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72 Cards in this Set
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- Back
- 3rd side (hint)
What are the preventative migraine drugs?
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Beta Blockers (propanolol, timolol)
TCAs (amitriptyline) CCBs (verapamil) Anti-Epileptics (Topiramate, Valproic Acid) NSAIDs |
5 classes
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Triptans MOA
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5-HT1 receptor agonists
constrict cranial vessels and reduce sterile inflammation these receptors are on neurons and intracranial blood vessels (prevents albumin leakage) |
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MOA difference between drugs for migraine prevention and acute attack
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acute- 5-HT1 agonist
prevention - 5-HT2 antagonist |
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Drawbacks/Contraindications to Ergots
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less selective than triptans
ergotism (convulsive, gangrenous) rebound HA (not in DHE) CONTRA: vascular, renal, heptaic, pregnant |
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Tx for migraine w/aura?
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verapamil
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mu opioid receptor
(where active? agonists? antagonists?) |
supraspinal action
agonists: b-endorphin, morphine, fentanyl antagonist: naloxone |
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kappa opioid receptor (where active? agonist? antag?)
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spinal action
agonist: dynorphins, pentazocine antag: naloxone |
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delta opioid receptor (where? ag? antag?)
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both spinal and supraspinal
agonist: enkephalins antag: naloxone |
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which opioid side effects do not induce tolerance?
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convulsant (meperidine, norcodeine)
miotic constipation |
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Mixed opioid agonists/antagonists
How do they work? |
pentazocine, nalbuphine, butorphanol
agonists at kappa recpetors but partial agonists (fxnl antag in presence of full agonist) at mu receptors |
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metabolites of
a. morphine b. meperidine c. codeine d. heroin |
a. active: 6-glucuronide
inactive: 3-glucuronide b. normeperidine c. morphine d. 6-acetylmorphine -> morphine |
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CV ADR for opioids
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hypotension
(supresses sympathetic outflow, psymp stimulation, morphine stimulates histamine release) |
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Which opioid is used in renal impairment?
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hydromorphone
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water
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methadone use?
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treat opioid dependence
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buprenorphine
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partial agonist useful for opioid dependence management
prevents withdrawal sxs |
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ADRs for SSRIs
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SEXUAL DYSFXN (persistent...yikes)
SEROTONIN SYNDROME (confusion, fever, altered conc, myoclonus) nervousness/irritability/insomnia (transient) Nausea/diarrhea/dyspepsia (transient) |
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SSRIs taken with what causes serotonin syndrome
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MAO-Is
TCAs Li Carbamazepine |
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SSRIs taken with warfarin, phenytoin et al causes what?
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potentiation of toxicity
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Advantage of sertraline over fluoxetine?
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sertraline has a shorter half life (faster steady state and faster washout)
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Paroxetine
(class, use, adr) |
SSRI with antichol action (sedating)
good for depression w/anxiety/insomnia Severe Discontinuation Syndrome |
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Which class of antidepressants is good for eating disorders?
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SSRIs
none for anorexia |
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Which class of antidepressants is contraindicated in eating disorders?
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NDRI (NE, DA, reuptake inhibit)
buproprion additive risk for SZ |
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Which class of antidepressants treats chronic pain?
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TCAs
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Indications for buproprion?
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Depression (fewer sexual adr)
smoking cess adhd |
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What are phenelzine and tranylcypromine?
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MAOIs (nonselective, irreversible)
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When would you use TCAs?
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resistant depression
enuresis chronic pain |
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What is venlafaxine?
(adr?) |
SNRI (along w/duloxetine)
adr - dose dependent HTN, withdrawal syndrome w/abrupt discontinuation |
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TCA poisoining Tx
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Cardiac Monitoring
Gastric Lavage NaBicarb and KCl Lidocaine or Phenytoin |
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what are the 3 main mood stabilizers?
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Li
Valproate Carbamazepine |
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What do you need to check before putting a pt on Li?
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Renal Labs
TSH Preg test ECG |
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What drugs increase blood Li levels?
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NSAIDs
non loop diuretics (dehydration) ACE-Is |
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Most common ADR of Li?
Others? |
*Hypothyroidism*
renal toxicity |
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How does Li toxicity present?
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tremor
fasiculations confusion/stupor/slurred speech seizure vomiting ataxia arrhythmia |
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Why shouldn't preggers take Li?
Which trimester? |
Eb(p)stein's anomaly (tricuspid malformation)
1st trimester |
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Indications for valproate in BP d/o?
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rapid cycling bp
mixed cycles |
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Pertinent ADRs for Valproate?
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can induce hepatic failure but increased LFTs is usually transient and asymptomatic
PolyCystOvarSyndrome TERATOGENIC (neural tube defects) |
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Indications for Carbamazepine in BP d/o?
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refractory to Li and valproate
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ADRs of Carbamazepine?
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FATAL Agranulocytosis
Stevens Johnson teratogenic hepatitis |
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Drug interactinos for carbamazepine?
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induces cyt p450 system
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Why give Lamotrigine for BP d/o?
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not teratogenic
BUT...causes Stevens Johnsons |
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When do heroin withrawal sxs begin (what are they)
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8-10 hrs after last dose
(lots. no seizures) |
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When do benzo withdrawal sxs begin? (which is dangerous?)
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8th or 9th day (seizures)
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When do mild EtOH withdrawal sxs begin? (what are they?)
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6-8hrs
(tremor, anxiety, insomnia) |
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Dangerous EtOH withdrawal sxs?
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seizures, hallucinations, hyperthermia
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Tx for Sed-Hyp withdrawal?
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supportive (prevent sz, replace electrolytes, thiamine replacement)
ADMIT in severe cases |
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Tx for Heroin Withdrawal?
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methadone/clonidine
admit preggers |
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Treatment for restless leg syndrome?
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pramipexole or ropinorole
(DA agonists) |
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Tx for Essential Tremor?
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Primodone (barb) and propranolol (beta blocker)
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Tx for debilitating Tourettes?
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High potency 1st gen antipsychotics (fluphenazine, haloperidol, pimozide)
Tx OCD component w/ fluoxetine |
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Tx for Huntington's Chorea?
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antidepressants to prevent suicide
supportive nothing slows dz progression |
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Tx for Tardive Dyskinesia?
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Stop offending med (1st gen antispychotic)
Remove central anti-chol (TCAs, anti-PD) give diazepam if acute switch to atypical antipsychotic |
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Tx for myoclonus?
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Clonazepam, Valproate (GABAnergic)
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Tx for dystonia (focal, general, acute)?
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focal - Botox
general - anticholinergic or benzo acute - IV/IM diphenhydramine or benzatropine |
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Tx for dementia w/Lewy Bodies?
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L-Dopa/carbidopa AND AChE-Is
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What drug classes are used to tx Parkinson's?
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Anticholinergis (benzatropine, trihexiphenidyl)
MAOB-Is (rasagiline, selegiline) COMT-Is (Tolcapone, Entacapone) Amantadine DA agonist (bromocriptine, pergolide, pramipexole, ropinorole) |
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Which antipsychotic is least likely to cause EPS?
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clozapine
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Dangers of non-selective MAO-Is
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cheese effect (tyramine -> Hypertensive crisis)
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Which parkinson's tx might be neuroprotective?
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MAOB-Is (rasagiline)
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BoTox is FDA approved for which 3 neurological conditions?
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blepharospasm
hemifacial spasm cervical dystonia |
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What is neuroleptic malignant syndrome? Tx?
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life threatening reaction from antispychotics
muscle rigidity, altered mental status, autonomic dysfxn Tx w/Dantrolene, DA agonist |
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what are the best drugs for drug-induced emesis?
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5HT3 receptor antagonist (ondansetron, granisetron)
metoclopromide |
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ADRs of 5HT3 receptor blockers?
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HA, diarrhea, constipation, asthenia, phlebitis
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What is aprepitant?
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substance p/NK1 antagonist
anti-emetic |
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Anti-emetics that you shouldn't use in kids?
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anti-psychotics
trimethobenzamide (reye's syndrome) |
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Difference in MOA btwn Benzos and Barbs?
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Barbs - increased duration of channel opening (no ceiling effect)
Benzos - increased frequency channel opening (ceiling effect) |
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Which benzos are not affected by cytP450?
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lorazepam, oxazepam, temazepam
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Time frame for withdrawal symptoms from BZDs?
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6 wks unlikely
1yr - hard to discontinue |
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AVOID BZDs in which populations?
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preggers
BP alcoholics COPD/OSAS memory impairment elderly (dizzy/ataxia) |
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ramelton MOA
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melatonin receptor agonist (rozerem)
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What are zolpidem, zaleplon and exzopiclone for? MOA?
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insomnia
GABA-A receptor agonist |
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Which insomnia drug has the shortest half life?
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zaleplon (sonata)
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generic names for:
a. ambien b. sonata c. lunesta |
a. zolpidem
b. zaleplon c. eszopiclone |
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