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Pharmacology > Pharm II - Test 2 > Flashcards

Pharm II - Test 2 Flashcards

1
Q

Which antidepressant class has the most significant side effects profile?

A

Monoamine oxidase inhibitors (MAOI)

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2
Q

Which antidepressant class requires dietary recommendations (restriction of tyramine-containing foods)

A

Monoamine oxidase inhibitors (MAOI)

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3
Q

What is the risk of combining MAOIs with foods high in tyramine?

A

MAO usually breaks down tyramine -> Inc. absorption of intact tyramine -> toxic elevation of catecholamines -> severe HA, N, HTN (potentially hypertensive emergencies)

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4
Q

Class: Amitriptyline (Elavil)

A

Tricyclic antidepressant

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5
Q

Indication: Amitriptyline (Elavil)

A

Major depression, bipolar d/o, migraine/tension HA (prophylaxis), chronic pain

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6
Q

MOA: Amitriptyline (Elavil)

A

CNS modulation of both serotonin and norepinephrine

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7
Q

Side effects: Amitriptyline (Elavil)

A

Anticholinergic effects (dry mouth, constipation, urinary hesistancy, blurred vision)

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8
Q

Which antidepressant does not have the side effect of weight gain?

A

Wellbutrin

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9
Q

Class: Trazodone (Desyrel)

A

Tetracyclic antidepressant

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10
Q

Indication: Trazodone (Desyrel)

A

MDD, anxiety, panic disorder, insomnia

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11
Q

MOA: Trazodone (Desyrel)

A

Serotonin reuptake inhibitor and partial antagonist (SARI)

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12
Q

Class: Fluoxetine (Prozac)

A

Selective serotonin reuptake inhibitor (SSRI)

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13
Q

Indication: Fluoxetine (Prozac)

A

MDD, OCD, bulimia, panic disorder

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14
Q

MOA: Fluoxetine (Prozac)

A

Dec serotonin reuptake at presynaptic cleft -> inc serotonin for neurotransmission

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15
Q

Side effects: Fluoxetine (Prozac)

A

Serotonin syndrome (fever, agitation, D, hypertension), sexual dysfxn (dec libido, impotency, anorgasmia)

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16
Q

What drugs can interfere and reduce the efficiency of SSRIs?

A

Aspirin, Ibuprofen, Naproxen

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17
Q

Class: Duloxetine (Cymbalta)

A

Serotonin and norepinephrine reuptake inhibitor (SNRI)

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18
Q

Indication: Duloxetine (Cymbalta)

A

MDD, general anxiety, PAINFUL PERIPHERAL NEUROPATHY, FIBROMYALGIA

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19
Q

Class: Bupropion (Wellbutrin)

A

Norepinephrine and dopamine reuptake inhibitors (NDRI) and nicotine receptor antagonist

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20
Q

Indication: Bupropion (Wellbutrin)

A

MDD, bipolar do, ADD, smoking cessation (Zyban)

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21
Q

MOA: Bupropion (Wellbutrin)

A

Blockade of NE and DOPA reuptake

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22
Q

Addition of what nutrient may improve SSRI response?

A

Folic acid

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23
Q

What is the brand name of activated folic acid?

A

Deplin

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24
Q

Ultra-short acting barbiturate

A

Thiopental (Pentothal)

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25
Q

Short-acting barbiturate

A

Pentobarbital (Nembutal)

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26
Q

Intermediate-acting barbiturate

A

Butalbital (Fiorinal)

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27
Q

Long-acting barbiturate

A

Phenobarbital (Luminal)

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28
Q

What is the most widely used anticonvulsant worldwide?

A

Phenobarbital (Luminal)

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29
Q

What are the most widely used group of anxiolytic drugs?

A

Benzodiazepines

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30
Q

Indication: Midazolam (Versed)

A

Sedation/anxiety prior to upper/lower GI endoscopy

Acute mgmt of aggressive, violent, or delirious patients

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31
Q

Midazolam (Versed) is not indicated for ___.

A

long-term mgmt of seizure disorders

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32
Q

Class: Diazepam (Valium)

A

Benzodiazepine anticonvulsant

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33
Q

Indication: Diazepam (Valium)

A

Anxiolytic, sedative, muscle relaxant, STATUS EPILEPTICUS

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34
Q

MOA: Diazepam (Valium)

A

Binds to benzodiazepine receptors in CNS to enhance GABA activity -> inc Cl- influx -> inhibition of CNS synaptic transmission

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35
Q

MOA: Benzodiazepine-like sedatives

A

Increase GABA receptor affinity for GABA by binding to site different than benzo or barbiturate site

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36
Q

Class: Zolpidem (Ambien)

A

Short-acting, non-benzodiazepine hypnotic

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37
Q

Class: Eszopiclone (Lunesta)

A

Benzodiazepine-like hypnotic

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38
Q

Indications: Zolpidem (Ambien)

A

Trouble falling asleep, but not necessarily maintaining sleep

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39
Q

Indication: Eszopiclone (Lunesta)

A

Insomnia

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40
Q

MOA: Eszopiclone (Lunesta)

A

Potentiation of GABA effect on Cl- ion channels

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41
Q

Class: Ramelteon (Rozerem)

A

Melatonin receptor agonist

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42
Q

Class: Fumazenil (Romazicon)

A

Benzodiazepine receptor antagonist

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43
Q

Indication: Fumazenil (Romazicon)

A

Reverse effects of benzos

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44
Q

The chief antipsychotic effects of neuroleptics appear related to blockade of ___ in the ___

A

dopamine D2 receptors, mesolimbic pathway

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45
Q

Neuroleptic malignant syndrome

A

Rare side effect of neuroleptic use characterized by catatonia, fluctuating BP, dysarthria, fever

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46
Q

Tx: Neuroleptic malignant syndrome

A

Dopamine agonist (Bromocriptine)

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47
Q

Class: Chlorpromazine (Thorazine)

A

Typical neuroleptic

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48
Q

MOA: Chlorpromazine (Thorazine)

A

D2 dopaminergic receptor blocker

Alpha-adrenergic blocker

H1-histamine blocker

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49
Q

Side effect: Chlorpromazine (Thorazine)

A

INC RELEASE OF PRL

Neuroleptic side effects (Sedation, dizziness, HA, D, Extrapyramidal effects)

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50
Q

Class: Prochlorperazine (Compazine)

A

Typical neuroleptic

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51
Q

Indication: Prochlorperazine (Compazine)

A

Better anti-emetic than other neuroleptics

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52
Q

MOA: Prochlorperazine (Compazine)

A

H1-histaine receptor antagonist

Alpha-adrenergic receptor antagonist

D2 dopaminergic receptor antagonist

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53
Q

Class: Haloperidol (Haldol)

A

Typical neuroleptic

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54
Q

Indication: Haloperidol (Haldol)

A

Psychosis, Tourette’s syndrome, Huntington’s disease, ACUTE AGITATED BEHAVIOR

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55
Q

MOA: Haloperidol (Haldol)

A

D2 dopamine receptor blocker

56
Q

Side effects: Haloperidol (Haldol)

A

neuroleptic malignant syndrome

57
Q

Class: Clozapine (Clozaril)

A

Atypical neuroleptic

58
Q

Indication: Clozapine (Clozaril)

A

Schizophrenia, esp. when other anti-psychotics have failed (3rd line)

59
Q

MOA: Clozapine (Clozaril)

A

Multiple receptor site blockage, greatest at D2 and 5-HT2 serotonin sites

60
Q

Class: Respiradone (Risperdal)

A

Atypical neuroleptic

61
Q

Side effects: Respiradone (Risperdal)

A

WEIGHT GAIN, HYPERGLYCEMIA, DIABETES, extrapyramidal effects, tardive dyskinesia, sedation, INC RISK FOR STROKE IN ELDERLY

62
Q

Class: Olanzapine (Zyprexa)

A

Atypical neuroleptic

63
Q

MOA: Olanzapine (Zyprexa)

A

Multiple site blocker (esp. D2 and 5-HT2)

64
Q

Side effects: Olanzapine (Zyprexa)

A

WEIGHT GAIN, HYPERGLYCEMIA, DIABETES, INC RISK FOR STROKE IN ELDERLY

65
Q

Side effects: Lithium carbonate (Eskalith)

A

NEPHROGENIC DIABETES INSIPIDUS

IMPAIRED CONCENTRATION CAPACITY DT REDUCED RENAL RESPONSE TO ADH

HYPOTHYROIDISM

66
Q

Class: Phenobarbital (Phenobarb)

A

Barbiturate anticonvulsant

67
Q

MOA: Phenobarbital (Phenobarb)

A

Enhanced GABA activity

68
Q

Which drug mb the initial drug of choice in children with seizures?

A

Phenobarbital (Phenobarb)

69
Q

Side effects: Phenobarbital (Phenobarb)

A

lower IQ scores in children

70
Q

Class: Primidone (Mysoline)

A

Barbiturate anticonvulsant

71
Q

MOA: Primidone (Mysoline)

A

Pro-drug of phenobarbital

72
Q

Contraindications: Primidone (Mysoline)

A

Category D

73
Q

Class: Clonazepam (Klonopin)

A

Benzodiazepine anticonvulsant (long-acting)

74
Q

MOA: Clonazepam (Klonopin)

A

Binds to benzodiazepine receptors in CNS to enhance GABA activity -> inc Cl- influx -> inhibition of CNS synaptic transmission

75
Q

Class: Phenytoin (Dilantin)

A

Anticonvulsant

76
Q

MOA: Phenytoin (Dilantin)

A

Reduces Na and Ca and currents across neuronal membranes

77
Q

Indication: Phenytoin (Dilantin)

A

Status epilepticus, focal (partial) seizures

78
Q

Side effects: Phenytoin (Dilantin)

A

NYSTAGMUS, GINGIVAL HYPERPLASIA, ataxia, hepatotoxicity, possible BM suppression

79
Q

Class: Carbamazepine (Tegretol)

A

Anticonvulsant

80
Q

MOA: Carbamazepine (Tegretol)

A

Similar to phenytoin (reduction of Na, Ca currents)

81
Q

Indication: Carbamazepine (Tegretol)

A

prophylaxis against all seizure types except absence

82
Q

Contraindications: Carbamazepine (Tegretol)

A

Use with monoamine oxidase inhibitors (inc. risk for HTN crisis)

83
Q

Class: Valproic acid (Depakote)

A

Anticonvulsant

84
Q

Indication: Valproic acid (Depakote)

A

Generalized (tonic-clonic) seizures, bipolar do, chronic pain syndromes

85
Q

Contraindications: Valproic acid (Depakote)

A

Pregnancy

86
Q

Class: Ethosuximide (Zarontin)

A

Anticonvulsant

87
Q

Indication: Ethosuximide (Zarontin)

A

Absence seizures, status epilepticus

88
Q

MOA: Ethosuximide (Zarontin)

A

Possibly affects T-type Ca ion channels

89
Q

Side effects: Ethosuximide (Zarontin)

A

HA, N, V, fatigue, ataxia, blurred vision, confusion, skin rashes, insomnia, GINGIVAL HYPERPLASIA, LUPUS-LIKE SYNDROME, hepatotoxicity

90
Q

Class: Gabapentin (Neurontin)

A

Anticonvulsant, atypical analgesic

91
Q

MOA: Gabapentin (Neurontin)

A

Appears to potentiate GABA and affects N-type Ca channels

92
Q

Indication: Gabapentin (Neurontin)

A

Adjunctive tx for partial seizures, CHRONIC PAIN SYNDROMES (POST-HERPETIC NEURALGIA), migraines

93
Q

Class: Lamotrigine (Lamactil)

A

Anticonvulsant

94
Q

Indication: Lamotrigine (Lamactil)

A

Generalized (tonic-clonic) seizures

95
Q

Class: Levetiracetam (Keppra)

A

Anticonvulsant

96
Q

Indication: Levetiracetam (Keppra)

A

Generalized (tonic-clonic) seizures

97
Q

The symptoms of Parkinson’s disease result from __

A

loss of dopamine-secreting cells in the pars compacta region of substantia nigra

98
Q

What enzyme converts Levodopa into dopamine?

A

Dopa-decarboxylase

99
Q

Levodopa is usually combined with a ___

A

peripheral dopa-decarboxylase inhibitor

100
Q

MOA: peripheral dopa-carboxylase inhibitor

A

prevents Levadopa from being prematurely converted into dopamine in the adrenal glands

101
Q

How long does treatment with Levodopa typically work?

A

Average of approximately 5 years

102
Q

Contraindications: Levodopa and combinations

A

Use with MAO inhibitor b/c of hypertensive crisis

Use in patients with psychiatric conditions (bc worsening of psychotic sxs)

Use with dopamine-blocking antipsychotic agent

103
Q

Class: L-dopa with Carbidopa (Sinemet)

A

Dopamine precursor with peripheral dopamine decarboxylase inhibitor

104
Q

Indication: L-dopa with Carbidopa (Sinemet)

A

Parkinson’s disease

105
Q

MOA: L-dopa with Carbidopa (Sinemet)

A

Increases dopamine levels in the brain, esp. in substantia nigra

106
Q

Side effects: L-dopa with Carbidopa (Sinemet)

A

Hallucinations, nightmares, dyskinesias, serpentine-like movement (chorea)

107
Q

Use of dopamine agonists (timing)

A

Often used early in tx so that L-dopa therapy can be delayed

108
Q

Class: Bromocriptine (Parlodel)

A

Dopamine agonist

109
Q

Indication: Bromocriptine (Parlodel)

A

Parkinson’s dz, PRL-secreting adenomas, acromegaly

110
Q

MOA: Bromocriptine (Parlodel)

A

Mimics dopamine in stimulation of dopamine receptor sites

Crosses BBB

111
Q

Class: Benzotropine (Cogentin)

A

Anticholinergic

112
Q

Indication: Benzotropine (Cogentin)

A

Parkinson’s (esp. when tremor or drooling are prominent) - minimal efficacy as monotherapy

Diminish side effects of antipsychotic drugs

113
Q

MOA: Benzotropine (Cogentin)

A

Anticholinergic antagonist at muscarinic receptor sites

114
Q

MOA: Amantadine (Symmetrel)

A

Mb N-methyl-D-aspartate (NMDA) receptor antagonist -> dec. dopamine reuptake

115
Q

Indications: Amantadine (Symmetrel)

A

Early PD (monotherapy) to delay L-dopa use

Adjunct in later PD (esp. in pts w/ levodopa-related dyskinesias

Influenza A

116
Q

Class: Amantadine (Symmetrel)

A

Anti-Parkinson’s, anti-viral agent

117
Q

Duration: Amantadine (Symmetrel)

A

Many pts experience diminished/absent response within 6 months or less

118
Q

Parkinson’s tx options by efficacy (most-least)

A

L-dopa > Bromocriptine > Amantadine > anticholinergics

119
Q

Class: Memantine (Namenda)

A

NMDA glutamate receptor antagonist

120
Q

MOA: Memantine (Namenda)

A

NMDA receptor blockage -> inhibition of prolonged influx of Ca2+ ions, which play an imp. role in neuronal excitotoxicity

5HT3 receptor antagonist

dopamine D2 receptor agonist

Nicotinic ACh receptor antagonist

121
Q

Indication: Memantine (Namenda)

A

Alzheimer’s disease

122
Q

What class of drugs are postulated to play a role in the neurologic deficits associated w/ Alzheimer’s disease?

A

Anticholinergics

123
Q

Class: Donepezil (Aricept)

A

Centrally-acting reversible acetylcholinesterase inhibitor

124
Q

Indication: Donepezil (Aricept)

A

Alzheimer’s disease, Autism

125
Q

What drug may potentially increase/improve vocab and expressive language of children with autism?

A

Donepezil (Aricept)

126
Q

Class: Rivastigmine (Exelon)

A

Centrally-acting reversible acetylcholinesterase inhibitor

127
Q

Indication: Rivastigmine (Exelon)

A

Mild-mod dementia dt Alzheimer’s

Mild-mod dementia dt PD

Younger onset dementia

128
Q

Class: Galantamine (Razadyne)

A

Acetylcholinesterase inhibitor

129
Q

Indication: Galantamine (Razadyne)

A

Mild-mod Alzheimer’s dz, vascular dementia

130
Q

OD Sxs: Acetylcholinesterase inhibitor

A

N, V, salivation, sweating, bradycardia, hypotension, convulsions, circulatory collapse

131
Q

Tx: Acetylcholinesterase inhibitor OD

A

Atropine

132
Q

Drugs for focal (partial) seizures (3)

A

Phenytoin (Dilantin)
Phenobarbital (Phenobarb)
Primidone (Mysoline)

133
Q

Drugs for absence (petit mal) seizures (1)

A

Ethosuximide (Zarontin)

134
Q

Drugs for generalized (tonic-clonic) seizures (4)

A

Lamotrigine (Lamictal)
Levetiracetam (Keppra)
Topiramate (Topamax)
Valproate (Depakote)

135
Q

What type of drugs are a first-line option for acute seizures, but not for long-term treatment?

A

Benzodiazepines (Diazepam, Clonazepam)

136
Q

Drugs for status epilepticus (4)

A

Lorazepam (Ativan)
Diazepam (Valium)
Phenytoin (Dilantin)
Ethosuximide (Zarontin)

137
Q

Indications: Lithium carbonate (Eskalith)

A

Bipolar d/o and manic episodes, schizophrenia

Pharmacology (4 decks)

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