Winter Pharm Exam 1 Flash Cards

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Title:	Winter Pharm Exam 1
Description:	Lectures 1-12
Number of Cards:	68
Save Count:	0
Author:	Mattwbrooks9
Created:	2011-12-17
Tags:	cns pharmacology
Private	No

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- Question
- Answer
- Side 3

- which pathway in the brain is associated with Parkinson's and extrapyramidal symptoms?
- Nigrostriatal system
- Many anitpsychotics cause extrapyramidal symptoms. These include all of the following except:
  A. Fine tremor
  B. Akathisia
  C. Dystonia
  D. Dementia
  E. Muscle Rigidity
- D. Dementia
  
  Extrapyramidal symptoms are brought on by drugs that blocks cholinergic activity on dopamine receptors in the nigrostriatal system. They include Akathisia (anxiety, restlessness, pacing, rocking), Dystonia (involuntary spasms and abnormal postures) and Parkinsonian symptoms (tremor, rigidity, slow movement).
  All of these control the body, but leave the mind alone. So no Dementia.
- which neurotransmitter is associated with depression, sleep, OCD and anxiety?
- 5-HT aka Serotonin
- Which neurotransmitter plays a role in schizophrenia and addiction?
- Dopamine
- what receptor is very important in memory and learning?
- NMDA
- What effect is most likely when you block muscarinic and histamine receptors?
- Sedation
- Postural hypotension results from blocking which receptor?
- Alpha-2
- Which neurotransmitter is incorrectly matched to its pathway or physiological association?
  A. Acetylcholine -> Alzheimers
  B. Serotonin -> Sleep
  C. Norepinephrine -> Addiction
  D. Dopamine -> Parkinson's
  E. Glutamate -> Seizures
- C. Norepinephrine is associated with Alertness, Pain and Depression. It is not associated with addiciction.
- Barbituates are generally considered bad for everyone, but who are they REALLY bad for?
- Patients with porphyria.
- Which barbituate is short acting and is still sometimes used as a precursor to anesthesia?
- Thiopental
- Which barbituate is long acting and is still widely used to control grand mal seizures (aka tonic-clonic seizures)?
- phenobarbital
- On whcih receptor do sedative-hypnotics and anxiolytics act? What is their primary mechanism of action?
- They bind to GABA-A receptors.
  They prolong duration of GABA
- Why are barbituates no longer recommended as sleep aids?
- decrease REM sleep. (poor quality of sleep)
  low margin of safety (Marilyn Monroe OD'd on these)
  high addiction and abuse potential
- If someone purposely took a lot of benzodiazapines, what would likely happen?
  If someone took a lot of benzos and subsequently died, what else was likely going on?
- They would sleep for 24-48 hrs.
  
  Fatalities may occur in people with respiratory difficulties, in children, and when benzodiazepines are combined with alcohol
- What should be given to someone who has taken too many benzos?
  How should it be given?
- Flumazenil
  Must be given IV. Has a shorter half-life than most benzos so it will likely need to be administered multiple times before effects of benzos completely wear off.
- What sedative should not be given to someone with liver disease?
- Ramelteon
- Which anxiolytic is the best choice for a recovering alcoholic who works as a long-haul trucker?
- Buspirone
  Good choice for alcoholics.
  Won't cause sedation.
- A patient is brought to the ER after overdosing on her roommates antiseizure medication. She is comatose, her respiratoy rate is below 10, and her BP is 90/60.
  What did she take?
  What should you do?
- She is showing the signs of a barbituate overdose.
  She likely took phenobarbital (still a popular anticonvulsant).
  You should treat her with supportive measures only (ventilate to support breathing and IV fluids to improve BP).
  DO NOT give her a stimulant to try to counter the sedation. Stimulants will increase mortality in barbituate OD.
- which benzo has the shortest half-life and is used as part of anesthesia?
- Midazolam
  Highly sedative and amnesiac.
  Will likely knock 'em out and even if it doesn't, they won't remember anything.
- Benzodiazepines are the standard treatment for anxiety. Which anxiety disorders should they NOT be used in?
- OCD
  Agoraphobia and Panic
  Post-traumatic Stress (PTS)
  Any anxiety in children/teenagers, pregnant women, or patients with sleep apnea.
- Patient is brought to the ER by her mother. Patient was found asleep with an open bottle of mom's Valium (diazepam) in her hand. Patient responds when shaken but keeps falling asleep despite attempts to revive her. OD is suspected.
  You start patient on IV Flumazenil and patient begins to seize. What is the likely cause of the seizure?
- Patient has been taking mom's valium chronically and has developed physical dependance to it.
  
  Other possibilities are that the patient took a barbituate or a TCA.
- your uncle wants to talk to you about his insomnia. he has a hard time getting to sleep at night, which is a problem, since he has to wake up early for his job. In the past he has tried taking tylenol pm or benedryl to help get to sleep, but they both left him too groggy in the morning.
  He talked to his dr, an older md, who gave him a script for sleeping pills. The pills help him get to sleep, but he finds he now wakes up two hours before his alarm goes off and cant' get back to sleep.
  1. What did the dr likely prescribe?
  2. What do you think might be a better possibility?
  
  You mention your alternative suggestion to your uncle and he says, "Oh yeah, the doc didn't give that one to me because of my ________."
  3. Fill in the blank. More than one possible answer.
- 1. The prescribed sleeping pills were most likely triazolam. They help you get to sleep, but may cause rebound insomnia. They half a short halflife so they won't leave you groggy in the morning.
  2. You should be thinking of the short-acting z drugs (zolpidem and zaliplon) and good alternatives. They're strong, rapid acting hynotics with short half lives wo they won't leave your uncle groggy and they rarely cause rebound insomnia. Plus pts rarely develop tolerance to them
  
  3. Z-drugs are not good choices for the elderly, or for patients with a history of sleep-walking, sleep-driving, sleep-eating, or patients with hx of drug or alcohol abuse.
- which drugs acts on the BZ receptor and has been approved for long-term treatment of insomnia?
- Eszopiclone
- Hey, doc, I like to drink a lot. How do I know if I have a problem?
- If you cannot limit your consumption (don't know when to say when) and if you continue to drink despite social and physical consequences directly related to drinking.
- Hey, doc, I like to drink a lot. What are the chances I'm going to damage my liver?
- greater than if you didn't drink at all, but still, only 15%-30% of heavy drinkers develop liver disease.
- Hey, doc, I downed a six pack of beer in under an hour. When should I be legally okay to drive to the store to buy more beer?
- In five hours.
  You can eliminate one beer per hour. if you consume 1 beer per hour and you should be okay. for every beer over that you need to wait an additional hour.
- Hey, doc, I quit drinking six months ago, but the holidays are coming around and I feel very tempted to jump off the wagon. What can you give me to curb the craving?
  Unfortunately, I used to take a lot of tylenol while I was drinking and I severely damaged my liver before I quit. Now what can you give me to keep me on the wagon?
- 1. Naltrexone. Descreases cravings. Contraindicated in patients with liver failure or active liver disease.
  2. Acamprostate. Excreted via kidneys. No liver toxicity.
- Hey, doc, I've been drinking for a LONG time. I've lost my marriage, my kids, and my job. Earlier this year, I ended up in the hospital after a five-day bender and they told me I had damaged my heart and my liver from many years of excessive drinking, and that if I kept drinking, I'd be dead in two years. So... I think I'm finally ready to quit, but I don't know if I can do it on my own.
  1. What happened to my heart and my liver?
  2. What will likely happen if I quit cold turkey?
  3. What is your plan to help me quit?
  4. Which benzodiazapine should be given for this patient?
- 1. From description, patient likely has cardiomyopathy and cirrhosis.
  2. I would expect this patient to experience sever withdrawal symptoms for about 5 days. These include anxiety, fear, hallucinations, delirium and tremors (the DT’s), tonic-clonic seizures, arrhythmias, increased blood pressure.
  Frankly, if he were able to not drink on his own, I think it would likely kill him.
  
  3. I would not recommend this patient try to quit on his own. With his history, I would want him detoxed in a hospital pharmicological assistance to prevent seizures, DT's and arrythmias. After discharge, patient should have prescription of acomprosate and frequent meetings with AA.
  4. Oxazepam - shortacting so more compatable with liver damamge
- What does disulfiram do for alcoholism?
- block aldehyde dehydrogenase.
  So you get sick when you drink.
  Not recommended because it is too unpleasant and doesn't prevent hard core drinkers from drinking anyway.
- when would five fomepizole?
- When pt drank methonal or antifreeze.
- what accounts for pharmacodynamic tolerance of alcoholics?
- down-regulation of GABA receptors (need more booze to get drunk) , and up-regulation of NMDA receptors (need booze to be functional).
- TCA's. What receptors and transmitters are they acting on?
  What effects do they have?
- Inhibit reuptake of NE and 5-HT
  Block muscarinic, alpha 1 and histamine receptors
  Decrease pain. Improve mood. Increase appetitie. Improve sleep.
- Althought no longer the first choice treatment, TCAs are effective antidepressants. They can also be used to treat all of the following, except:
  A. OCD
  B. Fibromyalgia
  C. Enuerisis
  D. Arrhythmia
  E. ADHD
- D. TCA's cause arrhythmia. They don't treat it.
- Which of the following antidressants is least likely to cause orthostatic hypotension?
  A. Sertraline
  B. Phenelzine
  C. Imaprimine
  D. Nortriptyline
- A. Sertraline is an SSRI and has no alpha-1 blocker. Therefore it would not cause orthostatic hypotension.
- best antidepressant for an elderly patient?
  A. Paroxetine (Paxil®)
  B. Sertraline (Zoloft®)
  C. Citalopram (Celexa®)
  D. Escitalopram (Lexapro®)
- A. Paroxetine
- worst antidepressant for a pregnant patient?
  A. Paroxetine (Paxil®)
  B. Sertraline (Zoloft®)
  C. Citalopram (Celexa®)
  D. Escitalopram (Lexapro®)
- A. Paroxetine
  contraindicated
- Best antidepressant for a patient on medications for HTN?
  A. Imipramine
  B. Phenelzine
  C. Citalopram
  D. Venlafexine
- C. Citalopram is a fast acting SSRI with few metabolic interactions.
- I want to decrease my patient's chronic muscle spasms without causing sedation. What can I give?
  how do I administer the drg?
- Baclofen
  can be given orally, but intrathecal injections will have better effect with fewer peripheral symptoms
- what receptor does baclofen act on?
- GABA-B
  B for Baclofen
- alpha 2 agonist that treats chronic muscle spasms due to spinal cord injury.
  Will cause sedation, dry mouth and some muscle weakness, especially in the elderly
- Tizanidine
- benzo used to treat acute muscle spasm?
- Diazepam
- central acting muscle relexant that metabolizes rapidly to meprobamate, which acts similarly to barbiturates
- Carisoprodol
- muscle relaxant that acts as sedative at level of brain stem. can cause hallucinations
- Cyclobenaprine
- Anesthesiologists keep this close at hand to counter malignant hyperthermia.
  What is the mechanism of action?
- Dantrolene
  affects excitation-contraction coupling in the muscle by interferring with Ca++ release in sarcoplasmic reticulum
- In large amounts it's very toxic. In small amounts it's useful for treating acute muscle spasms and dystonias.
  What is it?
  What is its mechanism?
- Botox.
  blocks the release of acetylcholine from presynaptic nerve terminals
- stimulant approved for ADHD and narcolepsy
- methylphenidate (Ritalin)
- stimulant approved for ADHD without abuse potential
- Atamoxetine (Straterra)
- blocks VMAT; increases release of newly formed DA and NE
  Used to treat ADHD.
- amphetamine (aderall)
- blocks adenosine; increases cAMP by inhibiting phosphodiesterase
  stimulant.
- caffeine
- muscle relxant that can be used to treat acute spasms concurrent with treatment for chronic spasms
- Diazepam can be given concurrently with baclofen
- prototypical antipsychotic that's also given for nausea and vomiting and as pre-anesthetic sedation
- chlorpromazine
- Drug of choice for acute schizophrenic attack.
- Haloperidol
  very fast acting, but not recommended for long eterm use to due severe extrapyramidal effects.
  no anticholinergic effect.
- antispychotic that also treats insomnia and depression
- Quetiapine
  (think "Quiet!" aka "Shut up and go to sleep")
- antipsycho medication that can result in retinal deposits?
- Thioridazine
- antipsycho med with fewer anticholinergic effects but more extrapyramidal effects
- Fluphenazine
- antipsycho med with no extrapyramidal effects but requires frequent blood testing to monitor for agranulocytosis
- Clozapine
- worst antipsycho med to give to elderly or heart patients due to prolonged QT interval
- Risperidone
- antipsycho med most likey to induce Type II DM due to weight gain
- Olanzapine
- drugs that treat the negative symptoms of schizophrenia
- Clozapine
  Risperidone
  Ziprasidone
  Olanzapine
  Quetiapine
  Aripiprazole
- drugs that treat the positive symptoms of schizophrenia
- Chlorpromazine
  Thioridazine
  Fluphenazine
  Haloperidol
- antipsycho that decreases motility of esophagus but has no weight gain effect
- Aripiprazole
- DOC for bipolar disorder
- Lithium
- mechanism of lithium toxicity
- excreted by kidney.
  competes with Na for reabsorption.
  low Na leads to high lithium concentration since it is reabsorbed freely.
  Thiazide diuretics and NSAIDs also increase lithium toxicity.
- drug of choice for schizophrenics with Parkinson's
- Clozapine
- antipsycho that treats both positive and negative effects of schizophrenia and is also approved for bipolar disorder?
  What's its major drawback?
- Olanzapine.
  Major drawback is weight gain
- First line drug for psychosis.
  Effective at treating positve and negative symptoms of schizophrenia?
  Low incidence of what with this drug?
  Major drawback?
- Risperidone
  low incidence of tardive dyskinesia
  low incidence of extrapyramidal symptoms
  Major drawback is prolonged QT interval - worst culprit of this effect. Don't give to elderly
- first-line drugs for schizophrenia, due to low incidence of side effects.
- Risperidone
  quetiapine
  olanzapine
- When would you give Clozapine to a schizophrenic?
- patients who fail to respond to at least two others, or who are disabled by tardive dyskinesia.