Pharm 4A

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atmu
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213359
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Pharm 4A
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2013-04-17 00:33:11
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Pharm 4A
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  1. MOA and indications for the BZ agonist sedative hypnotics - (Lunesta, Ambien, Sonata)
    MOA: Binds to benzo receptor type 1 - agonist effects

    -used short term for Insomnia
  2. How is ramelteon (Rozerem) different from BZ agonist and benzos?
    ramelteon (Rozerem) is a melatonin agonist, while BZ agonist is benzo receptor agonist and benzo enhance the actions of GABA (an inhibitory neurotransmitter of the CNS)
  3. Name the shortest (2) and longest (4) acting BZ and understand the potential for dependence
    Shortest (2-6 hrs):  Midazolam (Versed) & Triazolam (Halcion)

    • Longest (1-3 days)
    • -Diazepam (Valium)
    • -Quazepam (Doral)
    • -Flurazepam (Dalmane)
    • -Chlordiazepoxide (Librium)

    -Schedule IV; Must withdraw slowly with taper to avoid withdrawal of confusion, agitation, anxiety, and sometimes sz
  4. Which BZ used for conscious sedation? Alcohol withdrawal?
    Conscious sedation: Midazolam (Versed)

    Alcohol withdrawal: Chlordiazepoxide (Librium)
  5. TX of BZ overdose?
    Flumazenil (Romazicon) - IV
  6. Which meds are mainstay for GAD?
    • GAD:
    • -paroxetine (Paxil) -- SSRI
    • -sertraline (Zoloft) -- SSRI
    • -buspirone (Buspar) -- partial 5-HT agonist

    can also use BZ for acute anxiety

    Other: Venlafaxine (Effexor)
  7. What meds for panic disorder?
    • Benzos
    • 1. alprazolam (Xanax)
    • 2. lorazepam (Ativan)
    • 3. clonazepam (Klonopin)

    • SSRIs
    • 1. paroxetine
    • 2. escitalopram
    • 3. citalopram

    -Clomipramine (Anafranil) or Imipramine are also effective; TCAs
  8. Mainstay of therapy and most effective treatment for motor symptoms for Parkinsons?
    Mild - MAO type B inhibitor and amantadine

    Most effective -- Levodopa
  9. Major AE of L-dopa/carbidopa vs DA agonist?
    • L-dopa AE:
    • -Long-term therapy may have "wearing off effect"
    • -dyskinesias and excessive involuntary movements
    • -nausea
    • -hallucinations and confusion

    • DA agonist AE:
    • -N/V (apokyn high incidence)
    • -hallucinations
    • -dyskinesias
    • -yawing
    • -postural hypotension
    • -confusion sedation
    • -edema
  10. Role of MAO inhibitors e.g. selegiline for Parkinsons?
    prevents MAO-B in brain from breaking down dopamine
  11. Understand indications and AE of clozapine for schizophrenia
    5-HT (serotonin) and D2 (dopamine) antagonist (2nd gen.) - atypical antipsychotic

    -Less extrapyramidal effects so use if tardive dyskinesia appears

    -it also has high affninity for D1 receptors, whereas most neuroleptic drugs do not.

    • AE:
    • 1. agranulocytosis
    • 2. weight gain
    • 3. hyperglycemia --> DM
    • 4. sedation
    • 5. orthostasis
    • 6. anticholinergic and antiadrenergic effects
  12. Describe and compare the major AE of the TCA and the SSRI type antidepressants
    • TCA AE:
    • 1. Cardiotoxicity - QT prolongation
    • 2. orthostatic hypotension
    • 3. sedation
    • 4. anticholinergic efects

    • SSRI AE:
    • 1. sexual dysfunction
    • 2. nausea
    • 3. HA
    • 4. CNS stimulation: nervousness, insomnia, anxiety
    • 5. weight gain
    • 6. serotonin syndrome
  13. Understand the difference between the traditional antipsychotics (low potency vs high potency)
    Low potency: bind less DA receptor and have less extrapyramidal symptoms

    High potency: strongly bind to and block DA receptors causing more extrapyramidal symptoms
  14. Understand basic changes in geriatric patients re: pharmacology
    • -increased distribution of fat soluble drugs
    • -decreased distribution of water soluble drugs
    • -decline in phase I metabolism cus reduction of liver volume = increase in drug half-life
    • -decreased GFR = decreased renal clearance and increased half-life

    • -dec. density of autonomic receptors
    • -inc. sensitivity to antipsychotics, BZ, and opiods
    • -inc. response to warfarin and other anticoags
    • -inc. incidence of orthostatic hypotension
  15. Know the names (6) and the major AE of the atypical antipsychotics (6)
    • 1. clozapine (Clozaril)
    • 2. risperidone (Risperdal)
    • 3. olanzapine (Zyprexa)
    • 4. quetapine (Seroquel)
    • 5. aripiprazole (Abilify)
    • 6. ziprasidone (Geodon)

    • AE:
    • 1. Low EP effects at therapeutic dosages
    • 2. anticholinergic effects
    • 3. weight gain, hyperglycemia --> DM
    • 4. orthostatic hypotension
    • 5. sedation
    • 6. sexual and prolactin adverse effects
  16. SSRIs- major AE
    nausea and sexual issues
  17. monitoring parameters, and indications for Lithium carbonate tx
    Indications: bipolar; preferred for classic euphoric mania and hypomania w/o rapid cycling

    • Monitoring parameters:
    • 1. renal - creatinine every  6 months; UA w/ osmolarity and specific graviey if urine volume > 3L/day
    • 2. Thyroid function - every 6 months
    • 3. level obtained twice weekly until pts status and levels are stable; then take every 1-3 months
  18. Lithium AE (7)
    • 1. tremor of fingers 50% in 1st week then diminishes
    • 2. mild cognitive impairment
    • 3. renal - polydipsia and polyuria; rarely interstitial fibrosis
    • 4. muscle weakness and lethargy
    • 5. weight gain
    • 6. gastric distress w/ N/V and diarrhea
    • 7. thyroid abnormalities
  19. Know MOA, primary AE (side effects) and major types of drugs used to treat Alzheimers (e.g. cholinesterase inhibitors (4) and Nemantine glutamate receptor agonist (1))
    • Cholinesterase inhibitors - increase Ach
    • 1. tacrine (Cognex)
    • 2. donepezil (Aricept)
    • 3. rivastigmine (Exelon)
    • 4. galantamine (Reminyl)
    • -AE: N/D/V and insomnia; tacrine elevates liver enzymes by a lot

    • NMDA receptor antagonist - blocks NMDA glutamate receptors
    • 1. memantine (Namenda)
    • -AE: fatigue, HA, HTN, constipation, pain
  20. Discuss the major toxicity of the NSAIDs and understand reasons for COX II inhibitors (coxibs) like Vioxx removal from US market
    -NSAIDS and COX II inhib have potential for increased risk of CV events and GI bleeding

    -Vioxx withdrawn due to adverse CV events like prothrombotic states
  21. Gout - name the two xanthine oxidase inhibitors, how they work and major AE
    Allopurinol (Xyloprim) and Uloric (febuxostat)

    MOA: inhibitor of xanthine oxidase, which forms uric acid --> reduces uric acid in plasma

    • AE:
    • -hypersensitivity
    • -initial increase in acute gout
    • -maculopapular pruritic rash is m/c

    Uloric AE: liver function abnormalities, nausea, arthralgia, rash
  22. Gout- how is probenecid different from allopurinol
    probenecid is uricosuric agent that blocks reabsorption of uric acid in the proximal tubule
  23. Major toxicity of immunosuppressants (sirolimus (5) and tacrolius (4))
    • Tacrolimus:
    • -nephrotoxicity
    • -neurotoxicity
    • -increased risk of DM
    • -increased risk of OIs

    • Sirolimus
    • -HTN, edema
    • -hyperlipidemia and inc. cholesterol
    • -abd.pain, N/D/V
    • -increase infections
    • -increased risk of anemia, cytopeni
  24. Methotrexate- clinical use as immunosup and major AE/toxicities
    First line DMARD w/ RA pts; also used in lots of cancers

    • AE:
    • -pregnancy category X
    • -cytopenias
    • -liver toxicity
    • -acute penumonitis
    • -nephropathy
    • -GI distress (D/N/V)
    • -oral ulcers
    • -alopecia
  25. NSAID best for analgesia
    ketorolac
  26. NSAID used in acute gout
    Indomethacin
  27. Which meds are used as mood stabilizers for Bipolar D/O (4)? Bipolar depression?
    • Bipolar disorder:
    • 1. lithium
    • 2. divalproex
    • 3. carbamazepine
    • 4. antipsychotics

    • Bipolar depression
    • 1. lamotrigine
    • 2. buproprion
    • 3. citalopram
    • 4. escitalopram
    • 5. sertraline
  28. Long term effects of meds like haloperidol (high pot antipsych meds)
    • -tardive dyskinesia
    • -perioral tremor

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