Toxicology Exam 2

What drug classes are anxiolytics and “sleep” drugs?

• Benzos

• Anti-depressants

What drug class is classifies as a sedative-hypnotic agent and is known as “Mother’s Little Helper”?

Benzos

What are the generic names for benzodiazepines?

-pams and -lams

• Alprazolam (Xanax)

• Clonazepam (Klonopin)

• Lorazepam (Ativan)

• Diazepam (Valium) → muscle relaxant

• Triazolam → Insomnia

T/F: Antidepressants are used for anxiety

True

What is the MOA for benzos?

Increase affinity of GABA receptors → decreases ability to initiate action potential

What DEA schedule are Benzos?

IV

What drug class can cause seizures when someone is going through withdrawal from them?

Benzodiazepines

What is depleted by benzos due to its effect on the pineal gland?

Melatonin

What nutrient interacts with benzos and stimulates GABA receptors?

Niacin

How does Flumazenil act as an antagonist to benzos?

Competitive inhibitor

What antihistamine drug is also used for anxiety?

Hydroxyzine

What drug has the following adverse effect?

Long QT syndrome/Torsade de Pointes

Hydroxyzine

What is the MOA of Buspirone and what condition is it used for?

Partial serotonin agonist, weak dopamine antagonist

Anxiety

What analgesic is used “off-label” for anxiety?

Gabapentin

What drugs are used for insomnia?

• Zolpidem (Ambien)

• Eszopiclone (Lunesta)

• Trazadone

• Diphenhydramine

What drug(s) are used for difficulty falling asleep?

Both

What drug would you use for staying asleep and waking up early?

Zolpidem

What is the MOA of Zolpidem and Eszopiclone?

Binds to GABA receptor at benzo site

What class are Zolpidem and Eszopiclone?

IV

What sleeping drugs don’t have any anxiolytic, anticonvulsant, or muscle relaxant effect?

Zolpidem and Eszopiclone

What are the black box effects of Zolpidem and Eszopiclone?

1. Sleep-driving

2. Cooking and eating food

3. Making phone calls while asleep

4. Having sex while asleep

What is the black box effect of anti-depressant drug classes?

Suicidal thinking

What is caused due to getting depleated in adults who are taking anti-depressants?

Hyponatremia

What else is tricyclics used for other than as a anti-depressant?

Chronic pain syndromes (neuropathic)

What drug class has the following generic names?

-tryptylines

• Amitriptyline

• Nortriptyline

Tricyclics

What is the MOA of tricyclics?

• Inhibit re-uptake of norepinephrine and serotonin

• Block alpha-adrenergic, histaminic, and muscarinic receptors

What is the MOA of SSRIs?

Prevents re-uptake of serotonin

T/F: SSRIs affect histamine, muscarinic, and alpha-adrenergic receptors

False

How long does it typically take for the therapeutic effects of SSRIs to occur?

Several weeks

What drug class has the following generic names?

-x-ines and -prams

• Sertraline (Zoloft)

• Escitalopram (Lexapro)

• Fluoxetine (Prozac)

• Citalopram (Celexa)

• Paroxetine (Paxil)

SSRIs

What are the effects of TCAs?

• Drowsiness

• Decreased BP

• Antidepressant

What is an adverse effect of SSRIs?

Discontinuation syndrome (taper off drug)

Which SSRI is not recommended to be taken by pregnant women due to its teratogenic effects?

Paroxetine

What are the clinical uses of SNRIS?

• Fibromyalgia

• Chronic musculoskeletal pain

• Diabetic peripheral neuropathic pain

What is the MOA for SNRIS?

Block re-uptake of serotonin AND norepinephrine

T/F: SNRIs don’t affect histamine, muscarinic, or alpha-adrenergic receptors

True

What drug class has the following generic names?

-ines

• Duloxetine (Cymbalta)

• Venlafaxine (Effexor)

SNRI

What are the adverse effects of SNRIs that is different than SSRIs?

• Hypertension, tachycardia, & diaphoresis

• Weight loss

What is Bupropion used for?

• Depression

• Obesity

• ADHA

• Neuropathic pain

What drug lowers seizure threshold? TQ

Bupropion

What does Bupropion have serious interactions with?

Caffeine & methylene blue

What are the contraindications for Bupropion?

• Hx of seizures (lowers threshold)

• Hx of eating disorders (causes weight loss)

What pregnancy category does Bupropion fall into?

B

T/F: Patients on Bupropion will NOT show up as a + amphetamine on a urine screen

False

What is Trazodone used for?

• Depression

• Insomnia

• Migraine

• PTSD

What is the MOA for Trazodone?

Serotonin Antagonist and Reuptake Inhibitor (SARI)

What drug can cause adverse effects similar to TCAs but can also cause priapism?

Trazodone

What are the groups of antipsychotic meds?

• First generation

• Atypical (second generation)

What drug class has the following generic names?

• Chlorpromazine

• Haloperidol

• Prochlorperazine

First generation antipsychotics

What drug class has the following MOA?

• Blocks dopamine receptors

• Block cholinergic, adrenergic, and histamine receptors

First generation antipsychotics

What are the adverse effects of first generation antipsychotics?

• Movement disorders (extrapyramidal)

• Gynecomastia & hyperprolactinemia

• Blood sugar & lipid regulation

What drug class has the following generic names?

• Quetiapine

• Aripiprazole

• Olanzapine

• Risperidone

Atypical antipsychotics

What is the MOA for atypical antipsychotics?

Blocks dopamine & serotonin receptors

Which antipsychotic drug class has the following adverse effects?

• Less extrapyramidal symptoms

• More metabolic side effects (significant weight gain)

Atypical

T/F: The FDA has a warning label on atypical antipsychotic meds for compulsive or uncontrollable urges

True

What are the 2 main types of muscle relaxants?

1. Centrally acting (CNS depressants)

2. Direct acting (muscle)

What drug class has the following generic names?

• Tizanidine (Zanaflex)

• Baclofen

• Diazepam (Valium)

Chronic centrally acting

What drug is used to manage spasticity of chronic conditions and acute low back pain?

Tizanidine

What is the MOA for Tizanidine?

Alpha-adrenergic agonist

What are the uses of Baclofen?

Spasticity & pain

• MS

• Trigeminal neuralgia

• Spinal cord tumor/ischemia

What drug class has the following generic names?

• Cyclobenzaprine (Flexeril)

• Chlorzoxazone

• Metaxalone

• Orphenadrine

Acute centrally acting

What drug is typically used with diazepam for acute muscle spasms?

Tizanidine

What is Dantrolene used for?

Spasticity → MS & cerebral palsy

What is the MOA for Dantrolene?

Directly on muscle → doesn’t allow calcium release (blocks ryanodine channels)

What drug has the black box warning?

• Hepatic damage

• Significant muscle weakness

Dantrolene

What is the MOA for local anesthetics?

• Block nerve conduction (sensory)

  • Block sodium channels

What is typically used with local anesthetics to increase the duration it lasts for?

Epinephrine

What drug class has the following generic names?

• -caines

  • Procaine (Noocain)

  • Lidocaine

  • Bupivocaine

  • Cocaine

Local anesthetics

What drug has anesthetic and anti-arrhythmic properties?

Lidocaine

What can happen if a local anesthetic is injected into blood vessels?

Cardiovascular toxicity and seizures

What can happen if a local anesthetic is mixed with epi and is injected into a digit?

Vasoconstriction → necrosis

What are Opioids typically used for?

1. Severe/chronic pain

2. Depression of cough reflex

3. Diarrhea

What opioid is typically used for suppressing cough reflex?

Codeine and dextromethorphan

What is the MOA for opioids?

Bind g-protein coupled opioid receptors

• Mu and Kappa

Causes inhibition of adenylyl cyclase and ion channels

• Decrease in Ca2+ = impedes neuronal firing and neurotransmitter release

• Increase in K+ exiting = hyperpolarization

Decrease release Substance P (pain perception

Stimulates dopamine release (euphoria)

What drug class has the following effects?

• Analgesia

• Euphoria

• Depress respiration (common cause of death)

• Anti-tussive

• Miosis (pinpoint pupils)

• Vomiting

• Constipation

Opioids

What are the adverse effects of opioids?

• Tolerance & physic dependence → Significant withdrawal symptoms

• Neonatal withdrawal syndrome

When is the typical peak of opioid withdrawal symptoms?

72 hrs

What opioid is a schedule IV drug?

Tramadol

What drug class does the following drugs belong to and what are their schedule?

• Hydrocodone

• Oxycodone

• Codeine

• Morphine

• Methadone

• Fentanyl

• Dilaudid

• Demerol

Opioids

Schedule II

What is used during recovery from opioid abuse/addiction to help wean off the drug?

Methadone

What opioid is most commonly used as a transdermal patch?

Fentanyl

What is used to save lives during an opioid overdose?

Nalaxone (Narcan)

What is used during maintenance treatment of opioid dependence?

Naloxone w/ buprenoprphine

What is the MOA of NSAIDS?

COX inhibitor

What are the clinical uses for NSAIDS?

• Acute/chronic pain & inflammation

• Decreasing fever

• Decrease platelet aggregation

What are the 2 groups of NSAIDS?

1. Nonselective (COX-1 & COX-2)

2. Selective (COX-2)

What drug class does the following belong to?

• Ibuprofen

• Dicolfenac (Volteran gel)

• Indomethacin

• Naproxen

• Salicylates

Non-selective NSAIDS

Which of the following drugs irreversibly inhibits both COX-1 & COX-2 receptors?

Asprin (ASA)

What is the Black Box warning for NSAIDS

Can cause GI ulcers & bleeding leading to perforation

What cardio vascular Black Box warning does non-selective NSAIDS have?

Increased risk of MI and stroke

What adverse effect is associated with non-selective NSAID use with kidney drugs?

Hyperkalemia

T/F: NSAID use may compromise existing renal function

True

What type of surgery should a patient never use non-selective NSAIDs perioperatively and why?

Coronary artery bypass graft (CABG) → increased risk MI and stroke

When does non-selective NSAIDs change from a pregnancy risk category C to D?

30 weeks of gestation and beyond

What nutrients can be depleted with non-selective NSAIDs?

Folate & Iron

What is the generic name for selective COX inhibitors (NSAID)?

Celecoxib (celebrex)

What form of NSAIDs is used because it has less stomach side effects?

Selective (Celecoxib)

What is the problem associated with COX-2 inhibitors?

• Inhibits production of anti-thrombotic prostaglandin

• Increased risk of heart attacks and strokes → take aspirin

What is likely to be depleted with selective NSAIDs?

Folate

What is acetaminophen metabolized into that is highly reactive?

NAPQI