Antipsychotics
This antipsychotic is often used off-label for bipolar depression and is a good choice for minimizing risk of weight gain and metabolic side effects, but beware of akathisia! What is the medication?
Aripiprazole (Abilify)
This medication is a good choice for maintenance treatment of bipolar disorder, especially to prevent depressive episodes. Its main disadvantage is the very slow titration schedule recommended to decrease the risk of a life threatening skin rash. What is the medication?
Lamotrigine (Lamictal)
A group of anxiolytics that act on GABA receptors are known to be controlled substances, which category of controlled substance?
Schedule IV (benzos)
This medication is particularly useful for individuals whose depression is associated with fatigue and poor concentration. Absence of sexual side effects and weight gain make this an appealing option for many depressed patients. The seizure risk is not a concern for most patients when dosed appropriately. What is the MOA?
Dopamine and norepinephrine receptor uptake inhibitor (Wellbutrin/Bupropion)
This ADHD medication carries no abuse potential, causes less insomnia and anxiety, and is unlikely to worsen tics but it is generally less effective than stimulants, and takes longer to work (2–4 weeks). What is the MOA of this medication?
Selective norepinephrine reuptake inhibitor (Atomoxetine/Straterra)
Along with paliperidone, this antipsychotic (metabolized by CYP2D6) causes the most EPS and hyperprolactinemia of all the atypicals, what is the medication?
Risperdal
This medication is not considered a first-line treatment for bipolar disorder due to its side effect profile (including hematologic abnormalities including agranulocytosis, aplastic anemia, neutropenia, leukopenia, thrombocytopenia, and pancytopenia) and it is metabolized primarily through CYP3A4 and it also induces its own metabolism within 2–4 weeks and then stabilizes. What is this medication?
Carbamazepine (Tegretrol)
Anxiolytics that act on GABA receptors have a serious life threatening side effect if used in patients with sleep apnea, what is the side effect?
Respiratory Depression (Benzos)
An underweight, elderly depressed cancer patient was started on this medication for depression. Patient had too much sedation at the initial lower dose, and the dose was increased because this medication has increased noradrenergic effect relative to antihistaminergic effect at higher doses. What is the medication?
Mirtazipine (Remeron)
This medication for ADHD has advantages over stimulants include no worsening of tic disorders, lack of abuse potential, and no insomnia. However, its delayed onset of effect (2–4 weeks) and lower efficacy rates make it a second-line choice for ADHD generally. What should be monitored during the initial titration of this medication?
Blood pressure (Guanfacine; Centrally-acting, selective alpha-2 adrenergic agonist)
This antipsychotic which has good efficacy in acute schizophrenia and bipolar mania, low risk of QTc interval prolongation, high risk of weight gain causes a serious but rare potentially fatal drug reaction that often starts as rash that may spread, fever, swollen lymph nodes, and elevated type of white blood cell. What is this drug reaction (must include the entire name)?
DRESS: Drug reaction with eosinophilia and systemic symptoms
(Olanzapine/Zyprexa is the medication)
This medication used for bipolar disorder can cause clinically significant hyponatremia and patients of Asian descent should be screened for the variant HLA?B*1502 allele prior to starting this medication. This variant may increase risk of developing what life threatening side effect?
Stevens-Johnson syndrome and/or toxic epidermal necrolysis (Medication is oxcarbazepine/trileptal)
This anxiolytic is non-sedating, non-habit-forming alternative to benzodiazepines for anxiety, metabolized primarily through CYP3A4, t ½: 2–3 hours and requires 1–2 weeks for onset of therapeutic effects, with full effects occurring over several weeks . What is the MOA? (must name receptors)
serotonin 5-HT1A receptor partial agonist (buspar/buspirone)
This medication is somewhat more effective than SSRIs for depression but its side effect disadvantages, such as blood pressure elevation and discontinuation symptoms, relegate it to second-line use. No additional benefit seen with doses >225 mg/day in moderately depressed outpatients, but patients with more severe depression may respond to higher doses (350 mg/day). What is the MOA of this medication?
Serotonin and norepinephrine reuptake inhibitor
Venlafaxine (Effexor)
This medication (approved uses included ADHD and narcolepsy; off label uses include treatment resistance depression) has better side effect profile and somewhat lower abuse potential than amphetamines. It undergoes hepatic metabolism via carboxylesterase CES1A1, not CYP450. What is the MOA of this medication?
Stimulant that inhibits reuptake of dopamine and norepinephrine.
Methylphenidate (Methylin, Ritalin)
This medication offers some advantages, including no need for titration, once-daily dosing, relatively low-moderate metabolic profile, and relatively low QTc prolongation risk. However, its use is limited by the need to administer with ≥350 calories of food (which increases bioavailability 2-fold and peak serum levels roughly 3-fold). What is the medication?
Lurasidone (Latuda)
This medication is the go-to agent for acute manic episodes, featuring faster onset of response and efficacy for rapid cycling and relapse prevention. However, if a patient develop GI symptoms after starting this medication (abdominal pain, n/v), you should be considering what two black box warnings for this medication?
Liver damage and pancreatitis (Medication is Depakote)
This anxiolytic, which is effective and safe for use in performance anxiety, is also used off-label to treat a movement disorder. What is the movement disorder?
Akathisia (medication: propanolol)
Which three SSRIs are most likely to cause clinically significant P450 interactions?
Fluoxetine, fluvoxamine, and paroxetine
This medication is approved for treating excessive sleepiness associated with obstructive sleep apnea, narcolepsy, or shift-work disorder, but many people end up using it off-label for lifestyle enhancement, such as working, studying, and partying. It is a dopamine reuptake inhibitor and a schedule IV controlled substance. What is the medication?
Modafinil (Provigil)
How would you dose Clozaril to a target dose of (max dosage) and go with dosage criteria for outpatient setting. (will give partial points on this one if you get max dosage answer, and target dosage criteria)
Start 12.5 mg once or twice daily; ↑ gradually, in increments of 25 mg– 50 mg/day to target dose 300 mg–450 mg/day by end of 2 weeks; may ↑ further in increments ≤100 mg and no more frequently than once or twice weekly. Max 900 mg/day (usually in 2–3 divided doses). May take 4–6 weeks, or as long as 3–6 months, for response.
What are the 5 things to monitor prior to and during using Lithium ? (must get all 5 to get points)
1.) Lithium level
2.) TSH
3.) BUN/creatinine
4.) pregnancy test
5.) ECG if cardiac disease
This anxiolytic which is also used for post-MI cardioprotection and migraine prophylaxis can also be used for anxiety particularly when the sedating or cognitive side effects of benzos could interfere with an individual’s performance. What is the MOA for this anxiolytic? (must name all receptors and mechanism for points)
Non-selective beta-1 and beta-2 adrenergic receptor antagonist
(medication: propanolol)
This antidepressant's maximum daily dose was reduced to 40 mg/day by the FDA in August 2011 due to data suggesting increased QTc interval prolongation at doses >40 mg/day. What is this medication?
Citalopram (Celexa)
This medication primarily used for insomnia has long been a favored hypnotic for the elderly because of the lack of active metabolites, its short half-life, and absence of drug interactions (no CYP450 involvemnet). This medication starts at 15 mg qhs, with a max dose of 30 mg nightly. Serious side effects include anterograde amnesia, increased fall risk. What is the MOA of this medication?
Binds to benzodiazepine receptors to enhance GABA effect
Temazepam (Restoril)