imipramine, Amitryptyline
Tricyclic Antidepressants (TCAs)
75
MOA: TCAs
block reuptake of 5-HT &/or NE
76
TCAs are also potent ANTAGONISTS at, which receptors?
alpha-adrenergic
cholinergic
histaminergic
77
therapeutic use of TCAs
depression
OCD
chronic pain
78
which two classes of Antidepressants can be used for OCD?
SSRI, TCA
79
which two classes of Antidepressants can be used for chronic pain?
SNRIs, TCAs
80
which medication may have AE of both dry mouth and constipation?
Sertraline
Imipramine
Venlafaxine
Trazodone
Imipramine
(TCA - anticholinergic effects due to potent antagonist at cholinergic receptors)
81
name the MAOI
Selegline
Phenelzine
Tranylcypromine
82
MOA: selegline
inhibit MAO B
83
MOA: phenelzine
inhibit MAO A & B
84
MAOI use:
2nd option for depression
85
which two antidepressant classes, when taken together, are most likely to cause serotonin syndrome?
MAOI & SSRI
86
symptoms of serotonin syndrome
muscle rigidity/tremor/myoclonus
hyperthermia
hypertension - tachycardia
87
Hypertensive crisis can occur with:
MAOI + sympathomimetic amines
MAOI + food containing Tyramine
88
Trazadone & Nefazodone MOA
antagonist at 5-HT2
89
main AE of Trazadone
sedation
90
Maprotiline inhibits both: ? --> increases ?
NET & DAT
synaptic NE and dopamine (DA)
91
Maprotiline is most common use
psychotic depression
92
which medication is a WEAK blocker of DAT, NET, & SERT?
bupropion
93
Bupropion MOA at nicotinic cholinergic receptors?
noncompetitive antagonist
94
use of bupropion
depression
ADHD
smoking cessation
95
Which antidepressant has this MOA:
non-competitive glutamate NMDA antagonist
Esketamine
(like memantine)
96
use of Esketamine
resistant depression
97
true or false: Maprotiline comes as a nasal spray
false, esketamine does
(use nasal spray in conjunction w/ oral - under health care supervision)
98
AE of esketamine
sedation & dissociation
99
Which antidepressant must be administered at the medical office in the form of a nasal spray?
esketamine
100
When given in combination with SSRI or SNRI, this ingredient of St. John's Wort can be used off-label for depression
Hypericin
101
true or false: men are more likely to be affected by depression than women
false
women twice as likely
102
first-line treatment options for anxiety
SSRI, SNRI
103
second-line treatment option for anxiety
BNZ, Buspirone, Imipramidine, Pregabalin
104
Mood Stabilizing Agents
Lithium, Carbamazepine, Valproic Acid
105
mood stabilizing agents are used to treat ?
bipolar disorder (manic-depressive illness)
106
MOA: lithium
may affect
-ion transport (Na)
-serotonin system
-phosphatidyl inositol (PI) cascade/signaling in brain
107
true or false: lithium has a wide TI
false
narrow TI
108
most common AE of Lithium
tremor
109
What drug treats tremor caused by lithium?
Propranolol
110
What medication has an AE of polyuria and polydipsia?
Lithium
111
Which medication is contraindicated in pregnancy, renal disease, and cardiovascular disease?
Lithium
112
CNS Stimulants
Dextroamphetamine + amphetamine
Dextroamphetamine
Methylphenidate
Modafinil
113
use of CNS stimulants
ADHD, Narcolepsy
114
MOA of CNS stimulants
increase catecholamines
inhibit dopamine reuptake
115
Which drug class are sympathomimetic agents?
CNS stimulants
116
true or false: bradycardia is an AE of methylphenidate?
false,
tachycardia
117
true or false: chest pain is an AE of Modafinil?
true
118
What are opioids derived from?
opium poppy (papaver somniferum)
119
What type of receptor is common to all opioid receptors?
G-coupled
120
Which receptor subtype has the greatest affinity from Endorphins?
Mu
121
Which receptor subtype has the greatest affinity from Enkephalins?
Delta
122
Which receptor subtype has the greatest affinity from Dynorphins?
Kappa
123
Mu, Delta, and Kappa opioid receptors all share these two functions
spinal analgesia
modulation of hormone & neurotransmitter release
(Delta's only two functions)
124
Which opioid receptor has functions of sedation and inhibition of respiration?
Mu
125
Which opioid receptor has function of psychotomimetic effects?
kappa
126
pimary opioid receptor
mu
127
Pre-synaptic MOA for opioids
close Ca2+
inhibit neurotransmitter release (glutamate, ACh, NE, 5-HT, substance P)
128
Post-synaptic MOA for opioids
open K+ --> hyperpolarization --> inhibition of postsynaptic neurons
129
CNS Effects: analgesia
reduce pain, sensory & affective (emotional)
130
True or False: sleep is induced more easily in young, healthy individuals than elderly
false
more in elderly
131
true or false: Respiratory depression with CNS depressants is dose related
true
132
Do opioids cause miosis or mydriasis?
miosis
133
true or false: opioids decrease the tone of the large trunk muscles affecting ventilation
false, intensify the tone
134
true or false: opioids can cause nausea & vomiting
true
135
Do opioids cause an (increase or decrease) in biliary sphincter tone and pressure in the biliary tract?
increase
136
Opioids: increase or decrease in renal function?
decrease
due to less renal blood flow
137
Why do opioids cause prolongation of labor?
decreased uterine tone
138
Which of the following are decreased with opioid use?
ADH
Prolactin release
Luteinizing hormone release
Luteinizing hormone release
139
What dermal side effects are seen with opioid use?
flushing, itching, rash
140
What opioid is suggested with obstetric labor? Why?
meperidine - less respiratory depression
141
Which drug & route would be used for acute pulmonary edema?
IV morphine
142
Mechanism for relief of acute pulmonary edema?
reduced anxiety
decreased cardiac preload and afterload
143
relating to surgery, opioids are used as...
Preanesthetic - before surgery
(sedative, anxiolytic, and analgesic properties)
144
Which effects of opioids have minimal or no degree of tolerance to be developed with use?
constipation
convulsions
miosis
145
Which effect of opioids has a moderate degree of tolerance to be developed with use?
bradycardia
146
What opioid combination should be avoided?
full Agonist + partial agonist
147
What 5 contraindications are there with opioid therapy?
Pregnancy
Pulmonary (impaired function)
Head injury
Hepatic (impairment)
Renal (impairment)
Endocrine (disorders)
(Pregnant People's Heads Have Red Ends)
148
What drug groups are contraindicated with Opioids?
Sedative-hypnotics
Antipsychotic tranquilizers
149
What is the concern of taking opioids with sedative-hypnotics?
increased respiratory depression
150
What is the concern of taking opioids with antipsych tranquilizers?
increased sedative
variable resp.dep.
increased cardiovascular effects
151
true or false: opioids should be used as a rationale for withholding adequate pain control
FALSE
SHOULD NOT
152
What medication is used for acute opioid overdose?
Naloxone
153
what class is Naloxone?
nonselective, short-acting, antagonist
(IM or IV or nasal spray)
(30-60 min duration)
154
What medication is used to prevent relapse in opioid addiction?
Naltrexone
155
What drug class is Naltrexone?
Selective, long-acting antagonist
156
What is the t1/2 of Naltrexone?
10 h
157
What are high-potency opioids?
Morphine
Methadone
Meperidine
Fentanyl
Alfentanil
(more meth means fun afternoon)
158
Which high-potency opioid has a duration of action of 2 to 4 hours?
Meperidine
159
true or false: fentanyl is 100x more potent than morphine
true
160
What high potency opioid is metabolized to an active metabolite?
meperidine
161
Which high-potency opioid is used for brief, painful procedures?
Alfentanil
162
Which Moderate opioid is low potency?
codeine
(cough medicine)
163
Which moderate opioids are moderate potency?
hydrocodone, oxycodone
164
What is tramadol used for? risks?
Chronic pain
risk of: Serotonin syndrome
165
true or false: mixed agonist-antagonists have greater addictive potential and risk for respiratory depression
false
166
Which mixed opioid is not a kappa agonist, only mu agonist?
buprenorphine
167
what are the mixed agonist-antagonist opioids?
Buprenorphine, Butorphanol, Nalbuphine, Pentazocine
