Exam Three Study Guide Pharm PDF

**FDA warning on all antidepressants** ALL categories of antidepressants\ ♣ Increased risk of suicidal thoughts and behavior\ ♣ Children, adolescents, young adults up to 24 years of age\ ♣ First two months of treatment\ ♣ Depression and psychiatric illness risk factors 2. **SSRI medications**...

**FDA warning on all antidepressants** ALL categories of antidepressants\ ♣ Increased risk of suicidal thoughts and behavior\ ♣ Children, adolescents, young adults up to 24 years of age\ ♣ First two months of treatment\ ♣ Depression and psychiatric illness risk factors 2. **SSRI medications** a. Citalopram b. Escitalopram c. Fluoxetine -- First in USA to be approved for depression, inhibitors of CYPP450 d. Fluvoxamine -- only OCD in USA e. Paroxetine - inhibitors of CYPP450 f. Sertraline No specific monitoring with the exception of closely monitor for the first 2-3 weeks after initiation for assessment of suicidal ideation. 3. **What herbs interact with SSRI** Ginkgo Biloba [St. John\'s Wort] Garcinia cambogia (HCA) L-tryptophan (or 5-HTP) [SAMe (S-adenosyl-methionine) supplements.] Increase the risk for serotonin syndrome 4. **Onset of action of SSRI** Onset of action two weeks, up to 12 weeks for maximum benefit. T ½ 16-36 hours 5. **Mechanism of action of SSRI** 6. **Indications for SSRI** All SSRIs but fluvoxamine g. Depression h. Anxiety i. Panic disorders j. OCD k. Bulimia, off label anorexia l. Premenstrual dysphoric disorder m. PTSD n. Generalized anxiety social phobia 7. **Which medications are SNRI's** - - - - - - Mechanism of Action: Inhibit the reuptake of Serotonin &Norepinephrine - contraindicated in patients who received monoamine oxidase inhibitors (MAOIs) in the previous two weeks because of drug-drug interactions that cause the serotonin syndrome 8. **MOA of Desvenlafaxine a SNRI** o. Block reuptake of serotonin and norepinephrine p. Degree of the block is based upon dosage Glucuronidation excretion Hepatic and Renal Dose adjustment hepatic and renal impairment 9. **Side effects of SNRI** q. Common i. CNS ii. Nausea, constipation iii. Dry mouth iv. Sexual r. Higher dosages v. hypertension s. Similar to Venlafaxine t. Palpitation ADE Levomilnacipran u. Similar to others v. Urinary hesitation due to the dual mechanism of action SNRI and TCA may be effective in relieving pain such as HA or backpain associated with depression. They may also be affective in the treatment of diabetic neuropathy, postherpetic neuralgia, fibormyalgia, and low back pain. 10. **Side effects of mirtazapine** Atypical antidepressants - Mirtazapine enhances serotonin and norepinephrine neurotransmission - Sedation, increased appetite and weight gain 11. **Which medications are tricyclic antidepressants** w. Imipramine Trimipramine Nortriptyline Doxepin x. Desipramine Amitriptyline Clomipramine Protriptyline Amoxapine 12. **Indications for tricyclic antidepressants** Depression, panic disorder, prevent migraine, treat chronic pain syndrome 13. Dosing of tricyclic antidepressants when used for neuropathic pain Amitriptyline and duloxetine. Lower the dose 14. **Which anxiolytic to choose based on sleep patterns** For patients with sleep onset insomnia, a relatively short-acting medication is a reasonable choice for an initial trial of pharmacologic therapy.. zaleplon, zolpidem, triazolam, and ramelteon, temazepam, Eszopiclone. For patients with sleep maintenance insomnia, a longer-acting medication is preferable for an initial trial of pharmacologic therapy. zolpidem extended release, eszopiclone, temazepam, lorazepam, eszopiclone, low dose doxepin, and suvorexant. Longer-acting medications may increase the risk for hangover sedation. For patients with awakening in the middle of the night, both zaleplon and a specific sublingual tablet form of zolpidem have been developed for use during the night, with the constraint that there will be at least four hours of time in bed remaining after administration. 15. **Side effects of medications use to help patients sleep** Drowsiness and confusion, ataxia, cognitive impairment, sleepwalking/driving, anterograde amnesia, dizziness, HA, dry mouth peripheral edema somnolence, suicidal ideation 16. How to dose anxiolytics in the elderly and patients with sleep impairment (eszopiclone) Elderly and hepatic impairment decrease dose, Max 2mg 17. **Mechanism of action of zolpidem** y. Binds to GABAa Receptors z. Relative selectivity for α₁ subunit Has fewer withdrawal symptoms, minimal rebound insomnia and minor tolerance 18. **ADE associated with melatonin receptor agonists** vi. HA vii. Increased LFT viii. Abnormal dreams Include ramelteon and tasimelteon, agonist for MT1&2 19. **Goals and outcomes of treatment of anti-Parkinson's medications** Goal: restoring dopamine in the basal ganglia and antagonizing the excitatory effect of cholinergic neurons, end with correct dopamine/acetylcholine balance No drugs stop the progression or reverse the disease Management of individual patients requires careful consideration of a number of factors, including the patient\'s symptoms and signs, age, stage of disease, degree of functional disability, and level of physical activity and productivity 20. **Role of carbidopa and levodopa** Levodopa actively transported into the CNS where it is converted into dopamine Carbidopa Inhibits the metabolism of levodopa outside of the CNS 21. **Which medications are Monoamine oxidase type B inhibitors** Selegiline- administered with levodopa to enhance its effects. Metabolized to methamphetamine\ Rasagiline- 5x more potent than selegilin\ Safinamide -- used with levodopa/carbodopa 22. **Side effects associated with tolcapone** Tolcapone Prevents competition for transport of levodopa by 3-O-methyldopa. With a long duration of action. When with levo/carbo side effects include:\ Diarrhea, orthostatic hypotension\ Nausea, anorexia, dyskinesias, hallucinations, sleep disorders\ Tolcapone-hepatic necrosis 23. **Goal of treatment with donepezil in patients with Alzheimer's disease** Donepezil is an acetylcholinesterase inhibitor. That improves cholinergiv transmission and can cause cramps NVD tremors Goals of therapy Improve cholinergic transmission with the CNS Prevent excitotoxic actions from overstimulation of NMDA-glutamate receptors Reality Palliative Short-term none alter the disease process 24. **Side effects associated with memantine** Memantine blocks NMDA receptors prevents toxic CA levels. Side effects: Confusion, agitation, restlessness (similar to symptoms of Alzheimer's\ Disease) 25. **Common causes of neuropathic pain** Results from damage to or pathology with the nervous system Central or peripheral Causes diabetes mellitus Post-herpetic neuralgia Stroke Alcoholic neuropathy Cancer-related pain/treatment Phantom limb pain Trigeminal neuralgia Vitamin B₁₂ deficiency 26. **ADE's associated with gabapentin** Gabapentin/pregabalin is an anticonvulsant that is also used for neuropathic pain. It binds to CA channels. Preg is better absorped. Side effects include: dizziness, drowsiness, fatigue, peripheral edema 27. **Duration of a trial of gabapentin to treat neuropathic pain** For chronic use a trial may be required that lasts 2 months or more. PREg is faster onset. 28. **Specific therapy for managing trigeminal neuralgia** Carbamazepine is afirst like therapy for trigeminal neuralgia. It prevents repeated discharge in neurons to relieve pain. Related to TCAs TCAs have anticholergic and antihistaminergic effects. Like SNRIs, there effects on serotonin and norepinepherin reuptake inhibitors are what helps. TCAs needed a lower dose that what is used for depression and the effects can last for 1-3 weeks. The SNRIS specifically Venlafaxine: acute and chronic neuropathic pain. And Duloxetine: painful diabetic neuropathy, fibromyalgia, and more recently chronic low back pain and osteoarthritis. Do not forget about the ADE of dry mouth insomnia drowsiness and constipation 29. **Mechanism of action of capsaicin cream** The repeated application will deplete substance p from the primary afferent neurons. Watch for any burning or stinging or erythema. The patch works fast in an hour. The cream can take 6-8 weeks while being applied 3-4 times a day/ 30. **Ketamine dosing with a patient on chronic opioids** Ketamine reduces firing of NMDA receptors. its dosing is lower than anesthesia dose. When using for anesthesia you can not use it one infants less than 3month or known/suspected schizophrenia. May need to use doses at the higher range in opioid-tolerant patients. Reduce baseline opioids by 25% to 50% when used concomitantly with ketamine. Watch for agitation. Confusion. Hallucinations, vivid imagery. 31. **Topical lidocaine** Lidocaine is used as adjunctive or sometimes alone. It is for localized neuropathic pain. It will block initiation and conduction of nerve impulses and this is done by decreasing permeability to NA ions and inhibiting depolarization. It usually happens over about 4 hours. 32. Mechanism of action of gabapentin in the management of epilepsy Narrow spectrum for focal epilepsy Enhance Inhibition of gabaergic impulses Non- inducer oral contraceptive Attaches to the a2Bsubunit 33. Side effects of levetiracetam CNS Depression- almost all Suicidal Ideation Blood dyscrasias Steven Johnson Syndrome Nausea Weight gain/loss Hepatic failure 34. Contraindications to phenytoin 35. Monitoring parameters of carbamazepine history of bone marrow depression 36. Drug interactions of valproic acid with other antiepileptics 37. What are key concerns when prescribing antiepileptics to pregnant women 38. Mechanism of action of lamotrigine 39. Common side effects of topiramate 40. Contraindications to valproic acid 41. Monitoring parameters of ethosuximide with concomitant psychologic diseases 42. Which antiepileptic interferes with oral contraceptives 43. Which antiepileptics are safest during pregnancy 44. Common side effects associated with phenytoin 45. **Primary mechanism of action of COX-1 inhibitors leading to GI bleeding** COX-1 is expressed in most tissues but variably. It is described as a \"housekeeping\" enzyme, regulating normal cellular processes (such as gastric cytoprotection, vascular homeostasis, platelet aggregation, and kidney function), and is stimulated by hormones or growth factors. Gastric cytoprotection is what combats ulcers by increasing mucosal protection. 46. **Primary indications for COX-2 inhibitors** COX-2 is a highly regulated enzyme that is constitutively expressed in the brain, kidney, and bone, but which is undetectable in most other tissues increased during states of inflammation inhibited by glucocorticoids 47. **What is nociceptive pain?** Nociceptive pain is often due to musculoskeletal conditions, inflammation, or mechanical/compressive problems. In contrast to neuropathic pain, the pharmacologic approach to nociceptive pain primarily involves nonnarcotic and opioid analgesia. Medication is used in conjunction with non-pharmacologic therapies and approaches to relieve the source of the pain 48. Opioids are useful in the treatment of which type of pain 49. **MOA of NSAIDS** Indicated for mild to moderate pain, strain, and sprain. When combined with opioids the produce a dose-sparing effect. NSAIDs inhibit cyclooxygenase so there is no transformation of arachidonic caid to prostaglandins which leads to an anti-inflammatory response. Included are aspirin, celecoxib/cox-2l, diclofenac, ibuprofen, PGE₂ sensitizes nerve endings to the action of bradykinin, histamine, and other chemicals that are locally released during the inflammation process, NSAIDs inhibit the production of PGE₂, Antipyretic PGE₂ can elevate the set point of the anterior hypothalamic thermoregulatory center. Inhibition of prostaglandin formation helps restore normal regulationketorolac,meloxicam,naproxen,piroxicam. 50. Mechanism of action of naloxone 51. Opioids MOA for pain 52. Risk discussion with patients being prescribed opioids 53. Benefits of medicated patches 54. **ADEs associated with 5-alpha reductase inhibitors** 5-alpha reductase inhibitors are indicated for BPH. Examples include finasteride and dusateride ADE\ Decreased libido\ Impotence\ Gynecomastia\ Orthostatic hypotension 55. **Mechanism of action of GnRH analogs** Reversible chemical orchiectomy or oophorectomy. So it will temporarily disrupt the function of the testes/ovaries. It will reduce the production of sex hormones by inhibiting the pituatry glands release of lutenizing hormone and follicle stimulating hormone 56. **Anti-estrogen prevents osteoporosis** Raloxifene (Evista) prevention of osteoporosis, Post menopausal only 57. Which estrogen has the best estrogen when taken orally Estradiol has first-pass metabolism 58. **Medication interferes with progesterone used to terminate pregnancy** Mifeprisone\ RU486\ Terminates pregnancy\ Interferes with progesterone necessary to maintain pregnancy 59. **Contraceptive safe for use while breast feeding** **Intrauterine Devices (IUDs)**: Both hormonal and non-hormonal IUDs are safe and highly effective. Hormonal IUDs release progestin, which thickens cervical mucus to prevent sperm from reaching the egg1. It\'s important to avoid contraceptives containing estrogen, such as combined oral contraceptives, during the first few weeks postpartum, as they can affect milk supply