Lange - Drugs 1

Question 0

Patient presents with MAOIs overdose. General Management? If patient develops delirium? If patient develops ventricular arrhythmias? If patient develops seizures?

Answer 0

Supportive

Lorazepam if delirious

Lidocaine

Phenytoin

Question 1

Only two nonselective MAOIs?

Answer 1

Phenelzine

Tranylcypromine

Question 2

If patient taking this drug is in pain, do not give the meperidine?

Answer 2

MAOI or SSRI

Question 3

Patient with a typical depressive features. Atypical features respond best to which drug class?

Answer 3

MAOIs

Question 4

Patient in alcohol withdrawal. Suspected liver damage. Appropriate benzodiazepine treatment?

Answer 4

Lorazepam or oxazepam

Question 5

Patient started on neuroleptic develops akathisia. Management?

Answer 5

#Reduce neuroleptic dose as much as possible 
# propranolol
#Benztropine to manage extrapyramidal symptoms

Question 6

The most common serious complication of an NMS? Management?

Answer 6

Rhabdomyolysis

Dialysis

Question 7

Retinal pigmentation is known to occur with which drug? Can progress to? Benefit of stopping the drug?

Answer 7

Thioridazine

Blindness

May remit

Question 8

Minimum initial laboratory studies required before starting Li?

Answer 8

#BMP (Creatinine, BUN)
#Urinalysis
#TSH

Question 9

Most common side effects of methylphenidate? Porentially permanent side effect?

Answer 9

#Insomnia
#Increased in systolic blood pressure

Slow growth

Question 10

Class of drugs that may exacerbate the tics associated with Tourette’s disorder?

Answer 10

Stimulants

Question 11

Patient with Tourette’s disorder. Receptor modulation that would provide the most relief?

Drugs that do this?

Answer 11

D2 receptor antagonism

Haldoperidol and Pimozide

Question 12

Meige syndrome?

Answer 12

Oral facial dystonia involving blinking and chin thrusting and sometimes lip pursing or tongue movements

Question 13

Drugs to treat borderline personality disorder?

Answer 13

#Fluoxetine for impulsiveness and affective instability
#Antisychotics for impulsiveness and psychotic thinking

Question 14

Patient with bulimia – start them on this specific drug?

Answer 14

Fluoxetine

Question 15

Symptoms of SSRI discontinuation syndrome?

Answer 15

#Flulike symptoms
#Dizziness
#Nausea and vomiting
#Anxiety, irritability

Question 16

SSRI discontinuation syndrome – which specific drug is most likely to cause this?

Answer 16

Paroxetine (short half-life and no active metabolite)

Question 17

Mechanism of action of trazodone?

Answer 17

Week reuptake inhibition and antagonist of serotonin 1A, 1C, 2

Question 18

EKG changes due to lithium - most common? Rare? Changes in toxicity?

Answer 18

T-wave flattening or inversion

Sinus node dysfunction or first-degree AV block

#AV dissociation (Bradyarrhythmia)
#Ventricular tachycardia or ventricular fibrillation

Question 19

Patient on a thiazide diuretics is prescribed lithium - problem?

Other drugs that can do this?

Answer 19

Verizon diuretics can increase lithium levels

#NSAIDs
#Spironolactone
#Metronidazole and tetracyclines
#ACE inhibitors

Question 20

Best specific drug to use in OCD?

Answer 20

Clomipramine > SSRIs

Question 21

Mirtazapine – mechanism of action?

Answer 21

#Central alpha-2 antagonist (enhanced serotonin release)
#Serotonin 2/3 antagonist
#Histamine antagonist

Question 22

Treatment for refractory OCD?

Answer 22

Cingulotomy

Question 23

Patient with command auditory hallucinations – when to begin a trial of clozapine?

Answer 23

Failure of
#2 typical antipsychotics 
#1 atypical