Pharmacology of Zyban and Trazodone
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Questions and Answers

What is the off-label use of Bupropion (Zyban)?

  • Anxiety
  • Seizure disorder
  • ADHD and bipolar (correct)
  • Depression

    • What is the primary indication for Trazadone (Oleptro)?

  • ADHD
  • Insomnia
  • Depression (correct)
  • Anxiety

    • What is the MOA of Buspirone (Buspar)?

  • Inhibition of voltage-gated sodium channels
  • Monoaminergic neuronal activity, suppressing serotonergic activity while enhancing dopaminergic and noradrenergic cell firing (correct)
  • Inhibits reuptake of serotonin
  • GABA agonist

    • What is the primary indication for Lorazepam (Ativan)?

    <p>Seizure disorder</p> Signup and view all the answers

    What is the MOA of Lithium (Lithobid)?

    <p>Reduces excitatory neurotransmission and increases inhibitory neurotransmission</p> Signup and view all the answers

    What is the primary indication for Valproate (Depakote)?

    <p>Seizure disorder</p> Signup and view all the answers

    What is a black box warning for Bupropion (Zyban)?

    <p>Increased risk of suicide and neuropsychiatric events</p> Signup and view all the answers

    What is a side effect of Benzodiazepines?

    <p>All of the above</p> Signup and view all the answers

    What is the primary mechanism of action of Cromolyn?

    <p>Inhibits mast cell degranulation, preventing the release of histamine</p> Signup and view all the answers

    What is the pharmacological action of Theophylline?

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

    What is the primary therapeutic use of Fluticasone?

    <p>Allergic rhinitis</p> Signup and view all the answers

    What is the side effect of Montelukast?

    <p>Headache and nausea</p> Signup and view all the answers

    What is a common side effect of Oxymetazoline?

    <p>Nasal irritation and minor stinging or dryness</p> Signup and view all the answers

    What is the therapeutic use of Cromolyn sodium?

    <p>Prophylaxis of asthma</p> Signup and view all the answers

    What is the primary mechanism of action of Dextromethorphan?

    <p>Suppresses the cough reflex in the CNS and provides analgesia</p> Signup and view all the answers

    What is the adverse effect of Isoniazid?

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

    What is the mechanism of action of Rifampin?

    <p>Inhibits DNA-dependent RNA polymerase</p> Signup and view all the answers

    What is a contraindication for the use of Ipratropium?

    <p>Hypersensitivity to soy beans and peanuts</p> Signup and view all the answers

    What is the indication of Sertraline?

    <p>Depression treatment</p> Signup and view all the answers

    What is the primary therapeutic use of Albuterol?

    <p>Acute bronchospasm</p> Signup and view all the answers

    What is a side effect of Diphenhydramine?

    <p>Photosensitivity and paradoxical excitement</p> Signup and view all the answers

    What is the side effect of Duloxetine?

    <p>All of the above</p> Signup and view all the answers

    What is the mechanism of action of Doxepin?

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

    What is the primary mechanism of action of Phenylephrine?

    <p>Stimulates alpha-1 receptors, constricting nasal blood vessels</p> Signup and view all the answers

    What is the primary therapeutic use of Guaifenesin?

    <p>Productive cough, mucus clearance</p> Signup and view all the answers

    What is the black box warning of MAOI?

    <p>Increased risk for suicide</p> Signup and view all the answers

    What is the indication of Bupropion?

    <p>Depression treatment</p> Signup and view all the answers

    What is a contraindication for the use of Codeine?

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

    What is the mechanism of action of Lamotrigine?

    <p>Prolongs sodium channel inactivation, blocks specific calcium channels and blocks glutamate</p> Signup and view all the answers

    What is a common side effect of First Generation Antipsychotics?

    <p>Drowsiness, anticholinergic effects, sexual dysfunction, ortho hypotension</p> Signup and view all the answers

    What is the indication for Modafinil?

    <p>Daytime fatigue from narcolepsy, ADHD, obstructive sleep apnea, shift work sleep disorder</p> Signup and view all the answers

    What is the mechanism of action of Melatonin Receptor Agonists?

    <p>Activates melatonin receptors which control circadian rhythm and sleep/wakefulness</p> Signup and view all the answers

    What is the indication for Cromolyn?

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

    What is the indication for Benzodiazepine Receptor Agonists?

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

    What is the mechanism of action of Histamine One Receptor Antagonists?

    <p>Decreases histamine which leads to sedation</p> Signup and view all the answers

    What is the indication for Atomoxetine?

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

    What is the mechanism of action of Dual Orexin Receptor Antagonists?

    <p>Blocks orexin A and B</p> Signup and view all the answers

    What is the indication for Third Generation Antipsychotics?

    <p>Bipolar I disorder, irritability associated with autism spectrum disorder, schizophrenia, and Tourette's disorder</p> Signup and view all the answers

    What is the pharmacological action of Montelukast?

    <p>Leukotriene receptor antagonist</p> Signup and view all the answers

    What is a side effect of Cromolyn sodium?

    <p>Stinging and burning of nasal mucosa</p> Signup and view all the answers

    What is the therapeutic use of Reslizumab (Cinqair)?

    <p>Reduction of allergy symptoms</p> Signup and view all the answers

    What is a black box warning for Isoniazid?

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

    What is the mechanism of action of Rifampin?

    <p>Inhibits RNA synthesis</p> Signup and view all the answers

    What is a side effect of Theophylline?

    <p>None of the above</p> Signup and view all the answers

    What is a nursing intervention for Montelukast?

    <p>Monitoring ATL levels</p> Signup and view all the answers

    What is a contraindication for Montelukast?

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

    What is the mechanism of action of Fluticasone?

    <p>Inhibits inflammatory pathways</p> Signup and view all the answers

    What is a common side effect of Diphenhydramine?

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

    What is a contraindication for the use of Oxymetazoline?

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

    What is the therapeutic use of Dextromethorphan?

    <p>Cough suppression</p> Signup and view all the answers

    What is a common side effect of Albuterol?

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

    What is the mechanism of action of Acetylcysteine?

    <p>Breaks down mucus bonds</p> Signup and view all the answers

    What is a contraindication for the use of Ipratropium?

    <p>Hypersensitivity to soy beans and peanuts</p> Signup and view all the answers

    What is the therapeutic use of Phenylephrine?

    <p>Nasal congestion</p> Signup and view all the answers

    What is a side effect of Codeine Cough Syrup?

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

    What is a contraindication for the use of Guaifenesin?

    <p>Children under six</p> Signup and view all the answers

    Study Notes

    Respiratory Medications

    • Cromolyn (mast cell receptor stabilizer): inhibits mast cell degranulation, preventing release of histamine; instruct patient on proper inhaler or nasal spray technique and use prior to exposure
    • Diphenhydramine (H1 Receptor Agonist) - Benadryl:
      • Pharmacological action: blocks the effects of histamine at H1 receptors, resulting in antihistamine effects
      • Adverse effects: photosensitivity, paradoxical excitement (especially in children), anticholinergic effects, dry mouth, tachycardia, hypertension
      • Contraindications: hypersensitivity, narrow angle glaucoma, BPH, G.I. obstruction
    • Fluticasone (intranasal corticosteroid):
      • Therapeutic use: allergic rhinitis
      • Mechanism of action: inhibits inflammation pathways
      • Side effects: nasal irritation, epistaxis (nose bleeds)
      • Adverse effects: systemic effects with prolonged use (especially with oral steroids)
      • Contraindications: hypersensitivity; masks effects of infection, so do not use if patient has a known infection
    • Oxymetazoline (decongestant):
      • Pharmacological action: sympathomimetic vasoconstriction of nasal blood vessels
      • Mechanism of action: stimulates alpha-adrenergic receptors
      • Side effects: rebound congestion with prolonged use, nasal irritation, minor stinging or dryness
      • Nursing interventions: limit use to 3-4 consecutive days to prevent rebound congestion
      • Contraindications: hypertension, diabetes, thyroid disorder, heart disease

    Cough Medications

    • Dextromethorphan (antitussive):
      • Pharmacological action: suppresses cough reflex in CNS and provides analgesia
      • Side effects: dizziness, drowsiness, nausea
      • Adverse effects: rare, but can cause slurred speech, ataxia, hyperexcitability, stupor, respiratory depression, seizures, coma, and toxic psychosis
      • Contraindications: concurrent use of MAOIs
    • Codeine cough syrup:
      • Pharmacological action: suppresses cough reflex in CNS and provides analgesia
      • Side effects: sedation, constipation, respiratory depression
      • Nursing interventions: monitor for respiratory depression, assess for pain relief; be careful in patients with asthma as bronchoconstriction can occur

    Mucolytic Agents

    • Acetylcysteine (mucolytic):
      • Pharmacological action: breaks down bonds in mucus, reducing its viscosity
      • Therapeutic use: pulmonary disorders with thick, tenacious mucus (e.g., cystic fibrosis, chronic bronchitis)
      • Side effects: smells like rotten eggs

    Bronchodilators

    • Albuterol (beta-2 adrenergic agonist):
      • Pharmacological action: selective beta-2 adrenergic agonist, bronchial dilator
      • Therapeutic use: acute bronchospasm
      • Adverse effects: palpitations, headaches, tremors, restlessness, nervousness, tachycardia
      • Contraindications: hypersensitivity, cardiovascular effects
      • Interactions: concurrent use of beta blockers will inhibit the bronchodilation effects of albuterol; patients should avoid MAOIs within 14 days of beginning therapy
    • Ipratropium (anticholinergic):
      • Pharmacological action: anticholinergic, bronchial dilator
      • Therapeutic use: COPD, asthma exacerbations
      • Adverse effects: upper respiratory tract irritation, cough, dry nasal mucosa, hoarseness, sis
      • Contraindications: hypersensitivity to soybeans and peanuts

    Antihistamines

    • Diphenhydramine (H1 Receptor Agonist) - Benadryl:
      • Pharmacological action: blocks the effects of histamine at H1 receptors, resulting in antihistamine effects
      • Adverse effects: photosensitivity, paradoxical excitement (especially in children), anticholinergic effects, dry mouth, tachycardia, hypertension
      • Contraindications: hypersensitivity, narrow angle glaucoma, BPH, G.I. obstruction

    Antidepressants

    • Selective Serotonin Reuptake Inhibitors (SSRIs):
      • Mechanism of action: inhibit reuptake of serotonin to increase serotonin effects
      • Indications: depression, anxiety, obsessive-compulsive disorder
      • Off-label uses: premature ejaculation
      • Side effects: insomnia and sexual dysfunction
      • Black box warning: increased risk for suicide
      • First-line for depression and anxiety; relatively safe in pregnancy
    • Serotonin Norepinephrine Reuptake Inhibitors (SNRIs):
      • Mechanism of action: inhibit reuptake of serotonin and norepinephrine to increase effects
      • Indications: anxiety, major depression, migraine prevention, fibromyalgia
      • Side effects: sexual dysfunction, insomnia, hypertension, orthostatic hypotension, hepatotoxicity
      • Black box warning: increased risk for suicide
    • Tricyclic Antidepressants (TCAs):
      • Mechanism of action: inhibit reuptake of serotonin and norepinephrine
      • Indications: depression
      • Off-label uses: fibromyalgia, IBS, migraines, anxiety, and withdrawal syndrome
      • Side effects: anticholinergic effects, ECG changes like tachycardia, CNS depression, orthostatic hypotension, sedation, weight gain, urinary retention, blurred vision
      • Black box warning: increased risk for suicide
      • Not first-line treatment, as it takes many weeks to work

    Mood Stabilizers

    • Lithium (Lithobid):

      • Mechanism of action: reduces excitatory neurotransmission and increases inhibitory neurotransmission
      • Indication: bipolar disorder
      • Off-label uses: depression
      • Side effects: cardiac/renal/CNS effects, polyuria, polydipsia, bradycardia, weight gain
      • Black box warning: monitor lithium levels for toxicity
      • Patient education: requires lab monitoring, due to interfering with antidiuretic hormone (ADH); patient must drink adequate fluids

    • Valproate (Valproic Acid) - Depakote:

      • Mechanism of action: inhibition of voltage-gated sodium channels, decreasing neuron excitability and firing rate
      • Indications: seizure disorder, migraines, bipolar disorder
      • Black box warning: hepatotoxicity, teratogenic, pancreatitis, thrombocytopenia, bleeding, inhibits platelets

    • Lamotrigine (Lamictal):

      • Mechanism of action: prolongs sodium channel inactivation, blocks specific calcium channels, and blocks glutamate
      • Indications: seizure and bipolar disorder
      • Off-label uses: panic disorder, anxiety, migraines, and headaches, binge eating disorder, borderline personality disorder, post-traumatic stress disorder (PTSD)
      • Black box warning: Steven-Johnson syndrome, hemophagocytic lymphohistiocytosis, angioedema, toxic epidermal necrolysis### Medications for Respiratory Issues

    • Fluticasone (Intranasal Corticosteroid): used to treat allergic rhinitis, inhibits inflammation pathways, side effects include nasal irritation and epistaxis, contraindications include hypersensitivity and masking effects of infection.

    • Oxymetazoline (Decongestant): sympathomimetic vasoconstriction of nasal blood vessels, stimulates alpha adrenergic receptors, side effects include rebound congestion, nasal irritation, and minor stinging or dryness, contraindications include hypertension, diabetes, thyroid disorder, and heart disease.

    • Dextromethorphan (Antitussive): suppresses cough reflex in the CNS and provides analgesia, side effects include dizziness, drowsiness, and nausea, adverse effects include rare cases of slurred speech, ataxia, hyperexcitability, stupor, respiratory depression, seizures, coma, and toxic psychosis, contraindications include concurrent use of MAOIs.

    Cough Medications

    • Codeine Cough Syrup: suppresses cough reflex via the CNS and provides analgesia, side effects include sedation, constipation, and respiratory depression, nursing interventions include monitoring for respiratory depression and assessing for pain relief, careful use in patients with asthma due to bronchoconstriction.

    • Guaifenesin (Expectorant): increases respiratory tract fluid, reducing viscosity of mucus, therapeutic use is for productive cough and mucus clearance, contraindications include hypersensitivity and use in children under six.

    • Acetylcysteine (Mucolytic): breaks down bonds in mucus, reducing its viscosity, therapeutic use is for pulmonary disorders with thick tenacious mucus, cystic fibrosis, and chronic bronchitis, has a strong rotten egg smell.

    Bronchodilators

    • Albuterol (Beta-Adrenergic Agonist): selective beta-2 adrenergic agonist, therapeutic use is for acute bronchospasm, adverse effects include palpitations, headaches, and tachycardia, contraindications include hypersensitivity and cardiovascular effects.

    • Ipratropium (Anticholinergic): anticholinergic bronchial dilator, therapeutic use is for COPD and asthma exacerbations, adverse effects include upper respiratory tract irritation, cough, dry nasal mucus, and hoarseness, contraindications include hypersensitivity to soybeans and peanuts.

    Other Medications

    • Phenylephrine (Alpha-Adrenergic Agonist): stimulates alpha-1 receptors, constricting nasal blood vessels, therapeutic use is for nasal congestion, adverse effects include increased blood pressure and rebound congestion, contraindications include acute pancreatitis, heart disease, and narrowing angle glaucoma.

    • Methylxanthines (Caffeine, Theophylline): bronchial dilators, therapeutic use is for asthma, medication administration is oral or intravenously, contraindications include narrow safety margin with long-term use, patient interactions include numerous drug interactions.

    • Montelukast (Leukotriene Modifiers): leukotriene receptor antagonists, side effects include headache and nausea, adverse effects include rare neuropsychiatric events, contraindications include hepatic impairment.

    • Cromolyn sodium (Mast Cell Stabilizer): therapeutic uses include prophylaxis of asthma, allergy, and allergic rhinitis, adverse effects include bronchospasms, anaphylaxis, and stinging and burning of nasal mucosa.

    • Monoclonal Antibodies (Various): designed to attach to information mediators that reduce allergy symptoms, examples include Reslizumab and Omalizumab.

    • Isoniazid (Anti-Tubercular Drug): inhibits micro-bacterial cell wall synthesis, therapeutic use is for tuberculosis, adverse effects include neurotoxicity, paresthesia, and black box warning for hepatotoxicity.

    • Rifampin (Anti-Tubercular Drug): inhibits DNA-dependent RNA polymers in mycobacterial, side effects include orange discoloration of bodily fluids and gastrointestinal upset, adverse effects include hepatotoxicity.

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    This quiz covers the pharmacology of Zyban and Trazodone, including their mechanisms of action, indications, off-label uses, and adverse effects. Test your knowledge of these medications and their potential benefits and risks.

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