Random
First line anticholinergic for patient with cirrhosis and polypharmacy with Parkinson disease?
a. Donepezil
B. Galantamine
C. Rivastigmine
D. Memantine
Rivastigmine first choice
-not metab in liver, no sign drug interactions
-only one FDA approved for both AD and PD
Which of the following is true regarding lithium?
A. Decreased suicide rates only
B. Decreased suicide rates and reduced all cause mortality
C. Decreased suicide rates, mortality, and risk of dementia
D. Reduced mood relapse without broader health implications
C
If a patient has this diagnosis they cannot be prescribed Lemborexant. what is that diagnosis?
A. OSA
B. Hypersomnia
C. Insomnia
D. Narcolepsy
E. REM sleep disorder
Narcolepsy (deficient in orexin); These drugs are orexin antagonists
Name two strong CYP2D6 inhibitors
Paxil
Prozac
Which drug is approved for PTSD?
A. Lexapro
B. Prozac
C. Zoloft
D. Paxil
E. None of the above
D
Which anticholinergic should be completely avoided in patients with liver or kidney disease?
A. Donepezil
B. Galantamine
C. Rivastigmine
D. Memantine
Galantamine
2D6 and 3A4
AD (mild to moderate only)
A patient with bipolar disorder on unknown medication comes in with 2 weeks of new fatigue and easy bruising. She has scattered ecchymosis on her arms. Labs show thrombocytopenia. Which drug is responsible and BONUS what is the next step in tx if this happens?
A. Lithium
B. Carbamazepine
C. Lamictal
D. Depakote
E. Seroquel
Depakote
stop the medication and switch to a different agent
thrombocytopenia is dose dependent risk with VPA
What drug is FDA approved for agitation in the setting of Alzheimer Disease?
A. Risperdal
B. Seroquel
C. Pimavanserin (Nuplazid)
D. Brexpiprazole (rexulti)
E. Cariprazine (Vraylar)
D- Brexpiprazole
Use Pimavanserin for Lewy body disease psychosis given its mechanism as a selective serotonin 5-HT2A receptor inverse agonist, which does not exacerbate Parkinsonism.
Which drug below is associated with elevated QTc?
A. Celexa
B. Wellbutrin
C. Mirtazapine
D. Fluoxetine
E. Sertraline
A
risk is higher past 40mg
What mood stabilizer has the highest risk of causing PCOS?
A. Carb
B. VPA
C. Lithium
D. Topamax
E. Lamictal
VPA
Which drug is least likely to prolong QTc?
A. Lexapro
B. Celexa
C. Wellbutrin
D. Amitriptyline
E. Zyprexa
Wellbutrin
Someone on Lithium comes into the office with course tremor, nausea/vomiting, gait ataxia, and slurred speech. What do you do?
A. Continue lithium and recheck level in one week
B. Reduce caffeine intake and continue same dose
C. Stop lithium and check level urgently
D. Switch from IR to ER form
stop lithium and check level
EXTRA POINTS- 100 points for each one named
Name all CYP3A4 inducers (5) plus the one major CYP1A2 inducer
Rifampin, Carbamazepine, Phenytoin, Phenobarbital, St John's Wort
Cigarette smoke (polycyclic aromatic hydrocarbons)- clozapine, carb, ambien, zyprexa all substrates of 1A2