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Pharmacology > Unit 9: Neurological/Psych > Flashcards

Unit 9: Neurological/Psych Flashcards

1
Q

First line treatment for tension headaches

A

Acetaminophen and aspirin

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2
Q

Second line treatment for tension headaches

A

NSAIDs and excedrin

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3
Q

Prophylactic treatment for tension headaches

A

Antidepressants–amitriptyline

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4
Q

First line treatment for mild to moderate migraine

A

NSAIDs and aspirin

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5
Q

First line treatment for moderate to severe migraine

A

Triptans

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6
Q

Triptans

A

5-HT1 receptor agonists

Cause cerebral vasoconstriction and can treat both pain and nausea of migraine

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7
Q

Opioids for migraine

A

Used as rescue medication for severe migraines that do not respond to other medications
Used sparingly
Butorphanol, tramadol, acetaminophen + caffeine

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8
Q

Steroids for migraine

A

Can be used as rescue medication until patient is free for 24 hours

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9
Q

Prophylactic drugs for migraine

A

Anticonvulsants, beta blockers, triptans, ACEI, ARB, ca channel blocker, TCA, SSRI/SNRI, antihistamines, botox

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10
Q

First line therapy for partial seizures

A

Carbamazepine, phenytoin, fosphenytoin, valproic acid, lamotrigine, lacosamide, topiramate, oxcarbazepine

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11
Q

First line therapy for generalized tonic clonic seizures

A

Carbamazepine, lacosamide, phenytoin, valproic acid, fosphenytoin

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12
Q

First line therapy for absence seizures

A

Ethosuximide, valproic acid, lamotrigine

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13
Q

First line therapy for atypical absence, myoclonic, and atonic seizures

A

Valproic acid

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14
Q

Hydriantoins

A

Phenytoin + fosphenytoin
Most commonly used anti seizure meds
Increases efflux and decreases influx of Na

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15
Q

SE of phenytoin

A

gingival hyperplasia, hirsutism, rash, peripheral neuropathy

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16
Q

Benzodiazepines used for seizures

A

Clobazam, clonazepam, lorazepam (SE), diazepam

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17
Q

First line therapy for status epilepticus

A

IV benzodiazepine

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18
Q

4 common strategies for modifying drug therapy for major depressive disorder

A

increase dose, switch to different drug in same class, switch to different class, augment current drug, combine meds

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19
Q

Examples of SSRIs

A

Fluoxetine, citalopram, fluvoxamine, paroxetine, sertraline, escitalopram

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20
Q

Common SE of SSRI

A

Sexual dysfunction, potential to induce anxiety/insomnia–decreases REM sleep

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21
Q

Abrupt withdrawal of SSRI

A

flu like symptoms, insomnia, GI effects, anxiety

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22
Q

SNRIs

A

venlafaxine, desvenlafaxine, duloxetine, levomilnacipran

Indicated for more severe or resistant depression

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23
Q

SE of SNRI

A

More anticholinergic effects

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24
Q

TCA’s

A

-triptyline or -amine
Same efficacy as SSRI but worse SE- Anticholinergic effects, weight gain, life threatening cardiac conduction abnormalities, hypotension, sedation

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25
Q

Atypical antidepressants

A

Amoxapine, buproprion, maprotiline, mirtazapine, nefazodone, trazodone

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26
Q

MAO Inhibitors

A

Decrease degradation of NE, 5-HT, and dopamine
Increased SE and potential for hypertensive crises
Limited use
Phenelzine

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27
Q

Major neurotransmitters studied in anxiety pharmacology

A

NE, serotonin, GABA

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28
Q

Ideal anxiolytic therapy

A

Should promote calmness without resulting in daytime sedation and drowsiness and without producing physical or psychological dependence

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29
Q

What drugs are indicated in anxiety

A

Antidepressants, benzodiazepines, azapirones, novel anti-anxiety meds, and atypical antipsychotics

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30
Q

First line therapy for chronic management of anxiety disorders

A

Antidepressants
SSRI: citalopram, escitalopram, fluvoxamine, paroxetine, sertraline
SNRI: venlafaxine, duloxetine
TCAs: Imipramine

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31
Q

What drugs are indicated for short term management of anxiety

A

Benzodiazepines
2-4 weeks
Also used for acute exacerbations

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32
Q

Examples of benzodiazepines used for anxiety

A 
Alprazolam: Xanax
Clonazepam
Diazepam
Lorazepam: Ativan
Oxazepam
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33
Q

What drug is used in benzodiazepine OD

A

Flumazenil

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34
Q

Azapirones

A

Buspirone
Partial agonist at 5-HT1a receptor
Used as adjunct therapy for anxiety

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35
Q

MAOI in anxiety

A

Effective for panic attacks but not GAD

36
Q

First line treatment for GAD

A

SSRI or SNRI

Must give benzo initially until anti depressant begins to work

37
Q

Second line treatment for GAD

A

Imipramine or buspirone

38
Q

First line treatment for panic disorder

A

SSRI or venlafaxine

39
Q

First line treatment for social anxiety

A

SSRI and venlafaxine

40
Q

Drugs used to manage insomnia

A

Benzodiazepines, orexin receptor agonists, melatonin receptor agonist, first generation H1 blocker

41
Q

Benzodiazepines for insomnia

A

Bind to GABA in ascending RAS: blocks thalamus, hypothalamus, and limbic arousal

42
Q

Flurazepam

A

Long acting and rapid onset–used for sleep initiation

43
Q

Temazepam and Lorazepam

A

Intermediate acting

Used for sleep maintenance

44
Q

Benzodiazepine Receptor Agonists

A

Selective for alpha 1 of GABA A receptor–induces sleepiness but not anxiolysis or muscle relaxation
Long term use not recommended
Can increase parasomnias

45
Q

Examples of benzodiazepine receptor agonists

A

Eszoplicone, zolpidem (ambien), and zaleplon

46
Q

Orexin receptor antagonists

A

Suvorexant
Blockage of orexin neuropeptides–causes severe sleepiness
Achieves sleep initiation and maintenance

47
Q

Melatonin receptor agonists

A

Ramelteon
High affinity for MT1 and MT2 receptors
Shorten latency to sleep onset

48
Q

Antihistamines for insomnia

A

Diphenhydramine: Benadryl

Competitively inhibits H1 receptor causing sedative and anticholinergic effects

49
Q

Antidepressants for insomnia

A

Mirtazapine, Trazadone, Doxepin

Sedating antidepressants for use with co-morbid depression

50
Q

First line therapy for short term insomnia

A

Benzodiazepines, benzo receptor agonist, ramelteon

51
Q

Meds for restless leg syndrome

A

Dopaminergic agonists, opioids, benzos, anticonvulsants

52
Q

Dopaminergic agonists for restless leg syndrome

A

Ropinirole + pramipexole, low dose cardidopa-levodopa

53
Q

Narcoleptic triad

A

Excessive daytime sleepiness, cataplexy, sleep related hallucinations, sleep paralysis

54
Q

Diagnosis of narcolepsy

A

Presence of excessive sleepiness, levels of hypocretin in CSF, and multilatency sleep test

55
Q

Psychostimulants for narcolepsy

A

Modafenil + Armodafinil

Increase release of NE in subregions of hippocampus, centro lateral nucleus of thalamus and central nucleus of amygdala

56
Q

Amphetamines for narcolepsy

A

Methylpenidate

Stimulates CNS activity and blocks reuptake of NE

57
Q

Sodium oxybate

A

Approved to treat excessive daytime sleepiness and cataplexy

58
Q

ADHD pathophys

A

Decreased volume and functionality in prefrontal cortex/caudate and cerebellum–deficits in cognition, attention, motor planning, and processing speed
Problems with dopamine and NE

59
Q

First line treatment for ADHD

A

Stimulants

60
Q

Second line treatment for ADHD

A

Non stimulants

61
Q

Third line treatment for ADHD

A

Buproprion

62
Q

Stimulant medications

A

methylphenidate + amphetamines
Inhibit re-uptake of dopamine and NE
amphetamines also directly cause release of dopamine and NE from presynaptic cell

63
Q

SE of stimulant meds for ADHD

A

Sleep disturbances, decreased appetite, weight loss, agitation, nervousness

64
Q

Nonstimulants for ADHD

A

Used if patient has CI to stimulant

Atomexetin, guanfacine, clonidine, buproprion

65
Q

Atomexitine

A

Nonstimulant

Selectively inhibits reuptake of NE by inhibiting presynpatic NE transporter

66
Q

alpha 2 agonists

A

Guanfacine + Clondidine
Decreases NE release
Decreases hyperactivity, impulsivity, and distractibility

67
Q

Pathophys of Alzheimer Disease

A

ACh levels are decreased and excessive stimulation of glutamate

68
Q

First line tx for AD

A 
Cholinesterase inhibitors 
Or Memantine (more severe forms) or combo
69
Q

Cholinesterase inhibitors

A

Tx of cognitive symptoms
Donepezil, rivastigmine, galantamine
SE are cholinergic: DUMBBELSS

70
Q

Memantine

A

NMDA antagonist
Decreases glutamate
tx of cognitive symptoms
inhibits neuronal degeneration

71
Q

Antipsychotics for noncognitive symptoms of AD

A

Atypical antipsychotics preferred due to decreased EPS symptoms

72
Q

Benzos for AD

A

Tx of anxiety of episodic agitation
Lorazepam or Alprazolam
Long term use may worsen symptoms of AD

73
Q

Antidepressants for AD

A

Sertraline or Citalopram first line

74
Q

Drug induced parkinsonism may be due to

A

Typical antipsychotics or neuroleptic drugs

-Chlorpromazine, promazine, haloperidol, perphenazine, fluphenazine, pimozide, metoclopramide, valproic acid, methyldopa

75
Q

Symptoms of parkinson disease are due to

A

Decrease in dopamine–leads to breakdown of communication to motor regulators within the brain

76
Q

Hallmark signs of parkinson disease

A

Bradykinesia, resting tremor, cogwheel rigidity, difficulty maintaining balance

77
Q

Mild potency drugs for PD

A

Anticholinergics, amantadine, MAO-B inhibitors

78
Q

Anticholinergics for PD

A

Useful for treating drooling and tremor
Trihexyphenidyl + Benztropine
SE: anticholinergic

79
Q

Amantadine

A

May inhibit NMDA receptor

80
Q

MAO-B inhibitors

A

Modest improvement of motor symptoms
Selegiline + Rasagiline
Inhibits MAO-B metabolism of dopamine

81
Q

Moderate potency drugs for PD

A

Dopamine agonists

82
Q

Dopamine agonists

A

Less effective than levodopa but less dyskinesia seen

Pramipexole, ropinirole, rotigutine

83
Q

High potency drugs for PD

A

Levodopa and catechol-o-methyltransferase inhibitors

84
Q

Levodopa

A

Most effective tx for symptomatic relief of PD
Fastest onset of action
Can cross bbb and then converted to dopamine
Administered with carbidopa to limit peripheral breakdown

85
Q

Catechol-o-methyltransferase inhibitors

A

Entacapone + Tolcapone
Used in combo with levodopa to decrease wearing off effect
Can increase risk of dyskinesia
Decreases peripheral breakdown of levodopa

Pharmacology (56 decks)

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