38 Questions
In patients with hypotension, which agent may be the most effective management option according to the text?
Norepinephrine
Which of the following statements regarding tricyclic antidepressants (TCAs) and anesthetics is correct?
Induction of anesthesia may be associated with an increased risk of cardiac arrhythmias in patients treated with TCAs.
Which of the following statements regarding TCAs and anticholinergics is correct?
Glycopyrrolate is a quaternary ammonium compound, which limits its passage across the blood-brain barrier, potentially reducing the risk of drug interactions with TCAs.
Which of the following statements regarding TCAs and opioids is correct?
Doses of opioids and barbiturates should be decreased in the presence of TCAs to avoid exaggerated or prolonged depressant effects.
Which of the following statements regarding TCAs and antihypertensives is correct?
TCAs given in conjunction with α1 adrenergic antagonists increase the risk of hypotension.
Which of the following statements regarding TCA overdose is correct?
TCA overdose can be life-threatening, and both CNS and cardiotoxicity can be life-threatening.
When administering sympathomimetic agents to patients recently started on a tricyclic antidepressant (TCA), which of the following responses should be anticipated?
An exaggerated pressor response from both direct and indirect-acting sympathomimetics
Which of the following statements is true regarding the administration of sympathomimetic agents in patients chronically treated with tricyclic antidepressants (TCAs)?
Conventional sympathomimetics may not be effective in restoring systemic blood pressure
When administering direct-acting sympathomimetics to patients who have been on tricyclic antidepressants (TCAs) for more than 6 weeks, which of the following dosing strategies is recommended?
Administer a lower than usual dose, approximately 1/3rd of the usual dose
Which of the following statements is true regarding the administration of indirect-acting sympathomimetics, such as ephedrine, in patients chronically treated with tricyclic antidepressants (TCAs)?
Pressor responses are likely to be more pronounced compared to direct-acting agents
Which of the following factors may contribute to the potential ineffectiveness of conventional sympathomimetics in restoring systemic blood pressure in patients chronically treated with tricyclic antidepressants (TCAs)?
Both desensitization/down-regulation of adrenergic receptors and depletion of catecholamine stores
When administering sympathomimetic agents to patients chronically treated with tricyclic antidepressants (TCAs), which of the following statements is correct?
The administration of either direct-acting or indirect-acting sympathomimetics is acceptable, but initial doses may need adjustment
Which of the following is a contraindication for the use of droperidol?
All of the above
How do phenothiazines affect the ventilatory, miotic, and analgesic effects of opioids?
Phenothiazines exaggerate the ventilatory effects, increase the miotic effects, and potentiate the analgesic effects of opioids
What is the recommended approach for managing hypotension in a patient taking phenothiazines?
Use direct-acting vasopressors
Why are phenothiazines generally not used as anti-emetic agents?
They have a higher incidence of adverse effects like hypotension compared to butyrophenones
What is the hypothesized mechanism of action for antidepressant medications?
Inhibition of neurotransmitter reuptake, leading to increased neurotransmitter levels in the synaptic cleft
What is the effect of chronic administration of antidepressants on the autoreceptors on neurons?
Downregulation of the autoreceptors
Tricyclic antidepressants (TCAs) can increase the effects of sympathomimetic agents.
True
Patients recently started on a tricyclic antidepressant (TCA) will have a blunted response to sympathomimetic agents.
True
Indirect-acting sympathomimetics, such as ephedrine, are the preferred choice for managing hypotension in patients chronically treated with tricyclic antidepressants (TCAs).
False
Concomitant use of phenothiazines and opioids can lead to increased miotic (pupillary constriction) and sedative effects of opioids.
True
Phenothiazines can enhance the ventilatory effects of opioids.
False
Droperidol is contraindicated in patients with a prolonged QTc interval.
True
Phenothiazines are commonly used as anti-emetic agents due to their lower incidence of adverse effects compared to butyrophenones.
False
The analgesic effects of opioids are decreased when co-administered with phenothiazines.
False
Chronic administration of antidepressants leads to upregulation or sensitization of the autoreceptors on neurons.
False
Phenothiazines are contraindicated in patients with Parkinson's disease.
True
What is the main reason for avoiding the concomitant use of droperidol and phenothiazines?
Exaggerated CNS depressant effects
Why should phenothiazines be avoided in patients with Parkinson's disease?
Antagonism with dopamine
Which neurotransmitters play a crucial role in the normal brain neurochemistry according to the text?
Serotonin and norepinephrine
What effect does chronic administration of antidepressants have on autoreceptors on neurons?
Desensitization
Why are phenothiazines not commonly used as anti-emetic agents as per the text?
Higher incidence of hypotension
Which adverse effect is most likely when combining phenothiazines with opioids?
Respiratory depression
Which neurotransmitter's reuptake inhibition is hypothesized to increase with chronic antidepressant use?
Serotonin
What effect do phenothiazines have on the overall opioid use when combined?
Reduces opioid analgesia
Which class of drugs' ventilatory effects are amplified by phenothiazines according to the text?
Opioids
Why is glycopyrrolate recommended if an anticholinergic agent is needed?
Prevention of bradycardia
Test your knowledge on drug interactions involving anticholinergics, antihypertensives, opioids, barbiturates, phenothiazine antipsychotic agents, anti-arrhythmic agents, and tricyclic antidepressants (TCAs). Learn about the complexities and unpredictability of combining these different classes of medications.
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