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Yr 2 EOYS > BB EOYS12 > Flashcards

BB EOYS12 Flashcards

1
Q

A 45-year-old man is admitted to the intensive care unit following a head injury. His history is significant for alcohol use disorder and 5 mg of diazepam is administered intravenously every 2 hours as ordered. After administering a dose, you observe the patient’s respiratory rate change from 20 breaths/min to 6 breaths/min. Which drug should be readily available to treat this complication?

A. Fentanyl
B. Fluorouracil
C. Naloxone
D. Flumazenil

A

A 45-year-old man is admitted to the intensive care unit following a head injury. His history is significant for alcohol use disorder and 5 mg of diazepam is administered intravenously every 2 hours as ordered. After administering a dose, you observe the patient’s respiratory rate change from 20 breaths/min to 6 breaths/min. Which drug should be readily available to treat this complication?

A. Fentanyl
B. Fluorouracil
C. Naloxone
D. Flumazenil

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2
Q

Phenelzine belongs to which drug class

SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)

A

Phenelzine belongs to which drug class

MOAI (irreversible)

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3
Q

Tranylcypromine belongs to which drug class

SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)

A

Tranylcypromine belongs to which drug class

SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)

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4
Q

Eating a food like cheese contains tyramine, which inhibits which of the following

Phenelzine

A
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5
Q

Which of the following are antagonists to alpha 1 adrenoreceptors and create side effects like postural hypotension

SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)

A

Which of the following are antagonists to alpha 1 adrenoreceptors and create side effects like postural hypotension

SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)

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6
Q

Moclobemide belongs to which drug class?

SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)

A

Moclobemide belongs to which drug class?

SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)

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7
Q

Describe the mechanism of action of agomelatin

Binds to MT1 and MT2 receptors only
Binds to MT1 and MT2 receptors; 5HT agonist
Binds to MT1 and MT2 receptors; 5HT antagonist
5HT agonist
5HT antagonist

A

Describe the mechanism of action of agomelatin

Binds to MT1 and MT2 receptors only
Binds to MT1 and MT2 receptors; 5HT agonist
Binds to MT1 and MT2 receptors; 5HT antagonist
5HT agonist
5HT antagonist

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8
Q

Which combination of food and drug can result in an idiosyncratic reaction leading to hypertensive crises?

A. Ergotamine and cheese
B. Selegiline and beer
C. Phenelzine and red wine
D. Tranylcypromine and caffeine

A

Which combination of food and drug can result in an idiosyncratic reaction leading to hypertensive crises?

A. Ergotamine and cheese
B. Selegiline and beer
C. Phenelzine and red wine
D. Tranylcypromine and caffeine

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9
Q

Reboxetine is a drug used to treat depression that has the mechanism of action of which of the below?

noradrenaline reuptake inhibitor (NARI)
serotonergic reuptake inhibirot (SARI)
noradrenergic and specific serotonergic antidepressant (NaSSA)

A

noradrenaline reuptake inhibitor (NARI)

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10
Q

Which of the following binds to Monoamine oxidase A to cause inhibition?

Tranylcypromine
Moclobemide
Phenelzine
Selegiline

A

Which of the following binds to Monoamine oxidase A to cause inhibition?

Tranylcypromine
Moclobemide - reversible inhibitor; others all bind to MOA-B
Phenelzine
Selegiline

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11
Q

GI side effects are most common to which drug class

SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)

A

SSRI

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12
Q

Which drugs would you prescribe for treatment resistant:

  • Schizophrenia [1]
  • Depression [1]
A

Schizophrenia: Clozapine
Depression: Esketamine

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13
Q

Weight gain due to TCA use is due to antagonist effect at which receptor?

Alpha 1 adrenoreceptors
Alpha 2 adrenoreceptors
Muscarinic receptors
H1 receptors

A

Weight gain due to TCA use is due to antagonist effect at which receptor?

Alpha 1 adrenoreceptors
Alpha 2 adrenoreceptors
Muscarinic receptors
H1 receptors

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14
Q

Haloperidol is a typical anti-pyschotic used in SCH. Name one more [1]

A

chlorpromazine, thioridazine,
fluphenazine, , flupenthixol

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15
Q

Which of the following causes an increase in photosensitivity?

thioridazine
flupenthixol
chlorpromazine
fluphenazine
haloperidol

A

thioridazine
flupenthixol
chlorpromazine
fluphenazine
haloperidol

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16
Q

Olanzapine is a atypical antipsychotic. State which disease that prescribing this drug can cause [1]

A

Diabetes ( & metabolic syndrome)

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17
Q
A
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18
Q

Which is most toxic in an overdose?

SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)

A

Which is most toxic in an overdose?

SNRI
SSRI
MOA (reversible)
TCA
MOA (irreversible)

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19
Q

Describe the MoA of TCAs [2]

A
  • Inhibit reuptake of amines on the presynaptic terminal, so 5HT or NA cannot be taken back into neuron
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20
Q

Important AEs of TCAs? [4]

A
  • Dangerous (cardiotoxic) in overdose
  • Anti-cholinergic: dry mouth; blurred vision, constipation, urinary retention, aggravation of narrow angle glaucoma, fatigue, postural hypotension, dizziness, loss of libido, arrhythmias
  • Antihistaminic: sedation, weight gain.
  • Block alpha 1 adrenoreceptors: orthostatic hypotension - blood pressure drops on standing, cardiac effects

As a result aren’t the first choice!

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21
Q

Phenelzine, tranylcypromine belong to which drug class? [1]

A

Irreversible MONOAMINE OXIDASE INHIBITORS

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22
Q

Describe the MoA of monoamine oxidase inhibitors such Phenelzine, tranylcypromine [1]

Which type of food interact with MOIs? [1]

A

Irreversible inhibition of the enzyme monoamine oxidase [1]

Interactions with tyramine-containing food (mature cheese, pickled fish and meat, red wine, beer, broad bean pods, yeast extract)- restrictions continue at least 2 weeks after discontinuation

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23
Q

Moclobemide belongs to which drug class? [1]

A

REVERSIBLE MONOAMINE OXIDASE INHIBITOR

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24
Q

Describe MoA of Agomelatine [2]

Why is this potentially a really good drug? [2]

A

MoA:
* Agonist at melatonin MT1 & MT2 receptors: important for sleep control
* Antagonist of 5-HT2 receptors

Benefits of Agomelatine:
* improves sleep quality
* less sexual dysfunction than SSRIs;
* anxiolytic effects
* no ‘discontinuation syndrome’

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25
Q

Apart from inhibiting the reuptake of amines, which other receptors do TCAs bind to? [3]

Why is this problematic? [1]

A

Bind to:
* H1 receptors
* muscarinic receptors
* α1 and α2 adrenoceptors

Causes wide ranging side effects

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26
Q

What is the benefit of using SSRIs (citalopram, fluoxetine, paroxetine) with regards to AEs [3]

A

No anticholinergic activity
No cardiotoxic effects
Safe in overdose

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27
Q

AEs of SSRIs?

A

· Nausea vomiting

· Dry mouth

· Headache

· Asthenia

· Dizziness

· Anorexia

· Weight loss

· Nervousness

· Tremor

· Convulsions

· Sexual dysfunction

28
Q

What are the different targets for reverible MAOIs compared to irreversible MOAIs? [2]

Describe the benefits of reversible MAOIs compared to irreversible MAOs [2]

A

Drug targets:
* Reversible MAOI targets: MOA-A
* Irreversible MAOI targets: MAOA & MAOB

Differences:
* Reversible is safer than irreversible MAOIs
* Can switch drug classes quicker

29
Q

Depression drugs

Name a noradrenaline reuptake inhibitor used for depression treatment [1]

A

Reboxetine

30
Q

Depression Drugs

Name a serotonergic antagonist and reuptake inhibito (SARI) [1]

A

Trazodone

31
Q

Depression drugs

Name a noradrenergic and specific serotonergic antidepressant (NaSSA) [1]

A

Mirtazapine

32
Q

Explain why there is a delayed action for anti-depressant drug action for TCAs [4]

A

The immediate increase in synaptic concentration of amines
may lead to activation of somatic neuronal autoreceptors

The activated autoreceptors decrease firing of the neurones

During the first weeks of treatment the autoreceptors desensitize

The neurones will return subsequently to the normal firing rate

The inhibition of reuptake continues and the level of amines
continues to be high, resulting in full efficacy

33
Q

Name two risks of using antidepressant drugs used in bipolar disorder to treat periods of depression? [2]

A

can precipitate manic episodes or mixed
affective states

induce an increased frequency
in mood change cycles

34
Q

Name 4 non-pharmacological approaches for mood disorders

A

Electroconvulsive therapy (treatment-refractory severe depression with suicide risk)

Cognitive behavioural therapy (CBT) (can augment the effects of pharmacological treatment)

Vagal nerve stimulation (especially in chronic depression)

Deep brain stimulation (DBS); subcallosal cingulate white matter – Brodmann area 25)

35
Q

Which area is the DBS target for treating depression? [1]

What the is the Broadmann area?

21
22
23
24
25

A

Which area is the DBS target for treating depression: subgenual cingulate cortex

What the is the Broadmann area?

21
22
23
24
25

36
Q

Name two new therapeutic developments for depression [2]

What types of depression do they speficifically treat? [2]

What are their MoAs? [2]

A

Esketamine:
* NMDA glutamate receptor antagonist
* treatment-resistant depression

Brexanolone:
* progesterone-related compound, positive modulator of GABAA receptors
* approved for post-partum depression

37
Q

Most common AE of SSRI? [1]

A

gastrointestinal symptoms are the most common side-effect:

38
Q

30% schizophrenic patients do not respond to treatment. Which drug would you provied for those who have drug resistance? [1]

A

Clozapine

39
Q

The drugs used to treat schizophrenia are [] receptor [antagonists / agonists] [2]

They can be divided into typical and atypical drug treatments; what are the difference between them?

A

The drugs used to treat schizophrenia are D2 (dopamine) receptor antagonists

Typical:’ are older and cause generalised dopamine receptor blockade.

Atypical: are more selective in their dopamine blockade and also block serotonin 5-HT2A receptors.

40
Q

Atypical antipsychotic drugs target which receptor/s

D1 receptors
D2 receptors
D1 & D2 receptors
D1 & 5-HT2 receptors
D2 & 5-HT2 receptors

A

Atypical antipsychotic drugs target which receptor/s

D1 receptors
D2 receptors
D1 & D2 receptors
D1 & 5-HT2 receptors
D2 & 5-HT2 receptors

41
Q

Clozapine blocks [] receptors with high affinity
Aripiprazole is a partial [] at presynaptic D2 receptors but an [] at D2 postsynaptic receptors

A

Clozapine blocks D4 receptors with high affinity

Aripiprazole is a partial agonist at presynaptic D2 receptors but an antagonist at D2 postsynaptic receptors

42
Q

Atypical anti-psychotics target which receptors? [2]

A

Antagonists at:

  • D2 receptors
  • 5-HT2A receptors
43
Q

Name 3 extrapyramidal effects that occur due to antipsychotic drugs. [3]

Why do these occur? [1]

A

Extrapyramidal effects (EPS):
* acute dystonias
* parkinsonism
* tardive dyskinesia

Approx. 60% D2 receptor occupancy required for
antipsychotic efficacy; if >80% D2 receptors are blocked, then potential for EPS

44
Q

Which anti-psychotics can be adminstered by IM injections? [2]

A

fluphenazine decanoate

haloperidol decanoate

45
Q

Explain what tardive dyskinesia is and the length of the AE [2]

A

Involuntary movements of the lips, jaw, face; grimacing, constant chewing, tongue thrusting; rapid involuntary limb movements

typical antipsychotics,
taken for longer than a few months/years
In some patients it may be possible to overcome it

46
Q

Describe what neuroleptic malignant syndrome is a combination of [6]

A

Due to typical anti-psychotics

hyperpyrexia
muscle rigidity
tremor
confusion
autonomic instability

47
Q

The cingulate gyrus and parrahippocampal gyrus are continuous via a bundle of white matter called the []

A

The cingulate gyrus and parrahippocampal gyrus are continuous via a bundle of white matter called the cingulum

48
Q

Label A-E

A

A: cingulate gyrus
B: corpus callosum
C: fornix
D: parahippocampal gyrus
E: subcallosal area

49
Q

Label A-F

A

A: Fornix
B: Cingulate cortex
C: Thalamus
D: Mamilllary body
E: Hippocampus
F: Amygdala

50
Q

Label A-C

A

A: Anterior commissure
B: Amygdala
C: Hippocampal

51
Q

Label 14-17

A

14 Pulvinar of thalamus
15 Mamillary body
16 Optic tract
17 Anterior commissure

52
Q

Label 18-22

A

18 Fornix
19 Longitudinal stria
20 Dentate gyrus
21 Hippocampal fimbria
22 Pes hippocampi

53
Q

What are primary reinforcers?

A

Gene specified goals for action (for rewarding or punishment)

A Primary Reinforcer is a stimulus that is biologically important to an organism, such as food, water, sleep, shelter, safety, pleasure, and sex

54
Q

What is the role of the insula? [1]

A

Recieves data from cortex and amygdala. Has to make exec decision on whether the experience was worth remembering.

55
Q

What is this structure? [1]

A

Nucleus accumbens

56
Q

State the main function of the:

Hippocampus [1]
Parahippocampal gyrus [1]
Amygdala: [1]
Septal nucleus [1]
Cingulate cortex [1]

A

Hippocampus = Memory acquisition and recall, formation of long-term memory. Formation of memory not storage

Parahippocampal gyrus: storage and conversion of new experiences into memories

Amygdala = Emotional content of stimuli: fear, anxiety and danger

Septal nucleus = Pleasure and reward

Cingulate cortex = Affective significance

57
Q

Describe the route of Papez’s circuit

A

Cingulate cortex –> parahippocampal cortex –> hippocampus –> fornix –> mamillary bodies –> hypothalamus -> anterior thalamus –> cingulate cortex.

58
Q

Name the extremely fast response to an unexpected loud noise in babeies? [1]

A

Acoustic startle reflex / Moro reflex

59
Q

What is the difference in role between anterior and posterior cingulate cortex? [1]

A

Anterior cingulate cortex:
* monitors quality of pain continously; activates strategies to remove pain
* Evaluates the degree of pain / ppleasure experienced

Posterior cingulate cortex:
* Recalling emotional memories - NOT involved in non-emotional memories

60
Q

Describe the pathway in which amygdala controls the startle reflex [4]

A

Sensory information feeds into the basolateral amygdala

Feeds into the central amygdala

Central amygdala sends output to the central gray area of the midbrain

Information is relayed to the nucleus in the pons responsible for the startle reflex

61
Q

What is 8?

Corpus Callosum
Hippocampus
Subthalamic nuclei
Nucleus accumbens
Putamen

A

What is 8?

Corpus Callosum
Hippocampus
Subthalamic nuclei
Nucleus accumbens
Putamen

62
Q

What is 8?

Anterior commissure
Fornix
Lateral ventricle
Putamen
Nucleus accumbens

A

What is 8?

Anterior commissure
Fornix
Lateral ventricle
Putamen
Nucleus accumbens

63
Q

What is 5?

Hypothalamus
Fornix
Amygdala
Hippocampus
Thalamus

A

What is 5?

Hypothalamus
Fornix
Amygdala
Hippocampus
Thalamus

64
Q

What is 13?

Hypothalamus
Fornix
Amygdala
Hippocampus
Thalamus

A

What is 5?

Hypothalamus
Fornix
Amygdala
Hippocampus
Thalamus

65
Q

What is 3?

Hypothalamus
Fornix
Amygdala
Hippocampus
Thalamus

A

What is 3?

Hypothalamus (mamilliary body)
Fornix
Amygdala
Hippocampus
Thalamus

66
Q

What is 10?

Hypothalamus
Fornix
Amygdala
Hippocampus
Thalamus

A

What is 10?

Hypothalamus
Fornix
Amygdala
Hippocampus
Thalamus

67
Q

Label A-D

A

A:Cingulate cortex nuclei

B: Anterior thalamic

C:Mammillary bodies

D: hippocampus

Yr 2 EOYS (58 decks)

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