Pharmacology quiz 3
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Questions and Answers

What is the increased risk associated with all categories of antidepressants for certain age groups?

  • Increased risk of suicidal thoughts and behavior (correct)
  • Increased anxiety levels
  • Decreased effectiveness in treatment
  • Increased risk of weight gain

    • Which of the following SSRIs is approved solely for treating OCD in the USA?

  • Fluvoxamine (correct)
  • Escitalopram
  • Citalopram
  • Sertraline

    • What is the approximate time frame for the maximum benefit of SSRIs?

  • 1-2 weeks
  • Up to 12 weeks (correct)
  • 6-8 weeks
  • 24 weeks

    • Which herb is known to interact with SSRIs and increase the risk of serotonin syndrome?

    <p>Ginkgo Biloba</p> Signup and view all the answers

    Which of the following is a common side effect of SNRIs?

    <p>Nausea</p> Signup and view all the answers

    What are common side effects of mirtazapine?

    <p>Sedation and increased appetite</p> Signup and view all the answers

    What is the mechanism of action for Desvenlafaxine, an SNRI?

    <p>Inhibit serotonin and norepinephrine reuptake</p> Signup and view all the answers

    Which of the following medications is a tricyclic antidepressant?

    <p>Nortriptyline</p> Signup and view all the answers

    What should be closely monitored during the first 2-3 weeks after starting an SSRI?

    <p>Suicidal ideation</p> Signup and view all the answers

    For what conditions are tricyclic antidepressants indicated?

    <p>Depression and migraine prevention</p> Signup and view all the answers

    Which medication class is contraindicated for patients who have received monoamine oxidase inhibitors (MAOIs) in the previous two weeks?

    <p>SNRIs</p> Signup and view all the answers

    What is a recommended starting dose of amitriptyline for neuropathic pain?

    <p>5-10 mg/day</p> Signup and view all the answers

    Which medication is best for sleep onset insomnia?

    <p>Zaleplon</p> Signup and view all the answers

    What is a common side effect of medications used to help patients sleep?

    <p>Cognitive impairment</p> Signup and view all the answers

    How should anxiolytics be dosed in elderly patients?

    <p>Max 2 mg</p> Signup and view all the answers

    What is the mechanism of action of zolpidem?

    <p>Binds to GABAa receptors</p> Signup and view all the answers

    What is the primary goal of anti-Parkinson's medication treatment?

    <p>To restore dopamine levels in the basal ganglia</p> Signup and view all the answers

    What is the role of carbidopa in Parkinson's treatment?

    <p>It inhibits the metabolism of levodopa outside the CNS</p> Signup and view all the answers

    Which medication is a Monoamine oxidase type B inhibitor?

    <p>Selegiline</p> Signup and view all the answers

    What are common side effects associated with tolcapone?

    <p>Hepatic necrosis and orthostatic hypotension</p> Signup and view all the answers

    What is the effect of donepezil in Alzheimer's disease?

    <p>It improves cholinergic transmission</p> Signup and view all the answers

    What side effect is associated with memantine?

    <p>Confusion and agitation</p> Signup and view all the answers

    Which of the following melatonin receptor agonists is associated with abnormal dreams?

    <p>Ramelteon</p> Signup and view all the answers

    Which of the following statements regarding treatment goals in Alzheimer's disease is true?

    <p>The aim is to prevent excitotoxic actions from NMDA receptors</p> Signup and view all the answers

    What is a common cause of neuropathic pain?

    <p>Diabetes mellitus</p> Signup and view all the answers

    What is the primary action of gabapentin in treating neuropathic pain?

    <p>It binds to calcium channels.</p> Signup and view all the answers

    Which medication is considered first-line therapy for trigeminal neuralgia?

    <p>Carbamazepine</p> Signup and view all the answers

    What is a common side effect of gabapentin/pregabalin?

    <p>Dizziness</p> Signup and view all the answers

    How long should a trial of gabapentin for neuropathic pain typically last?

    <p>2 months or more</p> Signup and view all the answers

    What is the mechanism of action of capsaicin cream?

    <p>Depletes substance P.</p> Signup and view all the answers

    When using ketamine in patients on chronic opioids, how should baseline opioids be adjusted?

    <p>Reduce by 25%-50%</p> Signup and view all the answers

    What is an adverse effect of tricyclic antidepressants (TCAs)?

    <p>Dry mouth</p> Signup and view all the answers

    What serious side effect is associated with long-term opioid use?

    <p>Respiratory depression</p> Signup and view all the answers

    Which benefit is a key advantage of medicated patches?

    <p>Medication is delivered directly to the pain area</p> Signup and view all the answers

    What is a potential adverse drug effect (ADE) of 5-alpha reductase inhibitors?

    <p>Gynecomastia</p> Signup and view all the answers

    How do GnRH analogs affect the reproductive system?

    <p>They temporarily disrupt testicular/ovarian function</p> Signup and view all the answers

    Which medication is known for preventing osteoporosis in postmenopausal women?

    <p>Raloxifene</p> Signup and view all the answers

    Which form of estrogen is best when taken orally due to first-pass metabolism?

    <p>Estradiol</p> Signup and view all the answers

    What is the primary function of mifepristone in pregnancy termination?

    <p>It interferes with progesterone</p> Signup and view all the answers

    Which contraceptive method is safe for use while breastfeeding?

    <p>Hormonal IUDs</p> Signup and view all the answers

    Which type of pain are opioids primarily used to treat?

    <p>Chronic pain conditions</p> Signup and view all the answers

    What is the mechanism of action of NSAIDs?

    <p>Inhibit cyclooxygenase</p> Signup and view all the answers

    How does naloxone work to treat opioid overdose?

    <p>Displaces opioid agonists at the μ-opioid receptor</p> Signup and view all the answers

    What characterizes nociceptive pain?

    <p>It results from injury or damage to tissues.</p> Signup and view all the answers

    Which of the following statements about NSAIDs is correct?

    <p>They produce a dose-sparing effect when combined with opioids.</p> Signup and view all the answers

    What is one key function of endogenous opioids released by the body?

    <p>Provide natural pain relief</p> Signup and view all the answers

    Which of these conditions is NOT typically associated with opioid use?

    <p>Mild headaches</p> Signup and view all the answers

    Which receptor is predominantly targeted by opioids for analgesia?

    <p>Mu receptors</p> Signup and view all the answers

    What is the primary reason for monitoring ethosuximide in patients with psychological disturbances?

    <p>To adjust doses based on plasma levels</p> Signup and view all the answers

    Which antiepileptic is known to interfere with the effectiveness of oral contraceptives?

    <p>Carbamazepine</p> Signup and view all the answers

    Among the following antiepileptics, which is considered the safest during pregnancy?

    <p>Lamotrigine</p> Signup and view all the answers

    What are common side effects associated with phenytoin therapy?

    <p>Drowsiness and confusion</p> Signup and view all the answers

    What is the primary mechanism of action of COX-1 inhibitors that leads to gastrointestinal (GI) bleeding?

    <p>Decreased production of mucosal protection</p> Signup and view all the answers

    Which of the following statements regarding COX-2 inhibitors is true?

    <p>COX-2 activity is regulated by glucocorticoids</p> Signup and view all the answers

    Which of the following is an indication for using tricyclic antidepressants?

    <p>Chronic migraines</p> Signup and view all the answers

    What is the optimal starting dose of amitriptyline for neuropathic pain?

    <p>5-10 mg/day</p> Signup and view all the answers

    Which of these medications is best suited for patients with sleep maintenance insomnia?

    <p>Temazepam</p> Signup and view all the answers

    What is a potential side effect of medications used to help patients sleep?

    <p>Ataxia</p> Signup and view all the answers

    How should the dose of eszopiclone be adjusted in elderly patients?

    <p>Decrease the dose to a maximum of 2 mg</p> Signup and view all the answers

    What is typically observed when using shorter-acting medications for sleep onset insomnia?

    <p>Lower risk of dependency</p> Signup and view all the answers

    What type of pain are opioids particularly effective in treating?

    <p>Moderate to severe pain</p> Signup and view all the answers

    Which of the following statements accurately describes the mechanism of action of NSAIDs?

    <p>They inhibit cyclooxygenase to prevent the formation of prostaglandins.</p> Signup and view all the answers

    Naloxone primarily functions as what type of medication?

    <p>Opioid antagonist</p> Signup and view all the answers

    What is the primary action of opioids when they bind to their receptors in the body?

    <p>They inhibit the release of neurotransmitters involved in pain transmission.</p> Signup and view all the answers

    Which pain condition is characterized by intense spikes of pain that occur despite ongoing pain management?

    <p>Breakthrough pain</p> Signup and view all the answers

    What role do NSAIDs play when used in conjunction with opioids?

    <p>They enhance the effects of opioids without reducing their dosage.</p> Signup and view all the answers

    Which of the following conditions is NOT typically associated with the use of opioids?

    <p>Mild headaches</p> Signup and view all the answers

    PGE₂ sensitizes nerve endings in the context of pain. Which medication type inhibits its production?

    <p>NSAIDs</p> Signup and view all the answers

    What is the primary goal of anti-Parkinson's medications?

    <p>To restore dopamine balance in the basal ganglia</p> Signup and view all the answers

    Which medication is primarily responsible for inhibiting the metabolism of levodopa outside the CNS?

    <p>Carbidopa</p> Signup and view all the answers

    What side effect is more specifically associated with tolcapone?

    <p>Hepatic necrosis</p> Signup and view all the answers

    Which of the following is a focus of treatment with donepezil in patients with Alzheimer's disease?

    <p>Improving cholinergic transmission</p> Signup and view all the answers

    What is the major side effect associated with memantine?

    <p>Confusion</p> Signup and view all the answers

    Which of the following compounds is a Monoamine oxidase type B inhibitor?

    <p>Safinamide</p> Signup and view all the answers

    What is a common side effect of melatonin receptor agonists like ramelteon and tasimelteon?

    <p>Abnormal dreams</p> Signup and view all the answers

    Which condition does not improve with donepezil treatment in Alzheimer's patients?

    <p>Disease progression</p> Signup and view all the answers

    What is the primary risk associated with all categories of antidepressants for young adults under 24 years of age?

    <p>Increased risk of suicidal thoughts and behavior</p> Signup and view all the answers

    Which side effect is not commonly associated with SNRIs?

    <p>Severe allergic reactions</p> Signup and view all the answers

    What is the typical onset time for SSRIs to begin showing effects?

    <p>2 weeks to 12 weeks for maximum benefit</p> Signup and view all the answers

    What should be carefully monitored for the first 2-3 weeks after initiating SSRI treatment?

    <p>Suicidal ideation</p> Signup and view all the answers

    Which of the following herbs is known to increase the risk of serotonin syndrome when taken with SSRIs?

    <p>Garcinia cambogia</p> Signup and view all the answers

    For which of the following conditions are SNRIs indicated?

    <p>Chronic Pain Conditions</p> Signup and view all the answers

    What is a major contraindication for SNRIs?

    <p>Patients who received MAOIs in the previous two weeks</p> Signup and view all the answers

    What unique mechanism of action do SNRIs possess that aids in pain relief?

    <p>Inhibition of both serotonin and norepinephrine reuptake</p> Signup and view all the answers

    What is the primary mechanism of action of gabapentin in epilepsy management?

    <p>Enhances inhibition of gabaergic impulses</p> Signup and view all the answers

    Which side effect is commonly associated with levetiracetam?

    <p>CNS depression</p> Signup and view all the answers

    Which condition is NOT a contraindication for the use of phenytoin?

    <p>Severe hypertension</p> Signup and view all the answers

    What monitoring parameter is crucial for patients on carbamazepine?

    <p>Regular blood counts</p> Signup and view all the answers

    Which of the following is a key concern when prescribing antiepileptics to women who are pregnant?

    <p>Risk of major congenital malformations</p> Signup and view all the answers

    What is the mechanism of action of lamotrigine in seizure management?

    <p>Blocks sodium channels and enhances GABA</p> Signup and view all the answers

    What serious condition can arise from the use of valproic acid?

    <p>Hepatic failure</p> Signup and view all the answers

    Which of the following side effects is NOT associated with topiramate?

    <p>Weight gain</p> Signup and view all the answers

    What is the maximum duration for which adolescents and young adults should be monitored for suicidal ideation after starting antidepressant treatment?

    <p>2-3 weeks</p> Signup and view all the answers

    Which of the following conditions can SSRIs be off-label used to treat?

    <p>PTSD</p> Signup and view all the answers

    What is a significant interaction concern when combining herbs with SSRIs?

    <p>Serotonin syndrome risk</p> Signup and view all the answers

    Which SNRI medication requires dosage adjustment for hepatic and renal impairment?

    <p>Desvenlafaxine</p> Signup and view all the answers

    What is the half-life range of SSRIs?

    <p>16-36 hours</p> Signup and view all the answers

    Which common side effect is associated with higher dosages of SNRIs?

    <p>Hypertension</p> Signup and view all the answers

    Which of the following SSRIs was the first approved in the USA for depression treatment?

    <p>Fluoxetine</p> Signup and view all the answers

    What organ system primarily contributes to the glucuronidation excretion of Desvenlafaxine?

    <p>Hepatic system</p> Signup and view all the answers

    Which of the following conditions is a known cause of neuropathic pain?

    <p>Diabetes mellitus</p> Signup and view all the answers

    What is a key mechanism of action for carbamazepine in treating trigeminal neuralgia?

    <p>Prevents repeated discharge in neurons</p> Signup and view all the answers

    Which adverse effect is commonly associated with the use of gabapentin or pregabalin?

    <p>Peripheral edema</p> Signup and view all the answers

    What is the recommended duration for a trial of gabapentin when treating chronic neuropathic pain?

    <p>2 months</p> Signup and view all the answers

    Which of the following is a common side effect of tricyclic antidepressants (TCAs)?

    <p>Drowsiness</p> Signup and view all the answers

    What action does capsaicin cream have on substance P in neuropathic pain management?

    <p>Depletes substance P from neurons</p> Signup and view all the answers

    When adjusting opioids for a patient also being treated with ketamine, how should the baseline opioids be modified?

    <p>Reduce by 25% to 50%</p> Signup and view all the answers

    Which medication is specifically indicated for painful diabetic neuropathy?

    <p>Duloxetine</p> Signup and view all the answers

    What psychological issues can ethosuximide trigger, especially in younger patients?

    <p>Profound intellectual and affective issues</p> Signup and view all the answers

    Which antiepileptic medications are recognized as safer during pregnancy?

    <p>Lamotrigine and levetiracetam</p> Signup and view all the answers

    What is the primary action of COX-1 in the body related to gastrointestinal health?

    <p>Regulation of gastric cytoprotection</p> Signup and view all the answers

    Which antiepileptics are known to reduce the effectiveness of oral contraceptives?

    <p>Carbamazepine, phenytoin, and topiramate</p> Signup and view all the answers

    Which of the following describes nociceptive pain?

    <p>Pain due to inflammation or musculoskeletal conditions</p> Signup and view all the answers

    What is a common side effect of phenytoin?

    <p>Gingival hyperplasia</p> Signup and view all the answers

    What occurs when COX-1 is inhibited, particularly concerning gastrointestinal function?

    <p>Decreased mucosal protection</p> Signup and view all the answers

    Which condition is primarily treated with COX-2 inhibitors?

    <p>Chronic inflammation and pain</p> Signup and view all the answers

    Which type of pain are opioids primarily indicated for?

    <p>Moderate to severe pain, including post-surgical and cancer-related pain</p> Signup and view all the answers

    What is the primary mechanism of action of NSAIDs?

    <p>Inhibition of cyclooxygenase, reducing prostaglandin formation</p> Signup and view all the answers

    What is the role of naloxone in the treatment of opioid overdose?

    <p>Blocks mu-opioid receptors, reversing opioid effects</p> Signup and view all the answers

    Which of the following conditions is least likely to be treated effectively with opioid analgesics?

    <p>Mild headache pain</p> Signup and view all the answers

    What is the impact of combining NSAIDs with opioids?

    <p>Dose-sparing effect in pain management</p> Signup and view all the answers

    Which receptor type is primarily targeted by opioids for their analgesic effects?

    <p>Mu receptors</p> Signup and view all the answers

    Which of the following best describes the role of endogenous opioids in the body?

    <p>They are natural pain-relievers released in response to pain.</p> Signup and view all the answers

    What physiological effect occurs when opioids bind to mu receptors?

    <p>Inhibition of neurotransmitter release involved in pain signal transmission</p> Signup and view all the answers

    What is the primary action of levodopa in the treatment of Parkinson's disease?

    <p>It is converted to dopamine in the CNS.</p> Signup and view all the answers

    Which side effect is specifically associated with tolcapone?

    <p>Hepatic necrosis</p> Signup and view all the answers

    Which of the following medications is considered a Monoamine oxidase type B inhibitor?

    <p>Safinamide</p> Signup and view all the answers

    What potential serious side effect can result from long-term opioid use?

    <p>Respiratory depression</p> Signup and view all the answers

    Which benefit of medicated patches distinguishes them from oral medications?

    <p>Localized relief without systemic side effects</p> Signup and view all the answers

    What is the main goal of treatment with donepezil in Alzheimer's disease?

    <p>To improve cholinergic transmission and prevent excitotoxicity.</p> Signup and view all the answers

    What is a common adverse drug effect associated with 5-alpha reductase inhibitors like finasteride?

    <p>Gynecomastia</p> Signup and view all the answers

    What potential adverse effect might occur with the use of melatonin receptor agonists?

    <p>Increased liver function tests</p> Signup and view all the answers

    What is the primary mechanism of action of GnRH analogs?

    <p>Disrupt hormone release from the pituitary gland</p> Signup and view all the answers

    What common side effect might be observed with memantine treatment?

    <p>Confusion and agitation</p> Signup and view all the answers

    Which statement about raloxifene's role in osteoporosis prevention is accurate?

    <p>It is indicated for postmenopausal women only.</p> Signup and view all the answers

    What is the expected benefit of using carbidopa in conjunction with levodopa?

    <p>Prevents levodopa metabolism outside the CNS.</p> Signup and view all the answers

    Which statement about the goals of Parkinson's disease treatment is accurate?

    <p>Dopamine/acetylcholine balance is essential for treatment success.</p> Signup and view all the answers

    What property differentiates estradiol from other forms of estrogen when taken orally?

    <p>Significant first-pass metabolism</p> Signup and view all the answers

    What role does mifepristone (RU486) play in pregnancy management?

    <p>Terminates pregnancy by acting on estrogen receptors</p> Signup and view all the answers

    Which contraceptive method is most recommended for breastfeeding women?

    <p>Intrauterine Devices (IUDs)</p> Signup and view all the answers

    Study Notes

    FDA Warning on Antidepressants

    • All antidepressants carry an increased risk of suicidal thoughts and behavior, especially in children, adolescents, and young adults (up to 24 years old) during the first two months of treatment.
    • Depression and other psychiatric illnesses are risk factors.

    SSRI Medications

    • Citalopram
    • Escitalopram
    • Fluoxetine (First FDA-approved for depression, inhibits CYP450)
    • Fluvoxamine (Only FDA-approved for OCD in the USA)
    • Paroxetine (Inhibits CYP450)
    • Sertraline
    • Closely monitor patients for the first 2-3 weeks after starting any SSRI for suicidal thoughts.

    Herbs that Interact with SSRIs

    • Ginkgo Biloba
    • St. John's Wort
    • Garcinia cambogia (HCA)
    • L-tryptophan (or 5-HTP)
    • SAMe (S-adenosyl-methionine) supplements.

    Onset and Mechanism of Action of SSRIs

    • Onset of action is typically two weeks, and up to 12 weeks for maximum benefit.
    • Half-life (T½) is 16-36 hours.
    • SSRIs block the reuptake of serotonin, increasing its concentration in the synaptic cleft. This prevents serotonin from being reabsorbed by the presynaptic nerve, increasing serotonin availability at postsynaptic receptors.

    Indications for SSRIs

    • Depression
    • Anxiety
    • Panic disorder
    • OCD
    • Bulimia (off-label)
    • Anorexia (off-label)
    • Fluvoxamine is not indicated for depression.

    Other Medications

    • SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors):
      • Desvenlafaxine
      • Duloxetine
      • Levomilnacipran
      • Milnacipran
      • Venlafaxine
      • Block reuptake of serotonin and norepinephrine.
    • MOA of Desvenlafaxine
      • Blocks reuptake of serotonin and norepinephrine.
      • Degree of block is dose-dependent.
      • Dosage adjustment may be needed for hepatic or renal impairment.
    • Side Effects of Venlafaxine and Duloxetine:
      • Common: CNS effects, nausea, constipation, dry mouth, sexual dysfunction (higher dosages).
      • Higher Dosages: hypertension.
    • Side Effects of Milnacipran: Similar to Venlafaxine (such as palpitation), ADE Levomilnacipran similar to others, urinary hesitation.

    Tricyclic Antidepressants (TCAs) and Other Medications

    • Imipramine
    • Trimipramine
    • Nortriptyline
    • Doxepin
    • Desipramine
    • Amitriptyline
    • Clomipramine
    • Protriptyline
    • Amoxapine
    • Dosage for Neuropathic Pain: Amitriptyline and duloxetine are commonly used at low doses to control neuropathic pain
    • Anxiolytics for Sleep Patterns:
      • Zaleplon, zolpidem, triazolam, and ramelteon, temazepam, Eszopiclone (short-acting)
      • Zolpidem extended release, eszopiclone, temazepam, lorazepam, eszopiclone, low-dose doxepin, and suvorexant (longer-acting)
      • Longer-acting medications can increase the risk of morning drowsiness
    • Side Effects of Mirtazapine:
      • Sedation, increased appetite, weight gain.
    • Gabapentin/Pregabalin: used for neuropathic pain and binds to calcium channels
      • Chronic use may need a trial of 2 months or more.

    Ketamine

    • Used for chronic opioid pain, but at a lower dosage than for anesthesia.
    • Use with caution in patients with epilepsy or schizophrenia
    • Requires concomitant reduction in baseline opioid dose by 25% to 50%.

    Lidocaine (Topical)

    • Used to treat localized neuropathic pain.
    • Blocks nerve impulse conduction.

    Gabapentin

    • Mechanism involves increased GABAergic impulses.
    • Used for managing epilepsy.

    Antiepileptic Drugs

    • Levetiracetam - Side effects include CNS depression, suicidal ideation, blood dyscrasias, Steven-Johnson Syndrome, nausea, and weight gain/loss.
    • Phenytoin - Contraindicated with pregnancy, liver problems, sinus bradycardia, and hypersensitivity.
    • Carbamazepine - Monitor patients for bone marrow complications like leukopenia, thrombocytopenia, and agranulocytosis (agranulocytosis can cause death if not caught)
    • Valproic Acid - Can interact with other antiepileptics (e.g., carbamazepine and lamotrigine)
    • Lamotrigine - Risk of adverse effects is increased with valproic acid.
    • Topiramate- Side effects include numbness, tingling, weight loss/decreased appetite, nausea, diarrhea, blurred vision, mental slowing, anxiety, and metallic taste.
    • Contraindications to valproic acid include liver disease, urea cycle disorders, and genetic mitochondrial disorders (especially in children under 2).

    Other Indications and Contraindications

    • COX-1 Inhibitors: Gastric cytoprotection.
    • Opioids: Used for moderate to severe pain (post-surgical, cancer-related, trauma, chronic pain)
    • NSAIDs: Used for mild to moderate pain (strains, sprains).
    • Monoamine Oxidase Inhibitors (MAOIs) are contraindicated with SSRIs/SNRIs.
    • Ethosuximide Therapeutic drug monitoring is necessary.
    • Pregnancy Risks: Some anti-epileptic drugs (AEDs) have pregnancy risks, eg., valproic acid.
    • Anti-epileptics interference with Hormones: Certain AEDs induce the enzymes that break down other medications or interfere with hormone levels, requiring dose adjustments.
    • Hormonal Contraceptives: AEDs might reduce the effectiveness of oral contraceptives, requiring adjustments if necessary.

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    Description

    This quiz covers key information about antidepressants, particularly SSRI medications, their associated risks such as increased suicidal thoughts, and interactions with herbal supplements. Additionally, it discusses the onset and mechanism of action of these medications.

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