Wfusm Opiod Antidepressant Pharmacology

Front 1

Name opiod agonists, antagonists, agonist-antagonists

Back 1

Agonist-Morphine
Antagonist- Naloxone
Agonist-antagonist- Nalorphine

Front 2

Name 6 characteristics of Morphine
1-effective for what kind of pain
2- reversed by
3- more effective dull or sharp?
4-selective or non-specific?
5-does or does not alter pain perception
6 blocks

Back 2

1-severe pain
2-reversed by naloxone
3-effective on dull pain
4-selective
5-dose NOT alter perception
6-blocks spinal reflex

Front 3

Will a patient on morphine respond to a pin prick?

Back 3

yes

Front 4

What is the neurophysiology mode of action of opiates

Back 4

reduces neuronal firing rate
in regions like dorsal horn, periaquiductal gray matter, limbic system, thalamus

Front 5

Mu receptors
name endogenous ligand and distribution (6)

Back 5

Ligand- beta-endorphin
Distribution- thalamus, PAG, dorsal horn, accumbens, brainstem (respiration), basal ganglia

Front 6

Endogenous ligand and distribution of delta receptor (4 regions)
importantly not located in -

Back 6

ligand-enkephalin
Distribution: amygdala, accumbens, dorsal horn, BG
Importantly NOT in the thalamus or brainstem

Front 7

Delta receptors use what ligand and distribution

Back 7

Ligand- enkephalin
Distribution- amygdala, accumebs dorsal horn, basal ganglia
NOT in brainsteam

Front 8

Kappa receptors have what endogenous ligand and distribution?

Back 8

Ligand-dynorphin
Disribution analgesia areas (thalamus, PAG) basal ganglia
NOT in the brainstem

Front 9

Of enkephalin, B-Endorphin, and Dynorphin which is the most rapidly degraded?

Back 9

Enkephalin, its a pentapeptide

Front 10

Of enkephalin, B-Endorphin, and Dynorphin which is released from pituitary during stress

Back 10

B-Endorphin

Front 11

Which opiate is commonly used orally?

Back 11

Codeine, it is absorbed in GI

Front 12

Name 6 central effects of Morphine (non-alalgestic)

Back 12

1- Respiratory Depression
2- Miosis
3-Nausea
4-Anti Tussive
5-Sedation/euphoria
6-Increase in ADH

Front 13

What are 4 peripheral effects of morphine?

Back 13

Anti Diarrheal
Decreased Uterus Contraction
Bile (bilosis?)
Orthostatic hypotension

Front 14

Why does morphine cause respiratory depression?

Back 14

There are mu receptors in the brainstem nuclei for respiratory control

Front 15

Name two moderate analgesic opiate agonists

Back 15

Oxycodone (Percodan) and Meperidine (Demerol)

Front 16

Name two very weak opiate agonists

Back 16

Diphenoxylate (lomotil) and Propoxyphene (Darvon)

Front 17

Name a very strong opiat agonist (mostly used in veterinary setting)

Back 17

Etorphine (Immobilon)

Front 18

Name 3 strong opiate agonists

Back 18

Morphine, Heroin, and Methadone

Front 19

Which opiate agonist is a useful clinical anti diarrheal?

Back 19

Diphenoxylate (tradename- Lomotil)

Front 20

Drug that is as potent as morphine but more orally available?

Back 20

Methadone (Dolophine)

Front 21

Which opiate agonist is highly abused by over prescription?

Back 21

Oxycodone (Percodone)

Front 22

Name 2 opiod antagonists, which one is oral

Back 22

Naloxone and Naltrexone (oral)

Front 23

Name two opiate agonist-antagonists

Back 23

Nalorphine and Pentazocine

Front 24

Which opiate antagonist would you use in the Emergency Room for drug OD and which to treat addiction?

Back 24

Naloxone in the ED bc it is fast acting IV

Naltrexone in addiction bc it's a pill

Front 25

Why doesn't Pentazocine work that well to treat addiction? What has more success in this setting?

Back 25

It causes dysphoric side effects

Nalorphine has more success

Front 26

3 properties usually noticed with addictive drugs

Back 26

Tolerance
Physical Dependence
Psychological Dependence

Front 27

As a class the tricyclic antidepressants have this mechanism

Back 27

Inhibit the reuptake of NE and 5-HT

Front 28

Monoamina oxidase inhibitors have this mechanism of action

Back 28

Stop the breakdown of NE, 5HT and DA through inhibition of MOA

Front 29

Name 3 prominent tricyclic antidepressants

Back 29

Imipramine
Amytryptiline
Desipramine

Front 30

Name 3 prominent MAOis

Back 30

Tranycypramine
Phenezlzine
Isocarboxazid

Front 31

What is Buproprion used for and how does it work

Back 31

It's an atypical antidepressant
weak DA, NE uptake inhibitor

Front 32

What is Mitrazapine used for and how does it work

Back 32

It's an atypical antidepressant
Increases release of 5-HT and NE

Front 33

What is Lithium used for and how do we think it works?

Back 33

Mood stabilizer/anti manic
decreases synthesis and release of DA/NE

Front 34

Valproate is what type of drug and how does it work?

Back 34

Anticonvulsant
Sodium Channel blocker that blocks breakdown of GABA

Front 35

What kind of drug is carbamezepine and how does it work?

Back 35

Anticonvulsant
Sodium channel blocker
Can be a GABA agonist at some receptors

Front 36

What is Lamotrigine and how does it work

Back 36

Anticonvulsant
Sodium channel blocker
blocks glutamate release

Front 37

Name 3 drugs in the valproate class

Back 37

Divalproex, Depokate, and Depakene
these are anticonvulsants

Front 38

Name 2 drugs in the Carbazepine class

Back 38

Tegretol, Trileptal
These are anticonvulsants

Front 39

What drug is in the Lamotrigine class

Back 39

Lamictal
Anticonvulsant

Front 40

Why do antidepressants take 2-3 weeks to work?

Back 40

There is a compensatory decrease in firing rate
There can be a downregulation of autoreceptors

Front 41

What are side effects of TCAs?

Back 41

Anticholinergic effects- dry mouth, constipation, urinary retention
Alpha 1 blockade-hypotension

Front 42

Common side effects of SSRI

Back 42

GI disturbance and insomnia

Front 43

What kind of drugs potentiate side effects of TCAs?

Back 43

protein-bound like aspirin or scopolamine

Front 44

What kind of drugs interfere with metabolism and increase TCA concentration?

Back 44

Neuroleptics, oral contraceptives

Front 45

What drugs induce liver enzymes to decrease plasma concentration of TCAs

Back 45

barbiturates, sedatives, cigarette smoking

Front 46

Describe a toxic food and drug interaction with MAOis

Back 46

Hypertensive crisis- the inhibited MAOi cannot metabolize tyramine from diet which promotes release of catecholamines

Treat with alpha blocker like prazosin or phentolamine

Front 47

What kind of foods need to be monitored on patients taking MAOis

Back 47

tyramine containing ones like cheese, bananas, liver, smoked fish, avacado, beer/wine, and chocolate

Front 48

What is the class and action of luoxetine (prozac)

Back 48

Inhibits reuptake of monoamines

Front 49

Name 3 SSRIs and their mechanism of action

Back 49

Sertaline, Paroxetine, and Citolpram
Block 5-HT transporter

Front 50

Name a SNRI

Back 50

Duloxetine