Lecture 9-Neuropsychiatric Medications Flashcards
Status epilepticus first phase = ___-___ minutes; ___ is treatment of choice
status epilepticus first phase = 5-20 minutes; benzo is treatment of choice (i.e.: versed, Ativan, valium)
Status epilepticus second phase = ___-___ minutes; there ___ (is/is no) evidence based first choice; may use ___, ___, or ___
status epilepticus second phase = 20-40 minutes; there is no evidence based first choice; may use fosphenytoin, valproic acid, or keppra
Status epilepticus third phase = ___-___ minutes; can repeat any ___ (first/second) line therapy; ___ doses of thiopental, midazolam, pentobarbital, or propofol
status epilepticus third phase = 40-60 minutes; can repeat any second line therapy; anesthetic doses of thiopental, midazolam, pentobarbital, or propofol
Anticonvulsant medications are only approved to treat seizures–T/F?
False–there are several approved/unapproved indications
i.e.: neuropathic pain, mood stabilization, migraines, alcohol dependence
Anticonvulsants MOA–___ channel blockade, ___ channel blockade
sodium channel blockade, calcium channel blockade
Anticonvulsants calcium channel blockade–particularly the ___-type channels located in the ___ which act as ‘pacemakers’ of normal rhythmic brain function
Anticonvulsants calcium channel blockade–particularly the T-type channels located in the thalamus which act as ‘pacemakers’ of normal rhythmic brain function
Anticonvulsants other MOAs–GABA ___ (enhancers/inhibitors); glutamate ___ (enhancers/blockers); carbonic anhydrase ___ (enhancers/inhibitors); ___ hormones; synaptic vesicle protein ___
GABA enhancers [remember GABA is inhibitory]; glutamate blockers [remember glutamate is excitatory]; carbonic anhydrase inhibitors; sex hormones; synaptic vesicle protein 2A (SV2A)
Anticonvulsant medications–carbamazepine, oxcarbazepine, eslicarbazepine, phenytoin/fosphenytoin, lamotrigine, zonisamide, lacosamide, and cenobamate are all ___ channel blockers
all sodium channel blockers
Carbamazepine multiple uses–___ and ___ seizures; mood ___; ___ pain; ___ neuralgia
partial and generalized seizures; mood stabilizer; neuropathic pain; trigeminal neuralgia
Carbamazepine ___ (induces/inhibits) its own metabolism
Carbamazepine induces its own metabolism
Carbamazepine is a CYP3A4 ___ (inducer/inhibitor)
Carbamazepine is a CYP3A4 inducer
What is the most important thing to consider about carbamazepine?
Drug interactions–because it is a CYP inducer/substrate, it ramps up the metabolism of other drugs and itself, clears medications from the bloodstream faster, and shortens the duration of action of other drugs
Carbamazepine side effects–___ea, ___ syndrome, ___ (increased/decreased) LFTs, ___natremia
nausea, Stevens-Johnson syndrome, increased LFTs, hyponatremia
If patient is on carbamazepine, check ___ levels
sodium levels
Why was oxcarbazepine created?–to eliminate the auto-___ of carbamazepine
to eliminate the auto-induction of carbamazepine
As a person takes carbamazepine for a longer period of time, it loses its effectiveness because it’s an inducer and substrate–T/F?
True
Eslicarbazepine is a ___drug
prodrug –> S-licarbazepine
If patient has renal impairment, you need to adjust the dose of eslicarbazepine–T/F?
True
Main concerns for the -carbazepine anticonvulsants–check ___ levels, check for drug ___, check ___/___s
check sodium levels, check for drug interactions, check CBC/LFTs
Most common side effects with eslicarbazepine (> 10%)–___ness, ___lence, ___ea, ___ache, ___opia
dizziness, somnolence, nausea, headache, diplopia
Phenytoin is a ___ channel blocker; has ___ (linear/non-linear) pharmacokinetics; CYP enzyme ___ and ___
Phenytoin is a sodium channel blocker; has non-linear pharmacokinetics; CYP inducer and substrate
What is the therapeutic range for phenytoin?
10-20
Dose adjustments for phenytoin are ___ (small/large)
Small because it has non-linear pharmacokinetics
Example: Patient is on 300 mg phenytoin. You check a level and it comes back at 5. You increase the dose to 300 mg bid. You re-check the level and it is 28, and patient is dizzy, nauseous, and having vision changes. You may just add 30-50 mg at a time to get to desired therapeutic levels for phenytoin.
Fosphenytoin = ___drug for ___ (oral/parenteral) administration
prodrug for parenteral administration
Fosphenytoin is safer, better tolerated, and can run at faster infusion rates than phenytoin–T/F?
True
Side effects of phenytoin/fosphenytoin–gingival ___plasia; ___mias, CV ___, ___tension mostly at toxic levels; ___mus; vitamin ___ and ___ deficiencies; if given during pregnancy–cleft ___/___, congenital ___ disease, slowed ___ rate, mental ___
Side effects of phenytoin/fosphenytoin–gingival hyperplasia; arrhythmias, CV depression, hypotension mostly at toxic levels; nystagmus; vitamin K and folate deficiencies; if given during pregnancy–cleft lip/palate, congenital heart disease, slowed growth rate, mental deficiency
Lamotrigine is a ___ channel blocker
sodium channel blocker
If patient is on depakote/lamictal and stops taking both prior to surgery, if they are both not restarted in 3-4 days and you have to reinitiate, there is a long cross-taper period of 4-8 weeks where you can only make minor incremental increases in the dosages–T/F?
True
What happens if you reinitiate a person’s regular doses of depakote/lamictal after having stopped both drugs for 3-4 days or more?
Steven Johnsons syndrome–very high rates, can cause devastating skin reactions
Lamotrigine drug interaction with depakote = high risk of ___
high risk of SJS
Zonisamide side effects–can cause renal ___ in 1.5% of patients
can cause renal stones in 1.5% of patients
Lacosamide (Vimpat) has a ___ (low/high) side effect profile; pregnancy category ___
Lacosamide has a low side effect profile; pregnancy category C–still unsure of what the true risk is in pregnancy
Benzodiazepines should be restarted as soon as possible if held before/after a surgical procedure to avoid withdrawal–T/F?
True–continue Benzos as long as possible, restart ASAP
Higher lipophilicity for benzos = ___ (slower/faster) onset of action, ___ (shorter/longer) duration of action
higher lipophilicity for benzos = faster onset of action, longer duration of action
i.e.: diazepam (Valium), clonazepam (Klonopin)
Lower lipophilicity for benzos = ___ (slower/faster) onset of action, ___ (shorter/longer) duration of action
lower lipophilicity for benzos = slower onset of action, shorter duration of action
i.e.: alprazolam (xanax), temazepam (restoril)
Which benzodiazepine is only used for seizures and is not appropriate to use for anxiety/sleep? If this medication is discontinued, it needs to be restarted ASAP otherwise patient will experience wild withdrawal symptoms and will start seizing really quick. This medication has a long taper if you want to get a person off of it.
Clobazam (Onfi)
Primidone is a prodrug that is metabolized to ___
Primidone is a prodrug metabolized to phenobarbital
Vigabatrin has a risk of permanent ___, and for this reason is only available through a very specific program with REMS monitoring
Vigabatrin has a risk of permanent vision loss, and for this reason is only available through a very specific program with REMS monitoring
Gabapentin is more often used for ___ than ___ control
Gabapentin is more often used for neuropathic pain than seizure control
Gabapentin ___ (is/is not) protein bound, ___ (is/is not) metabolized, is excreted completely ___ (changed/unchanged) by the ___, ___ (has/has no) PK drug interactions
Gabapentin is not protein bound, is not metabolized, is excreted completely unchanged by the kidneys, has no PK drug interactions
A meta analysis of RCTs suggests that gabapentin given 1x 30 minutes pre-operatively in regional anesthesia for multiple procedures ___ (improves/worsens) post-op pain and ___ (increases/reduces) opiate requirements with increased post op ___ being the highest safety risk
A meta analysis of RCTs suggests that gabapentin given 1x 30 minutes pre-operatively in regional anesthesia for multiple procedures improves post-op pain and reduces opiate requirements with increased post op sedation being the highest safety risk
You may see increased side effects of gabapentin in patients with poor kidney function–T/F?
True–because it is completely eliminated by the kidneys
Gabapentin is very well tolerated–T/F?
True
December 2019 FDA safety communication–gabapentinoids in combo with opiates may lead to severe ___ distress
gabapentinoids in combo with opiates may lead to severe respiratory distress
Pregabalin main use is in ___, but also may be used to treat ___ and ___
Pregabalin main use is in neuropathy, but also may be used to treat seizures and anxiety
Lots of people taking pregabalin complain of difficulty ___
Lots of people taking pregabalin complain of difficulty walking
Valproic acid drug interactions occur through ___ (stimulation/inhibition) of oxidation and glucuronidation pathways
Valproic acid drug interactions occur through inhibition of oxidation and glucuronidation pathways
In utero exposure to valproic acid leads to lower ___ in children compared to other anti-epileptics
In utero exposure to valproic acid leads to lower IQ in children compared to other anti-epileptics
Valproic acid is pregnancy category ___-___
Valproic acid is pregnancy category D-X
Valproic acid may cause ___penia
thrombocytopenia–just like carbamazepine family, heparin, H2 receptor antagonists, SSRIs
Valproic acid may cause ___ammonemia
Valproic acid may cause hyperammonemia
If someone is on depakote and becomes confused, what should you do?
Check ammonia level because depakote increases ammonia levels
What labs should be routinely checked if patient is on valproic acid?
Ammonia, LFTs, CBC
If patient is pregnant and in status epilepticus, you can give valproic acid–T/F?
False–never use depakote in pregnancy, even if patient is in status epilepticus
What are (3) glutamate blockers?–___bamate, ___ramate, ___ampanel
Felbamate (felbatol), topiramate (topamax), perampanel (fycompa)
Felbamate (felbatol) is very rarely used in the US because it has high risk of ___ anemia and fatal ___ failure
Felbamate (felbatol) is very rarely used in the US because it has high risk of aplastic anemia and fatal hepatic failure
What is one common side effect of topiramate (topamax)? ___ slowing
Psychomotor slowing–want to do something, but can’t make it happen
Perampanel black box warning–serious or life threatening ___ and ___ adverse effects
Perampanel black box warning–serious or life threatening psychiatric and behavioral adverse effects–aggression, hostility, irritability, anger, homicidal ideation, threats
Common side effect of perampanel (in 43% of patients) = ___
dizziness
Levetiracetam MOA is possibly related to synaptic vesicle protein ___, which appears to be important for the availability of __-dependent neurotransmitter vesicles ready to release their content
Levetiracetam MOA is possibly related to synaptic vesicle protein 2A, which appears to be important for the availability of calcium-dependent neurotransmitter vesicles ready to release their content
Keppra–without SV2A, reduced action potential-___ (independent/dependent) neurotransmission, while action potential-___ (independent/dependent) neurotransmission remains normal
Keppra–without SV2A, reduced action-potential dependent neurotransmission, while action potential-independent neurotransmission remains normal
Keppra also inhibits ___ release from IP3-sensitive stores
Keppra also inhibits calcium release from IP3-sensitive stores
A significant side effect of keppra is ___ impairment
A significant side effect of keppra is cognitive impairment–have a convo and don’t even remember having it
Baclofen is a ___ analog
Baclofen is a GABA analog
Substance ___ is released in response to pain impulses
Substance P is released in response to pain impulses
How does baclofen work?–it inhibits substance ___ release into the spinal cord to reduce pain
Baclofen inhibits substance P release into the spinal cord to reduce pain
Baclofen is primarily used to treat muscle ___
Baclofen is primarily used to treat muscle spasm
If baclofen is abruptly discontinued, patients will experience ___ symptoms–i.e.: ___nations, ___er, ___tation, ___or, ___cardia, ___ure
If baclofen is abruptly discontinued, patients will experience withdrawal symptoms–i.e.: hallucinations, fever, agitation, tremor, tachycardia, seizure
Tizanidine is a centrally acting alpha ___–slows down ___ release using negative feedback
Tizanidine is a centrally acting alpha 2 agonist–slows down NE release using negative feedback
Withdrawal is possible with abrupt discontinuation of tizanidine–T/F?
True
Side effects of tizanidine–___ mouth, ___ation, anti___ effects
Side effects of tizanidine–dry mouth, sedation, anticholinergic effects
Dantrolene blocks ___ channel, reduces ___ release from the ___
Dantrolene blocks ryanodine channel, reduces calcium release from the sarcoplasmic reticulum
___ mutations are associated with malignant hyperthermia
RyR1 mutations are associated with malignant hyperthermia
Dantrolene has dose dependent ___rrhea and ___toxicity (BB warning > ___mg/day with long term use)
Dantrolene has dose dependent diarrhea and hepatotoxicity (BB warning > 800 mg/day with long term use)
Other side effects of dantrolene–___nea, ___phagia, ___lence
Other side effects of dantrolene–dyspnea, dysphagia, somnolence
Skeletal muscle relaxants ___ (should/should not) be used long term
Skeletal muscle relaxants should NOT be used long term due to significant ADRs and increased duration
Skeletal muscle relaxants have risks of ___ sedation and ___
Skeletal muscle relaxants have risks of over sedation and withdrawal
Zolpidem (Ambien), Zaleplon (Sonata), and Eszopiclone (Lunesta) are all ___, AKA ___-drugs
Zolpidem (Ambien), Zaleplon (Sonata), and Eszopiclone (Lunesta) are all sedative hypnotics, AKA Z-drugs
Ramelteon (Rozerem) is a ___ receptor agonist
Ramelteon (Rozarem) is a melatonin receptor agonist
Suvorexant (Belsomra) is a ___ antagonist; is associated with significant sleep ___
Suvorexant (Belsomra) is a norexin 2 antagonist; is associated with significant sleep activities
Our bodies release melatonin naturally every ___-___ hours ___ (before/after) we fall asleep
Our bodies release melatonin naturally every 2-3 hours before we fall asleep
Sedative hypnotics ___ (should/should not) be used regularly in the hospital to help patients sleep
Sedative hypnotics should NOT be used regularly in the hospital to help patients sleep
Sedative hypnotics like Zolpidem (Ambien) are benzodiazepine like drugs–T/F?
True
Patients can go through withdrawal when they stop taking sedative hypnotics like ambien, sonata, and Lunesta–T/F?
True–withdrawal symptoms include insomnia and anxiety
Sedative hypnotics help people fall asleep and provide restorative REM sleep–T/F?
FALSE–sedative hypnotics DO help people fall asleep, but they DO NOT provide restorative REM sleep
“Sleep behaviors” are very common with Z drugs, i.e.: sleep eating, sleep fighting, sleep walking; patients can hurt themselves when they take these medications–T/F?
True
Ramelteon and melatonin help you fall asleep–T/F?
True
Ramelteon and melatonin will help if you have difficulty staying asleep–T/F?
False–do not help you stay asleep, just help you fall asleep
(6) classes of antidepressant medications
- TCAs
- SSRIs
- SNRIs
- DNRIs
- 5HT2A antagonists
- Nuedexta
TCAs MOA–___ and ___ reuptake inhibition, anti___, ___ antiarrhythmic
TCAs MOA–serotonin and norepinephrine reuptake inhibition, anticholinergic, 1A antiarrhythmic
TCAs are not typically used to treat depression anymore, but may still be used to treat neuropathic pain/migraines–T/F?
True–have fallen out of favor to treat depression since prozac came out
Side effects of TCAs–anticholinergic side effects–___pation, ___fusion, ___tation in elderly/children, urinary ___, ___ vision, ___ mouth; CV effects–QT ___, ___mias
Side effects of TCAs–anticholinergic side effects–constipation, confusion, agitation in elderly/children, urinary retention, blurred vision, dry mouth; CV–QT prolongation, arrhythmias
TCA overdose–administer ___ d/t metabolic ___osis, supportive therapy
TCA overdose–administer NaHCO3 d/t metabolic acidosis, supportive therapy
Serotonin excitatory receptors
2, 3, 4, 6, 7
Increase cAMP
Serotonin inhibitory receptors
1, 5
Decrease cAMP
Side effects of SSRIs–___natremia, ___cytopenia, ___ality, ___mias, ___ syndrome, ___/___/___, weight ___
Side effects of SSRIs–hyponatremia, thrombocytopenia, suicidality, arrhythmias, serotonin syndrome, nausea/vomiting/diarrhea, weight fluctuations
All antidepressants, most anticonvulsant mood stabilizers, and most psychiatric medications have a black box warning for ___
suicidality
Neuroleptic malignant syndrome is precipitated by ___ antagonists; onset is ___-___ days
Neuroleptic malignant syndrome is precipitated by dopamine antagonists; onset is 1-3 days
Serotonin syndrome is precipitated by ___ agents; onset is < ___ hours
Serotonin syndrome is precipitated by serotonergic agents; onset is < 12 hours
NMS and SS identical features–___tension, ___cardia, ___pnea, ___thermia, ___salivation, ___phoresis
NMS and SS identical features–hypertension, tachycardia, tachypnea, hyperthermia (> 40 C), hypersalivation, diaphoresis
NMS demonstrates ‘___’ rigidity in all muscle groups
NMS demonstrates ‘lead-pipe’ rigidity in all muscle groups
SS has ___ (increased/decreased) muscle tone, especially in ___ (upper/lower) extremities
SS has increased muscle tone, especially in lower extremities
NMS distinct features–___reflexia, pupils ___ (normal/dilated), bowel sounds ___ (normal/increased/decreased)
NMS distinct features–hyporeflexia, pupils normal, normal bowel sounds
SS distinct features–___reflexia, ___ unless masked by increased muscle tone, pupils ___ (normal/dilated), bowel sounds ___active
SS distinct features–hyperreflexia, clonus unless masked by increased muscle tone, pupils dilated, bowel sounds hyperractive
What antibiotic can cause serotonin syndrome?
Linezolid (because it is an MAOI)
Opioids can cause serotonin syndrome–T/F?
True
Serotonin syndrome has a slower onset than neuroleptic malignant syndrome–T/F?
False–serotonin syndrome has a faster onset (<12 hours) than neuroleptic malignant syndrome (1-3 days)
Neuroleptic malignant syndrome has ___reflexia, whereas serotonin syndrome has ___reflexia
Neuroleptic malignant syndrome has hyporeflexia, whereas serotonin syndrome has hyperreflexia
Neuroleptic malignant syndrome pupils are ___, serotonin syndrome pupils are ___
Neuroleptic malignant syndrome pupils are normal, serotonin syndrome pupils are dilated
How do SNRIs like duloxetine, venlafaxine, desvenlafaxine, and levomilnacipran work?–___ and ___ reuptake inhibition
serotonin and norepinephrine reuptake inhibition
SRNIs side effects–___ syndrome, ___toxicity, ___tension, ___nia, abnormal ___, ___somnolence throughout the day d/t sleep interruptions throughout the night, ___/___/___, weight ___ (loss/gain), ___or, ___tation
SNRIs side effects–serotonin syndrome, hepatotoxicity, hypertension, insomnia, abnormal dreams, hypersomnolence throughout the day d/t sleep interruptions throughout the night, nausea/vomiting/diarrhea, weight loss, tremor, agitation
SNRIs can also cause ___natremia and ___cytopenia just like SSRIs
SNRIs can also cause hyponatremia and thrombocytopenia just like SSRIs
Bupropion (Wellbutrin) is a ___ and ___ reuptake inhibitor, has no ___ effects
Bupropion (Wellbutrin) is a dopamine and norepinephrine reuptake inhibitor, has no serotonergic effects
Side effects of bupropion (wellbutrin)–___nia, ___tation, ___iety, ___cardia, ___tension, weight ___ (loss/gain)
Side effects of bupropion (Wellbutrin)–insomnia, agitation, anxiety, tachycardia, hypertension, weight loss
Mirtazepine (Remeron) and Trazodone (Desryl) are ___ antagonists
Mirtazepine (Remeron) and Trazodone (Desryl) are 5HT2A antagonists
Side effects of 5HT2A antagonists–highly ___, ___ (increased/decreased) appetite, ___toxicity
Side effects of 5HT2A antagonists–highly sedating, increased appetite, hepatotoxicity
Think ___ with mirtazepine (remeron) and trazodone (desryl)
sedation
Nuedexta is a combination of ___ and ___
Nuedexta is a combination of dextromethorphan and quinidine
Nuedexta is the only medication approved by the FDA to treat ___
Nuedexta is the only medication approved by the FDA to treat pseudobulbar affect
Pseudobulbar affect is inappropriate ___ or ___, seen in patients with ___
Pseudobulbar affect is inappropriate crying or laughing, seen in patients with TBI
Nuedexta MOA–quinidine ___ (increases/decreases) dextromethorphan levels through enzyme inhibition; dextromethorphan may ___ (induce/inhibit) NMDA receptors, sigma 1 agonist
Nuedexta MOA–quinidine increases dextromethorphan levels through enzyme inhibition; dextromethorphan may inhibit NMDA receptors, sigma 1 agonist
Side effects of nuedexta–QT ___, ___us, GI effects, ___ma, ___mia, ___cytopenia
Side effects of nuedexta–QT prolongation, lupus, GI effects, edema, anemia, thrombocytopenia
Nuedexta drug interactions–quinidine is a strong 2D6 ___ (inducer/inhibitor)
quinidine is a strong 2D6 inhibitor
Check ___ if someone is on a neuropsychiatric medication
platelets…many of these meds cause thrombocytopenia
Lithium is a mood ___
Lithium is a mood stabilizer
Side effects of lithium–diabetes ___, ___uria, ___dipsia
diabetes insipidus, polyuria, polydipsia
It is important to check ___ levels and ___ levels in patients on lithium
It is important to check sodium levels and lithium levels in patients on lithium
What is the difference between first and second generation antipsychotics?
First generation = mostly dopamine (D2) blockers; second generation = S2, D2 blockers
Chlorpromazine (thorazine); prochlorperazine (compazine); and haloperidol (haldol) are all ___ (first/second) generation antipsychotics
first generation antipsychotics
Aripiprazole (Abilify); clozapine (clozaril); olanzapine (zyprexa); quetiapine (Seroquel); risperidone (risperdal) are all ___ (first/second) generation antipsychotics
second generation antipsychotics
Dopamine pathways in the CNS–meso___ = positive symptoms of schizophrenia and psychosis
Dopamine pathways in the CNS–mesolimbic = positive symptoms of schizophrenia and psychosis
Dopamine pathways in the CNS–meso___ = negative symptoms, cognitive and affective symptoms
Dopamine pathways in the CNS–mesocortical = negative symptoms, cognitive and affective symptoms
Dopamine pathways in the CNS–___ = Parkinsonian effects, i.e.: extrapyramidal symptoms, tardive dyskinesias
Dopamine pathways in the CNS–nigrostriatal = Parkinsonian effects, i.e.: extrapyramidal symptoms, tardive dyskinesias
Dopamine pathways in the CNS–___ = hyperprolactinemia
Dopamine pathways in the CNS–tuberohypophyseal = hyperprolactinemia
Side effects of antipsychotics–___ symptoms, ___ dyskinesias; metabolic side effects–weight ___ (gain/loss), ___glycemia; CNS side effects–___gy, ___ation, ___fusion; CV–QT ___, especially with ___
Side effects of antipsychotics–extrapyramidal symptoms, tardive dyskinesias; metabolic side effects–weight gain, hyperglycemia; CNS side effects–lethargy, sedation, confusion; CV–QT prolongation, especially with haldol
Black box warning for clozaril 2008–___ related death, ___cytosis
Black box warning for clozaril 2008–dementia (CV/stroke) related death, agranulocytosis
Antipsychotics should be used as a last resort when a patient is a risk to others and/or themselves–T/F?
True
Carbidopa/Levodopa (Sinemet) and Carbidopa/Levodopa/Entacapone (Stalevo) are ___ analogs
dopamine analogs
___ = dopamine precursor, looks and acts like dopamine
Levodopa = dopamine precursor, looks and acts like dopamine
___ = false dopamine; confuses the enzymes MAO and COMT to prevent breakdown of levodopa
Carbidopa = false dopamine; confuses the enzymes MAO and COMT to prevent breakdown of levodopa
___ = COMT inhibitor, has no effect on dopamine
Entacapone (Comtan) = COMT inhibitor, has no effect on dopamine
Benztropine (Cogentin) and trihexyphenidyl (Artane) are anti___ used to treat ___ associated with antipsychotic administration
Benztropine (Cogentin) and trihexyphenidyl (Artane) are anticholinergics used to treat EPS associated with antipsychotic administration
MAOB inhibitors rasaligine (azilect) and selegiline (eldepryl) ___ (increase/decrease) dopamine availability via enzyme inhibition
MAOB inhibitors rasaligine (azilect) and selegiline (eldepryl) increase dopamine availability via enzyme inhibition
Side effects of MAOB inhibitors are similar to dopamine agents because they increase the amount of dopamine available–T/F?
True
If you have a patient on MAOB inhibitors, you may see exaggerated effects of epi, NE, or ephedrine–T/F?
True
Nuplazid (Pimavanserin) acts only at ___ receptors
Nuplazid (Pimavanserin) acts only at serotonergic receptors
Two classes of Alzheimer’s medications–___ inhibitors, ___ receptor antagonist
acetylcholinesterase inhibitors, NMDA receptor antagonist
Side effects of acetylcholinesterase inhibitors–‘___’ side effects–___cardia, ___ stools, ___ bladder
‘rest and digest’ side effects–bradycardia, loose stools, overactive bladder
Acetylcholinesterase inhibitors drug interactions–anti___, ___choline, ___ neuromuscular blockers
anticholinergics, succinylcholine, non depolarizing neuromuscular blockers
Acetylcholinesterase inhibitors ___ (potentiate/reduce) the effects of succinylcholine
Acetylcholinesterase inhibitors potentiate the effects of succinylcholine (because you’re flooding the receptors with acetylcholine)
Acetylcholinesterase inhibitors ___ (potentiate/reduce) the effects of nondepolarizing neuromuscular blockers
Acetylcholinesterase inhibitors reduce the effects of nondepolarizing neuromuscular blockers
Never discontinue a psych medication without reviewing the risk of withdrawal–T/F?
True
What benzodiazepine has risk of wild withdrawal when stopped abruptly?
ONFI
Psych medications may require a taper if absolutely required to be discontinued for several days–T/F?
True
Withdrawal can be deadly–T/F?
True
Delirium and dementia are two different things–T/F?
True
Post op delirium may be fatal and is preventable in up to 40% of cases–T/F?
True
Post op delirium may be hypo, hyperactive, or a mixed presentation–T/F?
True
Almost 50% of cases of delirium are not reported–T/F?
True
Post op delirium may occur in up to 75% of cases–T/F?
True
JAMA Surgery 2018 STRIDE Trial–hip fracture repair, reducing sedation levels to reduce post op delirium–in the primary analysis, limiting the level of sedation provided no significant benefit in reducing incident delirium–T/F?
True
JAMA Surgery 2018 STRIDE Trial–hip fracture repair, reducing sedation levels to reduce post op delirium–in a prespecified subgroup analysis, lighter sedation levels reduced postoperative delirium for persons with a Charlson Comorbidity Index of 0 (less sick patients)–T/F?
True
Antipsychotics should not be used unless patient is at risk of harm to self or others–T/F?
True
If using antipsychotics, use the ___ (lowest/highest) dose for the ___ (shortest/longest) duration
If using antipsychotics, use the lowest dose for the shortest duration
Prophylactic low dose PO haloperidol did reduce delirium incidence in acutely hospitalized older patients–T/F?
FALSE–DID NOT reduce delirium incidence in acutely hospitalized older patients
Prophylactic haldol reduces mortality in critically ill adults at high risk of delirium–T/F?
FALSE–prophylactic haldol DOES NOT reduce mortality in critically ill adults at high risk of delirium
Do not initiate medications for dementia if not using prior to surgery–T/F?
True
Benzos should never be used unless in the case of ETOH withdrawal–T/F?
True
Benzos exacerbate delirium–T/F?
True
