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PHRM > ✅Sedative Hypnotic, Neuroleptics, Antidepressants > Flashcards

✅Sedative Hypnotic, Neuroleptics, Antidepressants Flashcards

1
Q

Which drugs are considered date rape drugs?

A

Alcohol (most common)
Flunitrazepam (rohypnol)
Gamma-hydroxybutyrate

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2
Q

Moa of benzodiazepines

A

Gaba A binding to increase freq of chloride channel opening; membrane hyperpolarization

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3
Q

Usual side effect of benzodiazepines

A

Anterograde amnesia

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4
Q

Which benzodiazepine has the longest half life?

A

Chlordiazepoxide

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5
Q

Benzodiazepines and ____ usually cause additive CNS depression

A

Ethanol

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6
Q

Name the preferred benzodiazepine in the following clinical setting:

Anticonvulsant maintenance

A

Clonazepam

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7
Q

Name the preferred benzodiazepine in the following clinical setting:

Status epilepticus

A

Lorazepam, diazepam

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8
Q

Name the preferred benzodiazepine in the following clinical setting:

Skeletal muscle relaxation (cerebral palsy)

A

Diazepam

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9
Q

Name the preferred benzodiazepine in the following clinical setting:

Panic disorders, phobias

A

Alprazolam, clonazepam

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10
Q

Name the preferred benzodiazepine in the following clinical setting:

Insomnia

A

Estazolam, flurazepam, triazolam

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11
Q

Name the preferred benzodiazepine in the following clinical setting:

Anesthesia induction

A

Midazolam, diazepam

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12
Q

Name the preferred benzodiazepine in the following clinical setting:

Bipolar disorder

A

Clonazepam

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13
Q

Name the preferred benzodiazepine in the following clinical setting:

Alcohol withdrawal

A

Chlordiazepoxide, diazepam

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14
Q

Do we use activated charcoal in benzodiazepine poisoning?

A

No. Antidote is flumazenil.

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15
Q

Toxic dose of benzodiazepine is ____x the therepeutic dose

A

1000x

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16
Q

MOA of flumazenil

A

Antagonist at benzodiazepine sites on GABA-A receptor

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17
Q

_____ may occur when flumazenil is administered in a patient who took both TCAs and benzodiazepines

A

Seizures and arrhythmias

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18
Q

Intermediate acting benzodiazepine

A

Lorazepam

Alprazolam
Clonazepam
Estazolam
Lormetazepam
Nitrazepam
Temazepan
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19
Q

Long acting benzodiazepine

A

Diazepam

Chlorazepate
Chlordiazepoxise
Flurazepam
Quazepam
Flunitrazepam
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20
Q

Ultrashort acting barbiturate

A

Thiopental

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21
Q

Similar drugs as with thiopental

A

Methohexital

Thiamylal

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22
Q

Moa of barbiturates

A

Bind to GABA A receptor sites (distinct from benzodiazepines); increases duration of chloride channel opening

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23
Q

Uses of thiopental

A 
Anesthesia induction
Increased ICP (dec cerebral blood flow)
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24
Q

Common side effect of barbiturates

A

Tolerance
Extension of CNS depressant action
Acute intermittent PORPHYRIA

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25
Q

Short and intermediate acting barbiturate

A

Pentobarbital

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26
Q

Uses of pentobarbital

A

Insomia, preoperative sedation

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27
Q

All barbiturates are CYP ____

A

Inducers

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28
Q

Long acting barbiturate

A

Phenobarbital

Mephobarbital
Primidone

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29
Q

Aside from seizure disorders, insomnia, abd status epilepticus, phenobarbital is also used for this disorder. Explain the MOA

A

Hyperbilirubinemias (Gilbert syndrome)

Increase hepatic transport of bile

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30
Q

What enzyme is deficient in acute intermittent porphyria?

A

HMB synthase (uroporphinogen 1)

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31
Q

What is the most catastrophic symptom of sedative hypnotic withdrawal?

A

Rebound suicide

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32
Q

What new hypnotic is user mainly for insomnia only

A

Zolpidem

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33
Q

What drug class is zolpidem in

A

Imidazopyridine

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34
Q

What is the MOA of zolpidem?

A

Bind selectively to a subgroup of GABA-a receptors, acting like benzodiazepines to enhance membrane hyperpolarization

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35
Q

What is unique with zolpidem making it specific only for insomnia?

A

It lacks anti convulsant, anti anxiety and muscle relaxant effects

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36
Q

Effects of zolpidem can be reveresed by?

A

Flumazenil

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37
Q

Anxiolytic drug used for GAD

A

Buspirone

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38
Q

Moa of buspirone

A

Partial agonist at 5Ht1 receptor and possibly D2

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39
Q

What is the notable side effect of buspirone and why is it not popular for usage?

A

It takes 1 week to take effect

SE: nonspecific chest pain, tachycardia, palpitations

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40
Q

Typical antipsychotics are divided into

A

Phenothiazines
Thioxanthenes
Butyrophenones

Mnemonic: PTB

41
Q

MOA of classic antipsychotic drugs

A

Bloackade of brain dopamine receptors especially D2

42
Q

How many dopamine receptors are there?

A

D1-5

43
Q

Dopamine agonist drugs has this effect on schizophrenia

A

Exacerbation of schiz

44
Q

The nucleus accumbens is important for

A

Addiction

45
Q

All antipsychotics reduce the _____ symptoms of schiz

A

Positive

46
Q

Atypical antipsychotics

A

Heterocyclics

Clozapine
Loxapine
Olanzapine
Risperidone
Quetuapine
Ziprasidone
Aripiprazole
47
Q

Ex of phenothiazines (typical antipsychotic)

A

Chlorpromazine
Thioridazine
Fluphenazine

48
Q

Ex of thioxanthenes (typical antipsychotic)

A

Thiothexene

49
Q

Haloperidol is an example of a

A

Butyrophenone (typical antipsychotic)

50
Q

Atypical antipsychotics are reported to improve some of the ____sx of schiz

A

Negative

51
Q

Endocrine toxicity of antipsychotics

A

Hyperprolactinemia

52
Q

Dopaminergic tracts in schiz

A 
Mesocortical-mesolimbic
Nigrostriatal
Tuberoinfundibular
Medullary-periventricular
Incertohypothalamic
53
Q

Dopaminergic tract responsible for anyicipatory motivational phase of copulatory behavior

A

Incertohypothalamic

54
Q

Dopaminergic tract responsible for eating behavior

A

Medullary-periventricular

55
Q

Treatment for Neuroleptic induced acute dystonia

A

Diphenhydramine

56
Q

Treatment for neuroleptic induced parkinsonism and rabbit syndrome

A

Benztropine

57
Q

____ commonly occurs with atypical neuroleptics while _____ with typical

A

Weight gain

Tremors

58
Q

MOA of atypical antipsychotics

A

Blockade or 5HT2 receptors more than D2

59
Q

____ deposits are usually seen as a sidr effect of chlorpromazine while ___ deposits are seen in thioridazine

A

Corneal and lens

Retinal

60
Q

Only antipsychotic with fatal overdose

A

Thioridazine

61
Q

Typical antipsychotic with major extrapyrimadial dysfunction and NMS as side effect.

A

Haloperidol

62
Q

Typical antipsychotic with strongest autonomic effect

A

Thioridazine

63
Q

Typical antipsychotic with weakest autonomic effect

A

Haloperidol

64
Q

Only atypical antipsychotic that reduces the risk of suicide

A

Clozapine

65
Q

Main side effect of clozapine

A

Agranulocytosis

66
Q

What are the features of neuroleptic malignant syndrome?

A

Mnemonic: FEVER

Fever
Encep
Vitals unstable
Elevated CPK
Rigidity
67
Q

Atypical antipsychotic that causes weight gain, hyperglycemia, hyperlipidemia

A

Olanzapine

68
Q

Atypical antipsychotic with somnolence, fatigue, sleep paralysis and hypnagogic hallucinations, cataracts and priapism

A

Quetiapine

69
Q

Atypical antipsychotic that is best for elderly bec of less sedative effects

A

Risperidone

70
Q

Only antipsychotic aprrived for schiz of the youth

A

Risperidone

71
Q

SE of risperidone

A

Hyperprolactinemia

Photosensitivity

72
Q

Notable SE of ziprasidone

A 
Postural hypotension
QT prolongation (TDP)
73
Q

Least sedating atypical antipsychotic

A

Aripiprazole

74
Q

One stop drug - typical antipsychotic called haloperidol. Aside from schiz, what diseases can it be used for?

A

Huntingtons
Parkinsons
Acute psychotic episodr

75
Q

Monotherapy with antidepressants in bipolar can precipitate ______

A

Manic episode

76
Q

Lithium is a teratogen because it causes

A

Ebstein’s anomaly

77
Q

Lithium is contraindicated in

A

Sick sinus syndrome

78
Q

Overdose with lithium is treated by

A

Hemodalysis

79
Q

Treshold for lithium toxicity is

A

2 meq/L

80
Q

What is the main hypothesis for mood that is used as basis to treat depression?

A

Amine hypothesis

NE and serotonin are neurotransmitters that function in the pathway of mood

81
Q

Major classifications of antidepressants

A 
TCAs
SSRI
SNRI
Serotonin receptor antagonist
Heterocyclic antidepressants
82
Q

Ex of TCAs

A

Imipramine, amitryptiline

83
Q

Ex of SSRIs

A

Fluoxetine, escitalopram, paroxetine, sertraline

84
Q

Ex of SNRIs

A

Duloxetine, venlafaxine

85
Q

Ex of MAOIs

A

Phenelzine
Selegiline
Tranylcypromine

86
Q

MOA of imipramine

A

Blocks NE and serotonin transporters

87
Q

Imipramine is used in MDD and what other pertinent indication?

A

Enuresis especially in children

88
Q

Notable in TCA overdose

A

Abnormal QRS complexes morphology
Prolonged QRS duration
Abnormal size and ratio of R and S waves in AVR

89
Q

What are the features of TCA overdose?

A

3 Cs of TCA overdose

Coma
Convulsions
Cardiotoxicity

90
Q

Treatment of TCA overdose

A

Supportive measures accdg to symptoms

Administration of bicarbonate (reverses cardiotoxicity)

91
Q

First line in the treatment of MDD

A 
Fluoxetine
Paroxetine
Escitalopram
Sertraline
Fluvoxamine
92
Q

SNRI with QT prolongation

A

Citalopram

93
Q

Fluoxetine when used with maois can precipitate

A

Seritonin syndrome

94
Q

What are the drugs that cause erectile dysfunction?

A

A SORE PEnis cant Fuck Hard

SSRIs
Opiates
Risperidone
Ethanol
Propanolol
Estrogens
Spirinolactone
Finasteride
HCTZ
95
Q

Which SNRI can cause hypertension?

A

Venlafaxine

96
Q

Which SNRI can cause hepatotoxicity?

A

Duloxetine

97
Q

Which serotonin receptor antagonist can cause priapism and which caused hepatotoxicity?

A

Trazodone

Nefazodone

98
Q

What drugs can cause priapism?

A 
Trazodone
Papaverine
Sildenafil
Quetiapine
Alprostadil
Warfarin
Bupropion
99
Q

What are the features of serotonin syndrome?

A

FAT CHD

Fever
Agitation
Tremor
Clonus
Hyperreflexia
Diaphoresis

PHRM (14 decks)

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