Erin's Flashcards
(272 cards)
1
Q
Adverse drug reactions (ADR) Type A
A
Exaggerated extensions of pharmacologic activity (expected based on known MAO); dose dependent
2
Q
Adverse drug reactions (ADR) Type B
A
Idiosyncratic reactions, usually immunologic or allergic; independent of dose or route of administration; eg. SI in SSRIs for teens
3
Q
Patient in ED appears flat, confused, has weight gain, slight tremor, and is thirsty with polyuria. What would account for these symptoms?
A
Lithium
4
Q
Melatonin is derived from ___
A
Serotonin
5
Q
Ion responsible for maintaining resting potential of neuron
A
Potassium (K+)
6
Q
What neuropeptide augments (enhances) the body’s response to CRH?
A
Vasopressin
7
Q
Stroke volume
A
Volume of blood pumped by the heart
8
Q
Vascular resistance is highest at ____
A
Arteries - Not capillaries, veins, or lymph vessels; think about drinking through a big straw vs little straw
9
Q
Erythropoietin
A
Produced in the kidneys and makes RBCs
10
Q
Acid-base balance is regulated at which portion of the nephron?
A
distal tubule
11
Q
Hypercapnia
A
condition of increased arterial concentrations of CO2; can be part of COPD
12
Q
Wampold hypothesis
A
There is no difference between pharmacotherapy and psychotherapy; all improvements are due to common factors & underlying shared mechanisms
13
Q
Quantal Curve
A
Quantal curve measures % of subjects responding at a particular dose (in dose response studies)
14
Q
Source of plasma creatinine
A
Muscle; Creatinine is constantly released from muscle & excreted by glomerular filtration
15
Q
Creatinine clearance
A
Best indicator of GFR (gold standard); plasma creatinine is stable when GFR is stable; when GFR decreases, plasma creatinine increases; important for monitoring chronic renal failure
16
Q
What commonly affects the power of a study?
A
1) alpha level - larger alpha = more power, but you don’t want to do this; 2) Larger size of effect in the population and larger effect size = easier to detect, but no control over this; 3) Sample size - larger sample = more power
17
Q
Nested Study Design
A
When certain providers only administer 1 arm of treatment. It can introduce error variance. Big threat to internal validity
18
Q
Dose-response curve
A
Dose is an example of a moderator in research. Variation in relationship between treatment and outcome across medication dosage. 2 types: graded and quantal
19
Q
Grade dose-response curve
A
plots effect of drug receptors binding vs dose of the drug, a measure of potency
20
Q
Pharmacodynamics
A
The drug’s effect on the body
21
Q
Pharmacokinetics
A
The body’s effect on a drug (ADME). A - absorption, D - distribution, M - metabolism, E - excretion
22
Q
Confidence intervals and effects size estimates
A
much more informative about the population and increasingly are considered mandatory elements of research. Significance testing not as valuable without these
23
Q
STEP-BD trial
A
Findings: Do not add antidepressant to antiepileptic (mood stabilizer). Antidepressants plus mood stabilizers = placebo. Lamotrigine is best for treatment resistant Bipolar Depression. Antidepressants increased rapid cycling (except Wellbutrin). For Bipolar Disorder: lamotrigine = risperidone = inositol
24
Q
STAR*D
A
Sequenced treatment for depression:
- meds:
1) citalopram > switch or add (1/3 got better)
2) sertraline, venlafaxine XR, bupropion, or cognitive therapy (25% more got better) 50% better after step 1 and 2
3) mirtazapine, nortriptyline, lithium (another 12-20% better)
4) tranylcypromine or venlafaxine plus mirtazapine (another 10% better)
-67% remission after all 4 trials; 1/3 did not reach remission
-patients requiring more treatment steps are more likely to relapse
25
California rocket fuel
-mirtazipine plus SNRI (venlafaxine)
For treatment resistant depression
- Dopamine double boost -> antagonist of 5HT2A and 5HT2C
- Serotonin quadruple boost -> SERT and alpha-2 antagonism and 5HT2A and 5HT2C antagonism
- Norepinephrine quadruple boost -> NET and alpha-2 antagonism and 5HT2A and 5HT2C antagonism
26
Endoplasmic reticulum
Membrane factory of the cell - specializes in synthesis and transport of proteins, lipid components of the cell’s organelles
27
Mitochondria
Supplies ATP = energy factory of the cell
28
Bupropion contraindications
Seizure disorders:
0.4% of patients had seizures at low doses (< 450 mg)
Seizure increase 10 times in doses between 450-600 mg
Do not use in bulimia/anorexia due to increased risk of seizures
29
Ascites
Accumulation of edema fluid in the abdomen; Associated with liver damage; Results from increased pressure in veins of liver (portal hypertension) and decreased albumin in the blood
30
Safety profile of a medication
Reflects the total number of adverse reactions experienced as a result of the medication
31
Nocebo effect in research
Deterioration or side effects in response to the placebo
32
CONSORT Statement
CONsolidated Standard Of Reporting Trials
Lists 25 recommendations of guidelines for reported results of RCTs
Can help to identify quality of research and gaps in articles summarizing RCTs
Guidelines standardize reporting and help consumers of literature
33
Informed consent elements
Informing client of nature of treatment
Possible alternative treatment
Risks & Benefits of treatment
34
Cochrane Central Register of Controlled Trials
- Bibliographic database of definitive controlled trials
- Part of an international effort to create an unbiased source of data for systematic reviews
35
CenterWatch
Largest online database of global clinical trials involving new drugs & devices regulated by the FDA & DHHS
36
How long can psychotropic medication be administered during a psychiatric emergency?
For as long as the crisis/emergency exists
37
In deciding what information to provide to a patient in obtaining informed consent, the courts have generally endorsed what standard?
The Reasonable Person Standard
38
Involuntary drug treatment could be the basis of a civil suit based on all of the following except:
A malpractice claim of battery
Negligent failure to provide informed consent
A violation of constitutional right to privacy
The insanity defense
D. The insanity defense
39
Surrogate decision making
- for patients who have lost ability to make rational & logical decisions
- may require that surrogate be designated by court
- is usually performed by next of kin
40
Surrogate outcome measures in pharmaceutical research
- substitutes for real clinical outcome measures, or measured in parallel to such measures
- chosen for their ability to produce statistically significant results by studying a smaller population than would be needed to study real clinical outcomes of actual morbidity/mortality on an intent-to-treat basis
41
Why don’t you use TCAs with depression in HIV patients?
- Potential for suicide & overdose
- TCAs are lethal in overdose
- Not great for suicidal patients
42
Which antidepressants are contraindicated in PTSD?
MAOIs
43
Exocytosis
- Process by which a cell secretes contents into extracellular space through fusion of the vacuole membrane to the cell membrane
- How neurons secrete neurotransmitters into synapse
44
Most patients w/diabetes are or are not insulin-dependent?
Are not, non-insulin dependent Type 2 is most common (85% of cases)
45
Black box warning for olanzapine?
Stroke (in elderly with dementia - related psychosis)
46
Depot form of olanzapine was initially not FDA approved due to which side effect?
Sedation
47
Cocaine toxicity reversal
Long-acting benzodiazepine
48
Which receptor type is more common in the body, G-protein coupled or ionotropic/ligand gated?
G-protein coupled (metabotropic)
49
What percent of all drugs are metabolized by CYP450 3A4/5 and 2D6?
55% of all drugs
3A4/5 = 36%
2D6 = 19%
50
Best known effect size statistic
Standardized mean difference
(d), variants g and delta
Difference between 2 groups means relative to the within-group SD
D of 0.5 = difference between means is half of the SD
Correlation Coefficient
Degree to which 1 variable can be predicted from another on a scale from -1.0 to 1.0
51
Common 2nd messengers
Most Common:
cAMP
cGMP
Less Common:
Phospholipase C - role in regulation of intracellular Ca2+
Diacylglycerol (DAG)
Inositol 1-4
IP3 - 5-trisphosphate
52
Vomitting is associated with injuries to the CNS that involve all of the following except:
Vestibular nuclei
Floor of the 4th ventricle
Brain stem compression
Frontal lobe
D. Frontal lobe
53
Which bipolar medication is structurally similar to TCAs?
Carbamazipine (Tegretol) - should not take carbamazepine with a TCA
54
Sundowning
Syndrome characterized by drowsiness, confusion, ataxia, & falling seen in elderly patients due to drug induced oversedation
55
Phenelzine (Nardil)
An MAOI
Do not give with meperidine (demerol) which is an opioid narcotic
Contra-indicated in patients with renal failure, liver failure, or congestive heart failure
56
Lithium & Caffeine interaction
May decrease serum concentration of lithium by increasing urinary elimination of lithium
57
Catabolism
Synthesis and breakdown of complex molecules into simple ones
58
Voltage-gated sodium channel properties
Activity is responsive to changes in voltage across the membrane
The channels open wider with increasing depolarization
NOT that they generate a shift in voltage associated with hyperpolarization
59
Treatment of alcohol withdrawal
Long-acting benzodiazepine (first choice); also thiamine (B-1)
60
Rate-limiting step of dopamine synthesis
Tyrosine hydroxylase
61
Inverse agonist
Have a higher affinity for drugs in the resting state than those in the active state
Ex: chlorpromazine & risperidone are inverse agonists at 5HT2A
Ex: clozapine & haloperidol are inverse agonists at D2
Actually causes the neuron to be underactive & prevents an agonist from activating the cell - opposite of an agonist
62
Enzymatic transmembrane receptors
Drug binds to an extracellular receptor site, which activates an intracellular enzyme
Associate with tyrosine kinase (located at cytoplasmic tail of receptor)
Insulin is an example
63
Pheochromocytoma (Symptoms & Testing)
Tumor on adrenal gland - a catecholamine-producing tumor
Test: serum metanephrines (tests for metabolites of catecholamines in blood) elevated = positive
Symptoms: high blood pressure, headaches, sweating, flushing, rapid heart rate
64
Medical conditions and medications that mimic mania
Hyperthyroidism
COPD & asthma drugs - albuterol and theophylline
Cocaine
Workup for mania:
1) General function tests of liver, kidney, electrolytes, blood chemicals
2) Specific tests (thyroid, symptom based)
3) Tests relevant to prescription drugs (lithium levels)
65
Diseases that look like extrapyramidal side effects
Multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), spinal cord injury, hypoxic encephalopathy
66
What percent of psychiatric patients actually had a medical disease producing their symptoms?
9% from Hall et al (1978)
Most common: infectious, pulmonary, thyroid, diabetic, hematopoietic, hepatic, & CNS diseases
Frequent presentations - depression, confusion, anxiety, speech and memory deficits
67
Anisocoria
Condition of unequal pupil size
68
Drugs with risk of Stevens-Johnson Syndrome
Mood stabilizers/antiepileptics:
Lamotrigine (Lamictal)
Carbamazepine (Tegretol)
Valproic Acid (Depakote)
Gabapentin (Neurontin)
Interventions: stop meds immediately! Refer to ED
69
Psychiatric medications that cause cognitive blunting
Lithium
Topiramate (Topamax = Dopa-max)
Carbamazepine
Valproic acid
Intervention: screen for drug interactions that may increase levels & switch to lamotrigine or oxcarbazepine
70
Guillain-Barre Syndrome
Autoimmune disorder that affects peripheral NS
Autoimmune destruction of myelin sheath in motor and sensory nerves, including respiratory muscles
Symptoms: sudden onset of weakness or paralysis, tingling in feet/hands, symmetric weakness
Starts with viral infection
Starts at feet and moves up the body
Treatment: Intravenous Immunoglobulin (IVIG)
71
What class of psychotropics may create a false positive on urine screen for methamphetamine?
MAOIs
72
Which condition is most associated with impaired cognitive development?
Downs (trisomy 21) is most common known form of intellectual disability
73
Benztropine
Anticholinergic medication
Treatment for Parkinson’s
Can use to treat Tardive Dyskinesia
Can also use Diphenhydramine to treat Tardive Dyskinesia
74
How to reverse heroin/opioid overdose?
Naloxone (Narcan) - inverse agonist at mu-opioid receptors
Nalmefene - opioid receptor antagonist
75
Treatment of alcohol toxicity
Supportive - fluids, oxygen, vitamins, glucose, thiamine
** Dangerous to mix alcohol and benzodiazepines due to respiratory effects & slowing of CNS
76
Cortico-spinal tract
Efferent motor - voluntary motor control
Decussates in medullary pyramids
77
Loss of function on the left side of face. Where is the stroke?
Right middle cerebral artery
78
Myasthenia gravis
Autoimmune disease affecting neuromuscular junctions
Immune system attacks & destroys ACh (nicotinic) receptors & muscle can’t contract
Symptoms: weakness, fatigue, often affects eyes, mouth, face, and respiratory muscles
Treatment: Anti-acetylcholine drugs, steroids, immunosuppressants
79
Blood proteins are synthesized by ___
Hepatocytes (in liver)
Blood proteins made up of:
Albumin (55%), globulins (35%), fibrinogen (7%), regulatory proteins (1%)
Function is to assist with transport of lipids, hormones, vitamins, minerals, and immune system
80
Histamine is released from what cells?
Mast cells
Histamine is present in mast cells of gastric mucosa & mast cells in other parts of the body
81
Huntington’s disease pathophysiology
Pathophysiology:
Excitotoxicity - increased GABA and Glutamate agonist release
Degeneration of neurons in putamen, caudate, & cerebral cortex
Autosomal dominant
Symptoms:
Symptoms start between 30-50 years
Motor: involuntary limb movements, chorea, then loss of control and dystonia
Psych: decreased attention, impulsivity, aggression, psychosis
Cognitive: First executive functioning, then dementia, slower processing
82
Baroreceptors respond to ___
Stretch/Pressure
Receptors that regulate heart rate
If BP increases, HR will decrease cardio functioning
83
Renin
Produced in kidney
Regulates blood pressure and fluid retention
When renin-angiotensin system is activated by a decrease in BP, angiotensin is converted to angiotensin 1, which is converted to angiotensin 2, which increases BP
New BP meds target renin or stop conversion of angiotensin 1 to angiotensin 2
84
Important renal buffers
Phosphate - filtered at glomerulus, combines with hydrogen to make lipid insoluble
Ammonia - not ionized, lipid soluble
Carbon dioxide (CO2)
85
Korsakoff Syndrome
Associated with chronic alcoholism
Caused by lack of thiamin (vitamin B1) in brain with 6 major symptoms:
Anterograde amnesia
Retrograde amnesia
Confabulation
Meager content in conversation
Lack of insight
Apathy
** Wernicke = acute phase; Korsakoff’s = chronic phase
86
Van Dijke et al (2010) found an inverse correlation with ___ and Borderline PD along a continuum of affect regulation
Somatoform disorder
BPD regulates too little
Somatoform regulates too much (not enough emotional awareness)
87
Pharmacokinetics
Body’s effect on the drug:
A - Absorption
D - Distribution
M - Metabolism
E - Excretion
88
Dexamethasone suppression test
Used to test for Cushing’s disease
When pituitary gland is producing too much Adrenocorticotropic hormone (ACTH)
Measures whether cortisol secretion by the adrenal gland can be suppressed
Can assess reason for excess cortisol in the body
89
Tachyphylaxis
Diminished response to a drug/substance because of previous exposure to the same substance
In pharmacology, this results in diminished response to repeatedly administered drugs
Tolerance
90
Where is melatonin secreted?
Pineal gland
91
Antihistamines for sleep
Work in the short-term but develop tolerance quickly (7-10 days)
92
Diaphoresis
Sweating, especially to an unusual degree due to an illness or side effect of a medication
93
Symptoms of myocardial infarction
Shortness of breath, diaphoresis, nausea, dizziness, and chest pain radiating down left arm and up neck
94
Most serious side effects of disulfiram (Antabuse) are associated with inhibition of ___.
Dopamine beta hydroxylase
Elevated brain concentrations of dopamine because it cannot be converted to norepinephrine
Side effects: cause psychosis and/or exacerbate schizophrenia
Also heart attack, unconsciousness, convulsions (seizures, death) - Very Rare
95
Disulfiram (Antabuse) inhibits what enzymes?
Aldehyde dehydrogenase (ALDH) which causes build up of acetaldehyde
Dopamine-beta-hydroxylase which causes buildup of dopamine which cannot be converted to norepinephrine
96
Calculation of therapeutic index
LD50/ED50 aka TD50/ED50
Toxic/Lethal dose in 50% divided by effective dose in 50%
Ratio of how close a toxic dose is to 1
97
Serotonin Syndrome Symptoms
S - shivering
H - hyperreflexia & myoclonus
I - Increased temp (fever)
V - vital signs unstable (increased HR and RR, BP labile)
E - Encephalopathy (altered mental status, LOC)
R - Restlessness
S - Sweating (diaphoresis)
Also mydriasis - dilated pupils
**Starts within a few hours**
98
Neuromalignant Syndrome Symptoms
F - fever
E - encephalopathy (altered mental status)
V - vital signs unstable (tachycardia, labile BP, sweating, urinary incontinence
E - Enzyme increase (creatine kinase, due to rhabdomyolysis from muscle rigidity)
R - rigidity (“lead-pipe rigidity”)
**Develops over days to weeks**
High risk = depo injections, male, dementia
99
Neuromalignant Syndrome vs Serotonin Syndrome
Both have:
Fever, altered mental status, autonomic hyperactivity, hypertension, tachycardia
Serotonin Syndrome:
Acute onset (hours), “Shaky Serotonin”, shivers, myoclonus (jerking), hyperreflexia, tremors, diarrhea/nausea/vomiting
NMS:
Slow onset (14-30 days), “Dopey Dopamine”, things slow down, lead-pipe rigidity, elevated WBC, increased creatine kinase, increased AST and ALT
100
Hunter Serotonin Toxicity Criteria
Used to diagnose Serotonin Syndrome
Used of a serotonergic agent AND
1 of:
Spontaneous clonus
Inducible clonus + agitation/diaphoresis
Ocular clonus + agitation/diaphoresis
Any clonus + hypertonia/fever
Tremor + hyperreflexia
Treatment: stop serotonergic medications, supportive management
Severe: sedation, vent, activated charcoal, benzodiazepines or chlorpromazine
101
Relative Risk Ratio (R/R)
Compares proportion of patients improving with medication to proportion of patients improving with placebo
No effect then RR = 1.0
Effective med then RR > 1.0
Ineffective med then RR 0-1.0
Ex: RR = 2.33 means person taking meds is 2.33x more likely to improve over placebo
102
Odds Ratio (OR)
Represents the odds of improving with medication vs odds of improving with placebo
OR > 1.0 = effective med
OR = 1.0 no effect
OR 0 - 1.0 = ineffective
103
Number Needed to Treat (NNT)
Represents the number of cases needed to receive the active treatment to generate one or more positive outcome than the comparison treatment
Opposite of number needed to harm (for adverse events)
Ex: NNT=6.25 means if you treat 6.25 people with the medication, you would get 1 more positive outcome than if you treated them with placebo
**Smaller NNT is better
Lowest is 1.0
104
Medication’s Absolute Risk
Probability of improvement from taking medication
Does not compare to placebo (that’s relative risk)
AR = # of patients improved from med divided by # of patients who took med
* Often confused with RR, but med might have good RR & bad AR or vice versa
105
PRISMA
Preferred Reporting Items for Systematic Reviews and Meta-analyses
Did for meta-analyses what CONSORT did for RCTs
Set of 27 recommendations for conduct & reporting of meta-analyses
106
Survival Analysis
In research, used to specifically study attrition
Asks “how many people are likely to drop out of each treatment and what variables predict attrition and time to attrition?”
Alternative to just intent to treat
Is a set of analyses
107
Elements of Informed Consent for Research
Statement that this is for research
Description of research (expectations & involvement for participants)
Risks/costs of participating
Potential benefits of participating
Consequences of not participating
Confidentiality/privacy
108
Phi Coefficient
The correlation coefficient in circumstances where both variables are dichotomous
109
At which phase are medications most likely to be pulled from the approval process?
Before Phase 3
110
Which antipsychotics are most likely to cause diabetes type 2?
Clozapine & Olanzapine
PINES - M1 anticholinergic
Clozapine is the absolute worst
111
Cimetidine medication & side effects
Tagamet - acid reducer and heartburn medicine
Mechanism: H2 antagonist decreases stomach acids
Side effects: can cause depression due to imbalance of H1 & H2 receptors; can also cause anxiety, agitation, hallucinations
112
Tamoxifen medication
Breast cancer medication
DO NOT prescribe strong CYP450-2D6 inhibitors like fluoxetine
Will make breast cancer treatment ineffective
113
Enzyme that converts norepinephrine to epinephrine
Phenylalanine-N-methyltransferase
114
Patient with anxiety is treated with SNRI and returns 2 weeks later with increased anxiety. What happened?
Beta-1 adrenergic receptors have not down regulated yet. So increasing norepinephrine
115
How does glutamate exhibit a neurotoxic effect?
Increase of calcium in hippocampus
116
Naltrexone (Revia) mechanism of action and side effects?
Mechanism of Action:
Pure opiate receptor agonist, binds at mu opioid receptors
Blocks euphoric high effects for alcohol or opioid use
Must stop opioid use 7-10 days before starting
Side effects:
Nausea, dizziness, symptoms of pneumonia
Can be hepatotoxic
117
Agnosia
Inability to recognize a previously familiar object without any evidence of sensory impairment (can see but can’t recognize a toothbrush)
Seen in dementia
118
On ECG, P wave represents ___.
Atrial contraction
119
On ECG, QRS wave represents ___.
Ventricular contraction
120
On ECG, T wave represents ___.
Repolarization of ventricles
121
Under anaerobic conditions, energy for the cell is provided by ___.
Glycolysis
122
Allodynia
Pain due to a stimulus that does not normally evoke pain
Sign of central sensitization of pain
A type of neuropathic pain
123
Lithium + Methyldopa (Aldomet)
Interaction causes lithium toxicity!
Methyldopa is a CNS antihypertensive alpha-2 agonist to decrease CNS outflow
124
Precursor for Nitric Oxide
L-Arginine
125
Which layer of the adrenal cortex is responsible for synthesis of glucocorticoid hormones like cortisol?
Zona fasciculata
126
Treatment for adrenal insufficiency
Injection of dexamethasone - a corticosteroid that treats inflammation, arthritis, and allergic reactions
127
What is the neurotransmitter associated with memory?
Acetylcholine
128
Amyotrophic lateral sclerosis (ALS)
Glutamate, hyperexcitability of neurons
Degeneration of upper and lower motor neurons in cortico-spinal tract
Progressive disease, no cure
Symptoms: weakness & paralysis, loss of voluntary muscle control, cognitive impairments in advanced stages, muscle cramps, twitching, paralysis, dysphagia, can’t speak, respiratory failure
129
MAOIs to remember
Phenelzine (Nardil)
Isocarboxid (Marplan)
Selegiline (EMSAM) - patch
Tranylcypromine (Parnate)
** Avoid tyramine foods/drinks
130
What must you avoid on MAOIs?
Tyramine containing foods and drinks
Aged cheeses, like cheddar
Cured meats, like sausage, pepperoni, and salami
Fermented soy products, like miso, soy sauce, and tofu
Sauerkraut
Draft beer, bottled beer, and ales
Red wine, White wine
Spirits, like whisky and liqueurs
131
Risk factors for tardive dyskinesia
Use of D2 antagonists
Elderly
Use of psychotropics for an affective disorder rather than schizophrenia
132
MMPI profile for chronic pain
Most discriminating:
Hypochondriasis (1-Hs)
Depression (2-D)
Hysteria (3-Hy)
Also chronic pain patients had higher general maladjustment and affective distress
More anxiety, depression, and somatic complaints
133
Reversal for benzodiazepine overdose
Flumazenil - benzo antagonist
134
QTC interval symptoms
Symptoms: new onset syncope, palpitations, dizziness
QT interval from EKG = time it takes for ventricles to contract & relax
135
Drugs with a risk of prolonged QTc interval
Most Risk: First Generation Antipsychotics/SGAs -> Ziprasidone, thorazine, haloperidol
Also a risk:
Methadone
Citalopram (>40 mg/day)
TCAs - Elavil, maprotiline
Lithium (>1.2 mEq/L) and with hypokalemia
Hydroxyzine + diphenhydramine
136
Non-drug risk factors for prolonged QTc
Eating disorders (AN/BN), malnutrition
Prolonged use of alcohol or methamphetamine
Old age (65+)
Female
Congenital long QT syndrome
History of drug induced long QT syndrome
History of heart disease
Being a slow metabolizer
Liver or kidney disease
Use of 2+ drugs that can carry risk of prolonged QTc
137
Hyponatremia symptoms
Abnormally low sodium level <130 mm/liter
Symptoms:
Can cause sudden delirium
Electrolyte imbalance - decreased Na2+
Confusion, fatigue, short temper, convulsions, seizures, feeling week, loss of consciousness, coma, nausea, vomiting
Oxcarbmazepine and Carbmazepine have highest risk
138
Torsades de Pointes
QT prolongation in which Q-T interval is too long, heart goes out of rhythm causing V-fib
Risk factors: family history of early cardiac death, exercise or high arousal caused dizziness
Symptoms: heart palpitations, dizziness, syncope, sudden death
Drugs that can cause it: Haldol, SSRIs (rare), Lithium, methadone (esp when taken with a P450 inhibitor)
This is a type of prolonged QTc
139
Mifepristone medication
Used for post-coital contraception
Progesterone antagonist, synthetic steroid
DO NOT take with Lithium - can cause prolonged QTc and Torsade de Pointes
Can also be used to treat psychotic depression and PTSD
140
Danazol medication
Treatment for endometriosis
An androgen similar to testosterone
Known to cause liver damage - avoid with other drugs that have hepatotoxic effects
Antipsychotics - Clozapine, Chloramazepine, Olanzapine
TCAs
Antiepileptics - Carbamazepine
141
Metronidazole medication
An antibiotic that has disulfiram-like reactions
Cannot take with alcohol
Do not take with disulfiram
142
Selegiline
MAOI
Can be used in treatment of Parkinson’s
Prevents breakdown of dopamine
143
Structure of Basal Ganglia
Purpose - fine-tune motor movements
Striatum:
Dorsal Striatum
Ventral Striatum (nucleus accumbens) + olfactory tubercle
Globus pallidus
Internal segment (GPi)
External segment (GPe)
Subthalamic nucleus
Substantia nigra
144
Structures of the Limbic System
Purpose - emotion and memory
Amygdala - fear
Hippocampus - memory
Parahippocampal gyrus - memory
Cingulate cortex/gyrus
Septal nuclei - connections with other limbic structures - pleasure, reward, reinforcement
Mammillary bodies - memory - connections with amygdala & hippocampus
Fornix - carries info to the thalamus
Hypothalamus - hormones via anterior pituitary
145
Which afferent pathway decussates at the medulla?
Dorsal column-medial lemniscal (DCML) - carries fine touch (tactile sensation), vibration, proprioception
146
Which afferent pathway decussates at the spinal cord?
Anterolateral spino-thalammic tract - carries crude touch & pressure, pain (through dorsal horn), and temperature
147
Anterior cerebral artery supplies ___.
Dorsolateral & medial portions of the frontal lobe
148
Cranial Nerves
Olfactory
Optic
Oculomotor
Trochlear - eye movement
Trigeminal - face sense & chewing
Abducens - eye movement
Facial - face movement & taste
Vestibulocochlear - hearing & balance
Glossopharyngeal - swallow, throat sense, taste
Vagus
Accessory - neck movement
Hypoglossal - tongue movement
Oh, Oh, Oh, To Touch And Feel Very Good Velvet, Ah Heaven
Some Say Marry Money But My Brother Says Big Boobs Matter More
149
Symptoms of Thyrotoxicosis
(Thyroid Storm)
Symptoms:
Rapid HR
High metabolic rate
Low heat tolerance
Presence of goiter in most cases
Labs: elevated T4 & T3, elevated radio iodine uptake
150
Kupffer cells
A phagocytic cell which forms lining of sinusoids of the liver
Involved in the breakdown of old RBCs
151
Elevated serum amylase suggests ___.
Pancreatic inflammation
152
What makes a 2nd gen antipsychotic atypical compared to 1st gen?
Blocks serotonin and dopamine receptors
Lower extrapyramidal side-effects
Effective in treating negative symptoms
153
Vitamin B6 deficiency
Results in fatal seizures due to deficiency in GABA
B6 is involved in synthesis of GABA
154
Alzheimer’s disease allele
apoE4 -> makes susceptible to developing Alzheimer’s
155
Clinical features of Alzheimer’s diease
Neurofibrillary tangles
Extracellular amyloid
Plaques
Diffuse loss of neurons, hippocampus atrophy
156
Most common site of origin of epileptic foci
Medial temporal lobe
157
Effects of pKa & pH on drug absorption
Weak acid accumulates in blood
Weak bases AND high pKa accumulate in GI tract
Low pKa absorbed quickly in GI tract
** Most drugs are weak acids
158
Azotemia
Elevated serum levels of urea
Elevated Blood Urea Nitrogen (BUN)
Too much N+, creatinine, and other waste in blood
Different causes: blood loss, dehydration, kidney damage, blockage in urinary tract
Check BUN with lithium
159
BUN normal range
Normal range = 7 - 20 mg/dL
Test of renal functioning (kidney)
Measures GFR & urine concentrating capacity
High BUN means low GFR
Increased BUN in dehydration & renal failure
160
Normal WBC count
5,000 - 12,000
161
Normal platelet count
150,000 - 400,000
162
Normal RBC
4.2 - 6.2
163
Old pregnancy categories for drugs (A, B, C, D, & X)
A - no risk in human studies - SAFE
B - no risk in animal studies. No adequate data/trials for humans
C - risk cannot be ruled out
D - evidence of human risk but benefits may outweigh risks
E - contraindicated -> fetal abnormalities, benefits do not outweigh risks
164
Reduplicative paramnesia
Rare delusional misidentification disorder. Person believes that a place or location has been duplicated, existing in 2 or more places, or has been “relocated”
Usually attributable to TBI (damage to right cerebral & both frontal lobes)
165
Phenylketonuria (PKU)
Rare condition in which a baby is born without the ability to break down the amino acid phenylalanine
Autosomal recessive genetic disorder
Treatment = dietary management
Mimics Autism or ADHD
Symptoms = mental retardation, developmental delay, hyperactivity
166
Ma-huang
Can cause ephedrine-induced mania
May be found in dietary supplements
Species of ephedra that contains alkaloids ephedrine & pseudoephedrine, which are non-selective sympathomimetic agents
Both alpha and beta adrenergic activities that stimulate the CNS, causing bronchodilation & vasoconstriction
167
Diaphoretic
A state of excessive sweating
May indicate presence of an underlying medical condition or side-effect of medications
168
Anosognosia
Unawareness or denial of a neurological deficit
E.g., denial of physiological blindness (as in recent brain trauma victims) or denial of weakness on one side of the body (denial of hemiparesis - can be seen in brain trauma victims)
169
College of Professional Psychology
APA practice organization that offers a mechanism for psychologists to identify to 3rd party payors that:
They have earned credentials in treatment for SUDs
Medical Psychologists have postdoctoral training in psychopharmacology & have taken the PEP
170
What medications mimic anxiety?
Codeine (pain)
Calcium channel blockers (for hypertension)
Angiotensin Converting Enzyme (ACE) Inhibitors (for hypertension)
Statins (cholesterol)
Benzodiazepines
Can cause dizziness, nausea, flushing, headache, etc)
171
Major Depression neurological changes
Decreased hippocampal volume
Loss of dendritic spines (synapse loss on MRI)
Dysregulation of HPA axis
Suppression of brain derived neurotrophic factor (BDNF) - possibly due to sleep disturbance
172
Normal Pressure Hydrocephalus
Excessive CSF accumulates in the brain’s ventricles
Symptoms: gait/balance impairments, cognitive deficits, urinary urgency/incontinence
Often misdiagnosed as Alzheimer’s or Parkinson’s
Referral to neurology to diagnose
Imaging (MRI, CT), spinal tap, neuropsych testing
173
Neurotransmitter implicated in mania
Too much norepinephrine
Treatments work by influencing NE and/or its downstream targets
174
Ethnic variabilities with CYP450
Asian - poor metabolizers of 2C19 (15-20%) & N-acetyltransferase (10-20%)
Ashkenazi Jews - poor metabolizers of 2C19
2D6 more common in some Whites
175
Symptoms of Cardiovascular Disease
Pain (minutes, not hours or days)
Dyspnea (SOB)
Palpitations
Edema
Syncope
Fatigue & weakness
Cyanosis (bluish-purple skin)
Angina pain: retrosternal, diffuse, left arm, jaw, back, aching/dull/pressing/squeezing, worse with effort
176
What medication has side effect of hyperammonemia (elevated ammonia in blood)?
Valproic Acid (Depakote)
177
Paresthesia
“Pins & needles” sensation, tingling, burning, pricking/prickling, skin-brawling, itching, numbness
Can be caused by nerve damage (including from diabetes) or pinched nerve
178
Pemoline medication (Cyclert)
Was used for ADHD & narcolepsy but was discontinued due to severe liver toxicity
179
Metabolic pathway for ethanol
**Metabolized in the liver
Ethanol broken down by enzyme dehydrogenase + catalase and turned to acetaldehyde
Aldehyde dehydrogenase (ALDH) converts to acetate
180
Gamma hydroxybutyrate (GHB)
CNS depressant drug of abuse
Narrow margin of recreational dose & toxic dose = high risk of overdose
Mechanism of action: binds to GABA-B complex
Schedule 1 drug
181
Hyperpyrexia
Exceptionally high fever > 106.7℉ or > 41.5℃
182
Major storage site for serotonin in the periphery
Platelets - this is why SSRIs can decrease WBC
183
Non-competitive antagonism
Usually associated with irreversible binding
184
Partial agonist
Produces a less than maximal effect
Considered partial because they cannot completely saturate the receptors
185
First dose phenomenon
Severe hypotensive response to alpha-1 blocker with lightheadedness, dizziness, palpitations, diaphoresis & syncope
Occurs within 30-90 minutes of initial dose or change in dose for anti-hypertensive drugs
**Can see with prazosin
Due to selective antagonism of alpha-1 and peripheral vasodilation
186
Pernicious anemia
Autoimmune condition that prevents body from absorbing vitamin B12
B12 is needed to make new RBCs
Can cause irreversible damage to nervous system (muscle weakness, dementia, numbness in hands/feet)
Heart problems - palpitations, heart failure
Symptoms = depression, balance problems
Treatment = B12 injections
187
Reticular formation
Alerts and arouses higher brain centers
Complex network of brainstem nuclei & neurons - serve as integration & relay information about pain sensitization, alertness, fatigue, sleep, & motivation
Located in brainstem (raphe nuclei are part of it)
188
To reverse severe muscle cramping with toriculus after Haldol, do what?
Administer benztropine parenterally (IV, IM, subcutaneously)
189
Which neurotransmitter triggers loss of muscle tone associated with REM sleep?
Acetylcholine
190
Salicylate
Can cause Reye Syndrome - rare but fatal condition - encephalopathy to fatty change in otherwise healthy liver
Children under 12 at highest risk
Symptoms: hyperthermia, respiratory alkalosis, hypokalemia, hypoglycemia, coma, hypo-thrombocytopenia, metabolic acidosis, hyperventilation
191
Russell’s sign
A pattern of calluses on back of hand from teeth repeatedly hitting knuckles during self-purging
Associated with bulimia nervosa and purging “bulimia knuckles”
192
Hematocrit
Percentage of RBC in a given volume of blood
Should be 3x the hemoglobin
High = polycythemia (too many RBC)
Males higher hematocrit than females
193
Vitamin __ is required for normal clotting factor synthesis by the __.
Vitamin K; Liver
194
Warfarin interactions primarily caused by __
Alterations in protein-binding - Warfarin is highly protein-bound
195
Atropine drug MOA & uses
Mechanism of Action:
Competitive, reversible antagonist at muscarinic receptors
Anticholinergic drug (blocks parasympathetic action of the heart) - increased rate of discharge at sinus node
Uses:
Treats bradycardia by increasing heart rate
196
Phenothiazines would have the least effect on which receptors?
Nicotinic
It would have effects on:
Muscarinic
Dopaminergic
Alpha-1 adrenergic
Phenothiazines are a class of first gen antipsychotics (e.g., chlorpromazine)
197
Areas of prefrontal Cortex
Orbitofrontal (OFC) - moral reasoning, decision making (Phineas Gage)
Dorsolateral PFC (DLPFC) - executive functioning, motor planning, organizing responses
Anterior Cingulate (ACC) - motivation, reward-based learning, error detection
Ventromedial PFC (VMPFC) - risk, fear; bridges cognitive & emotional functioning
198
Cipriani et al. (2018) study of antidepressants
Adults with Major Depression meta-analysis findings:
Only fluoxetine & agomelatine (Valdoxan) had better drop-out than placebo
Clomipramine had worse drop-out than placebo
All antidepressants were more efficacious than placebo
In head-to-head most efficacy for:
Agomelatine, amitriptyline, escitalopram, mirtazapine, venlafaxine, & vortioxetine
199
Donepezil side-effects
Acetylcholinesterase inhibitor to treat Alzheimer’s
Substrate of 2D6 & 3A4
Common SE:
GI (nausea, diarrhea, vomiting); at high doses - insomnia, muscle fatigue, anorexia
Serious SE:
Bradycardia & heart block; Neuroleptic Malignant Syndrome
200
“Compassionate Use” for non-FDA approved investigational drug
Pathway for a patient with a serious or immediately life-threatening disease to gain access to an investigational drug
Criteria:
Serious or immediately life-threatening condition
No comparable alternative treatment
Enrollment in clinical trials is not possible
Potential benefit outweighs potential risk
Providing access to drug will not interfere with ongoing investigational trials
201
For treatment of insomnia with nighttime awakening
Long half-life insomnia drugs:
Eszopiclone (Lunesta)
Suvorexant (Belsomra)
Temazepam (Restoril)
Flurazepam (Dalmanel)
202
Brain circuits affected in Bipolar Disorder
Gray matter decrease in PFC, temporal lobe, amygdala, and hippocampus
Prefrontal cortex (especially Ventromedial PFC)
Hippocampal-Amygdala - emotion processing and emotion regulation circuits bilaterally
Overactive left-sided ventral-striatal - ventrolateral & orbitofrontal cortical reward-processing circuitry
203
Common causes of occult bleeds of the brain
Arteriovenous malformation
Trauma
Hypertension
Amyloid angiopathy
Aneurysm rupture
Tumor
Coagulopathy
Infection, vasculitis
204
Mechanism of how amphetamines cause tachycardia
Indirect sympathomimetic effects in the periphery due to release of norepinephrine
205
Brain differences in bipolar disorder
Reduced amygdala volume
*Do not see this in PTSD
206
What might iatrogenic akathisia be confused as?
Agitation, mania, hyperactivity, anxiety
207
Tachypneic
Rapid respiration that leads to a buildup of CO2 in an individual and may lead to fainting
Aka - hyperventilation
Can be related to medical or psychological causes
Might be a reason to send to ED
208
Theophylline
A xanthine derived bronchodilator that has direct effect on smooth muscles of bronchi & blood vessels in respiratory tract
Do not work as rapidly as Beta-adrenergic agonist drugs
Can mimic mania (so can albuterol)
209
Factors that affect renal excretion of a drug?
Glomerular filtration rate
Renal blood flow
Protein binding of the drug
P-glycoprotein
210
P-glycoprotein
A transporter protein important for excretion & movement of some drugs across membranes
Usually transports drugs out of intestinal cells into lumen for elimination
If inhibited (e.g., grapefruit juice), drug can accumulate to toxicity
Subject to polymorphisms
211
Modafinil (Provigil)
Treatment for hypersomnia in narcolepsy, shift work sleep d/o & obstructive sleep apnea; Off label for ADHD
Mechanism of Action:
Activates NE receptors, increases orexin & histamine activity to increase wakefulness & alertness in the prefrontal cortex
212
Atomoxetine (Strattera)
Non-stimulant norepinephrine reuptake inhibitor
FDA approved for ADHD
213
From the Step-BD trial, what is the 1st line treatment for rapid cycling bipolar disorder?
Valproate - avoid antidepressants
214
Which neurotransmitter is most associated with the limbic system?
Dopamine (meso-limbic) - reward center
Serotonin
GABA
Glutamate
215
Graves disease vs hyperglycemia
Hyperglycemia symptoms:
Polyurea, polydipsia, extreme hunger, blurred vision, slow-healing cuts/sores, fatigue
Graves disease symptoms:
Nervous irritable, tremor, weight loss, goiter (thyroid gland enlargement), sensitive to heat, decreased sex drive/ED, fast HR, poor sleep
216
Graves vs Hashimoto’s vs Cushing’s diseases
Graves disease = hyperthyroidism
Hashimoto’s disease = hypothyroidism
Cushing’s disease = excess cortisol production from adrenal gland
217
Locus coeruleus
Norepinephrine is synthesized here; in the brainstem
218
What are the symptoms of damage to the anterior cingulate cortex?
Emotional dysregulation
219
Which drug is most likely to cause hyponatremia in a bipolar patient?
Oxcarbazepine (Trileptal)
Hyponatremia = low sodium
220
Bipolar patient develops significant weight gain & sedation while on medication. What drug is responsible?
Olanzapine (Zyprexa)
Lithium & Valproate also choices, but olanzapine is worse
221
Which brain region is most associated with sleep & pain control?
Raphe Nuclei (serotonin)
222
Hypercalcemia symptoms
Lithium can cause this
Too much calcium in the blood - weakens bones, kidney stones, effects on heart and brain
Happens when parathyroid gland is overactive (hyperparathyroidism)
Symptoms: nausea, vomiting, increased thirst, frequent urination, muscle weakness, twitches, tired, confused
223
Acamporsate (Campral)
Treatment of alcohol dependence & maintenance of alcohol abstinence
Mechanism of Action: dampens excitatory glutamate transmission & enhances GABA
Start after achieving sobriety, after withdrawal
Side effects: GI upset, insomnia, weakness, fatigue, dry mouth, anxiety/depression
224
Treatment of rapid cycling bipolar disorder
Valproate (Valproic acid/Depakote) better than Lithium
4 or more episodes in a year
Antidepressants will increase cycling
225
SGAs that must be taken with food
Lurasidone (Latuda) & Geodon (Ziprasidone)
226
Symptoms of subarachnoid hemorrhage
Seizures, headache (10/10), nausea/vomiting, double-vision, neck stiffness, trouble speaking, droopy eyelids, confusion, difficulty concentrating, sensitivity to light
227
Electrostatic vs covalent binding to receptors
Electrostatic - reversible, more common
Covalent - essentially irreversible
228
Potency formula
Compare ED50 between drugs
Effective dose at which 50% of the maximal response is observed
Lower ED50 = more potent
Not always better
229
Efficacy formula
The ability of a drug to bind to a receptor and produce an effect
Efficacy = EDmax -> dose at which maximal effect occurs
230
Threshold dose formula
Dose at which 10% of the response occurs = ED10
231
Physiological antagonism
Drug interaction due to effects at different receptor sites
Ex: Histamine -> bronchoconstriction
Epinephrine binds at beta2 receptors -> bronchodilation
232
Adverse Drug Reaction
Noxious & unintended effect that occurs at therapeutic doses (NOT due to overdose or overmedication)
Type A = expected due to pharmacological action
Type B = unpredictable, idiosyncratic, often immunological or allergic
233
Hydrophilic vs Hydrophobic/Lipophilic
Hydrophilic - difficult absorption across GI tract, low volume of distribution, tend to be contained in vascular compartments
Lipophilic - easier absorption across GI tract, wide distribution, higher volume of distribution, require higher initial doses to reach steady state
234
What kind of drug is codeine?
Pro-drug - it is activated by metabolism
Opioid pain reliever
235
Why is tylenol overdose dangerous?
Acetaminophen/tylenol active metabolites accumulate & become toxic leading to liver failure
236
Phase 1 metabolism
Drug binds to CYP450 enzyme
Undergoes hydroxylation, oxidation, hydrolysis, or reduction
Produces a reactive site on the drug molecule accounting for toxic effects
237
Phase 2 metabolism
A chemical group is added to the reactive site of the metabolite by transferases called conjugation
Increases polarity -> more hydrophilic -> easier for kidneys to excrete
238
What happens to a prodrug in the presence of an inhibitor?
Decreased therapeutic effect because a prodrug relies on metabolism for its activation
239
What percentage of overall blood flow goes to the kidneys?
0.25
240
Glial cells & functions
Astrocytes - most common (50:1)
Absorb excess potassium
Absorb NTs at synapse
Microglia - smallest
Absorb waste (similar to macrophages)
Part of CNS immune system
Oligodendrocytes
Produce myelin around axons in CNS
*In periphery, Schwann cells myelinate axons
*Most common in the brain
241
Ependymal cells
Not glial cells, but are “non-neuron” brain cells
Form epithelial layer of the choroid plexus
Primary role is secreting CSF into the ventricles
Also play a role in generating stem cells & controlling exchanges of substances between CSF & interstitial fluid
242
Purkinje cells
Neurons in the cerebellum - have extensive dendritic tree which gathers enormous amounts of input per neuron before sending info downstream
Releases GABA
Function is to regulate & coordinate motor movements
243
Parkinson’s disease symptoms
Symptoms: Hypokinesis, resting tremor, rigidity, akinesia, impairment of postural reflexes
Cause: Lesions in basal ganglia, predominantly substantia nigra
Also formation of Lewy bodies
Treatment: levo-dopa, dopamine agonists, MAO-B Inhibitors
244
Fetal effects of TCAs
Fetal tachycardia
245
Parahippocampal gyrus
Gray matter area surrounding hippocampus
Extensively involved in memory encoding & retrieval
Relays information between hippocampus and association cortex
246
Four criteria for substance to be classified a neurotransmitter
Must originate from a neuron, where it is stored & released via depolarization
Must induce effects postsynaptically on a target cell by specific receptors
Must be cleared or inactivated from the synapse through reuptake
Must produce the same effects on nervous tissue in vitro as those produced in vivo
247
Pons is involved in regulating ___?
Motor activity
Also contains the Raphe Nuclei, which is where serotonin is made
248
Diencephalon
Includes thalamus & hypothalamus
Early brain: telencephalon -> diencephalon -> mesencephalon -> metencephalon -> myelencephalon
249
Where (at what segments) do sympathetic and parasympathetic neurons exit the spinal cord?
Sympathetic: thoracic & lumbar (middle)
Parasympathetic: cervical & spinal (top & bottom)
250
Paraventricular nucleus produces what?
Corticotropin-releasing hormone (CRH)
Paraventricular nucleus is part of the hypothalamus
251
Where is histamine produced?
In the tuberomammillary nucleus of the hypothalamus
252
Nitric Oxide uses what kind of signaling?
Paracrine signaling
Tends to act on enzymes that lead to increased neuron excitability
Not stored in vesicles & can move freely through tissues
Usually a retrograde messenger
253
What symptom of borderline personality disorder is responsive to omega-3 fatty acids?
Cognitive perceptual disturbances
254
MAOIs to know
Phenelzine (Nardil) - treats MDD & atypical depression
Tranylcypromine (Parnate) - treats MDD
Selegiline (Eldepryl) - treats MDD & Parkinson’s
255
Adverse events of MAOIs as a class
Orthostasis dizziness, anticholinergic SE, sedation, sexual dysfunction, hepatic complications, insomnia
Increased risk of hypertensive crisis (requires dietary restrictions of high tyrosine foods)
Avoid soft cheeses, raisins, bananas, chocolate, yogurt, anything fermented (wine, beer, kimchi, sauerkraut)
256
TCA medications to know
Clomipramine (Anafranil) - approved for OCD only ages 10+
Amitriptyline (Elavil) - depression (12+)
Doxepin - most sedating; depression & insomnia
Imipramine (Togranil) - depression, enuresis in kids 12+
Trimipramine (Sumontil) - adults only
Nortriptyline (Pamelor) - adults only
Desipramine (Norpramin) - 12+
Protriptyline (Vivactil) - 12+
257
Adverse events of TCAs as a class
*All TCAs are lethal in overdose
Anticholinergic SE, sedation, orthostatic hypotension, cardiac conduction abnormalities (prolonged QTc), sexual dysfunction
Behavioral disturbances (activation, psychosis)
Lower seizure threshold
Headache, GI disturbance
Rash, hepatic, blood dyscrasias (abnormal blood cells - agranulocytosis/thrombocytopenia)
Weight gain
258
Tetracyclic compound drugs to know
Amoxapine (Asendin) - depression in ages 16+, SE - possible EPS
Maprotiline (Ludiomil) - depression adults only; SE - possible seizures
*all tetracyclic drugs are fatal in overdose
259
Adverse events of SSRI/SNRIs as a class
Headache, nausea/vomiting, diarrhea, sexual dysfunction, insomnia, nervousness, anxiety, akathisia
Risk of Serotonin Syndrome
Risk of discontinuation syndrome
Worst - Paxil & Effexor (short ½ lives)
Bad - Zoloft (no active metabolite)
Best - Prozac
260
Meperidine (Demerol)
Narcotic analgesic
SE - decrease respiration
*Do not take with MAOIs - can cause Serotonin Syndrome or severe respiratory depression
261
Alprazolam & premenstrual disorder
2nd line treatment (SSRIs are 1st)
Intermittent dosing in Luteal phase only
Helps protect against misuse/tolerance
262
Which pregnancy hormone causes increased sleepiness and increased appetite?
Progesterone
263
Tacrine (Cognex)
1st acetylcholinesterase inhibitor approved for Alzheimer’s disease but withdrawn from U.S. in 2012 due to liver toxicity
264
Thioridazine
1st generation antipsychotic
Highest risk of QTc prolongation
Known to cause retinal deposits, marked atropine-like effects, and abnormal EKGs
265
Erythrocyte sedimentation rate (ESR)
Measures how quickly RBCs settle to the bottom of test tube
Tests for inflammation:
With inflammation RBCs settle in clumps and sink faster
Faster/higher ESR = more inflammation
266
Azotemia
When there are too much waste products & nitrogen in the blood
Test for this with BUN
Causes: kidney damage due to injury, disease, or medications & can’t get rid of nitrogen waste in the body
267
Galantamine
Acetylcholinesterase-inhibitor used to treat Alzheimer’s
Also stimulates nicotinic receptors
268
Midazolam (Versed)
Benzodiazepine used before surgical anesthesia
269
Thiopental (Sodium Pentothal)
Short-acting barbiturate
“Truth serum”
Used in combination with pancuronium bromide & potassium chloride for lethal injections
Can treat status epilepticus
270
Nolathane (Fluothane)
General anesthetic no longer used because it sensitizes the heart to catecholamines, increased risk of cardiac arrhythmias
271
Donepezil mechanism of action
Acetylcholinesterase inhibitor for treatment of Alzheimer’s
272
Pain response at neuronal level
Parallel processes:
Large myelinated fibers carry info at high speed to brain & spinal cord, resulting in immediate reflexive action & info to the brain
Smaller, unmyelinated c-fibers carry info at slower, more prolonged rate - experience of pain is prolonged if injury requires attention over a period of weeks
