Deja Review Pharmacology (2nd Edition)

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BRS Microbiology and Immunology. BRS - Microbiology and Immunology. Atlas of Immunology, Second Edition. Applied Dairy Microbiology, Second Edition. Case Files- : Microbiology, Second Edition. World of Microbiology and Immunology. Review of Medical Microbiology. Illustrated Dictionary of Immunology, Second Edition. How many subunits is the nicotinic receptor made of? Five subunits. Which subunit of the nicotinic receptor does ACh bind to?

Sodium channel What is the most commonly used NMB? Succinylcholine, the only depolarizing NMB. This is an ideal drug for endotracheal intubation due to its fast onset of action and short duration of action. How does succinylcholine work at the NMJ?

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It behaves as a cholinergic agonist that remains bound to the ACh receptor for a prolonged period. What happens during each of the following phases of succinylcholine activity at the NMJ? Phase I The receptor becomes depolarized and transient fasciculations are observed as various motor units depolarize. Phase II The receptor becomes resistant to depolarization and a flaccid paralysis ensues. What are the two main uses of succinylcholine? It is used for facilitation of endotracheal intubation via relaxation of pharyngeal and laryngeal muscles.

It is used as an adjunct during electroconvulsive shock therapy to prevent prolonged full body convulsions which would result in muscle breakdown.

A tourniquet is placed on a lower extremity to prevent the drug from reaching this location so that the seizure is visible in a localized area and the rest of the body is spared. Is succinylcholine short or long acting? It is short acting with a duration of minutes because of rapid hydrolysis by plasma cholinesterase. What are the adverse effects of succinylcholine? Malignant hyperthermia; apnea; hypertension; hyperkalemia What are the signs and symptoms of malignant hyperthermia?

Muscular rigidity; increased oxygen consumption; increased carbon dioxide production usually the first sign detected during surgery ; tachycardia; hyperthermia is a late finding How is malignant hyperthermia treated? With dantrolene What is the mechanism of action of dantrolene? It inhibits calcium release from the sarcoplasmic reticulum of muscle cells, thereby relaxing muscle tone and reducing heat production.

Succinylcholine may have a prolonged half-life in what type of patients? Patients with a genetic deficiency or altered form of plasma cholinesterase What is the mechanism of action of nondepolarizing NMBs? Tubocurarine What antidote is used in tubocurarine overdose?

Small muscles of the face and eye 2. Fingers 3. Limbs, neck, trunk 4. Intercostals 5. Diaphragm Which antimicrobial class of drugs may act in synergy with nondepolarizing NMBs by inhibiting release of ACh from nerve endings by competing with calcium ions, thereby increasing neuromuscular blockade? Aminoglycosides most likely to occur with high doses; patients with hypocalcemia, hypomagnesemia, or neuromuscular disorders Give examples of nondepolarizing NMBs: Tubocurarine; atracurium; mivacurium; rocuronium; vecuronium; pancuronium; pipercuronium What is the only nondepolarizing NMB that does not require dosage reduction in patients with renal failure?

Atracurium, which excreted in bile, not in urine What nondepolarizing NMB has the most rapid onset of action? Epinephrine; norepinephrine; dopamine What amino acid is the precursor to dopamine, epinephrine, and norepinephrine? What two enzymes metabolize norepinephrine? Monoamine oxidase MAO 2. It inhibits the transport of norepinephrine from the neuronal cytoplasm into the synaptic vesicles.

What are the common side effects of reserpine? Depression; sedation What breakdown products of norepinephrine are excreted in the urine and can be measured to help diagnose pheochromocytoma? Vanillylmandelic acid VMA ; metanephrine; normetanephrine What are the two major classes of adrenergic receptors? Norepinephrine; epinephrine; serotonin; tyramine; dopamine What neurotransmitters does MAO type B metabolize?

Dopamine is metabolized by both the A and B type of the enzyme. How does cocaine increase norepinephrine levels in the synaptic cleft? It inhibits the reuptake of neurotransmitter back into the presynaptic neuron. How do amphetamine, ephedrine, and tyramine increase norepinephrine levels? They act as indirect sympathomimetic agents by entering the presynaptic neuron releasing stored norepinephrine into the synaptic cleft. Smooth muscle Where are D2-receptors found?

The central effects overwhelm the local effects leading to decreased blood pressure. Hypertension; severe pain; heroin withdrawal; nicotine withdrawal; ethanol dependence; clozapine-induced sialorrhea; prevention of migraines What is dexmedetomidine used for? It will cause insulin secretion to decrease.

It will cause insulin secretion to increase. Which receptor type does epinephrine preferentially bind to at low doses? Epinephrine What is the dose of epinephrine given for anaphylaxis? Note: The EpiPen epinephrine auto-injector that many patients with a history of anaphylaxis carry is 0. What is the concentration of epinephrine used for anaphylaxis? Epinephrine causes a vasoconstriction, thereby inhibiting the local anesthetics redistribution away from its site of action, so it increases the duration of local anesthesia. What is the concentration of epinephrine when given in combination with local anesthetics?

No Activation of dopamine receptors will cause what type of response in the mesenteric and renal vasculature? Vasodilation What is dopamine metabolized to? Homovanillic acid HVA What is dobutamine used for? Increases cardiac output in congestive heart failure CHF without affecting RBF unlike dopamine Tyramine is a breakdown product of which amino acid? Tyrosine Where is tyramine found? Examples of foods and beverages which contain tyramine include: beer, ale, robust red wines, chianti, vermouth, homemade breads, cheese, sour cream, bananas, red plums, figs, raisins, avocados, fava beans, Italian broad beans, green bean pods, eggplant, pickled herring, liver, dry sausages, canned meats, salami, yogurt, soup cubes, commercial gravies, chocolate, and soy sauce.

What enzyme is responsible for the breakdown of tyramine? Hypertensive crisis due to tyramine in the cheese which leads to the release of norepinephrine from storage vesicles in presynaptic neurons What is phenylephrine and pseudoephedrine used to treat? Nasal congestion What are mixed action adrenergic agonists? Phenoxybenzamine What are phentolamine and phenoxybenzamine mainly used for? Hyperplasia, though hypertrophy is still sometimes erroneously used. There is an actual increase in the number of prostatic cells in BPH. The cells do not simply increase in volume as do, for example, skeletal or cardiac muscle cells in response to increased used.

Sotalol What is intrinsic sympathomimetic activity ISA? Acebutolol 2. Remember that sweat glands have muscarinic receptors and are cholinergic rather than adrenergic. What does propranolol do to serum triglycerides? Increases serum triglycerides What does propranolol do to serum low-density lipoprotein LDL? Increases serum LDL Why does propranolol cause vivid dreams? The child developed what appeared to be a viral febrile illness which rapidly progressed. The infant now appears listless and has decreased muscle tone. What is the most likely diagnosis?

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While the child may have initially had a viral upper respiratory tract infection URI , ingestion of honey exposed the infant to C. The patient most likely had sporadic release of catecholamines from the tumor leading to periods of increased blood pressure. The most common neurotransmitter released from pheochromocytomas is norepinephrine.

A year-old man comes to his primary care physician for a regular checkup. His blood pressure has been mildly elevated on the last two office visits. He is also complaining of some difficulty initiating urination as well as getting up two or more times per night to urinate. What is the best pharmacotherapy to initiate at this time? It also relaxes vascular smooth muscle leading to decreased blood pressure.

Here, the dual action of prazosin makes it an ideal choice for this patient with two separate health concerns. Delirium; violent behavior; increased blood pressure; increased respiratory rate; irregular breathing rate and volume; amnesia; retching and vomiting with stimulation; disconjugate gaze Stage II excitement Depression of vasomotor center; depression of respiratory center; death may occur Stage IV medullary depression Eye movements cease; fixed pupils; regular respiration; relaxation of skeletal muscles Stage III surgical anesthesia Loss of pain sensation; patient is conscious; no amnesia in early part of this stage Stage I analgesia Give examples of inhaled anesthetics: Halothane; nitrous oxide; isoflurane; enflurane; sevoflurane; desflurane; methoxyflurane With regard to inhaled anesthetics, what does MAC stand for?

Minimum alveolar concentration. Note: this is not to be confused with monitored anesthesia care also commonly referred to as MAC, which is a combination of regional anesthesia, sedation, and analgesia. What is MAC in regard to inhaled anesthetics? Halothane 0.

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  • It decreases. The ratio of the total amount of gas in the blood relative to the gas equilibrium phase. It will be increased because the time to increase arterial tension is longer. Halothane Are MAC values additive? Yes Are MAC values higher or lower in elderly patients? They are lower, thus elderly patients generally require lower concentrations of inhaled anesthetics. They are lower. Do inhaled anesthetics increase or decrease the response to Pco2 levels? Decrease Do inhaled anesthetics increase or decrease cerebral vascular flow? Increase Do inhaled anesthetics increase or decrease intracranial pressure?

    Increase Do inhaled anesthetics relax or strengthen uterine smooth muscle contractions? Relax except methoxyflurane when briefly inhaled, therefore, can be used during childbirth Which of the inhaled anesthetics is not a halogenated hydrocarbon? Nitrous oxide Are the inhaled halogenated hydrocarbon anesthetics volatile or nonvolatile gases? Volatile gases Which inhaled anesthetic is associated with malignant hyperthermia? Halothane What characterizes malignant hyperthermia?

    Hyperthermia; muscle rigidity; acidosis; hypertension; hyperkalemia Should a patient with a family history positive for malignant hyperthermia be concerned? Yes, because a genetic defect in ryanodine receptors may be inherited. What drug is given to treat malignant hyperthermia?

    Dantrolene Which inhaled anesthetic is associated with increased bronchiolar secretions? Isoflurane Which inhaled anesthetic is associated with hepatitis? Halothane Halothane is not hepatotoxic in what patient population? Pediatric patients Which inhaled anesthetic is the least hepatotoxic? Nitrous oxide Which inhaled anesthetic is associated with increased bronchiolar spasms? Isoflurane Which inhaled anesthetic relaxes bronchial smooth muscle? Halothane Which inhaled anesthetic is associated with cardiac arrhythmias? Halothane Which inhaled anesthetics increase heart rate via reflex secondary to vasodilation?

    Isoflurane; desflurane Which inhaled anesthetics decrease heart rate? Halothane; enflurane; sevoflurane Which inhaled anesthetic decreases renal and hepatic blood flow? Halothane Give examples of intravenous IV anesthetics: Propofol; fentanyl; ketamine; midazolam; thiopental; etomidate Which of the previously mentioned IV anesthetics is a barbiturate? Thiopental Which of the previously mentioned IV anesthetics is a benzodiazepine? Midazolam Which of the previously mentioned IV anesthetics is an opioid? Fentanyl Is thiopental used for induction, maintenance, or both? Induction Pharmacodynamically, how does recovery occur with the rapid-acting barbiturates?

    Rapid redistribution from the central nervous system CNS to peripheral tissues State whether thiopental increases, decreases, or does not change each of the following physiologic effects: Cerebral blood flow No change Respiratory function Decreases Blood pressure Decreases Why should caution be taken when administering thiopental to asthmatic patients?

    May cause laryngospasm Midazolam offers which type of amnesia making it useful for monitored anesthesia care? Anterograde amnesia What is the antidote for midazolam-induced respiratory depression? Flumazenil, which is also the antidote for any benzodiazepine overdose What adverse drug reaction may be caused by fentanyl when given intravenously? Chest wall rigidity Does propofol have good analgesic properties? No About which allergies should a patient be questioned before administration of propofol?

    Egg and soybeans. Propofol is prepared as a lipid emulsion using egg and soybean lecithin. This gives propofol its white color and can cause allergic reactions in patients with sensitivities to these substances. Does propofol increase or decrease blood pressure? It decreases blood pressure. Is propofol used for induction, maintenance, or both?

    It is used for both. Which IV anesthetic causes dissociative anesthesia? Ketamine What is dissociative anesthesia? The patient is unconscious and feels no pain, yet appears awake. Eyes may open and the swallowing reflex is present, but the patient is sedated, immobile, and usually amnestic. Hallucinations and delirium are common. Which anesthetic has antiemetic properties?

    Propofol Which IV anesthetic is a cardiovascular stimulant increases blood pressure and cardiac output? Ketamine Which IV anesthetic causes vivid dreams and hallucinations? Ketamine Does ketamine increase or decrease cerebral blood flow? Increase What is the most cardiac-stable IV anesthetic agent? Etomidate Are local anesthetics weak acids or weak bases? Epinephrine, by inducing a local vasoconstriction Epinephrine should not be combined with local anesthetics when injecting near which anatomic sites?

    Digits; nose; ears; penis; and any end-artery circulation Which type of enzymes metabolize amide local anesthetics and where are they located? Amidases located in the liver Which type of enzymes metabolize ester local anesthetics and where are they located? Esterases located in tissues and blood What is the mechanism of action of local anesthetics? Ionized form Do local anesthetics need to be in the ionized or nonionized form to gain access to the sodium channel, which is located on the inner side of the axonal membrane?

    Nonionized form must be able to cross lipophilic axonal membrane All local anesthetics cause vasodilation with the exception of which drug? Cocaine causes vasoconstriction Nerve fibers most sensitive to blockade are of smaller or larger diameter? Smaller diameter Nerve fibers most sensitive to blockade have low or high firing rates? High firing rates Which nerve fibers are most sensitive to local anesthetics? Type B fibers; type C fibers Which nerve fibers are least sensitive to local anesthetics? Hypotension except cocaine ; nystagmus; seizures; dizziness; allergic reactions rare Allergic reactions are more associated with ester or amide local anesthetics?

    Inhibits calcium influx through voltage-gated ion channels, thereby inhibiting neurotransmitter release What is the mechanism of action of medications that activate postsynaptic opioid receptors? Increases potassium efflux from cells leading to membrane hyperpolarization and thereby inhibition of neurotransmitter release Opioid receptors are coupled to what type of proteins?

    Inhibitory G-proteins inhibits adenylyl cyclase What is the prototype opioid analgesic? Morphine Why must caution be taken when using opioids in patients with head injuries? Opioids may increase intracranial pressure Where in the midbrain are opioid receptors located? Primary afferent fibers binding to these receptors leads to inhibition of substance P release Are opioid analgesics better at relieving intermittent or persistent pain? Persistent pain What is the mechanism of morphine-induced hypotension and pruritus? Increased histamine release from mast cells Do opioid analgesics increase or decrease gastrointestinal GI peristalsis?

    Decrease they cause constipation Which two opioids are used specifically to treat diarrhea? Loperamide 2. Diphenoxylate Which opioid analgesic does not increase the tone of the biliary tract, bladder, and ureter? Meperidine antagonizes muscarinic receptors Do opioid analgesics increase or decrease uterine contractions during pregnancy? They decrease uterine contractions, thus a good contraction pattern should be achieved before placement of an epidural catheter during labor.

    Do opioid analgesics cause miosis or mydriasis of the pupils? Miosis common sign of opioid overdose is pinpoint pupils What is the mechanism of opioid-induced miosis? Increased parasympathetic cholinergic activity in the pupilary constrictor muscles Which opioid analgesic does not cause miosis? Meperidine antagonizes muscarinic receptors Which two opioids are used specifically to treat cough?

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    Codeine 2. Dextromethorphan Opioids suppress the cough reflex. Synthetic Is dextromethorphan a natural or synthetic opioid? Synthetic What is the mechanism of opioid-induced urinary retention? Increases antidiuretic hormone ADH Do opioid analgesics promote emesis or act as antiemetics?

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    Promote emesis What is the mechanism of opioid-induced emesis? Reduced sensitivity of respiratory center to carbon dioxide levels What is the most common cause of death in opioid overdose? Respiratory depression What are the two most lipophilic opioids? Heroin 2. Fentanyl These two medications rapidly cross the blood-brain barrier BBB to produce euphoric effects. Which opioid is the least lipophilic? Morphine Is morphine metabolized via phase I or phase II reactions?

    Phase II metabolism glucuronidation Does morphineglucuronide have analgesic activity? No Does morphineglucuronide have analgesic activity? Yes Which two opioid-induced effects do patients not develop tolerance to? Constipation 2. Miosis What are the signs and symptoms of opioid withdrawal? Lacrimation; rhinorrhea; diaphoresis; yawning; goose bumps; anxiety; muscle spasms; diarrhea; increased pain sensation Which medication is used to counteract the respiratory depression seen in opioid overdose?

    IV naloxone may need to give multiple doses as naloxone has a shorter half-life than morphine What is the mechanism of action of naloxone? Naltrexone Which opioid analgesic is used to prevent withdrawal symptoms in patients discontinuing heroin use? Methadone Name two synthetic opioid analgesics: 1.

    Meperidine 2. Methadone Fentanyl is chemically related to which synthetic opioid analgesic? Meperidine Does morphine have a high or low oral bioavailability? Dextromethorphan These combinations may produce serotonin syndrome. What drug do you get by acetylating morphine? Heroin Is codeine itself an active opioid analgesic? Alcohol dehydrogenase converts ethanol to acetaldehyde.

    What is the second step in ethanol metabolism? Acetaldehyde dehydrogenase converts acetaldehyde to acetate. What enzyme does disulfiram inhibit? Increased chloride ion influx into cells leading to membrane hyperpolarization and subsequent decreased neuronal firing What physiologic process takes place when GABA binds to the GABAB receptor? Increased potassium ion efflux out of cells leading to membrane hyperpolarization and subsequent decreased neuronal firing What medication binds specifically to the GABAB receptor?

    Baclofen What is baclofen used for? Muscle relaxation Do benzodiazepines potentiate GABA by increasing the duration or frequency of chloride ion channel opening? Frequency Do barbiturates potentiate GABA by increasing the duration or frequency of chloride ion channel opening? Duration Name three nonbenzodiazepine sleep aids that specifically bind to the BZ1-receptor subtype: 1. Eszopiclone 2.

    Zolpidem 3. Zaleplon Does zolpidem display anticonvulsant, antianxiety, or muscle relaxant properties? No, it is a selective hypnotic along with zaleplon and eszopiclone. Do benzodiazepines have good analgesic properties? No What types of actions do benzodiazepines display? Muscle relaxant; anticonvulsant; antianxiety; sedative-hypnotic; anterograde amnesia midazolam ; alcohol withdrawal Give examples of benzodiazepines: Diazepam; lorazepam; alprazolam; chlordiazepoxide; clonazepam; clorazepate; midazolam; flurazepam; flunitrazepam; temazepam; triazolam; oxazepam What is the name of the prototype benzodiazepine?

    Diazepam Which benzodiazepine is the shortest acting? Midazolam What three benzodiazepines undergo phase II metabolism? Lorazepam 2. Oxazepam 3. Temazepam Which benzodiazepines are commonly used as anticonvulsants? Diazepam; clonazepam Which benzodiazepines are commonly used to treat alcohol withdrawal? Oxazepam; lorazepam; diazepam; chlordiazepoxide Which benzodiazepines are commonly used as sleep aids?

    Temazepam; triazolam; flurazepam Which benzodiazepines are commonly used as anxiolytics? Diazepam; lorazepam; alprazolam Why is alprazolam not the drug of choice when treating patients with chronic anxiety? It has a short half-life, and therefore may cause withdrawal symptoms, such as anxiety, which subsequently worsens the condition and leads to higher addiction rates.

    Give examples of long-acting benzodiazepines duration of action of d : Diazepam; chlordiazepoxide; flurazepam; clorazepate Give examples of intermediate-acting benzodiazepines duration of action of h : Lorazepam; temazepam; alprazolam Give examples of short-acting benzodiazepines duration of action of h : Midazolam; oxazepam; triazolam Give examples of benzodiazepine withdrawal signs and symptoms: Insomnia; anxiety; agitation; seizures; restlessness; confusion What are the adverse effects of benzodiazepines?

    Flumazenil short half-life; therefore, multiple administrations may be necessary What is the mechanism of action of flumazenil? Benzodiazepine receptor antagonist Will flumazenil decrease the effects of barbiturates? Barbiturates 2. Alcohols Benzodiazepines may be potentially fatal but to a lesser extent than barbiturates and alcohols. Give examples of long-acting barbiturates duration of action of d : Phenobarbital; pentobarbital Give examples of short-acting barbiturates duration of action of h : Amobarbital; secobarbital Give an example of an ultra-short-acting barbiturate duration of action of 30 min : Thiopental What is phenobarbital commonly used to treat?

    Seizures generalized tonic-clonic and partial seizures What is thiopental commonly used for? Induction of anesthesia What are short-acting barbiturates commonly used for? Sedation; hypnosis What kind of drug interactions can barbiturates produce? Long-acting benzodiazepines Over-the-counter OTC sleep aids have what types of medications in them? Buspirone Does buspirone have anticonvulsant and muscle relaxant properties? No Is buspirone sedating? No How long does it take for buspirone to exert its anxiolytic effects? Serotonin 5-HT 2.

    Tranylcypromine 2. Phenelzine 3. Isocarboxazid Selegiline is commonly used in the treatment of which disease? Atypical depression How long does it take to see antidepressant effects in patients who are started on an MAOI? Orthostatic hypotension; xerostomia; blurred vision; drowsiness; constipation; urinary retention What life-threatening condition may develop when MAOIs and selective serotonin reuptake inhibitors SSRIs are used concomitantly?

    Serotonin syndrome What characterizes serotonin syndrome? Rigidity; diaphoresis; hyperthermia; seizures; autonomic instability; myoclonus What life-threatening condition may develop when patients taking MAOIs ingest foods containing tyramine? Hypertensive crisis What characterizes hypertensive crisis? Hypertension; headache; tachycardia; nausea; vomiting; stroke; cardiac arrhythmias A serotonin-like syndrome may develop when MAOIs are used concomitantly with what common OTC medication used to suppress cough?

    Dextromethorphan A serotonin-like syndrome may develop when MAOIs are used concomitantly with which opioid analgesic? Meperidine What is the mechanism of action of tricyclic antidepressants TCAs? Inhibits reuptake of 5-HT and NE into presynaptic neurons, thereby increasing neurotransmitter concentrations in the synaptic cleft What other types of neurotransmitter and hormonal receptors, other than 5-HT and NE, are inhibited by TCAs?

    Nortriptyline What is the name of the active metabolite of imipramine that selectively inhibits NE reuptake? Clomipramine Which TCA is also used to treat pediatric nocturnal enuresis? Imipramine Why is imipramine used for childhood enuresis? Increases contraction of internal sphincter of bladder; decreases stage 3 and 4 sleep What are the adverse effects of the TCAs? What is the treatment for TCA overdose? Activated charcoal to absorb the drug in the GI tract; sodium bicarbonate to correct acidosis and cardiac arrhythmias; phenytoin; magnesium What is the mechanism of action of trazodone and nefazodone?

    Inhibits reuptake of 5-HT into presynaptic neurons, thereby increasing neurotransmitter concentrations in the synaptic cleft What adverse effect is unique to trazodone? Priapism What is the mechanism of action of bupropion? Smoking cessation; OCD Does bupropion cause sexual dysfunction? No, making it a useful alternative in patients that experience sexual dysfunction with other antidepressant medications such as SSRIs Is bupropion safe to use in patients with epilepsy?

    No, because it lowers the seizure threshold. What is the mechanism of action of mirtazapine? Hypertension What is the mechanism of action of duloxetine? Fluoxetine Fluoxetine is also used in what settings other than depression? Yes, they can cause anorgasmia. Do SSRIs cause cardiac arrhythmias? No, they do not, in contrast to TCAs. What are the adverse effects of SSRIs? Bipolar disorder What is the traditional drug of choice for treating manic-depression? Lithium When is lithium used in the treatment of manic-depression what phases of the disease?

    Prevention; treatment of manic episodes Does lithium have a narrow or wide therapeutic window? Therapeutic levels range from 0. Lithium is eliminated renally in a similar fashion to which other salt? Sodium Is lithium toxicity exacerbated by low or high sodium plasma levels? Low sodium levels What is the mechanism of action of lithium? Unknown; may decrease cAMP levels thereby decreasing its function as a second messenger; may inhibit dephosphorylation of IP3 to IP2 and IP2 to IP thereby interfering with the recycling of inositol What are the adverse effects of lithium?

    Acne; seizures; visual disturbances; edema; ataxia; drug-induced nephrogenic diabetes insipidus; hypothyroidism; tremors How does lithium cause drug-induced nephrogenic diabetes insipidus? Uncoupling of the vasopressin V2 receptor in the kidney Which diuretic is usually used to treat nephrogenic diabetes insipidus? Thiazide diuretics Which drug is used to treat lithium-induced nephrogenic diabetes insipidus? Amiloride thiazide diuretics cause increased reabsorption of lithium which may lead to lithium toxicity How does lithium cause hypothyroidism?

    Converting thyroxine T4 to triiodothyronine T3 What is the name of the cardiac anomaly that may be found in neonates born to mothers using lithium? Ebstein anomaly What characterizes Ebstein anomaly? Malformation of the tricuspid valve leaflets partly attached to the fibrous tricuspid valve annulus; partly attached to the right ventricular endocardium; inferior displacement of the tricuspid leaflets What other medications mood stabilizers may be used in the treatment of manic-depression? Carbamazepine; valproic acid; benzodiazepines; gabapentin; topiramate Why are antidepressant agents not used to treat the depression phase of manic-depression?

    An excess of DA What characterizes the positive symptoms of schizophrenia? Hallucinations; delusions; thought disorders What characterizes the negative symptoms of schizophrenia? Inhibition of 5-HT2 receptors D2 receptors are still involved to some extent Give examples of typical antipsychotics: Haloperidol; chlorpromazine; thioridazine; fluphenazine; pimozide Give examples of atypical antipsychotics: Clozapine; risperidone; aripiprazole; olanzapine; ziprasidone; quetiapine Name two typical antipsychotics commonly used in the treatment of Tourette syndrome: 1.

    Haloperidol 2. Pimozide What are extrapyramidal symptoms EPS?

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    Parkinsonian-like symptoms dystonia, rigidity, tremor, and bradykinesia ; akathisia; tardive dyskinesia TD What is akathisia? Motor restlessness What is tardive dyskinesia TD? Inappropriate movements of the tongue, neck, trunk, and limbs associated with long-term use of DA antagonists What is the mechanism of anti-psychotic-induced TD? Long-term DA receptor inhibition leads to an upregulation and supersensitivity of DA receptors, thereby leading to DA overstimulation, especially when the antipsychotic has been discontinued.

    Which antipsychotics are more likely to cause EPS? High potency typical antipsychotics such as haloperidol and fluphenazine secondary to their weak anticholinergic activity Why do thioridazine and chlorpromazine have a lower EPS potential? They have high anticholinergic activity. What medications are used to treat antipsychotic-induced EPS? Benztropine; amantadine; diphenhydramine due to its anticholinergic action How do antipsychotics cause parkinsonian-like symptoms? Inhibition of DA receptors in the nigrostriatal pathway How do antipsychotics cause orthostatic hypotension?

    Inhibition of DA receptors in the anterior pituitary Which two antipsychotics possess the highest antimuscarinic activity? Chlorpromazine 2. Dry mouth Which antipsychotic agents are more effective at treating negative symptoms? Atypical antipsychotics Which phenothiazine antipsychotic is also used to treat intractable hiccups? Chlorpromazine Which phenothiazine antipsychotic may cause priapism, agranulocytosis, blue-gray discoloration of the skin, and lower seizure threshold?

    Thioridazine Which two typical antipsychotics can be formulated as depot intramuscular injections that may last up to 3 weeks? Fluphenazine Which atypical antipsychotic is usually reserved as a third-line agent to treat schizophrenic patients refractory to traditional therapy? Clozapine What is the major dose-limiting side effect of clozapine?

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    Agranulocytosis How are patients receiving clozapine therapy monitored? WBCs obtained at baseline and weekly for the first 6 months of therapy, every other week for the second 6 months, and monthly thereafter What adverse effect is more common with clozapine, agranulocytosis, or seizures? Risperidone induces prolactinemia only atypical antipsychotic that increases prolactin levels significantly What is a potential life-threatening adverse effect of antipsychotic medications? Hyperthermia; rigidity; altered mental status; cardiovascular instability What is the treatment for NMS?

    Weight gain; hyperglycemia; sialorrhea What are the additional adverse effects of quetiapine? Hypercholesterolemia; hypertriglyceridemia; weight gain; hepatotoxicity What is the mechanism of action of aripiprazole? Weight gain; rash; sialorrhea; hepatotoxicity Which antipsychotic has the highest incidence of sialorrhea? Bradykinesia; muscular rigidity; tremors; gait abnormalities; postural instability What neurotransmitter pathway is affected in PD? Dopaminergic pathway inhibitory neurons in the substantia nigra and corpus striatum neurotransmitter ratio shifts toward decreased DA and increased acetylcholine [ACh] What does increased levels of DA in the tuberoinf undibular tract lead to?

    Increased emesis What does increased levels of DA in the mesolimbic-mesocortical tracts lead to? Increased psychomotor activity; psychosis; schizophrenia; increased reinforcement Which DA receptor subtype is implicated in PD? Medications that will increase DA levels 2. Medications that will decrease ACh levels Do anti-Parkinson medications effect pathology, symptoms, or both? Symptoms Name two antimuscarinic medications that are used in the treatment of PD: 1. At the end of each chapter, you will find clinical vignettes that expose you to the pro-totypic presentation of diseases classically tested on the USMLE Step 1.

    These board-style questions put the basic science into a clinical context, allowing you apply the facts you have just reviewed in a clinical scenario. Remember, this text is not intended to replace comprehensive textbooks, course packs, or lectures. It is simply intended to serve as a supplement to your studies during your medical pharmacology course and Step 1 preparation.

    This text was contributed to by a number of medical students to represent the core topics tested on course examinations and Step 1.

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