Domain 1: Scientific foundation

1. Pharmacokinetics Body does to the drug 2. 4 phases of pharmacokinetics absorption, distribution, metabolism, elim- ination 3. Absorption Leaves the site of administration 4. Distribution Drug enters interstitum and cells 5. Metabolism Drug becomes chemically altered 6. Elimination Drug removed from the body 7. Pharmacodynamics Drug does to the body 8. How many 1/2 lives to reach steady state and to clear the drug 9. Who are poor metabolizers of 2D6? 10. Who are poor metabolizers of 2C19? 5 Caucasians Asian and Japanese populations 11. What is an enzyme inDucer? Decreases serum level of the drug-- sub- therapeutic drug levels 12. What is an enzyme inHIbitor? Increases serum level of the drug-- toxic drug levels 13. What are the enzyme inducers? (5) 14. What are the enzyme in- hibitors? (9) 1 Tegretol 2 St. John's Wort 3 Phenytoin 4 Phenobarbitol 5 Tobacco 1 Wellbutrin 2 Clomipramine 3 Zantac 15. Clozapine metabolized through what enzyme system for tobac- co? 16. What are the drug classes that reduce renal clearance? (3) 4 Clamithromycin 5 Fluroquinolones 6 Grapefruit and grapefruit juice 7 Ketoconazole 8 Nefazodone 9 SSRIs CYP 1A2 1 NSAIDS 2 Thiazide Diuretics 3 ACE inhibitors 17. Agoinist Opens ion channel 18. Inverse Agonist Closes ion channel 19. Partial agonist Drug doesn't fully activate the receptors 20. Antagonist Binds to the receptor but doesn't activate a biological response 21. Common uses of Lithium (3) 1 Gold standard for mania 2 Anti-suicidal effects 3 Neuroprotective 22. Lithium toxicity level above 1.5 23. Lihtium baseline labs (5) 1 TSH 2 BUN 3 Creatine 4 Pregnancy test (females 12-51) 5 ECG (over age 50) 24. What can increase lithium lev- els? (3) 1 Hyperkalemia 2 Hyponatremia 3 Thiazide Diuretics 25. Lithium Endocrine s/e Hypothyroidism 26. Lithium CNS s/e Coarse hand tremors (sign of toxicity) 27. Lithium Dermatology s/e Maculopapular rash 28. Lithium GI s/e (4) Diarrhea, vomiting, cramps, anorexia 29. Lithium heart s/e T-wave inversion 30. Lithium Hematological s/e Leukocytosis (increased WBCs) 31. Lithium pregnancy s/e Ebstein Anomaly (in 1st trimester) 32. Lamictal use Bipolar depression 33. Lamictal black box warning Steven-Johnson's syndrome 34. Tegretol use Acute manic episodes for bipolar 35. Tegretol black box warnings (3) 1 Agranulocytosis (suspect this if elevated temp) 2 Aplastic Anemia 3 Steven-Johnson's syndrome in Asians b.c of HLA-B 1502 antigen 36. Tegretol pregnancy side effect Neural Tube Defects 37. Trileptal side effect Increased BG while HgbA1c is normal 38. Depakote pregnancy side ef- fects (4) 1 Spina Bifda 2 Atrial Septal Defect 3 Cleft Palate 4 Possible long term developmental deficits 39. What is Symbax? Zyprexa and Prozac 40. What is Symbax FDA approved for? Bipolar depression 41. Latuda use Bipolar depression 42. Folic acid amount in pregnancy 0.4-0.8 mg/day 43. Medications that cause Mania (4) 44. Decreased things in older adults (5) 1 Steroids 2 Disulfram 3 Isoniazid 4 Antidepressants if bipolar 1 Liver capacity 2 Intracellular water 3 Protein binding 4 muscle mass 5 metabolism 45. Increased in older adults (1) body fat concentration 46. Antidepressants black box 24 warning until what age? 47. Celexa side effect QT prolongation 48. Max dose of Celexa 40mg/day 49. Max dose of Celexa in older adults 20 mg/day 50. Luvox side effect Agitation 51. Prozac side effect Insomnia 52. What is Prozac FDA approved for? 53. What is the longest SSRI half-life? 54. What SSRI can help control symptoms of Tourette's? Bulimia Nervosa Prozac Prozac 55. What is the safest antidepres- sant class to overdose on? 56. What is the most lethal antide- pressant class to overdose on? 57. What is the antidepressant class that causes the most sex- ual dysfunction? 58. What 2 antidepressant classes can decrease purging frequen- cy? SSRI TCAs SSRIs SSRIs and TCAs 59. Clomipramine use OCD 60. Clomipramine side effect seizures (increased risk above 250mg/day) 61. Amitryptyline other uses (2) chronic pain and insomnia 62. Pamelor other uses (2) Bed wetting and ADHD 63. Doxepin other uses Insomnia 64. Imipramine other uses (2) Bed wetting and separation anxiety 65. Desipramine off label use ADHD 66. How does Wellbutrin work? blocks reuptake of norepinephrine and dopamine 67. Uses for Wellbutrin (4) 1 Can increase energy 2 ADHD 3 Smoking Cessation 4 When other antidepressants cause sex- ual dysfunction 68. Wellbutrin contraindications (2) Purging and active seizure history 69. Trazodone rare side effect Priapism 70. Effexor side effect can raise BP 71. 2 Atypical antidepressants that can cause abrupt discontinua- tion syndrome Effexor and Cymbalta 72. Remeron side effects (3) weight gain, insomnia, increased chole- strol 73. Cymbalta side effects (2) raise BP and LFTs 74. Atypical antidepressant to take with food? 75. Medications that cause depres- sion (8) 76. What is Haldol, Abilify, and Pi- mozide FDA approved for? Viibryd 1 steroids 2 accutane 3 beta-blockers 4 interferon 5 some retrovirals 6 antineoplastic drugs 7 benzos 8 progesterone Tourette's syndrome 77. Clozapine uses (2) treatment-resistant schizophrenia and de- crease suicide risk 78. Atypical antipsychotics biggest offenders for weight gain (4) 79. Atypical antipsychotics weight neutral (3) 1 Clozapine 2 Seroquel 3 Risperidone 4 Zyprexa (biggest offender) 1 Abilify 2 Geodon 3 Latuda 80. Atypical antipsychotic that is the least sedating 81. Clozapine monitoring lab schedule 82. Clozapine sudden signs of in- fection (4) 83. Clozapine agranulocytosis pro- tocol Abilify weekly for the first 6 months, than every 2 weeks for the next six months fever, chills, sore throat, weakness discontinue if WBC 2,000-3,000 84. Clozapine neutropenia protocol discontinue if ANC under 1000 85. Clozapine side effects (3) 1 significant weight gain 2 risk of diabetes 3 myocarditis (rare) 86. What is the half-life of Abilify? 72 hours 87. Seroquel use psychotic features for bipolar disorder 88. Seroquel side effect cataracts (need a yearly eye exam) 89. Off-label use for Risperidone + SSRI OCD 90. Risperidone side effect galactorrhea 91. Atypical antipsychotic that needs to be eaten with food 92. What serotonin receptor does atypical antipsychotics work on? Latuda 5HT2A 93. Acute dystonia muscle spasms 94. Acute dystonia tx Cogentin 95. Akathisia restlessness/ inability to sit still 96. Akathisia tx (3) 1 beta blockers 2 benzos 3 cogentin 97. Akinesia absence of movement 98. Akinesia tx cogentin 99. Psuedo-parkinsonism symp- toms (3) muscle rigidity, pill rolling tremor, shuffling gait 100. Psuedo-parkinsonism tx cogentin 101. Tardive Dyskinesia symptoms (2) involuntary muscle movements, protrud- ing tongue 102. How long can TD take to occur 1-2 years after use of medication 103. TD txs (FDA approved) (2) Deutetrabenzene and Ingrezza 104. TD medication contraindica- tions (2) Cogentin and Reglan 105. NMS key symptoms (3) extreme muscular rigidity, mutism, hyper- reflexia 106. NMS abnormal labs (3) Elevated: CPK, WBCs, LFTs 107. NMS treatment Parlodel 108. NMS tx to relax muscles Dantrolene 109. What is the disadvantage to using benzodiazepines with a short half-life? 110. What diagnosis is benzodi- azepines contraindicated with? Increased risk for addiction PTSD 111. 111. What diagnoses do you use Lo- razepam for? (2) 112. Does Clonazepam have a short half-life or a long half-life? 113. Teratogenic effects of Benzodi- azepines (2) 114. What is the FDA use for Propra- nolol (Inderal)? 115. What is the off-label use of Pro- pranolol (Inderal)? (2) 116. What is Prazosin (Minipress) used for? 117. What are the uses of Gabapentin (Neurontin)? (4) 118. What age is FDA approval of Amphetamine (Adderall)? 119. What age is FDA approval of Methylphenidate (Ritalin and Conerta) 120. What age is FDA approval of In- tuniv, Clonidine, and Strattera? 121. What disorders can Intuniv and Clonidine be used for? (2) 122. Strattera is used to help with behavioral symptoms of what disorder? 1 seizures 2 alcohol withdrawal with hepatic disease Long half-life 1 floppy syndrome 2 cleft palate HTN 1 anxiety 2 performance-related anxiety Nightmares 1 anxiety 2 neuropathic pain 3 fibromyalgia 4 anti-cravings 3 and up Age 6 and up 6 and up 1 Autism Spectrum Disorder 2 Tourette's Tourette's 123. What SUD medication can be used for Autism? 124. What disorders are omega-3 fatty acids used for? (3) 125. What disorder is Sam-e used for? 126. What disorders is Tryptophan used for? (4) 127. What medications can cause Serotonin syndrome with the supplement of Tryptophan? (3) 128. What are the uses of Vitamin E? (3) 129. What are the uses of Mela- tonin? (2) 130. What disorder is Fish Oil used for? 131. What are the uses for Black co- hosh? (3) Naltrexone 1 ADHD 2 Learning disorders 3 Cognitive impairment/Dementia Depression 1 Depression 2 Insomnia 3 Headaches 4 Fibromyalgia 1 SSRIs 2 MAOIs 3 St. John's Wort 1 enhances immune system 2 neurological disorders 3 premenstrual syndrome 1 insomnia 2 jet lag Bipolar disorder 1 menopausal symptoms 2 premenstrual syndrome 3 dysmenorrhea 132. What is Belladonna used for? Anxiety 133. What is the psychoactive catnip used for? 134. What is Chamomile used for? (2) Sedation 1 sedation 2 anxiety 135. What is Ginkgo used for? (3) 1 Delirium 2 Dementia 3 Sexual dysfunction (caused by SSRIs) 136. What is Ginseng used for? (2) 1 Depression 2 Fatigue 137. What is Valerian used for? Sedation 138. Tolerance Decreased effects of the same dose of a medication over time 139. Kindling The tendency of some regions of the brain to react to repeated low-level bioelec- trical stimulation by progressive boost- ing synaptic discharges, thereby lowering seizure threshold 140. Examples of Kindling (3) 1 ETOH 2 Benzodiazepines 3 Wellbutrin 141. Potency The amount of drug required to produce an effect of given intensity 142. Neuron Basic cellular unit of the nervous system 143. Cell body/Soma Made up of the nucleus and cytoplasm within the cell membrane 144. Axon Transmits signals away from the neuron's cell body to connect with other neurons and cells 145. Dendrites Collects incoming signals from other neu- rons and send signal toward the neuron's cell body 146. What does the CNS contain? (2) 1 spinal cord 2 brain 147. Somatic nervous system is re- sponsible for what? 148. Autonomic Nervous system is responsible for what? Voluntary movements Involuntary movements 149. What comprises the PNS? (2) 1 Somatic Nervous System 2 Autonomic Nervous System 150. What comprises the autonomic nervous system? (2) 151. What does the Sympathetic nervous system do? (2) 1 Sympathetic nervous system 2 Parasympathetic nervous system 1 Fight or flight 2 Stimulates the activity of the organs 152. What does the Parasympathetic 1 Rest nervous system do? (2) 153. What is white matter composed of? 154. What is gray matter composed of? (2) 155. What is the function of gray matter? 156. What is the cerebrum com- posed of? (3) 157. What is the left hemisphere re- sponsible for? (2) 158. What is the right hemisphere re- sponsible for? (4) 2 Decreases the activity of the organs Myelinated axons of neurons 1 nerve cell bodies 2 dendrites area of neuronal connection 1 right hemisphere 2 left hemisphere 3 lobes of the brain 1 language 2 speech 1 attention 2 memory 3 reasoning 4 problem-solving 159. What is Broca's area? Expressive speech 160. What is Wernicke's area Language comprehension 161. Functions of the frontal lobe (4) 1 voluntary movement 2 expressive speech 3 personality 4 executive functions 162. Functions of the temporal lobe (4) 1 auditory (primary) 2 emotions 3 language comprehension 4 sensory 163. Functions of occipital lobe vision (primary) 164. Functions of the parietal lobe (3) 165. What does the Limbic system regulate? (2) 166. What does the Hypothalamus regulate? (7) 167. What does the Thalamus regu- late? (3) 168. What does the Hippocampus regulate? (4) 169. What does the Amygdala regu- late? (4) 1 Sensory (primary) 2 Taste 3 Reading and writing 1 emotions 2 memory 1 appetite 2 sensations of hunger and thirst 3 water balance 4 circadian rhythms 5 body temperature 6 libido 7 hormonal regulation 1 emotions 2 memory 3 related affective behaviors 1 motivation 2 stress 3 emotion 4 learning/ memory 1 emotional memories 2 anxiety 170. What are the functions of the basal ganglia? (2) 171. When is the pre-frontal cortex fully develop? 172. Pre-frontal Cortex causes in the body 173. The brainstem is made up of cells that produce 174. What are the contents of the brain stem? (5) 175. What are the contents of the midbrain? (2) 3 anger 4 stress 1 learning 2 autonomic actions (walking, driving a car) Mid 20's to early 30's Pain Neurotransmitters 1 Midbrain 2 Pons 3 Medulla 4 Cerebellum 5 Reticular Formation System (primitive brain) 1 Ventral Tegmental Area 2 Substantia Nigra 176. What is housed in the pons? locus ceruleus 177. Medulla in the brainstem regu- lates what? 178. What is the cerebellum respon- sible for? 179. What does the reticular forma- tion system responsible for? (3) 180. What is the synaptic cleft? (2) Internal body function Maintains equilibrium 1 involuntary movement 2 vital sign control 3 focus and attention 1 Neurons are communicating 2 Neurotransmitters release from electri- cal activity 181. Depolarization (2) 1 Excitatory response 2 Sodium and Calcium ions flows into the cell 182. Repolarization (3) 1 Inhibitory response 2 potassium leaves the cell 3 chloride enters the cell 183. Where is Norepinephrine pro- duce? 184. What is Norepinephrine re- sponsible for? (6) 185. What happens when Norepi is decreased? 186. What happens when Norepi is increased? Locus Coeruleus 1 altertness 2 focus attention 3 orientation 4 primes flight or fights 5 learning 6 memory Depression Anxiety 187. Where is Serotonin produced? raphe nuclei of the brainstem 188. What is Serotonin responsible for? (7) 189. What disorders occur when Serotonin is decreased? (4) 1 regulation of sleep 2 pain perception 3 mood states 4 temperature 5 regulation of agression 6 libido 7 precursor to Melatonin 1 Depression 2 OCD 190. Where is Dopamine produced? (3) 191. What is Dopamine responsible for? (5) 192. What disorders happen when Dopamine is decreased? (3) 193. What happens when Dopamine is increased? (2) 194. Dopamine Mesolimbic pathway (2) 195. Dopamine Mesocortical Path- way 196. Dopamine Nigrostriatal path- way (3) 197. Dopamine tuberoinfundibular pathway (2) 198. Where is acetylcholine pro- duced? 199. What is acetylcholine responsi- ble for? (7) 3 anxiety 4 schizophrenia 1 substantia nigra 2 nucleus acuments 3 Ventral tegmental area (VTA) 1 thinking 2 decision-making 3 reward-seeking behavior 4 fine muscle action 5 integrated cognition 1 SUD 2 anhedonia 3 Parkinson's 1 schizophrenia 2 psychosis 1 positive symptoms of Schizophrenia 2 Psychotic symptoms Depressive symptoms of Schizophrenia 1 increase Ach levels 2 EPS 3 Tardive Dyskinesia if long term 1 increased prolactin levels 2 osteoporosis if prolonged prolactin lev- els Basal nucleus of Meynert 1 attention 2 memory 3 thirst 200. What happens when Acetyl- choline is decreased? (2) 201. GABA is the most abundant neurotransmitter in the brain. 202. What happens when GABA is at the normal level? 203. What happens when GABA is decreased? (2) 204. What is GABA responsible for? (4) 205. Glutumate is the most abun- dant in the brain 206. What is Glutamate responsible for? (2) 207. What happens when Glutamate is decreased? (3) 208. What happens when Glutamate is increased? (2) 209. Where is the Corticotroponin Releasing Hormone released? (3) 4 mood regulation 5 REM sleep 6 sexual behavior 7 muscle tone 1 Alzheimer's 2 Impaired memory Inhibitory Calming effect 1 increased anxiety 2 can lead to anxiety disorders 1 reduces arousal 2 reduces aggression 3 reduces anxiety 4 reduces excitaton Excitatory 1 memory 2 autonomic functions 1 memory difficulty 2 learning difficulty 3 negative symptoms of schizophrenia 1 bipolar affective disorder 2 psychosis from excessive pruning or neurotoxicity 1 Amygdala 2 Hippocampus 3 Locus Coeruleus 210. Corticotroponin releasing hor- mone can cause an exacerba- tion increased in symptoms. 211. Positive Babinski sign is nor- mal under age of 212. How to test olfactory cranial nerve 213. How to test optic cranial nerve (2) 214. How to test oculmotor cranial nerve (3) 215. How to test Trochlear cranial nerve nerve 216. How to test Trigeminal cranial nerve 217. How to test Abudcens cranial nerve anxiety 2 patency of each nostril 1 Snellen 2 Confrontation test (peripheral vision) 1 EOM 2 PERRLA 3 Corneal light reflex cranial 3 and 6 Masseter muscles same as 3 and 4 218. How to test facial cranial nerve taste 219. How to test acoustic cranial nerve (2) 220. How to test glossopharyngeal cranial nerve 221. How to test vagus cranial nerve (2) 222. How to test accessory spinal cranial nerve 1 whisper test 2 weber and rinne test with 10 1 check uvula by saying "ah" 2 gag reflex strength of sternocleidomastoid and trapezius 223. How to test hypoglossal cranial nerve stick tongue out and check for tremors or deviations 224. How do you test equlibrium? Romberg test 225. Diadochkinesia Can't flip hands as much as possible be- cause lesion of parietal lobe 226. Greater than % on 85 growth chart is considered overweight. 227. What does High BMI lead to? (6) 1 diabetes 2 heart disease 3 stroke 4 HTN 5 osteoarthritis 6 some forms of cancer 228. What are common indicators of physical child abuse? (5) 229. What atypical antidepressant has one of the lowest possibili- ties for EPS? 230. What atypical antidepressant cause no increase in prolactin levels and no prolongation of QTc interval? 231. When taking disulfram, don't take for al least 12 hours of taking the medication and up until 2 weeks after discontinua- tion of the medication. 1 history of unexplained multiple fractures 2 burns or bite marks on hand 3 injuries at various stages of healing 4 evidence of neglect 5 bruising on padded parts of the body Abilify Abilify Alcohol 232. What lab test can be elevated due to taking Disulfram? 233. Benzodiazepines bind with receptors to potentiate calming effects 234. What disease is the suspected cause of hyperlipidemia in peo- ple under age 40? 235. What medications cause ortho- static hypotension? (2) 236. What is an example of test- ing the right hemisphere of the brain? 237. What enzyme is a tobacco in- ducer with Clozapine? 238. What is the first symptom of unilateral tinnitus? 239. What are the lack of delays that are present in Asperger's? (3) 240. What disorder happens in 1 of every 1,000 males and 1 of every 2,000 females? 241. Fragile X syndrome has from mild to severe 242. What are the physical features of Prader Willi? (5) LFTs GABA Arcus Senilis 1 Clozapine 2 Thorazine Clock drawing test CYP1A2 Acoustic neuroma 1 language 2 cognitive development 3 age appropriate self-help skills Fragile X syndrome Mental Retardation 1 obesity 2 small stature 3 small hands and feet 243. Antisocial personality disor- der is 5 times more com- 4 hypotonia 5 hypogonadism 1 first 2 degree mon among - 3 relatives .