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Pharm 2

Pharmacology Exam 2: Substance Abuse, Prescribing, Psychiatry

DEA Schedule: Highest potential for abuse, unpredictable, psychological & physical dependence, death, no medical use Schedule 1
DEA Schedule: Low potential for abuse, limited physical/psychological dependence, accepted medical use Schedule 4
DEA Schedule: Medium potential for abuse, moderate or low physical, high psychological dependence, accepted medical use Schedule 3
DEA Schedule: Lowest potential for abuse, limited physical / psychological dependence, accepted medical use Schedule 5
DEA Schedule: High potential for abuse, severe psychological/physical dependence, medical use accepted with restrictions Schedule 2
T/F: The United States has about 4.5% of the world’s population, yet we consume over half the illegal drugs in the world. True, goodness gracious
Primary pleasure reinforcement center of brain; where drugs increasing dopamine nucleus accumbens
Is dopamine release of substance reward or a natural reward stronger? If so, how much more? Yes, 3-5 x stronger than natural reinforcers.
What drugs can normalize the dopamine reward pathway after lengthy periods of abstienence? (3) Alcohol, Cocaine, Methamphetamine
Sedative-hypnotic developed as a sleep-aid with no known medical use. CNS depressant. Euphoric effect similar to alcohol, but at high doses can cause apnea Gamma Hydroxybutyrate (GHB)
A benzodiazepine, schedule 4. Ingested orally. Becomes invisible in drinks giving it the nicknames "date rape" drug or roofies. What additional effects can occur with alcohol? Can you buy it in the US? Flunitrazepam (Rohypnol); Respiratory Depression, Coma, Death; Not approved for sale in US.
Exhilaration often accompanied by nausea. Enhanced sensations and heightened feelings of empathy, emotional warmth, bruxism. Designer drug that can cause hyperthermia and hypertension (sympathomimetic toxidrome). Schedule 1. Ectasy or MDMA/3,4- methylenedioxymethamphetamine
What is bruxism? grinding your teeth
Hallucinogenic found as a sugar cube or "blotter" Schedule 1. Product of fungus Claviceps purpurea LSD or Lysergic Acid Diethyl amide
What are and describe each of the 4 phases of a LSD trip 1) Onset: flat surfaces appear to breath 2) Plateau: Visions appear from nowhere. 3) Peak: May feel like in different world where things are profound, mystical or frightening...can lead to psychosis. 4) Comedown- trip finished by 8 hours or so
Blurred vision followed by intoxicated stuporous state with psychoactive or mind-altering effects. Can cause varient of fetal alcohol syndrome in preg. Sudden death can occur. Volatile Inhalants
Progressive potentially life-threatening condition lasting 3-7 days. Tremors, autonomic hypersensitivty (loud and bright), depression, nausea, seizures in 15%. Treatment? Alcohol Withdrawal; Tx: Benzodiazepines (diazepam) and anti-convulsants (work on GABA receptor). Benzos DOC, safe in high doses w/ few adverse
How many months is there extremely high risk of relapse? 12-18 months
What is the Clinical Institute Withdrawal Assessment guide? Gold standard regarding alcohol withdrawal Sx and Tx
Acute autonomic hyperactivity and delirium including severe hyperthermia. Rare (1%), but mortality is 20%. Tx? Delirium Tremens; Fluids, cardiac monitoring, cooling blankets. Physical restraints or chemical restraints may be necessary (Lorazepam 2mg + haldol 5 mg every 30 min)
Inhibits aldehyde dehydrogenase causing acid aldehyde build up and effects (N, dizziness, HA, flushing), decreases desire to drink. Poor tolerability so impatient use only. Avoid ALL alcohol containing products Disulfiram
Can cause hepatotoxicity so don't use w/ impairment. Opioid antagonist blocking alcohol reward pathway (decreases craving). Persistent nausea. Slows progression of first drink to heavy (5+) drinking , not used in community alcohol abuse Tx Naltrexone
Renally cleared so CONTRA in renal disease, therefore no liver problems. Blocks NDMA receptor reducing glutamate release. Blocks alcohol relief pathway reducing cravings and urge to drink. Combine trial found its no better than placebo, but still used Acamprosate
Dampens withdrawal and triggering for another drink, well tolerated except for cramps and diarrhea (50% drop out with these Sx). Pts "lose interest in alcohol" Acamprosate
Which drug is most effective in subjects w/ strong family history of alcoholism and high levels of initial craving? Naltrexone
How can you get better compliance w/ naltrexone? IM injections monthly!
Which drug is most beneficial in highly motivated and directly observed patients? Disulfram
Opiate analog (diacetylmorphine), crosses BBB fast and in large amounts. Schedule 1. Rush followed by depressed respiration. Naloxone available as antidote. Heroin
Direct opioid substitution. Gold standards w/ large half life Methadone (no "high")
tetracyclic skeletal muscle relaxant for muscle cramps Cyclobenzaprine
anticholinergic agent for gastrointestinal symptoms of opioid detox Dicyclomine
alpha 2 adrenergic agonist to decrease tremor, diaphoresis, agitation Clonidine
What other drug used for alcohol can help opioid detoxification? Naltrexone
Partial mu agonist 40x potent as morphine for analgesia; cannot be fully reversed by naloxone. Used for opioid addiction maintenance Tx. Buprenorphine
45-90% discontinue illicit opioid use, criminal activity reduced in 80% of pts. Methadone
If injected, what drug combo leads to withdrawal Buprenorphine/Naloxone
5 As of BI to Tx tobacco dependance 1) Ask about use 2) Advise to quit 3) Assess willingness 4) Assist in cessation 5) Arrange follow up
Nicotine patch side effects? skin rxns, vivid dreams
How do you know when it is time to stop chewing nicotine gum? Peppery sensation...park gum at buccal pouch
What do we use Buproprion for and how does it work? What is it? anti-depressant we use for smoking cessation. NE and dopamine reuptake inhibition causing HA and insomnia
Start 7 days before quit date, partial nicotinic agonist that lessens withdrawal Sx/cravings. N/HA/insomnia adverse. Caution? Varenicline (Chantix); Caution: increased risk of mood disturbances and suicide ideation, not for depressed pts
Herbal and chemical mixtures that produce experiences similar to marijuana. The five most common active chemicals in synthetic marijuana are now illegal in the U.S. Synthetic Marijuana or K2
Stimulates “high” by triggering receptors in parts of brain that influence pleasure, memory, thinking, concentration, coordination. (good for pain, appetite, and suppressing reflexes (Cancer/AIDs) Marijuana
Which is more efficient way of getting THC into the body: smoking or eating? SMOKING
T/F: marijuana dependence increases the odds of a co-occurring mood disorder by 6.5 x, and of an anxiety disorder by 4.6 x True
Sympathomimetic Toxidrome hyperthermia, hypertension
hydrochloride salt that can be snorted or injected and the freebase version is smoked. Blocks the dopamine transporter protein, allowing D buildup in the synaptic cleft; also inhibits reuptake of serotonin and blocks axonal sodium channels. Schedule 2 Cocaine
Methamphetamine or Cocaine? Synthetic Meth
Methamphetamine or Cocaine? Stimulates dopamine and inhibits reuptake Meth
Methamphetamine or Cocaine? Used medically Cocaine
Tolerance, anxiety, insomnia. Psychotic behavior: paranoia, visual and auditory hallucinations, rages, aggression. Cardiovascular problems. Skin abscesses and broken teeth from bruxism Methamphetamine effects
Important/atypical Sx of methamphetamine? (2) Psychotic Sx that may persist for months or years, intense cravings
Anxiety, paranoia, psychosis, tremor, mydriasis, tachycardia, diaphoresis, hypertension and hyperthermia. Tx? Tx specifically for heart problems? Acute Stimulant Intoxication; Benzodiazepines first line; Heart Tx: CCBs (NO BETA BLOCKERS)
T/F: Counseling and other behavioral therapies don't have much effect with highly addictive drugs FALSE, they are critical
T/F: Veterinarians can write Rxs for pharmacists to fill and have are considered full-scope practitioners True
What 3 situations can you give a Rx to someone you didn't evaluate? 1) Admission orders for newly hospitalized 2) Rxing for another provider while taking call 3) Continuing medication on short-term basis for new pt prior to patient's first appointment
When can you Rx for yourself or family? minor illnesses and emergencies only. Best not to do it at all if you can avoid it.
T/F: 65-85% of professional discipline is related to controlled substance or alcohol issues True
What 7 things should all Rxs have? 1) Date 2) Pt name/address 3) Name of drug 4) Strength of drug 5) Quantity of drug 6) Directions for use 7) Practitioner info: name, address, phone number
What is a legend drug? Just another name for a prescription drug, or one that requires a practitioner to prescribe because it is considered harmful without supervision
How long are legend drug Rxs good for? Expire after 1 year
How long are refills authorized valid for? 1 year (life of prescription)
4 considerations for children with pediatric dosage calculations 1) skin thin 2) stomach lacks acid to kill bacteria 3) body temp poorly regulated and dehydrates easily 4) Liver/kidneys immature
T/F: Children dehydrate easier because they have a greater proportion of fluid per weight TRUE
When do serum protein levels reach adult levels? 6 months of age
When does the hepatic system mature? Renal? What is the consequence of this? 4 and 1 year respectively; Longer half life!
When do we generally start giving adult doses? (what kg or lbs) 40-50 kg or 80-90 lb child
T/F: it is possible to extrapolate dose in a drug in the same class with very similar pharmacology and use a comparative potency True
Normal stature child: What is Clark's Rule? (Wt in lb x Adult dose)/ 150lbs (average adult wt) = Dose for child
2 historical Tx for depression 1) St John's Wort 2) Ethanol
initially investigated in the United States for treatment of tuberculosis -- during testing it was noted to elevate mood in depressed patients, but hepatotoxic Iproniazid
antihistimine found to be an anti-depressant. Elevates mood in depressed, sedates non-depressed Imipramine
What is Reserpine? Medication for HTN found to induce severe depression by delpleting NE and 5-HT in CNS and PNS
Imipramine, Amitriptyline, Desipramine, Nortriptyline, Doxepin Tricyclic anti-depressants (TCAs)
Isocarboxazid, Phenelzine, Tranylcypromine, Selegeline Monoamide Oxidase Inhibitors (MAO-Is)
Norepinephrine & dopamine reuptake inhibitor. CONTRA? Adverse? Buproprion; C: seizures or recent head injury; A: anxiety, insomnia, wt loss
1st serotonergic agent (1981)? Trazodone, stimulated serotonin receptors and stopped reuptake
What abnormal regulations have been strongly associated with depression? How do they manifest? Serotonin and norepinephrine; Explain presence of both emotional and physical symptoms
1st line for depression. Also good for anxiety, bulemia, borderline personality disorder, alcoholism, migraines Selective Serotonin Reuptake Inhibitors
T/F: 75% of patients may have an adverse effect to SSRIs TRUE, including anxiety, tremors, insomnia, GI Sx, decreased libido
Reuptake inhibitor for serotonin and norepinephrine. Adverse include HTN Venlafaxine
Reuptake inhibitor for serotonin and norepinephrine. Adverse include elevation of liver enzymes Duloxetine
Serotonin and Alpha 2 antagonist w sedation and neutropenia Mirtazepine
Serotonin agonist/antagonist w/ sedation and dry mouth Trazodone
Multiple receptor blockade mechanisms that can cause fatal hepatotoxicity Nefazodone
An interaction when certain drugs are taken together causing mental status changes, hyperprexia, motor abnormalities, HTN and tachycardia. Benzos for Tx Serotonin Syndrome
TCA that also is used for urinary incontinence Imipramine
TCA also used for chronic pain, migraines, diabetic neuropathy Amitriptyline
TCA also used for chronic urticaria Nortriptyline
Why is TCA overdose dangerous? Cardiotoxic and anti-muscarinic: urinary retention, QRS prolongation, arrhythmias, tachycardia, hyperprexia
What MAO-I is used the most and why? Selegeline because it comes in a transdermal patch
What should you avoid while on MAO-Is? Foods w/ tyramine or tryptophan (causes hypertensive crisis
What kind of treatment does recurrent depression w/ multiple episodes indicate? Lifetime treatment
How should SSRIs and SNRIs be stopped? Tapered slowly. Withdrawal Sx can be uncontrolled tearing and electrical sensation
What drug do you not really have to worry so much about withdrawal Sx? Fluoxetine (Prozac)
TCA with least side effects? Desipramine
DSM-IV criteria for ADHD? 6+ Sx of inattention for 6 months+ AND/OR 6+ Sx of hyperactivity-impulsivity for 6 months+ AND Impairment
Etiology of ADHD? Dx? Unknown; Dx: clinical
What rates double in those who have ADHD? Tobacco and cocaine dependence
Therapy programs for children w/ ADHD? (4) Best result? Pharmacotherapy, Behavioral, psychosocial, educational interventions; Best: behavioral therapy and pharmacotherapy
What is the pharmacotherapy for ADHD and how does it work? Stimulants, cause release of presynaptic norepinephrine, dopamine, BLOCK reuptake of norepinephrine and dopamine
Drug off-labeled for ADHD approved for excessive sleepiness Modafinil
Provides cognitive focus in ADHD and is a NE reuptake inhibitor. Hepatotoxicity and suicidal events adverse Atomoxetine
Originally used for Tx of HTN, so can induce HypoTN. Not a CNS stimulant and MOA w/ ADHD is not known Guanfacine
What are some common adverse effects of stimulants (5)? Which are the most prominent? 1) Wt loss 2) Loss of appetite 3) Sx of depression 4) Tourette's 5) Growth suppression; Growth suppression and depressive episodes are the worst.
What percentage of adults 50 yo+ get prescriptions for ADHD 10%!
Created by: crward88



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