Advanced Pharmacology Final Exam
Expected Questions and Answers.
What are DMARDs?
a medication that suppresses the immune system
people may take them to slow disease progression in autoimmune or inflammatory
conditions
What is the first line therapy for Lupus (SLE)?
Hydroxychloroquine (Plaquenil)
How long does it take for hydroxychloroquine to work at full effect?
100 days (about 3 months) to see full effect of this medication in tissues
half-life = 50 days
Side Effects of Hydroxychloroquine (Plaquenil):
- prolongs QT interval
- hypoglycemia
- neuropsychiatric effects
- retinal toxicity (increased risk of retinopathy)
Use of Hydroxychloroquine in Caution with:
- G6PD deficiency
- hepatic impairment
- renal impairment
Is hydroxychloroquine safe for breastfeeding/pregnancy?
Yes
What is the first line therapy for Rheumatoid Arthritis?
Methotrexate
ALWAYS give methotrexate with ________.
folic acid
Side Effects of Methotrexate:
- renal impairment
- hepatic impairment/hepatotoxicity
- gum bleeding/ulcers
- macrocytic anemia
- GI hemorrhagic enteritis
Do not use methotrexate with ______.
Trimethoprim
Avoid methotrexate in ______ and _______ disease.
renal and liver
If methotrexate toxicity occurs, give _______.
folinic acid
JAK Inhibitors MOA:
,widespread inflammation suppression
widespread cytokine suppression
Avoid/Caution JAK Inhibitors in:
- history of diverticulitis
- GI perforation
- current or previous smoker
- prior MI/PE/DVT
Adverse Reactions to JAK Inhibitors:
- bowel perforation
- venous thromboembolic events
- malignancy
- herpes zoster
- anemias
Treatment Options for Multiple Sclerosis:
- Interferon-beta 1b
- Ocrevus (Ocrelizumab)
- glucocorticoids
- IVIG
Interferon Contraindications:
pulmonary artery hypertension
Ocrevus (Ocrelizumab) Contraindications:
- active infections
- cancer
_______ are the first-line treatment for acute alcohol withdrawal.
benzodiazepines (ex. diazepam, lorazepam, alprazolam)
due to their ability to prevent DT's and seizures
What is the first-line therapy for MODERATE to SEVERE AUD?
Naltrexone
tablets vs. injection (monthly injection improves adherence; pt must be opioid-free for at
least 7-10 days before administration)
If a person has liver disease, what would we consider to be first-line treatment for
MODERATE to SEVERE AUD?
Acamprosate (Campral)
What medication is considered second-line for treatment of MODERATE to
SEVERE AUD?
Disulfiram
due to unpleasant side effects
What is the first-line therapy for OUD?
Buprenorphine/Naloxone (Suboxone)
- for induction and maintenance
- helps reduce withdrawal cravings
,What is the second-line treatment for OUD?
Methadone
- provided by an opioid treatment program
- first-line in fentanyl misuse
- maybe utilized if Suboxone doesn't work
What are the three FDA approved drugs that help with smoking cessation?
- Bupropion (Zyban, Wellbutrin) - if no seizure history
- Varenicline (Chantix) - can cause vivid dreams
- NRT - FIRST LINE (patches, gum, lozenges, nasal spray, inhaler)
What are the top two SSRIs?
Sertraline (Zoloft)
Escitalopram (Lexapro)
due to lower side effect profile
Other SSRIs:
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
What would the recommended treatment be for a patient with MDD and
neuropathic pain?
Duloxetine (Cymbalta)
Why are TCAs no longer considered first-line therapy?
- severe side effects (sedation, weight gain, orthostatic hypotension, dry mouth,
urinary retention, constipation)
- lethality (overdose risk) (cardiotoxicity in overdose; QT prolongation, arrhythmias)
If a patient is struggling with sexual side effects from their SSRI, what medication
can we suggest?
Bupropion (Wellbutrin)
Black Box Warning for Many Mental Health Medications:
increased risk of suicide/suicidal thoughts in pediatric patients
STILL TREAT!!
monitor for worsening symptoms
Acute Mania or Hypomania First-Line Treatment Options:
- Lithium
- Atypical Antipsychotics (SGAs)
- Valproate/Depakote
What do you need to monitor with Valproate?
- monitor liver function
- monitor platelets
- monitor Depakote/Valproate levels
, Treatment for GAD:
SSRIs
_______ is a good medication for anxiety because it is not addictive. ______ have
a higher risk of addiction.
Buspirone; Benzodiazepines
What is the first-line therapy for panic attacks/panic disorder?
SSRIs + CBT
Treatment for Schizophrenia:
Atypical Antipsychotics (ex. Clozapine, Risperidone, Aripiprazole, Olanzepine,
Ziprasidone)
- less side effects
- long-acting injectable (SGAs) that we can use (Paliperidone palmitate), which
provides positive and negative symptoms control, enhances adherence, and prevent
misuse
What is the first-line therapy for mild to moderate pain?
NSAIDs, Acetaminophen, OTC, Nonpharmacologic
What should we utilize for neuropathic pain?
Gabapentin
First-Line Treatment for Chronic Pain:
Non-Pharmacologic
Treatment for Nociceptive Chronic Pain:
NSAIDs, Acetaminophen = First-Line
Treatment for Chronic Refractory Pain:
Opioids (last resort)
Medical Cannabis:
may be effective for neuropathic pain, fibromyalgia, cancer pain
In osteoarthritis, if one or two joints are affected, use _________.
topical NSAIDs
If the hip joint OR multiple joints are affected by osteoarthritis, use ________.
Oral NSAIDs
If the patient has osteoarthritis in multiple joints and concomitant comorbidities
that contraindicate oral NSAIDs, and for patients with knee osteoarthritis who
have not responded to other interventions, treatment would be:
Duloxetine (Cymbalta)
Treatment for an Acute Gout Flare:
Colchicine
Urate Lowering Therapy for Chronic Gout Management:
Oxidase Inhibitor
Allopurinol 100mg/daily
First-Line Therapy for Insomnia:
CBT (for chronic insomnia)
Sleep Hygiene (for acute insomnia)
Z-Drugs (Zolpidem, Zaleplon, Eszopiclone)
First-Line Therapy for Narcolepsy:
- Modafinil
- Armodafinil
Expected Questions and Answers.
What are DMARDs?
a medication that suppresses the immune system
people may take them to slow disease progression in autoimmune or inflammatory
conditions
What is the first line therapy for Lupus (SLE)?
Hydroxychloroquine (Plaquenil)
How long does it take for hydroxychloroquine to work at full effect?
100 days (about 3 months) to see full effect of this medication in tissues
half-life = 50 days
Side Effects of Hydroxychloroquine (Plaquenil):
- prolongs QT interval
- hypoglycemia
- neuropsychiatric effects
- retinal toxicity (increased risk of retinopathy)
Use of Hydroxychloroquine in Caution with:
- G6PD deficiency
- hepatic impairment
- renal impairment
Is hydroxychloroquine safe for breastfeeding/pregnancy?
Yes
What is the first line therapy for Rheumatoid Arthritis?
Methotrexate
ALWAYS give methotrexate with ________.
folic acid
Side Effects of Methotrexate:
- renal impairment
- hepatic impairment/hepatotoxicity
- gum bleeding/ulcers
- macrocytic anemia
- GI hemorrhagic enteritis
Do not use methotrexate with ______.
Trimethoprim
Avoid methotrexate in ______ and _______ disease.
renal and liver
If methotrexate toxicity occurs, give _______.
folinic acid
JAK Inhibitors MOA:
,widespread inflammation suppression
widespread cytokine suppression
Avoid/Caution JAK Inhibitors in:
- history of diverticulitis
- GI perforation
- current or previous smoker
- prior MI/PE/DVT
Adverse Reactions to JAK Inhibitors:
- bowel perforation
- venous thromboembolic events
- malignancy
- herpes zoster
- anemias
Treatment Options for Multiple Sclerosis:
- Interferon-beta 1b
- Ocrevus (Ocrelizumab)
- glucocorticoids
- IVIG
Interferon Contraindications:
pulmonary artery hypertension
Ocrevus (Ocrelizumab) Contraindications:
- active infections
- cancer
_______ are the first-line treatment for acute alcohol withdrawal.
benzodiazepines (ex. diazepam, lorazepam, alprazolam)
due to their ability to prevent DT's and seizures
What is the first-line therapy for MODERATE to SEVERE AUD?
Naltrexone
tablets vs. injection (monthly injection improves adherence; pt must be opioid-free for at
least 7-10 days before administration)
If a person has liver disease, what would we consider to be first-line treatment for
MODERATE to SEVERE AUD?
Acamprosate (Campral)
What medication is considered second-line for treatment of MODERATE to
SEVERE AUD?
Disulfiram
due to unpleasant side effects
What is the first-line therapy for OUD?
Buprenorphine/Naloxone (Suboxone)
- for induction and maintenance
- helps reduce withdrawal cravings
,What is the second-line treatment for OUD?
Methadone
- provided by an opioid treatment program
- first-line in fentanyl misuse
- maybe utilized if Suboxone doesn't work
What are the three FDA approved drugs that help with smoking cessation?
- Bupropion (Zyban, Wellbutrin) - if no seizure history
- Varenicline (Chantix) - can cause vivid dreams
- NRT - FIRST LINE (patches, gum, lozenges, nasal spray, inhaler)
What are the top two SSRIs?
Sertraline (Zoloft)
Escitalopram (Lexapro)
due to lower side effect profile
Other SSRIs:
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
What would the recommended treatment be for a patient with MDD and
neuropathic pain?
Duloxetine (Cymbalta)
Why are TCAs no longer considered first-line therapy?
- severe side effects (sedation, weight gain, orthostatic hypotension, dry mouth,
urinary retention, constipation)
- lethality (overdose risk) (cardiotoxicity in overdose; QT prolongation, arrhythmias)
If a patient is struggling with sexual side effects from their SSRI, what medication
can we suggest?
Bupropion (Wellbutrin)
Black Box Warning for Many Mental Health Medications:
increased risk of suicide/suicidal thoughts in pediatric patients
STILL TREAT!!
monitor for worsening symptoms
Acute Mania or Hypomania First-Line Treatment Options:
- Lithium
- Atypical Antipsychotics (SGAs)
- Valproate/Depakote
What do you need to monitor with Valproate?
- monitor liver function
- monitor platelets
- monitor Depakote/Valproate levels
, Treatment for GAD:
SSRIs
_______ is a good medication for anxiety because it is not addictive. ______ have
a higher risk of addiction.
Buspirone; Benzodiazepines
What is the first-line therapy for panic attacks/panic disorder?
SSRIs + CBT
Treatment for Schizophrenia:
Atypical Antipsychotics (ex. Clozapine, Risperidone, Aripiprazole, Olanzepine,
Ziprasidone)
- less side effects
- long-acting injectable (SGAs) that we can use (Paliperidone palmitate), which
provides positive and negative symptoms control, enhances adherence, and prevent
misuse
What is the first-line therapy for mild to moderate pain?
NSAIDs, Acetaminophen, OTC, Nonpharmacologic
What should we utilize for neuropathic pain?
Gabapentin
First-Line Treatment for Chronic Pain:
Non-Pharmacologic
Treatment for Nociceptive Chronic Pain:
NSAIDs, Acetaminophen = First-Line
Treatment for Chronic Refractory Pain:
Opioids (last resort)
Medical Cannabis:
may be effective for neuropathic pain, fibromyalgia, cancer pain
In osteoarthritis, if one or two joints are affected, use _________.
topical NSAIDs
If the hip joint OR multiple joints are affected by osteoarthritis, use ________.
Oral NSAIDs
If the patient has osteoarthritis in multiple joints and concomitant comorbidities
that contraindicate oral NSAIDs, and for patients with knee osteoarthritis who
have not responded to other interventions, treatment would be:
Duloxetine (Cymbalta)
Treatment for an Acute Gout Flare:
Colchicine
Urate Lowering Therapy for Chronic Gout Management:
Oxidase Inhibitor
Allopurinol 100mg/daily
First-Line Therapy for Insomnia:
CBT (for chronic insomnia)
Sleep Hygiene (for acute insomnia)
Z-Drugs (Zolpidem, Zaleplon, Eszopiclone)
First-Line Therapy for Narcolepsy:
- Modafinil
- Armodafinil
