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Pharmacology III > CNS Drugs: Interactions & Withdrawal > Flashcards

CNS Drugs: Interactions & Withdrawal Flashcards

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1
Q

This alcohol tolerance occurs with CYP2E1 induction… it leads to increased EtOH metabolism

A

pharmacokinetic

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2
Q

The downregulation of GABA receptors and upregulation of NMDA receptors results in what two things?

A

pharmacodynamic tolerance and withdrawal sxs

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3
Q

Anterograde amnesia occurs with blockade of…

A

NMDA receptors

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4
Q

What 2 drugs can be administered if seizures due to acute alcohol toxicity?

A

lorazepam, phenytoin

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5
Q

Chornic alcohol abuse can lead to Wernicke-Koraskoff Syndrome, which is due to a deficiency of…

A

Thiamine

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6
Q

Which pharmacologic tx for EtOH abuse can be used with liver disease?

A

acamprosate

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7
Q

What two BZs can be used to prevent seizures in EtOH withdrawal?

A

diazepam, chlordiazepoxide

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8
Q

what type of tolerance?

increased metabolism

A

pharmacokinetic

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9
Q

what type of tolerance?

receptor downregulation

A

pharmacodynamic

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10
Q

the opposite of tolerance is _______, it is increased responsiveness after repeated use. The dose/response curve is shifted ______

A

sensitization

left shift

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11
Q

does physiologic dependence mean addiction?

A

no

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12
Q

typically, abused drugs activate the ______

A

mesolimbic DA pathway (reward pathway)

VTA to NAc to PFC

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13
Q

the below Class I drugs act on what target?

opioids
THC
GHB

A

GCPRs in VTA

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14
Q

The below Class II drugs act on what target?

BZs
Nicotine
EtOH

A

Ion Channels in VTA

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15
Q

the below Class III drugs work on what target?

cocaine
amphetamine
ecstasy

A

transporters in VTA, NAc

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16
Q

Amphetamines can cause increased release of…

A

DA

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17
Q

this drug reverses DA transport through the DAT

A

amphetamines

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18
Q

Meth causes a decrease in ____

A

DA transporters

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19
Q

This drug inhibits DA reuptake leading to postsynaptic receptor downregulation and severe cravings, physical and psych dependence…

A

cocaine

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20
Q

what differentiates crack cocaine from powder cocaine?

A

rapid onset

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21
Q

This drug reduces overall brain activity, can cause formications, severe withdrawal and has an intense physiologic dependence

A

cocaine

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22
Q

Three overdose/toxic effects of chronic cocaine use

A

arrhythmia
stroke/hemorrhage
seizures

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23
Q

which drug can decrease craving for cocaine?

A

bromocriptine

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24
Q

This drug blocks reuptake of 5HT and increases expression of 5HT receptors

A

MDMA

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25
What three complications lead to MDMA fatality?
hyperthermia dehydration kidney failure
26
the intense, depression-like hangover from MDMA is due to...
decreased 5HT
27
LSD, Mescaline, and psilocybin act on what receptors in the brain?
5HT
28
Do LSD, Mescaline, and psilocybin cause dependence? why?
no, don't stimulate DA
29
NMDA receptor antagonists...
PCP/ketamine
30
weak GABA receptor agonist...
GHB
31
PCP psychosis can be treated with...
haloperidol
32
chronic nitrous oxide use can cause...
peripheral neuropathy
33
inhalants general have what mechanism?
smooth muscle relaxant
34
Phenytoin, carbamazepine and phenobarbital induce...
CYP450s
35
_______ is an anticonvulsant metabolized by, induces and inhibits CYP450s
phenytoin
36
______ increases the metabolism of anticonvulsants, haloperidol, and OCPs
carbamazepine (CYP450 inducer)
37
Carbamazepine, phenytoin, phenobarbital metabolism is inhibited by...
valproic acid
38
carbamazepine metabolism is increased by...
phenobarbital, phenytoin
39
What increases the metabolism of lamotrigine?
CYP450 inducers (carbamazepine, phenytoin, phenobarbital)
40
which drug doubles the half life of lamotrigine?
valproic acid (enzyme inhibitor)
41
Ethosuximide metabolism is inhibited by...
valproic acid (CYP450 inhibitor)
42
at low doses, valproic acid (induces/inhibits) its own metabolism
inhibits
43
Withdrawal from anticonvulsants results in...
rebound seizures
44
OD of anticonvulsant results in
non-fatal CNS depression
45
The withdrawal from ____ can be severe... it includes the below sxs... ``` orthostatic hypotension hyperactive reflexes seizures restlessness anxiety weakness ```
barbiturates
46
BZs should be prescribed with caution in what population?
elderly
47
which three BZs can be helpful to provide a tapered withdrawal from alcohol and barbiturates?
chlordiazepoxide, diazepam, lorazepam
48
abrupt discontinuation of BZs and Z drugs can result in ______, therefore they should be tapered slowly
rebound insomnia, anxiety
49
Ramelteon when combined with _____ has an additive effect
etoh, sedatives
50
which spasmolytic is similar to barbiturates and therefore should be used with caution in addicts?
carisoprodol (soma)
51
TCA metabolism by _____ makes drug interactions common
CYP2D6
52
tolerance to what three TCA effects can occur
sedation hypotension anticholinergic effects
53
Major issue with TCA toxicity
Torsades/cardiotoxic
54
TCAs + _____ can cause serotonin syndrome
MAOIs
55
severe CNS toxicity presented as hyperpyrexia, convulsions, coma
serotonin syndrome
56
TCAs compete with _____ which can lead to toxicity
SSRIs
57
TCAs can cause HTN when combined with...
amphetamine
58
TCAs potentiate the effects of.. (2)
depressants, anticholinergics
59
SSRIs (induce/inhibit) CYP450 meaning they have many drug interactions
inhibit
60
SSRIs + MAOIs can cause...
serotonin syndrome
61
CYP450 inhibition means increased toxicity of what three drugs?
TCAs, phenytoin, carbamazepine
62
fluoxetine inhibits conversion of this prodrug to active form...
codeine
63
SSRIs + Meperidine =
serotonin syndrome
64
SSRIs + tramadol =
seizure risk
65
MAOIs + TCAs Meperidine DXM SSRIs
serotonin syndrome (hyperpyrexia)
66
MAOIs + sympathomimetics (ephedrine, amphetamines)
HTN
67
MAOIs inhibit ______ which effects SSRI, CCB metabolism
CYP2D6
68
St. John's wort + antidepressants =
serotonin syndrome
69
What drug class should be avoided with... anticholinergics sedative hypnotics (supraadditive) TCAs (seizures, cardiotoxic) CYP450 inducers (tobb, carbamazepine) antihypertensives
antipsychotics
70
Can lithium/antipsychotics be taken with BZs?
yes
71
lithium + NSAIDs =
increased toxicity
72
tolerance is not developed for what three effects of opioids
miosis, constipation, seizures
73
opioid withdrawal can be reduced by use of... (2)
clonidine or methadone
74
morphine, hydrocodone (prodrug), oxycodone, codeine (prodrug) are metabolized by...
CYP2D6
75
fentanyl is metabolized by ____ making drug interactions likely
CYP3A4
76
Tramadol + MAOIs, TCAs, SSRIs =
serotonin syndrome, seizures
77
L-dopa + MAOI-As =
HTN
78
L-Dopa + pyridoxine =
increased peripheral metabolism
79
Apomorphine + odansetron =
HTN
80
AChE Inhibitors are metabolized by...
CYP450
81
Memantine cannot be taken with what two drugs?
meperidine, DXM

Pharmacology III (15 decks)

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