Neuropsychiatric meds

Question 1

Which antiepileptic is the treatment of choice for status epilepticus according to most recent treatment guidelines?

Answer 1

lorazepam (Ativan)

Question 2

Order of meds to give for seizure

Answer 2

1. Benzodiazepine

If benzo not available try: phenobarbital IV, diazepam rectal, nasal or buccal midazolam

2. Second phase: fosphenytoin IV, valproic acid IV, levetiracetam IV
3. Repeat of any second line therapy
   Anesthetic doses of thiopental, midazolam, pentobarbital, or propofol

Question 3

Which sodium channel blocker has the most side-effects, drug interactions, and causes hyponatremia?

Answer 3

Carbamazepine

Question 4

Which sodium channel blocker induces its own metabolism (reduces its own levels)?

Answer 4

Carbamazepine

Question 5

Which sodium channel blocker has unpredictable pharmacokinetics and has similar antiarrhythmic properties as lidocaine?

Answer 5

Phenytoin (fosphenytoin is the oral prodrug)

Question 6

Which sodium channel blocker causes gingival hyperplasia, arrythmias due to class 1B antiarrythmic association, and can cause cleft palate/congenital heart disease/slowed growth rate/mental deficiency if given during pregnancy?

Answer 6

Phenytoin

Question 7

Which sodium channel blocker, when given with depakote, can cause TERRIBLE rash that is life-threatening and basically Steven-Johnson X 1,000?

Answer 7

Lamotrigine (lamictal)

Lam”oh my god”trigine

Question 8

Which sodium channel blocker has the highest rates of kidney stones?

Answer 8

Zonisamide

Kidney ZONES…zonisamide!

KIDNEYZONISAMIDE

STONEISAMIDE

Question 9

Which sodium-channel blocker has the best safety profile?

Answer 9

Lacosamide

La”coast”amide

Question 10

Which benzodiazepine has the highest rates of withdrawal?

Answer 10

Clobazam (Onfi)

Question 11

Which benzo is the most and least lipophilic?

Answer 11

clobazam and temazepam

Question 12

______ is only available through a very specific program with REMS monitoring because of risk of permanent vision loss,

Answer 12

Vigabatrin

Vi”sual”gabatrin

Question 13

What is gabapentin mostly used for?

Answer 13

Neuropathic pain or anxiety. Helps reduce pain post-operatively

Question 14

Which combination of medications greatly increases the risk of hyponatremia?

Answer 14

SSRIs and Carbamazepine (Tegretol)

Question 15

What is a fairly common yet weird side-effect of pregabalin?

Answer 15

Difficulty walking, gait abnormalities

Question 16

This seizure medication may raise ammonia levels leading to possible confusion, agitation, and delirium

Answer 16

Valproic Acid

Valproic A”mmonia”cid

Question 17

With in utero exposure, ______ can lower IQ in children compared to other anti-epileptics (category D-X)

Hint: it also raises ammonia levels

Answer 17

Valproic Acid

“Valprammonia”

Question 18

Which anticonvulsant can make you feel like your mind and body are disconected?

Answer 18

Topiramate

Top”off”iramate

Question 19

This seizure med can cause SEVERE cognitive impairment? Example of professors friend who would forget everything

Answer 19

Levetiracetam (keppra)

Question 20

What the fuck does dantrolene do

Answer 20

Blocks ryanodine channel, reduces Ca ++ release from SR

Med of choice for malignant hyperthermia

Question 21

Which class of antidepressant has significant anticholinergic properties?

Answer 21

TCAs- tricyclic antidepressants

Tricyclic anticholinergic antidepressants..

Question 22

What do you give for a tricyclic antidepressant overdose?

Answer 22

NaHCO3 d/t metabolic acidosis, supportive therapy

Question 23

What do all anti-depressants have BLACK BOX WARNING FOR?

Answer 23

Suicidal ideations

Question 24

Which SSRI has a black box for QT prolongation

Answer 24

Citalopram (Celexa)

Question 25

______ are the most highly sedating anti-depressants

Answer 25

5HT2A antagonist (trazadone is an example)

Question 26

_______ is used for Pseudobulbar affect (laughing inappropriately)

Answer 26

Nuedexta

“Nuts”dexta

Question 27

Which generation of antipsychotics are supposed to be safer, but aren’t really?

Answer 27

2nd

Question 28

_______ have a black box warning for dementia related death, agranulocytosis

Answer 28

Antipsychotics

Question 29

Levodopa is a ______, and carbidopa is _______

Answer 29

Levodopa = dopamine precursor
Carbidopa = false dopamine

Question 30

What are the two classes of Alzheimer’s Medications

Answer 30

Acetylcholinesterase Inhibitors

NMDA receptor antagonists

Question 31

What is the most common side effect of AChEi

Answer 31

Rest/digest side effects

Bradycardia
Loose stools
OAB

Question 32

What do alzheimers meds do to succinylcholine and other NMB?

Answer 32

POTENTIATE succinylcholine

REDUCE blockade of other NMB

Question 33

Antipsychotics - too much dopamine
Parikinsons - not enough dopamine

Answer 33

Yep

Question 34

Carbidopa/Levodopa (Sinemet) improves Parkinson’s symptoms via which mechanism of action?

Answer 34

Dopamine receptor agonist

Question 35

One way to predictably reduce the incidence of post-operative delirium is to use lighter sedation.

Answer 35

FALSE

Question 36

Aricept (Donepezil), a medication used for Alzheimer’s disease, may antagonize the effects of succinylcholine.

Answer 36

FALSE

Question 37

Which seizure medication has similar antiarrhythmic properties as Lidocaine?

Answer 37

Phenytoin (Dilantin)

Question 38

An FDA safety communication from 12/2019 stated that gabapentinoids (like Gabapentin) increase the risk of which side effect when combined with opiates?

Answer 38

Respiratory depression