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Pharm 2
Pharmacology Exam 2: Substance Abuse, Prescribing, Psychiatry
| Term | Definition |
|---|---|
| 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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