BH pharmacology

Question 1

BZD MOA

Answer 1

Binds postsynaptic GABA neuron (inhibitory) -> potentiates endogenous GABA

Question 2

BZD ADRs (5)

Answer 2

• Sedation
• Dizziness, confusion, ataxia
• Teratogenicity
• Withdrawal sx
• Abuse potential

Question 3

BZD clinical pearl

Answer 3

Use SHORT TERM for anxiety until AD kicks in

Question 4

Alprazolam indications (4)

Answer 4

• GAD
• Panic disorder +/- agoraphobia
• Short-term relief of anxiety
• Anxiety assoc. w/ depression

Question 5

Clonazepam indications (2)

Answer 5

• Panic disorder +/- agoraphobia

- Seizure disorder

Question 6

Lorazepam indications (4)

Answer 6

• Short-term relief of anxiety
• Status epilepticus
• Sedation/amnesia
• ETOH withdrawal/”agitation”

Question 7

Diazepam indications (2)

Answer 7

• Seizure disorders

- “conscious sedation”

Question 8

Midazolam indications (1)

Answer 8

• “conscious sedation”

Question 9

First line drug for anxiety

Answer 9

SSRI

Question 10

First step for treating pediatric patients with anxiety

Answer 10

CBT

Question 11

BZDs BBW

Answer 11

Taking benzodiazepines at the same time as opioids can lead to extreme sedation, slow and ineffective breathing, comas, and even death

Question 12

SSRI MOA

Answer 12

Blocks serotonin reuptake -> increases synaptic serotonin

Question 13

SSRI BBW

Answer 13

Suicide (monitor @ initiation, dose changes)

Question 14

SSRI ADRs (7)

Answer 14

• Sexual side effects (decreased libido, delayed ejaculation, anorgasmia)
• Anorexia -> wt. loss -> wt. gain
• Bruxism
• SIADH
• Long QT
• Serotonin syndrome
• Discontinuation/FINISH syndrome

Question 15

Serotonin syndrome sx

Answer 15

• Flushing
• Hyperthermia
• Agitation
• Muscle rigidity
• Seizure
• Coma

Question 16

Discontinuation/FINISH syndrome sx

Answer 16

• Flu-like sx
• INsomnia
• Imbalance
• Sensory disturbances (coordination)
• Hyperarousal (agitation/anxiety)

Question 17

SSRI categories in pregnancy (1st trimester)

Answer 17

C - all others (use fluoxetine! most data)

D - paroxetine (CV malformation)

Question 18

SSRI adverse events in pregnancy (3rd trimester)

Answer 18

• Neonatal ICU syndrome
• Withdrawal rxns
• Persistent pulmonary hypertension

Question 19

Which SSRI has the longest half life? Shortest half life?

Answer 19

Longest: fluoxetine
Shortest: paroxetine

Question 20

Fluoxetine indications (5)

Answer 20

• MDD
• OCD
• Panic disorder +/- agoraphobia
• Bulimia
• PMDD

Question 21

Sertraline indications (6)

Answer 21

• MDD
• OCD
• Panic disorder +/- agoraphobia
• Social anxiety disorder
• PMDD
• PTSD

Question 22

Paroxetine indications (6)

Answer 22

• MDD
• OCD
• Panic disorder +/- agoraphobia
• Social anxiety disorder
• GAD
• PMDD
• PTSD

Question 23

Citalopram indications (1)

Answer 23

• MDD

Question 24

Escitalopram indications (2)

Answer 24

• MDD

- GAD

Question 25

SNRI MOA

Answer 25

Inhibit serotonin & NE reuptake (pain management MOA unknown)

Question 26

SNRI ADRs (4)

Answer 26

- Nausea - Constipation - Dizziness - Insomnia - BP and HR increase - Serotonin syndrome - Discontinuation/FINISH syndrome

Question 27

Duloxetine specific ADR

Answer 27

Hepatotoxicity

Question 28

Which SNRI has the greatest risk of discontinuation syndrome?

Answer 28

Venlafaxine

Question 29

Velafaxine indications (4)

Answer 29

- MDD - GAD - Panic disorder +/- agoraphobia - Social anxiety disorder

Question 30

Desvenlafaxine indications (1)

Answer 30

- MDD

Question 31

Duloxetine indications (3)

Answer 31

- MDD - GAD - Pain* (diabetic neuropathy, fibromyalgia, chronic MSK pain) *not first line

Question 32

Milnacipran (type of SNRI) indication (1)

Answer 32

- Fibromyalgia

Question 33

Levomilnacipran (type of SNRI) indication (1)

Answer 33

- MDD

Question 34

Bupropion MOA

Answer 34

"Amphetamine-like"

Question 35

Bupropion indications

Answer 35

- MDD - SAD - Adjunct in smoking cessation

Question 36

Bupropion ADRs (4)

Answer 36

- Seizure threshold lowering (esp. bulimic, anorexic pt.) - HA - Anxiety - Insomnia

Question 37

Bupropion pearl

Answer 37

Good choice if sexual function concerns

Question 38

Trazadone indications (1)

Answer 38

- MDD (esp. if insomnia present!!!!)

Question 39

Trazadone MOA

Answer 39

1. Serotonin receptor antagonist 2. Inhibits serotonin reuptake (SSRI) 3. Antagonist of histamine and alpha receptors

Question 40

Trazadone ADRs (4)

Answer 40

- Sedation - Postural hypotenion - QT prolongation - Priapism

Question 41

Mirtazapine MOA

Answer 41

Involves NE, serotonin, histamine

Question 42

Mirtazapine indications

Answer 42

- MDD + insomnia | - MDD + anorexia

Question 43

Mirtazapine ADRs

Answer 43

- Weight gain d/t increased appetite - Sedation - Dry mouth

Question 44

TCAs

Answer 44

next