Pharm Review Exam 3

Dopamine is a neurotransmitter that plays a crucial role in movement control. In Parkinson's disease, there is a deficiency of dopamine in the brain. Although dopamine itself can alleviate the symptoms of Parkinson's, it cannot be used as a treatment because it is unable to cross the blood-brain barrier. The blood-brain barrier is a protective barrier that prevents certain substances, including dopamine, from freely entering the brain. Therefore, alternative treatments such as dopamine agonists or medications that increase dopamine levels indirectly are used to manage Parkinson's disease.

Both pramipexole and ropinirole are FDA approved for Restless Leg Syndrome. This means that both drugs have undergone rigorous testing and have been found to be safe and effective in treating this condition. Patients with Restless Leg Syndrome can be prescribed either pramipexole or ropinirole, depending on their individual needs and preferences. It is important for patients to consult with their healthcare provider to determine the most appropriate medication for their specific situation.

Donepezil, rivastigmine, and galantamine are all medications used in the treatment of Alzheimer's disease. They belong to a class of drugs called cholinesterase inhibitors, which means they work by inhibiting the enzyme acetylcholinesterase. Acetylcholinesterase is responsible for breaking down acetylcholine, a neurotransmitter involved in memory and cognition. By inhibiting this enzyme, these medications increase the levels of acetylcholine in the brain, which can help improve cognitive function in individuals with Alzheimer's disease. Therefore, the correct answer is that these medications inhibit acetylcholine esterase.

Sodium phosphate is a medication commonly used as a laxative. However, it is important to exercise caution when recommending this medication to patients with congestive heart failure (CHF), hypertension (HTN), or renal failure. This is because sodium phosphate can potentially worsen these conditions due to its effects on fluid and electrolyte balance. Therefore, healthcare professionals need to carefully evaluate the risks and benefits before prescribing sodium phosphate to patients with CHF, HTN, or renal failure.

Calcium citrate is known to have the best oral absorption compared to other calcium supplements. This is because it does not require stomach acid for absorption, making it more easily absorbed by the body. Additionally, calcium citrate can be taken with or without food, which further enhances its absorption.

Risperidone is the correct answer because it is a second-generation antipsychotic medication that has been associated with the highest rate of Extrapyramidal Side Effects (EPSEs) among the options given. EPSEs are movement disorders that can be caused by antipsychotic medications, and risperidone has been found to have a higher risk of causing these side effects compared to other antipsychotics.

Memantine is an Alzheimer's drug that protects cells from glutamate. Glutamate is a neurotransmitter that can cause the death of surrounding neurons if it is present in excessive amounts. Therefore, by blocking the effects of glutamate, memantine prevents the damage and death of neurons, providing neuroprotection and potentially slowing down the progression of Alzheimer's disease.

SSRIs, or selective serotonin reuptake inhibitors, are the preferred antidepressant treatment for patients with AD, which likely refers to Alzheimer's disease. SSRIs are commonly prescribed for depression, including in patients with AD, as they work by increasing the levels of serotonin in the brain. Serotonin is a neurotransmitter that plays a role in regulating mood, and by increasing its levels, SSRIs can help alleviate symptoms of depression. Other antidepressant classes like MAO-Is, TCAs, and SNRIs may also be used, but SSRIs are generally considered the first-line treatment due to their efficacy and favorable side effect profile.

In a situation where a bipolar patient is acutely agitated and psychotic, the administration of a benzodiazepine would be the appropriate choice. Benzodiazepines are commonly used to manage acute agitation and anxiety due to their sedative and calming effects. They work by enhancing the effects of the neurotransmitter gamma-aminobutyric acid (GABA) in the brain, which helps to reduce excessive neuronal activity and promote relaxation. This can be particularly beneficial in managing acute episodes of agitation and psychosis in bipolar disorder. Valproic acid is primarily used as a mood stabilizer in bipolar disorder, while buproprion is an antidepressant and first-generation antipsychotics are typically not the first-line treatment for acute agitation in bipolar disorder.

Senna is a laxative that is safe to take daily. It is derived from the leaves of the Senna plant and works by stimulating the muscles in the intestines to promote bowel movements. Senna is commonly used for short-term relief of constipation and is considered safe for daily use as long as it is taken at the recommended dosage. However, it is always important to consult with a healthcare professional before starting any new medication or laxative regimen.

Phenobarbital is a barbiturate that is commonly used as a preventative treatment for seizures in children. It acts by suppressing abnormal electrical activity in the brain, thereby reducing the occurrence of seizures. This medication has been found to be effective in managing various types of seizures, including generalized tonic-clonic seizures and partial seizures. It is often prescribed for long-term use in children with epilepsy to help control and prevent seizures from happening. Phenobarbital has a long history of use and has been proven to be safe and effective in managing seizures in pediatric patients.

2nd generation antihistamines do not work by blocking H1 receptors in the skin, vasculature, and CNS. Instead, they selectively target peripheral H1 receptors in the body, minimizing their penetration into the central nervous system (CNS). This reduces the risk of sedation and other central side effects commonly associated with 1st generation antihistamines. Therefore, the statement is false.

Calcitonin is not considered a first-line treatment for osteoporosis. While it can help reduce bone loss and increase bone density, other medications such as bisphosphonates are generally preferred due to their proven effectiveness and lower risk of side effects. Therefore, the statement that calcitonin is a first-line treatment for osteoporosis is false.

The given answer "No" is correct because TCAs (Tricyclic Antidepressants) are not considered appropriate second-line treatment for depression in the elderly. TCAs have a higher risk of side effects, including anticholinergic effects and cardiac toxicity, which can be particularly problematic in older adults. Selective serotonin reuptake inhibitors (SSRIs) and other newer antidepressants are generally preferred as second-line options due to their better tolerability and safety profile in the elderly population.

Duloxetine is the correct answer because it is an SNRI (serotonin-norepinephrine reuptake inhibitor) that has been approved by the FDA for the treatment of fibromyalgia. Venlafaxine and desvenlafaxine are also SNRIs, but they are not specifically approved for fibromyalgia treatment. Therefore, duloxetine is the most appropriate choice for this question.

The given answer "Duh!" suggests that it is obvious or common knowledge that second-generation antipsychotics block serotonin receptors, as well as dopamine receptors D1, D2, and D4. This implies that the information provided in the question is basic and widely known, making the correct answer apparent to anyone familiar with the topic.

The statement is true because akathisia, which is a movement disorder characterized by restlessness and an inability to sit still, can be effectively treated with anticholinergic drugs like benztropine. These drugs work by blocking the action of acetylcholine, a neurotransmitter that is involved in motor control. By inhibiting acetylcholine, anticholinergic drugs can help reduce the symptoms of akathisia and provide relief to individuals experiencing this condition.

Raloxifene's MOA is as an estrogen agonist/antagonist. This means that it acts as both an agonist and antagonist of estrogen receptors in different tissues. In some tissues, it acts as an agonist, mimicking the effects of estrogen, while in others it acts as an antagonist, blocking the effects of estrogen. This selective estrogen receptor modulator (SERM) activity allows raloxifene to have estrogen-like effects on bone, reducing bone resorption and increasing bone density, while also having anti-estrogenic effects on breast and uterine tissues, reducing the risk of breast cancer and endometrial hyperplasia.

Mirtazepine is the best-suited medication for the patient based on the given information. Mirtazepine is an antidepressant that is known to increase appetite and improve sleep, which would address the patient's anorexia and insomnia symptoms. Buproprion and fluoxetine are also antidepressants, but they are not specifically known for their appetite-stimulating and sleep-improving effects. Phenelzine is a monoamine oxidase inhibitor (MAOI) antidepressant, which may have side effects and interactions that make it less suitable for this patient.

The average daily dose of calcium and vitamin D for an adult over 50 is 1000 mg of calcium and 800 IU of vitamin D. This is the recommended amount to support bone health and prevent conditions such as osteoporosis. Calcium is not toxic to humans when consumed in appropriate amounts.

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Guaifenesin is recommended for patients with a productive cough because it is an expectorant. It helps to loosen and thin mucus in the airways, making it easier to cough up and clear the lungs. This can be beneficial for patients with a productive cough, as it helps to alleviate congestion and promote the removal of mucus from the respiratory system. Benzonatate is a cough suppressant, codeine is an opioid analgesic that can also suppress coughing, and dextromethorphan is another cough suppressant. These medications may be more appropriate for patients with a dry or non-productive cough.

GABA is actually an inhibitory neurotransmitter in the central nervous system (CNS). It works by reducing the activity of neurons and decreasing the likelihood of an action potential being generated. This inhibitory effect helps to regulate and balance the overall excitability of the brain. Therefore, the statement that GABA is an excitatory CNS neurotransmitter is incorrect.

Desipramine and nortriptyline are considered first-line tricyclic antidepressants (TCAs) because they have a decreased risk of side effects compared to other TCAs. These medications are commonly used to treat depression and other mood disorders. By being first-line options, it means that they are often prescribed as initial treatment choices before other TCAs are considered. Their reduced side effect profile makes them more tolerable for patients and increases their overall safety.

Ibandronate is a drug that is commonly prescribed for patients who are taking prednisone for more than 3 months. Prednisone is a corticosteroid medication that can cause bone loss and increase the risk of osteoporosis. Ibandronate is a medication that helps to prevent bone loss and reduce the risk of fractures in patients taking prednisone. Therefore, ibandronate is considered to be a drug of choice (DOC) for all patients taking prednisone for more than 3 months.

Oxazepam is an acceptable barbiturate to use in the elderly because it has a shorter half-life compared to other barbiturates. This means that it is less likely to accumulate in the body and cause excessive sedation or other adverse effects in older individuals who may have decreased drug metabolism and elimination. Additionally, oxazepam is generally well-tolerated in the elderly population and has a lower risk of drug-drug interactions compared to other barbiturates.

Propanolol is the correct answer because it is a medication commonly used to relieve symptoms of anxiety disorders. It belongs to a class of drugs called beta blockers, which work by blocking the effects of adrenaline on the body's beta receptors. By doing so, propanolol helps to reduce the physical symptoms of anxiety, such as rapid heart rate, trembling, and sweating. It is often prescribed for patients with persistent autonomic nervous system (ANS) symptoms associated with anxiety disorders. Temazepam and diazepam are benzodiazepines used for treating insomnia and anxiety, while buspirone is an anti-anxiety medication.

Pentobarbital is the correct answer because it is a sedative that both enhances the effects of GABA (a neurotransmitter that inhibits brain activity) and directly activates GABA receptors. This dual action allows pentobarbital to effectively induce sedation and promote relaxation. Triazolam, zolpidem, and chlordiazepoxide may also have sedative effects, but they do not possess both potentiating and direct agonist actions on GABA receptors like pentobarbital does.

Antipsychotics are not an appropriate treatment for anyone with AD to treat aggression and hallucinations. While antipsychotics may be prescribed in some cases, they are not the first-line treatment and should be used with caution due to potential side effects. Other non-pharmacological interventions and medications may be more suitable and effective for managing aggression and hallucinations in individuals with AD.

Calcitonin does not activate Vitamin D. Calcitonin is a hormone released by the thyroid gland that helps regulate calcium levels in the blood by inhibiting the breakdown of bone tissue and promoting the excretion of calcium by the kidneys. Vitamin D, on the other hand, plays a role in calcium absorption in the intestines and bone health. It is activated by a series of steps involving the liver and kidneys. Therefore, the statement that calcitonin activates Vitamin D is false.

Buproprion is the correct answer because it is an atypical antidepressant that does not significantly affect serotonin levels in the brain. Serotonin Syndrome is a potentially life-threatening condition that can occur when there is an excess of serotonin in the body. SSRIs and TCAs, on the other hand, are known to increase serotonin levels and therefore carry a risk of causing Serotonin Syndrome. Mirtazepine, although it does increase serotonin levels, has a lower risk of causing Serotonin Syndrome compared to SSRIs and TCAs.

Diphenhydramine, an antihistamine, is commonly used to treat allergic reactions and rashes in individuals of all ages, including the elderly. It helps to relieve symptoms such as itching, redness, and swelling by blocking the effects of histamine, a chemical released during an allergic reaction. While it is important to consider the specific needs and potential side effects in the elderly population, diphenhydramine is generally considered safe and effective for treating allergic reactions and rashes in this age group. Therefore, the statement is true.

These three benzodiazepines, diazepam, alprazolam, and triazolam, have significant interactions with the CYP450 enzyme system. The CYP450 enzymes are responsible for metabolizing many drugs in the body. When these benzodiazepines are taken, they can inhibit or induce the activity of certain CYP450 enzymes, leading to altered metabolism of other drugs that are also metabolized by the same enzymes. This can result in drug interactions and potentially affect the efficacy or toxicity of the co-administered drugs. Therefore, it is important to monitor and adjust the doses of these benzodiazepines when used in combination with other medications.

The correct answer is degeneration of cholinergic neurons and overactivation of unregulated glutamate signaling. In Alzheimer's disease, there is a progressive loss of cholinergic neurons in the brain, leading to a decrease in the neurotransmitter acetylcholine. This contributes to cognitive decline and memory impairment. Additionally, there is evidence of overactivation of glutamate signaling, which can lead to excitotoxicity and neuronal damage. These alterations in the CNS are characteristic of Alzheimer's disease.

Lithium treatment for bipolar disorder can have several adverse effects. One of these is teratogenicity, which means it can cause harm to a developing fetus if taken during pregnancy. This is why it is important for women of childbearing age to use effective contraception while taking lithium. Another adverse effect is sexual dysfunction, which can include problems with libido, arousal, and sexual performance. These side effects can have a significant impact on a person's quality of life and may require additional management strategies. Hyperthyroidism, depression, and weight loss are potential side effects of other medications used to treat bipolar disorder, but they are not specifically associated with lithium treatment.

Benztropine is not an effective treatment for tremor, drooling, and gait problems associated with PD. It is primarily used to treat the side effects of antipsychotic medications, such as parkinsonism. PD is typically treated with medications that increase dopamine levels in the brain, such as levodopa. Therefore, the statement is false.

The drugs that can cause insomnia are SSRIs, oral decongestants, caffeine, corticosteroids, and Parkinson's drugs. These medications can interfere with sleep patterns and disrupt the normal sleep-wake cycle, leading to difficulty falling asleep or staying asleep. Insomnia is a common side effect of SSRIs, which are a type of antidepressant. Oral decongestants, such as pseudoephedrine, can stimulate the central nervous system and cause sleep disturbances. Caffeine is a well-known stimulant that can keep individuals awake and prevent them from falling asleep. Corticosteroids, used to reduce inflammation, can also disrupt sleep patterns. Parkinson's drugs, which are used to manage symptoms of Parkinson's disease, can cause insomnia as a side effect.