Final exam part 2

Question 1

FDA approved for panic disorder

Answer 1

Alprazolam (Xanax)
paroxetine (Paxil)
clonazepam
fluoxetine
sertraline

Question 2

First-line meds for OCD

Answer 2

fluoxetine
fluovxamine
sertraline
paroxetine

Question 3

First-line meds for PTSD

Answer 3

Sertraline (Zoloft)

paroxetine (Paxil)

Question 4

Medication for nightmares

Answer 4

Prazosin

Question 5

key neurotransmitter in anxiety

Answer 5

GABA - deficit
serotonin
norepinephrine

Question 6

FDA approved for GAD

Answer 6

Alprazolam (Xanax)
duloxetine (cymbalta)
escitalopram (Lexapro)
paroxetine (Paxil)
venlafaxine (Effexor)

Question 7

alternative to benzos for anxiety

Answer 7

Gabapentin

Lyrica

Question 8

Good for performance axiety

Answer 8

beta blockers (propanolol)

Question 9

manic episodes with or without psychosis and/or major depression

Answer 9

Bipolar I

Question 10

hypomanic episode with major depression; no history of manic or mixed episodes

Answer 10

Bipolar II

Question 11

Cyclothymia

Answer 11

hypomania and depressive symptoms that do not meet criteria for bipolar for at least 2 years- no major depressive episodes

Question 12

Lithium therapeutic level

Answer 12

0.5-1.5 mEq/L

Question 13

Pregnancy considerations for lithium

Answer 13

excretion increases during pregnancy but decreases after delivery
excreted in breast milk

Question 14

Meds that increase lithium levels

Answer 14

NSAIDs
Thiazide diuretics
ACE inhibitors
Metronidazole

Question 15

signs of lithium toxicity

Answer 15

Mild: vomiting, dizziness, slurred speech, ataxia
Moderate: Anorexia, blurred vision, convulsions, delirium
Severe: Convulsions, renal failure, oliguria

Question 16

litium toxicity levels

Answer 16

Mild: 1.5-2.0
Moderate: 2.0-2.5
Severe: >2.5

Question 17

Management of lithium toxicity

Answer 17

Mild: Contact provider, go to ER
D/C lithium, lithium levels, CMP, Renal function, EKG
Severe: Emesis, GI lavage, activated charcoal, hemodialysis (>4)

Question 18

patient education with lithium

Answer 18

last dose should be 12 hours before lab draw
no sudden changes in diet or fluid
caffeine and alcohol lower serum concentrations
vigorous exercise may affect lithium levels

Question 19

therapeutic depakote level

Answer 19

50-100 mcg/mL

Question 20

Lamictal side effects

Answer 20

dizziness, ataxia, headaches, blurred vision, rash

Question 21

lamictal and depakote

Answer 21

depakote doubles lamictal concentration

Question 22

Important dosing information about lamictal

Answer 22

escalate slowly to BID starting at 25 mg/day for two weeks, double every two weeks until 200 mg/day

take with or without food

Question 23

Tegretol important factor

Answer 23

Lots of D2D interactions (CYP450 inducer)

Decreases concentration of several drugs including birth control

Question 24

What medications to avoid with treatment of bipolar

Answer 24

antidepressants

symbyax is the exception - olanzapine/fluoxetine

Question 25

first line treatment for pregnant bipolar

Answer 25

antipsychotic

Question 26

best mood stabilizer for pregnancy (only if antipsychotic is not tolerated)

Answer 26

Lithium

Question 27

Tegretol therapeutic level

Answer 27

4-12 mcg/mL

Question 28

lamotrigine and birth control

Answer 28

birth control may decrease Lamictal concentration