Unit 5 Flashcards
1
Q
treatment of major depressive disorder in children
A
fluoxetine (prozac)
lexapro
2
Q
what age is fluoxetine approved for
A
children 8 and up
3
Q
what age is lexapro approved for
A
children 12 and up
4
Q
4 supplements used as adjunctive therapy in major depressive disorder
A
St. Johns Wort
SAMe
Omega-3
Folate
5
Q
MOA of benzos
A
binds to GABA-A receptors in the brain, increasing the opening of chloride channels along the cell membrane, leading to an inhibitory effect on cell firing
6
Q
Xanax duration
A
short acting
7
Q
Oxazepam (Serax) duration
A
short acting
8
Q
Ativan duration
A
intermediate acting
9
Q
Chlordiazepoxide (Librium) duration
A
long-acting
10
Q
valium duration
A
longest-acting
11
Q
SSRI onset of action
A
4-6 weeks
12
Q
TCA common SE (4)
A
sedation
ortho hypotension
anticholinergic effects
sexual dysfunction
13
Q
best treatment of anxiety/agitation in dementia
A
benzos short term
14
Q
SNRI MOA
A
potent inhibition of neuronal uptake of serotonin and norepinephrine and weak inhibition of dopamine reuptake
15
Q
venlafaxine drug class
A
SNRI
16
Q
duloxetine drug class
A
SNRI
17
Q
milnacipran drug class
A
SNRI
18
Q
fluoxetine drug class
A
SSRI
19
Q
paroxetine drug class
A
SSRI
20
Q
wellbutrin SE (6)
A
stimulant—suppresses appetite
dizziness
constipation
wt. loss
lowers seizure threshold (esp with etoh)
Tachycardia
Rhinitis
Dry mouth
Blurred vision
21
Q
what is discontinuation syndrome
A
non-life threatening
flu-like symptoms that occur after abrupt cessation of an SSRI
taper the dose!
22
Q
first line treatment of insomnia (4)
A
benzos
BZRAs: lunesta, ambien
rozerem
23
Q
second line treatment of insomnia (2)
A
sinequan
trazodone
24
Q
third line treatment of insomnia
A
Orexin receptor agonist— suvorexant (Belsomra)
25
treatment of insomnia in children
melatonin short term
26
treatment of insomnia in elderly
antihistamines or short acting benzo
27
treatment of insomnia in pregnant
unisom (doxylamine succinate)
28
med class to avoid in RLS
dopamine antagonists (Haldol, chlorpromazine)
29
treatment of RLS
dopamine agonists: requip, mirapex
gabapentin enacarbil (horizant)
30
novel agent used to treat generalized anxiety disorder
lyrica (pregablin)
30
first line treatment of generalized anxiety disorder
SSRIs and SNRIs
31
second line treatment of generalized anxiety disorder
TCA- imipramine
buspar
32
5 atypical antipsychotics used as adjunctive therapy for generalized anxiety disorder
abilify
seroquel
risperdal
geodon
zyprexa
33
prophylactic bowel regimen for opioid use (4)
1. Diet/ lifestyle modifications or Senna-S 2 tabs at bedtime
2. If no BM for 1 day → increase Senna-S 2-3 tabs 2-3x/day
3. If continued constipation → Miralax, Milk of Mag, or Mag Citrate
4. If no BM for 2 days → Dulcolax suppository, Dulcolax tab
34
what patients should you avoid giving morphine
renal impairment
35
MOA of tylenol
PG inhibition in the CNS
COX3 inhibitor
36
MOA of NSAIDs
reversible inactivation of COX1 and COX2
37
MOA of ASA
irreversible inactivation of COX1 and COX2
38
6 types of pain
acute
chronic
cancer-related
breakthrough
nociceptive
neuropathic
39
define nociceptive pain
occurs as a result of nerve receptor stimulation following a mechanical, thermal, or chemical insult. Considered purposeful or function pain.
40
3 types of nociceptive pain
somatic
visceral
inflammatory
41
define somatic pain
assoc. with muscle, skin, bone injury
localized
42
where are MU receptors located
CNS and GI tract
43
where are kappa receptors located
CNS
44
what do kappa receptors cause (4)
miosis
sedation
dysphoria
analgesia
45
where are delta receptors located
CNS
46
what do delta receptors cause (3)
antidepressant
euphoria
analgesia
47
what do mu receptors cause (9)
analgesia
resp depression
sedation
confusion
N/V
pruritus
urinary retention
miosis (pinpoint pupils)
constipation
48
oral morphine to oral hydromorphone potency
1:4
49
oral morphine to oral oxy potency
1:1.5
50
oral morphine to IV hydromorphone potency
1:20
51
define opioid use disorder
s/sx of withdrawal upon abrupt cessation, rapid dose decrease, or administration on antagonist
52
opioid withdrawal symptoms (14)
tremors
sweating
fever
anxiety
yawning
tearing
runny nose
dilated pupils
goosebumps/muscle twitch
N/V
diarrhea
abd cramps
muscle/bone pain
53
severe opioid withdrawal symptoms (6)
increased RR
perspiration
lacrimation (watery eyes)
mydriasis (dilated pupils)
hot/cold flashes
anorexia
54
common side effects of anti-epileptic meds used to treat neuropathic pain (gabapentin/lyrica) (5)
sedation
nausea
dizziness
wt gain
ataxia
55
diagnostic studies to assess for complications of NSAIDs (4)
creatinine
endoscopy
BP
aPTT, PT
56
why doesn't codeine achieve pain control in some patients
codeine is pro-drug converted to morphine facilitated by CYP2D6
assoc. with polymorphism leading to variability in metabolism
57
max dose of tylenol in older adults
3g
58
max dose of tylenol when 2 or more alcoholic drinks per day
2g
59
children max dose of tylenol
10-15kg
60
groups of patients medical cannabis is contraindicated (8)
pregnancy
severe cardiopulmonary disease
severe liver/kidney disease
neurologic symptoms
dyskinetic disorders
psychosis
adolescents
neonates
61
define cannabis use disorder
problematic pattern of cannabis use leading to clinically significant impairment or distress
cannabis withdrawal syndrome (10%)
62
what is marinol/dronabinol
synthetic THC for anorexia and chemo induced n/v
63
5 phytocannabinoids
Delta 9 THC
CBD
CBN
THCV
precursor acids
64
what is cesamet
synthetic THC derivative for chemo induced n/v
65
what is epidiolex/cannabdiol
used for children over age 2
oral CBD approved for treatment of seizures assoc with Lennox-Gastaut Syndrome
66
what is delta 9 THC (4)
responsible for psychoactive effects, memory, sensory, appetite
67
CBD effects (6)
mild psychoactive effects
antiepileptic
anti-cancer
anti dystonic
anti-inflammatory
may attenuate brain damage from ischemia
68
precursor acids have what effect
greatest COX 1&2 anti inflammatory effect
69
THCV effects (3)
panic attack reduction
appetite suppression
bone growth
70
CBN effects (2)
mildly psychoactive
sedative
71
where are cannabinoids metabolized
liver
72
pharmacokinetics of cannabinoids
highly lipophilic
high vol of distribution
highly protein bound
73
bioavailability of inhaled cannabinoid
rapid <10min
31%
74
bioavailability of oral cannabinoids
6%
slow onset 2-4 hrs
75
symptoms of cannabis OD (9)
dizziness
reddened eyes
dry mouth
dysphoria
ataxia
sedation
changed visual perceptions
altered sense of time
bronchitis
76
common side effects of metformin (6)
GI upset:
N/V/D
gas
loss of appetite
metallic taste
77
severe adverse event related to metformin (1)
lactic acidosis (esp with CKD/AKI)
78
common side effect of sulfonylureas (1)
wt gain
79
adverse events related to sulfonylureas (2)
hypoglycemia (esp etoh abuse, overexertion)
sulfa allergy
80
3 common side effects of thiazolidinediones
sodium retention
wt gain **
fat redistribution
81
5 adverse events related to thiazolidinediones
hepatotoxicity
CHF exac
bladder CA
hypoglycemia in combo with other oral antidiabetics
decreased efficacy of OCP
82
2 common side effects of meglitinides
wt gain
GI upset
83
6 adverse events related to meglitinides
hypoglycemia
URI
headache
arthralgias
back/chest pain
constipation/diarrhea
84
what to avoid when taking meflitinides (2)
BB
alcohol
85
common side effect of alpha glucosidase inhibitors
GI upset d/t delayed carb absorption
poorly tolerated
86
4 common side effects of incretins
N/V/D/dyspepsia
87
2 severe adverse reactions related to incretins
pancreatitis
hypoglycemia in combo with sulfonylurea
88
4 common side effects of DPP4 inhibitors
nausea at onset of therapy
URI
UTI
HA
89
5 severe adverse reactions related to DPP4 inhibitors
hypoglycemia with sulfonylurea
sitagliptin:
hypersensitivity
Steven Johnson syndrome
pancreatitis
elevated LFTs
90
3 common side effects of SGLT2
UTI
candida vulvovaginitis
wt loss
91
5 severe adverse reactions related to SGLT2
hypotension
dehydration
hyperkalemia
renal insufficiency
mycotic infection
92
common side effect of dopamine receptor agonists
nausea
93
6 adverse reactions related to dopamine receptor agonists
somnolence
fatigue
dizziness
vomiting
HA
ortho hypotension
94
4 common side effects of amylin analogs
N/V
HA
anorexia
95
how to treat hyperthyroidism in pregnancy
propylthiouracil (PTU)
lowest dose possible
decreases as pregnancy progresses and then increases again after birth
Tapazole is safe to admin 2-3rd trimester(patients can switch or continue with PTU)
96
first line treatment for DMI
four injection regimen
long acting daily
rapid or short acting at mealtimes
or combo intermediate and short acting
97
when to treat DMII
HBA1C >9
98
How to treat DMII
triple oral therapy + consider basal and short acting insulin
99
which medication is a biguanide
metformin
100
3 sultonylureas
glipizide
glimepiride
glyburide
101
when are sulfonylureas most effective
early in the disease process
102
which medication is a thiazoladinedione
pioglitazone (actos)
103
what is the onset of pioglitazone
4-6 weeks
104
contraindications of pioglitazoner
HF and RF (renal failure)
causes Na retention
105
2 big side effects of pioglitazone
weight gain **
fat redistribution
106
meglitinides suffix
-glinides
Ex repaglindine (prandlin)
107
which medication is an alpha glucodase inhibitor
acarbose (precose), miglitol (Glyset)
108
DPP4 inhibitors suffix
-agliptin
Sitagliptin (junuvia), saxagliptin (onglyza)
109
GLP1 receptor Agonist medication
-tide
semaglutide (ozempic), liraglutide (saxenda)
110
DPP4 contraindications (3)
DMI
RF- renal failure
pancreatitis
111
what class of medications should DPP4s NOT be prescribed with
GLP1 agonists produce natural GLP1 so DPP4 enzymes don't affect it
112
what class of medication should not be prescribed with sulfonylureas
DPP4 d/t increased risk of hypoglycemia
113
what is prescribed with metformin to preserve kidney function, reduce MACE, and weight loss
SGLT2
114
contraindications of metformin (4)
CHF
pregnancy
heavy ETOH use
Cr >1.4
115
hypothyroidism meds (3)
Synthroid
cytomel
armour thyroid
116
hyperthyroidism meds (3)
tapazole
propylthiouracil
radioactive iodine
116
adjunctive meds for hyperthyroidism
BBB (help with HR and anxiety symptoms)
Lithium (block release of thyroid hormone from gland)
Glucocorticoids (reduce conversoid form T3->T4)
117
monitoring for treatment fo thyroid disorders
TSH
Free T4
q4-6 weeks
q6mo when therapeutic, then eventually anually
118
when is the expected time for therapy to reach a steady state for thyroid disorders
6-8 weeks
119
when will patients receiving treatment for thyroid disorders feel symptom relief
2-4 weeks
120
PTU + methimazole- SE
fatal agranulocytosis
check and monitor CBC
121
PTU black box warning
severe liver injury
CBC and full LFTs before treatment initiation
122
levothyroxine life-threatening SE
cardiac events (arrhythmias, HF) esp in patients with pre-existing disease
123
injectable diabetes medication
Insulin
GLP1 receptor agonists
exenatide
liraglutide
dulaglutide
