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Flashcards in Pharmacology Deck (65)
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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