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Pharamcology > Week 6 > Flashcards

Week 6 Flashcards

1
Q

signs of clinical depression

A

SIGECAPS

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2
Q

where is the detailed assessment of depression discussed?

A

DSM-IV

diagnostic and statistical manual of mental disorders

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3
Q

what is a scale used to measure depression

A

Hamilton depression scale

HAM-D (abbreviated)

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4
Q

A HAM-D of ____ is regarded within the normal range and a HAM-D of ____ is thought of as serious depression

A

7

25

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5
Q

clinical depression may be due to low levels of what?

A
  • monoamine neurotransmitters norepinephrine
  • serotonin
  • dopamine
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6
Q

what are two common tricyclic antidepressants

and these drugs are available as generic

A
  • Amitriptyline

- Imipramine

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7
Q

TCA’s prevent repute of ____ and _______ at afferent neurons, thus untensifying

A
  • serotonin

- norepinephrine

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8
Q

what are some adverse effects of TCA’s

A 
orthostatic hypotension
dry mouth
urinary retention
sedation
heart block
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9
Q

unlabelled uses if tricyclics include

A

migraine headaches

neurological pain

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10
Q

____ ____ were some of the earliest antidepressants on the market in the 60;s. they inhibit ___ ____ in the brain and hence increase noreepi levels at brain synaese. Thus patients should stay away from food that are higher in NE such as figs, banana, and avocados.

A

MAO inhibitors

monoamine oxidase

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11
Q

____ ____ _____ _____ are the most commonly prescribed prescibed family of antidepressant drugs. This drug works by increasing the amount of serotonin in the brain controlling mood. They have less adverse effects when compared to TCA’s These drugs will not cause heart ___ and or ____. The use of these drugs for patients under ___ is controversial because of a small increase in suicide rates.

A

selective serotonin re-uptake inhibitors
arrhythmias and or seizures
14

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12
Q

______ suggest that SSRIS are only modestly better than placebo and difference may be due to breaking blind

A

Metaanalysis

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13
Q

_____ (——)(1989) was the first SSRI and at one time the most commonly prescribed antidepressant. It has been approved for treating depression, OCD, pre-menstrual syndrome, bulimia, panic disorder it primarily inhibits re-uptake of serotonin

A

Fluoxetine (Prozac)

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14
Q

what are major adverse effects f prozac
50%-
21%-
20%-

A

sexual dysfunction
nausea
headache

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15
Q

Prozac has a half about a ____. Prozac inhibits several isozymes of the _____-___

A

week

cyt P-450

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16
Q

What are four other SSRI’s

A

Paxil
Sertraline (zoloft)
Citalopram (celexa (1998)
Escitalopram (Lexapro)2001

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17
Q

what was the first most commonly prescribed SSRI in 2005 and what was the second most common

A

Sertraline

Escitalopram

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18
Q

The 4 SSRI’s are similar to prozac but they have shorter __ ___. They also have less inhibitor of ___-___ thus fewer drug interactions.

A

half-lives

CYT P-450

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19
Q

SSRI’s can cause insomnia and anxiety sometimes and this can be alleviated by taking a TCA such as _____ which tends to be sedating.
SSRI’s can produce E___ ____ ___ causing nausea, vomiting, agitation and sweating.

A

amitriptyline

Excess Serotonin Syndrome

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20
Q

High dosages if SSRI’s should not be terminated abruptly as it can cause ___ ____ ____ (flu-like withdraw symptoms: nausea, tremors and dizziness)

A

Serotonin discontinuation syndrome

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21
Q

what is the SARI and what drug is it

A

Serotonin Antagonist and reuptake inhibitors

Trazodone

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22
Q

_____ is thought to inhibit serration repute and to block certain serotonin receptors. It is also used as a sedative for insomnia as well as second line antidepressant.

A

trazodone

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23
Q

____ are classified separately from tricyclics because do not have as many adverse effects of TCA’s

A

SNRI antidepressants

Serotonin and norepinephrine Reuptake inhibitors.

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24
Q

_______ claims lower incidence of agitation than SSRI’s because it is a SNRI. This drug has a short half life which has contributed to substantial withdrawal problems. Effexor XR is available as the long acting form

A

Venlafaxine

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25
Q

______ is actually a metabolite of fenlafaxine. It is not cleat that it is any better than venlafaxine as an anted and is not approved in _____

A

Desvenlafaxine

europe

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26
Q

______ is a potent inhibitor of both serotonin and noreepi repute because it is a SNRI. it has also been approved by the FDA for treatment of depression and diabetic neuropathic pain. it has obtained FDA approval for treating _____ and generalized anxiety disorder.

A

cymbalta

fibromyalgia

27
Q

what does NDRI stand for and what is a drug in its class

A

Norepinephrine andd dopamine reuptake inhibitors

Bupropion

28
Q

______ has less effect on sexual disfunction which is a weak inhibitor of NE and dopamine repute. This drug is a NDRI and there is risk of cardia arrhythmias at high doses. This drug takes about 3-4 weeks to show effect. ____ is the same drug which is used for aiding smoking cessation.

A

Bupropion

Zyban

29
Q

Bipolar people that cycle from manic to depressed stages rapidly are called _____ cyclers and ____ cyclers go through the stages more slowly. Patients who have very elevated moods during the manic phase are called ____ bipolar. those who have high anxiety levels are referred to as _____

A

rapid
slow
euphoric
dysphoric

30
Q

____ _____ was the drug of choice for treatment of bipolar disorder. This drug has a low ti and numerous adverse effects. it must be taken 2 to 3 times a day because it is pee’d out. Effect don’t usually appear until 1-2 weeks.

A

Lithium Carbonate

31
Q

these three drugs are anti seizure drugs and are approved for bi-polar disorder

A

Valproic acid
Carbamazepine
Trileptal

32
Q

what are four atypical anti-psychotic medications approved for bi-polar disorder

A

Zyprexa
Seroquel
abilify
Risperidone

33
Q

what are 4 SSRI’s as appetite suppressants

A

Fenfluramine (drowsiness counter acted by PHENTERMINE and combo is known as fen-phen)
Redux
Meridia
Xenedrine

34
Q

If your systolic blood pressure is over _____ and diastolic is over ____ then you have hypertension. ( this was the past)
The number are now ___/____

A

140
90
120/80

35
Q

Blood pressure can be reduced by three ways???

A
  • reduce blood volume (Diuretics)
  • Vasodilation
  • decrease pumping rate or strength (beta blockers)
36
Q

it is estimated that 50 million americans have some degree of hypertension but about 37 million are being treated and only ___ million have blood pressure under control

A

25

37
Q

Many people have a dip on the order of __ mm HG in their blood pressure during the night, flooded by a blood pressure surge in the morning. there is an increased incidence of ___ in the morning

A

15

MI

38
Q

what are some non-pharmacological methods of reducing blood pressure

A
  • weight reduction
  • DASH (Diet Approach to stop hypertension) diet low in saturated fats, high fruits/veggies
  • reduce caffeine
  • reduce alcohol
  • aerobic exercise
  • na restriction
39
Q

what are some medications that increase BP

A
  1. Birth control pills
  2. antihistamines
  3. corticosteroids
  4. Tricyclic antidepressants
40
Q

what are first line drugs for reducing blood pressure

A
  1. diuretics
  2. ACE inhibitors and ARBS
  3. Ca channel blockers
  4. beta-1-blockers
41
Q

Diuretics are used primarily in the treatment of ___ and to reduce ____ in congestive Heart failure. They work by inhibiting ___ resorption which inhibits water resorption which in turn lowers blood volume. These drugs are recommend by the ___ (JNC). Ample data indicates that diuretics not only lower hypertension, they also reduce heart attacks, heart failure and stroke. They are also effective when combined with low does of Ca channel blockers, ACE inhibitors and beta blockers.

A

hypertension
edema
Joint National Committee

42
Q

________ works to inhibit Na+ resorption in EARLY distal convoluted tubule. It is more commonly used for treatment of hypertension. this drug was #13 of the most commonly prescribed drugs in 2008

A

Hydrochlorothiazide (HCTZ)

43
Q

Hydrochlorothiazide (HCTZ) causes, electrolyte imbalance, dehydration, hyperlipidemia, and not used while breast feeding, and hypokalemia which can be treated by a.) b.) c.)

A

a. ) K supplements
b. ) K sparing drugs
c. ) Diets rich in fruits and veggies

44
Q

______ (#17 in number of prescriptions in 2008) is the most potent common diuretic. it works on the ASCENDING LOOP OF HENLE and is sometimes referred to as _____ _____ or __ _____ ___. This drug has a higher efficacy than HCTZ but higher risk of same adverse effects

A

Furosemide (lasix)
loop diuretic
high ceiling diuretic

45
Q

what is a rare adverse effect of lasix

A

ototoxicity

46
Q

potassium sparing diuretics inhibit na+/K+ exchange in ____ convoluted tubule. expect for spironolactone and they are rarely given by themselves because they are not very potent diuretics

A

distal

47
Q

what are three potassium sparing diuretics

A

amiloride
triamterene
spironolactone

48
Q

________ inhibits the synthesis of Na+/K+ exhacnge protein in the last distal convoluted tubule and hence conserves potassium. This drug take _____ day to reach full efficacy because it doesn’t inhibit the already present channel protein. It was shown to reduce ___ ____ ____ (RALES study) by 30%. it is a weak ____ inhibitor thus may cause gynecomastia in males and its off label uses are to reduce facial hair growth in trans-genders

A

spironolactone
several
congestive heart failure
testosterone

49
Q

______ is freely filtered at the glomerulus and has minimal reabsorption. it sets up osmotic pressure differential result in no reabsorption by the kidneys. it is given IV in medical emergencies such as ____ failure, and cerebral _____ resulting from head injuries

A

Mannitol
renal
edema

50
Q

what are 2 beta-1 blockers

A
  • metoprolol

- atenolol

51
Q

Beta-1 blockers work better in ____ and _____ aged patients. In old people and blacks they do not seem to reduce the blood pressure or risk of heart attacks. Adverse effects include fatigue, depression, male sexual dysfunction and slight increased risk of diabetes. Do seem to reduce the risk of a second MI.

A

young and middle

52
Q

decrease mortality =

decrease blood pressure=

A

real clinical outcome

surrogate outcome.

53
Q

what are two other specific alpha and non-specific beta blockers that are trying to replace atenolol and metoprolol. X2

A

CARVEDILOL

Bystolic`

54
Q

likewise the ASCOT trial likewise showed a reduction in mortality in patients on the calcium channel blocker ____ compared with the beta-1 blocker atenolol

A

amlodipine

55
Q

ACE inhibitors work by inviting the synthesis of the potent ______ _____ ___

A

Vasoconstrictor angiotensin II

56
Q

angiotensin II stimulates ____ secretion in the adrenal cortex which results in Na ion and water retention

A

aldosterone

57
Q

Angiotensin II causes vasoconstriction of arterioles, as well as venous vasoconstriction. Inhibition of ____ causes vasodilation and resulting lower blood pressure. These are used in the treatment of hypertension and congestive heart failure. They have also been found to reduce progression of kidney failure in diabetics. These are often less effective in the ___ and ____

A

ACE

elderly and african americans

58
Q

ACE inhibitors can cause ____ therefore K supplements should be DC’d. ACE inhibitors also cause fetal injury and are teratogenic in the ___ trimester and _____ in the trimester. They also cause persistent dry ___ in 5-12% of people.

A

hyperkalemia
2nd
3rd
cough

59
Q

what was the six most commonly prescribed drug in 2008 for an ACE inhibitor

A

Lisinopril

60
Q

____ is used IV for hypertensive crisis and for clinical test as well as PO for reduction of hypertension

A

Enalapril

61
Q

_____ was the first ACE inhibitor on the market. It has a short half-life 2hrs and should be taken on an empty stomach because absorption is inhibited by food. it is rarely prescribed except for clinical _____ medicine test assessing _____ _____ where its short half life allows its rapid elimination.

A

Capoten
nuclear
renal stenoses

62
Q

what are 3 other ACE inhibitors

A

Accupril
Ramipril
Benazepril

63
Q

Angiotensin II Receptor Anagonsits or Blockers (ARA’s or ARB) act as inhibitors of the angiotensin II receptor sire in the vascular system and adrenal cortex. These do not cause persistent ___ that occurs with ACE inhibitors. They are ineffective in ___ and are teratogenic in the2nd and 3rd trimester. They are commonly prescribed especially to ___ patients and __ patients. All of the generic names end with -_____

A 
cough
blacks
diabetic
asian
-sartan
64
Q

what are 5 ARB’s

A 
Valsartan
Losartan
olmesartan
Irebesartan
candesartan

Pharamcology (12 decks)

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