Okay, here is the deal: I made a bunch of questions as I was going ...


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Okay, here is the deal: I made a bunch of questions as I was going ...

  1. 1. Okay, here is the deal: I made a bunch of questions as I was going through the Pharm. Lectures. I may have made mistakes, and I know I made a lot of typos, so please ignore any that you see. Get out your “drugs you need to know list” for each lecture, and then use it as you try to answer the questions (that way you have an idea about which drugs you would be able to choose from in a multiple choice test). I hope this helps! -Cara Tillotson Neurodegenrative Disorders (PD) 1. Stimulation of each of the following receptors will lead to what? a. D1 receptor b. D2 receptor 2. This is the main drug of choice in treatment for PD. 3. These drugs are MAO-B inhibitors used with levodopa and may be neuroprotective (2 drugs) 4. These two parkinson’s drugs are not used often, are D1 and D2 agonists, and are ergot derivatives. 5. These two drugs are used in combination with levodopa to decrease peripheral metabolism and side effects. One also increases the half life of levodopa. 6. These are D2 and D2 agonist used prior to levodopa – it is contraindicated in patients with glaucoma (3 drugs). 7. This drug reduces free radical damage and is used as first line or adjunct in treatment. 8. Studies have shown that these two drugs act as adenosine receptor antagonists – they may be neuroprotective, though their mechanisms are not entirely understood. 9. This drug is injectable only and is available in an infusion pump. 10. These drugs are used in PD patients with hallucinogenic disturbances. 11. You should avoid using this drug with antihypertensives. 12. This drug is genereally well tolerated, but may cause peripheral edema, cognitive changes, and livedo reticularis. It is an antiviral used because it blocks DA reuptake and stimulates D2 and D3 receptors. 13. This drug is a peripheral COMT inhibitor only. 14. This drug is both a central and peripheral COMT. 15. This drug is used for Restless Leg syndrome.
  2. 2. Answers: 1. a. D1 = excitatory  increased cAMP  increased Ca2+  activation of protein kinase C. b. D2 = inhibitory  hyperpolarization. 2. Leodopa. 3. Seligiline and Rasagilene. 4. Bromocriptine and Pergolide. 5. Carbidopa (increases ½ life, also decreases nausea) and Benserazide. 6. Trihexyphenidyl, Benztropine Mesylate, and Diphenhydramine. 7. Pramipexole. 8. Caffiene and Istradefylline. 9. Apomorphine. 10. Clozapine. 11. Apomorphine. 12. Amantadine. 13. Entacapone. 14. Tolcapone. 15. Ropinirole.
  3. 3. Neurodegenerative disorders (AD, HD, ALS). 1. This drug is a AChE inhibitor, was the first AD drug, and is no longer used due to liver toxicity. 2. This drug is more selective for AChE than BChE and significantly improves performance scores; it is reversible and competitive. 3. This drug has 100% bioavailability. 4. HMG CoA Reductase inhibitors thought to have antioxidant effects, but many drug interactions. 5. This drug is “pseudoreversible” and inhibits central and peripheral AChE. 6. This is the main side effect that causes people to stop using the above drug. 7. This drug is used to treat both AD and PD – it is a monoamine oxidase inhibitor and can reduce the production of free radicals. 8. Herbal thought to improve memory. 9. Doses over how much per day is not indicated for Vitamin E? 10. These two drugs are used to treat disease-associated depression in AD. 11. These two drugs are used to treat diseases-associated spasticity. 12. When using this drug, which inhibits glutamate release, you must monitor hepatic function. 13. This drug increases pre-synpatic inhibition and decreases spasticity.
  4. 4. Answers: 1. Tacrine. 2. Galatamine. 3. Donepezil. 4. Statins. 5. Rivastigmine. 6. GI effects. 7. Seligiline. 8. Ginkgo. 9. 400 IU. 10. Fluoxetine (SSRI), Carbamazepine (Anti epileptic) 11. Baclofen (Gaba agonist), Benzos. 12. Riluzole 13. Tizanidine.
  5. 5. Demylenating disorders. 1. Which type of MS is characterized by steady increase in disability without attacks? 2. This type of drug is used in the treatment of an exacerbation (attack) of a demyelnating disorder. 3. This is one of the primary drugs for RRMS – the two types antagonize the effects of cytokine activity. 4. This drug is an anti-seizure medication used to control neuropathic pain in MS. 5. This drug is used only in RPMS. 6. This drug blocks access of lymphocytes to CNS by blocking integrin interactions at the BBB. 7. This drug’s side effects include flu-like symptoms, which can be controlled with ibuprofen or acetominophen. 8. This drug is often effective in patients who do not responde well to IFN. 9. This vitamin may reduce disease progression. 10. These two drugs are antihistamines used to treat balance and coordination difficulties in MS. 11. This drug is used to treat bladder specificity associated with MS. 12. I don’t think we need another question about steroids, so just be aware that you use them.  13. This antiviral is used to treat fatigue in MS. 14. This OTC medication is used to decrease immune cell migration and chemotaxis. 15. This drug’s main side effects are pain and swelling at the injection site. 16. This drug targets CD25 antigen (part of the IL-2 receptor) and stimulates natural killer cells.
  6. 6. Answers: 1. Primary progressive MS. Other three are Progressive Relapsing (steady decline since onset with attacks), Secondary Progressive (Initial relapsing-remitting MS that suddently begins to have decline without periods of remission), and relapsing-remitting (unpredictable attacks followed by periods of remission). 2. Glucocorticoids. 3. IFN-Beta. 4. Gabapentin 5. Glatiramir 6. Natalizumab. 7. IFN- Beta. 8. Rituximab. 9. Vitamin D. 10. Meclizine and Promethazine. 11. Oxybutinin. 12. Prednisone! 13. Amantidine. 14. Alpha-lipoic acid. 15. Glatiramir 16. Daclizumab.
  7. 7. Narcotic Analgesics 1. No miosis, least urinary retention in this drug. 2. Less euphoric effects – used for addiction. 3. Drug of choice for opiod overdose. 4. Drugs used for neuropathic pain. 5. Used in mid/moderate pain, similar to morphine but less potent. 6. The main side effect of this drug is cardiotoxicity and pulmonary edema. 7. Rank the order of potency for Fentanyl, Alfentanil, Sufentanil, and Remifentanil. 8. This drug is used during surgeries because of its rapid onset and rapid recovery; it can be given IV only. 9. This drug inhibits NE and serotonin reuptake and is contraindicated in patients taking MAOIs. 10. This drug is more potent than morphine, used to treat moderate to severe pain and is a partial M agonist. 11. This drug acts at K receptors and has the side effect of dysphoria. 12. This drug acts at K receptors and mildly at the M receptor. 13. This drug is the drug of choice for treating alcoholism. 14. This drug is used for diabetic neuropathy and trigeminal neuralgia. 15. This drug has no histamine release (kinda broad, I know…but just go with it). 16. What are the meperidine derivatives used for the treatment of diarrhea that are (two drugs): a. Combined with atropine? b. Poorly absorbed due to P-protein pump? 17. This drug is in OTC cough preps because it elevates CNS cough threshold.
  8. 8. Answers: 1. Meperidine. 2. Methadone. 3. Naloxone. 4. TCAs 5. Codeine. 6. Propoxyphene. 7. Sufentanyl > Fetanyl = Remidentanyl > Alfentnyl. 8. Remidentanyl. 9. Tramodol. 10. Buprenorphine. 11. Nalbuphine. 12. Pentazocine. 13. Naltrexone. 14. Gabapentin. 15. Fentanyl 16. A. Diphenoxylate B. Loperamide. 17. Dextromethorphan.
  9. 9. Epilepsy medications 1. These two drugs are the first line treatment for status epilepticus. 2. The major side effect of this drug is decreased Vitamin K. 3. Drugs of choice for partial and generalized tonic – clonic seizure. 4. Drug used for partial tonic-clonic seizures, status epilepticus, but should be avoided in absence seizures. 5. MOA that slows the rate of recovery of voltage-gated Na channels, upregulates adenosine in the brain, and blocks NE reuptake. 6. Drug above also often used to treat what psychiatric disorder? 7. IV version of phenytoin. 8. The major side effects of this drug, which is used to treat Lennox-Gastaut syndrome, are Stevens-Johnson rash and DIC. 9. Drug of choice for absence seizures. 10. This drug may increase the metabolism of birth control drugs. 11. This drug is used to treat tonic-clonic, myoclonic, absence seizures, and bipolar disorder. 12. This drug’s main side effects are Parkinson’s like sndrome and photophobia. 13. This barbiturate was the 1st anti-seizure medication and is sometimes still used today. 14. This drug for long term seizure management has the lease side effects of all anti- seizure agents. 15. This drug is used in Lenox-Gaustaut and for “refractory epilepsy.” 16. This drug is very well tolerated and is also used to treat diabetic neuropathy. 17. This drug works by inhibition of GAT-1. 18. The drug, with “novel pharmacological profile,” works by inhibiting the burst-fire without inhibiting normal neuronal activity. 19. The major side effect of this drug is aplastic anemia and hepatic failure. 20. This drug blocks keinate type glutamate receptors. 21. This drug irreversibly binds GABA-T. 22. This drug’s major side effect is metabolic acidosis. 23. This drug is easily combined with other drugs because it does not induce the P450.
  10. 10. Answers: 1. Phenytoin, Diazepam. 2. Phenytoin. 3. Carbamazepine. 4. Phentoin 5. Carbamezepine 6. Bipolar disorder 7. Fosphenytoin 8. Lamotrigene 9. Ethosuzimide 10. Carbamazepine 11. Valproic acid (and Carbamazepine) 12. Ethosuximide 13. Phenobarbital 14. Clonazepam 15. Felbamate or Topiramate 16. Gabapentin 17. Tigabine 18. Levetircacetam 19. Felbamate 20. Topiramate 21. Vigabatrin 22. Zonisamide 23. Ethosuximide.
  11. 11. Antipsychotics 1. Increased activity in this pathway may cause the positive symptoms of Schizophrenia. 2. Decrease activity in this pathway may cause the negative symptoms. 3. Inhibition of this pathway causes extrapyramidal side effects. 4. Inhibition of this pathway leads to increased serum prolactin. 5. In general, Neuroleptics (“typical” antipsychotics) have what mode of action? 6. Atypicals are active at what receptor? 7. Binding affinity to which receptor determines potency for the neuroleptics? 8. Positive symptoms are alleviated via (increase/decrease) dopamine. (Pick one). 9. Major movement disorder that is a side effect for anti-psychotics is.. 10. What two antipsychotics are marketed as anti-metics only? 11. Which four antipsychotics have the least anti-adrenergic activity? 12. This antipsychotic is a partial agonist at D2 and 5HT1A and an antagonist at 5HT2A; t is primarily use in bipolar disorder and has decreased extrapyramidal side effects. 13. Which two drugs may be antidotal for neuroleptic malignant syndrome? 14. Which drug offers lowest weight gain? 15. Which drug is most likely to cause blood dyscrasias? 16. Antipsychotics may produce more severe extrapyramidal effects when combined with which drug? 17. Nephorgenic diabetes inspidus responds to what drug? 18. Which two drugs are becoming the 1st line treatment for bipolar disorder? 19. Which antipsychotics are histamine H1 antagonists? 20. What are the four high potency antipsychotics? 21. What is the main receptor of action for clozapine? 22. This drug can cause weight gain, hyperglycemia, and type II diabetes. 23. This drug is antisopaminergic, antiserotonergic, increases glutamate uptake in astrocytes, and increases endrogenous antioxidants in astrocytes. 24. This drug is short acting and used in anesthesia. 25. This drug is used to treat Tourette syndrome and other tic disorders. 26. These two drugs mac act at the alpha1, alpha 2, 5HT, muscarinic, and histamine H1 receptors and may improve cognitive function in psychotic disorders.
  12. 12. Answers: 1. Mesolimbic pathway. 2. Mesocortical. 3. Nigrostriatal 4. Tuberoinfundibular 5. Competitive agnonists at D2 receptors. 6. Serotonin, some D2 7. D2 8. Decreased 9. Tardive dyskinesia 10. Prochlorperazine and Thiethyperazin (NOT for motion sickness). 11. Fluphenazine, Trifluoperazine, haloperidol, and reisperadone. 12. Aripiprazole 13. Dantrlene and bromocripitine. 14. Aripiprazole 15. Clozapine 16. Lithium 17. Amiloride 18. Valproic acid and carbamazepine 19. Cholorpromazine, clozapine 20. Fluphenazine, trifleoperazine, thiothixene, haloperidol. 21. D4 22. Olanzapine 23. Risperidone 24. Droperiodol 25. Pimozide 26. Quetiapine/ flumaute
  13. 13. Drugs for Affective Disorder 1. What is the mode of action for: a. MAOIs b. TCAs/heterocyclic c. SSRIs 2. What is the treatment for cardiac overstimulation due to increased catecolamine activity? 3. Which class of antidepressents have the longest half lives? 4. Galucoma, epilepsy, cardiac problems, and MAOI use are all contraindications for which class? 5. Current class of antidepressents considered to be the drugs of choice for depression. 6. The most severe side effect/ toxicity effect of SSRIs is called what? 7. This SSRI may impair blood glucose control in diabetics. 8. The major concern with using SSRIs in children and young adults is what? 9. Ingesting this compound, present in red wine and smoked meats, can be deadly for people on MAOIs. 10. What class of drugs do Venlafaxine and Duloxetine belong to? 11. Current drugs of choice for panic disorder. 12. What is the drug of choice for generalized anxiety disorder? 13. Group of antidepressents used to treat enuresis and diabetic neuropathy. 14. The drug of choice for OCD 15. This drug is used to treat OCD, PTSD, panic disorder, and it is preferred in the elderly. 16. This drug decreases nicotine cravings. 17. When switching someone from a SSRI/SNRI to an MAOI, or vice versa, how much time should you wait after discontinuing one class before starting the next? 18. This MAOI has no dietary restrictions and it is MAO-B selective. 19. These two MAOIs are irreversible inhibitors of MAO-A and B and have dietary restrictions. 20. This atypical antidepressent is contraindicated in patients with hepatic dysfunction or kidney disease; it equally inhibits NE and serotonin reuptake. 21. This drug may cause hypotension and priapism. 22. This SSRI has the longest half life. 23. SSRI for the treatment of PTSD and PD; has significant drug interactions due to CYP inhibition. 24. This is the active metabolite of imipramine that selectively blocks NE reuptake. 25. This is contraindicated in people with manic-depression (class of antids).
  14. 14. Answers: 1. a. inhibit MAO  increased monoamines  increased release of NT. b. Inhibit NE and 5HT transporter  increased NE and 5HT. c. Inhibit 5HT mediated reuptake of 5HT. 2. Bicarbonate. 3. TCA and heterocyclic. 4. Same as ^ 5. SSRI 6. Serotonin syndrome 7. Fluoxetine 8. Increased suicidal ideation 9. Tyramine 10. SNRIs 11. Sertaline, paroxetine, fluvoxamine 12. Paroxetine, venlafaxine 13. Tricyclics 14. Fluvoxamine 15. Sertraline 16. Bupropion 17. 14 days 18. selagine 19. phenzlizine, tranylcypromine 20. duloxetine 21. trazodone 22. fluoxetine 23. paroxetine 24. Despiramine 25. TCAs.