Medications Most of the medication questions are covered as part of specific Disorders. The following are some outside Disorders. As of 15January2012. Main source, Stahl’s: The Prescribers Guide.2009

This PowerPoint Section This PowerPoint Section only addresses a few meds as most meds are covered in the psychiatric management parts of the PowerPoints devoted to specific Disorders.

Gabapentin Q. Gabapentin is FDA approved for?

Benzodiazepines Q. How do benzodiazepines work?

Benzodiazepines Ans. Binds to benzodiazepine receptors at the GABA-A ligand-gated chloride channel complex.

Gabapentin Ans. 1] partial seizures 2] post-herpetic neuralgia [So, much as many of us have had good results with gabapentin, it will frequently be the wrong answer on exams where FDA approval is implied.]

Clozapine Q. FDA approves clozapine for?

Clozapine Ans. 1] “Resistant” schizophrenia 2] People with schizophrenia who are high suicide risk.

SSRIs Q. List the SSRIs.

SSRIs Ans. Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline

Flumazenil Q. FDA approves flumzenil for?

Flumazenil Ans. Reversal of sedative side effects of benzodiazepines, such as overdose, including such a need in children.

Risperidone Q. Risperidone’s notable side effects?

Risperidone Ans. Stahl lists four: Increase risk for diabetes Increase risk for dyslipidemia Dose-related hyperprolactinemia

Modafinil Q. Modafinil is FDA approved for?

Modafinil Ans. Reducing excessive sleepiness associated with: -- narcolepsy -- shift-work sleep disorder -- obstructive sleep apnea

Acamprosate Q. Acamprosate is thought to work on which receptor sites?

Acamprosate Ans. Stabilize glutamatergic function.

Carbamazepine – lab tests Q. What lab tests are needed when using carbamazepine?

Carbamazepine – lab tests Ans. Blood count: every two weeks for 2 months, then every three months. Liver, kidney and thyroid function: every 6 to 12 months Consider monitoring sodium

Carbamazepine – life threatening Q. What are the life-threatening conditions to worry about when using carbamazepine?

Carbamazepine – life threatening Ans. 1.Rare, aplastic anemia, agranulocytosis 2.Rare, Stevens-Johnson syndrome 3.Rare, SIADH = syndrome of inappropriate antidiuretic hormone secretion with hyponatremia

Clozapine – tests/monitoring Q. What tests are to be run with clozapine? What do you want to monitor in addition to the lab test and physical findings

Clozapine – tests - 1 Ans. Complete blood count: -- before treatment -- weekly for 6 months -- then biweekly for months after one year, then every four weeks -- then 4 weeks after treatment discontinued See next screen

Clozapine – tests - 2 Ans. Continued: Track: weight, q 3 months BMI, q 3 months waist circumference, q 3 months fasting glucose, q 3 months lipids, q 3 months

Clozapine – monitoring - 3 Ans. Vigilant for diabetic ketoacidosis by monitoring: rapid onset of polyuria rapid onset of polydipsia weight lost nausea or vomiting dehydration increased R weakness clouding of sensorium, [including, of course, coma]

Valproate – tests and monitoring Q. What to test and monitor for when prescribing valproate?

Valproate – tests and monitoring Ans. Lab tests before beginning treatment: platelet count coagulation test liver function tests Also monitor weight Follow above frequently, especially in first six months, then once or twice a year.

Prazosin Q. Use of prazosin [Minipress] in psychiatry?

Prazosin Ans: PTSD’s nightmares.

Bupropion’s use in anorexia nervosa Q. Discuss bupropion’s use in anorexia nervosa.

Bupropion’s use in anorexia nervosa Ans. Has FDA black box because of increased of seizures in pts with eating disorders.

Warfarin Q. What should not be used with warfarin [Coumadin]?

Warfarin Ans. bupropion citalopram disulfiram mifeprestone [RU 486 [may not be complete] [answer may be to use with caution, rather than not at all]

Anticholinergic signs Q. What are the untoward anticholinergic signs?

Anticholinergic signs Ans. 1. dry mouth 2. blurred vision 3. constipation 4. tachycardia 5. urinary retention 6. hyperthermia 7. decreased cognition 8. [also, bad for narrow-angle glaucoma]