pharmacology discussion

8/16/2019 Pharmacology Discussion

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NEUROPHARMACOLOGY EXAM

September 4, 2015,

Name_________________________________________I!_____________________

I."C, a 22#$ear#%&' ()*+&e, *emp&%$e' ma*, -a( br%+.t )*t% t.e emer+e*/$ 'epartme*tE! % a me*ta& .ea&t. .%(p)ta& b$ t.e p%&)/e ater .e -a( %*' r**)*+ bare%%te'

'%-*t%-* '%'+)*+ /ar( )* (b3er% -eat.er I* t.e ER, "C -a( etreme&$ r)+.te*e', a*'

(tate' t.e$ -%*6t &et me +%7

"C )( a+)tate' ea()&$ a*' t.reate*( t.e )*ter8)e-er -.e* a(9e' :e(t)%*( re+ar')*+ .)(

)&&*e(( "C (a)' .e /ame t% t.)( /)t$ 5 $ear( a+% t% be t.e 9)*+ % ;a33 m()/7 He .a( *%

/&%(e r)e*'(, a*' '%e( *%t tr(t m%(t pe%p&e He .ear( 8%)/e( % 'ea' pe%p&e7 -.% te&&.)m .e )( -%rt.&e(( a*' -)&& be 9)&&e'7 He (a$( t.e *e-(/a(ter( %* t.e te&e8)()%* are

rea')*+ m$ m)*' a*' te&&)*+ e8er$%*e m$ per(%*a& (e/ret(7 .at 'r+( -%&' $% (e t% a//%mp&)(. t.e )r(t +%a&?


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4 "C -a( +)8e* a ()*+&e '%(e % &%ra3epam 2 m+ IM H)( a+)tat)%* re(%&8e' ater t.e )r(t)*;e/t)%* >.at )( t.e *et me')/at)%* 'e/)()%* *ee'e' %r "C, a*' -.at a/t%r( (.%&' be

/%*()'ere' -.e* (e&e/t)*+ a* a*t)p($/.%t)/ %r t.e a/te a*' (tab)&)3at)%* p.a(e(?

5 >.e* (.%&' "C6( tar+et ($mpt%m( (tart t% re(p%*' t% %&a*3ap)*e?

@ It )( @ m%*t.( &ater M%(t % "C6( ($mpt%m( .a8e )mpr%8e', .e )( re()')*+ )* a(()(te'

&)8)*+ .%()*+, a*' .e )( -%r9)*+ part#t)me at G%%'-)&& I*'(tr)e( A&t.%+. .e )( *%t

tr%b&e' b$ a*$ ()'e ee/t(, .e (ee( *% p%)*t )* /%*t)*)*+ .)( me')/at)%* S.%&' t.e$ be')(/%*t)*e'? >.at are /rre*t pra/t)/e +)'e&)*e( re+ar')*+ &%*+#term treatme*t?

II. AR )( a 25#$ear#%&' -%ma* -.% pre(e*t( t% t.e (t'e*t .ea&t. /&)*)/ %r a r%t)*e p.$()/a&eam)*at)%* !r)*+ .er 8)()t, AR (tate(, I68e bee* ee&)*+ 'epre((e' &ate&$ a*' ee& &)9e

+)8)*+ p7 Her p.$()/a& eam)*at)%* )( *remar9ab&e, a*' a&& &ab%rat%r$ te(t( are -)t.)*

*%rma& &)m)t( A #.ma* /.%r)%*)/ +%*a'%tr%p)* te(t )( *e+at)8e S.e ta9e( *%


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me')/at)%*( %t.er t.a* a* %ra& /%*tra/ept)8e a*' 'e*)e( 'r)*9)*+ a&/%.%& %r ()*+ %t.er

re/reat)%*a& (b(ta*/e(

>.e* a(9e', AR (tate( t.at (.e .a( .a' )*/rea()*+ per)%'( % 'epre((e' m%%' %8er t.e pa(t

e- m%*t.( a*' %te* )*'( .er(e& /r$)*+ %r *% part)/&ar rea(%* S.e rep%rt( t.at (.e .a(

*% )*tere(t )* .er %&' .%bb)e( O8er t.e &a(t 2 m%*t.(, .er appet)te .a( 'e/rea(e' a*' (.e.a( &%(t 15 p%*'( S.e )( e*+a+e' t% be marr)e' )* = m%*t.(, bt ee&( .%pe&e(( ab%t a&&

% t.e p&a*( t.at (.e *ee'( t% ma9e %r .er -e'')*+ S.e .a( '))/&t$ (&eep)*+, a*' .a( *%

e*er+$ 'r)*+ t.e 'a$ S.e )*'( )t '))/&t t% /%*/e*trate %r ma9e 'e/)()%*( .at )( $%r ')a+*%()(?

2 >.at )( t.e r)(9 % AR .rt)*+ .er(e&? H%- (.%&' ()/)'a& )'eat)%* be a((e((e'?

= >.at 'r+ %pt)%*( are a8a)&ab&e %r AR6( 'epre(()8e ($mpt%m(? >.at /%*()'erat)%*(

(.%&' be ma'e -.e* (e&e/t)*+ a*t)'epre((a*t t.erap$?

4 AR )( +)8e* a pre(/r)pt)%* %r (ertra&)*e 50 m+ B! PO a*' )( a(9e' t% retr* t% t.e /&)*)/)* 4 -ee9( %r %&&%-#p H%- (%%* (.%&' AR6( tar+et ($mpt%m( be+)* t% re(%&8e?

5 >.at are t.e m%(t /%mm%* ()'e ee/t( rep%rte' -)t. SSRI(, a*' .%- (.%&' t.e$ be

ma*a+e'?

III. SL, a $%*+ -%ma*, )( br%+.t t% t.e emer+e*/$ 'epartme*t E! *re(p%*()8e, e/ept t%

*%)%( (t)m&) Her r)e*'( rep%rt a* e8e*)*+ % .ea8$ 'r)*9)*+ %* t.e %//a()%* % .ert-e*t$#)r(t b)rt.'a$ Her re(p)rat)%*( are breat.(Dm)* a*' (.a&&%- &%%' pre((re P

)( 100D@0 mm H+, p&(e )( 100 beat(Dm)*, a*' temperatre )( =@F C A (tat7 arter)a& b&%%'

+a( 'eterm)*at)%* re8ea&( a pH % 2 *%rma&, =@ t% 44, P/%2 % 52 mm H+ *%rma&,=5 t% 45, a*' HCO=

# % 1 mE:DL *%rma&, 21 t% 2

1 >.$ )( SL6( re(p)rat%r$ (tat( % /%*/er*?


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2 >.at t.erap$ (.%&' be )*)t)ate' t% ma*a+e SL6( re(p)rat%r$ 'epre(()%*?

=


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2 Are a*$ %t.er m%%' (tab)&)3er( ee/t)8e %r ma)*te*a*/e % b)p%&ar ')(%r'er?

= >.at a'')t)%*a& %pt)%*( are a8a)&ab&e %r b)p%&ar pat)e*t( -.% a)& t% re(p%*' t% &)t.)m,

8a&pr%)/ a/)', %r /arbama3ep)*e?


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V. NK, a 25#$ear#%&' -%ma*, .a( bee* emp&%$e' a( a ba*9 /&er9 %r t.e pa(t 5 $ear( S.e

.a' a* e/e&&e*t -%r9 re/%r' *t)& @ m%*t.( a+%, -.e* e/e(()8e ab(e*/e( a*' a te*'e*/$

t% be/%me ea()&$ p(et at /(t%mer( a*' /%#-%r9er( be/ame *%t)/eab&e Up%* /&)*)/a&a((e((me*t, NK /%mp&a)*( % be)*+ t)re', )rr)tab&e, a*' te*(e, -)t. re:e*t (t%ma/. p(et

a*' ')arr.ea S.e .a( *% .)(t%r$ % me*ta& )&&*e((J .%-e8er, (.e a'm)t( t% be)*+ (tre((e'

a*' -%rr$)*+ t%% m/. ab%t ;(t &)tt&e t.)*+(7, -.)/. (.e /a**%t (eem t% /%*tr%& *% matter .%- .ar' (.e tr)e( NK 'e*)e( eper)e*/)*+ ep)(%')/ atta/9(7 % (e8ere a*)et$ -.)/.

m)+.t be )*')/at)8e % pa*)/ ')(%r'er, %r % .a8)*+ %b(e(()8e#/%mp&()8e t.%+.t( %r

be.a8)%r(

NK6( p.$()/a& eam)*at)%* )( *remar9ab&e, a*' (.e .a( *% .)(t%r$ % me*ta& )&&*e(( )* .er

am)&$, a&t.%+. .er m%t.er -a( a *er8%( per(%*7 NK 'e*)e( a*$ pa(t %r pre(e*t (e %

a*$ )&&)/)t (b(ta*/e( %r a&/%.%&

NK (tate( t.at at t)me( (.e .a( '))/&t$ (pea9)*+, )( *ab&e t% re&a, a*' (tart&e( ea()&$

S.e rea&)3e( t.at -%r9 .a( bee* '))/&t %r .er &ate&$ a*' (.e .a( bee* t%&' b$ .er

(per8)(%r t.at .er ;%b )( )* )mme')ate ;e%par'$ *&e(( (.e )mpr%8e( .er per%rma*/e NK(tate( t.at (.e ;(t -a*t( t% be ab&e t% per%rm .er ;%b -e&&, re&a, a*' e*;%$ &)e Her

)*()+.t a*' ;'+me*t are +%%', a*' (.e )( m%t)8ate' t% %bta)* treatme*t NK 'e*)e( a*$()/)'a& )'eat)%*

1 >.at -%&' $%r ')a+*%()( be a*' -.$?

2 a(e' %* t.e )*%rmat)%* pre(e*te' )* NK6( /a(e, .%- /a* )t be 'eterm)*e' -.et.er

treatme*t )( )*')/ate'? >.at are t.e +%a&( % treatme*t?

= >.at a/t%r( (.%&' be /%*()'ere' )* t.e pr%/e(( % (e&e/t)%* % t.e m%(t appr%pr)ate

treatme*t %pt)%* %r NK?

4 The physician decides that N.K. is a good candidate for benzodiazepine treatment.

What factors are important in the selection of a particular benzodiazepine agent for

N.K.?


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C.&%r')a3ep%)'e .a8e .a&#&)8e( bet-ee* 10#40 .%r( a*' are metab%&)3e' t% a* a/t)8e

metab%&)te 'e(met.$&')a3epam t.r%+. .epat)/ %)'at)8e pat.-a$( .at

p%te*t)a& %r ab(e a*' 'epe*'e*/e )( a((%/)ate' -)t. be*3%')a3ep)*e(? H%- (.%&' NK

be /%*(e&e' re+ar')*+ be/%m)*+ a'')/te'7 t% &%ra3epam?


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VI. AR )( a 14#$ear#%&', 40#9+, ema&e .)+. (/.%%& (t'e*t AR .a' t.ree ebr)&e (e)3re(

-.e* (.e -a( = $ear( %&' S.e re/e)8e' p.e*%barb)ta& pr%p.$&a)( %r ab%t @ m%*t.(7

%&&%-)*+ .er (e/%*' ebr)&e (e)3re S)*/e t.e*, (.e .a' *% rep%rte' (e)3re( *t)& (.e .a'a /%*8&()%*7 at (/.%%& (.%rt&$ ater arr)8)*+ %r .er )r(t /&a(( % t.e m%r*)*+ A tea/.er

-.% -)t*e((e' t.e ep)(%'e 'e(/r)be( .er a( be.a8)*+ %''&$7 be%re t.e (e)3re S.e

abrpt&$ +%t p r%m .er /&a((r%%m 'e(9 a*' be+a* t% -a&9 /&m()&$ t%-ar' t.e '%%rJ (.e bmpe' )*t% (e8era& 'e(9( a*' ')' *%t re(p%*' t% t.e tea/.er6( attempt( t% re')re/t .er ba/9

t% .er (eat Ater appr%)mate&$ 1 m)*te % t.)( be.a8)%r, (.e e&& t% t.e &%%r a*'

eper)e*/e' a* appare*t +e*era&)3e' t%*)/#/&%*)/ (e)3re t.at &a(te' %r appr%)mate&$ 0(e/%*'( !r)*+ t.e ep)(%'e, (.e -a( )*/%*t)*e*t % r)*e a*' -a( 'e(/r)be' a( tr*)*+ 9)'

% b&e7 %&&%-)*+ t.)( ep)(%'e, AR -a( tra*(p%rte' t% t.e .%(p)ta&

O* arr)8a& at t.e .%(p)ta&, AR appeare' 'r%-($ a*' /%*(e' Lab%rat%r$ (t')e()*/&')*+ /%mp&ete b&%%' /%*t CC, (erm +&/%(e, e&e/tr%&$te(, 'r+Da&/%.%& (/ree*,

a*' a &mbar p*/tre -ere *%rma& P.$()/a& eam)*at)%* a*' /%mp&ete *er%&%+)/

e8a&at)%* -ere *%rma& A* EEG (.%-e' ')(e (&%-)*+ -)t. %/a& ep)&ept)%rm

')(/.ar+e( )* t.e &et temp%ra& areaJ )t -a( )*terprete' a( ab*%rma& .at a/t%r( (.%&' be /%*()'ere' )* a 'e/)()%* t% treat AR6( (e)3re( -)t. a*t)ep)&ept)/me')/at)%*?

= !)(/(( t.e AE!( /%mm%*&$ (e' %r AR6( (e)3re t$pe a(e' %* t.e (b;e/t)8e a*'%b;e/t)8e 'ata a8a)&ab&e, re/%mme*' a )r(t#/.%)/e a*t)ep)&ept)/ me')/at)%* %r AR


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VIII. "E, a =4#$ear#%&' -%ma*, )( (/.e'&e' t% *'er+% a +$*e/%&%+)/ &apar%(/%p$ *'er

+e*era& a*e(t.e()a, %* a* %t#pat)e*t ba()( S.e )( ta9e* t% (r+er$J a*e(t.e()a )( )*'/e'

-)t. pr%p%%& a*' ma)*ta)*e' -)t. )(%&ra*e e*ta*$& )( a'm)*)(tere' )*tra%perat)8e&$ %ra*a&+e()a Ner%m(/&ar b&%/9a'e pr%'/e' b$ 8e/r%*)m )( re8er(e' -)t. *e%(t)+m)*e

a*' +&$/%p$rr%&ate I* t.e re/%8er$ r%%m, "E be/%me( *a(eate' a*' .a( (e8era& emet)/

ep)(%'e(

1 >.at '% $% re/%mme*'?

2 H%- /%&' "E6( a*e(t.et)/ re+)me* .a8e bee* m%'))e' t% re'/e t.e &)9e&).%%' % PON?


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pharmacology discussion

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