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Pharm Flashcards

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1
Q

Compare barbiturates vs bezodiazepines

A

Barbiturates:

  • deadly via decreased heart and respirations
  • no antidote
  • highly addictive

Benzos:

  • plateau so not as deadly, though can become deadly with opioids and alcohol
  • antidote
  • addictive but less so than barbiturates
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2
Q

Xanax

A

alprazolam

benzo

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3
Q

Ambien

A

zolpidem

non-benzo

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4
Q

Low-potency benzos with long half-life

A

diazepam

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5
Q

Valium

A

diazepam

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6
Q

Low-potency benzos with short half-life

A

temazepam

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7
Q

High-potency benzos with long half-life

A

clonazepam

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8
Q

High-potency benzos with short half-life

A

alprazolam

lorazepam

traizolam

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9
Q

Ativan

A

lorazepam

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10
Q

What drug accentuates GABA activity by increasing the FREQUENCY of Cl- channel opening in response to GABA?

A

benzos

local hyperpol–> cell doesn’t fire

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11
Q

Uses for benzos

A

anxiety

sedative

anticonvulsant

amnesia/anesthesia
–> some anterograde amnesia

skeletal muscle relaxant

alcohol withdrawal

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12
Q

Rohypnol

A

date-rape drug

benzo

anterograde amnesia

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13
Q

Most common benzo side effect

A

drowsiness

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14
Q

Who is susceptible/resistant to benzos

A

susceptible: elderly
resistant: alcoholics, barbiturate abusers

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15
Q

Abrupt d/c of long-term benzo use leads to

A

rebound insomnia

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16
Q

What benzos also used for insomnia?

A

triazolam

temazepam

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17
Q

What drug a/w respiratory depression and arrest when used for sedation in non-critical care settings?

A

IV midazolam (versed)

benzo

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18
Q

What benzo used for preop sedation, general anesthesia, anxiety and amnesia?

A

midazolam (versed)

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19
Q

What drug is used only for insomnia that is safe in pregnancy?

A

zolpidem (Ambien)

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20
Q

What drug binds BZ1 receptors of GABAa and is mainly for sleep maintenance?

A

zolpidem (ambien)

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21
Q

What drug can cause complex sleep behaviors (sex while asleep, sleep-driving, sleep-walking, etc) after taking?

A

zolpidem (ambien)

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22
Q

What drug is an antagonist of benzo-binding sites on GABAa?

A

flumazenil

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23
Q

What drug is used to manage benzo overdose and reverse benzo-induced sedation?

A

flumazenil

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24
Q

What drug is a/w seizures with long-term sedation or concomitant TCA use?

A

flumazenil

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25
Barbiturate used to control tonic-clonic seizures
phenobarbital (long-acting)
26
Barbiturate that is short-acting sedative/anesthetic but has been replaced by Propofol and banned in US d/t lethal injections
thiopental
27
What drugs increase the duration of GABA-gated Cl- channel opening?
barbiturates hyperpol-->reduce cell firing
28
Why are barbiturates so deadly?
at high doses, open Cl- channels without need for GABA--> can't be controlled CNS depression--> low BP and respiratory rate
29
What drugs are inducers of CYP450?
barbiturates -->increase metabolism of drugs
30
What drug is a non-benzo anxiety med that acts on serotonin receptors and lacks tolerance, dependence and withdrawal?
buspirone
31
Can you have additive CNS depression with buspirone and other sedative drugs?
no minimal psychomotor impairment
32
What drug is used for sleep disorders and activates MT1/2 in SCN in CNS?
ramelteon (melatonin analog)
33
Can you have abuse, withdrawal or dependency with ramelteon?
no
34
What drug blocks binding of orexins and is used with difficulty falling asleep?
suvorexant
35
What drug antagonizes H2 receptors, inhibits reuptake of serotonin and norepi, and is used for sleep maintenance and tmt of resistant MDD?
doxepin
36
Do antihistamines act on anxiety?
no, only cause sedation
37
When to use benzos in GAD?
use acutely until SSRIs kick in reserve for pts without hx abuse disorder
38
What drug has been shown to reduce anxiety in GAD without risk of dependence?
buspirone
39
How to treat separation anxiety?
CBT | SSRI
40
Can you still get constipation and dilated pupils with opioid tolerance?
yes
41
What are examples of opioid antagonists?
naloxone (narcan) naltrexone (prevents euphoria, decrease cravings)
42
What are the 3 major classes of opioid receptors?
mu kappa delta
43
What is the most serious adverse effect of opioids?
respiratory depression
44
Side effects of opioids
main: resp depression ``` constipation urinary retention orthostatic hypotension emesis birth defects increase ICP ```
45
What G protein receptor is involved in opioid signaling?
Gi
46
Pure opioid agonists act at what receptors?
mu and kappa
47
Pentazocine acts on what opioid receptors?
antagonist at mu agonist at kappa
48
Butorphanol acts on what opioid receptors?
partial agonist at mu agonist at kappa
49
Buprenorphine acts on what opioid receptors?
partial agonist at mu antagonist at kappa ***used to treat addicts (Subloxone)
50
What responses does the mu opioid receptor cause?
``` analgesia (+ kappa) respiratory depression sedation (+ kappa) euphoria physical dependence decreased GI motility/constipation (+kappa) ```
51
What responses does the kappa opioid receptor cause?
analgesia sedation constipation
52
Why are oral doses of opioids larger than iv doses?
significant first-pass metabolism
53
Why give kids less dose of opidoids?
blood brain barrier not fully developed
54
What responses to opioids are affected with tolerance?
analgesia euphoria sedation respiratory depression NOT constipation or miosis
55
Are withdrawal from opioids dangerous/fatal?
NO (3Bs are fatal) unpleasant so withdraw gradually
56
Why do you avoid anticholinergic drugs (atropine, antihistamines, TCAs) with opioids?
exacerbate constipation and urinary retention
57
Triad of opioid overdose
coma respiratory depression pinpoint pupils
58
What opioid is 100x more potent than morphine, has same adverse effects and multiple formulations?
fentanyl think prince and tom petty
59
What opioid is more potent than morphine and used for induction and maintenance of anesthesia?
alfentanil remifentanil sufentanil
60
What is an IV opioid with rapid onset and brief duration (used for postop analgesia)?
remifentanil
61
What opioid used to be used for migraines is in decline d/t short half life (frequent dosing), adverse reactions and toxic metabolite build-up? Also abused by healthcare workers d/t lack of pinpoint pupils (anticholinergic effect)?
meperidine (demerol)
62
What drug is an NMDA receptor antagonist, similar to morphine, long duration of action but causes disproportionate number of deaths via torsades?
methadone
63
What drug has higher lipid solubility vs morphine and gives a greater high when injected?
heroin
64
What drug is used for mod-severe pain, similar SA c/t morphine, reversed by naloxone and more water soluble (can be diluted in smaller volume for injection)?
hydromorphone (Dilaudid) oxymorphone, levorphanol
65
What drug is the prototype for moderate-severe opioid agonist, given PO, can be converted to morphine-->analgesia, and formulated alone or with nonopioid analgesics? Also used as cough suppressant.
codeine
66
What drug is similar to codeine and metabolized by CYP3A4?
oxycodone (OxyContin)
67
What drug is similar to codeine but only available in combo with other drugs?
hydrocodone w/ acetaminophen--> Vicodin
68
What drug is a mu opioid antagonist that can't cross BBB, used for opioid-induced constipation?
methylnaltrexone
69
What drug is a mu opioid agonist that can't cross BBB, used for acute and chronic diarrhea?
loperamide
70
Large quantities of this drug (used for a high or alleviate withdrawal sx) can cause?
torsades de pointes d/t QT prolongation
71
What opioid is safe for use in renal and hepatic insufficiency?
fentanyl
72
Interaction of opioids with CNS depressants
increased respiratory depression and sedation
73
Interaction of agonist-antagonist opioids with pure opioids
precipitation of withdrawal reaction
74
Interaction of opioids with anticholinergic drugs
increased constipation and urinary retention
75
Interaction of opioids with hypotensive agents
increased hypotension
76
Interaction of opioids with monoamine oxidase inhibitors
hyperpyrexic (F) coma
77
What is an ingredient in vaping that is the primary cause of lung injuries and is used as thickening agent?
vitamin E acetate
78
Does vaping contain nicotine?
yes
79
What is an orally administered synthetic 9-THC that acts mainly on CB1 and produces analgesia, appetite enhancement, muscle relaxation, psychological effects and hormonal actions?
dronabinol
80
Dronabinol indications
anorexia in AIDS pts chemotherapy-induced N/V off-label: OSA
81
What is a THC capsule approved for chemo-induced N/V?
nabilone
82
Adverse effects of THC/marijuana
judgement and coordination--> increase risk for accidents sedation, bloodshot eyes, depression, dizziness, tachy, hypotension, hallucinations, dry mouth
83
What kind of pain is cannibis preferred for?
neuropathic and chronic pain
84
Contraindications for cannabis use
hx psychosis current or past substance abuse disorder heart or lung disease
85
What is CBD useful to treat?
epilepsy Dravet syndrome (myoclonic seizure) Lennox-Gastaut syndrome (tonic seizures)
86
What is the difference between stimulant and non-stimulant meds for ADHD?
stimulants are amphetamine derivatives
87
Side effects of stimulants
dyspepsia, GI distress headache decreased appetite --> weight loss, reduced growth insomnia anxiety irritability/agression/agitation elevated BP/HR
88
Rare effects of stimulants
priapism seizures sudden cardiac death stroke and MI in adults chemical leukoderma w/ Daytrana patch
89
What drugs are controlled substances?
stimulants onset of activity 24 hours
90
What amphetamine stimulants are immediate release tablets?
dextroamphetamine dextroamphetamine (adderall) methamphetamine (desoxyn)
91
What amphetamine stimulants are immediate release liquid?
dextroamphetamine sulfate (procentra)
92
What amphetamine stimulants are immediate release capsules?
amphetamine sulfate (evekeo)
93
What amphetamine stimulants are extended release capsules?
dextroamphetamine (adderall xr) dextroamphetamine lisdexamfetamine (vyvanse) amphetamine mixed salt (mydayis)
94
What amphetamine stimulants are extended release liquids?
amphetamine (dyanavel xr)
95
What are methylphenidate-based stimulates that are immediate release tablets?
dexmethylphenidate methylphenidate (ritalin)
96
What are methylphenidate-based stimulates that are immediate release liquids?
methylphenidate (methylin)
97
What are methylphenidate-based stimulates that are sustained tablets?
methylphenidate (ritalin-SR)
98
What are methylphenidate-based stimulates that are extended release tablets?
methylphenidate HCL (concerta) methylphenidate ER
99
What are methylphenidate-based stimulates that are extended release capsules?
methylphenidate (aptensio XR) dexmethylphenidate hcl (focalin xr) methylphenidate hcl (metadate cd) methylphenidate hcl er (ritalin LA)
100
What are methylphenidate-based stimulates that are extended release transdermal patch?
daytrana (methylphenidate transdermal)
101
What are methylphenidate-based stimulates that are extended release chewable tablets?
methylphenidate hcl (quillichew)
102
What are methylphenidate-based stimulates that are extended release liquids?
methylphenidate (quillivant xr)
103
MOA of non-stimulant meds for ADHD
inhibit NE pre-synaptic uptake agonist of CNS alpha 2 adrenergic receptors
104
What drugs are useful for patients intolerant of stimulant effects?
non-stimulants 1-4 week onset of activity nonscheduled
105
Capsule non-stimulant
atomoxetine (straterra ER)
106
Non-stimulant meds that are antihypertensives
clonidine ER guanfacine ER both tablets risk of rebound HTN
107
What are stimulant users at risk of?
future substance abuse psychosis
108
Non-IR stimulant with formulation of amphetamine
adzenys XR-ODT 3:1 d to l isomer qd, dissolves on tongue
109
Which ADHD stimulant is a pro-drug?
Lisdexamfetamine
110
Abstinence syndrome
sx that occur with withdrawal of a drug in a dependent person
111
What classifies drug dependence?
signs and sx caused by withdrawal from chronic use or abrupt lowering of dose AKA physical dependence
112
Define designer drug
synthetic derivative of a drug with a slightly modified structure no major change in action
113
Describe sensitization
increase in response with repetition of same dose of drug | shifts left vs tolerance shifts right
114
Most commonly abused prescription depressants
alprazolam (xanax) zolpidem zaleplon
115
Most commonly abused prescription stimulants
adderal methylphenidate
116
NMDA antagonist that reduces desire to drink alcohol
acamprosate
117
What can caffeine be used for?
improve alertness migraine ha ha after epidural anesthesia asthma ADHD memory
118
What drugs are abused but aren't necessarily adductive?
LSD PCP/angel dust Ketamine (special k)
119
How long does 1 oz of alcohol take to metabolize?
1 hour so 6oz--> 6 hrs
120
Drugs for tmt of acute methanol or ethylene glycol poisoning
ethanol fomepizole
121
Drugs for prevention of alcohol abuse
acamprosate disulfiram (antabuse) naltrexone
122
Drugs for tmt of acute alcohol withdrawal syndrome
diazepam (valium) lorazepam (ativan) oxazepam thiamine (Vit B1)
123
Naltrexone MOA
alcohol and opiate dependence mu opioid antagonist reduces craving and short-term rate of relapse
124
Acamprosate MOA
weak NMDA antagonist and GABAa agonist reduces short and long-term relapse rates
125
Disulfiram MOA
irreversibly inhibits ADH--> causes extreme discomfort in pts who drink alcohol
126
Describe Neuroleptic Malignant Syndrome (NMS)
after antipsychotic use (new or increased dose) can be hours-->30 days until onset of sx ``` Malignant FEVER: ~Myoglobinuria (muscle damaged, releases myoglobin, can cause acute renal failure) ~Fever ~Encephalopathy ~Vitals unstable ~increased Enzymes, specifically CK ~muscle Rigidity ```
127
Tmt for Neuroleptic Malignant Syndrome (NMS)
dantrolene: binds ryanodine receptor, decreases calcium release to relax muscles bromocriptine (dopamine agonist) D/C CAUSATIVE AGENT
128
Typica/First Gen Antipsychotics
``` Haloperidol Pimozide Trifluoperazine Fluphenazine Thioridazine Chlorpromazine ``` -azine
129
What antipsychotic to use in delirium?
haloperidol (haldol)
130
High potency first gen antipsychotics
Hal Tries to Fly HIGH Haloperidol Trifluoperazine Fluphenazine more neuro SE like EPS
131
Low potency first gen antipsychotics
Cheating Thieves are low Chlorpromazine Thioridazine
132
MOA of first gen psychotics
block D2 receptors--> increase CAMP decrease dopamine, also block these receptors: muscarinic (ACh) histamine alpha-1
133
SE of first gen anitpsychotics
``` EPS hyperprolactinemia metabolic syndrome (obesity, DM, hyperlipidemia) antimuscarinic (dry mouth, constipation) antihistamine (sedation) alpha: orthostatic hypotension QT prolongation corneal deposits (chlorpromazine) retinal deposits (thioridazine) NMS ```
134
Sx of hyperprolactinemia
galactorrhea oligomenorrhea gynecomastia
135
What antipsychotic causes corneal deposits
chlorpromazine (1st)
136
What antipsychotic causes retinal deposits
thioridazine (1st)
137
Describe hours-days sx of EPS
acute dystonia - ->muscle spasm, rigidity/stiffness - ->oculogyric crisis tmt: benztropine (blocks muscarinic receptors to decrease ACh which increases dopamine) and diphenhydramine
138
Describe days-months sx of EPS
akathisia (restlessness) -->tmt: propranolol or other B blocker, benztropine, benzos parkinsonism (bradykinesia) - -> d/t decreased dopamine - -> tmt: benztropine, amantadine
139
Describe months-years sx of EPS
Tardive dyskinesia -->choreathetosis, smaking gums, etc tmt: clozapine, valbenazine, deutetrabenazine (VMAT 2 inhibitors)
140
What is EPS
d/t decreased dopamine, decreased modulation of movement via basal ganglia
141
Atypical/2nd generation antipsychotics
``` Aripiprazole Asenapine Clozapine Olanzapine Quetiapine Iloperidone Paliperidone Risperidone Lurasidone Ziprasidone ``` - idone - piprazole - apine
142
MOA of -idone atypical antipsychotics
block serotonin (2A) and dopamine (D2) receptors
143
MOA of -piprazole atypical antipsychotics
partial serotonin and dopamine agonist
144
What drug to use for tmt-resistant schizoprhenia or schizoaffective disorder
clozapine
145
What drug to use for suicide prevention in schizophrenia
clozapine
146
universal SE of atypical antipsychotics
prolonged QT fewer EPS and anticholinergic c/t typical antipsychotics
147
SE of atypical -apines (antipsychotics)
metabolic syndrome: weight gain, DM, hyperlipidemia olanzapine clozapine O-->obesity
148
SE of clozapine
2nd gen/atypical antipsychotic: Agranulocytosis (monitor WBC) Seizures (dose related) must watch bone marrow CLOZely with CLOZapine
149
SE of risperidone
2nd gen/atypical antipsychotic: hyperprolactinemia -->galactorrhea, amenorrhea, gynecomastia
150
Long-acting injectables to treat non-adherence of antipsychotics
Risperidone Olanzapine Aripiprazole Paliperidone
151
What is the most common drug-induced cause of hyperprolactinemia?
antipsychotics (fluphenzine, haloperidol, risperidone)
152
Tmt of EPS
benztropine (antimuscarinic) diphenhydramine (antihistamine)
153
Tmt of tardive dyskinesia
VMAT 2 inhibitors (-benazine)
154
Difference between typical and atypical antipsychotics
typical: EPS, side effects, act only on dopamine D2 receptor atypical: more serotonin (2a) receptor activity vs dopamine, less EPS and anticholinergic effects
155
What can cause drug rxn w/ eosinophilia and systemic sx (DRESS)?
olanzapine
156
Cause sedation and anticholinergic SE the most
chlorpromazine thioridazine cariprazine clozapine (other -apines)
157
Cause orthostatic hypotension SE the most
chlorpromazine thioridazine clozapine cariprazine
158
Antipsychotic least likely to cause weight gain
ziprasidone
159
Antidepressant used for nicotine withdrawal
bupropion
160
Antidepressant used for enuresis/bedwetting
imipramine
161
Antidepressant used for diabetic peripheral neuropathy
duloxetine
162
Antidepressant used for fibromyalgia
duloxetine
163
Antidepressant used for chronic musculoskeletal pain
duloxetine
164
Antidepressant used for stress incontinence
duloxetine

Psych (12 decks)

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