Sleep Disorders
Brand name for pitolisant?
Wakix
Which three drugs are used to treat absence seizures?
-Valproic acid, Ethosuximide, lamotrigine
Which otc formulation provides more nicotine- lozenge or gum?
Lozenge
Which of the following are motor symptoms of PD?
a. Dysphagia
b. Confusion
c. Sialorrhea
d. Constipation
a. Dysphagia
What are the two types of SE, and which one is more severe?
convulsive and non-convulsive(higher mortality)
List all of the wakefulness promoters
histamine, acetylcholine, orexin, serotonin, dopamine, norepi
24 year old male presents to the ED after being in a motor vehicle accident. Tests are performed and patient has a GCS of 13 with a CT scan showing a skull fracture. Is the patient a candidate for seizure prophylaxis, and if so what would you use?
Phenytoin or levetiracetam
Calculate a pack year for a patient who smokes 12 cigarettes a day for 32 years
19.2
For end of dose wearing off what could you do to help manage the motor complications?
a. Add COMT inhibitor
b. Avoid ER formulation
c. Give on a empty stomach
d. Add amantidine
a. Add COMT inhibitor
Which benzodiazepine would you give if you don't have IV access
a. Ativan
b. Versed
c. Valium
b. versed
Patient presents to the clinic with a chief complaint of some left leg discomfort, that gets worse at night and is only lessened by moving their leg. What would be the most appropriate therapy?
a. Pramipexole
b. Sinemet
c. Rotigotine
d. Ramelteon
a. Pramipexole
Patient is taking phenytoin 100mg a day and has a blood serum concentration of 0.8 (ideal range 1.0-2.0), physician decides to double her dose to 200mg daily. If the patent has low albumin what would you expect to happen?
a. Would expect her new level to be too low as there would be more bound drug
b. Would expect her new level to be too low due to a greater amount getting metabolized
c. Would expect her new level to be too high due to more free albumin
d. Would expect her level to be within theraputic range
c. Would expect her new level to be too high due to more free albumin
Which drug is likely to have a decreased effect in someone who smokes?
a. Hydroxycholorquine
b. Hydrocortisone
c. Hydralazine
d. Haloperidol
d. haloperidol
For peak dose dyskinesia what could you do to help manage the motor complications?
a. Add apomorphine
b. Use ODT formulation
c. Provide smaller doses of sinemet
d. Avoid ER formulations
c. Provide smaller doses of sinemet
Why don't we give phenytoin as an IV?
can cause phlebitis and tissue injury with extravasation and arrythmias
What medication can be used for sleep maintenance?
a.Triazolam
b. Temazepam
c. Ambien
d. Flurazepam
b. Temazepam
Patient is recently starting on dual therapy lamotrigine and carbamazepine after being on mono carbamazepine therapy. How should you titrate the starting dose of lamotrigine?
a. normal starting dose
b. decrease the dose by half
c. Double the starting dose
d. only use immediate release dosage form
c. Double the starting dose
When should you take chantix based on the quit date?
1 week before
or
8-35 days/gradual dose tapered approach
For non motor complications such as REM sleep disorder what medication would your recommend for initial treatment?
a. clonidine
b. Clozapine
c. clonazepam
d. Ramelteon
c. clonazepam
How do you define SE?
Seizure lasting more than 5 min
Patient presents to the clinic and has episodic loss of voluntary muscle tone when falling asleep/waking with sudden bilateral loss of muscle tone. What therapy would be most appropriate?
a. Provigil
b. Belsomra
c. Wakix
d. Trazodone
c. Wakix
Patient presents to the ED and diagnosed with having a partial seizure. Patient has been screened and does have the HLA-B gene. Additionally they have a past medical history of alcoholic cirrhosis. Which drug therapy would you recommend?
a. zonisamide
b. topiramate
c. carbamazepine
d. valproic acid
d.
a. zonisamide
Patient presents to your clinic motivated to stop smoking and are looking at otc items. They've been smoking a pack a day for the last 8 years, and when they wake up in the morning they'll usually smoke within the first 15 min. Patient states they are getting a crown put in soon. What is the most appropriate starting dose and formulation.
a. Nicoderm 14mg
b. Nicoderm 21mg
c. Nicoderm 4 mg
d. Nicorette 4mg
e. Nicorette 2mg
b. Nicoderm 21mg
48 year old female diagnosed with PD is exhibiting signs of rigidity and slowed movement. What would be the best initial therapy?
a. Carbidopa/Levodopa
b. Rasagiline
c. Entecapone
d. Pramipexole
d. Pramipexole
32 year old female is present in the ED for seizures. Patient was given ativan and valproic acid but despite these interventions has been seizing for 40 min. She has a HR of 65 and a BP of 82/60. Should she be given refractory treatment and if so what?
a. No treatment necessary at this time
b. propofol
c. pentobarbital
d. midazolam
d. midazolam