Must Know

Question 1

Dosing for lithium

Answer 1

Start at 300 mg PO daily
Increased by 300 mg every 1 to 5 days
Maximum of900 to 1800 mg per day as b.i.d.

Question 2

Monitoring for lithium

Answer 2

Check levels 4-5 days after initial dose and after every dose change.
Then every week for two weeks.
Then every one to three months.
Check TSH and creatinine q6m

Question 3

Lithium side effects

Answer 3

Epstein’s anomaly

G.I. symptoms
Tremor, headache, 
nephrogenic diabetes insipidus, renal toxicity
Call me to impairment
Hypothyroidism, hypercalcemia
Cardiac dysrhythmias, increased QT

Question 4

Quetiapine dosing for mania

Answer 4

Extended release 300 mg PO Q HS
Titrate up by 100 mg every 7 days
Max 400 to 800 mg per day

Question 5

Quetiapine side effects

Answer 5

Weight gain, prolonged QT, EPS, NMS, sedation, HAM side effects

Question 6

Quetiapine monitoring for acute mania

Answer 6

Annual AIMS exam

Question 7

Valproic acid dosing

Answer 7

Start at 250 mg PO BID
Increased by 250 mg every 1 to 3 days
Maximum 1500-2500 milligrammes daily as b.i.d.

Question 8

Valproic acid monitoring

Answer 8

Target serum level 50 to 125 mcg/mL’s
Monitor valproic acid serum levels every 3 to 4 days after dose changes, then every six months, then every 2 to 3 times per year
Metabolic profile
– Get ammonia level if delirious
CBC, liver function test, DEXA, serum testosterone

Question 9

Valproic acid side effects

Answer 9

Neural tube defect’s

G.I. symptoms
Tremor, ataxia, dysarthria,
Hair loss, easy bruising, probably cytopenia,
CNS: Cong An to changes, sedation
Sexual dysfunction
Hepatotoxicity, haemorrhagic pancreatitis, encephalopathy
Menstrual changes
Increase in testosterone may cause polycystic ovarian syndrome and women

Question 10

What do we use for maintenance phase of bipolar disorder?

Answer 10

Lamotrigene

Question 11

Lamotrigene dosing

Answer 11

Start at 12.5 mg PO BID for two weeks
Then go to 25 mg PO b.i.d. for two weeks
Increase by 25 to 50 mg daily every week
Maximum 50 to 200 mg daily

Question 12

Monitoring for lamotrigene

Answer 12

None

Question 13

Lamotrigene Side effects

Answer 13

CNS: call me to blunting, sedation, dizziness, headache
Tremor, ataxia, and diplopia,
G.I.: nausea and vomiting, diarrhoea, anti-cholinergic effects
STEVENS-JOHNSON SYNDROME

Question 14

Risperidone side effects

Answer 14

Blood abnormalities
No electric malignant syndrome
QT prolongation
Sedation
EPS
Orthostatic hypotension
Sexual dysfunction
Metabolic symptoms

Question 15

Treatment for major neurocognitive disorder caused by Alzheimer’s disease

Mild to moderate

Answer 15

Galantamine

Question 16

Dosing for Galantamine

Answer 16

Start at 4 mg PO b.i.d.
Increased to 8 mg PO bID
Increased to 12 mg PO BID
Change the dose every four weeks

Question 17

Side effects of galantamine

Answer 17

G.I. upset
Muscle cramps
Fatigue, headaches, dizziness
Decreased appetite and weight loss

Question 18

Contra indications to Galantamine

Answer 18

Decreased heart rate, PUD, asthma, epilepsy

Question 19

Treatment for moderate to severe nature neurocognitive disorder caused by Alzheimer’s disease

Answer 19

Memantine

Question 20

Dosing for memantine

Answer 20

Start at 5 mg PO daily
10 mg PO daily, 15 mg PO daily, 20 mg PO daily
Change weekly

Question 21

Side effects of memantine

Answer 21

Dizziness, confusion, headache, constipation

Question 22

Drug treatment for ADHD, dosing

Answer 22

Ritalin/methylphenidate
Start at 5 mg PO be ID
Increase by 5 mg weekly
Maximum daily dose is 60 mg

Question 23

Side effects of Ritalin

Answer 23

G.I. upset
Headache
Insomnia
Decreased appetite
Increased blood pressure
Decreased growth by 2 cm
Sudden cardiac death

Question 24

Escitalopram dosing

Answer 24

Start at 5 mg per day
Increase by 5 mg every week
Maximum 20 mg