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NU 560 Pharmacotherapeutics > Unit 5 > Flashcards

Unit 5 Flashcards

1
Q

treatment of major depressive disorder in children

A

fluoxetine (prozac)
lexapro

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2
Q

what age is fluoxetine approved for

A

children 8 and up

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3
Q

what age is lexapro approved for

A

children 12 and up

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4
Q

4 supplements used as adjunctive therapy in major depressive disorder

A

St. Johns Wort
SAMe
Omega-3
Folate

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5
Q

MOA of benzos

A

binds to GABA-A receptors in the brain, increasing the opening of chloride channels along the cell membrane, leading to an inhibitory effect on cell firing

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6
Q

Xanax duration

A

short acting

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7
Q

Oxazepam (Serax) duration

A

short acting

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8
Q

Ativan duration

A

intermediate acting

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9
Q

Chlordiazepoxide (Librium) duration

A

long-acting

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10
Q

valium duration

A

longest-acting

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11
Q

SSRI onset of action

A

4-6 weeks

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12
Q

TCA common SE (4)

A

sedation
ortho hypotension
anticholinergic effects
sexual dysfunction

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13
Q

best treatment of anxiety/agitation in dementia

A

benzos short term

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14
Q

SNRI MOA

A

potent inhibition of neuronal uptake of serotonin and norepinephrine and weak inhibition of dopamine reuptake

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15
Q

venlafaxine drug class

A

SNRI

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16
Q

duloxetine drug class

A

SNRI

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17
Q

milnacipran drug class

A

SNRI

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18
Q

fluoxetine drug class

A

SSRI

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19
Q

paroxetine drug class

A

SSRI

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20
Q

wellbutrin SE (6)

A

stimulant—suppresses appetite
dizziness
constipation
wt. loss
lowers seizure threshold (esp with etoh)
Tachycardia
Rhinitis
Dry mouth
Blurred vision

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21
Q

what is discontinuation syndrome

A

non-life threatening
flu-like symptoms that occur after abrupt cessation of an SSRI
taper the dose!

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22
Q

first line treatment of insomnia (4)

A

benzos
BZRAs: lunesta, ambien
rozerem

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23
Q

second line treatment of insomnia (2)

A

sinequan
trazodone

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24
Q

third line treatment of insomnia

A

Orexin receptor agonist— suvorexant (Belsomra)

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25
Q

treatment of insomnia in children

A

melatonin short term

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26
Q

treatment of insomnia in elderly

A

antihistamines or short acting benzo

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27
Q

treatment of insomnia in pregnant

A

unisom (doxylamine succinate)

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28
Q

med class to avoid in RLS

A

dopamine antagonists (Haldol, chlorpromazine)

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29
Q

treatment of RLS

A

dopamine agonists: requip, mirapex
gabapentin enacarbil (horizant)

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30
Q

novel agent used to treat generalized anxiety disorder

A

lyrica (pregablin)

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30
Q

first line treatment of generalized anxiety disorder

A

SSRIs and SNRIs

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31
Q

second line treatment of generalized anxiety disorder

A

TCA- imipramine
buspar

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32
Q

5 atypical antipsychotics used as adjunctive therapy for generalized anxiety disorder

A

abilify
seroquel
risperdal
geodon
zyprexa

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33
Q

prophylactic bowel regimen for opioid use (4)

A
  1. Diet/ lifestyle modifications or Senna-S 2 tabs at bedtime
  2. If no BM for 1 day → increase Senna-S 2-3 tabs 2-3x/day
  3. If continued constipation → Miralax, Milk of Mag, or Mag Citrate
  4. If no BM for 2 days → Dulcolax suppository, Dulcolax tab
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34
Q

what patients should you avoid giving morphine

A

renal impairment

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35
Q

MOA of tylenol

A

PG inhibition in the CNS
COX3 inhibitor

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36
Q

MOA of NSAIDs

A

reversible inactivation of COX1 and COX2

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37
Q

MOA of ASA

A

irreversible inactivation of COX1 and COX2

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38
Q

6 types of pain

A

acute
chronic
cancer-related
breakthrough
nociceptive
neuropathic

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39
Q

define nociceptive pain

A

occurs as a result of nerve receptor stimulation following a mechanical, thermal, or chemical insult. Considered purposeful or function pain.

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40
Q

3 types of nociceptive pain

A

somatic
visceral
inflammatory

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41
Q

define somatic pain

A

assoc. with muscle, skin, bone injury
localized

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42
Q

where are MU receptors located

A

CNS and GI tract

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43
Q

where are kappa receptors located

A

CNS

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44
Q

what do kappa receptors cause (4)

A

miosis
sedation
dysphoria
analgesia

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45
Q

where are delta receptors located

A

CNS

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46
Q

what do delta receptors cause (3)

A

antidepressant
euphoria
analgesia

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47
Q

what do mu receptors cause (9)

A

analgesia
resp depression
sedation
confusion
N/V
pruritus
urinary retention
miosis (pinpoint pupils)
constipation

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48
Q

oral morphine to oral hydromorphone potency

A

1:4

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49
Q

oral morphine to oral oxy potency

A

1:1.5

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50
Q

oral morphine to IV hydromorphone potency

A

1:20

51
Q

define opioid use disorder

A

s/sx of withdrawal upon abrupt cessation, rapid dose decrease, or administration on antagonist

52
Q

opioid withdrawal symptoms (14)

A

tremors
sweating
fever
anxiety
yawning
tearing
runny nose
dilated pupils
goosebumps/muscle twitch
N/V
diarrhea
abd cramps
muscle/bone pain

53
Q

severe opioid withdrawal symptoms (6)

A

increased RR
perspiration
lacrimation (watery eyes)
mydriasis (dilated pupils)
hot/cold flashes
anorexia

54
Q

common side effects of anti-epileptic meds used to treat neuropathic pain (gabapentin/lyrica) (5)

A

sedation
nausea
dizziness
wt gain
ataxia

55
Q

diagnostic studies to assess for complications of NSAIDs (4)

A

creatinine
endoscopy
BP
aPTT, PT

56
Q

why doesn’t codeine achieve pain control in some patients

A

codeine is pro-drug converted to morphine facilitated by CYP2D6
assoc. with polymorphism leading to variability in metabolism

57
Q

max dose of tylenol in older adults

A

3g

58
Q

max dose of tylenol when 2 or more alcoholic drinks per day

A

2g

59
Q

children max dose of tylenol

A

10-15kg

60
Q

groups of patients medical cannabis is contraindicated (8)

A

pregnancy
severe cardiopulmonary disease
severe liver/kidney disease
neurologic symptoms
dyskinetic disorders
psychosis
adolescents
neonates

61
Q

define cannabis use disorder

A

problematic pattern of cannabis use leading to clinically significant impairment or distress
cannabis withdrawal syndrome (10%)

62
Q

what is marinol/dronabinol

A

synthetic THC for anorexia and chemo induced n/v

63
Q

5 phytocannabinoids

A

Delta 9 THC
CBD
CBN
THCV
precursor acids

64
Q

what is cesamet

A

synthetic THC derivative for chemo induced n/v

65
Q

what is epidiolex/cannabdiol

A

used for children over age 2
oral CBD approved for treatment of seizures assoc with Lennox-Gastaut Syndrome

66
Q

what is delta 9 THC (4)

A

responsible for psychoactive effects, memory, sensory, appetite

67
Q

CBD effects (6)

A

mild psychoactive effects
antiepileptic
anti-cancer
anti dystonic
anti-inflammatory
may attenuate brain damage from ischemia

68
Q

precursor acids have what effect

A

greatest COX 1&2 anti inflammatory effect

69
Q

THCV effects (3)

A

panic attack reduction
appetite suppression
bone growth

70
Q

CBN effects (2)

A

mildly psychoactive
sedative

71
Q

where are cannabinoids metabolized

A

liver

72
Q

pharmacokinetics of cannabinoids

A

highly lipophilic
high vol of distribution
highly protein bound

73
Q

bioavailability of inhaled cannabinoid

A

rapid <10min
31%

74
Q

bioavailability of oral cannabinoids

A

6%
slow onset 2-4 hrs

75
Q

symptoms of cannabis OD (9)

A

dizziness
reddened eyes
dry mouth
dysphoria
ataxia
sedation
changed visual perceptions
altered sense of time
bronchitis

76
Q

common side effects of metformin (6)

A

GI upset:
N/V/D
gas
loss of appetite
metallic taste

77
Q

severe adverse event related to metformin (1)

A

lactic acidosis (esp with CKD/AKI)

78
Q

common side effect of sulfonylureas (1)

A

wt gain

79
Q

adverse events related to sulfonylureas (2)

A

hypoglycemia (esp etoh abuse, overexertion)
sulfa allergy

80
Q

3 common side effects of thiazolidinediones

A

sodium retention
wt gain **
fat redistribution

81
Q

5 adverse events related to thiazolidinediones

A

hepatotoxicity
CHF exac
bladder CA
hypoglycemia in combo with other oral antidiabetics
decreased efficacy of OCP

82
Q

2 common side effects of meglitinides

A

wt gain
GI upset

83
Q

6 adverse events related to meglitinides

A

hypoglycemia
URI
headache
arthralgias
back/chest pain
constipation/diarrhea

84
Q

what to avoid when taking meflitinides (2)

A

BB
alcohol

85
Q

common side effect of alpha glucosidase inhibitors

A

GI upset d/t delayed carb absorption
poorly tolerated

86
Q

4 common side effects of incretins

A

N/V/D/dyspepsia

87
Q

2 severe adverse reactions related to incretins

A

pancreatitis
hypoglycemia in combo with sulfonylurea

88
Q

4 common side effects of DPP4 inhibitors

A

nausea at onset of therapy
URI
UTI
HA

89
Q

5 severe adverse reactions related to DPP4 inhibitors

A

hypoglycemia with sulfonylurea
sitagliptin:
hypersensitivity
Steven Johnson syndrome
pancreatitis
elevated LFTs

90
Q

3 common side effects of SGLT2

A

UTI
candida vulvovaginitis
wt loss

91
Q

5 severe adverse reactions related to SGLT2

A

hypotension
dehydration
hyperkalemia
renal insufficiency
mycotic infection

92
Q

common side effect of dopamine receptor agonists

A

nausea

93
Q

6 adverse reactions related to dopamine receptor agonists

A

somnolence
fatigue
dizziness
vomiting
HA
ortho hypotension

94
Q

4 common side effects of amylin analogs

A

N/V
HA
anorexia

95
Q

how to treat hyperthyroidism in pregnancy

A

propylthiouracil (PTU)
lowest dose possible
decreases as pregnancy progresses and then increases again after birth
Tapazole is safe to admin 2-3rd trimester(patients can switch or continue with PTU)

96
Q

first line treatment for DMI

A

four injection regimen
long acting daily
rapid or short acting at mealtimes
or combo intermediate and short acting

97
Q

when to treat DMII

A

HBA1C >9

98
Q

How to treat DMII

A

triple oral therapy + consider basal and short acting insulin

99
Q

which medication is a biguanide

A

metformin

100
Q

3 sultonylureas

A

glipizide
glimepiride
glyburide

101
Q

when are sulfonylureas most effective

A

early in the disease process

102
Q

which medication is a thiazoladinedione

A

pioglitazone (actos)

103
Q

what is the onset of pioglitazone

A

4-6 weeks

104
Q

contraindications of pioglitazoner

A

HF and RF (renal failure)
causes Na retention

105
Q

2 big side effects of pioglitazone

A

weight gain **
fat redistribution

106
Q

meglitinides suffix

A

-glinides
Ex repaglindine (prandlin)

107
Q

which medication is an alpha glucodase inhibitor

A

acarbose (precose), miglitol (Glyset)

108
Q

DPP4 inhibitors suffix

A

-agliptin
Sitagliptin (junuvia), saxagliptin (onglyza)

109
Q

GLP1 receptor Agonist medication

A

-tide
semaglutide (ozempic), liraglutide (saxenda)

110
Q

DPP4 contraindications (3)

A

DMI
RF- renal failure
pancreatitis

111
Q

what class of medications should DPP4s NOT be prescribed with

A

GLP1 agonists produce natural GLP1 so DPP4 enzymes don’t affect it

112
Q

what class of medication should not be prescribed with sulfonylureas

A

DPP4 d/t increased risk of hypoglycemia

113
Q

what is prescribed with metformin to preserve kidney function, reduce MACE, and weight loss

A

SGLT2

114
Q

contraindications of metformin (4)

A

CHF
pregnancy
heavy ETOH use
Cr >1.4

115
Q

hypothyroidism meds (3)

A

Synthroid
cytomel
armour thyroid

116
Q

hyperthyroidism meds (3)

A

tapazole
propylthiouracil
radioactive iodine

116
Q

adjunctive meds for hyperthyroidism

A

BBB (help with HR and anxiety symptoms)
Lithium (block release of thyroid hormone from gland)
Glucocorticoids (reduce conversoid form T3->T4)

117
Q

monitoring for treatment fo thyroid disorders

A

TSH
Free T4
q4-6 weeks
q6mo when therapeutic, then eventually anually

118
Q

when is the expected time for therapy to reach a steady state for thyroid disorders

A

6-8 weeks

119
Q

when will patients receiving treatment for thyroid disorders feel symptom relief

A

2-4 weeks

120
Q

PTU + methimazole- SE

A

fatal agranulocytosis
check and monitor CBC

121
Q

PTU black box warning

A

severe liver injury
CBC and full LFTs before treatment initiation

122
Q

levothyroxine life-threatening SE

A

cardiac events (arrhythmias, HF) esp in patients with pre-existing disease

123
Q

injectable diabetes medication

A

Insulin
GLP1 receptor agonists
exenatide
liraglutide
dulaglutide

NU 560 Pharmacotherapeutics (5 decks)

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