Pharm II Exam 1

Escitalopram, Fluoxetine, Sertraline, and Paroxetine

What meds are SSRIs?

Venlafaxine and Duloxetine

What meds are SNRIs?

Alprazolam, Lorazepam, Clonazepam, and Diazepam

What meds are Benzodiazepines?

Buspirone

What med belongs to the Azapirone class?

Propranolol

What med is a non-selective beta-blocker used for performance anxiety?

Methylphenidate, Dexmethylphenidate, Amphetamine/Dextroamphetamine, and Lisdexamfetamine

What meds are CNS Stimulants?

Atomoxetine

What med is a selective Norepinephrine Reuptake Inhibitor (NRI)?

Guanfacine ER and Clonidine ER

What meds are Alpha-2 Agonists?

SSRIs and SNRIs

What are the first-line pharmacotherapy drug classes across all anxiety disorders?

CNS Stimulants

What is the first-line medication class for ADHD?

Selectively blocks the reuptake of serotonin by targeting the serotonin transporter

What is the mechanism of action of SSRIs?

Inhibits the reuptake of both serotonin and norepinephrine with weak dopamine reuptake inhibition

What is the mechanism of action of SNRIs?

Binds to GABA receptors and enhances the inhibitory effect of GABA

What is the mechanism of action of Benzodiazepines?

Acts as a partial agonist at serotonin receptors and an agonist at dopamine D2 receptors

What is the mechanism of action of Buspirone?

Non-selectively antagonizes beta-1 and beta-2 adrenergic receptors

What is the mechanism of action of Propranolol?

Blocks reuptake and increases release of norepinephrine and dopamine in the extraneuronal space

What is the mechanism of action of CNS Stimulants?

Selectively inhibits norepinephrine reuptake

What is the mechanism of action of Atomoxetine?

Stimulates alpha-2 adrenergic receptors in the brain

What is the mechanism of action of Alpha-2 Agonists in ADHD?

GABA

What is the primary inhibitory neurotransmitter that hyperpolarizes membranes by allowing Cl- influx?

Glutamate

What is the primary excitatory neurotransmitter that depolarizes membranes by allowing Na+ influx?

Sexual dysfunction, weight gain, and GI disturbances

What are the three primary side effects of SSRIs?

Serotonin syndrome

What life-threatening syndrome can occur if SSRIs or SNRIs are combined with MAOIs?

Jitteriness, palpitations, and increased short-term anxiety

What short-term paradoxical side effects can occur upon initiating SSRIs or SNRIs?

Black Box Warning for increased risk of suicidal thoughts and behaviors in patients under 25

What major Black Box Warning is shared by all SSRIs and SNRIs?

Sustained diastolic hypertension

What unique cardiovascular side effect is associated with the SNRI Venlafaxine?

Dry mouth and constipation

What are the common anticholinergic side effects associated with SNRIs?

Glaucoma

What eye condition is a contraindication for using SNRIs?

Cirrhosis, alcohol abuse, or other chronic liver disease

In what patient conditions are SNRIs contraindicated?

Respiratory depression, cognitive impairment, and decreased motor control

What are three major safety-related side effects of Benzodiazepines?

Profound sedation, respiratory depression, coma, and death

What is the Black Box Warning for concurrent use of Benzodiazepines and opioids?

Black Box Warning for addiction, misuse, dependence, and withdrawal reactions

What are the Black Box Warnings associated with Benzodiazepines?

Azoles and Clarithromycin

What are two common antimicrobials that interact with Benzodiazepines to increase benzo levels?

Dizziness and drowsiness

What are the most common side effects of Buspirone?

Severe renal impairment

In what patient population is Buspirone contraindicated?

Hypotension, bradycardia, weight gain, hyperlipidemia, and hypertriglyceridemia

What are the side effects of Propranolol?

Bronchospasm, severe bradycardia, and heart block

What are the primary warnings/risks associated with Propranolol?

Myocardial infarction

What cardiovascular risk can occur if Propranolol is stopped abruptly?

Insomnia and loss of appetite

What are the two most common side effects of CNS Stimulants occurring in over 50% of patients?

Black Box Warning for abuse, misuse, and addiction

What is the Black Box Warning for all CNS Stimulants?

Severe cardiac disease or structural cardiac abnormalities

What cardiovascular conditions are contraindications for CNS Stimulants?

Black Box Warning for suicidality in children and adolescents

What is the Black Box Warning for Atomoxetine?

Sedation, somnolence, headache, fatigue, abdominal pain, and hypotension

What are the primary side effects of Alpha-2 Agonists?

Cardiovascular disease or conduction disturbances

In what conditions should Alpha-2 Agonists be used with caution?

Rebound hypertension

Why must extended-release Alpha-2 Agonists like Clonidine ER be tapered gradually?

Start low and go slow

What is the clinical dosing pearl when initiating SSRIs in anxious patients?

Taper off gradually

How should SSRIs and SNRIs be discontinued to avoid withdrawal/discontinuation syndrome?

Paroxetine

Which SSRI has the highest risk of discontinuation syndrome due to its short half-life?

Four to six weeks

How long must an SSRI or SNRI be given at a therapeutic dose before being deemed ineffective?

Two to four weeks

When do the clinical anxiolytic effects of SSRIs and SNRIs typically begin to appear?

Optimize, switch, then augment

What is the proper sequencing of steps when a patient's first-line anxiety treatment fails?

Short-term relief of four weeks or less, or as an initiation bridge

When benzodiazepines are used, what duration and role is recommended?

One to two weeks

How long does it take for Buspirone to show a therapeutic effect?

At least twelve months

How long should effective pharmacotherapy for anxiety be continued before attempting a taper?

One dose step per month

What is a recommended slow discontinuation taper strategy for anxiety medications?

Growth effects like reduced weight gain and delayed height curves

What physical development parameters are limited to the first 1-3 years of CNS Stimulant therapy?

Decrease by 0.1 mg every 3 to 7 days

What is the recommended discontinuation taper rate for Clonidine ER?

Paroxetine

Which SSRI is the most anticholinergic, most sedating, and on the Beers list for older adults?

Fluoxetine

Which SSRI has a very long half-life and is first-line for OCD and panic disorder?

Sertraline

Which SSRI is known for a strong tolerability profile and is first-line for PTSD, Panic, and SAD?

Pregabalin, quetiapine, risperidone, and olanzapine

What are the evidence-based augmentation options for treatment-resistant GAD?

Alprazolam, Oxazepam, Midazolam, and Triazolam

Which Benzodiazepines are classified as short-acting with a half-life under 24 hours?

Temazepam, Lorazepam, and Clonazepam

Which Benzodiazepines are classified as intermediate-acting with a half-life of 12-40 hours?

Diazepam, Chlordiazepoxide, and Flurazepam

Which Benzodiazepines are classified as long-acting with a half-life of 40-250 hours?

Midazolam

Which short-acting Benzodiazepine is preferred for sedation and amnesia in critical care?

Oxazepam

Which Benzodiazepine is preferred for alcohol withdrawal in a patient with cirrhosis or acute hepatitis?

Diazepam

Which Benzodiazepine is available in oral, IM, IV, and rectal gel formulations?

One to three minutes

What is the onset of action of diazepam when administered intravenously?

Fifteen to sixty minutes

What is the onset of action of oral diazepam?

More than twelve hours

What is the duration of action of diazepam?

No abuse potential, no sedative effects, and no cognitive impairment

What are three safety advantages of Buspirone over Benzodiazepines?

Buspirone and Hydroxyzine

Which two anxiolytics are effective essentially only in GAD and not other anxiety disorders?

Propranolol

Which medication is limited to as-needed use for performance-only social anxiety?

Lisdexamfetamine

Which CNS stimulant is formulated as a prodrug?

Ritalin and cocaine

Which two substances block the dopamine transporter to increase synaptic dopamine levels?

CYP2D6 poor metabolizers

What genetic profile requires a lower starting dose of Atomoxetine?

Atomoxetine

Which nonstimulant is preferred and often first-line when substance-use risk, diversion, or comorbid anxiety is a concern?

Alpha-2 Agonists

Which ADHD medication class is useful for comorbid tics, aggression, or insomnia?

Bupropion

Which third-line ADHD agent is off-label, has the weakest evidence, and can lower the seizure threshold?

Behavioral therapy

What is the first-line treatment for ADHD in preschool children aged 4 to 5 years?

Failure of one stimulant class warrants a trial of the other class

What is the clinical protocol if a patient fails to respond to a methylphenidate-based stimulant?

The Controlled Substances Act (CSA)

What federal law places regulated substances into one of five schedules based on medical use, abuse potential, and safety?

Schedule I

Which drug schedule contains substances with no currently accepted medical use and a high potential for abuse?

Schedule II

Which drug schedule contains substances with high abuse potential where use potentially leads to severe psychological or physical dependence, but have accepted medical use?

Schedule III

Which drug schedule contains substances with a moderate to low potential for physical and psychological dependence?

Schedule IV

Which drug schedule contains substances with a low potential for abuse and low risk of dependence?

Schedule V

Which drug schedule contains substances with the lowest potential for abuse under the CSA, often used as antidiarrheals, antitussives, or analgesics?

Heroin, LSD, marijuana, MDMA, peyote, and methaqualone

What are key examples of Schedule I substances?

Cocaine, methamphetamine, PCP, methadone, hydromorphone, meperidine, oxycodone, fentanyl, and methylphenidate

What are key examples of Schedule II substances?

Ketamine, anabolic steroids, testosterone, and products with limited codeine

What are key examples of Schedule III substances?

Alprazolam, carisoprodol, diazepam, lorazepam, zolpidem, and tramadol

What are key examples of Schedule IV substances?

Pregabalin, Lomotil, and cough preparations with limited codeine

What are key examples of Schedule V substances?

Addiction

What is defined as a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and life experiences, characterized by compulsive use despite harmful consequences?

Substance Use Disorders

What is defined as a pathological pattern of behaviors related to the use of a chemical substance?

Tolerance

What is defined as the need for increased doses of a substance to achieve the desired effect, or a reduced effect when the usual dose is consumed?

Physical Dependence

What state develops as a result of adaptation (tolerance) produced by a resetting of homeostatic mechanisms (allostasis) in response to repeated drug use?

Withdrawal Syndrome

What is the only actual clinical evidence of physical dependence, occurring when blood or tissue concentrations of a substance decline in an individual who had maintained prolonged heavy use?

Positive Reinforcement

What is the capacity of drugs to produce positive effects that increase the likelihood that the individual will take the drug again?

Negative Reinforcement

What process describes how the removal of an aversive stimulus (such as a negative emotional state or withdrawal) increases the probability of drug-taking behavior?

Relapse and Reinstatement

What is defined as the return to using a substance after a period of sobriety?

Substance-induced disorders

What describes the development of a reversible, substance-specific syndrome (like intoxication) due to recent ingestion that occurs during or shortly after use?