Pick my meds
Rounded to the nearest 100,000, at its peak in the mid-1950s, roughly how many psychiatric inpatient beds existed in U.S. state hospitals?
~560,000
500k or 600k is acceptable
Today, it is 37,000.
Lithium can caused increased levels of ___ , which can be measured on a BMP or CMP.
Calcium (hyperparathyroidism and hypercalcemia)
(Creatinine and BUN are acceptable answers)
What 1952 drug is credited as the first true antipsychotic, sparking the deinstitutionalization movement that emptied state hospitals?
Chlorpromazine (Thorazine)
Johnson & Johnson paid $2.2 billion in 2013 to settle claims it illegally marketed an antipsychotic to children and the elderly — including for a side effect that causes abnormal breast growth in boys.
What was the name of that antipsychotic?
Risperidone
In 2019, a single teen won a jury verdict for 8 billion dollars for developing breast tissue. It was slashed on appeal down to 6.8 million.
The 1994 memoir that turned an SSRI into a household name and a cultural buzzword was called ___ Nation.
Prozac Nation
Rounded to the nearest 500, what is the cost of a 1-month prescription of Caplyta without insurance? (with goodrx coupon)
$1500-2000
Lithium most commonly causes what kidney disease?
nephrogenic diabetes insipidus
Technically more correct: chronic tubulointerstitial nephropathy (aka chronic lithium nephropathy) = gradual scarring of the kidney's structural tissues and tubules and can lead to CKD/ESRD
Which mood stabilizer has LOW teratogenic risk?
Lamotrigine
What is the most expensive SSRI on the market?
Vortioxetine (Trintellix) at $500 per month
Prozac is the cheapest at $5 per month
Which SSRI has the highest QTc effect?
Citalopram (also escitalopram but a bit less)
The Rolling Stones' 1966 song "Mother's Little Helper" satirized the mass tranquilizing of American housewives. What benzodiazepine is it most popularly associated with?
President JFK was famous for taking this.
Valium (diazepam)
though some music historians argue the timeline better fits Miltown (meprobamate), since Valium was brand new in '66.
Your patient's clozapine level comes back at 1174. Risk for what concerning symptom is especially elevated at this level?
Seizure!
(other major risks include sedation, AMS/delirium, anticholinergic effects, hypotension)
Lithium use during pregnancy can result in what congenital malformation?
Epstein's Anomoly (tricuspid valve is displaced downward into the right ventricle and its leaflets are malformed)
What is the most popular mood stabilizer IN THE UNITED STATES with over 10 million prescriptions annually?
Lamotrigine
Lithium is the most worldwide.
Lamotrigine has narrow side effect profile, no lab monitoring, is affordable, and has many off-label uses (depression, migraines, chronic pain).
A QTc greater than ___ is considered prolonged?
450ms (men), 460ms (women)
The most commonly prescribed antipsychotic in the US, Canada, and Europe?
(or bonus question, in Japan)
Seroquel (28% of all antipsychotic prescriptions in the US)
Abilify in Japan due to strict regulations around metabolic side effects.
Abilify is the 2nd most common worldwide.
Rounded to the nearest 5%, what percent of patients taking lithium long-term develop clinically significant hyperthyroidism?
15-20%
(Though 30% may develop subclinical hypothyroidism)
Name one of the antipsychotics with HIGH teratogenic risk.
Risperidone, Olanzapine, Abilify
During her 2021 conservatorship testimony, Britney Spears said she was forced onto which classic mood stabilizer — one that, coincidentally, used to be a soft drink ingredient?
Lithium
Name ONE of the antipsychotics that has the LEAST amount of QTc prolongation?
Aripiprazole, brexpiprazole, cariprazine, and lurasidone
Abilify actually is associated with shorter QTc in some trials
Your patient wants to take an antipsychotic with very low QTc risk. They are VERY concerned about metabolic side effects. They eat sporadically, sometimes fasting for days. They are uninsured and cannot afford a new-to-market antipsychotic.
Which antipsychotic should they use?
Abilify
-Latuda must be taken with food
-Cariprazine (Vraylar), brexpiprazole (Rexulti) is expensive
Your patient who has been taking high-dose depakote decided to start taking their old lamotrigine "just for fun." They now present with extreme lethargy and altered mental status. What blood product is likely elevated?
Ammonia
valproate-induced hyperammonemic encephalopathy can occur even with normal LFTs
Which SSRI has the highest teratogenic risk?
Paroxetine
Your patient recently immigrated from Thailand and has agreed to start Oxcarbazepine. What special test should you consider ordering?
HLA-B*1502 genotype testing
(strong association with SJS/toxic epidermal necrolysis)
Which atypical antipsychotic got Eli Lilly hit with the largest single corporate criminal fine in U.S. history at the time — $1.415 billion in 2009 — for marketing it off-label to treat dementia in nursing home patients?
Zyprexa
The internal marketing campaign was called "Viva Zyprexa!"