Non-pain treatments

Question 1

First line treatment for delirium

Answer 1

Haldol
Works quickly
Treats both hyper and hypoactive
Cant use in parkinsons
Can prolong QTc

Question 2

Treatment for parkinson’s related hallucinations

Answer 2

Quetiapine

Question 3

Second line for delirium treatment

Answer 3

Quetiapine
Can also use for night time sedation
Contraindications: Hypotension, seizures

Question 4

Indication for valproic acid in delirium

Answer 4

Indication: mood and behavior fluctuation (episodes of aggressive sexual behavior)
Weak evidence for agitation in dementia

Contraindications: Liver disease

Question 5

Indication of risperidone in delirium

Answer 5

Better for long term use because lower risk of extrapyramidal symptoms
Live expectancy weeks to months

Contraindication: parkinsons dz

Question 6

Indication for aripiorazole for delirium

Answer 6

Does not effect QTc, less sedating than other antipsychotics
Maybe better for hypoactive delirium

Contraindications: parkinsons, seizures
SE: sedation, EPS, weight gain, HA

Question 7

Digoxin toxicity in elderly

Answer 7

Anorexia, nausea and confusion

Question 8

Risk factors for developing anxiety disorder in cancer survivor

Answer 8

1 younger age

2. living alone
   female
   shorter time since cancer diagnosis

Question 9

Signs of serotonin syndrome

Answer 9

Neurologic- seizures, AMS, myoclonus, tremors, ataxia
autonomic - tachy, hyperthermia, HTN, flushing
Diarrhea

Question 10

Common side effect of modafinil

Answer 10

Headache

Overdose: agitation, palpitations, HTN, insomnia

Question 11

Insomnia dosing for Mirtazapine

Answer 11

7.5mg or higher

Question 12

Use for Kava-kava

Answer 12

anxiety/adjustment disorder

Question 13

Use of sympathyl

Answer 13

anxiety

Question 14

Which TCAs have less anticholinergic side effects

Answer 14

Desipramine and nortriptyline

Question 15

Presentation of neuroleptic malignant syndrome

Answer 15

Fever, muscle rigidity, hyperthermia, AMS, autonomic dysfunction

Usually caused by antipsychotics

Question 16

Neuroleptic malignant syndrome caused by clozapine

Answer 16

Atypical
less likely to have muscle rigidity or tremors

Question 17

MOA Tizanidine

Answer 17

Central alpha 2 adrenergic receptor agonist

inhibits presynaptic motor neurons

(msk relaxer)

Question 18

MOA Baclofen

Answer 18

GABA agonist
reduces the release of excitatory neurotransmitters and substance P

Question 19

MOA orphenadrine

Answer 19

muscarinic antagonist

blocks NMDA receptors

Question 20

MOA cyclobnzaprine

Answer 20

similar to first gen TCA
inhibits norepi reuptake receptors and sertonergic pathways in spinal cord

Question 21

Tx for diarrhea

Answer 21

BRAT diet
Kaolin and Pectin (bulk forming agent, can take 48hr to work and interfere with absorption of other meds)
Loperamide (opioid, only for noninfectious)

Question 22

tx for infectious diarrhea

Answer 22

Antibiotics (if infectious cause)
Bismuth (added to abx if e. coli)

Question 23

tx for radiation induced enteritis

Answer 23

Aspirin
cholestyramine
psyllium

Question 24

MOA loperamide

Answer 24

opioid
decreases gut peristalsis
increases water reabsorption
promotes fecal continence

only weakly crosses BBB

initial dose 4mg (max 54mg/day)

Question 25

Tx for diarrhea iso IBS

Answer 25

Mesalamine

Question 26

tx for secretory diarrhea in pt with HIV

Answer 26

octreotide

Question 27

Tx hiccups

Answer 27

Chlorpromazine (haldol as alternative) Gabapentin Phenytoin (if CNS etiology) Baclofen (did not eliminate but improved sx) Metaclopramide (if stomach distention is etiology)