Pharmacology 3 hard version

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which condition is NOT commonly associated with neuropathic pain?

Phantom limb pain

Diabetes mellitus

Trigeminal neuralgia

Acute pancreatitis (correct)

What is a primary mechanism of action for gabapentin?

Binds to NMDA receptors

Inhibits serotonin reuptake

Enhances GABA activity

Binds to calcium channels (correct)

What is a common adverse effect associated with the use of TCAs for neuropathic pain?

Increased heart rate

Acute renal failure

Elevated liver enzymes

Dry mouth (correct)

Which statement about capsicum cream is accurate?

It depletes substance P from afferent neurons Signup and view all the answers

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

Carbamazepine Signup and view all the answers

What should be done to the baseline opioid dosage when starting ketamine in an opioid-tolerant patient?

Reduce by 25-50% Signup and view all the answers

What is a key side effect of pregabalin compared to gabapentin?

Peripheral edema Signup and view all the answers

Which of the following is NOT a characteristic of lidocaine usage for localized neuropathic pain?

Only effective for chronic pain Signup and view all the answers

Which type of pain are opioids primarily indicated for?

Moderate to severe pain Signup and view all the answers

What is the primary mechanism of action of NSAIDs?

They inhibit cyclooxygenase enzyme. Signup and view all the answers

What role does naloxone play in opioid overdose situations?

Competes with opioid agonists at receptors. Signup and view all the answers

Which statement correctly describes the mechanism of action of opioids?

Opioids activate pathways that inhibit neurotransmitter release. Signup and view all the answers

What effect do NSAIDs have when combined with opioids?

They produce a dose-sparing effect. Signup and view all the answers

What is one of the primary side effects associated with mirtazapine?

Sedation Signup and view all the answers

Which of the following is NOT a type of pain that opioids are effective for treating?

Mild headaches Signup and view all the answers

How do NSAIDs alleviate inflammation?

By inhibiting the formation of prostaglandins. Signup and view all the answers

Which of the following medications is recognized as a tricyclic antidepressant?

Amitriptyline Signup and view all the answers

Which of the following conditions would NOT be classified as an opioid-responsive pain?

Mild osteoarthritis Signup and view all the answers

For which condition are tricyclic antidepressants NOT indicated?

Insomnia Signup and view all the answers

What dosing strategy is recommended for amitriptyline when used for neuropathic pain?

Initiate at low doses to assess tolerance Signup and view all the answers

What is a recommended choice for patients experiencing sleep onset insomnia?

Zaleplon Signup and view all the answers

Which of these side effects is commonly associated with medications intended for sleep?

Anterograde amnesia Signup and view all the answers

How should the dosage of eszopiclone be adjusted for elderly patients?

Decrease the dose, with a maximum of 2mg Signup and view all the answers

What is the primary mechanism of action of zolpidem?

Binding to GABAa receptors Signup and view all the answers

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

Restoring dopamine balance and reducing excitatory cholinergic effects Signup and view all the answers

Which of the following are recognized side effects associated with tolcapone?

Diarrhea, orthostatic hypotension, and hepatic necrosis Signup and view all the answers

Which medications are classified as Monoamine oxidase type B inhibitors?

Rasagiline and selegiline Signup and view all the answers

What role does carbidopa play in the treatment of Parkinson's disease?

It inhibits the metabolism of levodopa outside the CNS Signup and view all the answers

What is the primary action of donepezil in Alzheimer's disease management?

It enhances cholinergic transmission in the CNS Signup and view all the answers

What is a significant psychological side effect of ethosuximide in certain populations?

Profound intellectual and affective issues Signup and view all the answers

What side effects are commonly associated with memantine?

Confusion, agitation, and restlessness Signup and view all the answers

What is one of the potential adverse reactions associated with melatonin receptor agonists?

Increased liver function tests Signup and view all the answers

Which antiepileptic drugs are known to reduce the efficacy of oral contraceptives?

Carbamazepine, phenytoin, topiramate Signup and view all the answers

Which of the following statements about the management of anti-Parkinson's medications is accurate?

The approach must be tailored to symptoms, age, and functional ability. Signup and view all the answers

Which antiepileptic medication is considered safest during pregnancy due to a lower risk of major congenital malformations?

Levetiracetam Signup and view all the answers

Which of the following is NOT a common side effect associated with phenytoin?

Bradycardia Signup and view all the answers

What is the primary function of COX-1 in gastrointestinal physiology?

Facilitating gastric cytoprotection Signup and view all the answers

What is a primary concern with long-term opioid use?

Tolerance and dependence Signup and view all the answers

Which condition is primarily associated with nociceptive pain?

Musculoskeletal conditions Signup and view all the answers

What is a significant advantage of using medicated patches for pain relief?

They allow for consistent pain relief over time Signup and view all the answers

What characterizes COX-2 as compared to COX-1?

Increased during inflammatory states Signup and view all the answers

What adverse effect is NOT associated with 5-alpha reductase inhibitors?

Nausea Signup and view all the answers

Which of the following is NOT a typical side effect of ethosuximide?

Gingival hyperplasia Signup and view all the answers

What is the mechanism of action for GnRH analogs?

Disrupting pituitary gland function Signup and view all the answers

What is the function of Raloxifene in postmenopausal women?

It prevents osteoporosis Signup and view all the answers

Which estrogen has the best bioavailability when taken orally?

Estradiol Signup and view all the answers

What is the primary role of Mifepristone (RU486)?

Terminating pregnancy Signup and view all the answers

Which contraceptive method is considered safe for breastfeeding mothers?

Hormonal IUDs Signup and view all the answers

Study Notes

FDA Warning on All Antidepressants

Increased risk of suicidal thoughts and behavior 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 approved in the USA for depression; inhibits CYP450.
Fluvoxamine - Primarily used for OCD in the USA.
Paroxetine - Inhibits CYP450.
Sertraline
Closely monitor patients for the first 2-3 weeks after starting any of these medications for suicidal ideation.

Herbs that Interact with SSRIs

Ginkgo Biloba
St. John's Wort
Garcinia cambogia (HCA)
L-tryptophan (or 5-HTP)
SAMe (S-adenosyl-methionine) supplements
These can increase the risk of serotonin syndrome.

Onset of Action of SSRIs

Onset typically takes 2 weeks, up to 12 weeks for maximum benefit.
Half-life (T½) is 16-36 hours.

Mechanism of Action of SSRIs

SSRIs block the reuptake of serotonin in the synaptic cleft.
This increases the concentration of serotonin in the synapse, making more available to bind to postsynaptic receptors.
This prevents the reuptake of serotonin back into the presynaptic nerve.

Indications for SSRI Use (excluding Fluvoxamine)

Depression
Anxiety
Panic disorders
OCD
Bulimia (off-label use)

Which Medications Are SNRIs?

Desvenlafaxine
Duloxetine
Levominacipran
Milnacipran
Venlafaxine

MOA of Desvenlafaxine (SNRI)

Blocks the reuptake of serotonin and norepinephrine.
The degree of blockade is dose-dependent.

Side Effects of SNRIs (Venlafaxine/Duloxetine)

Common: CNS effects (nausea,constipation, dry mouth, sexual effects), higher dosage may increase hypertension
Adverse effects: similar to those in SSRIs (and/or) palpitation, potential for ADEs similar to other medications.

Side Effects of Mirtazapine

Sedation, increased appetite, and weight gain.

Which Medications Are Tricyclic Antidepressants?

Imipramine, Trimipramine, Nortriptyline, Doxepin
Desipramine, Amitriptyline, Clomipramine, Protriptyline, Amoxapine

Dosing of Tricyclic Antidepressants (for Neuropathic Pain)

Amitriptyline and duloxetine are commonly used.
Start with low doses (5-10 mg/day) to assess tolerance.

Which Anxiolytic to Choose Based on Sleep Patterns

Sleep onset insomnia: Zaleplon, zolpidem, triazolam, ramelteon, temazepam, Eszopiclone
Sleep maintenance insomnia: Zolpidem extended release, eszopiclone, temazepam, lorazepam, eszopiclone, low dose doxepin, suvorexant

Side Effects of Medications for Sleep

Drowsiness, confusion, ataxia, cognitive impairment, sleepwalking, driving, anterograde amnesia, dizziness, headache, dry mouth, peripheral edema, somnolence, and suicidal ideation.

Mechanism of Action of Zolpidem

Binds to GABAa receptors.
Relatively selective for the a1 subunit.
Fewer withdrawal symptoms, minimal rebound insomnia, and minor tolerance.

ADEs Associated with Melatonin Receptor Agonists

Headache (HA)
Increased liver function tests (LFT)
Abnormal dreams

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers FDA warnings regarding the use of antidepressants, focusing specifically on SSRIs and their interaction with various herbs. It also discusses the increased risk of suicidal thoughts in young patients and the mechanisms of action of these medications. Test your knowledge on the critical safety information and pharmacology related to SSRIs!