Drugs Last Day

Question 1

Reduce craving for alcohol - mech?

Answer 1

Naltrexone - block Mu receptor

Question 2

1st Line Treat Alcohol Withdrawal

Answer 2

Benzodiazepines

• Long acting = chlordiazepoxide
• Long acting = diazepam

Question 3

Treat GAD?

Answer 3

Venlafaxine/duloxetine = SNRI
Fluoxetine/sertraline/citalopram/paroxetine = SSRI

Question 4

Treat GAD w/ bu…

Answer 4

Buspirone = bus = slow onset of action (2 weeks)

• partial agonist 5HT-1A receptor
• few sedative effects
• no tolerance, dependence
• no muscle relaxant or anticonvulsant properties

Question 5

Treat Panic Disorder:

Answer 5

Pt is not acutely symptomatic: SSRI

Acute need: benzodiazepine (bad for pt’s w/ substance abuse past, also tolerance issue)

Question 6

Amitriptyline overdose

Answer 6

TCA overdose = tachy, delirium, dilated, flushed, sweating

• inhibit reuptake of NE & Serotonin
• die due to Na+ channel inhibition = arrhythmias

Question 7

Sleep hygiene vs. Stimulus control

Answer 7

Hygiene: avoid naps, avoid caffeine after lunch; dark bedroom & cool; don’t exercise b4 bedtime
Stimulus: Bed only for sex & sleep, leave after 20 minutes; go to bed only when sleepy; fixed wake-up time

Question 8

Tachy, HTN, dilated, agitation, seizure, myocardial ischemia

Answer 8

Cocaine intoxication - blocks presynaptic reuptake

Question 9

Treat Obsessive-Compulsive

Answer 9

SSRI + Cognitive-Behavioral therapy

Question 10

Treat specific phobias: fear of elevator

Answer 10

Behavioral therapy: exposure, systematic desensitization

Question 11

Tremors, anxiety, perceptual disturbances, psychosis, insomnia
Seizure, tachy, palpitations

Answer 11

Benzodiazepine withdrawal

Question 12

N/V, abdominal cramps, muscle aches

Dilated pupils, yawning, lacrimation, hyperactive bowel

Answer 12

Heroin withdrawal

Question 13

Increased appetite, hypersomnia, severe depression (crash), intense psychomotor retardation

Answer 13

Cocaine withdrawal

Question 14

Tremors, anxiety, agitation, delirium, psychosis

Seizures, tachy, palpitations

Answer 14

Alcohol withdrawal

Question 15

Olanzapine side effects

Answer 15

Atypical Antipsychotic

• weight gain
• dyslipidemia
• hyperglycemia

Question 16

Schizophreniform disorder

Answer 16

1month-6months = same symptoms as schizophrenia

- functional decline not required

Question 17

Pica

Answer 17

Compulsive consumption of nonfood or non-staple food source for 1+ month

Question 18

Treat Otitis Media

• Strep pneumo
• H. flu
• M. catarrhalis

Answer 18

Amoxicillin + clavulonic acid
Cephalosporins

If recurrent in kids: tympanostomy tubes

Question 19

Name the SNRI’s

Answer 19

Venlafaxine

Duloxetine

Question 20

Name the SSRI’s

Answer 20

Sertraline
Citalopram
Fluoxetine
Paroxetine

Question 21

Drug classes to avoid in elderly?

Answer 21

TCA
Barb/Benzo
Antiarrhythmics
1st gen antihistamines
Alpha blockers (orthostatic hypotension)
Sulfonylureas
Muscle relaxants

Question 22

Lithium

Answer 22

Treat Bipolar

• Ebstein anomaly
• narrow TW
• tremor = early side effect

Question 23

Low volume of distribution…

Answer 23

High molecular weight
High plasma protein binding
Hydrophilicity
High charge

Question 24

If C1 C4 esterase inhibitor levels are low, don’t use…

Answer 24

ACE inhibitor - increased bradykinin - increased angioedema

Question 25

Treat shock after ceftriaxone w/ low BP?

Answer 25

Epi

Question 26

Isoniazid is metabolized by...

Answer 26

Acetylation

Question 27

Neuroleptic malignant syndrome vs. | Serotonin syndrome

Answer 27

Both: Mental status, hyperthermia, autonomic instability NMS: rigidity SS: hyperreflexia, clonus, shivering

Question 28

Sledge hammer | Funnel

Answer 28

MAOinhibitors Sledge hammer = Selegiline = MAOB inhibitor Phenelzine = MAO nonselective inhibitor Tyramine - cheese, wine = usually degraded by MAOA but if on inhibitor = sympathomimetic effect 3rd line for Depression only for recalcitrant Can cause HTN crisis or resistant HTN

Question 29

Buspirone vs. | Bupropion

Answer 29

Buspirone: treat GAD; anxious if I miSS the Bus = Serotonin agonist at 5-HT1A Buproprion: atypical antidepressant - also reduce urge to smoke - NO Sexual SE's - SE: Seizure - can't use in anorexia/bulimia

Question 30

Mirtazapine vs. | Trazodone

Answer 30

``` Mirtazapine: atpyical antidepressant + a2 antagonist - increase release NE & 5-HT - SE: weight gain (good for elderly) - SE: sedation (good for insomnia) Trazodone: atypical antidepressant - treat insomnia; block 5-HT and alpha2 - PRIAPISM ```

Question 31

Treat insomnia, nothing else going on

Answer 31

Ramelteon | - melatonin agonist - few SE's

Question 32

Name the 2nd generation anti-histamines

Answer 32

Fexofenidine Cetirizine Loratidine dine zine dine SE: far less than 1st gen; less lipophilic; don't enter BBB as easily

Question 33

1st Generation Histamine blockers & SE

Answer 33

``` Chlorpheniramine Diphenhydramine Dimenhydrinate - zine SE: anti-cholinergic, sedation, weight gain, easily cross BBB, anti-alpha1 adrenergic = hypotension/postural ```