Neuro Exam 2

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pharmschool
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136802
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Neuro Exam 2
Updated:
2012-02-22 16:38:30
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Neuro
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Description:
PTSD, OCD, Anxiety, Sleep Disorders, Toxicology
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  1. PTSD Re-experiencing symptoms include:
    • flashbacks
    • nightmares
    • intrusive images
    • sensory impressions
  2. PTSD Avoidance symptoms include:
    Avoiding people, situations, or circumstances
  3. PTSD Emotional Numbing symptoms include:
    • Lack of feelings
    • Feeling detached
    • Giving up on activities
  4. PTSD Hyperarousal symptoms include:
    • startled response
    • irritability
    • difficulty concentrating
    • sleep disturbances
  5. Diagnosis for PTSD requires all of the following happening for at least 1 month
    • At least 1 re-experiencing symptoms
    • At least 3 avoidance symptoms
    • At least 2 hyperarousal symptoms
    • Symptoms that make daily life activities difficult
  6. 1st line therapy for PTSD:
    SSRIs

    **May also use TCAs and MAOIs**
  7. These are the only two SSRIs with an FDA-approved indication for PTSD:
    • Paroxetine
    • Sertraline
  8. 2nd line therapy for PTSD
    • TCAs: Amitriptyline & Imipramine
    • MAOI: Phenelzine
    • SNRI: Venlafaxine ER
    • Others: Trazadone, Bupropion, Mirtazapine
  9. TCAs cause muscharinic side effects which include:
    dry mouth, urinary retention, decreased GI motility
  10. True or False: BZDs are not effective for PTSD symptoms
    True!
  11. The acute phase of PTSD (the 1st four weeks) should be treated with:
    Cognitive Behavioral Therapy (CBT)
  12. What is the primary stress hormone involved in PTSD?
    Cortisol
  13. For PTSD, how many weeks after CBT should an SSRI be started?
    4 weeks
  14. After how many weeks of trialing an SSRI for PTSD would you switch to a different agent if no response?
    8 - 12 weeks
  15. For PTSD, how long should treatment be continued in patient's that are responding to pharmacotherapy?
    at least 12 months (to 24 months)
  16. The two neurochemicals thought to be in disruptions in OCD include:
    Serotonin & Dopamine
  17. For OCD, Obsessions are ________ and Compulsions are _______
    Thoughts

    Actions
  18. Initial treatment for OCD should start with:
    Cognitive Behavioral Therapy (CBT)
  19. 1st line pharmacotherapy agents for treating OCD are:
    SSRIs
  20. 2nd/3rd Line pharmacotherapy agents for treating OCD are:
    TCA: clomipramine
  21. These are the only four antidepressants with an FDA-approved indication for OCD:
    • Fluoxetine
    • Fluvoxamine
    • Sertraline

    Clomipramine
  22. Sertraline Oral Concentrate Solution can only be diluted in:
    • orange juice
    • lemonaide
    • water
    • ginger ale
  23. What is the safest drug to use during pregnancy for OCD?

    What drug should be avoided?
    Fluoxetine

    Clomipramine
  24. For OCD, what drug can be used as an augmenting agent for the elderly?
    Buspirone
  25. For OCD, what drugs should be started at a lower dose in patients with renal disease?
    • Fluoxetine
    • Fluvoxamine
    • Paroxetine
  26. The antidepressants used to treat OCD are metabolized extensively by the:
    Liver
  27. For OCD, what is the duration of therapy for CBT?
    Once weekly for at least 13-20 weeks
  28. For OCD, pharmacotherapy should be continued in patients for:
    8-12 weeks
  29. What is the source of Coca?
    Dried leaves of Erythroxylum coca Lam. or E. truxillense
  30. Benzoylmethylecgonine
    A tertiary amine diester
    Colorless
    Low water solubility
    HCl salt is the most common watersoluble derivative
    Cocaine Chemistry
  31. Pharmacodynamics of Cocaine; 2 predominant actions
    1. Local Anesthesia --- acting on the PNS

    2. Stimulation --- acting on the CNS
  32. Cocaine's MOA for stimulation:
    Cocaine blocks the uptake of the following biogenic amines, via bindingto the transporters of these amines:

    Dopamine / Norepinephrine / Serotonin
  33. Major CNS AEs of Cocaine:
    Respiratory Depression and Death

    Temperature: Marked pyrexia (prominent feature of overdosage)
  34. Major Cardiovascular AEs of Cocaine:
    • Acute increase in arterial pressure (PNS)
    • Increased risk for: stroke / MI

    Latter stages: BP drops --> death may occur

    Large IV doses of cocaine may produce immediate death due to direct toxicity on the myocardial musculature
  35. Major Ophthalmic AEs of Cocaine:
    • Sloughing of the corneal epithelium
    • Corneal pitting
    • Corneal ulceration
  36. Major AEs of Cocaine-derived topical anesthetics
    • Seizures
    • Coma
    • Death
  37. What is the method of administration for Coca Paste Abuse?
    Smoking

    "freebasing" increases the effects/potency
  38. What is the method of administration of Crack Cocaine?
    Smoking
  39. What is the method of administratino of Cocaine Snorting?
    Intranasal ingestion
  40. Chemistry of LSD:
    Indoleamine -- Conversion of tryptophan to this compound
  41. LSD MOA:
    **High Affinity for 5-HT2A receptor**

    Binds to receptor - couples to G proteins - generates ITP - release of intracellular Ca++ ---- Causes Hallucinations
  42. What is the source/chemistry of LSD?
    • Does not occur naturally
    • Prepared:
    • --Chemically, via semi-synthesis from (+)-lysergic acid chloride + diethylamine
    • --Microbially, via the growth of Claviceps paspali with the hydroxyethylamide
  43. The major actions of LSD are on the CNS which affects:
    both pyramidal (conical portion of medulla oblongata) and extrapyramidal systems
  44. Signs/Symptoms of Acute LSD Intoxication
    • Mydriasis
    • Hypertension
    • Tachycardia
    • Hyperglycemia
    • Hyperthermia
    • Piloerection
    • Hyperactive tendon reflexes
    • Visual Hallucinations
  45. What is the most common form of LSD abuse?
    Tripping - intensify the environment / have a novel experience
  46. Three well-established AEs of "bad tripping" with LSD include:
    • Acute panic reactions
    • Hallucinogen Persisting Perception Disorder (suicide is possible)
    • Prolonged Psychosis (paranoia & schizophrenia)
  47. For the diagnosis of Panic Disorder, how many Somatic or Cognitive symptoms does one have to have?
    At least 4
  48. Treatment for Panic Disorder includes:
    • BZDs
    • SSRIs: Fluoxetine, Paroxetine, Sertraline, Citalopram, Fluvoxamine
    • TCAs: Clomipramine and Imipramine
    • SNRI: Venlafaxine ER
    • MAOI
    • Mirtazapine
  49. Which BZDs are long-acting?
    • Chlordiazepoxide
    • Clonazepam
    • Diazepam
    • Flurazepam
  50. Which BZDs are short/intermediate acting?
    • Alprazolam
    • Lorazepam
    • Oxazepam
    • Temazepam
    • Triazolam
  51. Excessive anxiety and uncontrollable worry that persists for at least 6 months is:
    Generalized Anxiety Disorder (GAD)
  52. FDA-approved agents for GAD includes:
    • Buspirone
    • BZDs
    • SSRIs: Paroxetine, Escitalopram
    • SNRIs: Venlafaxine ER, Duloxetine
    • Beta-Blockers: Propranolol
    • Hydroxyzine (Vistaril)
    • Diphenhydramine
  53. Max Buspirone Dose is?
    60 mg/day
  54. Pharmacologic Treatment for Social Anxiety Disorder:
    • 1st line: SSRI or Venlafaxine
    • 2nd line: BZD (Clonazepam)
  55. Which BZDs are good to use in the elderly?

    **Those that undergo phase 2 metabolism**
    • Lorazepam
    • Oxazepam
    • Temazepam
  56. BZD-receptor agonists MOA:
    Interact with the GABAAα receptor subunit on or near BZD receptors
  57. Primary difference between BZD-receptor agonists and BZDs is:
    BZD-receptor agonists preserve stage 3 NREM sleep whereas BZDs do not
  58. Ramelteon MOA:
    Agonist at the MT1 and MT2 receptors
  59. Doxepin MOA:
    H1 receptor antagonist
  60. What is the antidote for acetaminophen?
    N-acetylcysteine
  61. What is the antidote for organophosphate?
    atropine/pralidoxime
  62. What is the antidote for methanol/ethylene glycol?
    Fomepizole
  63. What is the antidote for cyanide?
    Hydroxycobalamin
  64. What is the antidote for opiods?
    Naloxone
  65. What is the appropriate therapy for Jimson Weed poisoning?
    Physostigmine 0.5 to 2 mg via slow IV push
  66. What are the risks associated with Dextromethorphan abuse?
    • INCOORDINATION
    • DROWSINESS
    • CONFUSION
    • BLURRED VISION
    • SLURRED SPEECH
    • HALLUCINATIONS (Visual/Auditory)
    • CNS DEPRESSION
  67. Treatment of Dextromethorphan Abuse:
    • Supportive Care
    • SECONDARY TOXICITY: Acetaminophen, Diphenhydramine, & Decongestants

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