Neuroleptics and oral contraceptives (increase/decrease) metabolism of (SSRI/TCA)
Decrease
TCAs (by CYP450)
Give examples of drugs/substances that increase TCA drug metabolism
Cigarettes and barbiturates
TCAs can block the centrally mediated anti-HT effect of which drug?
Clonidine
A rare and severe reaction can occur if TCAs are combined with which other antidepressant?
MAOi
Hyperpyrexia, convulsions, coma Sx
T/F: Li partially substitute for Na in excitable cells (ex: neurons)
True
Li (simulated/inhibits) (influx/efflux) of (X) through NMDA receptor.
Inhibits
Influx
X = Ca
Li primarily excreted via:
PCT (kidney)
Na (overload/depletion) decreases Li clearance and increases risk of toxicity.
Depletion
List examples of CNS (stimulants/sedatives) that act by blocking vesicular monoamine transporters.
Stimulants;
Amphetamines, Meth, MDMA (ecstacy)
Amphetamines MOA
- Inhibits monoamine reuptake
- Increases monoamine release at synapse (disrupts vesicular storage, thus causing increase in their non-vesicular release)
MDMA primary effects in the brain on (X) neurons
X = serotonergic
Death from Cocaine can result
from the drug’s propensity to cause (X), even at low doses.
X = hyperthermia
Increased heat production, Impaired autonomal adjustment to heat, Impaired heat perception
Peripherally, cocaine potentiates actions of (X) NT. Thus, patient will present with (brady/tachy)-cardia, (hyper/hypo)-tension, (dilated/constricted) pupils.
X = NE
Tachy; hyper; dilated
The positive reinforcing properties of psychostimulants are associated with the activation of the (X) NT system.
X = mesolimbic (DA)
Projections to the (X) brain structure are associated with
habit formation
X = Dorsal striatum
Medical uses of cocaine are currently limited to:
- Topical/local anesthetic
- Vasoconstrictor for ENT surg
Dose not to exceed 10% (or 200 mg)
Medical uses of amphetamines are currently limited to:
- Obesity??
- ADHD
- Narcolepsy
Modafinil is used to treat:
sleepiness (but NOT cataplexy) of narcolepsy
MPH (methylphenidate) is structurally similar to (X) drug, but its effects are similar to those of (Y) drug.
X = amphetamines Y = cocaine
DAT inhibition;
Also NET inhibition
(X) drug is used to treat ADHD, but is NOT a stimulant. What’s its MOA?
X = Atomoxetine
Inhibits NE reuptake selectively (but not DA, so not likely abused)
T/F: Adopted children tend to show the drinking patterns characteristic of their biological rather than their adoptive parents.
True
Delirium tremens, aka (X), has mortality rate of (Y)%.
X = delirium from alcohol/benzos withdrawal Y = 20!!!
(X) drug is used for alcohol withdrawal, particularly in patients who have liver failure
X = lorazepam
(X) drug blocks the breakdown of alcohol and results in (Y) accumulation. Thus, ingestion of alcohol causes intense nausea, HA, and flushing, which act as aversive stimuli.
X = Disulfuram (antabuse) Y = acetaldehyde
For moderate (instead of heavy) alcohol drinkers, (X) drugs may be useful since they blunt the positive effects of alcohol.
X = naltrexone or acomprosate
The classic clinical triad of opioid overdose:
Coma, resp depression, miosis
T/F: Like barbituate/EtOH withdrawal, opioid withdrawal can be quite fatal
False - rarely fatal (“flu-like” illness/Sx)
In general, stimulants (drugs) work by (increasing/decreasing) the availability of (X) NT in brain synapses.
Increasing
X = DA
Some stimulant drugs, such as (X), work by stimulating the release of (Y).
X = amphetamines Y = DA
Some stimulant drugs, such as (X), work by inhibiting the reuptake of (Y).
X = Cocaine Y = DA
The “high” of cocaine dissipates quickly and is often followed by (X) mood. This change can occur in as little as (Y) amount of time.
X = depressive Y = under 1 h
Patient in ER appears agitated, combative, and nasal mucosal atrophy. You suspect (X) drug use and can verify by checking pupils for (miosis/mydriasis). Which psychotic symptoms, if any, would you most commonly witness in this patient?
X = cocaine
Mydriasis
Tactile (“cocaine bugs” crawling on skin)
Which drugs are used to treat stimulant misuse/toxicity?
- Benzos (to treat agitation)
- Antipsychotics
SUPER important to treat CV symptoms as well as to prevent seizures
List examples of hallucinogens (drugs).
- LSD (lysergic acid diethylamide)
- PCP (phencyclidine)
- Cannabis (marijuana, hashish)
T/F: LSD and PCP are both orally ingested.
False - PCP is smoked
LSD v PCP: which NT systems affected?
LSD: increase SA availability
PCP: bind NMDA receptors of glutamate-gated ion channels
(LSD/PCP) use is associated with elevated blood pressure, agitation, and episodes of violent behavior
PCP
Hyperthermia and horizontal/vertical nystagmus is seen in patients with (X) drug use.
X = PCP
Elevated levels of (X), a metabolite of nicotine, are found in the urine of smokers.
X = cotinine