Psych/neuro

Question 1

Benzodiazepines *

Answer 1

Drugs- alprazolam (Xanax), clonazepam (klonopin), diazepam (Valium), estazolam, flurazepam, lorazepam (Ativan), midazolam, oxazepam, quazepam (doral), temazepam (restoril), Triazolam (halcyon), chlordiazepoxide (librium), clorazepate (tranxene)
Controlled substance
MOA- enhanced GABA effect
Uses- reduction in anxiety although not DOC, sedative, hypnotic, Anticonvulsants, anterograde amnesia, muscle relaxant, muscular skeletal spasms
Not recommended in pregnancy or nursing infants
Dependence!
ADE- drowsiness, confusion, ataxia, cognitive impairment, use in caution with liver patients and alcohol use patients can enhance CNS depression, avoid with opioids can cause death

Question 2

Benzodiazepines antagonist *

Answer 2

Drugs- flumazenil
MOA- anatagonize GABA, reverse effects of benzos for toxicity or OD
IV only
Short half life may need multiple doses
ADE- seizures if benzo was used to control; or pt is taking TCAs or antipsychotic concurrently, n/v, agitation

Question 3

Antidepressants for anxiety *

Answer 3

SSRIs like escitalopram, paroxetine
SNRIs like venlafexine or duloxetine
Alone or in combo with benzos
4-6 weeks for effects

Question 4

Buspirone *

Answer 4

Uses- GAD
MOA- mediated by serotonin receptors and potentially dopamine-serotonin receptors
Similar efficacy as benzo but not for acute anxiety and lacks anticonvulsant and muscle relaxant properties
ADE- HA, dizziness, nervousness, nausea, lightheartedness, minimal sedative effects

Question 5

Barbiturates

Answer 5

Drugs- amobarbital (amytal), methohexital (brevital), pentobarbital (nembutal), phenobarbital, secobarbital (seconal)
Controlled substance
MOA- GABA enhancement receptor site different from benzos, blocks glutamate receptors
Uses- anesthesia, anticonvulsant, sedative hypotonic, can cause CNS/RESPIRATORY DEPRESSION
Do not give in pregnancy/breast feeding
ADE- drowsiness, impaired concentration, mental and psychomotor impairment, CNS depression worsens with alcohol, hangover feeling
D-D- CYP450
Contraindicated in acute intermittent porphyria
do not abrupt withdrawal can cause cardiac arrest
Death can occur from OD
No reversal agent

Question 6

Zolpidem (ambien) *

Answer 6

Uses- hypnotic agent for about 5 hrs
MOA- binds to GABA, relative selectivity as benzos but anticonvulsant or muscle relaxant properties
Controlled substance
Few withdrawal effects
ADE- HA, dizziness, anterograde amnesia, next morning impairment, sleep walking , sleep driving
D-D- CYP450

Question 7

Zaleplon (sonata) *

Answer 7

Oral non benzo hypnotic similar to zolpidem
Fewer residual side effects on psychomotor or cognitive function
Rapid elimination
For this have difficulty falling asleep
CYP3A4 metabolite

Question 8

Eszopiclone (lunesta)*

Answer 8

Non benzo hypnotic
Effective for insomnia for 6 months
Rapid absorption
CYP450 metabolite
ADE- anxiety, dry mouth, HA, peripheral edema, somnolence, unpleasant taste

Question 9

Melatonin receptor agonist *

Answer 9

Drugs- ramelteon (rozerem), tasimelteon (hetlioz)
MOA- selective agonist in MT 1 and 2, for melatonin a natural circadian rhythm hormone
Minimal potential for abuse
Uses- insomnia due to difficult falling asleep, non 24 hour sleep wake disorder
ADE- increase prolactin levels, HA, abnormal dreams, increase in LFT, URI
D-D- CYP1A2 and CYP3A4 metabolite

Question 10

Antihistamine *

Answer 10

Drugs- diphenhydramine (Benadryl), hydroxyzine, doxylamine
Uses- mild insomnia

Question 11

Sedating Antidepressants *

Answer 11

Doxepin- TCA
Trazodone-TCA
Quetiapine- antipsychotic
Both used for insomnia

Question 12

Orexin receptor antagonist *

Answer 12

Drug- suvorexant (belsomra), lemborexant (dayvigo)
MOAa antagonist for OX1R and 2, ore in is a neuro peptide that promote wakefulness
ADE- nacrolepsy like, sleep paralysis, cataplexy, hypnogogic and hypnopompic hallucinations, daytime sommolence, SI
D-D- CYP3A4 metabolite

Question 13

SSRIs*

Answer 13

Drugs- citalopram (celexa), escitalopram (lexapro), fluoxetine (Prozac), fluboxamine (Luvox), paroxetine (Paxil), sertraline (zoloft)
MOA- block reuptake of serotonin leading to increased concentrations
Takes 2-12 weeks for max benefit
Uses- MDD, anxiety, OCD, panic disorder, GAD, PTSD, social anxiety, PMDD, bulimia (Prozac only)
ADE- HA, sweating, anxiety, agitations, hyponatremia, n/v/d, weakness, fatigue, sexual dysfunction, sleep disturbances, prolong QT
Use caution in children/adolescents
Withdrawal symptoms
DOC for MDD

Question 14

SNRIs*

Answer 14

Drugs- desvenlafaxine (pristiq), duloxetine (cymbalta), levomilnacipron (fetzima), venlafexine (effexor); milnacipran (savella)
MOA- dual inhibition of serotonin and norepinephrine reuptake
Uses- pain syndromes (savella) , depression, anxiety
ADE- nausea, HA, sexual dysfunction, dizziness, insomnia, sedations, constipation, increase in BP/HR at high doses max, sweating
Withdrawal effects

Question 15

Brexanolone (zulresso)

Answer 15

Atypical antidepressant
MOA- positive allosteric modulator if GABA
Uses -PPD
IV
ADE- excessive sedation, loss of consciousness, hypoxia
Monitoring required

Question 16

Bupropion (Wellbutrin)*

Answer 16

Atypical antidepressant
MOA- weak dopamine and norepinephrine reuptake inhibitor
Uses- depression, smoking cessation
ADE- dry mouth, sweating, nervousness, tremor, seizures
Low instance of sexual dysfunction
Low D-D interactions
Avoid in seizure patients and those with history of anorexia or bulimia

Question 17

Esketamine (spravato)

Answer 17

Atypical antidepressant
MOA- S enantiomer of racemic ketamine, non selective, non competitive antagonist of N methyl D aspartate
Faster acting
Uses- adjunct therapy for treatment resistant MDD, or MDD with SI or behavior
ADE- sedative- must be monitored for 2 hours post admin; n/v, dissociation, hallucinations, elevated BP
Controlled substance for misuse

Question 18

Mirtazapine (remeron)*

Answer 18

Atypical antidepressant
MOA- enhances serotonin and norepinephrine, antibody for alpha receptors
ADE- Sedation, increased appetite, dry mouth, weight gain

Question 19

Nefazodone and trazodone *

Answer 19

Atypical antidepressant
MOA- weak inhibitors of serotonin and norepinephrine reuptake. Antagonist of 5HT receptor
Sedating effect
D-D-CYP3A4
ADE- priaprism, hepatotoxicity, orthostatics, dizziness, nausea, dry mouth

Question 20

Vilazodone (viibryd)*

Answer 20

Atypical antidepressant
MOA- serotonin reuptake inhibit and 5HT receptor partial agonist
D-D CYP3A4
ADE-similar to SSRIs
Withdrawal syndrome

Question 21

Vortioxetine (trintellix)*

Answer 21

Atypical antidepressant
MOA- serotonin reuptake inhibitor inhibition, 5HT 1 agonism, 5HT 3 and 5HT7 anatagonist
ADE- nausea; constipation, sexual dysfunctions

Question 22

TCAs*

Answer 22

Drugs- amitriptyline, amoxapine, clomipramine (anafranil), doxepin (silenor), imipramine (tofranil), maprotiline, nortriptyline (pamelor), protriptyline, trimipramine (surmontil)
MOA- inhibit norepinephrine and serotonin reuptake, affect several other receptors like 5HT2, dopamine, histamine-more side effects than SSRIs
Uses- MDD moderate to severe, panic disorders, nocturnal enuresis, migraines, chronic pain, insomnia
ADE- blurred vision, xerostomia, urinary retention; sinus tachycardia, constipation, aggregation of angle closure glaucoma, exacerbate arrhythmia, orthostatic hypotension, dizziness, sedation, weight gain, sexual dysfunction
Uses in caution in BPD - may case a switch to manic behavior
narrow therapeutic index
Monitor those with depression and suicidal ideations
Many D-D interactions

Question 23

MAOIs*

Answer 23

Drugs- isocarboxazid (marplan), phelelzine (nardil), selegiline (emsam), tranylcypromine (parnate)
MOA- increased stores on norepinephrine, serotonin, dopamine, inhibit MOA which catalyzes oxidation delaminating of drugs and tyramine containing foods
Uses- depression, usually intolerant or unresponsive to other agents
Many D-D interactions - no SSRIs, pseudoephedrine
Food interactions - must avoid tyramine containing foods like cheese, wine, aged meats, liver, picked or smoked fish- can cause large amounts of catecholamines to release cause hypertensive crisis, arrhythmia, cardiac arrest
ADE- drowsiness, hypotension, blurred vision, dry mouth, constipation

Question 24

Serotonin-dopamine antagonist *

Answer 24

Second generation antipsychotic
Drugs- aripiprazole, brezipiorazole, quetiapine
MOA- block serotonin and dopamine receptors
Adjunct therapy for antidepressants

Question 25

Mania and BPD*

Answer 25

-Lithium salt- for mania and hypomania; MOA not fully understood; therapeutic index low, monitor serum concentration; ADE- HA, dry mouth, polydipsia, polyuria, polyphagia, GI distress, tremor, dizziness, fatigue, skin reactions, sedation; signs of toxicity-ataxia, slurred speech, tremors, confusion, seizures;associated with nephrogenic diabetes insipidus, monitor thyroid function; use caution in renal patients -valproate- also anti seizure, for maniac, not effective for MDD used as secondary agent, less toxic, monitor blood levels, no liver disease, pregnancy or mitochondrial disorders, ADE/ n/d; tremor, sedation, elevated LFTs, HA, rash, low platelet -others- -carbamazepine/oxabarazepine- acute maniac no blood level needed, ADE- n/v, constipation, dizziness. Rash, monitor level with cabramazepine, also WBC can cause agranulocytosis divakproex, haloperidol, chlororpromazine, atypical antipsychotic like risperidone, olanzapine, quetiapine -lamotrigine (not acute), unknown MOA, folic acid issues try not to use in pregnancy, ADE- HA, dry mouth, rash, DRESS

Question 26

First generation antipsychotics *

Answer 26

Drugs- chlororomazine, thioridazine (low potency), fluphenazine, haloperidol (haldol), loxapine, molindone, perphenazine, pimozide (orap), prochlorperazine (compro, procomp), thiothixene, trifluoperazine (High potency) MOA- competitive inhibitors of variety of receptors mainly dopamine More like to have EPS and movement disorders

Question 27

Second generation antipsychotic *

Answer 27

Drugs- aripiprazole (abilify), asenapine (saphiris, secuado), brexipiprazole (rexulti), cariprazine (vraylar), clozapine (clozaril), lloperidone (fanapt), lumateperone (caplyta), lurasidine (latuda), olanzapine (zyprexa), paliperidone (invega), pimavanserin (nuplazid), quetiapine (seroquel), risperidone (risperdal), ziprasidone (geodon) MOA- blockage of both serotonin and 5HT 2 and dopamine Lower incidence of EPS, Uses- first line for schizophrenic, antiemetic affects, agitation and disruptive behavior in other disorders like autism, tics ADE- EPS, TD, neuroleptic malignant syndrome, anticholinergic effects, drowsiness, sedation, gynecomastia prolong QT, higher risk for DM, HLD, weight gain May lower seizure threshold BBW INCREASED RISK OF MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA

Question 28

Methylxanthines *

Answer 28

Drugs- theophylline (elixophyllin), theobromine, caffeine Tea, cola, energy drinks, chocolate, cocoa, coffee MOA-translocation of extra cellular calcium, increased cyclic adenosine and cyclic guanosine, inhibition of phosphodiesterase and adenosine receptors Actions- on CNS can decrease fatigue and increased mental alertness, 1.5 grams or more can product anxiety or tremors, spinal cord is stimulated at very high doses. On CV- inotropic or chronotropic effects, diuretic. In GI- avoid in peptic ulcer stimulates gastric secretions. Uses- asthma, migraines Tolerance and withdrawal symptoms ADE- insomnia, anxiety, agitation, emesis and convulsions at toxic doses, lethal dose is 10 grams (100 cups of coffee), cardiac arrhythmias

Question 29

Nicotine *

Answer 29

Drugs- nicoderm, nicorette, nicotrol MOA- ganglion stimulation, CNS stimulant, can produce euphoria, arousal or relaxation, improve attention; increase BP, increase vasoconstriction including coronary arteries High doses can lead to respiratory paralysis and hypotension Uses- not therapeutic unless weaning from cigarettes ADE- irritability, tremors, cramps, diarrhea, increased HR, BP, increased rate of drug metabolism Addition and withdrawal

Question 30

Varenicline (chantix)*

Answer 30

MOA- partial agonist of nicotinic receptors in CNS, less euphoric than nicotine Uses- weaning from cigarette, adjunct therapy Monitor for SI, vivid nightmares, mood changes

Question 31

Cocaine *

Answer 31

Highly addictive, schedule 2 MOA- blockade of reuptake of norepinephrine, serotonin, dopamine Potentials and prolongs CNS and peripheral actions, and pleasure system Chronic use can deplete stores of dopamine creating craving Death usually due to hyperthermia When used with etoh causes cocaethylene which further causes cardiac issues

Question 32

Amphetamines *

Answer 32

Drugs- dextroamphetamine (Dexedrine, zenzedi), lisdexamfetamine (vyvanse) methamphetamine (speed), methylenedioxymethamohetamine (MDMA) MOA- elevation of catecholamines and neurotransmitters in space; inhibit reuptake, similar to cocaine, decreases appetite, insomnia, CNS stimulant Uses- some are schedule1/2, ADHD, narcolepsy, appetite suppression ADE- at high doses psychosis and convulsions can occur, insomnia, irritability, weakness, dizziness, confusion, delirium, panic, SI, amphetamine psychosis in long term abuse, dependence, arrhythmias, CHF, cardiac arrest

Question 33

Methylphenidate (concerta, cotempla, daytrana, Ritalin) *

Answer 33

MOA- dopamine and norepinephrine transport inhibitor Uses- ADHD Schedule 2 ADE- abdominal pain, nausea, anorexia, insomnia, nervousness, fever, cardiac issues similar to amphetamines, increase seizures in epilepsy

Question 34

Modafinil (provigil) and armodafinil (nuvigil)*

Answer 34

MOA- unclear, promotes more wakefulness but less psychoactive or euphoric effects Uses- 1st line for narcolepsy ADE- HA, nausea, nervousness, some potential for abuse and dependence Controlled substance

Question 35

Levodopa and carbidopa*

Answer 35

MOA- metabolic precursors of dopamine, enhanced synthesis of dopamine Uses- PD ADE-anorexia, nausea, vomiting, orthostatic hypotension, tachycardia, ventricle extrasystole, arrhythmia, blood dycrasias, hallucinations, abnormal involuntary movements, mood changes D-D vitamin pyridoxine B6, MAOIs

Question 36

Selegiline (eldepryl, zelapar), rasagiline (azilect), safinamide (xadago)

Answer 36

MOA- selectively inhibits MAO type B the metabolite of dopamine, increases dopamine levels, Amphetamine like actions Uses- PD ADE- hypertensive crisis. Insomnia, nausea, serotonin syndrome, HA, confusion

Question 37

Catechol -o- methyltransferase inhibitors

Answer 37

Drugs- entacapone (comtan), opicapone (ongentys), tolcapone (tasmar) Uses- PD MOA- selection inhibits COMT for increased 3 I methyldopa a levodopa metabolite ADE- similar to levodopa-diarrhea, postural hypotension, nausea, anorexia, dyskinesia, hallucinations, sleep disorders Monitor LFTs

Question 38

Dopamine receptor agonist *

Answer 38

Drugs- bromicriptine(parlodel), Ropinirole (requip), pranipexole (mirapex), rotigotine neupro), apomorphine (apokyn, kynmobi) MOA- dopamine agonist, Longer DOA than levodopa, not effective for those who have not responded to levodopa Uses- PD complicated by motor function and dyskinesia ADE- nausea, vomiting, somnolence, postural hypotension, loss of impulse control-uncontrolled spending, increased libido, binge eating, hallucinations, mental conditions can worsen, pulmonary fibrosis (bromocriptine)

Question 39

Amantadine (gocovri)*

Answer 39

Antiviral by nature but has PD uses MOA- releases dopamine, blocks cholinergic receptors, inhibits NMDA ADE- restlessness, agitation, confusion, hallucinations, high doses can induce psychosis, orthostatic hypotension, urinary retention, edema, dry mouth

Question 40

Antimuscarinic drugs

Answer 40

Drugs- benztropine (congentin), trihexyphenidyl Uses- PD MOA-Blockage of cholinergic transmission, helps correct dopamine and acetylcholine balance ADE- mood changes, confusion, zerostomia, constipation, visual problems

Question 41

Adenosine receptor antagonist *

Answer 41

Drugs- istradefyllibe (nourianz) MOA- antagonist for adenosine A2A receptor Uses- PD, adjunct therapy with levodopa/carbidopa ADE- dyskinesia, nausea, constipation; hallucinations, insomnia, loss of impulse control

Question 42

Acetylcholinesterase inhibitors *

Answer 42

Drugs- donepezil (aricept), galantamine (razadyne), rivastigmine (exelon) Uses- Alzheimer’s MOA- inhibits acetlycholinesteraae which improves selectivity for acetylcholine transmission ADE-nausea, diarrhea, vomiting, anorexia, tremors, bradycardia, muscle cramps

Question 43

NMDA receptor antagonist *

Answer 43

Drug- memantine (namenda) Uses- Alzheimer’s MOA- antagonist for NMDA which is thought to accelerate apoptosis Well tolerate some ADE include confusion, agitation and restlessness Often used in combo with acetlychonlinesteraae

Question 44

Aducanumab (aduhelm)

Answer 44

Class- amyloid beta directed monoclonal antibody Uses- Alzheimer’s MOA- reduces amyloid plaques in the brain uncertain if it delays progression ADE- Brain edema, micro hemorrhage, HA, diarrhea

Question 45

Sphingosine 1 phosphate receptor modulators

Answer 45

Drugs- fingolimod (gilenya), ozanimod (zeposia), ponesimod (ponvory), siponimod (mayzent) Uses-MS MOA-alter lymphocyte migration by modulating sphingosine 1 phosphate receptors, reduce lymphocytes in CNS ADE- bradycardia, macular edema, PML, increased risk for OI

Question 46

Teriflunomide (aubagio)

Answer 46

MOA- pyrimidine synthesis inhibitor and decreased lymphocytes in CNS Uses-MS ADE- elevated LFTs, avoid in pregnancy

Question 47

Nuclear factor like 2 activators

Answer 47

Drugs-Dimethyl fumarate (tecfidera), diroximel fumarate (vumerity), mono methyl fumarate (bafiertam) MOA- activated nuclear factor like 2 antioxidant pathway Uses- MS ADE- OI, PML, liver injury

Question 48

Brivaracetam (briviact)*

Answer 48

Uses- treatment of focal seizures in adults MOA- high and selective affinity for synaptic vesicle protein, exact MOA unknown D-D CYP450

Question 49

Cannabidiol (epidiolex)

Answer 49

Uses- seizures due to Lennox gastaut syndrome, Dravet syndrome, Tuberous sclerosis complex MOA- canibinoid like but no psychoactive features D-D- CYP450 ADE-drowsiness, diarrhea, vomiting, decreased appetite, elevated LFTs

Question 50

Carbamazepine ((tegretol) *

Answer 50

Uses- also can be used for BPD, focal seizures, tonic clonic, trigeminal neuralgia MOA- blocks sodium channels inhibiting generation of repetitive action potential D-D- CYP1A2, CYP2C, CYP3A, UGT ADE- hyponatremia Do not give in absent seizures type can increase seizures

Question 51

Cenobamate (xcopri)*

Answer 51

MOA- sodium channel blocker, Modulates GABA Uses- focal seizures ADE- fatigue, HA, dizziness, double vision

Question 52

Eslicarbazepine (aptiom)*

Answer 52

MOA- sodium channel blocker Uses- focal seizures ADE/ dizziness, somnolence, diplopia, HA, rash, psychiatric effects, hyponatremia

Question 53

Ethosuximide (zarontin)*

Answer 53

MOA- reduces prolongation of animal electrical activity in the brain by inhibiting T type calcium channels Used- absent seizures

Question 54

Felbamate (felbatol)

Answer 54

Uses- broad spectrum, reserves for refractory epilepsy like Lennox gastaut syndrome MOA- blocking sodium channels, competing with NMDA sites, blocks calcium channels and potential GABA ADE- aplastic anemia, hepatic failure

Question 55

Fenfluramine (fintepla)

Answer 55

Uses- dravet syndrome related seizures MOA- 5 HT 2 receptor agonist ADE- valvular heart disease and pulmonary HTN, drowsiness, lethargy, reduced appetite, weight loss

Question 56

Gabapentin (neurotin) *

Answer 56

MOA- exact unknown Uses- many but seizures in this case ADE- mild usually well tolerated Few D-D interactions

Question 57

Lamitrigine (lamictal)

Answer 57

MOA- block sodium Channel and calcium channel Uses- focal, generalized, absent and Lennox gastaut syndrome, BPD Slow titration ADE- rash, to life threatening

Question 58

Levetiracetam (keppra)*

Answer 58

Uses- treatment of focal onset seizures and adjunct for myoclonic and tonic clonic in children and adults MOA- high affinity for synaptic vesicle protein ADE- mood alterations lower dose to reduce Few D-D

Question 59

Oxcarbazepine (trileptal)*

Answer 59

MOA- reduces to 10 mono hydroxy metabolite responsible for anticonvulsant activity, blocks sodium channels and some calcium ADE- hyponatremia

Question 60

Phenobarbital and primidone (mysolin)*

Answer 60

Pheno-inhibitory effects of GABA, used in status epilepticus when other agents fail Primidone- metabolizes to phenobarbital and phenylethylmalonamide both are anticonvulsant

Question 61

Phenytoin (dilantin) and fosphenytoin (cerebyx) *

Answer 61

MOA- sodium channel blocker Uses- focal and generalized tonic clonic, status epilepticus ADE- CNS depression, gingival hyperplasia, long term use can cause peripheral neuropathy and osteoporosis Fosphenytoin can be given IM and phenytoin CANNOT CAUSES TISSUE NECROSIS AND DEATH

Question 62

Pregabalin (Lyrica)*

Answer 62

MOA- bunds to subunit of Calcium channels inhibiting excitatory neurotransmitter release Uses- focal onset seizures, diabetic neuropathy, posttherpetic neuralgia, fibromyalgia ADE- few D-D- few

Question 63

Rufonamide (banzel)*

Answer 63

MOA- sodium channel Used- adjunct for Lennox gastaut syndrome in children 1 year or older and adults Food increase absorption D-D- carbamazepine and Pheytoin can decrease concentration and valproate cane increase ADE- short QT

Question 64

Stiripentol (diacomit)*

Answer 64

MOA- modulate GABA Uses- dravet syndrome along with clobazam

Question 65

Tiagabine (gavitril)

Answer 65

MOA- GABA reuptake inhibitor Uses- adjunct for focal seizures

Question 66

Topiramate (topamax)*

Answer 66

MOA- blocks sodium channels, reduce calcium currents and acts in NMDA site Uses- focal seizures and primary generalized epilepsy D-D- Pheytoin, carbamazepine ADE- somnolence, weight loss; paresthesia, kidney stones, glaucoma l, decreased sweating, hyperthermia

Question 67

Valproic acid Valproate Divalproex (depakote) *

Answer 67

MOA- sodium channel blockage and blocks GABA, and T type calcium channel Uses- focal, primary generalized epilepsy ADE- liver toxicity avoid in women and children under age 2

Question 68

Vigabatrin (sabril)*

Answer 68

MOA- irreversible bind to inhibit GABA ADE- vision loss Not widely used

Question 69

Zonisamide (zonegran)*

Answer 69

MOA- Sulfa derivative blocks sodium and calcium channels Uses- focal ADE- kidney stones, CNS issues, hyperthermia, decreased sweating Contraindicated in sulfa allergies or carbonic anyhydrase inhibitor allergy

Question 70

Actetylcholine (miochol E)

Answer 70

MOA- “rest and digest”, inactivates cholinesterases -decreased HR and cardiac output, decreased blood pressure, increases salary secretion, gastric secretion, broncoconstriction, detrusor activity, constriction of pupils Direct acting cholinergic

Question 71

Bethanechol (urecholine)*

Answer 71

Direct acting cholinergic MOA- rest and digest properties, muscarinic receptor activity Uses- stimulate atonic bladder, urinary retention ADE- sweating, salivation, flushing, decreased BP, abdominal pain, diarrhea, bronchospams

Question 72

Cabachol (miostat)

Answer 72

Direct acting cholinergic MOA- rest and digest action, muscarinic action Uses- eye surgery of constriction and decrease IOP ADE- few is used ophthalmic

Question 73

Pilocarpine (salagen, isopto carpine)*

Answer 73

Direct acting cholinergic MOA- rest and digest properties Uses- glaucoma, DOC to reduce IOP emergency for open and angle closure glaucoma ADE- blurred vision, night blindness, brow ache

Question 74

Edrophonium (enlon)

Answer 74

indirect cholinergic MOA- rest and digest properties, binds to acetylcholine Uses- MG by increase amounts of acetylcholine to peripheral muscle not DOC better agents removed from market

Question 75

Physostigmine *

Answer 75

Indirect cholinergic agonist MOA- rest and digest, muscarinic stimulation that causes GU smooth muscle contraction, miosis, bradycardia, hypotension Uses- OD on anticholinergics ADE- convulsions, decrease CO, skeletal muscle paralysis

Question 76

Neostigmine (bloxiverz)*

Answer 76

Indirect cholinergic agonist MOA- rest and digest properties but cannot enter CNS, and greater action on skeletal muscles and stimulates contractility Uses- stimulate bladder and GI tract and reversal agent for paralytic agents, MG symptoms ADE- salivation; flushing, decrease BP, nausea, abdominal pain, diarrhea, bronchospams Contraindicated in intestinal or urinary bladder obstruction

Question 77

Pyridostigmine (mestinon)*

Answer 77

Indirect cholinergic agonist Uses- MG ADE similar to neostigmine

Question 78

Tacrine Donepezil (aricept) Rivastigmine (exelon) Galantamine (razadyne)

Answer 78

Indirect cholinergic Uses- Alzheimer’s due to deficiency in acetylcholine, delays AD progression

Question 79

Atropine

Answer 79

Anticholinergic MOA- prevents acetylcholine binding, fight or flight properties Uses- eye dilation, antispasmodic for GI tract, increased HR, antidote for cholinergic OD ADE-dry mouth, blurred vision, tachycardia, urinary retention, constipation, delirium, CNS changes

Question 80

Scopolamine

Answer 80

Anticholinergic MOA - blocks acetylcholine, fight or flight properties Uses- motion sickness, sedation at high doses ADE- same as most anticholinergics

Question 81

Ipratropium (atrovent)

Answer 81

Anticholinergics MOA- blocks acetylcholine, fight or flight properties Uses- promote bronchodilation in asthma/COPD Inhalation

Question 82

Tropicamide (mydriacyl) and cyclopentolate (cyclogyl)

Answer 82

Anticholinergic - fight or flight properties Ophthalmic solution for eye dilation

Question 83

Benztropine (congentin) and trihexyphenidyl

Answer 83

anti cholinergic- fight or flight properties Adjuvants for PD, or EPD caused by antipsychotics

Question 84

Oxybutynin (ditropan, gelnique, oxytrol)

Answer 84

Anticholinergic- fight or flight properties Uses- overactive bladder ADE- dry mouth, constipation, blurred vision, fewer CNS issues

Question 85

Ganglionic blockers

Answer 85

For smoking cessation on nicotinic receptor Anticholinergics

Question 86

Non depolarizing blockers

Answer 86

Drugs-tubocurarine, cisatracium (nimbex), mivacurium (mivacurium), rocuronium, vecuronium MOA- block acetylcholine on skeletal muscles Uses- paralyzing muscles for surgery, intubation ADE- few D-D- cholinesterase inhibitors, halogenated hydrocarbon anesthetics, aminoglycoside, CCB

Question 87

Succinylcholine (anectine, quelicin)

Answer 87

Neuromuscular blocking agent MOA- binds to nicotinic and acetylcholine receptors, mainly affects respiratory muscles Uses- intubation ADE- hyperthermia, prolonged muscle weakness, hyperkalemia

Question 88

Epinephrine (adrenaclick, adrenalin, epipen)

Answer 88

Direct acting adrenergic agonist MOA- interacts on both alpha and beta receptors. Fight or flight properties -increase HR, CO, vasoconstriction, bronchodilator, hyperglycemia Uses-bronchospasm, anaphylaxis, cardiac arrest, adjunct to local anesthesia ADE-anxiety, fear, tension, HA, tremor, arrhythmia, pulmonary edema, tachycardia,

Question 89

Norepinephrine (levophed)

Answer 89

Direct acting adrenergic agonist MOA- alpha receptors, fight or flight not as strong as epi -vasoconstriction, baroreceptor reflex which can trigger bradycardia, may diminish blood flow to kidneys Uses- shock ADE-similar to epi, blanching and sloughing of skin, tissue necrosis if extravasation occurs, give in central vein

Question 90

Dopamine

Answer 90

Direct acting adrenergic agonist MOA-alpha and beta receptors and dopaminergic receptors fight or flight properties -increased CO, vasoconstrictions, increase blood flow to kidneys, Uses- cardiogenic shock, septic shock, hypotension, CHF, bradycardia ADE- same as other and nausea, hypertension, arrhythmias

Question 91

Phenylephrine (neo synephrine, sudafed PE)

Answer 91

Direct acting adrenergic agonists MOA-alpha receptor activity, fight or flight -vasoconstriction, reflex bradycardia, Uses- hypotension in hospitalized or surgical patients especially if tachycardia, nasal decongestant, eye dilation ADE- hypertension HA, cardiac irregularities

Question 92

Naphazoline, oxymetazoline (afrin), tetrahydrozoline (visine)

Answer 92

direct acting adrenergic agonist MOA-act on alpha 1 and alpha 2 receptors -vasoconstriction, Uses- nasal decongestant, rosacea ADE- nervousness, HA, trouble sleeping, irritation, sneezing Do not use for more than 3 days due to rebound congestion

Question 93

Midodrine

Answer 93

Direct acting adrengeric agonist MOA- selective alpha agonist Increases BP Uses- orthostatic hypotension Given 3-4 X a day To avoid supine hypertension do not give within 4 hours of bedtime

Question 94

Clonidine (catapres, duraclon)

Answer 94

Direct acting adrenergic agonist MOA- acts on alpha 2 receptors, which deceased sympathetic outflow to peripheral Uses- HTN, ADHD ADE- lethargy, sedation, constipation, xerostomia Abrupt DC can cause rebound HTN

Question 95

Dobutamine

Answer 95

direct acting adrenergic agonist MOA- beta 1 receptor and some beta 2 and alpha 1 -increase HR, CO, few vascular issues Uses- inotropic support after cardiac surgery, acute CHF use caution in a fib as it increases AV conductors ADE- similar to epi Tolerance

Question 96

Isoproterenol (isuprel)

Answer 96

Direct acing adrenergic agonist MOA- beta 1 and beta 2 -increases HR, CO, dilation of skeletal muscle arterioles, slight BP increase, potent bronchodilator ADE- similar to epi and beta receptor agonist

Question 97

Albuterol (proair, proventil, ventolin), levoalbuterol (xoponex), metaproterenol, terbutaline

Answer 97

direct acting adrenergic agonists MOA- short acting beta 2 agonist Uses- bronchodilator, by inhaler Terbutaline also used to suppress premature labor ADE- tremor, restlessness, apprehension, anxiety, tachycardia, arrhythmias, D-D- MOAIs can potentiate CV ADE

Question 98

Formoterol (foradil, perforomist) indacaterol (arcapta), olodaterol (striverdi), salmeterol (serevent)

Answer 98

Direct acting adrenergic agonist MOA- beta 2 selective Uses- asthma, COPD by inhaler like dry powder, long acting Effective when used in combo with inhaled steroid

Question 99

Mirabegron (myrbetriq) and vibegron (gemtesa)

Answer 99

Direct acting adrenergic agonist MOA- act on beta 3 which relaxes Detrusor muscle and increases bladder capacity Uses- OAB Mirabegron may increase BP D-D- can increase digoxin level, CYP2D6

Question 100

Indirect acting adrenergic agonist

Answer 100

-amphetamine- alpha 1 and beta 1 activity- increased BP, increase HR -tyramine- not a clinical drug but found in aged cheese, wine, fermented foods- if concurrently taking a MOAI can cause catecholamine release -cocaine- blocks sodium and chloride, causing norepinephrine to remain in synapse, increases BP by alpha 1 and beta effects

Question 101

Mixed action adrenergic agonists

Answer 101

Drugs- ephedrine (akovaz, emerphed) and pseudoephedrine (sudafed, genaphed) MOA- act on alpha and beta receptors, similar to epinephrine, Long duration of action -raises BP, bronchodilator, alertness, decrease fatigue, prevents sleeps Uses- nasal decongestant

Question 102

Phenoxybenzamine (dibenzyline)

Answer 102

Adrenergic blockers MOA- blocks alpha 1 and alpha 2 -decreased BP, reflex tachycardia Uses- reverse epinephrine, swearing, HTN with pheochromocytoma, off label-HTN crisis, neurogenic bladder, prostate obstruction ADE- postural hypotension, nasal stuffiness, inhibited ejaculation, GI irritation, reflex tachycardia

Question 103

Phentolamine

Answer 103

Adrenergic blocker MOA- blocks alpha 1/2 Uses- for dx of pheochromocytoma and HTN crisis, can be used locally for dental procedures

Question 104

Prazosin (minipress), terazosin, doxazosin (cardura)

Answer 104

Adrenergic blockers MOA- alpha 1 receptor blocker -relaxes smooth muscles, some decrease in BP Uses- HTN but not first line, BP Take at bedtime to avoid orthostatic hypotension ADE- dizziness, fatigue, nasal congestion, HA, drowsiness, orthostatic hypotension, floppy Iris syndrome

Question 105

Propranolol (inderal, innopran)

Answer 105

Adrenergic blocker MOA- beta blocker 1 and 2 receptors -diminishes CO, negative inotrope, bradycardia, decrease in cardiac workload, decrease BP, bronchoconstriciton, decreased glucose and glucagon Use- angina, HTN, MI, migraine, hyperthyroid ADE- bronchoconstriction, arrhythmias if stopped abruptly, hypoglycemia, depression, fatigue, dizziness, lethargy, weakness, visual disturbances D-D- CYP1A2, CYP2D6- bupropion, fluoxetine, paroxetine, quindine, amiodarone, diltiazem, lidocaine

Question 106

Nadalol (corgard) and timolol (betimol, istalol, timoptic)

Answer 106

MOA- Non selective beta antagonists Uses- open angle glaucoma, portal HTN in cirrhosis

Question 107

Acebutolol, atenolol (tenormin), betaxolol (betoptic), bisoprolol, esmolol (brevibloc), metoprolol (lopressor, toprol), nebivolol (bystolic)

Answer 107

MOA- Selective beta 1 antagonist, lower BP, increase exercise tolerance in angina, arrhythmia control Uses- angina, CHF,

Question 108

Acebutolol and pinodol

Answer 108

MOA-Antagonist but weakly stimulate beta 1/2 Uses- HTN with some bradycardia

Question 109

Labetalol and carvedilol (coreg)

Answer 109

MOA- antagonist for alpha and beta receptors Uses- pregnancy induced HTN, CHF, emergency anti HTN ADE- orthostatic hypotension, dizziness

Question 110

Sleep

Answer 110

1st like melatonin If not Adequate can they trazadone, mirtazapine, doxepin, amitriptyline

Question 111

SSRI OD

Answer 111

Citalopram can cause QT prolong and arrhythmias Seizures Serotonin syndrome- hyperthermia, muscle rigidity, sweating, myoclonus, mental status change, unstable vitals

Question 112

DC syndrome *

Answer 112

From abrupt antidepressants withdrawal, Prozac has lowest risk for syndrome due to half life HA, malaise, flu like syndrome, agitation, irritability, nervousness, changes in sleep

Question 113

Combination therapy *

Answer 113

Bupropion can be added to SSRI or SNRI most common Mirtazapine added to SSRI or SNRI-2nd line Trazodone to SSRI SNRI- 3rd line TCA to SSRI or SNRI- last try

Question 114

MDMA aka molly aka ecstasy

Answer 114

Hallucinogenic properties with serotonin release Bruxism and jaw clenching Hyperthermia, AMS, serotonin syndrome

Question 115

Cyproheptadine

Answer 115

Tx for serotonin syndrome

Question 116

Synthetic cathinones aka bath salts

Answer 116

Cause catecholamine release like cocaine and amphetamines Similar tx for cocaine or meth

Question 117

LSD

Answer 117

Psychedelic effects potent agonist of 5HT2a receptors Hallucinations, mood and sleep alterations, anxiety Hyperthermia, tachycardia, HTN Losing judgement and impaired reasoning

Question 118

MJ

Answer 118

THC main psychoactive component Can produce euphoria, drowsiness, relaxation Mood hallucination effect Withdrawal- cravings; insomnia, MDD, pain or irritability

Question 119

Etoh abuse tx

Answer 119

Disulfiram (anatbuse( blocks oxidation of acetylhyde Results in accumulation causes flushing, tachycardia, hyperventilation, nausea Naltrexone- competitive and long action opioid agonist to decrease craving Acamprosate- decrease craving by NMDA effects

Question 120

Direct acting anti cholinergic

Answer 120

Acetylcholine- muscarinic and nicotinic receptors -decrease HR, and cardiac output, lower BP, increase gastric acid secretions and saliva production, vasoconstriction, can increase bladder tone and pupil constriction

Question 121

Cevimeline (evoxac)

Answer 121

Direct acting cholinergic agonist Produce secretions, less effect on BP For xerostomia in XRT and sjorgrens

Question 122

Anticonvulsants classes

Answer 122

Benzos Bind synaptic vesicle protein- keppra, briviact Sodium channel blockers/ tegretol, trileptal, aptiom Hydantoins- Dilantin, cerebyx CCB- zarotin Glutamate effects- fycompa Barbiturates- primidone; phenobarbital GABA effects/ xcopril, diacomit, Antrim, sabril multiple- depakote, felbatol, vinpat, lyrica, lamacital, topamax, zonegran Unknown- epidolex, fenetepla, neurotin, banzel