1. Medications As of 19 April 2014

2. PowerPoint This PowerPoint is weak as to the source of the answers. Many relied upon THE PRESCRIBER’S GUIDE.

3. Metabolism of Contraceptives Q. List some meds that increase the metabolism of oral contraceptives.

4. Metabolism of Oral Contraceptives Ans. Carbamazepine Oxcarbazepine Topiramate [probably others]

5. Gabapentin Ans. 1] partial seizures 2] post-herpetic neuralgia [shorter list than many of us would have thought]

6. Action of Benzodiazepines Q. What is the action of benzodiazepine?

7. Action of Benzodiazepines Ans. Binds to the benzodiazepine receptors at the GABA-A ligand-gated chloride channel complex leading to enhancing the inhibitory effects of GABA

8. When to Use Physostigmine q. When to use physostigmine?

9. When to Use Physostigmine Ans. Physostigmine is used to address anticholinergic intoxication, such as overdoses of atropine or scopolamine.

10. Signs of Imipramine Toxicity Q. What are the signs of imipramine toxicity?

11. Signs of Tricyclic Toxicity Signs not limited to but likely to reach answer to multiple choice question: Excitement Restlessness Dry mouth Dilated pupils Tachycardia

12. Asthma Q. Name some meds not to use with asthma

13. Asthma Ans. Beta-blockers, e.g., propranolol

14. Buspirone Q. What is action of buspirone and for what is it FDA approved for?

15. Buspirone Ans. Action: Serotonin 1A partial agonist FDA approved for: anxiety

16. Remeron Q. What is the action of Remeron and for what is it FDA approved?

17. Remeron Ans. Action: Alpha 2 antagonist FDA approved for: MDD

18. Alopecia Q. Some meds that cause alopecia?

19. Alopecia Ans. Li Valproate [Far from complete listing]

20. Some Reasons to Avoid Barbiturates Q. What are some reasons to avoid barbiturates?

21. Some Reasons to Avoid Barbiturates Ans. 1] Porphyria 2] On Sodium oxybate [GHB] 3] History of addictions

22. GHB Q. What is GHB?

23. GHB Ans. 4-hydroxybutanoic acid is a naturally occurring substance with names of sodium oxybate and trade name of Xyrem.

24. GHB Used To Treat? Q. For what is GHB used to treat?

25. GHB is Used to Treat? Ans. 1] Cataplexy 2] Narcolepsy’s daytime sleepiness

26. GHB’s Concerns Q. What are some concerns about GHB?

27. GHB Concerns Ans. 1] used as date rape drug. 2] overused to enhance athletic performance

28. Uses of Clonazepam Q. For what is clonazepam FDA approved?

29. Uses of Clonazepam Ans. In additions to seizures, panic disorder

30. Uses of Clonidine Q. For what is clonidine FDA approved?

31. Uses of Clonidine Ans. ADHD

32. Pimozide Q. For what is pimozide used?

33. Pimozide Ans. Tourette

34. Pimozide Concern Q. A concern about pimozide?

35. Pimozide Concern Ans. QTc prologation

36. Hyperprolactinemia Q. What does hyperprolactinemia cause?

37. Hyperprolactinemia Ans. 1] Sexual dysfunction* 2] Depression 3] Anxiety * Most likely the focus of multiple choice questions

38. Effect of Nicotine Q. Effect of nicotine?

39. Effect of Nicotine Ans. Increases dopamine Increases glutamate

40. Untoward Birth Defect with Valproate Q. What is the untoward birth defect associated with valproate?

41. Untoward Birth Defect Associated with Valproate Ans. Neural tube defect.

42. PTSD Nightmares Q. Used to treat nightmares in PTSD

43. PTSD Nightmares Ans. Prazosin [Minipress]

44. Avoid with Warfarin Q. What meds to avoid with warfarin?

45. Avoid with Warfarin Ans. Carbamazepine SSRIs impact too, but not as much as carbamazepine

46. Associated with Torsade de Pointes Q. What meds associated with torsade de pointes?

47. Associated with Torsade de Pointes Ans. 1] thioridazine 2] ziprasidone

48. Anticholinergic Signs Q. Lists anticholinergic signs.

49. Anticholinergic Signs Ans. 1.Dry mouth 2. Blurred vision 3. Constipation 4. Urinary retention 5. Hyperthymia 6. Decreased cognition 7. Tachycardia

50. Benzodiazepine Action Q. On what does benzodiazepine act?

51. Benzodiazepine Action Ans. Chloride channel of GABA A

52. Risperidone Problems Q. List some negatives as to using risperidone.

53. Risperidone Problems Ans. EPS Prolactin elevation sexual problems Weight gain in adolescence

54. Clozapine Q. FDA approves clozapine for?

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

56. SSRIs Q. List the SSRIs.

57. SSRIs Ans. Citalopram Fluoxetine Fluvoxamine Paroxetine Sertraline [needs to be updated]

58. Flumazenil Q. FDA approves flumzenil for?

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

60. Modafinil Q. Modafinil is FDA approved for?

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

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

63. Acamprosate Ans. Stabilize glutamatergic function.

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

65. 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 More frequent for the elderly Consider monitoring sodium

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

67. 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

68. 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

69. Clozapine – tests - 1 Ans. Complete blood count: -- before treatment -- every two weeks for six months -- then every four weeks -- then 4 weeks after treatment discontinued See next screen

70. 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

71. 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]

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

73. 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.

74. Use of amitriptyline in elderly Q. Discuss use of amitriptyline in the elderly.

75. Amitriptyline in the elderly Ans. Should be avoided because of significant anticholinergic effects.

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

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

78. Wash Out - most Q. How many weeks for washing out before using an MAOI, most meds?

79. Wash Out - most Ans. Two weeks.

80. Wash Out - Fluoxetine Q. How many weeks to wash out if pt is on fluoxetine?

81. Wash Out - Fluoxetine Ans. Five weeks

82. Wash Out - Insufficient Q. If wash out time is too short in switching from fluoxetine to an MAOI, what happens?

83. Wash Out – Insufficient Ans. Serotonin syndrome.

84. NMS - signs Q. Signs of Neuroleptic Malignant Syndrome?

85. NMS - signs Ans: 1] Hyperthermia 2] Rigidity There are an assortment of lesser signs

86. NMS – lab findings Q. Prominent lab finding?

87. NMS – lab findings Ans. Creatine kinase elevation is most commonly the one focused on.

88. NMS - treatment Q. Treatment?

89. NMS - treatment Ans. 1] DC medication. 2] Consider ICU for extreme findings. 3] Meds used: bromocriptine amantadine dantrolene 4] ECT is an effective option

90. Isotretinoin Side Effects Q. List psychiatric side effects of isotretinoin [accutane], a med used for acne.

91. Isotretinoin Side Effects Ans. Depression, psychosis, and suicidal thoughts

92. Nortriptyline dosing Q. What is dosing of nortriptyline?

93. Nortriptyline dosing Ans. Initial 10-25 hs Increase 25 mg/3-7 days Usually: 75 – 150 mg/d Max 300 mg/d

94. Haloperidol and Antihypertensive Meds Q. Pt is on antihypertensive meds. Giving haloperidol results in?

95. Haloperidol and Antihypertensive Meds Ans. May increase the effects of effects of antihypertensive meds except quanethidine which haloperidol may antagonize, thus lower effect.

96. Triazolam Side Effects Q. Side effects of triazolam [Halcyon].

97. Triazolam Side Effects Ans. Next day: Ataxia Amnesia Daytime sedation

98. Clonidine – Off label Q. What are some psychiatric conditions clonidine is recommended even though off-label?

99. Clonidine – Off Label Ans. ADHD Tourette’s Substance withdrawal PTSD Social Anxiety Disorder Clozapine-induced hypersalivation

100. Flumazenil Q. FDA approved uses of flumazenil?

101. Flumazenil Ans. Reversal of sedative effects of benzodiazepines

102. Memantine Q. Memantine works on which amine system?

103. Memantine Ans. Glutamine

104. Causes Pathological Gambling Q. What medication has been associated with causing pathological gambling?

105. Causes Pathological Gambling Ans. First reports were of pramipexole.

106. Warfarin and SSRIs Q. SSRI given to pt on warfarin?

107. Warfarin and SSRIs Ans. May increase bleeding.

108. Meds for GAD Q. FDA approved for GAD?

109. Meds for GAD Ans. Alprazolam Duloxetine Escitalopram Paroxetine Venlafaxine

110. Seasonal Affective Disorder Q. Med/s approved for SAD?

111. Seasonal Affective Disorder Ans. Bupropion

112. Acamprosate Q. What does acamprosate do?

113. Acamprosate Ans. Normalizes an aberrant glutamate system that may be the basis of protracted withdrawal and early craving.

114. Delirium Caused by Anticholinergic Meds Q. How to treat the delirium named above?

115. Delirium Caused by Anticholinergic Meds Ans. Physostigmine IM

116. Side Effects of Interferon Q. Side effects of interferon?

117. Side Effects of Interferon Ans. Long list but one of following may reach the multiple choice of the question: Depression Flue-like Alopecia

118. FDA Approved for Migraine Headache Q. Meds used in psychiatry that are FDA approved for migraine headache?

119. FDA Approved for Migraine Headache and used in psychiatry Ans. Topiramate Valproate

120. Metabolizes Antidepressants Q. Antidepressants are metabolized by?

121. Metabolizes Antidepressants Ans. Liver’s cytochrome P 450 enzyme system

122. Li and Pregnancy Q. Increase incidence of _____ with Li use in pregnancy

123. Li and Pregnant Ans. Ebstein’s anomaly.

124. Medication Causes Priapism Q. Medication associated with priapism?

125. Medication Causes Priapism Ans. Trazodone

126. Blocking H1 Q. Blocking H1 results in?

127. Blocking H1 Ans. Sedation Weight gain

128. EPS Q. In using typical antipsychotics, EPS is most likely to occur in?

129. EPS Ans. Those who have Parkinson’s disease Adolescents Senior citizens

130. Metabolic Syndrome Q. Signs of metabolic syndrome?

131. Metabolic Syndrome Ans. Abdominal obesity BP up Glucose up Cholesterol up

132. Diabetes Lab Findings Q. Name two lab findings defining diabetes.

133. Diabetes Lab Findings Ans. Glucose >125 HGBA1c <6.5

134. Modafinil Q. Modafinil is FDA approved for?

135. Modafinil Ans. Excessive sleepiness in narcolepsy Obstructive sleep apnea Shift-work sleep disorder

136. Donepezil Q. What class of meds is donepezil

137. Donepezil Ans. Cholinesterase inhibitor.

138. Clonidine Receptor Site Q. What receptor site does clonidine influence?

139. Clonidine Receptor Site Ans. Alpha-2 agonist

140. Antipsychotics Q. High potency typical antipsychotics are less __________ than low potency.

141. Antipsychotics Ans. Sedating/calming

142. Hyperprolactinemia Q. Which antipsychotics have hyperprolactinemia?

143. Hyperprolactinemia Ans. All typical and risperidone.

144. Time Trial Q. Time trial for SSRIs?

145. Time Trial Ans. 6 – 8 weeks

146. Narcolepsy and Cataplexy Q. One med for both?

147. Narcolepsy and Catalepsy Ans. Oxybate [Xyrem]

148. Valproate and Pregnant Q. Valproate is associate with what untoward result in pregnancy?

149. Valproate and Pregnancy Ans. Neural tube

150. Nicotine and Clozapine Q. Nicotine’s impact on clozapine blood levels?

151. Nicotine and Clozapine Ans. Lowers level

152. Nicotine and Li Q. Nicotine’s impact on Li blood levels?

153. Nicotine and Li Ans. Lowers blood level.

154. Benzodiazepines and Pregnancy Q. If mother took benzodiazepines during pregnancy, what will have a higher incidence in the baby?

155. Benzodiazepines and Pregnancy Ans. Floppy babies.

156. FDA and OCD Q. FDA approved for OCD

157. FDA and OCD Ans. Clomipramine Fluoxetine Fluvoxamine Paroxetine Sertraline

158. Inhibitor and Excitatory Q. Chief inhibitor and chief excitatory substance in the brain?

159. Inhibitory and Excitatory Ans. GABA is chief inhibitory. Glutamate is chief excitatory