Test 2 Flashcards
1
Q
Alzheimer’s Med Categories
A
Cholinesterase inhibitors, NMDA receptor antagonist, Combination
2
Q
Cholinesterase inhibitors
A
Donepezil
Rivastigmine
Galantamine
3
Q
NMDA receptor antagonist
A
Memantine
4
Q
Combination Alzheimer Med
A
Donepezil + Memantine
5
Q
Cholinesterase Inhibitor MoA
A
• Selectively inhibit cholinesterase [enzyme that hydrolyzes (inactivates) Ach] in the CNS
6
Q
Cholinesterase Inhibitor effect
A
May slow deterioration of cognitive function
– Preserves memory, learning, attention (does NOT affect the underlying degenerative process
7
Q
Cholinesterase Inhibitors Adverse Effects - ALL
A
Diarrhea, Nausea and vomiting
Bradycardia, dizziness, syncope
Urinary incontinenced
Hypersalivation, sweating
8
Q
Rivastigmine AE
A
Hepatotoxicity
9
Q
Donepezil AE
A
Insomnia
10
Q
Galantamine AE
A
Weight gain
11
Q
Cholinesterase Inhibitors drug ineractions
A
anticholinergic drugs
drugs that induce 3A4
12
Q
Memantine MOA
A
NMDA receptor antagonist
13
Q
Memantine Indications
A
Indicated for moderate to severe disease
– Can be used alone or in combination with cholinesterase inhibitors
14
Q
Memantine AE
A
– Headache, confusion, dizziness, hallucinations
– Hypertension
15
Q
Memantine can be combined with
A
donepezil (combo drug is called Namzaric®)
16
Q
Alzheimer’s combination agents
A
Namzaric (Donezepil & Memantime)
17
Q
Parkinson’s drug classes
A
Dopaminergic COMT Inhibitors MAO-B inhibitors Dopamine Receptor Agonists Acetyl Choline Receptor Agonists
18
Q
Parinkson’s Psychosis Drg
A
Pimavanserin
19
Q
Dopaminergic agents
A
Levodopa
20
Q
COMT Inhibitor agents
A
Tolcapone
Entalcapone
21
Q
MAO-B Inhibitors
A
Selegiline
Rasagaline
Safinamide
22
Q
Dopamine Receptor Agonists
A
Pramiprexole
Ropinirole
23
Q
Acetylcholine Receptor Agonists
A
Benztropine
Trihexyphenidyl
24
Q
Epilepsy Drug Classes
A
Sodium Channel Blockers GABA Agents Glutamate Agents T-Type Calcium Channel Blockers Miscellaneous
25
Sodium Channel Blockers
Phenytoin
Carbamazepine
Zonisamide
Lamotigrine
26
GABA Agents
Phenobarbital
| Valproic Acid
27
Glutamate Agents
Topiramate
Perampanel
Levetiracetam
28
T-type Calcium Channel Inhibitors
Ethosuximide
29
Miscellaneous Epilepsy Drugs
Cannabidiol and Benzos
30
Depression Meds
```
TCAs
MAOIs
SSRIs
SNRIs
Miscellaneous
```
31
TCAs
Amitriptyline
Doxepin
Nortriplyine
32
MAOIs
Selegiline
33
SSRIs
```
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
Fluvoxamine (Luvox)
Citalopram (Celexa)
Escitalopram (Lexapro)
```
34
SNRIs
Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)
Milanacipran (Saveila)
35
Misc Depression Drugs
Bupropion (Wellbutrin)
| Mirtazapine
36
Antipsychotic Drugs
D2 Receptor Agonists (Typical)
Serotonin-Dopamine Agonists (Atypical)
Newer 2nd gen antipsychotics
37
D2 Receptor Agonists (typical antipsychotics)
Haloperidol (Haldol)
38
Serotonin-Dopamine Agonists (atypical)
```
Clozapine
Olnazapine
Quetiapine
Aripiprazole (Abilify) [Aristada IM]
Risperidone
```
39
Newer 2nd gen antipsychotics
Brexpiprazole
| Cariprazine
40
Bipolar Meds
Lithium
| Anti-Psychotics
41
Post Partum Meds
Brexanolone
42
Treatment Resistant Depression Med
Esketamine
43
Levodopa MoA
increases conc of dopamine in the brain
| biosyntetic precursor of dopamine
44
Levodopa AE
Nausea and vomiting
Orthostatic hypotension, sedation
Depression, delirium, paranoia, delusions, hallucinations
Motor fluctuations
45
Levodopa metabolism
Metabolised by COMT
| Less than 1% reaches brain (why we combine with meds)
46
Levodopa combined with
Carbidopa & COMT inhibitor
47
Levodopa + Carbidopa
Sinemet, Sinemet CR, & Parcopat (oral disintegrating); Rytary new control release
48
Carbidopa MoA
Decarboxylase inhibitor
Inhibits conversion of levodopa to dopamine in peripheral tissues
Increases amount of levodopa that enters the brain
49
Carbidopa metabolism
Wearing off phenomenon (2-5 years efficacy)
| Titrate to minimum 75 mg daily
50
COMT Inhibitor MoA
Inhibits peripheral metabolism of levodopa through inhibition of COMT
51
COMT AE
```
Hepatotoxicity (tolcapone)
Orthostatic hypotension
Diarrhea
Hallucinations
Brown-orange urine discoloration (entacapone)
```
52
COMT combined with levo/carbidopa
Entacapone
53
Entacapone + Levodopa + Carbidopa
Stalevo
54
MAO-B Inhibitors MoA
MAO-B breaks down dopamine so these drugs irreversibly inhibit this action
55
MAO-B Inhibitor AE
Increase levodopa toxicity (dyskenesia, psych symptoms)
| Nausea, dizziness, orth htn, hallucination, insomnia, serotonin syndrome if combined with other serotenergic agents
56
MAO-B inhibitor interactions
foods/drinks high in tyramine (e.g. aged cheese, smoked meat, red wines, others)
57
DA receptor agonist MoA
directly activates dopamine receptor in brain and elsewhere
58
DA receptor agonist advantage over levodopa
– Direct action on receptor – less free radicals released – Less motor fluctuations and dyskinesias
– Longer half-life = longer action
59
disadvantages of DA receptor agonists
– Difficult to use in elderly due to increased CNS effects – May cause or exacerbate dyskinesias
60
DA receptor agonist AE
– Nausea, anorexia, vomiting (reduced if taken with food)
– Postural hypotension
– Sedation and hallucinations, confusion, vivid dreams
– Impaired impulse control, sleep attacks
– Behavioral (Impulse) side effects (gambling, shopping) • Less common (<10%)
61
Ach receptor antagonist therapuetic effects
Helps reduce tremor more than other manifestations
| Favorable effects on rigidity and bradykinesia
62
Acetylcholine Receptor Antagonists MoA
– Competes with Ach at muscarinic receptors
| – Block dopamine reuptake–prolonging dopamine effect
63
Ach receptor antagonist AE
– Sedation, depression, confusion
– Dry mouth, blurred vision, constipation, urinary retention
– Patients often find them difficult to tolerate
64
PD Psychosis drug
Pimavanserin
65
Primavenserin MoA
Selectively blocks 5-HT2a and 2c receptors
66
Primavenserin AE
Worsening hallucinations, QTc prolongation, death
| BBW: Increased mortality in elderly patients with dementia- related psychosis (all antipsychotics)
67
How do Antiepileptic Drugs Work?
– Limit repetitive firing of neurons
– Enhance GABA-mediated synaptic inhibition
– Attenuate Glutamate-mediated excitatory responses
68
Key Sodium Channel Blockers
Phenytoin
Carbamazepine
Zonisamide
Lamotrigine
69
Phenytoin use
• Focal and generalized seizures
• No activity against absence
seizures
70
Pheyntoin routes
PO and IV
71
Phenytoin max infusion rate
50 mg/min
72
Phenytoin pharmacokinetics
- high protein binding
- metabolized by liver
- dose dependent: enzyme system may become saturated and small dose increase may result in large increase in levels
73
Target Phenytoin concentration
– Total concentration: 10 - 20 micrograms/mL
| – Free concentration: 1 - 2 micrograms/mL
74
Phenytoin Concentration dependent side effects
– > 20 micrograms/mL = Nystagmus
– > 30 micrograms/mL = ataxia, seizures reported
– > 40 micrograms/mL = lethargy, coma
75
Adjust total phenytoin level if:
– Low albumin (albumin <3.2 mg/dL)
76
What causes low albumin
Renal disease, malnutrition, cancer, liver failure
77
Adverse Effects of Phenytoin
* Nystagmus – can develop tolerance
* Diplopia/ataxia – indication to check level (may be dosed too high)
* Phenytoin anticonvulsant hypersensitivity syndrome (AHS): rash, increased LFTs, and fever
* Gingival hyperplasia (A) - ~ 20% of chronic use
* Hirsutism (B) – can be dose related
* Gingival hyperplasia (A) - ~ 20% of chronic use
* Hirsutism (B) – can be dose related
* Purple glove syndrome (C) - extravasation of phenytoin (do not use)
* Hypotension
78
Phenytoin Drug Interactions
Other high protein bound drugs (valproic acid)
79
Phenytoin metabolism
metabolized by liver, dose dependent, high protein binding; INDUCER
80
Carbamazepine indications
Focal and tonic clonic
81
Carbamazepine PK
```
highly protein bound
requires TDM (goal 6-10 mcg/mL)
```
82
Carbamazepine metabolism
– Extensively hepatic metabolism to active metabolite
– Substrate and Inducer of CYP 3A4 and others
– AUTOINDUCTION: Up-regulates
83
Carbamazepine AE
– CNS: blurred vision, unsteadiness, headache, sedation (30%)
– Nausea/GI upset (take with food)
– Black box warnings: dermatologic reactions, blood dyscrasias (AHS)
– Hyponatremia (SIADH) –more common in elderly
84
Carbamazepine drug interactions
– Induces metabolism of many drugs
• Example: oral contraceptives
– Displacement interactions (high protein binding)
85
Anticonvulsant Hypersensitivity Syndrome (AHS)
Rare, life-threatening immunologic adverse drug reaction
Associated with several anticonvulsants
– Phenytoin, carbamazepine, lamotrigine, others
Variable onset: 2-12 weeks after exposure
Cross-reactivity between agents can occur
86
Zonisamide indications
Focal, generalized, and unknown seizures
87
Zonisamide metabolism
Oral formulation only
Requires dose increases if given with CYP 3A4 inducers
Approximately 85% excreted by kidneys unchanged
88
Zonisamide AE
– Somnolence, ataxia, anorexia, nervousness, fatigue
– Renal stones (rare 1%)
– Suicidal ideations
– Metabolic acidosis (rare-renal dx, severe diarrhea) -- Monitor bicarbonate levels before and periodic after start
89
Zonisamide contraindications
– Sulfa allergy (skin reaction)
| – CrCl < 50 mL/min
90
Lamotrigine indications
Focal, generalized, and unknown seizures
91
Lamotrigine metabolism
liver
92
Lamotrigine AE
– Dizziness, blurred vision, headaches
| – Skin reactions - AHS( black box warning;d/c at firs tsign)
93
Lamotrigine drug interactions
- oral contraceptives (can be reduced)
- Fosphenytoin/phenytoin can decrease lam levels
- Valproate can increase lam levels
94
Phenobarbital routes
po, IV
95
Phenobarbital indications
Generalized and focal seizures (not absence), status epilepticus (and refractory cases)
96
Phenobarbital MoA
Synaptic inhibition through increasing GABA
97
Which two IV drugs cause hypotension
Phenobarbital & Phenytoin
98
Phenobarbital metabolism
inducer and longer 1/2 life (2-6 days)
99
Phenobarbital AE
```
– Hypotension/respiratory depression (IV)
– Sedation (may develop tolerance)
– Nystagmus and ataxia (toxicity)
– Irritability
– Hyperactivity (more so in children)
– Confusion (more so in elderly)
```
100
Seizure meds that require TDM
Phenobarbital, Carbamazepine, phenytoin, valproate, Keppra (w/seizures), ethosuximide
101
Phenobarbital TDM
Goal 10-40 ug/mL)
102
Valproate route
po, IV
103
Valproate indications
Generalized and focal (including absence)
104
Valproate MoA
stimulates enzyme that converts glutamate to GABA
| inhibits GABA degradation
105
Valproate metabolism
Highly protein bound
Hepatically metabolized
Inhibitor (many drug interactions)
106
Valproate TDM
50 - 100 micrograms/ml, up to 140 for status epilepticus
107
Valproate AE
Black box warnings: pancreatitis (rare), hepatotoxicity, teratogenicity (neural tube
defects)
CNS: headache, dizziness, somnolence, sedation, tremor
108
Valproate drug interactions
– Displacement reactions (e.g.phenytoin)
– CYP-mediated (inhibit smetabolism of phenytoin, phenobarbital, carbamazepine) – Increases lamotrigine levels (serious skin reactions)
-slowly titrate doses
109
Topiramate indications
Generalized and focal seizures (including absence and LGS)
110
Topiramate MoA
Antagonizes AMPA subunit of glutamate
| – Also inhibits Na channels, K efflux (hyperpolarization), enhances GABA
111
Topiramate metabolism
Inducer/inhibitor
Excreted in urine -- decrease dose for CLcr<70
does should be slowly titrated!!
112
Other uses of topiramate
migraines and weight loss
113
Topiramate AE
– Somnolence, dizziness, difficulty with memory and concentration, aggressive
behavior
– Weight loss, oligohydrosis (decreased ability to sweat)
– Nephrolithiasis (counsel need for fluid intake)
– Metabolic acidosis (renal disease)
114
Perampanel indications
Generalized and focal seizures
115
Perampanel MoA
AMPA glutamate receptor antagonist
116
Perampanel AE
– Black Boxed Warning: neuropsychiatric disorders (aggression, anger, hostility, irritability)
– Weight gain, nausea, dizziness, headache
– CNS (dizziness, gait disturbances, sedation)
117
Which seizure meds are controlled substances?
perampanel and phenobarbital
118
Perampanel PK
* Highly protein bound
* Major 3A4 substrate
* Use not recommended with CrCL < 30
119
Levetiracetam (Keppra) indications
Generalized and focal seizures
120
Levetiracetam (Keppra) MoA
Binds to a synaptic vesicle protein (SV2A) – responsible
for reducing presynaptic glutamate release
121
Levetiracetam (Keppra) PK
* Low protein binding (< 10%)
| * Primarily excreted in urine – adjust for renal impairment
122
Levetiracetam (Keppra) TDM
ONLY if having seizures on medication – can help verify if patient is compliant with medications
123
Ethosuximide indications
Absence seizures
124
Ethosuximide MoA
(T-type) Calcium Channel Inhibitor
125
Ehtosuximide PK
* Very low protein binding
| * Metabolized by the liver
126
Ehtosuximide AE
– Nausea and vomiting (divide dose), anorexia, weight loss, abdominal cramps
– Psychosis, mania, sleep terrors, aggressiveness – CNS depression
– Parkinsonian movements (dose related)
– Blood dyscrasias
127
Ehtosuximide TDM
Goal 40-100 mcg/mL
128
Cannabidiol MOA
Not entirely known, enhances cannabinoid receptors, enhances natural endocannabinoids
129
Cannabidiol AE
diarrhea, vomiting, somnolence, LFT abnormalities
130
Cannabidoil metabolism
Metabolized by 3a4 and 2C19 (think drug interactions)
131
Benzo MoA
Enhances activity of GABA
132
Benzo AE
depressed mental status, respiratory
depression, hypotension
133
Benzo hosptial recommendations
– Lorazepam (Ativan); IV
– Diazepam (Valium); IV and rectal
– Midazolam (Versed); IM (intranasal or buccal if IM not available)
• Can also be given IV
134
Avoid these epilepsy meds in pregnancy
phenytoin, carbamazepine, valproate, phenobarbital, topiramate
135
Safest epilepsy meds in pregnancy
Levetiracetam and lamotrigine
136
Depression meds effects 1-2 weeks
Improve sleep and reduced anxiety
137
Depression meds effects 1-3 weeks
improved self care, concentration, energy level and activity level up
138
Depression meds effects 2-4 weeks
improved mood, reduced suicidal ideation
139
TCA MoA
Nonselective inhibition of NE and serotonin reuptake
140
TCA AE
Orthostatic htn, sedation, dry mouth, constipation, cardiotoxicity--arrythmias, QTc prolongation, sexual dysfunction, weight gain, hepatotoxicity, seizure,
141
TCA tertiary amines
Amitriptyline
| Doxepin
142
TCA secondary amines
Nortriplyine
143
Secondary amines description
lack active metabolism and have linear kinetics (wider therapeutic window)
144
TCA metabolism
Long half-lives; high concetrationsin CNS and cardiac tissue
145
TCA withdrawal
– GI complaints, dizziness, insomnia, restlessness
– Hyper-salivation, diarrhea, headache, vivid dreams
– Gradual dose reductions of per week helps reduce symptoms
146
TCA drug interactions
MAOI
SSRIs
Alcohol, other CNS depressants
147
MAOI MoA
– Irreversible inhibition of monoamine oxidase (1 to 2 weeks to restore)
– Responsible for metabolism of NE, 5-HT and dopamine within the neuronal synapse
• MAO-A – non-selective (NE, 5HT)
• MAO-B – selective for dopamine
148
Selegline dose for depression vs. PD
dosed higher for depression
149
MAOIs AE
– Postural hypotension
– Hypertensive crisis (food interaction)
– Sleep disturbances, weight gain
150
MAOIs drug interactions
```
– TCAs
– SSRIs
– Sympathomimetic agents (e.g. cocaine)
– Linezolid (antibiotic)
– MAO inhibition may persist for up to 10-14 days following discontinuation
```
151
SSRI MoA
Blocks serotonin transporter
| Reuptake of 5HT into presynaptic neuron = increased circulating 5HT
for post synaptic uptake
152
Which SSRI has the longest half life and what is it?
Fluoxetine (prozac) -- 5 days (5 week washout)
153
Which SSRI has the highest percentage of weight gain?
Paroxetine (paxil)
154
SSRI AE
• CNS
– Fluoxetine – activating (insomnia, anxiety, agitation) – Paroxetine – sedating
• Gastrointestinal
– Nausea, vomiting, diarrhea (highest with sertraline)
• Hematologic (monitor)
– rise risk of bleeding, esp. with aspirin, NSAIDs, anticoagulants
• Sexual dysfunction
– SSRIs have the highest percentage incidence
• Weight gain
– Paroxetine > all others
Cardio--QT prolongation
Hyponatremia
155
SSRI Withdrawal Syndrome
– GI complaints, flu-like symptoms, anxiety, insomnia
| – Most notable with paroxetine
156
Which SSRIs have QT prolongation?
Citalopram (celexa) and escitalopram (lexapro)
157
SSRI drug interaction
MAOIs, TCAs, Linezolid
158
Waiting period after SSRI before MAOI
5 weeks
159
Waiting period after MAOI before SSRI
2 weeks
160
With SSRIs have fewest drug interactions?
citalopram (celexa) and escitalopram (lexapro), and sertraline (zoloft)
161
Depression med used for smoking cessation
Buproprion (Wellbutrin)
162
Bupropion (Wellbutrin) AE
– Lowers seizure threshold
• Associated with high doses and abrupt withdrawal – Activating (tremor, insomnia)
– NO sexual dysfunction/weight gain
163
Mirtazapine AE
– Sedation–often given at bedtime (histamine blockade)
– Weight gain (higher than other options-increased appetite)
– Low incidence of sexual dysfunction
164
SNRIs MoA
Bind to serotonin (SERT) and norepinephrine (NET) transporters
– Prevent reuptake of both 5HT and NE (selective for NE)
165
SNRIs AE
– Hypertension (NE)
– Sexual dysfunction
– Insomnia (take in the morning) – Nausea
166
First line add-ons for depression
Burpoprion and Mirtazapine
167
Other add-ons for depression
– Atypical-antipsychotics
– SNRI / TCA (low doses)
– Buspirone (indicated for general anxiety disorder)
168
Depression meds that target anxiety or insomnia
Trazodone, buspirone or mirtazipine
169
Dpression rate in pregnant women
14-23%
170
Best depression med for pregnancy
sertraline
171
Depression meds associated w/ birth defects
Paroxetine (Paxil) /Fluoxetine (prozac)
172
Schizophrenia positive symptoms
```
– Delusions
– Hallucinations
– Disorganized speech – Unusual behavior
– Hostility
– Excitement
– Grandiosity
```
173
Schizophrenia negative symptoms
```
– Blunted affect
– Lack of motivation and pleasure
– Emotional withdrawal – Uncooperativeness
– Social withdrawal
– Poverty of speech
```
174
Antipsychotic Drugs MoA
– Dopamine (D2) receptor blockers inhibit the release of DA and thereby alleviate the positive symptoms of schizophrenia
– Serotonin (5-HT2) receptor blockers increase the release of DA and thereby alleviate the negative symptoms of schizophrenia
175
Typical Antipsychotic agent
Haloperidol (Haldol)
176
Typical Antipsychotics MoA
D2 receptors antagonists (Also block muscarinic, histamine and alpha-1 receptors)
177
Haldol route
tablet, injection, solution, depot
178
Typcial antipyschotics AE
anticholinergic side effects, orthostatic hypotension, QTc prolongation, extrapyramidal side effects, hyperprolactinemia
179
Haldol AE levels
Very low sedating, anticholinergic and hypotensive
| Very high EPS
180
Advantages of atypical antipsychotics
Less sedation, movement disorders and tardive dyskinesia
181
Disadvantages of atypical antipsychotics
More weight gain and metabolic disturbances
182
IM version of abilify
aristada
183
beneftis of abilify
less EPS and weight gain
184
Abilify indications beyond schizophrenia
MDD and BPD
185
Dosing for aristada
IM avail every 4-6 weeks
186
Transitioning to aristada
must continue PO treatment of abilify for the first 3 weeks
187
Abilify AE
Prolongation of QT
Anticholinergic effects -- dry mouth, urinary retention, constipation
Weight gain
Impaired glucose tolerance
Sexual dysfunction
hematologic (clozapine--agranulocystosis)
188
Which atypical antipsychotic can cause agranulocytosis
Clozapine
189
Atypical antipsychotics that cause weight gain the most
clozapine and olanzapine
190
Atypical antipsychotics that cause most sedation
clozapine and quetiapine
191
Atypical antipsychotics that cause most QTc prolongation
Ziprasidone
192
Atypical antipsychotic that doesn't cause QTc prolongation
Abilify
193
Atypical antipsychotic that has the highest EPS
Risperidone
194
Antipsychotic that treats schizo and MDD
Brexipiprazole
195
Antipsychotic that treas schizo and BD
Cariprazine
196
Med that newer gen antipsychotic has similar AE profile
Abilify
197
Lithium metabolism
Narrow range b/w therapeutic and toxic levels
| Frequent need for blood levels
198
Lithium warnings/contraindications
– Renal insufficiency
– Dehydration
– Sodium depletion
[decreased clearance -- increased risk of toxicity]
199
Lithium drug interactions
NSAIDs
– ACEI and ARBs
– Diuretics
[increased conc -- increased risk of toxicity]
200
Lithium AE
tremor, even when therapeutic
NVD
Cog impairment, fatigue
Seizures and death at v. high conc
201
Brexanolone MoA
Modulates GABAa
202
Brexanolone dosing
one time 60 hour infusion
203
Brexanolone indications
post-partum depression for those with no response to SSRIs at 6-8 weeks
204
Brexanolone AE
sedation/loss of consciousness (pulse ox needed)
205
Esketamine indications
used in combination with oral
antidepressant for treatment-resistant depression
206
Esketamine dosing
intranasal twice weekly in office
207
Esketamine AE
Extreme HTN, cog impairment, unsafe in pregnancy
208
Antiepileptic to avoid with sulfa allergy
Zonisamide
209
Which cholinesterase inhibitor would you give if a patient cannot tolerate PO meds?
Rivastigmine -- transdermal patch
210
Which drug class do you have to be careful prescribing patients who are on cholinesterase inhibitors?
Anticholinergics
211
Pharmacologic tx of Parkinson’s aims to increase _______ and decrease________ .
Dopamine, acetylcholine
212
Dopamine from ________ normally regulates _____ in ___________
substantia nigra, Ach, corpus striatum
213
Levodopa must be given as a combined therapy with______ which is given at____mg daily dose minimum.
Carbidopa, 75
214
A patient with Parkinson’s disease comes in concerned about their urine that is looking brown-orange. Which medications do you suspect this patient is taking? Is this a concerning adverse effect?
Entancapone prescribed with levodopa/carbidopa
215
A pt is prescribed Selegiline. What diet changes must you educate the patient on and why?
MUST avoid foods that contain Tyramine
(aged cheese, red wine, smoked meat, soy beans, etc)
Tyramine is a compound that regulates BP that can cause vasoconstriction and MAO breaks down NE
MAO inhibited with increased Tyramine → increased BP → HTN crisis → hemorrhagic stroke
216
Which of the following helps reduce tremor more than other manifestations?
Pramipexole
Rasagiline
Primavanserin
Benztropine
Benztropine
| Ach Receptor Antagonist
217
```
You have a 83 year old patient with dementia-related psychosis. Which medication would you be concerned about if you saw it prescribed to this patient?
Pimavanserin
Carbidopa
Tolcapone
Selegiline
```
Pimavanserin, b/c of BBW
218
Name the drugs that have a risk for causing AHS?
Phenytoin, carbamazepine, lamotrigine
219
What increases the risk for AHS?
HLA-B 1502 allele - southwest asian descent
220
Which drug class is used for status epilepticus?
Benzos
221
Name a drug that is highly protein bound
Phenytoin, perampanel, valproate, carbamazepine
222
What else causes high risk for drug interactions with phenytoin?
-- induced of 3A4, metabolized by 2C9 and 2C19 -- the more pathways it impacts, the more drug interactions!
223
Which oral antiepileptic is partially metabolized via autoinduction?
Carbamazepine
224
Education points for Carbamazepine
Give with food, watch for rash, careful with intense exercise, birth control change? Or at least use condoms
225
Antiepileptics to use during pregnancy
Keppra and lamictal
226
A 63 year old male with PMH of controlled epilepsy on one drug, uncontrolled DMT2, and controlled HTN on one drug. Allergies: PCN and sulfa drugs.
Recently CrCl = 55 so his drug dose is decreased.
Which drug is he on?
Topiramate
227
Antiepileptics that are excreted by the kidney
Zonisamide & topiramate
228
What are the advantages and disadvantages of atypical antipsychotics?
Advantages: less sedation, fewer movement disorders and TD
Disadvantages: metabolic disturbances
229
What to watch for with atypical antipsychotics
weight gain, glucose levels/A1C, lipids
230
Which antipsychotic medication are you likely to give an elderly, overweight patient with a history of cardiac dysrhythmias?
Aripiprazole (Abilify)
231
34 year old male with PMH depression and BMI 30 presents to clinic. Has been taking Escitalopram 20mg daily for 2 years, but recently his symptoms have increased. He reports lack of energy and inability to get out of bed in the morning or join social activities. What drug does the nurse anticipate will be added to his regimen?
Wellbutrin
232
Why give wellbutrin to overweight patient with no energy?
activating! and no weight gain
233
A patient taking Amitriptyline tells you after taking the medication for 2 weeks he doesn’t think it is working and just stopped taking the medication abruptly. What would you tell this patient and what effects (if any) would you expect to see?
Onset usually takes at least 4-6 weeks for full effect
Withdrawal syndrome
GI complaints, dizziness, insomnia, restlessness, hypersalivation, diarrhea, HA, vivid dreams
234
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Pt started on Fluoxetine and comes in complaining of low energy and drive. Which drug would you consider switching the patient to?
Paroxetine
Venlafaxine
Buproprion
Mirtazipine
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venlafaxine
235
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Which of the following medication combinations would not have adverse drug interactions?
Fluoxetine, Selegiline
Fluoxetine, Bupropion
Linezolid, Sertraline
Amitriptyline, Paroxetine
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Fluoxetine, Bupropion
| SSRIs have significant interactions with MAOIs, TCAs, Linezolid (has MAO inhibition)
236
Antibiotic that has MAO inhibition
linezolid
237
_________ receptor blockers alleviate the positive symptoms of schizophrenia, and_______ receptor blockers alleviate the negative symptoms of schizophrenia.
D2 receptor blockers inhibit the release of DA and alleviate the positive symptoms of schizophrenia
5-HT2 receptor blockers increase the release of DA and alleviate the negative symptoms of schizophrenia
238
List anticholinergic effects:
Dry mouth, urinary retention, constipation
239
What are 3 contraindications for Lithium?
Renal insufficiency
Dehydration
Sodium depletion
