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Neuro Therapeutics > Neuro Exam 2 > Flashcards

Neuro Exam 2 Flashcards

1
Q

Parkinson’s Disease

A

-state of dopamine deficiency in brain
-functional imbalance between inhibitory dopamine + excitatory acetylcholine
–> loss of dopaminergic cells in substantia nigra + basal ganglia (requires 80% of nigral cell death before disease manifests clincally)
–> formation of lewy bodies

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2
Q

Bradykinesia (along with diagnosis criteria for PD)

A

(slowness + difficulty initiating voluntary movement)
2 of the following:
–> limb muscle rigidity (resistance to passive ROM)
–> resting tremor
–> pastural instability

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3
Q

Clinical presentation of PD

A

Primary: bradykinesia, postural instability, resting tremor, rigidity
Motor symptoms: dec dexterity, dysarthria, freezing at initiation of movement, slow turning
-autonomic symptoms: bladder + anal sphincter disturbances, constipation, diaphoresis
-mental status change: confusion, dementia, psychosis

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4
Q

PD meds to use to tx presence of symptoms + impairment

A

Rasagiline

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5
Q

If PD pt has tremor > 65 y/o

A

carb/levo

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6
Q

if PD pt has tremor and < 65

A

anticholinergic drug

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7
Q

If PD pt is < 65 and has bradykinesis or postural instability

A

dopamine agonist then anticholinergic

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8
Q

Anticholinergic meds in PD

A

-Benztropine & Trihexyphenidyl
–> use these in younger pts with tremor
–> SEs: mydriasis, dry mouth, fever, depressed mental state, flushed skin

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9
Q

Levodopa

A

gold standard! (precursor to dopamine)
SEs: dyskinesia, decreased effectiveness over time, psychiatric disturbances, nausea, hypotension, saliva sweat or urine discoloration, NMS w/ abrupt d/c
**always give with dopa!!

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10
Q

Carbidopa

A

-only purpose is to increase 1/2 life of levadopa!
**never use as mono-therapy, CI in pregnancy and lactation

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11
Q

Carbidopa/Levodopa (Sinemet)

A

-1:10 or 1:4 ratio
-Sinemet CR: dec in total “off” time and dec dosing frequency, can use supp IR along with CR

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12
Q

Inbrija

A

levodopa powder
-intermittent tx of “off” episodes in pts with PD treated w/ carb/levo
AEs: somnolence, hallucinations, dyskinesia, cough, nausea, upper tract infection
-CI in pts with asthma and COPD

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13
Q

Enracapone

A

-COMT inhibitors: prevents breakdown of L-dopa + extend effects of L-dopa
no effect in absence of L-dopa
SEs: may produce brown/orange urine

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14
Q

Tolcapone

A

COMT inhibitor
**do not use w/hepatic disease (rarely used)

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15
Q

Selegiline

A

MAO-Bs (dont have to worry about tyramine effects- decs breakdown of dopamine + dec free radical production)
–> has 3 active metabolites: reason why it has side effects
SEs: hypertensive crisis, serotonin syndrome, insomnia, jitteriness, hallucinations

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16
Q

Rasagiline

A

MAO-IB
-potentially disease modifying
SEs:
–> mono-therapy: headache, arthralgia, GI upset, falls
–> w/ levodopa: dyskinesia, GI upset, headaches, weight loss, arthralgia + orthostasis

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17
Q

Safinamide

A

MAO-IB
-Na and K channel blocker, dec glutamate release
indication: adjunctive to L-dopa for wearing off symptoms
AEs: dopaminergic, daytime somnolence, NMS symptoms, retinal pathology
CI in child-Pugh class C

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18
Q

Amantadine

A

-decreases rigidity, tremor, bradykinesia, L-dopa induced dyskinesia!!(only agent we can add on to dec this symptom)
-AEs: orthostatic hypotension, hallucinations, sedation, anticholinergic AEs, LIVEDO RETICULANS (skin molting)

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19
Q

Dopamine agonists

A

-may be used as mono therapy –> reduced risk of developing motor complications
-used as adjunctive agent: to get better control of symptoms w/ L-dopa
AEs: N/V, vivid dreams, pedal edema, impulsive behaviors, psychosis

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20
Q

What are the dopamine agonists used in PD?

A

-pramipexole (most common)
-ropinirole
-bromocriptine
-cabergoline
-rotigotine (transdermal patch)
-apomorphine (refectory pts- used as needed for off episodes, pretreat with antiemetic)

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21
Q

managing “wearing-off” or “on-off” response in PD

A

-increase frequency, switch to CR, adjunctive DA ag/MAOI/COMT/amantadine

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22
Q

managing “off, no-on” response in PD

A

delayed stomach emptying/dec absorption: inc dose/freq/water

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23
Q

Managing delayed onset response in PD

A

-empty stomach (no water or protein)
-switch off CR or add IR

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24
Q

managing peak-effect dyskinesia in PD

A

-dec dose
-inc frequency
-add amantadine
-use CR simemet, DA ag

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25
Q

managing dystonia in PD

A

-take early am
-CR at HS
-DA ag
-add baclofen or botox

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26
Q

managing freezing in PD

A

-inc dose
-add DA ag
-gait modification/physical therapy

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27
Q

what medication is used to treat dementia and cog impairment in PD?

A

Rivastigmine

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28
Q

How is psychosis treated in PD?

A

1) d.c meds with highest risk:benefit, anticholinergics, D/C amentadine, selegiline, DA ag + decrease L-dopa
2) consider adding atypical antipsychotic drug

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29
Q

what drugs are used to treat psychosis in PD?

A

-quetipaine
-clonazipine
-Pimavanserin tartrate indicated for hallucinations & delusions in PDP
BBW: inc death in elderly with dementia
AEs: QT prolongation, peripheral edema, nausea, confusion

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30
Q

Dementia:

A

a syndrome characterized by progressive decline of intellectual ability from a previously attained level

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31
Q

Alzheimers Disease

A

-progressive, neurodegenerative disease affecting cognition, behavior (most common form of dementia)
-formation of beta-amyloid plaques and neurofibrillary tangles

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32
Q

Acetylcholinesterase inhibitors (for AD tx)

A

-blocks acetylcholinesterase, block metabolism of Ach
AEs (SLUDGE), sialorrhea, lacrimation, urination, defecation, GI, emesis

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33
Q

Donepezil

A

(ACHI)
-indicated for mild to moderate AD
AEs: symptomatic bradycardia can occur, rare cases of rhabdomyolysis and/or NMS

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34
Q

Rivastigmine

A

(ACHI)
-indicated for mild-severe AD and mild-moderate parkinsons dementia
AEs: GI*** (slow titration), taking with food: incs AUC, dec GI upset
(patch) –> indicated for mild-severe AD

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35
Q

Galantamine

A

(ACHI)
-indicated for mild to moderate AD
-should NOT be used in pts w/ end-stage renal disease or severe hepatic impairments

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36
Q

Memantine

A

-NMDA receptor antagonist
-approved for moderate to severe stages of AD
*clearance is sig reduced by alkaline urine
**use w/ caution in pts with hx of seizures and cardio disease

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37
Q

Namzaric (memantine ER + Donepezil)

A

-take in the evening w/ or w/o food
*pt must be stable on donepezil 10 mg before starting this combo

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38
Q

TX for behavior issues in AD

A

antidepressants, anxiolytics, antipsychotics, antiepiliptic drugs

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39
Q

antipsychotics in AD

A

-risperidone (best bish), quetiapine, olanzapine, aripiprazole
–> BBW: elderly pts w/ dementia-related psychosis treated with antipsychotics are at an increased risk of death

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40
Q

SNRI FDA approved for GAD

A

duloxetine, venlafaxine

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41
Q

SSRI FDA approved for GAD

A

escitalopram, paroxetine

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42
Q

Non-benzos approved for GAD

A

duloxetine, escitalopram, paroxetine, sertraline, venlafaxine, buspirone, hydroxyzine

43
Q

SEs of paroxetine

A

nausea, dry mouth, headache, somnolence, insomnia & male sexual dysfunction- BLEEDING!

44
Q

antidepressant side effects

A

headache, GI upset, insomnia, sexual dysfunction, weight gain, inc anxiety, drowsiness, tremor, inc risk of bleeding, serotonin syndrome, withdrawal, d/c syndromes

45
Q

what is the BBW for antidepressants?

A

increase in the risk of suicidality w/ antidepressants in ppl under 24 y/o

46
Q

FDA approved benzos for anxiety (CCLAD)

A

clorazepate (dont use with PPI), chondiazepoxide, lorazepam (good for hepatic disease), alprazolam + diazepam

47
Q

what drugs should not be used in pregnancy to treat. GAD?

A

-divalproex : neural tube defect
-carbamazepine: spina bifida
-lamotrigine: cleft palate
-lithium: ebsteins anomaly, increased doses needed during pregnancy

48
Q

drugs used to treat panic disorder: panic symptoms

A

venlafaxine > fluoxetine > paroxetine > sertraline > citalopram

49
Q

drugs used to treat panic disorder: anxiety symptoms

A

mirtazapine > venlafaxine > citalopram > fluvoxamine> paroxetine

50
Q

SSRI FDA approved for tx of panic disorder

A

fluoxetine, paroxetine & sertraline (& venlafaxine)
Im panicking: fuck vast pussy skunks

51
Q

FDA approved drugs for social anxiety disorder

A

paroxetine, sertraline

52
Q

what 3 drugs are “safer” in breast feeding and what 2 drugs are a big NO in breastfeeding?

A

safer: paroxetine, sertraline, & nortriptyline
NO: benzos and fluoxetine

53
Q

FDA approved for PTSD tx

A

paroxetine and sertraline

54
Q

pt with PTSD is experiencing intrusive thots and hyper vigilance

A

augment with risperadone, quetiapine, olanzapine

55
Q

pt with PTSD is experiencing nightmares

A

augment with prazosin or clonidine

56
Q

pt with PTSD is experiencing anger

A

augment with lamotrigine

57
Q

pt with PTSD is experiencing sleep

A

augment with trazadone

58
Q

FDA approved drugs for OCD

A

fluoxetine, fluvoxamine, paroxetine and sertraline

59
Q

Key concepts of Bipolar Disorder

A

-lithium & valproate are the mainstays of tx for both acute mania and prophylaxis for recurrent manic & depressive episodes
-lamotrigine and carbamazepine & aripiprazole & quetiapine are alt adjuncts

60
Q

1st line meds for acute bipolar depression

A

lithium, valproate or quetiapine

61
Q

FDA approved for treating schizoaffective disorder

A

paliperidone & clozapine

62
Q

FDA drugs approved for acute mania and mixed episodes in BPD

A

-litium, VPA
-carbamazepine
-aripiprazole
-asenapine
-cariprazine
-olanzapine
-quetiapine
-risperadone
-ziprasidone

63
Q

FDA approved for maintenance in BPD

A

-lithium
-lamotrigine
-aripiprazole
-olanzapine
-quetiapine
-risperadone
-ziprasidone

64
Q

FDA approved for acute depression in BPD (QOL)

A

quetiapine
olanzapine/fluoxetine
-lurasidone
initial monotherapy: lithium, lamotrigine, QOL

65
Q

what meds are apprived for acute depression in BP-2

A

olanza/flou and lurasidone

66
Q

what LAIs are approved for BPD (BP-1)?

A

-apriprazole (abilify maintena)
-risperidone (risperdal conseta)

67
Q

SGA FDA approved for BPD (Angry Amy Came Last October Quitting Random Zits)

A

Apriprazole
Asenapine
Cariprazine
Lurasidone
Olanzapine
Quetiapine
Risperadone
Ziprasidone

68
Q

Lithium facts

A

-best for euphoric mania, onset 6-10 days, full effect: 8 weeks
*1st line for acute mania, acute bipolar and maintenance in BPD 1 & 2
-may unmask Brugada syndrome (genetic, fast and irregular heartbeat)

69
Q

Lithium CI & AEs

A

CI: severe renal or cardiac disease
AEs: polydipsia + polyuria, kidney injury (AKI to CDK 3), muscle weakness, lethargy, cardiac effect, may cause acne
Avoid: NSAIDs, ACE/ARBs (to avoid toxicity) = fatal (hemodialysis rebound)
–> floppy baby syndrome, CI in breastfeeding

70
Q

FDA approved anticonvulsants & BBW

A

-valpraote, lamotrigine, carbamezepine ER
BBW: increased risk of suicide

71
Q

Valproate

A

-FDA approved for acute manic or mixed episodes
BBW: pancreatitis, liver toxicity, hepatotoxicity, urea disorders
AEs: sedation, prolonged bleeding, weight gain, hyperammonemia

72
Q

Lamotrigine

A

potenital cardiac issues
-preferred over valproate for bipolar depression
-dose escalation must be low and slow! (SJS)
-missing dose requires re-tapering

73
Q

Carbamazepine

A

-generally reserved for use after 1st line
AEs: neutropenia, leukopenia, hematologic disease, arganulocutosis, HLA-B (asians), porphyria

74
Q

What benzos are used for adjunctive agents in BPD?

A

-high potency: clonazepam and lorazepam (use IM as well)

75
Q

CC is a 30-year old obese male with a history of depression and some previous episodes of mania which included euphoria, grandiosity and impulsivity. He recently arrived to the emergency department while experiencing an acute depressive episode. The attending prescriber is considering the use of a benzodiazepine (BZD) in addition to a second generation antipsychotic (SGA) for future episodes and manic symptoms. What would you advise CC’s prescriber of the appropriate role of BZD in the treatment of bipolar disoder? Please select all that apply (SATA):
A: Use lowest effective BZD dose
B: shor term augmentation with BZD and then discontinue
C: use shcedules doses of BZD only
D: absolute avoidance of BZD is essential

A

A: use lowest effective BZD dose
B: short term augmentation with BZD and then discontinue

76
Q

CC is a 30-year old obese male with a history of depression and some previous episodes of mania which included euphoria, grandiosity and impulsivity. He recently arrived to the emergency department while experiencing an acute depressive episode of his bipolar disorder. The attending prescriber is considering the use of a second generation antipsychotic (SGA) for the management of future episodes. Which of the following SGAs are FDA approved for bipolar disorder and has evidence to support efficacy in treating depressive episodes? Please select all that apply (SATA):
A: Aripiprazole (Abilify)
B: Risperidone (Risperdal)
C: Quetiapine (Seroquel)
D: Lurasidone (Latuda)

A

C: Quetiapine (seroquel)
D: Lurasidone (Latuda)
remember QOL

77
Q

In addition to bipolar disorder, which of the following psychiatric conditions are appropriate FDA approved uses for the antipsychotic quetiapine (Seroquel)? Please select all that apply (SATA)
A: Depression augmentation
B: Social Anxiety Disorder (SAD)
C: Insomnia
D: Psychosis

A

A: depression augmentation
D: psychosis
QOL: depression augmentation
psychosis in PD = QLP

78
Q

KB is a 70 year old female patient who was diagnosed in the past with generalized anxiety disorder (GAD) and has recently described a recurrence of anxiety symptoms. Her psychiatrist started her on paroxetine (Paxil) 20mg 2 weeks ago; however she is finding her “physical” symptoms of anxiety too overwhelming to wait for the SSRI to start working. She has been self-medicating with OTC antacids for stomach symptoms and Tylenol PM (acetaminophen with diphenhydramine) for insomnia for the last few weeks. Her complete medication list includes the following: Paroxetine (Paxil) 20mg daily Maalox (aluminum/magnesium) 1 tablespoonful TID PRN Acetaminophen with diphenhydramine (Tylenol PM) HS PRN Ibuprofen (Motrin) 200mg TID PRN for arthritic pain KB’s psychiatrist decides to initiate clonazepam (Klonopin) 0.5mg three times daily as needed for her anxiety and at the same time instructs the patient to discontinue her acetaminophen with diphenhydramine (Tylenol PM). KB arrives to your clinic 2 weeks later for a psychiatric follow up. During her appointment, she reports finding blood in her stool. If this bleeding were confirmed to be a result of an adverse drug event, what drug would most likely contributed to this adverse effect?
A: clonazepam (Klonopin)
B: acetaminophen (Tylenol)
C: paroxetine (Paxil)
D: diphenhydramine (Benadryl)

A

C: Paroxetine (Paxil)
antidepressant side effects: headache, GI upset, insomnia, sexual dysfunction, weight gain, inc anxiety, tremor, inc risk of BLEEDING, serotonin syndrome & withdrawal symptoms

79
Q

ZZ is a 66 year old female patient who was diagnosed in the past with generalized anxiety disorder (GAD) and has recently described a recurrence of anxiety symptoms. Her psychiatrist started her on paroxetine (Paxil) 20mg 2 weeks ago; however she is finding her “physical” symptoms of anxiety too overwhelming to wait for the SSRI to start working. She has been self-medicating with OTC antacids for stomach symptoms and Tylenol PM (acetaminophen with diphenhydramine) for insomnia for the last few weeks. Her complete medication list includes the following: Paroxetine (Paxil) 20mg daily Maalox (aluminum/magnesium) 1 tablespoonful TID PRN Acetaminophen with diphenhydramine (Tylenol PM) HS PRN Ibuprofen (Motrin) 200mg TID PRN for arthritic pain ZZ’s psychiatrist decides to initiate clonazepam (Klonopin) 0.5mg three times daily as needed for her anxiety and at the same time instructs the patient to discontinue her acetaminophen with diphenhydramine (Tylenol PM). ZZ is very concerned about her recent bleeding episode and she would like to know what other adverse effects she is at high risk of experiencing relative to the medication she is currently taking. Which of the following drugs and appropriately matched (commonly associated) adverse effect would you warn her about? Please select all that apply (SATA):
A: Clonazepam: increased risk of falls and fractures
B: Diphenhydramine: increased risk of thrombocytopenia C: Acetaminophen: increased risk of renal failure
D: Paroxetine: withdrawal symptoms if she forgets to take her daily dose

A

A: clonazepam: increase risk of falls and fractures
D: Paroxetine: withdrawal symptoms of she forgets to take her daily dose

80
Q

MO is a 45-year-old male patient who was recently admitted to the emergency department due to sweating, chills, racing heart, difficulty breathing and chest pain. The patient reported he believed he was experiencing a heart attack. Upon admission, MO’s symptoms were determined to be a panic attack. He has a history of panic attacks in the past, but has never taken medication. MO’s physician diagnoses him with panic disorder and would like to initiate medication. Which of the following medications would be appropriate selections as mono-therapy for panic disorder? Please select all that apply (SATA):
A: Fluoxetine (Prozac)
B: Venlafaxine (Effexor) XR
C: Sertraline (Zoloft)
D: Temazepam (Restoril)

A

A: Fluoxetine (Prozac)
B: Venlafaxine (Effexor) XR
C: Sertraline (Zoloft)

Im panicking: Fuck Vast Suck

81
Q

PP is a 61-year-old military veteran who was recently diagnosed with post-traumatic stress disorder (PTSD) who denies any history of substance use/abuse. His current comorbid medical conditions include benign prostatic hypertrophy, insomnia and glaucoma. He has been taking sertraline (Zoloft)100mg daily (the MDD is 200mg) for 4 weeks and describes a reduction in symptoms however is still expressing distress over memories of witnessing deaths of fellow servicemen during combat. What would you recommend for PP at this time?
A: Add clonazepam (Klonopin) 1mg three times daily PRN intrusive thoughts B: Add phenelzine (Nardil) 15mg at bedtime
C: Add quetiapine (Seroquel) 25mg daily
D: Increase sertraline to 150mg

A

D: increase sertraline to 150 mg
always want to max dose out before adding something new

82
Q

PP’s MD contacts you a few weeks later, thanking you for your recommendation and describes an improvement in PP’s function and core symptomatology. Now, the MD would like to prescribe another medication to help PP with some nightmares and flashbacks that continue to be a problem every few nights. What agent do you recommend?
A: Metoprolol Succinate (Toprol XL)
B: Prazosin (Minipress)
C: Clonazepam (Klonopin)
D: Estazolam (Prosom)

A

B: Prazosin (Minipress)
nightmares: Prazosin or clonidine

83
Q

Which of the following serotonin norepinephrine reuptake inhibitors (SNRIs) is most the appropriate recommendation to treat major depressive disorder (MDD) and co-occuring generalized anxiety disorder (GAD) in a 34 year old female patient without any additional medical comorbidities?
A: Paroxetine (Paxil)
B: Venlafaxine (Effexor)
C: Desvenlavaxine (Pristiq)
D: Escitalopram

A

B: venlafaxine
A and D are SSRIs, desvenlavaxine only approved for depression

84
Q

What are potential adverse events of selective serotonin norepinephrine reuptake inhibitors (SNRIs)? Please select all that apply (SATA)
A: Abnormal bleeding
B: Increased blood pressure
C: Mania if used as monotherapy in patients with bipolar disorder
D: Hypernatremia

A

A: abnormal bleeding
B: increased blood pressure
C: mania if used as monotherapy in pts with bipolar disorder

SNRI AEs: abnormal bleeding due to 5-HT reuptake on platelets, potential for increased risk of activation of mania, elevated blood pressure, hyponatremia and serotonin syndrome and discontinuation syndrome

85
Q

Mrs. G is a 54-year-old woman who presents to the movement disorder clinic complaining of a one-year history of “stiffness” in her right arm and difficulty with fine motor tasks. Her husband has also noticed that she has begun walking more slowly and with a slightly stopped, shuffling gait. Upon physical exam and further supportive findings, she is diagnosed with mild idiopathic Parkinson’s disease. She will initiate pharmacologic treatment. Mrs. G is in good overall health, has no significant past medical history and is not currently taking any medications aside from a multivitamin. Which among the following choices are appropriate monotherapies for initial treatment of Mr. G’s Parkinson’s Disease? Select all that apply.
A: Carbidopa/Levodopa (Sinemet) 25/100 mg tablets, 1 tablet TID.
B: Pimavanserin (Nuplazid) 2x17 mg tablets QD.
C: Apomorphine (Apokyn) 0.2 ml, titrated to effect and given “as needed” for “off” episodes.
D: Ropinirole (Requip) 0.25 mg TID, to be titrated to effect. E: Entacapone (Comtan) 200 mg TID

A

A: Carbridopa/Levodopa
D: Ropinirole

Monotherapy in PD: Carb/levo, selegiline, rasagaline, DA agonists (pramipexole, ropinirole, bromocriptine, cabergoline, rotigotine, apomorphine (this one for refractory pts only)

86
Q

Mr. Z’s doctor accepted your recommendation, and Mr. Z and his daughter report immediate improvement in his symptoms of hallucinations. However, 1 year later they return to the office reporting that the hallucinations have returned. Mr. Z frequently sees strangers in his house, and has had several urine accidents during the nighttime due to being afraid to leave his bed to use the bathroom. Mr. Z’s neurologist does not wish to reduce the dose of any of his PD medications at this time, as his motor function has continued to decline. Mr. Z’s neurologist asks for your recommendation about an appropriate antipsychotic medication for Mr. Z. Which is the LEAST appropriate recommendation for Mr. Z?
A: Pimavanserin (Nuplazid) 2x17 mg tablets QD.
B: Clozapine 12.5 mg QHS.
C: Quetiapine (Seroquel)
D: haloperidol 2 mg QHS

A

D: Haloperidol

drugs used in psychosis in PD: Quetiapine, clonazipine & primavariserin (QCP)

87
Q

Mr. Z is an 85-year-old man with 15-year history of PD. He presents to clinic with his caregiver, his daughter. Mr. Z’s daughter reports that he has been experiencing a 1-year history of visual and auditory hallucinations; frequently, he will see strangers in the house or in his yard, when in fact no one is there. The hallucinations are frightening to him and sometimes keep him from leaving his bedroom during the day. His current medications include: Sinemet 25/100 mg tablets, 1.5 tablets qid, rasagiline 1 mg PO QD, lisinopril 20 mg qd, benztropine 1 mg BID and tamsulosin 0.4 mg QD. After ruling out medical causes of Mr. Z’s symptoms (such as infection or electrolyte imbalance), Mr. Z’s neurologist asks you for your recommendation. Which of the following is the MOST appropriate recommendation at this time?

A: Attempt to switch rasagiline 1 mg po QD to selegeline ODT (Zelapar) 1.25 mg QD.
B: Initiate pimavanserin (Nuplazid) 2x17 mg tablets QD.
C: Attempt to reduce Sinemet dosing frequency to 1.5 tablets TID.
D: Attempt to taper and discontinue benztropine 1 mg BID.

A

D: attempt to taper and d/c benzotropine 1 mg BID

88
Q

Which of the following is TRUE regarding rasagiline (Azilect?) Select all that apply.

A: Rasagiline works by inhibiting catechol o-methyl transferase (COMT), thereby preventing breakdown of l-dopa and prolonging its effect.
B: Rasagiline may have potential disease-modifying effects in treatment of PD based on large clinical trials.
C: Rasagiline should not be used as a monotherapy in treating Parkinson’s disease.
D: When used in the correct therapeutic dosing range for Parkinson’s Disease, rasagiline selectively inhibits the monoamine oxidase B enzyme.

A

B: Rasagiline may have potential disease-modifying effects in tx of PD based on large clinical trials
D: when used in the correct therapeutic dosing range for PD, rasagiline selectively inhibits the monoamine oxidase B enzyme

MAOI,can be used as monotherpy

89
Q

Mr. F is a 64-year-old man diagnosed with PD 3 years ago. He currently takes Sinemet 25/100 mg tablets TID. He presents to the clinic complaining that although the medication seemed to be working well at first, he has lately been experiencing “wearing-off” of his medication about an hour before it is time to take his next dose, with particularly bothersome symptoms of slowness and “stiffness” which prevent him from doing his exercises. He is on no other concomitant medications and has no comorbid medical conditions. Which of the following is THE MOST appropriate recommendation regarding Mr. F’s medication regimen at this time?

A: Recommend increasing Mr. F’s Sinemet 25/100 mg dosing frequency from TID to QID.
B: Counsel Mr. F to always take his Sinemet with a full, protein-rich meal in order to increase absorption of the medication. C: Recommend Mr. F increase his Sinemet dose to 25/100 mg, 2 tablets TID.
D: Recommend addition of benztropine 1 mg BID for better symptom control.

A

A: recommend increasing Mr. F’s Simemet 25/100 mg dosing frequency from TID to QID

*“wearing -off”: increase frequency, switch to CR, adjunctive DA ag/MAOI/COMT/amantadine

90
Q

Which of the following is TRUEconcerning the etiology and pathophysiology of Parkinson’s disease (PD)? Select all that apply.

A: Urban life and cigarette smoking are 2 known factors which increase the risk of developing PD.
B: PD is characterized by a state of dopamine deficiency in the brain, caused by loss of dopaminergic cells in the substantia nigra and basal ganglia.
C: Decreased acetylcholine signaling is thought to be responsible for the motor symptoms of PD.
D: The accumulation of beta-amyloid plaques and neurofibrillary tangles in the brain is a pathophysiologic hallmark of PD.
E: The accumulation of Lewy bodies (clumps of alpha-synuclein protein) in the substantia nigra and other areas of the brain is a pathophysiologic hallmark of PD.

A

B: PD is characterized by a state of dopamine deficiency in the brain, caused by loss of dopaminergic cells in the SN and basal ganglia
E: the accumulation of Lewy Bodies in the Sg and other areas of the brain is a pathophysiologic hallmark of PD

91
Q

JM is a 74 year old male who was diagnosed with bipolar disorder in his mid-20s and who now developed swallowing difficulties due to progressively worsening dementia. JM’s psychiatrist would like to order a mood stabilizing long acting antipsychotic (LAI) injection that can appropriately manage his bipolar disorder. Which of the following second generation antipsychotics (SGAs) are available as LAI? Please select all that apply (SATA):

A: Aripiprazole (Abilify)
B: Risperidone (Risperdal)
C: Quetiapine (Seroquel)
D: Lurasidone (Latuda)

A

A: Aripiprazole
B: Risperidone

92
Q

WD is a 68 year old male currently hospitalized for mania. Because WD had previously exhibited depressive episodes of bipolar disorder (BP-I), his psychiatrist is considering ordering an antidepressant to WD’s regimen upon discharge. What is the most appropriate way to use antidepressant agents in patients with bipolar disorder?

A: Only use antidepressants for bipolar mania
B: Only use dual action antidepressant agents (SNRIs, TCAs)
C: Only use when prescribed along with a mood stabilizer
D: Only use as monotherapy if they are FDA approved for use

A

C: only use when prescribed along with a mood stabilizer

93
Q

WD is a 68 year old male currently hospitalized for mania. His treatment team psychiatrist would like to hear about additional antipsychotic options to treat bipolar disorder. Which of the following second generation antipsychotics (SGAs) is approved for treatment of bipolar disorder and is least likely to worsen potential metabolic cardiovascular risks in this patient?

A: Quetiapine (Seroquel)
B: Aripiprazole (Abilify)
C: Clozapine (Clozaril)
D: Thioridazine (Mellaril)

A

B: Aripoprazole

94
Q

WD is a 68 year old male currently hospitalized for an episode of mania. His daughter attends a treatment planning team for her dad and she weighs in on her concerns about his care. She mentions she has heard that some antipsychotics have been associated with gynecomastia and she wants to avoid having her dad experience that side effect. Which of the following second generation antipsychotic agents (SGA) is approved for use in bipolar disorder and is also most likely to cause gynecomastia in males?

A: Lurasidone (Latuda)
B: Iloperidone (Fanapt)
C: Risperidone (Risperdal)
D: Vilazodone (Viibryd)

A

C: Risperidone

95
Q

BW is a 32-year-old white male patient who arrives to the emergency department today in distress and was triaged to address what was determined to be an episode of bipolar depression. BW reports he has experienced feelings of depression in the past, however said he could “ignore” his symptoms before but knows he needs someone else’s help today. What pharmacotherapeutic combination represents an optimal intervention for a patient experiencing an acute episode of bipolar depression in a patient diagnosed with BP-II disorder? Please select all that apply (SATA):

A: quetiapine (Seroquel) with divalproex (Depakote)
B: olanzapine (Zyprexa) with fluoxetine (Prozac)
C: paliperidone (Invega) with gabapentin (Neurontin)
D: ziprasidone (Geodon) with aripiprazole (Abilify)

A

A: quetiapine with divalproex
B: olanzapine with fluoxetine

96
Q

A 53-year-old female patient recently diagnosed with a 1st episode of MDD by their primary provider has been referred for antidepressant therapy. The patient reports a loss of interest in activities she typically enjoys, insomnia, and difficulty concentrating at work each day. Past Medical History: Type 2 diabetes with diabetic peripheral neuropathic pain Current medications: Metformin 1000mg twice daily, vitamin B12 500 mcg intranasally in one nostril once weekly, insulin glargine 60 units every evening, insulin lispro 18 units 15 minutes before meals, sliding scale insulin, atorvastatin 40 mg daily, lisinopril 40 mg daily Substance use: Caffeine: Denies Tobacco: Denies Alcohol: Denies Illicit: Denies Vital signs: Pulse: 78 beats per minute Blood pressure: 143/82 mmHg Height: 75 inches Weight: 120 kg Given the patient’s diabetic neuropathy and depression, which of the following serotonin norepinephrine reuptake inhibitor (SNRI) antidepressant medication is FDA approved for both neuropathic pain and depression?

A: Duloxetine (Cymbalta)
B: Phenelzine (Parnate)
C: Fluvoxamine (Luvox)
D: Fluoxetine (Prozac)

A

A: Duloxetine

97
Q

Which of the following antidepressants is most correctly paired with the adverse effect most likely associated with its use?

A: Citalopram (Celexa): Avoid in patients with seizure disorder
B: Bupropion (Wellbutrin) : Avoid in patients with QTc prolongation
C: Paxil (paroxetine): Avoid in patients who are pregnant D: Sertaline (Zoloft): Avoid in patients who smoke

A

C: Paxil: avoid in pts who are pregnant

98
Q

PP confides in you and shares that that his 22-year-old son was just diagnosed with obsessive compulsive disorder (OCD). PP feels that this may be because his son is always worried about him and how his PTSD symptoms are “destroying his dad’s life”. He wants your opinion about pharmacologic options for him. Which of the following would be the best medication to initiate for his son’s treatment and is FDA approved for monotherapy in OCD? Please select all that apply (SATA):

A: Sertraline (Zoloft) 50mg daily
B: Paroxetine (Paxil) 20mg daily
C: Quetiapine (Seroquel) 100mg daily
D: Lorazepam (Ativan) 1mg daily

A

A: Sertaline
B: Paroxetine

first line in OCD: fluoxetine, fluvoxamine, paroxetine, sertraline

99
Q

JJ is a 37-year-old patient that presents to the ED with severe social anxiety disorder (SAD) that has caused significant impairment. The physician is planning to prescribe an antidepressant, however would also like to initiate a benzodiazepine (BZD) with quick onset for his acute exacerbation of anxiety. Because JJ may have latent hepatitis B infection, the physician would like a BZD that represents the safest option for use in patients with hepatic impairment and that is FDA approved for anxiety. Which of the following BZDs would be most appropriate for use in patients with anxiety and impaired hepatic function?

A: Diazepam (Valium)
B: Temazepam (Restoril)
C: Lorazepam (Ativan)
D: Oxazepam (Serax)

A

C: lorazepam

lorazepam is good for hepatic disease!

100
Q

Larry is in a nursing home and has severe Alzherimer’s disease. He has become quite combative with the nursing staff and other residents. non-pharmacologic methods, but the agitation remains problematic. You have educated the prescriber, staff and family on the black box warning for antipsychotics but all believe benefit outweighs the risk. They ask you, according to AHRQ, which antipsychotic has the highest antipsychotic efficacy data for dementia agitation AND dementia overall?
A: Aripiprazole
B: Quetiapine
C: Risperidone
D: Olanzapine

A

C: Risperadone

101
Q

Marilyn is taking Aricept 5 mg QHS. She comes to the pharmacy and tells you she has started to experience very vivid dreams, which are sometimes nightmares that awake her from her sleep. Which is the appropriate counseling point at this time?

A: Offer to call her presciber and recommend a switch to rigastigmine capsules 3 mg BID
B: Advise her to try taking Aricept in the morning
C: Advise her to take Aricept with food
D: Tell her this is not a side effect of Aricept and offer to review the rest of her medications

A

B: advise her to try taking Aricept in the morning

102
Q

True or False: Prior exposure to anticholinergic medications has been shown to cause Dementia.
A: True
B: False

A

False!!

103
Q

Sally saw her neurologist and after an extensive work-up diagnosed her with mild Alzheimer Disease. Her neurologist would like to start her these medications can cause a lot of stomach upset and would like to avoid it if possible? Which of the following acetylcholinesterase inhibitors is MOST known for GI adverse effects?

A: Rivastingmine capsules
B: Glantamine ER capsules
C: Aricept ODT tablets
D: Memantine tablets

A

A: Rivastingmine Capsules

*Aricept = donepezil, memantine (for moderate to severe)

104
Q

Norma is a 75 year old woman. She is experiencing some difficulty with her memory. She is taking the following medications: Lisinopril 10 medications is of the greatest concern for her memory? Choose one.
A: Lisinopril 10 mg
B: Lexapro 10 mg
C: Atorvastatin 20 mg
D: Oxybutynin 10mg

A

D: Oxybutynin 10 mg (she hates this drug in the elderly)

Neuro Therapeutics (4 decks)

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