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NMSP > Test 1 > Flashcards

Test 1 Flashcards

1
Q

Deprescribing Anti-Depressives

A 
"Titration" 
Helps Avoid Withdrawal like Symptoms
-Flu like Symptoms
-Insomnia
-Nausea
-Poor Balance
-Sensory Disturbance
-Hyperarousal
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2
Q

Bupropion

A

Treats Nicotine Withdrawal

NDRI

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3
Q

Imipramine

A

Treats Enuresis

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4
Q

Duloxetine

A

Treats: Diabetic Neuropathy, Fibromyalgia, MSK pain, stress incontinence
-SNRI

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5
Q

What is an anti-depressant that treats stress incontinence?

A

Duloxetine

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6
Q

Fluvoxamine

A

SSRI only for OCD

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7
Q

Amoxapine

A

SSNRI+ Dopamine Antagonis

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8
Q

SARAs (Sertonin Adrenergic Receptor Antagonist)

A

Nefazodone
Trazodone
Mirtazapine

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9
Q

MAOI

A

Isoscarboxazid
Phenelzine
Segeline
Trancyclopromine

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10
Q

NDRI (Nadi/DA reuptake inhibitor)

A

Bupropion
enhanced pre-synaptic release of NE and DA via VMAT
selectively inhibits pre-synaptic reuptake of NE via NET and DA via DAT

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11
Q

SSRIs

A 
Citalopram
Escitalopram
Sertiline
Fluoxetine
Paroxetine
Valazodone
Vortioxetine

less impact on histamine/ muscarinic/ adrinergic receptors

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12
Q

SNRIs

A 
TCAs
Desvenlafaxine
Duloxtine
Venalfaxine
Lenomilnacipran
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13
Q

SSRI MOA

A

inhibit presynaptic re-uptake of serotonin via SERT

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14
Q

SSRI Side effects

A 
sexual dysfunction
CNS sedation/insomnia
withdrawal rxns
QT Prolongation
Hyponatremia (esp in old people)
Sertonin Syndrome
Suicidality esp in young adults
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15
Q

Why should you be very cautious giving SSRIs to old people?

A

Risk of hyponatremia

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16
Q

Serotonin Syndrome

A

Sweating, Hyperreflexia***, Myoclonus, Tremors, Dilated pupils, hyperactive bowel sounds

-HTN, Tachycardia, Tachypnea, Hyperthermia

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17
Q

Neuroepileptic Malignant Syndrome

A

-HTN, Tachycardia, Tachypnea, Hyperthermia

hyporeflexia***, normal pupils, normal bowel sounds

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18
Q

Why should you be cautious with using opioids and antidepressants?

A

Increased risk of serotonin syndrome

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19
Q

Fluoxetine

A

broad and strong inhibitor of CYP (most powerful)

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20
Q

Least CYP inhibition form SSRI

A

Vortioxetine

Escitalopram

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21
Q

secondary amines

A

amoxapine
desipramine
nortriptyline

inhibit NE>5HT

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22
Q

Tertiary amines

A

Amytriptyline
Clomipramine
Doxepin
Imipramine

generally inhibit NE and 5HT equally except clomipramine and amytriptyiline

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23
Q

What is unique about Amitriptyline and Clomipramine?

A

Tertiary amines that inhibit 5HT more than NE

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24
Q

TCAs

A 
amitriptline
clomipramine
doxepine
imipramine
amoxapine
desipramine
Nortriptyline

**Blocks other receptors (histamine, muscarinic, adrinergic)

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25
Q

Side effects of TCAs

A 
Tachycardia
Orthostatic hypotension
Dysrythmia
Dry mouth
Urinary Retention
Blurred Vision
Sedation/Fatigue
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26
Q

TCA overdose

A

coma, cardiotoxicity, convulsions

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27
Q

TCA effects in cardio cells

A

slows conductions
changes QRS
blocks sodium channels
(quinedien like)

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28
Q

Non-TCA SNRI

A

Desvenlafaxine,
Duloxetine
Venlafaxine
Levomilnacipran

*less risk of sexual dysfunction

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29
Q

Mirtazapine

A

Blocks alpha 2 receptors on NE and 5-HT presynaptically and blocks post-synaptic 5-HT 2/3

  • No SERT/NET actvity
  • *H1 blockade (Sedation)

**weight gain

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30
Q

Nefazodone & Trazodone

A

**H1 blockade (sedation)
block post-synaptic alpha one receptor and post synaptic 5-HT2
Orthostatic Hypotension

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31
Q

NDRI side effects

A 
Stimulating
Agitation/Insomnia
HTN, Tachycardia
Weight loss
Seizures
32
Q

MAOI MOA

A

Increase level of monoamines in neuronal vesicles to increase serotonin, 5-HT, and DA released
-Oral—>irreversible
(non-selective except segeline)

33
Q

Segeline

A

MAOI
transdermal patch
selective at low doses
non-selective MAOa in GI inhibits Tyramine metabolism

34
Q

MAOI Side Effects

A 
Orthostatic hypotension
Sexual dysfunction
Insomnia/Agitation
Drug interactions (SSRIS, TCA)--->2 week washout
**Risk of HTN crisis
risk of serotonin syndrome
35
Q

What is the major concern with MAOI?

A

Hypertensive Crisis due to increased tyramine

36
Q

Why is Tyramine of Concern?

A

causes a HTN crisis
levels increased with MAOA (when inhibited by MAOI)
age cheese, soy, beer

37
Q

Esketamine

A

NMDA (glutamate) antagonist
treatment resistant depression
Nasal Spray
–must watch for 2 hours post

38
Q

Brexanolone

A

GABA allosteric modulator (endogenous to allopregnenalone)
indicated for post partum depression
60 hour IV infusion

39
Q

Mood Stabilizers (Anti-seizure meds)

A

Carbamazepine
Lamotrigine
Valporic Acid

40
Q

Lithium

A 
Mood stabilizer
-neuroprotective
-neuroproliferative
Inhibits dopamine neurotransmission
downregulates NMDA
**increases GABA levels in CSF
handled by kidneys like sodium 
**narrow therapeutic index
41
Q

Lithium Side Effects

A

Polyuria like Diabetes Insipidus

tremor
goiters
serotonin syndrome

42
Q

Lithium Drug Interactions

A

Diuretics
ACE inhibitors
NSAIDS

43
Q

Lithium Therapeutic Index

A

Narrow

0.6-1.2 mEq/L

44
Q

Indications for Lithium

A
  • acute& maintance of bipolar 1/ mania
  • reduced risk of suicide
  • augment unipolar depressive treatment with poor response
45
Q

Carbamazpiene

A

major CYP inducer

acute and maintance of Bipolar 1

46
Q

Lamotrigine

A

maintance of bipolar 1 and 2

antiseizures

47
Q

Valporic Acid

A

acute bipolar 1

48
Q

Flumazenil

A

Benzodiazapene antagonist esp if benzo overdose

associated with seizures

49
Q

Long Acting Barbiturates

A

Phenobarbital

50
Q

Short Acting Barbiturates

A

Secobarbital

51
Q

Ultra-Short Acting Barbiturate

A

Thiopental

52
Q

Sedatives

A

Drug that decreases CNS activity, moderates excitement, and calms recipient
-Anxiolytic

53
Q

Hypnotic

A

Drug that produces drowsiness and facilitates onset and maintenance of sleep
-More pronounced CNS depression

54
Q

Benzodiazapines

A

acts on Gaba A receptor enhances Gaba activity
—hyperpolarization with CL- influx
(sedation and hypnotic effects, relaxation, anxiolytic, anticonvulsant)
-wide distribution throughout body: breast milk
-dependence and tolerance
-“LAMS and “PAMS”
-high therapeautic index
-cumulative toxicity

55
Q

Barbiturates

A

acts on GabaA receptor
widely distributed throughout the body (placenta/breastmilk)
-mild sedation and anesthsia

-treats seizures, insomnia, tension HA with acetominophen and caffeine
can counteract the effects of stimulants
induces CYP450

56
Q

Contraindications to Diazepam

A

Myasthenia Gravis
Respiratory Insuffiency
Hepatic 3 Insufficiency
Sleep Apnea Syndrome

**don’t use with alcohol or other CNS depressant

57
Q

Alprazolam

A 
CYP3A
-management of anxiety disorders
-panic disorder
CI: acute narrow angle glaucoma, ketoconazole, itraconazole
Dependence & withdrawal: seizures
58
Q

Midazolam

A

given IM or IV
pre-op anxiolytic/ sedation/ amnesia
given before other anesthesia
BBW: respiratory depression

59
Q

Diazepam

A

anxiolytic, sedative, muscle relaxant, anticonvulsant
prolonged half life: 48 hours (increased in cirrhosis)
active metabolite
-rapid rate of oral onset
–management of anxiety disorders
–treat for acute alcohol withdrawal syndrome

60
Q

Triazolam

A

short term treatment of insomnia

BBW: profound sedation, respiratory depression, coma, death

61
Q

Chlordiazepoxide

A

BENZODIAZEPINE

  • pre-op apprehension/anxiety
  • short relief of anxiety
  • withdrawal symptom of alcoholism

BBW: sedation, respiratory depression, coma, death esp with opiods

62
Q

Lorazepam

A

Treatment of seizure disorder**

pre-op anxiety

63
Q

Flurazepam

A

long acting hypnotic for insomnia treatment

64
Q

Thiopental

A

ultrashort acting barbiturate

  • IV only
  • used for brief procedures
  • first anesthesia given before “big anesthesia”
  • controls anesthesia induced convulsions
  • decreases intracranial pressure

AE: cardiac arrythmias, laryngospasm, bronchospasm

65
Q

Secobarbital

A

preanesthetic

**short term treatment for insomnia (loss of effect after 2 weeks)

66
Q

Secobarbital Contraindications

A 
latent porphyria
impaired liver functions test
respiratory disease (obstruction/dyspnea)
67
Q

Phenobarbital Cautions

A

depressed patients with/without suicidal ideations

68
Q

Phenobarbital

A

used as sedative/hypnotic

Induces liver enzymes****

69
Q

Phenobarbital Contraindications

A

latent porphyria

70
Q

Good insomnia drugs

A 
Zolpidem (sustained sleep maintenance)
Zalpelon
Ezopicalone
-CYP3A4
-Short half life
-binds alpha 1 subunit of GABAa subunit
71
Q

Zolpidem (ambien)

A

barbituate

sustained sleep

72
Q

Rameleton

A

MT1 and MT2 agonist
AE: dizziness, somnolence, fatigue, endocrine changes

Avoid coadministration with fluvoxamine (an SSRI)

**treats disorder of sleep onset

73
Q

Buspirone

A

generalized anxiety disorder
CYP3A4
–no sedation/hypnosis/euphoria
MOA unknown

74
Q

Zaleplon

A

non benzo hypnontic
short term tx of insomnia
GabaBZ receptor
short term insomnia treatment

75
Q

Chloral Hydrate

A

short term sedative
treat alcohol withdrawal syndrome
relieves anxiety with other drug withdrawal

76
Q

Meprobramate

A

short term anxiety relief

slows activity of brain

77
Q

Ezopicalone

A

treatment for insomnia
improve sleep maintanence
risk of morning impairment and CNS depression

AE: dry mouth, hallucination, anxiety, infection

NMSP (2 decks)

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