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Therapeutics 2 > Final Exam > Flashcards

Final Exam Flashcards

1
Q

goals of therapy for depression

A

alleviate the signs and symptoms

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2
Q

types of depression

A

reactive (60%)
MDD (25%)
Bipolar Affective (15%)

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3
Q

physiological signs of depression

A

decreased sleep, appetite changes, fatigue, psychomotor dysfunction

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4
Q

psychologic symptoms of depression

A

dysphoric mood, worthlessness, guilt, loss of interest/pleasure

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5
Q

cognitive symptoms of depression

A

decreased concentration, suicidal ideation

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6
Q

Drug induced depression

A

antihypertensive and cardiovascular agents, sedative hypnotics, anti-inflammatory and analgesics, steroids, anti-Parkinson, anti-neoplastics, neuroleptics

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7
Q

onset of action of anti-depressant drugs

A

biochemical effects within hours; clinical changes are not seen for weeks

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8
Q

MOA for MAOIs (monoamine oxidase inhibitors)

A

MAO-A inhibitors- blocks the degradation of NE and 5HT causing more NE and 5HT to be released from the vesicles into the synapse
MAO-B inhibitors - block the break down of dopamine

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9
Q

Non-selective MAO inhibitors; used for treatment resistant depression; irreversible inhibitors

A

Phenelzine (Nardil)
Tranylcypromine (Parnate)

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10
Q

MAO-B selective inhibitors; used for Parkinson’s; reversible inhibitors

A

Selegiline (Eldepryl/Ensam)

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11
Q

MAO-A selective inhibitors; not used in the US; reversible

A

Moclobemide (Manerix)

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12
Q

MAO inhibitors SE

A

headache, drowsiness, dry mouth, weight gain, orthostatic hypotension, sexual dysfunction

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13
Q

MAO inhibitors drug interactions

A

cause hypertensive crisis; otc cold medications, TCAs, SSRIs, L-DOPA

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14
Q

reuptake blockers site of actions

A

allosteric

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15
Q

indications for tricyclic antidepressants

A

depression, panic disorder, chronic pain, and enuresis; warning: patients more likely to commit suicide or self harm 2 weeks into treatment

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16
Q

tertiary amines

A

inhibit both NET and SERT and are antagonists at H1, M, and A1 receptors

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17
Q

side effects of tertiary amines

A

sedation, autonomic side effects, weight gain, cardiovascular conduction disturbances

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18
Q

tertiary amine drugs; have a three-ring structure

A

Imipramine (Tofranil)
Amitriptyline (Elavil)
Clomipramine (Anafranil)
Doxepin (Adapin)

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19
Q

Secondary amines drugs

A

Desipramine (Norpramin)
Nortriptyline (Pamelor)
Protriptyline (Vivactil)
Maprotiline (Ludiomil) (NET inhibitor)

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20
Q

Secondary amines info

A

Better at inhibiting NET than SERT
Less sedation, anticholinergic, autonomic, weight gain, and cardiovascular SE than tertiary amines

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21
Q

Side effects of all TCAs (general)

A

anticholinergic, CV, neurological, weight gain, look for suicidality

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22
Q

SSRIs drugs

A

Fluoxetine (Prozac)
Fluvoxamine (Luvox)
Paroxetine (Paxil)
Sertraline (Zoloft)
Citalopram (Celexa)
Escitalopram (Lexapro)

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23
Q

side effects of SSRIs

A

N/V, HA, sexual dysfunction, anxiety, insomnia, tremor

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24
Q

SSRI discontinuation

A

brain zaps, dizziness, sweating, nausea, insomnia, tremor, confusion, vertigo

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25
Q

serotonin syndrome symptoms

A

hyperthermia, muscle rigidity, restlessness, myoclonus, sweating, shivering, seizures, coma

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26
Q

s/o to buspirone MOA

A

5HT1A (serotonin 1A) agonist

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27
Q

SSRI and 5HT1A partial agonists

A

vilazodone (Viibryd)
vortioxetine (Brintellix)

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28
Q

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

A

Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)
Milnacipran (Ixel)
Levomilnacipran (Fetzima)

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29
Q

NE selective reuptake inhibitors

A
  • reboxetine (Vestra) (not used in US)
  • Atomoxetine (Strattera)
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30
Q

NMDA antagonists

A

glutamate antagonists; act as channel blockers (ketamine and scopolamine, esketamine)

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31
Q

treatment for PPD

A

fluoxetine, paroxetine, and venlafaxine, CBT, brexanolone

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32
Q

Brexanolone MOA and info

A

re-sensitizes GABA-A receptors after pregnancy

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33
Q

Filbanserin (Addyi)

A

for hypoactive sexual desire disorder; agonist at 5HT1A and 5HT2A/C antagonist

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34
Q

pharmacotherapy of bipolar

A

mood stabilizers, atypical antipsychotics, CCBs

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35
Q

Lithium MOA

A

ion; depletes PIP2 and Gq receptor signaling (PLC and IP3)

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36
Q

anticonvulsants used for bipolar mood stabilizers

A

Valproic acid and sodium valproate, carbamazepine/oxcarbazepine, lamotrigine, topiramate

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37
Q

risk of recurrence in depression

A

1 episode: 50-60%
2 episodes: 70%
3 episodes: 90%

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38
Q

recurrence info

A
  • risk becomes lower over time as duration of remission increases
  • persistent mild symptoms during remission is a predictor of recurrence
  • function deteriorates during the episode and goes back to baseline upon remission
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39
Q

diagnostic info

A

at least one of the symptoms must be depressed mood or loss of interest or pleasure in doing things

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40
Q

DSM-5 Criteria SIG E CAPS

A

difficulty sleeping, interest decreased, guild, energy loss, concentration difficulties, appetite change, psychomotor agitation, suicidal ideation

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41
Q

Self-administered rating scales

A

PHQ-9; Patient Health Questionnaire (Primary care)
QIDS-SR-16: Quick inventory of Depressive Symptomatology Self-Report (psych practice)
Mood disorder questionnaire (MDQ) (used to rule out bipolar)

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42
Q

Goals of treatment for depression

A
  • reduce or eliminate signs/symptoms of depression
  • restore occupational/psychosocial functioning to baseline
  • reduce the risk of recurrence/relapse
  • reduce the risk of harmful consequences/suicidal ideation
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43
Q

risk of suicidality

A

boxed warning for suicidality in all patients 24 and younger; counsel them

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44
Q

clinical factors for bipolar

A
  • depression is the mood pole experienced most; often misdiagnosed
  • alcohol and substance use common in bipolar
  • anxiety disorders are common comorbidities
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45
Q

DSM-5 classification

A
  • Bipolar 1 disorder: > = 1 manic episode
  • Bipolar 2 disorder; major depressive and hypomanic episodes
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46
Q

pharmacotherapy for bipolar

A

mood stabilizers and antipsychotics

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47
Q

lithium use and dosing

A

very effective for bipolar 1; associated with decrease in suicidality, but has a narrow therapeutic index = dangerous and can be fatal in overdose
- use 1:1 conversion for different dosage forms

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48
Q

lithium SE and other

A

may cause hypothyroidism, teratogenic; causes cardiac structural abnormality (avoid use in first trimester)

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49
Q

Lithium monitoring

A

need to keep sodium levels and water levels consistent; renally eliminated; do not use with NSAIDs

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50
Q

Valproate info

A
  • several dosage forms; 1:1 conversion but ER dosage form less bioavailable
  • risk for GI ulcerations in the syrup and capsule
  • serum levels 80-125mcg/mL
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51
Q

Valproic acid AE

A
  • unsafe in pregnancy; neural tube defects & negative IQ effects
  • may cause PCOS
  • anorexia, N/V/D, dyspepsia, ulceration, thrombocytopenia, platelet dysfunction, weight gain, hyperammonemia
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52
Q

Valproate monitoring

A
  • pregnancy test, LFTs, and CBC
  • Serum concentration
  • serum ammonia (if needed)
  • interacts with lamotrigine (stevens-johnson syndrome)
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53
Q

other mood stabilizers

A
  • carbamazepine: thrombocytopenia/hematologic effects
  • oxcarbazepine: CYP3A4 inducer, hyponatremia
    -lamotrigine: for depressive episodes only
  • topiramate: weight loss, heat intolerance, metabolic acidosis/kidney stones, teratogen (cardiac structural defects)
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54
Q

Antipsychotics

A

atypical antipsychotics can be used as monotherapy or can be used in combination with other mood stabilizers (valproate or lithium)
- monitor for weight gain, tardive dyskinesia, etc.

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55
Q

which bipolar meds cannot be used in pregnancy

A

valproic acid, carbamazepine, topiramate, lithium (first trimester)
- often choose to use atypical antipsychotics in pregnancy

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56
Q

AB fibers

A

fastest, identify touch and pressure and innervate the skin

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57
Q

AS fibers

A

fast; identify sharp/prickly pain “first pain”

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58
Q

C fibers

A

pain, temperature, touch, pressure, itch, dull/aching pain

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59
Q

role of substance P

A

vasodilation, degranulation of mast cells, release of histamine, inflammation and prostaglandins, increase sensitization (ex: sunburn)

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60
Q

neuropathic pain causes

A

increased AMPA and NMDA expression and sensitivity

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61
Q

inflammatory pain

A

throbbing, pulsating,

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62
Q

neuropathic pain

A

stabbing, shooting, burning, tingling

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63
Q

visceral pain

A

squeezing

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64
Q

CYP 3A4 opioids

A

makes opioids starting with nor

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65
Q

morphine

A

bioavailability is 25%
CYP 3A4 and 2D6

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66
Q

fentanyl

A

potent af

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67
Q

opioids that are full agonists

A

fentanyl
hydromorphone and oxymorphone
morphine
hydrocodone
oxycodone

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68
Q

non-phenanthrene opioids

A

tramadol; mild opiate- has SNRI properties
meperidine (demerol)- used to treat rigors; metabolized by 3A4; neurotoxic

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69
Q

opioids with NMDA block

A

methadone (blocks ion channel glutamate receptor; blocks pain signal in spinal cord)
prolongs QTC interval

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70
Q

opioids used for anti-diarrheals

A

diphenoxylate/atropine (lomotil)
loperamide (Imodium) - no BBB access
Eluxadoline (Viberzi) Mu/Kappa agonist; delta antagonist

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71
Q

buprenorphine MOA

A

partial Mu agonist, weak k agonist, and sigma antagonist

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72
Q

adverse opioid effects

A

tolerance/hyper-algesia: euphoria, respiratory depression, urinary retention, nausea

no tolerance: itch, constipation, miosis

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73
Q

methadone MOA

A

slow acting full agonist, provides relief from withdrawal, NMDA antagonist

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74
Q

buprenorphine

A

partial agonist to reduce withdrawal and euphoric symptoms

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75
Q

naltrexone MOA

A

ER IM injection or daily PO; will cause withdrawal, full antagonist

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76
Q

Naloxone MOA

A

antagonist, rapid onset, short half life

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77
Q

Naltrexone MOA

A

antagonist, PO with 4 hour half life

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78
Q

Neonatal Abstinence Syndrome symptoms

A

tremors, yawning, poor feeding, sweating in 24-48 hours after birth; serious withdrawal caused by heroin and other opiates including seizuresp

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79
Q

pharmacologic neonate abstinence syndrome treatment

A

morphine sulfate, SL buprenorphine, clonidine

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80
Q

Mu

A

endorphins (Mu-ey like reed)

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81
Q

Kappa

A

Dynorphins (kappa delta)

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82
Q

Delta

A

Enkephalins (keflex after delta dental)

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83
Q

orphanin/ORL1

A

nociceptin/orphanin (orphans are noice)

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84
Q

pain pathway

A

mediators recruit inflammatory cells: eicosanoids: arachadonic acid metabolites, prostaglandins (redness, heat, pain), thromboxanes, leukotrienes (swelling), cytokines (pain)

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85
Q

COX 1 protects stomach lining when expressed in the GI system

A

through PGE-2 and PGI-2

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86
Q

Aspirin MOA

A

irreversible inhibition of COX-1

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87
Q

Other NSAIDS MOA

A

competitive inhibitors of COX-1 and COX-2

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88
Q

reyes syndrome

A

vertigo/tinnitus, respiratory alkalosis, metabolic acidosis

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89
Q

aspirin overdose tx

A

increase urinary excretion; dextrose, sodium bicarbonate

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90
Q

misoprostol use

A

PGE-1 analog; protects GI lining

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91
Q

enolic acid nsaids

A

meloxicam; cox-2 selective at low doses; used for arthritis

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92
Q

NSAIDS AEs

A

peripheral edema, GI bleeding, inhibition of uterine motility

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93
Q

AE for acetaminophen

A

hepatic necrosis; do not take with alcohol

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94
Q

COX-2 selective inhibitors

A

reduce ulcers and GI bleeds, higher risk of blood clots, stroke, and heart attacks (reduced PGI2 formation)

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95
Q

contraindications to NSAIDS

A

CKD, PUD, GI bleed history.
other issues: inc. CV risk, interferes with bone healing, asthma exacerbations

96
Q

sodium channel blockers that can be used for pain

A

SNRIs, Duloxetine, Venlafaxine, Milnacipran, lamotrigine, carbamazepine, amitriptyline, gabapentin, pregabalin

97
Q

DEA schedule 1

A

no medical use; marijuana, THC, LSD

98
Q

schedule 2

A

medical use; high abuse; cocaine and PCP

99
Q

schedule 3

A

moderate abuse and dependence risk; marinol (THC)

100
Q

schedule 4

A

low abuse and dependence; benzos

101
Q

schedule 5

A

lower risk; cough suppressants; lomotil

102
Q

opioids MOA

A

act on Mu opioid receptors

103
Q

LSD aand mushrooms MOA

A

act on serotonin receptors 2a and 2c

104
Q

marijuana, K2, and spice MOA

A

cannabinoid receptor agonists

105
Q

Caffeine MOA

A

adenosine receptors

106
Q

cocaine/amphetamine MOA

A

act on dopamine transporter

107
Q

nicotine MOA

A

act on ionotropic ach receptors; agonist

108
Q

PCP; ketamine MOA

A

ionic NMDA receptor antagonist

109
Q

benzos and barbiturates

A

positive allosteric modulators of ionic GABAa receptors

110
Q

neuronal plasticity changes

A

rewarding substances cause relative increase in glutamatergic AMPA receptors

111
Q

withdrawal symptoms

A

goose bumps, muscle spasms, grand mal seizures, delerium tremens

112
Q

physical dependence

A

tolerance

113
Q

psychological dependence

A

addiction

114
Q

pain pneumonic

A

PQRSTU
Palliative or precipitating
quality of pain
region of pain location
severity of pain
time
impact on U (daily activities)

115
Q

objective pain assessment

A

behavioral changes
mydriasis
pallor
sweating
tachycardia
tachypnea

116
Q

acute pain

A

<3 months

117
Q

chronic pain

A

> 3 months

118
Q

goals of therapy

A

correct underlying cause of pain
minimize pain and symptoms
improve quality of life and activities of daily living
limit pharmacotherapy side effects

119
Q

step therapy: step 1

A

non-opioids: tylenol and NSAIDS
adjuvant therapy: Gabapentinoids, SNRIs, tricyclic antidepressants, skeletal muscle relaxants, antiepileptics, topical agents

120
Q

tylenol patient considerations

A

available PO, liquid, IV solution, suppository
dosing 325-1000mg PO q4-6H (max 3-4g/day)
liver disease max 2g/day
pediatrics max dose 75mg/kg/day

121
Q

side effects of NSAIDs

A

GI bleeding, nephrotoxicity, fluid retention, increased CV events

122
Q

Aspirin patient considerations

A

formulations: chewable tab, ec tab, suppository
adult dosing: max 4g/day
avoid in children
avoid for pain in patients taking blood thinners

123
Q

Ibuprofen patient considerations

A

formulations: cap/tab, suspension, IV solution
adult dosing: max 3200mg/day
child dosing: max 40mg/kg/day

124
Q

Diclofenac patient considerations

A

formulations: cap/tab, IV solution, suppository, topical, patch, eye drop
Dosing: 50mg PO q8h or 2-4g QID
Pearls: minimal systemic effects with gel
Can be used with CKD and CVD

125
Q

Naproxen patient considerations

A

formulations: cap/tab, suspension
dosing: adults max 1000mg/day

126
Q

Ketorolac patient considerations

A

formulations: tab, eye drop, IV/IM, nasal spray
adult: 15-30mg IV q6h or 10mg PO q6h
pediatric: 0.5mg/kg q6h
pearls: max duration of use is 5 days

127
Q

celecoxib patient considerations

A

capsule/solution
200mg PO BID
Cox-2 selective; less GI effects (caution in CVD)

128
Q

gabapentin and pregabalin patient considerations

A

uses; fibromyalgia, neuropathy, post-op pain
- formulations: tabs/caps, solution
- dosing: gabapentin (max 3600mg/day), lyrica (max 600mg/day)
- SE: sedation, dizziness, drowsiness, edema
- pearls: renally adjusted, titrate dose up, start low and titrate

129
Q

venlafaxine and duloxetine considerations

A

uses: fibromyalgia and neuropathy
dosing: venlafaxine (max 225mg/day)
duloxetine (max 60mg/day)
SE: nausea, HA, HTN, sedation, weakness
avoid duloxetine in CrCl<30, renally adjust venlafaxine

130
Q

TCAs:
Amitriptyline and nortriptyline (pamelor) considerations

A

uses (off-label): fibromyalgia, neuropathy, migraine prophylaxis
dosing: max 150mg/day
SE: anticholinergic, sedation
last line option due to SE

131
Q

Muscle relaxants:
cyclobenzaprine, baclofen, methocarbamol, carisoprodol, and tizanidine considerations

A

uses: musculoskeletal pain/spasms
formulations: parenteral (methocarbamol and baclofen)
dosing: cyclobenzaprine (max 30mg daily)
baclofen (max 80mg daily)
carisoprodol (max 1050 daily)
methocarbamol (max 8g/day)
tizanidine (max 24mg/day)
SE: sedation/drowsiness, dizziness, dry mouth, vision changes
short term use <3 weeks

132
Q

antiepileptics: carbamazepine (Tegetrol)

A

use: neuropathic pain
dosing: 200-400mg daily in 2-4 doses (max 1200mg/day)
hypersensitivity reaction with HLAB*1502 allele
autoinduction of hepatic enzymes (levels fall over first few weeks of use)

133
Q

lidocaine

A

formulations; patch, injection, topical cream or gel
dosing; remove after 12 hours
SE: hypotension, arrythmia
pearls: tachyphylaxis with continuous use
12 hour break between patches, local effect

134
Q

capsacian

A

uses: muscle/joint pain, neuropathic pain
lotion/gel/cream, patch
apply 3-4 times per day or 1 patch for 8 hours
SE: skin irritation/pain
pearls: do not get in eyes, wash hands after applying, can be used for vomiting

135
Q

recommendation for NSAIDs and aspirin >=325mg/day in adults>65

A

Not recommended

136
Q

Indomethacin and ketorolac in adults >65

A

do not use

137
Q

skeletal muscle relaxants in adults >65

A

avoid

138
Q

SNRIs, TCAs, and carbamazepine in adults >65

A

use with caution

139
Q

opioids with benzos in adults >65

A

avoid combination

140
Q

opioids with gabapentin/pregabalin in adults >65

A

avoid unless transitioning from opioid to gabapentin or using gabapentin to reduce opioid dose

141
Q

anticholinergic medications

A

minimize the number of anticholinergic drugs in older adults. why? cognitive decline, delerium, falls, and fracture risk

142
Q

antiepileptics, gabapentinoids, antidepressants, antipsychotics, benzos, z drugs, opioids, and skeletal muscle relaxants

A

avoid use of three or more together

143
Q

medications to use in the elderly to minimize side effects

A
  • tylenol
  • diclofenac, capsaicin, lidocaine
  • SNRIs
  • gabapentinoids
144
Q

opioid antagonsit

A

naloxone

145
Q

opioid weak agonists

A

codeine, tramadol

146
Q

opioid full agonists on exam

A

morphine
hydrocodone
oxycodone
meperidine
fentanyl
methadone

147
Q

opioid overdose signs

A
  • sedation/unconsciousness
  • pinpoint pupils
  • decreased respiratory rate
  • bradycardia
  • hypotension
  • pale and clammy
148
Q

opioid withdrawal signs

A
  • insomnia/agitation
  • dilated pupils
  • increased respiratory rate
  • tachycardia
  • hypertension
  • sweating
149
Q

who should have naloxone?

A
  • history of overdose
  • history of SUD
  • high opioid dosages
  • concurrent benzo use
150
Q

opioid withdrawal onset

A

short acting (heroin): 8-24 hours after last dose; duration of 4-10 days
long acting: (methadone): 12-48 hours after last use; duration of 10-20 days

151
Q

opioid withdrawal treatment

A

clonidine for symptoms (htn, sweating, vomiting, anxiety)
buprenorphine/suboxone
methadone

152
Q

codeine patient considerations

A

tablet and cough syrup
metabolized to morphine via cyp 2D6
not recommended in breast feeding mothers or children under 12

153
Q

tramadol considerations

A

capsule, tablet, solution
risk of serotonin syndrome w/ other serotonergic meds
- renally dose adjusted
CYP3A4 and 2D6

154
Q

morphine

A
  • oral, injectable, and suppository formulations
  • may cause itching
  • accumulates in renal dysfunction
  • avoid with AKI or CKD
  • do not take with alcohol
155
Q

hydromorphone

A

oral, injectable, and suppository
boxed warning for dosing errors

156
Q

hydrocodone/acetaminophen

A

oral tablets and solutions
caution with CYP3A4 inhibitors and extra acetaminophen

157
Q

Oxycodone/APAP

A

oral tabs and solutions; no IV
abuse deterrent formulations
caution CYP 3A4 and acetaminophen

158
Q

Fentanyl/Duragesic

A

SL/buccal, lozenge, injectable, and patch
monitor 3A4
less hypotension
only for opioid tolerant patients (morphine 60mg/day for one week)

159
Q

fentanyl patches counseling

A

do not cute (may cause overdose) and do not let it get too warm

160
Q

methadone (methadose)

A

last time treatment for chronic pain; can be used for opioid detox
oral, solution, and injectable
only opioid with QTC prolongation warning
long half life

161
Q

meperidine (demerol)

A

injectable, oral, tablet
avoid in elderly and renal impairment
warning with CYP 3A4, do not use with MAOIs, metabolized by liver, accumulation leads to delerium and seizures, not commonly used

162
Q

potential side effects

A

seizures and serotonin syndrome

163
Q

natural opiates

A

morphine
codeine

164
Q

semi synthetic opiates

A

hydromorphone
oxycodone
oxymorphone
hydrocodone
buprenorphine

165
Q

synthetic opioids

A

fentanyl
methadone
meperidine
tramadol

166
Q

when are non-opioid therapies preferred?

A

for subacute and chronic pain

167
Q

what type of opioid should be used when starting opioid therapy and how much?

A

IR dosage forms in the lowest effective dosage

168
Q

when to taper/reduce opioids

A
  • when the patient requests a dosage reduction
  • no clinically meaningful improvement in pain or function
  • doses over 50 MME/day without benefit or use concurrently with benzos
  • signs/sx of SUD
  • experiences overdose or adverse event
  • warning signs for overdose risk
169
Q

how to reduce opioid doses

A

decrease by 10% per month is patient has been on it more than one year
decrease by 10% per week if it has been weeks to months

170
Q

hospital orders for acute pain

A

can only have one order for each severity of pain

171
Q

fibromyalgia recommended treatment

A

pregabalin or duloxetine
other: TCAs, gabapentin, venlafaxine

172
Q

neuropathic pain recommended tx

A

firs line: SNRIs, gabapentin/pregabalin
second line: topical lidocaine, TCAs

173
Q

nicotine mechanism

A

nicotine is membrane penetrable at physiologic pH (is a weak base)
not degraded by acetylcholinesterase; longer duration of action than Ach

174
Q

why is there a higher success for quit rate for varenicline than NRT?

A

varenicline is a partial agonist; reduces cravings and takes away the reward

175
Q

why doesn’t Phenylephrine work?

A

extensive first pass metabolism inactivates it; the nasal spray does work

176
Q

caffeine + amphetamine

A

fenethylline

177
Q

Cocaine MOA

A
  • DAT, SERT, and NET antagonist
    DAT>SERT>NERT
    prevents dopmine reuptake, increases DA concentration, increases duration of DA action
178
Q

Meth, ecstasy, and bath salt MOA

A

resemble exogenous DA and NE and compete for reuptake
push out DA from vesicles
amphetamines are MAOis
Activate trace amine associated receptor (TAAR1)
- phosphorylates DAT and induces reverse transport function

179
Q

synthetic cathinones effect

A

mild euphoria and excitement; similar to strong coffee

180
Q

synthetic cathinones

A

designer drugs; similar to nutmeg. bath salts, molly,

181
Q

clinical effects of meth abuse

A

neurologic: delerium, tremor
psych; anxiety, paranoia, hallucinations, delusions, repetitive behavior
ENT: dental decay
CV: tachycardia, hypertension, vasospasm
skin: diaphoresis
(basically all anticholinergic effects except for sweating)

182
Q

using methamphetamine causes down-regulation of dopamine receptors

A

causes withdrawal symptoms

183
Q

sympathomimetic toxidrome

A

MATHS
Mydriasis
Agitation, arrythmia, angina
Tachycardia
Hypertension, hyperthermia
Seizure, sweating

184
Q

acute cannabis intoxication perceptual

A

temporal slowing, auditory, visual, or tactile illusions, de-personalization.

185
Q

acute cannabis intoxication affective

A

euphoria, disinhibition, anxiety, emotional lability

186
Q

acute cannabis intoxication physical

A

tachycardia, hypotension, conjunctival injection, dry mouth, increased appetite

187
Q

acute cannabis intoxication cognitive

A

suspiciousness or paranoid ideation, impaired judgement, impaired reaction time, and impaired attention

188
Q

what comprises the endocannabinoid system?

A

CB1 and CB2 receptors, anandamide and 2-AG ligands, EMT transporter, and enzymes

189
Q

what do endocannabinoids and phytocannabinoids do?

A

serve as retrograde regulators of neurotransmission inhibiting the release of GABA and glutamine

190
Q

THC vs synthetic cannabinoids action on CB1R

A

THC is a partial agonist
synthetics are full agonists

191
Q

In the brain, the CB1 receptor has more expression than the CB2 receptor

A

low levels of CB2 on respiratory centers of the brainstem, decreasing the likelihood od respiratory depression and coma

192
Q

CB2 and Cb1 expression in periphery?

A

CB2»CB1
CB2 on lymphocytes
CB1 in liver

193
Q

Marinol about

A

Dronabinol; synthetic delta 9 THC in sesame oil; for loss of appetite
causes tachycardia and red eyes

194
Q

Nabilone about

A

Cesamet
THC mimetic; anti-emetic and used for chronic pain

195
Q

CBD pharmacology and use

A

low affinity for CB receptors
may antagonize THC at CB1
no euphoric effects; most commonly used for pain

196
Q

cannabinoid hyperemesis syndrome treatment

A

cannabis cessation
benzodiazepines
haloperidol
capsaicin cream

197
Q

phenethylamine molecular target

A

increase release of serotonin>DA, NE

198
Q

what are the classical psychedelic drugs derivatives of?

A

phenethylamine, tryptamine

199
Q

Classic psychedelic target

A

Serotonin 2A receptor

200
Q

MDMA MOA

A

stimulates serotonin release

201
Q

psychedelic AE; short term physiologic

A

tachycardia, hypertension, tremors, dry mouth, nausea, hyperthermia

202
Q

psychedelic AE; acute dysphoric reaction

A

terrifying thoughts, fear of insanity, fear of losing control, fear of death

203
Q

psychedelic AE; psychotic reations

A

flashbacks, enduring changes in personality, exacerbate underlying psychotic disorder, instigate prolonged psychotic disorder, rate of psychosis after LSD1 to 5%

204
Q

potential therapeutic uses

A

cancer related psychological distress
PTSD
depression
SUD for alcohol

205
Q

dissociative psychedelic MOA

A

NMDA antagonists, disinhibition of glutamate release, inhibition of GABA release

206
Q

ionotropic glutamate receptors

A

NMDA receptor antagonist; induce anesthesia and analgesia

207
Q

Dextromethorphan

A

serotonin reuptake inhibitor; NMDA receptor antagonist

208
Q

phencyclidine

A

NMDA antagonist more potent than ketamine (D2 receptor agonist) associated with severe dissociation and analgesia, psychotic reactions, violence, and suicide

209
Q

muscimol MOA

A

GABAa agonist that acts on channels. benzos and alcohol are allosteric modulators. This is orthosteric

210
Q

alkyl nitrates

A

nitric oxide release; smooth muscle contraction, relaxes anal sphincter, enhanced erections and euphoria. may also cause methemoglobinemia

211
Q

volatile solvents of abuse

A

toluene, acetone, benzene, butane

212
Q

acute effects of volatile solvents

A

locomotor stimulation, euphoria, exhilaration, CNS depression, slurred speech, disorientation, weakness, sedation

213
Q

effects of repeated exposure of volatile solvents

A

lipid accumulation: adipose tissue, lipid-rich organs

214
Q

risks of inhalant abuse

A

asphyxiation, suffocation, convulsions, coma, choking, fatal injury, development of fatal arrythmia, and neurotoxicity

215
Q

alcohol metabolism

A

90% in liver by alcohol dehydrogenase (ADH), microsomal ethanol oxidizing system (MEOS) only at high concentration and involves CYP2E1 (low affinity for alcohol), then metabolized by aldehyde dehydrogenase

216
Q

fomepizole

A

alcohol dehydrogenase inhibitor; slow formation of formaldehyde and toxic metabolites

217
Q

metabolism of acetaldehyde

A

metabolized by aldehyde dehydrogenase

218
Q

disulfiram (antabuse)

A

strong inhibitor of ALDH2; irreversible inhibitor with effect persisting up to 14 days. Causes a strong hangover.

219
Q

targets of alcohol

A
  • allosteric activator of GABAa receptors (inhibitory)
  • NMDA receptor inhibitor
    Alpha7 nicotinic receptor
    causes neurotransmitter release; enkephalins (dopamine), serotonin/NE, Ach, increases CNS and blood ACTH levels
220
Q

blood alcohol level measurement

A

0.1% = 100mg/dL = 100mg%

221
Q

Driving limit

A

0.08%

222
Q

pharmacologic actions of low levels of alcohol

A

30-60mg/dL = euphoria, disinhibition, talkative
60-90mg/dL = analgesia
80-120mg/dL = CNS stimulation; mood swings/aggression
100-200mg/dL = CNS depression; slurred speech, ataxia, sedation, loss of motor control, irrational behavior
300-500mg/dL = respiratory paralysis, coma, death

223
Q

acute cardiovascular effects

A

vasodilation, reduced BP, increased HR

224
Q

moderate use CV effects

A

reduced risk of coronary disease; increased HDL

225
Q

Heavy/Chronic use CV effects

A

cardiomyopathy, arrythmias, hypertension, hemostasis

226
Q

physiological effects of alcohol consumption

A

hypothermia (possibly lethal), chronic gastritis, appetite stimulant (low dose), appetite depressant (high dose)

227
Q

long term AEs in liver

A

increased fat metabolism, fatty liver leading to cirrhosis, vitamin deficiencies, small intestine damage = diarrhea, edema, ascites, effusions

228
Q

long term AEs in blood

A

anemia, gastritis, folic acid deficiency

229
Q

long term AEs cancer

A

liver cancer or mouth, larynx, esophagus, stomach

230
Q

Drug interactions with alcohol

A

CNS depressants, aldehyde dehydrogenase inhibitors (antimicrobials), (sulfonylureas), acetaminophen, aspirin

231
Q

teratogenic effect of alcohol

A

fetal alcohol syndrome:
- facial dysmorphology, low birth weight, decreased brain size, mental retardation, lower testosterone and sperm quality

232
Q

alcohol withdrawal

A

anxiety, insomnia, seizures, N/V, tactile hallucinationsa

233
Q

alcohol withdrawal treatment

A

benzos, phenytoin, electrolytes, clonidine, guanfacine

234
Q

FDA approved treatments for alcoholism

A

disulfiram (causes flushing, throbbing, headache, N/V, sweating, hypotension, confusion)
Acamprosate (NMDA receptor antagonist/GABA antagonist)
Naltrexone (Revia) (opioid receptor antagonist)

235
Q

off-label treatments

A

topiramate, baclofen, varenicline

Therapeutics 2 (9 decks)

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