Antipsychotics, antidepressants, opioids, drugs of abuse, endocrine Flashcards
1
Q
target action of typical antipsychotics
A
D2 receptors in caudate putamen, nucleus accumbens, cerebral cortex, hypothalamus
2
Q
dopaminergic tract-regulating mentation and mood
A
meso-cortical, meso-limbic
3
Q
dopaminergic tract-extrapyramidal function
A
nigrostriatal
4
Q
dopaminergic tract-control of prolactin relace
A
tuberoinfundibular
5
Q
dopaminergic tract-eating behavior
A
medullary-periventricular
6
Q
dopaminergic tract-anticipatory motivational phase of copulatory behavior
A
incertohypothalamic
7
Q
antipsychotic of choice for drug resistance
A
clozapine
8
Q
caused by supersensitivity of dopamine receptors
A
tardive dyskinesia
9
Q
tx for acute dystonia
A
diphenhydramine
10
Q
tx for parkinsonism
A
benztropine
11
Q
tx for rabbit syndrome
A
benztropine
12
Q
tx for tardive dyskinesia
A
nonerome
13
Q
tx for akathisia
A
decrease dose, diphenhydramine
14
Q
tx for neuroleptic malignant syndrome
A
withdraw drug, dantrolene, diazepam, dopamine agonist
15
Q
typical antipsychotic; SE: corneal and lens deposits, neuroleptic malignant syndrome, contact dermatitis
A
chlorpromazine
16
Q
typical antipsychotic; SE: retinal deposits, cardiotoxicity, w/ strongest autonomic effects, fatal ovedose
A
thoridazine
17
Q
typical antipsychotic known for major EPS, also used for Huntington’s and Tourette’s, least sedating among typicals
A
haloperidol/droperidol
18
Q
only antipsychotic that reduces the risk of suicide
A
clozapine
19
Q
weight gain attributed to atypical antipsychotics
A
probably from H1 and 5-HT2 blockade
20
Q
atypical antipsychotic also used for manic episodes; SE: cataracts, hypnagogic hallucinations, priapism
A
quetiapine
21
Q
only antipsychotic approved in the youth
A
risperidone
22
Q
atypical antipsychotic; SE: QT prolongation, increased mortality in elderly with dementia-related psychosis
A
ziprasidone
23
Q
least sedating among atypical anti-psychotics
A
aripiprazole
24
Q
atypical antipsychotics with no atropine like effects, do not cause hypergly, hyperprolactinemia or weight gain
A
ziprasidone, aripiprazole
25
features of neuroleptic malignant syndrome
FEVER: fever, encephalopathy, vitals unstable, elevated CPK, rigidity`
26
MOA of lithium
decreases cAMP, inhibits inositol-1-phosphatase
27
SE of lithium; Tx
LITH: leukocytosis, insipidus, teratogen (Ebstein's anomaly), thyroid enlargement, tremors, heart (bradycardia); also acneiform skin eruptions; hemodialysis
28
threshold for lithium toxicity
2 mEq/L
29
NTs responsible for mood
NE and serotonin
30
back-up drug for MDD
TCAs: imipramine (clomipramine, desipramine, amitryptyline, nortryptiline)
31
toxic dose of TCAs; lethal dose
7mg/kg; 15 mg/kg
32
ECG findings in TCA overdose
abnormal QRS morphology, prolonged QRS, abnormal R and S waves in AVR
33
features of TCA overdose; Tx
coma, convulsions, cardiotoxicity; bicarbonate (for QRS>100msec)
34
first line for MDD
SSRI (fluoxetine, paroxetine, citalopram, escitalopram, sertraline, fluvoxamine)
35
notable SE of SSRIs
erectile dysfunction
36
tx for serotonin syndrome
cyproheptadine
37
inhibits neuronal reuptake of serotonin and NE
SNRIs (venlafaxine, duloxetine, desvenlafaxine)
38
SNRI with hepatotoxicity SE
duloxetine
39
SNRI with cardiotoxicity and CYP450 inhibitio
venlafaxine
40
weak 5-HT reuptake inhibitors that blocks 5-HT2 receptors to make serotonin available to other receptors, SE: priapism; SE: hepatotoxicity
trazodone and nefazodone; trazodone; nefazodone
41
tetracyclic antidepressant which causes amenorrhea-galactorrhea syndrome and lowers seizure threshold
amoxapine
42
tetracyclic antidepressant which can be used as appetite stimulant; can cause nightmares
mirtazapine
43
tetracyclic antidepressant which can also be used for smoking cessation; also causes priapism, aggravation of psychosis, lower seizure threshold
bupropion
44
inhibits monoamine oxidase type A and B, increases NE and serotonin
MAOIs (phenelzine, tranylcypromine, selegiline)
45
causes hypertensive crisis when taken with tyramine (indirect acting sympathomimetic in cheese)
MAOIs
46
features of serotonin syndrome
FAT CHD; fever, agitation, tremors, clonus, hyperreflexia, diaphoresis
47
features of malignant hyperthermia
FCHART; fever, acidosis, rhabdomyolysis, trismus, clonus, HPN
48
precipitating drugs for serotonin syndrome
SSRIs, MAOIs, TCAs, meperidine, MDMA, St. John's wort
49
opioids with shortest and longest half-lives
remifentanil; buprenorphine
50
mu opioid receptor (function, affinity)
inhibition of respiration, endorphins
51
delta opioid receptor (function, affinity)
dev't of tolerance, enkephalin
52
kappa opioid receptor (function, affinity)
slowed GI transit, dynorphin
53
opioid analgesic which may be given trandermally or via lollipop
fentanyl
54
most potent opioid
ohmefentanyl
55
opioid of choice for relief in pancreatitis and labor pains
meperidine
56
opioid which causes serotonin syndrome w/ SSRIs or MAOIs
meperidine
57
agonist of mu and kappa receptors
meperidinethadone
58
opioid used for opioid dependence/withdrawal, can cause drug-induced hyperthyroidism, currently being investigated as a novel treatment for leukemia
methadone
59
partial opioid agonist; SE: hypogonadism, hearing loss
hydrocodone/oxycodone
60
partial opioid agonist which depresses medullary cough center through sigma receptor stimulation
dextrometorphan/ codeine
61
weak opioid agonist withdrawn due to fatal cardiotoxicity
propoxyphene
62
opioid which is a strong agonist of kappa receptors but weak antagonist of mu receptors
nalbuphine, buprenorphine, butorphanol, pentazocine
63
effects resistant to naloxone reversal
nalbuphine, buprenorphine, butorphanol, pentazocine
64
systemic opioid antagonist
naloxone
65
systemic opioid antagonist which also reduces alcohol dependence
naltrexone
66
dual-acting opioid analgesic, weak agonist of mu receptor, also inhibits reuptake of serotonin and NE, lowers seizure threshold and may cause serotonin syndrome
tramadol
67
CI of tramadol use
epilepsy
68
triad of opioid overdose
PRC: pupillary constriction, respiratory depression, coma
69
NT believed to cause addiction
excessive dopaminergic stimulation
70
antidepressants with limited benefit against amphetamine withdrawal symptoms
amineptine, mirtazapine
71
congeners of amphetamines
dimethoxymethylamphetamine (DOM), methylene dioxyamphetamine (MDA), methylene dioxymethamphetamine (MDMA/ ecstacy)
72
electrolyte imbalance which may be caused by ecstacy
profound hyponatremia
73
"speed", "superspeed"
methamphetamine, cocaine
74
causes crack lung (hemorrhagic alveolitis), mydriasis, HPN, vasoconstriction, psychomotor agitation, hyperthermia, dyspnea, bowel ischemia, thrombus formation
cocaine overdose
75
presents with agitation, hypertension, tachycardia, delusions, hallucinations, hyperthermia, seizures
methamphetamine overdose
76
teratogenic, causes cystic cortical lesions on CT
cocaine
77
psychotomimetic effect
phencyclidine/ ketamine
78
most dangerous hallucinogenic agent
phencyclidine
79
"angel dust"
phencyclidine
80
causes nystagmus, hypertension and seizures; tx
phencyclidine; IV diazepam/lorazepam
81
no actions on dopaminergic neurons unlike most drugs of abuse
phencyclidine
82
psychedelic effects
lysergic acid diethylamide (LSD), mescaline, psilocybin
83
purified more potent form of marijuana
hashish
84
reddened conjunctiva
marijuana
85
increases IGF-1 in liver and cartilage; used for short stature syndromes (Turner, Noonan, Prader-Willi), AIDS wasting, failure to thrive
somatropin
86
somatostatin analog, suppresses GH, IGF-1, serotonin and GI peptides; used for acromegaly, pituitary GH-secreting adenoma, carcinoid, gastrinoma, glucagonoma, variceal bleeding
octreotide/lanreotide
87
syndrome of ovarian enlargement, ascites, hypovolemia, possible shock
ovarian hyperstimulation syndrome
88
FSH analog, used for controlled ovarian hyperstimulation, infertility due to hypogonadism in male
follitropin alfa, menotropins (hMG)
89
LH analog, used for ovulation induction and hypogonadotropic hypogonadism
choriogonadotropin alfa, hCG, menotropins (hMG), lutropin
90
GnRH analog
leuprolide (gonadorelin, goserelin, histrelin, nafarelin, triptorelin)
91
effect of leuprolide
increased LH and FSH with intermittent admin; dec with prolonged continuous admin; may temporarily exacerbate precocious puberty or prostate CA
92
GnRH antagonist
ganirelix, cetrorelix, abarelix, degarelix
93
does not cause tumor flare-ups when used for tx of advanced prostate CA
ganirelix, cetrorelix, abarelix, degarelix (GnRH antagonist)
94
drug against hyperprolactinemia, pituitary adenoma (prolactin-secreting), acromegaly, Parkinson's which may cause erythromelalgia and Raynaud's phenomenon
bromocriptine (pergolide, cabergoline, quinagolide)
95
may cause fluid retention (water intoxication), placental/uterine rupture
oxytocin
96
CI for oxytocin
fetal distress, prematurity, CPD, predisposition for uterine rupture
97
increases F VIII activity in patients w/ mild hemophilia A
desmopressin
98
used for central DI, vW disease, variceal bleeding, primary nocturnal enuresis
desmopressin
99
ADH antagonist used for SIADH, hyponatremia
conivaptan, tolvaptan, lixivaptan
100
tyrosine residues are iodinated to form MIT or DIT
iodine organification
101
T4
levothyroxine
102
T3
liothyronine
103
T4 must be lowered in patients with
CV disease or longstanding hypothyroidism
104
Tx for myxedema coma
IV loading dose of levothyroxine (300-400mcg) followed by 50-100 mcg daily, IV hydrocortisone if w/ adrenal or pituitary insufficiency
105
inhibits thyroid peroxidase
thioamides (PTU, methimazole)
106
inhibits thyroid peroxidase and peripheral conversion of T4 and T3, DOC for thyroid storm and pregnant patients; SE: fulminant hepatitis; thrice daily dosing
PTU
107
inhibits thyroid peroxidase, can cause cholestatic jaundice and cutis aplasia; once daily dosing
methimazole
108
onset of action of thioamides
3-4 weeks
109
tx for agranulocytosis
d/c PTU/methimazole, administer recombinant G-CSF (Vilgrastine); prophylactic antibiotics
110
emits beta rays causing destruction of thyroid parenchyma; CI
radioactive iodine; pregnant and nursing mothers
111
inhibits iodine organification and hormone release; reduces size and vascularity of thyroid
potassium iodide/lugol's solution
112
used as preparation for thyroidectomy or radiation prophylaxis
potassium iodide
113
should not be used alone (escape in 2-8 weeks)
potassium iodide
114
fetal exposure causes fetal goiter
potassium iodide
115
ingestion of iodine causes hypothyroidism due to negative feedback
Wolff-Chaikoff effect
116
ingestion of iodine causes hyperthyroidism (e.g. endemic goiter)
Jod-Basedow phenomenon
117
utility of beta blockers in thyroid dse
inhibits peripheral conversion
118
used to treat thyrotoxicosis-related arrhythmias
esmolol
119
causes clinical improvement without altering thyroid hormone levels
propranolol
120
inhibit peripheral conversion of T4 to T3
PTU, propranolol, hydrocortisone
121
granulocyte count in thyroid storm
<500 cells/mm3
122
high dose of methimazole increasing risk for throid storm
>40mf/d
123
done to prevent Jod-Basedow effect
administer PTU before SSKI
124
Tx for thyroid storm
PTU, SSKI, Propranolol, Hydrocortisone
125
Drugs which cause drug-induced hyperthyroidism
Clofibrate, amiodarone, methadone
126
drug which can cause either hyper or hypothyroidism
amiodarone
127
difference of 21 and 11 B-hydroxylase deficiency
21-hypotension, 11-hypertension (due to accumulation of 11-B deoxycortisol)
128
glucocorticoid with highest anti-inflamm property
betamethasone
129
glucocorticoid with highest salt-retaining potency
fludrocortisone
130
low potency hydrocortisone
desonide ("di sanay")
131
medium potency hydrocortisone
fluticasone, mometasone (fruity moment)
132
high potency hydrocortisone
desoximetasone, clobetasol (di saucy kubeta)
133
glucocorticoid used for prevention of organ transplant rejection, beain swelling, post-chemo vomiting, lowering ICP secondary to brain tumors
prednisone
134
SE: steroid rage (behavioral changes), osteoporosis, glucose intolerance, growth inhibition
prednisone
135
GC which hastens fetal lung maturation
betamethasone
136
mineralocorticoid used for chronic adrenal insufficiency, CAH, adrenal replacement post-adrenalectomy; additive hypoK with loop and thiazide diuretics
fludrocortisone/deoxycorticosterone
137
corticosteroid antagonist which inhibits desmolase, blocking conversion of cholesterol to pregnenolone, used for breast Ca and Cushing's
aminoglutethimide
138
azole antifungal which can inhibit cholesterol side chain cleavage, preventing steroid synthesis; used for adrenal CA, breast and prostate CA, hirsutism
ketoconazole
139
selective inhibitor of 11-hydroxylation used for diagnosis and Tx of Cushing's
metyrapone
140
DOC for pregnants w/.Cushing's
metyrapone
141
ethinyl estradiol use increases risk of ____; prevent by combining w/ ____
endometrial CA and breast CA; progestin
142
synthetic estrogen used for atrophic vaginitis, HRT, metastatic prostate CA
DES
143
notable SE of progestings
HPN, decreased HDL, weigh gain, reversibly dec in bone mineral density
144
type of OCPs with constant dosage throughout menstrual cycle
monophasic
145
type of OCPs with change/s in dosage throughout menstrual cycle; mimics hormonal changes in menstrual cycle
biphasic/triphasic
146
association of combined OCPs and breast CA
lifetime risk will not change, but there is earlier onset
147
IM depot preparation of progestin-only contraceptive
medroxyprogesterone acetate (depo-provera)
148
used for emergency contraception
levonorgestrel
149
estrogen agonists in some tissues but partial agonists or antagonists in other tissues
selective estrogen receptor modulators
150
estrogen antagonist in breast and CNS, agonist in uterus, liver and bone; used in ER+, PR+ breast CA; decreases risk of_____ and ____, increased risk of ______
Tamoxifen; osteoporosis and atherosclerosis; endometrial CA
151
estrogen antagonist in breast, uterus and CNS, agonist in liver and bone; used in osteoporosis and breast CA prevention
Raloxifene
152
partial agonist of estrogen in pituitary, increases FSH and LH; used for induction of labor; notable SE
Clomiphene; ovarian enlargement, multiple pregnancies (CLONE ME PHLEASE), increase risk of low-grade ovarian CA with long term use
153
SERM inhibiting aromatase used for precocious puberty and tamoxifen resistant breast CA
anastrozole
154
SERM used for endometriosis, fibrocystic disease (cyclical painful breast mass), hemophilia
danazol
155
medical abortifacient which may cause sepsis due to Clostridium sordelli
Mifepristone
156
sex hormone-binding globulin is increased by; decreased by
estrogen, thyroid hormone, cirrhosis; androgen, growth hormone, obesity
157
site of conversion of testosterone to DHT; enzyme involved
prostate, penis scrotum; 5 alpha reductase
158
androgen agonist aside from testosterone; increases muscle bulk and RBC production but can cause paradoxical feminization
oxandrolone
159
androgen antagonist; administered with leuprolide to prevent acute flare-up of prostate cancer
flutamide
160
androgen antagonist used for surgical castration
nilutamide
161
androgen antagonist with progestational effect; orphan drug status
cyproterone
162
inhibits 5-alpha reductase, used for BPH, male pattern baldness and hirsutism; controversial use in prevention of prostate CA
finasteride/ dutasteride
163
all insulin preparations contain
zinc
164
glucose transporter for basal uptake of glucose
GLUT 1
165
glucose transporter for transport across blood brain barrier
GLUT 1
166
glucose transporter for regulation of insulin release and glucose homeostasis
GLUT 2
167
glucose transporter for uptake into neurons
GLUT 3
168
glucose transporter for insulin mediated uptake of glucose
GLUT 4
169
transporter for absorption of fructose
GLUT 5
170
glucose transporter found in all tissues
GLUT 1
171
rapid acting insulin
lispro, aspart, glulisine
172
short acting insulin
regular
173
intermediate acting insulin
NPH, lente
174
ultra long acting insulin
glargine, detemir, lantus
175
MEN 1
Wermer syndrome; parathyroid adenoma/hyperplasia, pancreatic tumor, pituitary tumor
176
MEN 2A
Sipple syndrome; pheochromocytoma, parathyroid hyperplasia, medullary thyroid CA
177
MEN 2B
pheochromocytoma, neuroma/ganglioma, medullary thyroid CA
178
long acting insulin
ultralente
179
group of drugs which can block signs and symptoms of hypoglycemia
B-blockers
180
counter-regulatory hormones of insulin
GH, cortisol, glucagon, epinephrine
181
tx for somogyi effect
decrease evening dose of insulin
182
tx for dawn phenomenon
increase evening dose of insulin
183
tx for waning of insulin dose
increase evening dose of insulin
184
period in type 1 DM when exogenous insulin reqts decrease due to an increase in endogenous production of insulin
honeymoon period
185
depolarizes pancreatic B cell and triggers insulin release
insulin secretagogue
186
insulin secretagogue; 1st gen sulfonylurea, causes disulfiram reaction, weight gain, highest risk for hypoglycemia
chlorpropramide, tolbutamide, tolazamide
187
insulin secretagogue; 2nd gen sulfonylurea, causes less hypoglycemia than 1st gen, cholestatic jaundice
glipizide, glimepiride, glibenclamide (risk for cholestatic jaundice), gliclazide
188
insulin secretagogue; effective for postprandial hyperglycemia, least hypoglycemic among secretagogues, can cause URTI, used in diabetics with sulfa allergies
repaglinide, nateglinide, mitiglinide
189
insulin secretagogue; least hypoglycemic, may be used in CKD patients
nateglinide
190
activates AMP-stimulated protein kinase leading to inhibition of hepatic and renal gluconeogenesis; associated with lactic acidosis; DOC for obese diabetics and DM prevention among high risk
metformin
191
increases tissue sensitivity to insulin by activating PPAR-y receptor; also for DM prevention; can cause fluid retention, CHF, hepatotoxicity, macular edema, dyslipidemia; CI in pregnant and CHF pts
pioglitazone (thiazolinediones)-pampaPOGI ng insulin
192
slows down glucose absorption causing reduction in postprandial hyperglycemia (not fasting); causes GI disturbance(flatulence), minor glucose-lowering defect
alpha glucosidase inhibitors (e.g. acarbose, miglitol, voglibose)
193
amylin analog which suppresses glucagon release, delays gastric emptying, reduces appetite (anorectic effect)
pramlintide
194
activates GLP-1 receptors to augment glucose-stimulated insulin release
exenatide (incretin modulator)
195
inhibits dipeptyl peptidase-4, degrading GLP-1 and other incretins
sitagliptin
196
antiobesity drug inhibiting GI and pancreatic lipases; causes rebound weight gain upon discontinuation; CI in pregnancy
Orlistat
197
antiobesity drug inhibiting NE and serotonin reuptake, reduces appetite (anorectic effect); withdrawn due to increased CV risk
sibutramine
198
antiobesity drug inhibiting cannabinoid-1 receptors, reduces appetite (anorectic effect); withdrawn due to increased suicidal risk
rimonabant
199
bangkok pills; increased risk for ____
ephedrine, fenfluramine, phentermine; valvular heart dse
200
increases heart rate and force of contraction hence useful for B-blocker overdose
glucagon
201
present w/ decreased aa in blood, anemia, diarrhea, weight loss and necrolytic migratory erythema
glucagonoma
202
recombinant PTH used for osteoporosis; must be administered in _______ to stimulate bone formation
teriparatide; low intermittent dosing
203
used for rickets and osteomalacia commonly added to dairy products
ergocalciferol/ cholecalciferol
204
indication for active vitamin D (calcitriol)
secondary hyper PTH in CKD, hypocalcemia in hypoparathyroidism, psoriasis, liver dse
205
inhibits bone resorption, used in Paget's dse of bone, hypercalcemia, osteoporosis, tumor marker for medullary thyroid CA
calcitonin/ salcatonin
206
suppresses activity of osteoclasts, used in Paget's dse of bone, hypercalcemia, osteoporosis, causes esophagitis (100%) so take with large quantities of water
alendronate, pamidronate, zoledronic acid
207
phosphate binding resin used to treat hyperphosphatemia in CKD, vit D intoxication and hypoparathyroidism
sevelamer
