psychopharm

Question 1

most potent inhibitor of CYP 450

Answer 1

fluoxetine

Question 2

biggest anesthesia concern with SSRIs

Answer 2

antiplatelet activity! ( inhibition of CYP450 and serotonin syndrome also other concerns)

Question 3

what monoamine does MAO B block

Answer 3

phenyethylamine

Question 4

most common MAOI SE

Answer 4

orthostatic HoTN, especially prominent in the elderly

Question 5

MAOI OD tx

Answer 5

will look like excessive sympathetic discharge- tachy, hyperthermia, mydriasis, sz–>coma. tx supportive, try gastric lavage or dantrolene

Question 6

phenothaizines and thioxanthenes

Answer 6

for generalized anxiety disorder, but takes two weeks to work. non benzo, partial agonist at serotonin receptor. no direct effect on GABA (no cross reactivity with benzo, barbs, ETOH)

Question 7

droperidol metabolism

Answer 7

liver, clearance is perfusion dependent, accumulation of drug with decreased hepatic blood flow

Question 8

drug that causes dysphoria

Answer 8

butyrphenones

Question 9

2nd generation antipsychotics

Answer 9

MOA-antagonize D2 and serotonin receptors, metabolized by CYP450
all can cause extrapyramidial symptoms
risperidone- severe HoTN, active metabolite, zip- prolonged QT, torsaddes, olanzapine- severe HoTN, thrombocytopenia

Question 10

therapeutic and toxic lithium range

Answer 10

therapeutic range: 1-1.2 mEq/L

toxic: 2.5 mEq/L

Question 11

amiloride

Answer 11

drug protective against lithium kidney damage, a potassium sparing diuretic- can decrease urine volume

Question 12

drugs to avoid with lithium

Answer 12

-NSAIDs, esp ketorolac, anesthetic requirements may be decreased esp, CNS agents like benzos, induction agents, action of NMB may be PROLONGED

Question 13

seizure drugs that do not affect CYP450

Answer 13

keppra and gabapentin

Question 14

seizure drugs that induce CYP450

Answer 14

phenobarb, phenytoin, carbamezapine

Question 15

phenytoin administration

Answer 15

precipitates. do not mix with anything or give IM, do not run faster than 50mg/min or 1-3mg/kg/min

Question 16

COMT inhibitors

Answer 16

entacapone, added to sinemet when the effects wane

tolcapone

Question 17

levodopa lab measurements

Answer 17

can cause false positive test for ketoacidosis, transient increase in BUN, increase in liver enzymes

Question 18

decarboxylase inhibitors

Answer 18

carbidopa, benserazide

Question 19

synthetic dopamine agonists

Answer 19

longer 1/2 life than levodopa, no enzymatic conversion required. parlodel (ergot), pramipexole, ropinerole (nonergot)

Question 20

anticholinergics for parkinsons

Answer 20

trihexyphenidyl and benztropine (cogent). help correct balance between Ach and dopamine

Question 21

amantadine

Answer 21

enhances dopamine release into the synapse and delays reuptake into the nerve endings, an antiviral drug

Question 22

alzheimers disease patho

Answer 22

deficits in cholinergic signaling and cholinergic neuron loss in hippocampus and frontal cortex (executive functioning). decreases in choline acetyltransferase, Ach, acetyllcholinesterase, choline transport, NaCh receptor expression, amyloid plaques, neurofibrillary tangles

Question 23

alzheimers 2 drug classes

Answer 23

cholinesterase inhibitors, NMDA receptor antagonists