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Flashcards in Pharmacology Deck (65):
0

Pt treated for psychosis develops generalized muscle stiffness and shaking of hand -- treatment?

Drug-induced parkinsonism
caused by antipsychotics that block D2 receptors

Treatment:
- antimuscarinic agents like benztropine

Levodopa and dopamine agonists like bromocriptine are CONTRAINDICATED because they can precipitate psychosis

1

Antibiotic that can precipitate serotonin syndrome?

Linezolid

2

Commonly used drugs that can precipitate serotonin syndrome in pts using other serotonergic drugs?

Tramadol (analgesic)
Ondansetron (antiemetic)
Linezolid (antibiotic)

3

Atypical antidepressant that treats insomnia and is associated with priapism?

Trazodone
(trazoBONE)

also side effect of postural hypotension (strong alpha1 blockade in addition to 5-HT2 blockade)

4

Treatment for tonic-clonic seizures and bipolar disorder?

Valproic acid

5

What class of drugs is used to treat motion sickness? Side effects?

Antimuscarinics (like scopolamine) and antihistaminics

Antimuscarinic side effects: blurry vision, dry mouth, palpitations, urinary retention, constipation

6

How to treat symptoms of pt with pronounced negative symptoms of schizophrenia?

Atypical antipsychotics treat both positive and negative symptoms (vs. typical antipsychotics that work only on positive symptoms)

It's ATYPICAL for OLd CLOSets to QUIETly RISPER from A to Z.
Olanzapine
Clozapine
Quetiapine
Risperidone
Aripiprazole
Ziprasidone

7

Feature of methadone that makes it an effective substitution for heroin addiction treatment?

long half-life
slow kinetics means there is no "rush" and prolonged effects with tapering effect is used to suppress withdrawal symptoms in heroin dependent patients

8

Schizophrenia pt with retinal deposits? with corneal deposits?

reTinal deposits - Thioridazine

Corneal deposits - Chlorpromazine

both are antipsychotics (block D2 receptors)

9

What is naloxone and what is it used for?

opioid receptor antagonist

used to treat opioid toxicity/overdose

10

What is used for benzodiazepine toxicity?

Flumazenil (competitive antagonist at the GABA benzodiazepine receptor)

11

Dilated pupils, yawning, rhinorrhea, lacrimation, diarrhea, nausea/vomiting may be due to withdrawal from what type of drugs?

Opioids (e.g., heroin, morphine, etc.)

12

Mechanism of action of ethosuximide? Use?

blocks thalamic T-type Ca2+ channels

used for absence seizures

13

What is the mechanism of action for phenytoin, carbamazepine, and valproic acid?

all increase Na+ channel inactivation (reducing ability of channels to recover from inactivation)

Valproic acid also:
- increases GABA concentration by inhibiting GABA transaminase
- blocks T-type Ca2+ channels so can be used in absence seizures

14

What are the COMT inhibitors?

entacapone
tolcapone

prevent L-dopa degradation to increase availability to the CNS/brain

15

Which opioid side effects are most resistant to tolerance?

Miosis/pinpoint pupils and constipation

16

What is lamotrigine? Side effects?

anticonvulsant
blocks voltage-gated Na+ channels

Stevens-Johnson syndrome: malaise and fever prodrome followed by rapid onset of erythematous/purpuric macules (oral, ocular, genital) that progresses to epidermal necrosis and sloughing
also seen in carbamazepine and ethosuximide (other antiepileptics)

17

Farmer with sweating, wheezing, bradycardia, constricted pupils? Treatment? What symptoms are addressed by each treatment?

Organophosphate poisoning / cholinesterase inhibitor poisoning

Treatment:
atropine (competitive muscarinic inhibitor) -- ONLY treats the side effects due to muscarinic receptor stimulation (DUMBELSS except for the Excitation of muscle/muscle paralysis)

pralidoxime -- regenerates AChE if given early enough and thus reverses BOTH muscarinic and nicotinic effects

18

Which sympathetic receptors increase insulin release? decrease insulin release?

beta-receptors stimulate insulin secretion (beta2)

alpha-receptors inhibit insulin secretion (alpha2)

19

Pt treated for MI with prolonged expirations and wheezing -- explanation?

beta blockers -- inhibit NT interaction with receptor in adrenergic synapses

beta1 blockade = decreased heart rate
beta2 blockade = bronchoconstriction and wheezing

BETA2 BLOCKADE EXACERBATES COPD AND ASTHMA

20

What is the mechanism of beta blocker use in glaucoma?

decreases secretion of aqueous humor from the ciliary epithelium (mediated by beta2 receptors)

timolol and other nonselective beta blockers

21

What are the high potency antipsychotics? What are the low potency antipsychotics? What are the major side effects of each?

High potency: "Try to Fly High"
Trifluoperazine
Fluphenazine
Haloperidol

Low potency: "Cheating Thieves are low"
Chlorpromazine
Thioridazine

High potency antipsychotics = more likely to cause extrapyramidal symptoms

Low potency antipsychotics = more likely to cause non-neurologic side effects (sedation, anticholinergic, orthostatic hypotension)

22

What is minimal alveolar concentration (MAC) for an inhaled anesthetic? What is the relationship between MAC and potency?

percentage of anesthetic in the inspired gas mixture that renders 50% of pts unresponsive to painful stimuli (ED50)

MAC and potency: inverse relationship
lower the MAC, the more potent the anesthetic

23

What are the symptoms of serotonin syndrome? What is the precursor AA for serotonin?

hyperthermia, sweating, confusion, myoclonus, muscle rigidity, cardiovascular collapse

tryptophan

24

What does adding carbidopa to levadopa treatment do?

Carbidopa inhibits peripheral conversion of levadopa to dopamine

reduces most of the peripheral side effects of levodopa (including nausea/vomiting due to CTZ in area postrema, which is OUTSIDE the BBB)

behavioral/central changes can worsen with carbidopa thought, because more dopamine available to brain

25

Treatment for narcolepsy?

modafinil (non-amphetamine stimulant)
amphetamines

nighttime sodium oxybate (GHB)

26

What psychotropic medication has a side effect of hypothyroidism?

Lithium

also causes nephrogenic diabetes insipidus (polyuria)

27

What is the treatment for alcohol withdrawal and DTs?

benzodiazepines (diazepam, chlordiazepoxide)

28

Barbiturates like thiopental have rapid recovery from anesthesia (used for induction and short procedures) -- what is the mechanism of recovery?

Effect terminated by rapid redistribution of drug into tissue and fat (NOT due to metabolism of drug)

29

What is the treatment for serotonin syndrome?

Cyproheptadine
(5-HT receptor antagonist)
an antihistamine with anti-serotonergic properties

30

What is the treatment for benzodiazepine overdose?

Flumazenil

31

What is the treatment for opioid overdose?

Naloxone
pure opioid receptor antagonist
binds all receptor types but greatest affinity for mu receptors

32

What is a common side effect of SSRI use?

sexual dysfunction

also GI upset and potential for serotonin syndrome
much better side effect profile vs. TCAs

33

What is the effect of beta2 stimulation on uterine tone?

beta2 receptors lead to uterine relaxation
used in obstetrics to defer premature labor (ritodrine and terbutaline)

34

Alternative to SSRIs for pts that want an agent without sexual side effects? Other use?

Buproprion
also used for smoking cessation

35

Pt with atypical, severe depression comes in after a pizza dinner with high BP and HR? Mechanism?

hypertensive crisis due to tyramine-containing food consumption (cheese) while on an MAO inhibitor

- MAOI prevents MAO degradation of monoamines like NE, 5HT, DA)
- Tyramine acts as a NE releaser (mobile pool)

leads to hypertensive crisis (alpha1 and beta1 activation)

36

Treatment for status epilepticus?

administer a benzodizepine (lorazepam or diazepam) for ACUTE treatment
load with phenytoin for PROPHYLAXIS

if seizures continue, add barbiturate; if still persist, intubate and anesthetize

37

Periodic sudden-onset arrhythmic jerking movements, usually early in the morning (aggravated by sleep deprivation), not preceded by urge to make movement, does not lose consciousness -- what kind of seizure? Treatment of choice?

Myoclonic seizure
type of generalized seizure but typically no loss of consciousness

Drug of choice is valproic acid.

38

Side effects of H1 blockers like diphenhydramine?

antimuscarinic (pupillary dilation, cycloplegia, dry mouth, urinary retention, constipation)
anti-alpha-adrenergic (hypotension, postural dizziness)
anti-serotonergic

39

Pt with berry aneurysm and blood in subarachnoid space -- 3days later, has weakness in arm and leg. What drug could have prevented these sequelae?

calcium channel blocker like nimodipine

decreases morbidity and mortality due to cerebral vasospasm when used as a preventative agent following subarachnoid hemorrhage

40

What are pramipexole and ropinirole?

Dopamine agonists
(bromocriptine = ergot; pramipexole and ropinirole = non-ergot/preferred)

used to treat Parkinson disease

41

Describe the action of Selegiline and COMT inhibitors.

Selegiline
selective MAO-B inhibitor
inhibits CENTRAL dopamine degradation (MAO-B present in the brain)

COMT inhibitors (entacapone, tolcapone)
decrease breakdown of L-dopa in the PERIPHERY
thus increase the amount of L-dopa in the brain

42

What is akathisia? Side effect of what drugs?

inner restlessness and inability to sit or stand in one position

extrapyramidal side effect of antipsychotics (particularly the high potency drugs -- Trifluoperazine, Fluphenazine, Haloperidol)

43

Drug of choice for trigeminal neuralgia? Side effects?

Carbamazepine

- aplastic anemia
- P450 inducer
- teratogenesis
- SIADH
- Stevens-Johnson syndrome

44

Pt with BP of 180/100 and HR of 120 after major surgery with fever, muscle rigidity? Treatment

Malignant hypertension

Treatment: dantrolene (prevents Ca2+ release from SR of skeletal muscle)

45

What precipitates malignant hypertension? Mechanism and treatment?

hypersensitivity of skeletal muscles to inhalation anesthestics (esp. halothane) and succinylcholine (muscle relaxant)

autosomal dominant mutation in ryanodine receptor on SR
leads to huge increase of Ca2+ in cell, huge contractile response

Treatment: dantrolene (acts on ryanodine receptor to prevent further release of Ca2+ into cytoplasm of muscle fibers)

46

Agent for atropine toxicity?

Physostigmine
tertiary amine, so reverses BOTH peripheral and CNS symptoms by crossing BBB

47

Buproprion side effects?

- seizures (especially in pre-existing epilepsy, bulimia, and/or anorexia)
- stimulant effects (tachy, insomnia)
- headache

NO sexual side effects

48

Pt with seizure disorder, mental illness and gingival hyperplasia? Main side effects?

Phenytoin

- mainly affects cerebellum and vestibular system (ataxia and nystagmus)
- gingival hyperplasia, hirsutism
- decreased folate absorption and megaloblastic anemia
- P450 induction
- tetratogenic (fetal hydantoin syndrome)

49

Gingival hyperplasia and hirsutism?

Phenytoin

50

How can a muscarinic agonist mediate vasodilation?

walls of peripheral blood vessels do NOT have cholinergic innervation
but muscarinic receptors are present on the endothelial surface

binding of muscarinic agonists to these receptors leads to NO release and vascular smooth muscle relaxation

51

Pt after general anesthesia develops elevated AST, ALT, bilirubin? Findings?

Toxicity of inhaled anesthetics -- highly lethal, fulminant hepatitis that causes rapid and massive hepatic necrosis/atrophy (shrunken liver)

52

Epilepsy drug with generalized lymphadenopathy? Other side effects?

Phenytoin

also:
- hirsutism, coarsening of facial features
- gingival hyperplasia
- megaloblastic anemia (decreased folate absorption)
- SLE-like syndrome
- P450 induction
- teratogen (fetal hydantoin syndrome)

53

What are the P450 inducers?

CHRONIC ALCOHOLic MOna STeals PHEN-PHEN and Never Refuses Greasy Carbs

Chronic alcohol
Modafinil
St. John's wort
Phenytoin
Phenobarbital
Nevirapine
Rifampin
Griseofulvin
Carbamazepine

54

What is Haloperidol? Uses and major toxicities? Treatment of toxicities?

antipsychotic / neuroleptic
blocks D2 receptors (Gi coupled) to increase cAMP
used in schizophrenia, also in Huntington's (to decrease Dopamine)

Extrapyramidal symptoms (high potency antipsychotic)

Neuroleptic malignant syndrome
- hyperthermia
- extreme general rigidity
- autonomic instability
- altered mental status
Treatment: dantrolene and D2 agonists (bromocriptine, etc.)

Tardive dyskinesia
Treatment: discontinue and switch to atypical

55

Best means of close contacts prophylaxis for N. meningitidis?

Rifampin

56

Anti-epileptic with risk for aplastic anemia? Other major side effects?

Carbamazepine

also:
- hepatotoxicity (monitor LFTs)
- increased ADH secretion (SIADH)
- P450 induction
- Stevens-Johnson syndrome

57

Drug of choice for Listeria?

Ampicillin
not covered by cephalosporins

HELPSS
Hemophilus influenzae
E. coli
Listeria
Proteus
Salmonella
Shigella

58

Major side effects of clozapine?

atypical antipsychotic

agranulocytosis and seizures

59

What is essential tremor? What is the treatment?

action tremor, worsened by holding posture/limb position
improved by EtOH

Treatment: nonspecific beta blocker (PROPANOLOL)

60

First-line and second-line for absence seizures? EEG pattern?

Ethosuximide, then valproate

EEG pattern: generalized 3.0 Hz spike-wave pattern complexes superimposed on normal background activity

61

Child with absence seizures and tonic-clonic seizures -- treatment?

Valproate
drug of choice

(Ethosuxamide is not effects against generalized tonic-clonic, only absence)

62

What is thiopental? How is it eliminated and where does it go?

Barbiturate used in general anesthesia (SHORT-ACTING)
- induction
- short surgical procedures

rapid plasma decay of thiopental NOT metabolism but redistribution to other tissues:
- skeletal muscles
- adipose tissue

63

What is atypical depression? Treatment?

main characteristic: mood reactivity (improved mood in response to positive events, although very brief)

also:
- leaden fatigue (heavy limbs)
- increased sleep and appetite
- rejection sensitivity (overly sensitive to slight criticism)

Treatment: MAOIs, SSRIs

64

Pt treated for depression with severe confusion, hallucinations, dry mouth, flushed face, low BP, high HR, QRS prolongation, premature ventricular beats? Treatment?

TCA toxicity -- quinidine-like effect on cardiac conduction system
- QRS/QT prolongation
- cardiac dysrythmias

sedation, alpha1-blocking effects, anticholinergic effects

Tri-C's:
Convulsions
Coma
Cardiotoxicity

Treatment: NaHCO3 (sodium bicarbonate) for cardiovascular toxicity