Y2S2B2 - Pharm - Review

Front 1

NE & DA are converted from what amino acid?

Back 1

tyrosine

Front 2

stimulation of which serotonin receptor causes emesis?

Back 2

5-HT3

Odansetron is

Front 3

Which NE bundle arises from the locus coeruleus ajd projects all over the CNS?

Back 3

Dorsal bundle. Anterior strokes along this path can cause a functional depression

Front 4

Where do serotonergic neurons arise from?

Back 4

Raphe nuclei

Front 5

What are 2 drugs that decrease NE or 5-HT and are depressive?

Back 5

reserpine & methyldopa

Front 6

Which receptors are down-regulated in anti-depressant tx?

Back 6

alpha2 & beta1 adrenergic receptors & 5-HT2 receptors

Front 7

Which TCA decreases seizure threshold?

Back 7

desipramine

Front 8

Which TCA can be used for neuropathic pain?

enuresis?

Back 8

Amitriptyline

Imipramine

Front 9

Akathesis occurs particularly w/ which SSRI?

Back 9

fluoxetine

Front 10

Which antidepressant class causes increased concentration of clozapine & may precipitate seizures?

Back 10

SSRIs

Front 11

Which SSRI is most stimulatory?

most sedating?

in the middle?

Back 11

stimulating - Fluoxetine
sedating - Paroxetine
middle - Sertraline

Front 12

Nefazodone (atypical antidepressant) has significant interactions w/ which drugs?

Back 12

triazolam, alprazolam (triazolobenzodiazepines)

Front 13

How do diuretics affect Lithium levels?

Back 13

Anything that decreases Na leads to increased Li reabsorption in the proximal tubules (Na+-depleting diuretics like thiazides). NSAIDs also facilitate proximal tubular reabsorption. Excretion is increased by volume-depleting diuretics.

Lithium may initially cause polyuria/polydippsia. It may induce nephrogenic diabetes insipidus.

Front 14

Which drug accumulates in thyroid and interferes with TH synthesis? Can cause reversible goiter or hypothyroidism.

Back 14

Lithium

Front 15

Overdose of carbamazepine should be treated like an overdose of what?

Back 15

TCA

Front 16

What drug can cause blood dyscrasias?

Back 16

Carbamazepine (unlikely w/ tx of mood disorders)

also long-term use can cause drowsiness, vertigo ataxia, blurred vision, N/V

Front 17

HTN is seen in some pts w/ which SNRI?

Back 17

Venlafaxine

Duloxetine can have urinary retention and liver effects

Front 18

Used for acute relief/panic attack?

Back 18

Alprazolam or Clonazepam

NOT diazepam d/t SE profile

Front 19

Which drugs bind directly to GABA site at high doses?

Back 19

Barbiturates! not BZDs

Front 20

Which short-acting BZDs are good for sleep disorders?

Back 20

triazolam or oxazepam

Front 21

Most benzos are metabolized by CYP3A4 and CYP2C19 in liver to desmethyldiazepam, except which one that is converted to the active metabolite somewhere else?

Back 21

Clorazeptate - decarboxylated in gastric juice

Front 22

Sedative effects of benzos can be reversed w/ what?

Back 22

Flumazenil (competitive antag of BZD receptor)

Front 23

Which benzos should be used in elderly?

Back 23

Oxazepam or Lorazepam - not likely to accumulate b/c they directly undergo conjugation before excretion. no active metabolites.

Front 24

Which anti-anxiety drug can you use for pts with a history of drug abuse? What are other good uses of it?

Back 24

Buspirone - can also be used in pregnancy/lactation & it doesn't cause sedation
partial agonist at 5-HT1a receptors

Front 25

Which opioid inhibits 5-HT reuptake, has anti-muscarinic effects, and decreases seizure threshold?

Back 25

Meperidine

Tramodol (weak opioid) also inhibits serotonin reuptake.

Front 26

Drugs used to wean off heroin addicts?

Used for outpt opioid detox?

Back 26

mixed-acting (pentazocine, nalbuphine, butorphanol)

partial agonist - buprenorphine

Front 27

Drugs indicated in fibromyalgia tx?

Back 27

Pregabalin, Duloxetine/Gabapentin, Tizanidine, Trazodone, Amitriptyline/Nortriptyline

Front 28

Triptans (tx of migraine) are CI in what pts?

SE?

Back 28

CI: pregnancy & pts w/ gangrene
SE: throat or chest pain

MOA: 5H1d receptor agonist -> vasoconstriction

Front 29

DOC for post-herpetic neuralgia?

DOC for trigeminal neuralgia?

Back 29

Gabapentin (or pregabalin)

Carbamazepine

Diabetic periph neuropathy can be treated w/ Pregabalin/duloxetine

Front 30

Long-term use of N2O can cause symptoms similar to what vitamin defic?

Back 30

B12 (pernivious anemia) --> neuropathy, tinnitus, numbness

Front 31

What drug is CI in dz's that involve air-filled cavities (bowel obstruction, pneumothorax, etc.)?

Back 31

N2O

Front 32

What may help improve liver fxn when there is abnormal fxn from valproate?

Back 32

oral or IV L-carnitine

Front 33

Which drug is approved for monotherapy in absence seizures in kids?

Back 33

Ethosuximide

it is NOT protein bound (most AEDs are) and can cause weight loss

Front 34

Which AED has a narrow TI and a non-linear/saturable metabolism and non-linear elimination of drug (individual variation in steady state plasma conc)?

Back 34

Phenytoin

Front 35

Paradoxical increase in seizure frequency occurs with which AED?

Back 35

phenytoin (>150 umol/L)

Front 36

Chronic use of which AED can cause gingival hyperplasia esp in children & young adults & hirsutism esp in young females?

Back 36

Phenytoin

can also cause hypERglycemia and osteomalacia. also hypoprothrombinemia in neonates.

Front 37

What drug is usually given IV for status epilepticus after BZDs and can cause cardiac arrhythmias?

Back 37

Fosphenytoin (more water soluble than phenytoin)

Front 38

Which AED has fluid retention/hyponatremia as a SE?

Back 38

Carbamazepine

(decreased plasma levels of endogenous ADH)

It is more pronounced in its prodrug - oxcarbazepine

Front 39

Which AED is MCly a/w SJS?

Back 39

Carbamazepine

strongly a/w HLA-B1502 allele & greater risk in asians

Front 40

What drugs are useful in febrile seizures in children and in status epilepticus?

Back 40

Phenobarbitol (esp recurrent febrile), a long-acting barbiturate that acts at GABAa receptors to increase duration for which Cl channels remain open

It is habit-forming and a/w behavioral problems in kids/agitation&confusion in adults

Also Diazepam (rectal) & Lorazepam (BZDs)

Front 41

What drugs are indicated in absence seizures refractory to ethosuximide & valproate, Lennox-Gastaut syndrome, infantile spasms & restless legs?

Back 41

Clonazepam & Clorazepate (clorazepate not in <9 yo)

Front 42

order of pharm management for status epilepticus

Back 42

IV Diazepam or Lorazepam (monitor for resp depression) --> add longer acting AED such as phenytoin of fosphenytoin (monitor cardio status) --> phenobarbitol (monitor for resp depression & hypotension) --> general anesthesia & intubation

Front 43

Which AED can cause decreased sweating in children, aplastic anemia, renal stones and is CI in sulfonamide allergies & children <12yo?

Back 43

Zonisamide. it blocks Na & t-type Ca channels. excreted mostly in urine & has long t1/2.

Front 44

Large doses of what during regional anesthesia may lead to accumulation of o-toluidine (oxidizing agent capable of converting HgB to metHg). The pt may appear cyanotic - blood is dark.
What is the tx?

Back 44

Prilocaine

tx: IV methylene blue (reducing agent)

Front 45

Amino (esters/amides) are metabolized to p-aminobenzoic acid derivatives, which may cause allergic rxns.

Back 45

esters

Front 46

Which 2nd gen atypical antipsychotic is only used if pt is tx-resistant or has tardive dyskinesia or severe EPS (to relieve it quickly)?

Back 46

Clozapine

Front 47

Which antipsychotic causes hypersalivation instead of dry mouth?

Back 47

Clozapine

also known for cardiac arrhythmias & seizures, & neutropenia

Front 48

Drugs used for acute psychotic break?

Back 48

Olanzapine (MC), Haloperidol, RIsperidone

Front 49

Which drug is used to treat psychoses in PD pts or in nursing home pts?

Back 49

Quetiapine

slightly more sedation & postural hypotension

Front 50

Which antipsychotic not only blocks 5-HT2 but also is a partial agonist at 5HT1a & D2 receptors, and blocks serotonin reuptake?

Back 50

Aripiprazole

recently approved as adjunct in depression. minimal weight gain. black box warning for increase death/stroke in dementia