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DT2 Exam 2 > Pharm > Flashcards

Pharm Flashcards

1
Q

caution for acetaminophen

A

liver disease, alcoholics

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2
Q

side effects acetaminophen

A

hepatotoxic

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3
Q

side effects aspirin and NSAIDs

A

gastric ulcers, inhibit platelet aggregration

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4
Q

caution for NSAIDs

A

if person on aspirin for CV protection do not add NSAID

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5
Q

location of mu receptor

A

CNS, myenteric neurons in gut,

vas deferens

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6
Q

effects of mu receptor

A

supraspinal analgesia, respiratory depression, euphoria and dependence, miosis gastric transit

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7
Q

location of delta receptors

A

olfactory bulbs, nucleus accumbens, caudate putamen, neocortex

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8
Q

physiological effects of delta receptors

A

affective behaviors

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9
Q

location of kappa receptors

A

cerebral cortex, nucleus accumbens, claustrum, hypothalamus, spinal cord

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10
Q

effects of kappa receptors

A

mediates spinal cord analgesia, miosis, sedation

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11
Q

strong agonists

A 
morphine
hydromorphone
methadone
heroine
oxycodone
meperidine
fentanyl, alfentanil, remifentanil, sufentanil
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12
Q

moderate agonists

A

codeine

propoxyphene

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13
Q

receptors for buprenorphine

A

partial mu agonist

kappa antagonist

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14
Q

receptors for pentazocine and butorphanol

A

kappa agonist

mu/delta antagonist

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15
Q

receptors for naluphine

A

kappa agonist

mu antagonist

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16
Q

antagonists

A

naloxone
naltrexone
nalmefene

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17
Q

mechanism of action for morphine

A

activates mu receptors
acts on areas involved in respiration, pain perception, mood, emotion
K in spinal cord
prevents substance P release

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18
Q

CNS effects of morphine

A

analgesia without loss of consciousness
drowsiness, itchy nose
euphoria/dysphoria
nausea and vomiting-action on CTZ

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19
Q

pupil effects of morphine

A

miosis-excitation at Edinger-Westphal nucleus of oculomotor nerve

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20
Q

respiration effects of morphine

A

usually cause of death in overdose

respiration depressed by direct effect on brain stem (decrease sensitivity to CO2)

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21
Q

cardiovascular effects of morphine

A

minor
peripheral vasodilation, inhibition of baroreceptors
orthostatic hypotension and fainting

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22
Q

GI effects of morphine

A

decrease motility
increase duodenal tone
increase biliary tract
leads to constipation

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23
Q

endocrine effects of morphine

A

decrease LH and testosterone
menstrual cycle irregularities
male sexual impotence

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24
Q

tolerance and dependence to morphine

A

tolerance does not develop to miosis/constipation/respiratory effects
opioids demonstrate cross tolerance

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25
Q

signs of withdrawal from morphine

A

increased sensitivity to noxious stimuli (hyperalgesia)
hyperventilation
dilation of pupils, diarrhea, dysphoria

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26
Q

drug interactions for morphine

A

phenothiazines, MAO inhibitors, TCA
phenothiazines increase sedative effects and decrease analgesia
amphetamine enhances analgesia

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27
Q

contraindication for morphine

A

hepatic insufficiency
respiratory insufficiency (emphysema, severe obesity)
head injury patients

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28
Q

cough suppression

A

codeine/hydrocodone
decrease sensitivity of CNS cough centers to peripheral stimuli
decrease mucosal secretion

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29
Q

pharmacokinetics morphine

A

low bioavailability of oral due to 1st pass effect
readily absorbed from GI tract, nasal mucosa, lung
metabolism-glucuronide conjugation with urinary excretion
active metabolites

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30
Q

side effects of methadone

A

constipation

biliary spasms

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31
Q

receptors for methadone

A

no kappa activity

so no euphoria

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32
Q

metabolism of diacetylmorphine

A

6MAM and then to morphine

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33
Q

BBB penetration of heroin

A

diacetylmorphine and 6MAM

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34
Q

effect of heroin

A

6MAM and morphine

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35
Q

detectable in urine tests

A

6MAM

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36
Q

OD of meperidine

A

not blocked by naloxone

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37
Q

side effects of meperidine

A 
respiration depressed
postural hypotension
does not suppress cough
variable on pupil size 
less constipation and urinary retention
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38
Q

meperidine and MAO inhibitors

A

severe reaction

excitation, delirium, hyperpyrexia, convulsions, respiratory depression

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39
Q

fentanyl

A

meperidine analog
available as a patch or lozenge
produces less nausea than morphine

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40
Q

metabolism of codeine

A

to morphine by CYP2D6

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41
Q

slow metabolizers of codeine

A

codeine ineffective analgesic

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42
Q

high metabolizers of codeine

A

fast conversion to morphine leads to OD

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43
Q

propoxyphene

A

less potnetial for dependence

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44
Q

tramadol

A

binds opiate receptors

inhibits NE and 5HT reuptake

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45
Q

side effects of tramadol

A

constipation

nausea, vomiting, dizziness, drowsiness

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46
Q

DOC in opioid OD

A

naloxone

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47
Q

naltrexone

A

treatment in alcoholism and opioid treatment

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48
Q

dextromethorphan

A

suppresses cough center, no analgesia

less constipation than codeine

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49
Q

uses for clonidine

A

neuropathic pain

cancer pain

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50
Q

MOA clonidine

A

activation of pre and post alpha 2 receptors in projection neurons of dorsal horn and primary afferents

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51
Q

uses for antidepressants

A

neuropathic pain

SSRI not effective

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52
Q

MOA antidepressants

A

NE and 5HT reuptake inhibitors promote NE activation of pre and post alpha 2 receptors

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53
Q

MOA gabapentin and pregabalin

A

reduce activation of N and P/Q Ca channels

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54
Q

MOA carbamazepine

A

stabilizes inactive state of voltage gated sodium channels

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55
Q

use for pregabalin

A

post herpetic neuralgia

painful diabetic neuropathy

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56
Q

use for carbamazepine

A

trigeminal neuralgia

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57
Q

abuse of antiepileptics

A

potentiates opioid action

pregabalin faster onset than gabapentin

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58
Q

capsaicin

A

TRPV1 antagonist

ion channel expressed on afferent nociceptors

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59
Q

NMDA antagonists

A

ketamine-blocks NMDA and thus glutamate signaling

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60
Q

MOA baclofen

A

GABAb receptor activator

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61
Q

pharmacokinetics of baclofen

A

takes 3-4 days to work
rapid oral absorption
excreted 85% intact

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62
Q

side effects of baclofen

A

drowsiness, vertigo, dizziness, psychiatric disturbances, ataxia, insomnia, slurred speech
weakness
chest pain, syncope

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63
Q

cautions for baclofen

A

CNS depressants can enhance effect
caution in elderly
abrupt withdrawl can cause hyperpyrexia, obtundation, rebound spasticity

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64
Q

uses of diazepam

A 
muscle spasms (iv or im)
muscle relaxant (oral)
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65
Q

carisoprodol pharmacokinetics

A

rapid onset
CYP2C19
active metabolite meprobamate

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66
Q

side effects carisoprodol

A

anti-cholinergic
drowsiness
dizziness
headache

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67
Q

cautions for carisoprodol

A

not for elderly or under 16
tolerance after 2-3 weeks
use caution in patients with drug abuse

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68
Q

mechanism of action cyclobenzaprine

A

reduces tonic somatic motor activity influencing both alpha and gamma motor neurons

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69
Q

side effects of cyclobenzaprine

A

antimuscarinic
drowsiness
dizziness
xerostemia

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70
Q

cautions for cyclobenzaprine

A

caution in elderly

don’t use in liver impaired

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71
Q

pharmacokinetics metaxalone

A

longer half life in females

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72
Q

side effects of metaxalone

A

dizziness, drowsiness

hemolytic anemia, leukopenia, jaundice

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73
Q

cautions metaxalone

A

use with care in elderly

use care in liver and renal impaired patients

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74
Q

methocarbamol pharmacokinetics

A

hepatic dealkylation and hydroxylation

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75
Q

side effects of methocarbamol

A

amnesia, confusion, seizures, dyspepsia, metallic taste, bradycardia, leukopenia, jaundice

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76
Q

cautions of methocarbamol

A

use with care in elderly
use care in liver or renal impaired patients
IV contraindicated in renal impairment
use care in patients with seizures

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77
Q

mechanism of action tizanadine

A

alpha2 adrenergic agonist

acts at spinal cord

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78
Q

side effects of tizanadine

A

hypotension, bradycardia
somnolence, dizziness, depression, anxiety
xerostomia
increase in liver enzymes

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79
Q

cautions for tizanadine

A

use with care in elderly
caution in patients with cardiac disease (esp if on antihypertensives), care in psych patients, care in hepatically impaired, avoid if on oral contraceptives

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80
Q

kininogens

A

precursors of kinins

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81
Q

kallikreins

A

serine proteases that cleave kininogens into kinins

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82
Q

synthesis of bradykinin

A

HMWK cleaved by plasma kallikrein into bradykinin

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83
Q

synthesis of kallidin

A

LMWK cleaved by tissue kallikrein into kallidin

cleaved by aminopeptidase into bradykinin

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84
Q

factor 12

A

12a converts plasma prekallikrein to plasma kallikrein

positive feedback plasam kallikrein activates factor 12a

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85
Q

metabolism of kinins

A 
kinase I cleaves kinins into active kinin metabolites (des-Arg9-bradykinin/des-Arg10-Kallidin)
kinase II (ACE) inactive metabolites from bradykinin
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86
Q

ACE inhibitors on blood pressure

A

increase in bradykinin (not being metabolized into inactive products)

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87
Q

B1 receptors

A

activated by bradykinin and kinin active metabolites
induced by tissue damage, inflammation
stimulates release of prostaglandins, NO, EDHF

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88
Q

B2 receptors

A

activated by bradykinin and kallidin
in most tissues
stimulates release of prostaglandins, NO, EDHF

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89
Q

drug interactions with kinins

A

NSAIDS reduce bradykinin by inhibiting cyclo-oxygenase

corticosteroids increase lipocortin (phospholipase A2 inhibitor)

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90
Q

CGRP

A

potent vasodilator peptide in trigeminal system

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91
Q

kinins and inflammation

A

increase permeability of microcirculation which can promote edema

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92
Q

kinins and respiration

A

induce bronchospasms

kinin levels can be elevated in asthma

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93
Q

serotonin and platelets

A

platelets do not make serotonin but they store them

released during platelet aggregation which leads to vasoconstriction

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94
Q

serotonin on the heart

A

induces vasoconstriction

positive inotropic and chronotropic effects on heart

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95
Q

enterochromaffin cells in the GI

A

release of serotonin in response to vagal stimulation and stretching
regulates motility

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96
Q

serotonin in the CNS

A

neurons in raphe nuclei project throughout the brain and spinal cord
regulate sensory perception and nociception

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97
Q

inactivation of serotonin

A

inactivated by MAO-A

platelets only express MAO-B

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98
Q

urinary metabolite of 5HT

A

5-HIAA

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99
Q

5HT1D receptor

A

induce vasoconstriction of cranial blood vessels

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100
Q

5HT1B receptor

A

inhibits nociceptive trigeminal afferents

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101
Q

levels of 5HT in migraine

A

lower in urine and platelet

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102
Q

beta blockers for migraine contraindication

A

asthma

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103
Q

side effects of amitriptyline and nortriptyline

A

anti-muscarinic properties

weight gain and tiredness

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104
Q

approved beta blockers for migraine

A

propranolol and atenolol

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105
Q

approved anticonvulsants for migraine

A

valproic acid
topiramate
gabapentin
levetiracetam

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106
Q

MOA anticonvulsants for migraine

A

increase GABA

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107
Q

contrindications for valproic acid

A

contraindicated in pregnancy due to teratogenicity

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108
Q

side effects valproic acid

A

drowsiness, anorexia, nausea, ataxia, alopecia, tremor, liver toxicity

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109
Q

approved calcium channel blockers for migraine

A

verapamil

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110
Q

side effects verapamil

A

negative inotropic cardiac effects and hypotension

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111
Q

cyproheptadine MOA

A

antagonist of histamine, acetylcholine, and serotonin

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112
Q

side effect cyproheptadine

A

CNS depression and sleepiness

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113
Q

MOA botox

A

blocks conduction by binding to sites on motor nerve terminals

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114
Q

nonspecific abortive therapy

A

NSAIDs, Ibuprofen, naproxen, acetaminophen, ketorolac

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115
Q

ketorlac max

A

5 days

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116
Q

abortive therapy in children

A

acetaminophen and ibuprofen

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117
Q

abortive therapy in pregnant women

A

ibuprofen and acetaminophen

all NSAIDs should be avoided in last trimester-bleeding and premature closure of ductus arteriosus

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118
Q

MOA ergot alkaloids

A

agonist effects at 5HT1 receptors

parital agonist and antagonist activity at serotonergic, dopaminergic, and adrenergic receptors

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119
Q

routes of administration for ergot alkaloids

A

ergotamine sublingual due to extensive first pass effect

dihydroergotamine-nasal spray or injection

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120
Q

side effects for ergot alkaloids

A

nausea and vomiting

vasoconstriction

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121
Q

contraindications for ergot alkaloids

A 
pregnancy
can cause fetal stress and miscarriage 
peripheral vascular disease
ischemic heart disease
cannot use with triptans
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122
Q

advantages of triptans

A

less nausea and generalized vasoconstriction

more selective for 5HT1B/D

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123
Q

vascular effect of triptans

A

vasoconstriction of cranial blood vessels

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124
Q

neurogenic effect of triptans

A

reduction of trigeminal sensory nerve activation and inhibition of vasoactive neuropeptide release

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125
Q

central effect of triptans

A

inhibition of neurotransmitter release from activated trigeminal nerves in brainstem and upper cervical spinal column

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126
Q

sumatriptan

A

short onset and duration of action

sq

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127
Q

advantages of naratriptan and zolmitriptan

A

lipophilicity-greater distribution to brain stem

greater bioavailability

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128
Q

metabolism of zolmitriptan and naratriptan

A

p450
50% in urine unchanged
lower dose in renal dysfunction

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129
Q

advantages of frovatriptan

A

highest affinity for 5HT1B receptor

slower onset and longest acting

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130
Q

advantages of rizatriptan

A

sublingual faster than sumatriptan
less nausea than sumatriptan
metabolism MAO

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131
Q

adverse effects of triptans

A

headache recurrence

tingling, paresthesia, dizziness, flushing, neck pain and drowsiness

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132
Q

contraindications for triptans

A

ergot within 24 hours
peripheral vascular disease
ischemic heart disease

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133
Q

drug interactions for triptans

A

SSRI-leads to serotonin syndrome

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134
Q

acute treatment for cluster headache

A

oxygen

rapid onset triptans

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135
Q

prophylactic treatment for cluster headache

A

high dose prednisone

Ca channel blockers (Verapamil)

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136
Q

prophylactic treatment of tension headaches

A

TCA and antiepileptic (gabapentin)

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137
Q

drug therapy for idiopathic intracranial hypertension

A

carbonic anhydrase inhibitors

acetazolamide and topiramate

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138
Q

side effects of carbonic anhydrase inhibitors

A

nausea, fatigue, tingling in hands and feet, altered taste, distal paresthesia, weight loss

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139
Q

nigrostriatal pathway in schizophrenia

A

causes extrapyramidal side effects

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140
Q

mesolimbic pathway in schizophrenia

A

hyperactive causing positive symptoms

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141
Q

mesocortical pathway in schizophrenia

A

hypoactive causing negative symptoms (DLPFC for cognitive and VMPFC for affect)

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142
Q

tuberoinfundibular pathway in schizophrenia

A

prolactin

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143
Q

drugs causing psychosis

A

phencyclidine/hallucinogens
amphetamines, cocaine
alcohol withdrawal
sedative-hyponotic withdrawal

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144
Q

toxic agents causing psychosis

A

heavy metals
digitalis toxicity
L-dopa

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145
Q

metabolic causes of psychosis

A 
hypoglycemia
acute intermittent porphyria
Cushing's syndrome
hypo/hypercalcemia
hypo/hyperthyroidism
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146
Q

nutritional causes of psychosis

A

thiamine deficiency
niacin deficiency
B12 deficiency

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147
Q

neurological causes of psychosis

A

stroke
brain tumor
early Alzheimers or Picks
hypoxic encephalopathy

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148
Q

positive symptoms of schizophrenia

A 
agitation
delusions
disorganized speech
disorganized thinking
hallucinations
insomnia
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149
Q

negative symptoms of schizophrenia

A 
apathy
affective flattening
lack of motivation
lack of pleasure
poverty of speech
social isolation
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150
Q

affinity typical antipsychotics

A

D2>5HT2

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151
Q

affinity atypical antipsychotics

A

5HT2>D2

selectivity for mesolimbic over nigrostriatal

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152
Q

causes of adverse effects for antipsychotics

A

alpha1 adrenergic
histamine
muscarinic

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153
Q

antipsychotic pharmacokinetics

A

absorbed erratically from GI
parenteral administration available for some
renal excretion of glucuronide conjugates

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154
Q

actions of antipsychotics at dopamine receptors

A

decrease in K currents leads to presynaptic block

long term inactivated neruons and receptor sensitivity at postsynaptic

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155
Q

response to antipsychotics 1-3 days

A

decrease agitation/hostility
decrease anxiety
normalize eat/sleep patterns

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156
Q

response to antipsychotics 1-2 weeks

A

increase mood
increase socialization
increase self care habits

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157
Q

response to antipsychotics 3-6 weeks

A

increase thought disorder

decrease delusions/hallucinations

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158
Q

special uses for haloperidol

A

Tourette

Huntington disease

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159
Q

deposits in lens and cornea

A

chlorpromazine

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160
Q

contraindicated in patients with seizures

A

chlorpromazine

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161
Q

deposits in retina

A

thioridazine

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162
Q

cannot be used as anti-emetic

A

aripiprazole

thioridazine

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163
Q

special use for prochlorperazine

A

drug induced nausea

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164
Q

special use for scopolamine

A

motion sickness

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165
Q

extrapyramidal side effects of antipsychotics

A

akathisia
pseudoparkinsonism
dystonias-facial grimacing, torticollis

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166
Q

drugs most likely to give extrapyramidal side effects

A

haloperidol
fluphenazine
thiothixene

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167
Q

drugs most likely to have fewer extrapyramidal side effects

A

thioridazine
chlorpromazine
also atypicals less likely

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168
Q

treatment of extrapyramidal side effects

A

trihexyphenidyl
benztropine mesylate
procyclidine HCl
Biperidin

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169
Q

tarditive dyskinesia

A

develops after months/years

results from supersensitivity to DA

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170
Q

likely causes of tarditive dyskinesia

A

more common in typicals

171
Q

low incidence of tarditive dyskinesia

A

clozapine

172
Q

neuroleptic malignant syndrome

A

muscle rigidity
elevated temperature
altered consciousness
autonomic dysfunction

173
Q

likely causes of neuroleptic malignant syndrome

A

typicals

174
Q

treatment of neuroleptic malignant syndrome

A 
administer bromocriptine (d2 agonist) and dantrolene
switch to atypical
175
Q

results of increased prolactin

A 
menstrual irregularities
loss of libido
swelling of mamillary glands
galactorrhea
osteoporosis
176
Q

common causes of prolactin increase

A

phenothiazines-chlorpromazine, fluphenazine, thioridazine, trifluoperazine, mesoridazine, perphenazine

177
Q

common causes of cholinergic dysfunction

A

thioridazine, chlorpromazine, olanzapine

clozapine increass salivation

178
Q

common causes of adrenergic dysfunction

A

chlorpromazine and mesoridazine

179
Q

common causes of sedation

A

chlorpromazine, olanzapine, quetiapine, clozapine

180
Q

metabolic side effects of antipsychotics

A

more common with atypical
sedation, lack of movement
endocrinological changes
results-T2DM, hypertension, hyperlipidemia

181
Q

causes of metabolic side effects

A

clozapine, olanzapine
chlorpromazine
risperidone
haloperidol

182
Q

cause of leukopenia and agranulocytosis

A

clozapine

183
Q

cause of perioral tremor=rabbit syndrome

A

from prolonged antipsychotic

treat with anti-cholinergic antiparkinson drugs

184
Q

cause of QT prolongation

A

ziprasidone

185
Q

cause of T wave abnormalities and ventricular arrhythmias

A

thioridazine

186
Q

contraindications for antipsychotics

A

pregnant and nursing mothers

187
Q

drug interactions for antipsychotics

A 
central depressants and opioid analgesics
amphetamines 
anticholinergics
SSRI-worsen extrapyramidal symptoms
hypotensive effects of antihypertensives
188
Q

source of addictive nature of drugs

A

mesolimbic dopamine

189
Q

direct increase in dopamine

A

cocaine

amphetamine

190
Q

indirect increase in dopamine

A 
nicotine
alcohol
opioids
benzos
cannabinoids
PCP
191
Q

craving in drug

A

PFC and hippocampus

192
Q

effects of opioids at abuse doses

A

euphoria/dysphoria

tranquility

193
Q

OD from loperamide

A

dysrhythmia and prolonged QT

death from cardiac

194
Q

treatment of OD from opioids

A

ventilation

IV or IM naloxone

195
Q

signs of withdrawal from opioids

A

pupil dilation
yawning
increased bowel sounder
hypotension from volume depletion-diarrhea and comiting

196
Q

treatment of dysphoria and restlessness

A

clonidine

197
Q

treatment of myalgias and arthralgias

A

NSAID or acetaminophen

198
Q

teatment of nausea and vomiting

A

loperamide

199
Q

crushing of oxycodone

A

leads to heroin high

200
Q

opioids plus gabapentin

A

potentiates opioid action

201
Q

antidote for benzo

A

flumazenil

202
Q

benzo withdrawal

A

tremors, anxiety, dysphoria, psychosis, seizure

203
Q

treatment of benzo withdrawal

A

diazepam

204
Q

danger of barbituates

A

can lead to respiratory depresion (unlike benzo)

no antidote

205
Q

short term effects of propofol

A

mild euphoria, hallucinations, and disinhibition

206
Q

long term effects of propofol

A

addiction

207
Q

GHB date rape drug MOA

A

increase then decrease dopamine

increase release of endogenous opioids

208
Q

MOA alcohol

A

effect on GABA and opioid transmission

stimulates both

209
Q

drugs to treat alcohol abuse

A

naltrexone

disulfiram-makes you vomit from buildup of acetaldehyde

210
Q

MOA amphetamines

A

incrase levels of dopamine in nucleus accumbens
metamphetamine best at crossing BBB
increase neurotransmission of central NE, DA, 5HT
block reuptake
inhibition of MAO

211
Q

low amphetamine dose

A

NE release

212
Q

moderate amphetamine dose

A

NE and DA

213
Q

high amphetamine dose

A

NE, DA, 5HT

214
Q

acute effects of amphetamines

A 
increase attention and concentration
increase wakefulness
decrease fatigue and appetite 
increase mood, euphoria
psychomotor stimulation
215
Q

adverse effects of amphetamines

A

insomnia, agitation
convulsions at high doses
paranoid schizophrenia like state
delusions and hallucinations

216
Q

cardiovascular effects of amphetamines

A

palpitations, arrhythmias, hypertension, anginal pain, circulatory collapse

217
Q

GI effects of amphetamines

A

anorexia, nausea, vomiting, abdominal cramps, diarrhea

218
Q

other effects of amphetamines

A 
headache
hyperthermia
DIC
rhabdomyolysis
renal failure
hepatotoxicity
meth mites and meth mouth
219
Q

tolerance to amphetamines

A

develops to euphoria

does not develop to CNS effects

220
Q

OD amphetamines

A 
CNS stimulation
tachycardia
hypertension
dilated pupils
diaphoresis
hyperthermia
221
Q

treatment of amphetamine OD

A 
stabilize airways
activated charcoal
modify urine pH
avoid beta blockers 
benzo-lorazepam, diazepam
antipsychotic-chlorpromazine, haloperidol, droperidol, ziprasidone
222
Q

withdrawal from amphetamine

A

mental depression
fatigue
ravenous hunger

223
Q

effects and MOA of MDMA

A

blocks reuptake of serotonin
sympathomimetic, increased euphoria
enhances pleasure, heightens sexuality

224
Q

toxicity of MDMA (ecstasy)

A 
narrow margin of safety
cardiac arrhythmias
hyperthermia
convulsions
rhabdomyolysis
renal failure
chronic-liver damage
225
Q

MOA cocaine

A

blocks reuptake of NE, DA, 5HT
blocks Na channel and blocks nerve conduction
increases glutamate and aspartate in nucleus accumbens

226
Q

cocaine metabolites

A

benzoylecgonine-spontaneous hydrolysis
ecgonine-pseudocholinesterase
norcocaine-p450 induced

227
Q

cocaine+alcohol

A

cocaethylene
crosses BBB
formed by transesterification
active metabolite as potent as cocaine

228
Q

signs of cocaine OD

A 
delirium, violent behavior
pulse-weak, irregular
tonic-clonic seizures
malignant encephalopathy 
rapid elevation of BP can lead to stroke, irregular HB, cardiac arrest
229
Q

treatment of cocaine OD

A

benzo, phentolamine
aspirin, nitroglycerine, phentolamine
NO BETA BLOCKERS

230
Q

drug to reduce craving of drug

A

bromocriptine

231
Q

prolonged cocaine use

A 
malnutrition
weight loss
sexual problems
mental confusion
anxiety
232
Q

bath salts

A

similar to amphetamines

233
Q

khat

A

common in African immigrants

234
Q

nicotine

A

rapidly absorbed and distributed
tars accelerate metabolism of nicotine
metabolite-cotinine

235
Q

MOA nicotine

A

activates cholinergic nicotinic receptors
inhibits MAO-activate DA neurotransmission
stimulates release of NE and DA

236
Q

side effects of nicotine

A

improved memory
increased concentration
mild euphoria
appetite suppression

237
Q

pharmacokinetics nicotine

A

absorption via oral mucosa of lung, GI, mucosa, skin
crosses placenta and secreted in milk
metabolism in liver and lung
urinary excretion

238
Q

adverse effects of nicotine

A

irritability
tremors
intestinal cramps/diarrhea
increased HR and BP

239
Q

nicotine toxicity

A

central respiratory paralysis

severe hypotension caused by medullary paralysis

240
Q

nicotine withdrawal

A 
1-2 days after quitting 
irritability
anxiety
restlessness, frsutration
difficulty concentrating
headache
insomnia
241
Q

MOA caffeine

A

translocation of extracellular calcium
increase cAMP by inhibiting PDE
blocks adenosine receptors

242
Q

effects of caffeine

A 
decrease fatigue
increase mental alertness
increase anxiety and tremors at higher levels 
mild diuretic
increase secretion of gastric HCl
high doses-emesis and convulsions
243
Q

LSD MOA

A

agonist at 5HT1 and 5HT2

244
Q

block LSD hallucinations

A

haloperidol

245
Q

MOA ketamine

A

antagonizes glutamate

anticholinergic activity

246
Q

treatment for shroom OD

A

activated charcoal, diazepam

247
Q

locations of receptors for marijuana

A

basal ganglia, hippocampus, cerebellum

248
Q

alterations with orbitofrontal cortex

A

responsible for impulsivity and hyperactivity

249
Q

dorsolateral prefrontal cortex and dorsal anterior cingulate cortex

A

attention deficits

250
Q

ADHD treatment goals

A

increase DA and NE signaling

251
Q

MOA methylphenidate

A

increase NE and DA

inhibitor of NET and DET

252
Q

side effects of methylphenidate

A

GI-abdominal pain, nausea, weight loss
restlessness, anxiety, insomnia, agitation, aggressivness
convulsions

253
Q

contraindications methylphenidate

A

epileptics

glaucoma patients

254
Q

pharmacokinetics impatced by food

A

metadate

not impacted with concerta

255
Q

contraindications amphetamine

A

avoid in CV
avoid in glaucoma
avoid MAOI

256
Q

atomoxetine MOA

A

selective NE reuptake inhibitor

257
Q

CYP2D6 metabolism

A

codeine

atomoxetine

258
Q

side effects atomoxetine

A 
abdominal pain
headache, insomnia, somnolence
urinary retention
orthostasis
psychotic symptoms
259
Q

cautions atomoxetine

A

avoid in CV disease
CYP2D6 metabolizers
avoid MAOI

260
Q

advantages of clonidine or guanfacine

A

good for reducing aggression

be careful in history of CV disease

261
Q

drugs for ODD and CD

A

relates to limbic function
ADHD meds
mood stabilizers
atypical antipsychotics

262
Q

ASD inattention and hyperactivity

A

ADHD linked-methylphenidate, alpha2-adrenergic agonists, atomexatine, risperidone
anxiety linked-SSRI, buspirone

263
Q

ASD disruptive behavior

A 
risperidone or other atypicals
alpha2 adrenergic agonists
mood stabilizers
antiepileptics
SSRI
264
Q

ASD repetitive behavior

A

fluoxetine
clomipramine
risperidone

265
Q

ASD sleep problems

A

melatonin
risperidone
SSRI

266
Q

target of treating tics in Tourette

A

dopamine

267
Q

treatment of tics

A

atypical antipsychotics-D2 antagonists (fluphenazine, pimozide)
dopamine reuptake inhibitors-tetrabenzine
low dose ropinirole-dopamine agonist
botox for focal motor and vocal tics

268
Q

MOA desmopressin

A

regulates water reabsoprtion in collecting tubule

269
Q

administration of desmopressin

A

1 hr before bedtime

270
Q

cautions for desmopressin

A

fluid or electrolyte imbalance

271
Q

MOA imipramine

A

relax detrusor
stimulate detrusor
decrease amount of time in REM sleep

272
Q

administration of imipramine

A

1 hr before bedtime

273
Q

caution for imipramine

A

check for CVD

274
Q

potency

A

expressed as minimum alveolar concentration

275
Q

MAC

A

inspired concentration of anesthetic required to produce anesthesia in 1/2 of subjects

276
Q

factors that dont impact MAC

A 
type of noxious stimulus
sex
height
weight
duration of exposure
277
Q

factors that impact MAC

A

age
health status
drug interactions
red hair

278
Q

age on MAC

A

increase in infancy

decrease in old age

279
Q

health on MAC

A

increase in hyperthyroidism

decrease in hypothyroidism

280
Q

drugs on MAC

A

increase with amphetamines

decrease with sedatives

281
Q

red hair on MAC

A

increase

282
Q

equilibrium in anesthesia induction

A

alveoli to arteries to brain

283
Q

factors that increase rate of induction

A

concentration of anesthetic in inspired gas

alveolar ventilation

284
Q

factors that decrease rate of induction

A

solubility of anesthetic (blood:gas partition)

cardiac output

285
Q

mechanism of action of anesthetics

A

may impede breakdown of GABA
potentiation of GABA-increased Cl influx
increase K efflux, reduce Na, Ca influx

286
Q

characteristics of halothane

A

potent anesthetic
weak analgesic
blood:gas partition coefficient
do not repeat at intervals less than 2-3 weeks

287
Q

cardiovascular effects of halothane

A

sensitizes heart to catecholamines (increased risk of arrhythmias)
decrease BP, decrease CO, depress baroreceptor reflex

288
Q

respiratory effects of halothane

A

breathing is rapid/shallow

decreased responsiveness to CO2

289
Q

metabolic effects of halothane

A

liberation of hydrocarbons, bromide ion can result in hypersensitivity and hepatitis

290
Q

characteristics of enflurane

A

less potent than halothane

rapid induction/recovery

291
Q

cardiovascular effects of enflurane

A

less sensitization of heart to catecholamines

reduced tendency for arrhythmias

292
Q

respiratory effects of enflurane

A

respiratory depression in dose-dependent manner

293
Q

muscular effects of enflurane

A

greater potentiation of muscle relaxants
depolarizing-succinylcholine
enhances effects of non-depolarizing NM blockers
block Ach at NMJ

294
Q

CNS effects of enflurane

A

seizures

295
Q

metabolic effects of enflurane

A

producing Fl, renal excretion

296
Q

isoflurane characteristics

A

smooth/rapid induction and recovery

297
Q

cardiovascular effects of isoflurane

A

does not produce arrhythmias, does not sensitize heart to catecholamines, doe snot decrease CO

298
Q

respiratory effects of isoflurane

A

dose dependent decrease in respiration

299
Q

muscular effects of isoflurane

A

relaxes skeletal muscle directly and via CNS depression

enhances depolarizing/nondepolarizing blocking agents

300
Q

metabolism of isoflurane

A

low biotransformation

low organ toxicity

301
Q

cardiovascular effect of desflurane

A

decrease BP

CO maintained

302
Q

respiratory effect of desflurane

A

respiratory irritant

dose dependent decrease in respiration

303
Q

muscular effect of desflurane

A

relaxes skeletal muscle directly and via CNS depression

304
Q

production of compound A

A

sexoflurane reacting with soda lime

305
Q

potential risk of toxicity from sevoflurane

A

Fl release during metabolism

306
Q

cardiovascular effects of NO

A

potentiates depression of narcotics

307
Q

respiratory effects of NO

A

enhances depression of other agents

can lead to hypoxia during recovery

308
Q

chronic exposure to NO

A

leads to megablastic anemia

oxidizes cobalt of B12 which inhibits methylation of macromolecules

309
Q

second gas effect

A

rapidly absorbed of one gas increases uptake of another anesthetic gas
nitric oxide is frequently used

310
Q

elimination of inhalation anesthetics

A

lungs
metabolism in liver releases halide ions which cause hepatic and renal toxicity
low blood solubility eliminated at faster rate

311
Q

intravenous anesthetic agents

A

rapid induction of anesthesia which is maintained by inhalation agent

312
Q

agents used in IV anesthetic

A

others
barbituates
benzos
opioids

313
Q

characteristics of propofol

A

rapid recovery
cardiovascular and respiratory depression
not analgesic
antiemetic

314
Q

MOA propofol

A

potentiate GABA signaling

315
Q

cardiovascualr effects of propofol

A

hypotension
more pronounced in elderly
bradycardia, arrhythmias

316
Q

respiratory effects of propofol

A

respiratory depressant

respiratory acidosis

317
Q

CNS effects of propofol

A

decreases CBF and ICP

minor excitatory effects

318
Q

characteristics of etomidate

A

minimal cardiovascular effects
decrease blood flow to brain-good for brain surgery
post op nausea and vomiting
not analgesic

319
Q

characteristics of thiopental

A

short acting
used for induction and sedation
no antagonist in OD
redistributed to less vascular regions

320
Q

adverse effects of barbituates

A

transient rise in BP
hypotension, circulatory collapse, cardiac arrest
respiratory depression

321
Q

contraindications for barbituates

A

variegate porphyria

acute intermittent porphyria

322
Q

MOA benzodiazepams

A

increase frequency of channel opening

may cause respiratory depression

323
Q

benzo antagonist

A

flumazenil

324
Q

opioids as anesthetic

A

preserves cardiac output and myocardial contractility

used in cardiac surgery

325
Q

opioid drug interactions

A

propofol

gaseous anesthetics

326
Q

side effects of opioids

A

hypotension, respiratory depression
muscle rigidity
postanesthetic N/V

327
Q

uses of anticholinergics

A

combat secretions

prevent vagal effects

328
Q

prevention of salivation

A

scopalamine>atropine

329
Q

preventing reflex bradycardia

A

atropine>scopalamine

330
Q

characteristics of glycopyrrolate

A 
long acting
less sedating
less tachycardia
more effective at preventing bradycardia
does not cross BBB
causes peripheral effects
331
Q

dissociative anesthesia

A

mental state where individual appears to be dissociated from environment without complete loss of consciousness

332
Q

recovery on ketamine

A

delirium, hallucinations, irrational behavior (less likely in children)

333
Q

stage I of anesthesia

A

patient is conscious and conversational

334
Q

stage II of anesthesia

A 
delirium and violent
increase BP, tachycardia
increase in respiration
mydriasis
increase in skeletal muscle tone
urinary and fecal incontinence
335
Q

stage III of anesthesia

A

regular respiration

relaxation of skeletal muscle

336
Q

stage IV of anesthesia

A

medullary paralysis
depression of respiratory and vasomotor centers
death

337
Q

ester anesthetics

A

benzocaine
chloroprocaine
cocaine
procaine

338
Q

amide anesthetics

A 
bupivacaine
etidocaine
lidocaine
mepivacaine
prilocaine
ropivacaine
339
Q

characteristics of local anesthetics

A

amine, weak base
ionized at low pH
inflammation/acidosis decreases pH

340
Q

MOA local anesthetics

A

binds Na channel-ionized has more affinity

prolongs inactivation state of channel

341
Q

easily anesthetized

A

small, unmyelinated fibers

easier to block autonomic and sensory nerves than motor

342
Q

metabolism of ester type drugs

A

esterases, plasma cholinesterases

343
Q

amide metabolism

A

amidases, liver

344
Q

adverse side effects local anesthetics

A

CNS-restlessness, tremor, euphoria
hypotension, cardiac depression
allergic dermatitis or asthmatic attack from PABA

345
Q

vasoconstrictors for local anesthetics

A

prolong effects
slows rate of absorption
decreases drug plasma concentration

346
Q

sites to not use vasoconstrictors

A

end arteries
fingers, toes, ears, nose, penis
can lead to gangrene
increase oxygen consumption with hypoxia

347
Q

contraindications for vasoconstrictors

A

hypertensive

ventricular arrhythmias

348
Q

use of benzocaine

A

skin

349
Q

use for mucous membranes and cornea

A

tetracaine
lidocaine
cocaine
epineprine does not penetrate mucous membranes

350
Q

LET

A

lidocane
epinephrine
tetracaine

351
Q

EMLA

A

eutetic mixture of lidocaine and others

352
Q

infiltration anesthesia

A

injected directly into tissues

epinephrine doubles duration of anesthesia

353
Q

iontophoresis

A

electrical current forces anesthetic into a tissue

354
Q

field block anesthesia

A

forms a wall of anesthesia encircling operative field

less drug for greater area than infiltration

355
Q

nerve block anesthesia

A

injected into or adjacent to a nerve or nerve plexus

produces large area of anesthesia

356
Q

spinal anesthesia

A

injection into lumbar subarachnoid space below level at which cord terminates
spread controlled by tilt
can be used in people contraindicated for general for lower body surgery

357
Q

epidural anesthesia

A

injection into lumbar or caudal epidural space
bupivacaine for labor/delivery
monitor closely to prevent cardiac depression and neurotoxicity

358
Q

cocaine as anesthetic

A

causes vasoconstriction

359
Q

characteristics of procaine

A

short duration
parenteral administration
metabolized to PABA

360
Q

characteristics of lidocaine

A

metabolized in liver to monoethylglycinexylidide and glycinexylidine
topical/parenteral administration

361
Q

can cause methemoglobinemia

A

prilocaine

due to metabolism to O-toluidine

362
Q

causes of symptomatic epilepsy

A

drug use
hypoglycemia
brain injury
tumors

363
Q

status epilepticus

A

generalized tonic-clonic seizures so frequent that another seizure occurs before the patient returns to normal consciousness from the postictal state
MEDICAL EMERGENCY

364
Q

treatment of status epilepticus

A

IV benzo (lorazepam/diazepam/midazolam)
IV phenytoin
if still refractory-phenobarbital/midazolam/propofol

365
Q

aura present in seizures

A

convulsive/partial

366
Q

aura absent in seizures

A

absence, myoclonic

367
Q

postictal confusion absent

A

absence

368
Q

MOA phenytoin

A

blockade of Ca influx
enhancement of Cl mediated inhibitory post synaptic potentials
enhanced affinity for inactivated Na channels at more depolarized membrane potentials

369
Q

uses of phenytoin

A

all except absence and atonic

370
Q

pharmacokinetics of phenytoin

A

IM results in crystallization and necrosis at injection site
highly protein bound in plasma
metabolism is rate limited

371
Q

side effects of phenytoin

A

gingivaial hyperplasia (can also occur in cyclosporine, nifedepine, diltazem, verapamil)
hirsuitism
nystagmust, ataxia, diplopia
hyperglycemia, osteomalacia, lymphadenopathy
SJS
leukopenia, megaloblastic anemia, thrombocytopenia, agranulocytosis, aplastic anemia

372
Q

fetal abnormalities from phenytoin

A

cleft lip, cleft palate, heart malformations

373
Q

toxic effect of phenytoin

A

cardiovascular collapse

374
Q

drug interactions phenytoin

A

enhanced by carbamazepine
decreased by microsomal enzymes
induces CYP3A4-reduce levels of digoxin, steroids, vitamin K
vitamin K prevents hypoprothrombinemia and bleeding

375
Q

fosphentyoin

A

prodrug of phenytoin

can be administerd IM

376
Q

carbamazepine MOA

A

decrease Na conductance

377
Q

uses carbamazepine

A

generalized tonic-clonic seizures
complex partial seizures
trigeminal neuralgia

378
Q

ineffective uses of carbamazepine

A

makes myoclonic worse

ineffective in absence

379
Q

pharmacoknetics carbamazepine

A

metabolized to 10,11 epoxide

autoinduction of metabolism (increases in first 4-6 weeks)

380
Q

side effects carbamazepine

A

GI
vertigo, diplopia, blurred vision, ataxia
hematological-aplastic anemia, thrombocytopenia, hyponatremia, agrnaulocytosis, leukopenia
hepatotoxicity

381
Q

MOA phenobarbital

A

enhances GABA Cl flux

382
Q

uses phenobarbital

A

generalized tonic-clonic epilepsy
partial seizures
prophylaxis for febrile convulsions

383
Q

side effects phenobarbital

A

sedation-tolerance develops
rashes-scarlatiniform or morbilliform
ataxia, nystagmus

384
Q

drug interactions phenobarbital (same as primidone)

A

additive to other depressants

valproic acid increases phenobarbital in blood

385
Q

primidone MOA

A

blockade of sodium channels

potentiate GABA via formation of phenobarbital

386
Q

uses primidone

A

complex partial seizures
generalized tonic-clonic seizures
simple partial seizures
essential tremor

387
Q

pharmacokinetics primidone

A

metabolized in liver to phenobarbital and phenylethylmalonamide

388
Q

sie effects primidone

A

rash, leukopenia, thrombocytopenia, SLE
CNS depression
ataxia, cognitive impairment
depression of respiration

389
Q

MOA valproic acid

A

interacts with GABA neurons
indues blockage of Na and K
inhibits T type Ca channels

390
Q

uses valproic acid

A 
absence seizures refractory to ethosuximide
myoclonic seizures
reflex epilepsies 
generalized tonic clonic seizures
complex partial seizures
bipolar disorder
391
Q

pharmacokinetics valproic acid

A

fatty acid
absorbed from gut and metabolized to active metabolites and inactive conjugates before excretion
sprinkled

392
Q

side effects valproic acid

A

alopecia
N/V
ataxia, tremor
heaptic failure, elevated liver enzymes (under 2 yo greatest risk)
decrease in platelet and clotting function

393
Q

drug interactions valproic acid

A

increases lamotrigine, phenobarbital, primidone
inhibits p450
displaces and decreases elimination of phenytoin

394
Q

birth defects from valproic acid

A 
spina bifida
atrial septal defect
cleft palate
hypospadias
polydactyly
craniosynostosis
395
Q

MOA ethosuximide

A

blocks t type Ca channels of thalamic interneurons that interrupt the neuronal hypersynchorny of thalamocortical pathways

396
Q

uses ethosuximide

A

absence seizures

397
Q

side effects ethosuximide

A

GI irritation
euphoria, dizziness
uticaria, SJS
blood dyscrasias

398
Q

lorazepam MOA

A

binding to GABAa
blockage of Na channels
blocks neuronal Ca channels

399
Q

MOA gabapentin

A

increase release of GABA from central neurons

400
Q

uses gabapentin

A 
partial seizures
partial seizures-pediatric
postherpetic neuralgia
diabetic neuropathy
migraine
401
Q

side effect gabapentin

A

ataxia, dizziness, drowsiness, nystagmus, tremor
weight gain
dyspepsia, constipation

402
Q

drug interactions gabapentin

A

decreased bioavailability with antacids

403
Q

lamotrigine MOA

A

inhibits voltage sensitive Na channels
inhibits glutamate and aspartate release
may inhibit Ca channels

404
Q

uses lamotrigine

A 
partial seizures
generalized tonic-clonic
atonic
absence seizures
add on for lennox-gastaut syndrome
405
Q

side effects lamotrigine

A

dizziness, diplopia, ataxia

skin rash-SJS (highest risk

406
Q

drug interactions lamotrigine

A

metabolism induced by phenytoin, carbamazepine
inhibited by valporic acid
levels of valproic acid decreased by lamotrigine
lamotrigine can induce its own metabolism

407
Q

MOA topiramate

A

inhibits voltage dependent sodium channels
potentiates action of GABA
blocks excitatory amino acid receptors

408
Q

uses topirimate

A

adjunctive in partial seizures and primary generalized seizures
lennox-gastaut >2yo
monotherapy refractory partial and tonic/clonic
migraine

409
Q

side effects topirimate

A 
fatigue, ataxia, nystagmus
renal stone formation
hypersensitivity 
weight loss
paresthesias
GI
410
Q

uses levetiracetam

A

adjunct for partial seizures
good for those with liver problems
migraine

411
Q

side effects levetiracetam

A

dizziness, headache

412
Q

MOA oxcarbazepine

A

blocks voltage Na channels resulting in stabilization of hyperexcited neural membranes

413
Q

uses oxcarbazepine

A

monotherapy for partial seizures

medication resistant epilepsy

414
Q

pharmacokinetics oxcarbazepine

A

metabolized to 10-hydroxycarbamazepine

no autoinduction

415
Q

side effects oxcarbazepine

A

headache, somnolence, ataxia
N/V
hyponatremia

416
Q

MOA pregabalin

A

modulates Ca and glutamate flux

417
Q

uses pregabalin

A

adjunct for partial onset seizures
neuropathic pain
diabetic peripheral neuropathy

418
Q

side effects zonisamide

A 
SJS
headache, ataxia
kidney stones
agranulocytosis, aplastic anemia
psychosis, mania, depression
419
Q

MOA vigabatrin

A

increase GABA by inhibition of GABA transaminase

420
Q

side effects vigabatrin

A

drowsiness, weight gain, confusion, dizziness

421
Q

planned pregnancy on antiepileptics

A

switch from barbituates and phenytoin

increase folic acid

422
Q

cause of increased seizures during pregnancy

A

increased drug clearance

increased maternal volume

423
Q

uses vagal nerve stimulation

A

partial onset seizures

depression

DT2 Exam 2 (6 decks)

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