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Week 6 (Exam 3) Flashcards

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1
Q

Recommended opioids w/ Hepatic insufficiency

A

Fentanyl: totally safe

Codeine, Meperidine, Methadone: totally unsafe

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2
Q

Endocannabinoid transmission process

A

Produced in post-synapse, raising intracellular Ca++
This activates DAG lipase
Cannabinoids go into space, bind CB1Rs pre-synapse
This inhibits Adenylyl cyclase, pre-syn hyperpolarization

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3
Q

Suvorexant MOA

A 
Blocks Orexin (wakefulness) binding
Lemborexant is similar
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4
Q

Preferred obstetric analgesic

A

Meperidine: less effect on fetal respiration and uterine contractions

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5
Q

Genito-pelvic pain penetration disorder

A

persistent or recurring difficulties with 1+ for 6mos:
Vaginal penetration
Vulvovaginal or pelvic pain during sex
Fear or anxiety about pain before or during sex
Tension or tightening of pelvic floor muscles during

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6
Q

Withdrawl symptoms associated with barbiturates, benzos, and EtOH

A

Anxiety, insomnia, delirium, tremors, seizures, death

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7
Q

Female orgasmic disorder

A

delay in or absence of orgasm 70-100% of the time for 6 mos

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8
Q

Cannabinoids

A

Anandamide (partial agonist)

2-Arachidonoylglycerol (2-AG, full agonist)

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9
Q

Splitting

A

People are either pure good or pure evil

Primitive, seen in borderline personality disorder

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10
Q

Lithium metabolism

A

Monovalent Ion
Competes with Na, builds up in Principal cells of CD
Can cause ADH resistance: Polyuria/polydipsia
(picture of nephrogenic DI)

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11
Q

Tourettes

A

multiple motor and vocal tics for more than 1 year

clinical triad of ACD, ADHD, Tourettes

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12
Q

Blocking

A

Temporary inhibition of thinking. Just “stops” momentarily

Neurotic

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13
Q

Black box warning for diazepam / benzos

A

Dont use with opioids: respiratory depression, coma, death

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14
Q

Drugs approved to tx tourettes

A

Haloperidol, Pimozide, Aripirazole

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15
Q

Undoing

A

Hoping to fix or reverse previously unacceptable behavior
Bulemia, intimate partner violence, compulsive behavior, superstition, checking behavior
Neurotic

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16
Q

Whats the difference between 2 and 3-amine SNRIs?

A

2 favors NE over 5-HT
3 favors 5-HT over NE (except clomipramine/amitriptyline)
Other SNRIs favor 5HT

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17
Q

Introjection / identification

A

Unconsciously taking others behaviors or emotions and internalizing them (when aware of it, its imitation)
Neurotic

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18
Q

Most common cause of death in abused children

A

Neglect

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19
Q

Modafinil

A

For Adults Only, tx ADHD

Inhibits DA reuptake

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20
Q

Persistent (chronic) motor or vocal tic disorder

A

One or the other, not both!

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21
Q

Trazodone MOA

A

Heterocyclic / Atypical antidepressant that acts as an SSRI and SARA (serotonin adrenergic receptor antagonist)

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22
Q

Bulemia criteria

A

Binge eating and inappropriate compensatory behaviors at least 2x/week for 3 mos
Body weight can be variable, unlike AN

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23
Q

Cluster A personality disorders

A

Schizotypal (magical/bizarre beliefs, egocentric)
Paranoid
Schizoid (loner by choice, flat affect)

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24
Q

Loperamide

A

u-agonist that cant readily cross BBB
Indicated for acute and chronic diarrhea
Take a lot to get high? risk torsade

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25
Cluster B personality disorders
Borderline (impulsive, emotional, self-harm) Histrionic Antisocial Narcissist
26
Lithium MOA
Limits DA (via Gs and Gi) and Glutamate (via NMDA) Increases GABA release and GABAb receptors Limits Myoinosital (via IPPase and IMPase) Limits PKC and MARCKS (anti-manic) and GSK-3 Increases CREB, producing BDNF and Bcl-2 (protect)
27
Varenicline MOA
Nicotinic receptor partial agonist | This is Chantix
28
Special MOA of Vortioxetine
SSRI that is also a 5HT-1b partial agonist Full agnost to 5HT-1a Full antagonist to 5HT-1D(3,7)
29
What two clinical indications are specific for administering Clozapine as an anti-psychotic?
Multi-drug resistant disease | Psychosis with anti-suicidal-thoughts/behaviors
30
Lithium Na/K-drug interations
Diuretics (esp thiazides): Na loss, Li reabsorption ACEi's (esp Lisinopril): renal eliminated NSAIDs: alteration of renal perfusion
31
Why would you want to tirade down from clonidine
Risk of Rebound HTN | do it over 1+ weeks depending on dose to discontinue
32
How do you treat a psychosis patient with poor adherence?
Long Acting Injectabe Agents | Risperidone, Olanzapine, Aripiprazole lauroxil (and paliperidone palmitate - fyi)
33
Non-stimulant ADHD medication MOA
Inhibit NE pre-synaptic uptake | Agnoists of CNS a2a adrenergics (guanfacine/clonidine)
34
Suspicious abuse injuries
``` Posterior rib fractures Scapular fracture Spinous process fracture Sternal fracture Metaphyseal lesions ```
35
Causes of positive schizophrenia sx
Overactive mesolimbic pathway VTA to Nucleus Accumbens D2
36
Carbamazepine indications
acute and maintenance treatment of acute mania and mixed episodes (Bipolar I) Major CYP450 inducer!
37
Sx of serotonin syndrome
``` Hyper-reflexia Clonus Dilated pupils Hyperactive bowels Tremors Sweating ```
38
Nigrostriatal Pathway
Fron SN to BG Stimulates purposeful movement D2 antagonism induces extrapyramidal sx
39
forms of methylphenidate rx
Tab: dexmethylphenidate (Focalin) and methylphenidate Liquid: Methylphenidate oral
40
How does HTN crisis result from an MAOi?
MAO-A is necessary for tyramine metabolism in the GI Tyramine buildup releases catecholamines Selegiline blocks MAO more as the dose goes up
41
Dronabinol
Synthetic d-9-THC | For anorexia in AIDS patients, Chemo-induced N/V
42
Main distinction between ASD and Intellectual disability
Presence of restricted interests or repetitive behavior
43
XR amphetamine formulations
Adzenys XR-ODT (dl-amphetamine) 3:1 D:L 50-50 IR and XR No water necessary, ages 6+, q.d. dosing
44
Therapeutic concentration of Li
0.6 - 1.2 mEq/L | Trough at steady state (7-10 days)
45
Tablet medications for ADHD
Dextroamphetamine (AMP/Adderall, Zenzidi)
46
Considerations for Guanfacine and Conidine
Do not crush, chew, or break Ages 5+, q.d. dosing (H.S. for clonidine) Non-stimulant treatment of ADHD
47
Moderate drinking
Men: 2 drinks or fewer / day | Women, people over 65: 1 or fewer/day
48
Special indications for alprazolam and diazepam
alprazolam has anti-depressant and anti-panic effects | diazepam has skeletal muscle relaxing effects
49
Major warnings associated with SSRIs
``` Serotonin Syndrome (sweat, hyperreflexia, tremors, etc) Suicidality (esp young people) ```
50
What unique side effect is associated with Clozapine?
Agranulocytosis
51
Cariprazine MOA
5HT-2a and DA antagonist | Partial DA/5HT-1a Agonist
52
5HT-2a/DA antagonists for tx psychosis
Iloperiodone, Lurasidone (also partial 5HT-1a agonist), Paliperidone (from risperidone), Risperidone, Ziprasidone
53
reaction formation
Taking unconscious threatening wishes or impulses and making them opposite Neurotic
54
Opioids + anti-cholinergics
increased constipation and urinary retention
55
Buprenorphine MOA
Partial u-opiod receptor agonist
56
Somatization / Hypochondriasis
Transforms negative feelings towards others to self, pain, illness, anxiety Neurotic
57
Disulfiram MOA
Irreversibly inhibits aldehyde dehydrogenase | Causes extreme sickness if EtOH is consumed
58
Ego
Resolves conflicts | Keeps us grounded to reality
59
SARA Side effects
CNS (sedation): most w/ Trazadone and Mirtazapine Orthostatic HPTN: most w/ Trazadone Weight Gain: most w/ Mirtazapine
60
Mechanism behind Pre-synaptic release of NE and DA when taking Bupropion
VMAT2
61
Considerations of hydrocodone
Only available formulated with other drugs like ibuprofen
62
Enzymes that hydrolyze cannabinoids
FAAH: does Anandamide post-synapse | MAG-Lipase does 2-AG presynaptically
63
Doxepin
H1 antagonist, NE/5HT reuptake inhibitor Causes sedation, maintenance for insomnia Treatment resistant major unipolar depressive disorder
64
Why is codeine ineffective in some people?
They might lack the CYP2D6 Gene, which metabolizes it to morphine (required for analgesia)
65
Naltrexone
Prevents euphoria from opioids (but not craving) | Reduces craving for alcoholism
66
Causes of negative and cognitive schizophrenia sx
Mesocortical pathway dysfunction | VTA to frontal cortex
67
Whats the difference between SNRIs and TCAs?
TCAs are SNRIs, except they also impact: | Histamine (H1), Muscarinic (cholinergic), and a1 (adrenergic) receptors
68
Brexanolone
GABAa receptor (positive allosteric modulator) Identical to Allopregnanolone, for Postpartum Depression Superior efficacy at 60 hours, lasts up to 30 days
69
Histrionic comorbidities
Somatic Sx, Conversion, Depressive
70
Head injury and opioids
they can increase intracranial pressure and make it worse, actually
71
Female sexual interest / arousal disorder
At least 3 of the following for 6 months: | Absent/reduced interest; thoughts; initiation; pleasure; interest in response to cues; sensation during sex
72
Treatment for binge eating disorder
Vyvanse
73
Presentation of Borderline Personality Disorder
Pattern of undermining self right before success | State of crisis, unpredictable, splitting
74
Overdose effects that appear as drunken behavior
Barbiturates, benzos, EtOH
75
Primitive defense mechanisms
Childhood, dreams, psychotic adults Rearrange external experiences so no need to cope Projection, Denial, Splitting
76
How to treat splitting and other attachment dangers associated with borderline personality disorder
Dialectical Behavioral Therapy
77
Second gen anti-psychotic MOA
Block D2 post-synapse AND 5HT2a (more strongly)
78
Buprenorphine MOA
partial u agonist and full k antagonist
79
treat opioid withdrawl
``` Buprenorphine or methadone Buprenorphine and naloxone Clonidine for BP Diphenhydramine for itching and rhinorrhea Imodium for diarrhea ```
80
Side effects of MAOi's
Drug interactions w/ 5HT/NE drugs: 2 week washout period (5 weeks for fluoxetine) HTN Crisis Risk Serotonin Syndrome Risk Orthostatic HPTN, sexual dysfunction, weight gain, etc
81
Atomoxetine
24 hour capsule for non-stimulant ADHD medication Metabolized by CPT 2D6 Ages 6+, q.d. dosing
82
Drugs able to treat irritability and agitation associated with autism
Risperidone | Aripiprazole
83
At-Risk drinking
Men: more than 14 /week or 4/occasion Women: more than 7/week or 3/occasion
84
General, constitutional, "other" side effects of Li
Tremor, Confusion, Dizziness, Sedation Thyroid Goiter (hypothyroidism) Leukocytosis (stimulates M-CSF) Seizures and Serotonin Syndrome
85
Epipiolex
Oral CBD to treat Childhood epilepsies Lennox Gastaut and Dravet
86
Sustained release methylphenidate-based stimulations
Methylphenidate-SR, methamphetamine tabs Methylphenidate transdermal Methylphenidate HCL, chewable Methylphenidate XR, liquid
87
Delayed ejaculation
Either delayed ejeculation or infrequent or absent ejaculation for 6 mos
88
The 5 R's of anti-depressants
``` Response (or partial response) Remission (sx free) Relapse (return of sx after remission, before recovery) Recovery (6-12 months of remission) Recurrence (return of sx after recovery) ```
89
Multi-acting receptor-target agents (2nd gen anti-psychotics)
Asenapine, Clozapine, Olanzapine, Quetiapine | Lumateperone
90
Nefazodone MOA
Heterocyclic / Atypical antidepressant that acts as an SSRI and SARA (serotonin adrenergic receptor antagonist)
91
Etiology of ADHD Executive Function Defect
DA/NE deficiency in PFC (Dorsal Anterior Mid-Cingulate Cortex)
92
Indications for the variations of Fentanyl
Anesthesia
93
butalbital indications
headache pain (half life ~35 hrs)
94
Methylnaltrexone
u-antagonist that cannot readily cross BBB | Indicated for opioid-induced constipation
95
Temazepam indications
insomnia (along with triazolam)
96
Valproic Acid / Divalproex indications
Acute Bipolar I | Therapeutic [serum] 50 - 125 mcg/mL
97
Which antidepressant is the only one used to treat OCD?
Fluoxetine
98
Ramilteon MOA
Activates MT1 and 2 (melatonin) receptors in Suprachiasmatic nuclei of CNS for sleep disorders Fluvoxamine inhibits its metabolism Tasimelteon is similar
99
First generation Anti-Psychotic MOA
Primary Block D2 post-synapse | also may block muscarinics, histaminics, a-adrenergics, D2 in nigrostriatal and tuberoinfundibulnar paths
100
Diazepam metabolism
CYP3a4 (major)
101
ADHD Dx tools
Computerized: TOVA, Conners Checkists: Vanderbilt, Conners
102
What SSRI has the most drug interactions (CYP450) and what has the least?
Most: Fluoxetine Mid: Citalopram, sertraline vlazodone Least: Vortioxetine and Escitalopram
103
Binge drinking criteria for men and women
4+ drinks in an occasion for women, 5 for men
104
Preferred analgesic for MI
Morphine
105
Acamprosate
Alcoholism medication | Reduces desire to drink
106
Binge Eating Disorder Criteria
1x/week for at least 3 mos, at least 3 of: Binging when not hungry; eating rapidly; becoming uncomfortably full; eating alone because of it; guilt/depression/disgust after purge
107
Manage a patient on nolly
Hypertonic saline Ice bath Benzos for psychomotor agitation and shivering Cyproheptadine for Serotonin Symptom Signs
108
Where are CB2 receptors found?
Immune cells, they modulate cytokine release | Anandamide and 2-AG have more CB-1 Affinity
109
Barbiturate MOA
Binds GABAa and increases duration of Cl- opening Hyperpolarizes cell for fewer APs High doses can directly open Cl in absence of GABA Inhibit some glutamate receptors
110
Naltrexone MOA
u-opioid receptor antagonist (long acting)
111
Drugs for treating acute methanol or ethylene glycol poisoning (2)
Ethanol | Fomepizole
112
Barbiturates and sleep
Loss of REM. Made up for when discontinued gives sense of restlessness RAS is particularly targeted by barbiturates
113
Nabilone
THC capsule for chemo-induced N/V
114
Bupropion
Tx ADHD, may increase risk of seizure
115
Lamotrigine indications
Maintenance of Bipolar I and II
116
Special ability of codeine
cough suppressant
117
Capsule medications for ADHD
Amphetamine Sulfate Dextroamphetamine XR Lisdexamfetamine Amphetamine (mixed)
118
Non-benzo BZ-1 binders
Zolepidem Eszopidone Zaleplon
119
Isolation of affect
voiding emotion from ideas and events. | Neurotic
120
Oxycodone metabolism
CYP3A4
121
First generation Anti-Psychotics (6)
``` -azine's (Chlorprom/Fluphen/Thiorid) Haloperidol Loxapine Molindone Pimozide Thiothixene ```
122
Alcohol Detox order set
Benzos, anti-psychotics, fluids (Mg, K), Vitamins (thiamin, folic acid), Restraints if needed
123
Cluster C personality disorders
Dependent Avoidant (fear of rejection) OCPD (inflexible, rigid, order and detail)
124
Tuberoinfundibular pathway
Prolactin Release Hypothalamus to infundibular region Inhibited by DA (inhibition increases prolactin)
125
Signs of overdose with Stimulants like blow
Agitation, HTN, Tach, seizures, death
126
Toxic ingestion / OD of tricyclics
Coma, Cardiotoxicity, Convulsions
127
ED
One of the three in almost all occasions for 6 mos: | Difficulty obtaining; difficulty maintaining to completion; decrease in rigidity
128
ADHD first line treatment for 12-18
Medication (can add therapy too)
129
ADHD first line treatment for age 6-11
medications AND/OR behavior therapy
130
Side effects of NDRI's (Bupropion)
SIEZURES (dose dependent, or those at risk) | Stimulation: agitation, insomnia, HTN/Tach/Tremors, Weight Loss
131
Special MOA of bupropion
Heterocyclic / atypical antidepressant that also increases NE and DA pre-synaptic release
132
What are the two u-blocking k-agonizing opioids?
Pentazocine | Butorphanol
133
Benzo MOA
Increases Cl- channel opening on GABAa Greater post-synaptic response to released GABA local hyperpolarization means cell is less likely to fire
134
What unique side effect is associated with Olanzapine?
DRESS: drug reaction w/ eosinophilia and systemic sx
135
Midazolam
pre-operative sedation (this is versed) acid is water soluble, then lipid soluble in vivo associated with respiratory depression and cardiac arrest
136
Criteria for antisocial personality disorder
Must be 18 years old with evidence of behavior patterns before 15 years old
137
Risk factors for child maltreatment
Fussy, colicky infant Behavioral problems (esp hyperactive) Illness, Prematurity, non-biological caregiver
138
Drugs to help gain weight from Anorexia
Olanzapine 2.5 - 10mg/day
139
Medications to avoid when treating anorexia
Bupropion!! (seizures) (goes for bulimia as well) TCAs (cardiotoxic) Anti-psychotics and antidepressants (QT prolongation)
140
Partial DA/5HT-1A receptor agonists for tx psychosis
Aripiprazole | Brexpiprazole
141
Special MOA of Vilazodone
SSRI that is also a 5HT-1a partial agonist
142
What should you determine in all patients considered for anti-psychotics?
Serum glucose, lipids, weight, BP, Waist circumference, FHx of metabolic and CV disease
143
Drugs for treating acute alcohol withdrawal (4)
Diazepam (Valium) Lorazepam Oxazepam Thiamine (B1)
144
Premature ejaculation
finish within 1 minute almost every time for 6 mos
145
Mirtazapine MOA
Heterocyclic/atypical antidepressant that is also an SSRI Blocks pre-synaptic a2 receptors on NE and 5HT recs Blocks Post-Synaptic 5HT-2/3 receptors No SERT/Net Activity Also H1 blockade (sedation)
146
Sensate focus
No intercourse allowed for a while, eventually systematically reintroduce it
147
Intellectualization
Focusing on / exaggerating intellectual aspect of a situation to avoid the anxiety part. e.g. focusing on lab results of a crazy disease Neurotic
148
Liquid medications for ADHD
Amphetamine/Dyanavel XR | Dextroamphetamine Sulfate
149
Rare side effects of ADHD stimulants
Priapism, Seizures (may lover convulsive threshold), sudden cardiac death, stroke/MI, leukoderma w/ Daytrana patch
150
Treat extra-pyramidal side effects of first gen anti-psychotics
Anticholinergics (benztropine, trihexyphenidyl) | Antihistamines (diphenhydramine)
151
Pimavanserin
Inverse 5HT agonist/antagonist | Parkinson's Psychosis
152
ADHD stimulant MOA
Block reuptake and inhibit VMAT Increase NE, then DA, then 5-HT at increasing dose D-isomers have more CNS activity
153
DA-assoicated side effects of first gen anti-psychotics
Hyperprolactinemia (amenorrhea, galactorrhea, gyno, decreased libido) Tardive dyskinesia/acute akathisia/dystonia/PD-like
154
Treat stimulant overuse
HTN and hyperthermia: Phentolamine | Psychotic sx: Haloperidol
155
Special MOA of selegiline
MAO inhibitor that is only selective at low doses. High doses are non-selective (like every other MAOi) Anti-depressant version comes as a patch
156
Presentation of anti-depressant withdrawl
Flu-like, Insomnia, Nausea, imbalance, sensory disturbance, hyperarousal
157
Treat Tardive Dyskinesia associated with first gen anti-psychotics
Selective vesicular monoamine Transporter 2 (VMAT2) inhibitors: Valbenazine, Deutetrabenazine
158
Tuberomammilary nucleus
Controls general states of metabolism and consciousness
159
Flumazenil
Non-Benzo GABAa binder (blocks them) | Black box for seizures, esp. w/ long-term sedation or TCAs
160
Regions of the brain protected by lithium
Anterior cingulate cortex Superior temporal gyrus Ventral prefrontal cortex Hippocampus
161
Frotteuristic disorder
touching or rubbing against a non-consenting person
162
Diazepam indications
alcohol withdrawal, anxiety, muscle spasm, status epileptics | Off-label: chloroquine toxicity, sympathomimetic toxicity, opioid withdrawal, serotonin syndrome, vertigo
163
Side effects of Tricyclics
Cardio: Tach, Ortho HPTN, Dysrhythmias Anti-Cholinergic: Dry mouth, retention, blurred vision CNS: sedation/fatigue, dizziness/seizures
164
Recommended opioids w/ renal insufficiency
Fentanyl: safe Methadone: kinda safe Meperidine and Codeine: totally unsafe
165
SERT
Does Pre-synaptic Serotonin Reuptake
166
Acamprosate MOA
weak NMDA antagonist and GABAa agonist
167
Opioids + MOAIs
Hyperpyrexic coma
168
Special MOA of methadone
Not only a u and k agonist but also NMDA antagonist
169
Pharmacotherapy for Bulimia
1. Fluoxetine 60mg/day or taper up from 20 2. SSRIs like Sertraline or Fluvoxamine. High dose 3. TCAs, Topiramate, Trazodone, MAOIs
170
ADHD First line treatment 4-5 years old
Parent and/or teacher administered behavioral therapy
171
Phenobarbital indications
tonic-clonic seizures
172
Male Hypoactive Sexual desire disorder
Must last 6 months
173
What effects do Mu receptors have that Kappa don't?
Respiratory depression Euphoria Physical dependence
174
Methylphenidate MOA
Inhibits DA reuptake (doesn't stimulate its release)
175
What drug do you use to treat alcohol withdrawal if there is a known liver impairment?
Lorazepam
176
Neuroleptic Malignant Syndrome
Rare Parkinson-like movement disorder with wide-spread muscle contraction Associated with 2nd gen anti-psychotics Tx w/ Dantrolene
177
Off label use of Li
Reduces risk of suicide and all-cause mortality in patients with mood disorders
178
Drugs for preventing alcohol abuse (3)
Acamprosate Disulfiram Naltrexone

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