Pharm

Question 1

Clomipramine

Answer 1

Class: TCAD
Use: OCD in kids and adults

Question 2

Treatment of OCD

Answer 2

TCADs, SSRIs

Question 3

CNS stimulants for ADHD (three)

Answer 3

dextroamphetamine
methylphenidate
pemoline

Question 4

Management of leukopenia caused by clozapine

Answer 4

Mild (3000-3500): 2x per week CBC with diff

More serious (2000-3000): daily CBCs, cessation of clozapine, reinstitute clozapine after WBCs normalize

Agranulocytosis: protective isolation, d/c clozapine, obtain bone marrow specimen. If progenitor cells suppressed, don’t restart clozapine.

Question 5

Management of lithium toxicity

Answer 5

Mild-mod: supportive therapy with IV saline, Is/Os, frequent lithium levels
Severe (>3mEq/L): emergency dialysis

Question 6

Lab monitoring with carbamazepine therapy

Answer 6

Prior to initiation: CBC, PLT, retic, lytes, LFTs, preg test

After initiation: LFTs and LDH every month for first 2 months, then ever three months due to risk of hepatotoxicity

Question 7

Antidepressants and weight gain

Answer 7

TCAD > SNRI/MAOI > SSRI

Question 8

Uses of St John’s wort

Answer 8

depression, sedative, anxiolytic

Question 9

Uses of Ginseng

Answer 9

stimulant for fatigue, depression

Question 10

Treatment of bipolar in pregnancy

Answer 10

Valproic acid category X

Lithium category D (preferred)

Question 11

Treatment of acute dystonia 2/2 antipsychotic treatment

Answer 11

Treat acutely with benztropine or diphenhydramine

Long term consider decreasing antipsychotic, prescribing benztropine or diphenhydramine to prevent recurrence

Question 12

Antipsychotics with highest risk of glucose abnormalities

Answer 12

olanzapine, clozapine

Question 13

Management of akathisia 2/2 antipsychotics

Answer 13

Reduce offending med if possible. Propranolol for symptom reduction.

Question 14

ECT anesthesia

Answer 14

Methohexital as anesthetic
Succinylcholine as muscle relaxant
Anticholinergics to reduce salivation, prevent bradycardia

Question 15

Uses of buproprion

Answer 15

Depression

Hypoactive sexual desire disorder

Question 16

Treatment of tourette disorder

Answer 16

Antipsychotics

Question 17

Treatment of narcolepsy

Answer 17

Daytime sleepiness: stimulants (methylphenidate, pemoline, amphetamine)

Cataplexy: meds that decrease REM (TCAs, SSRIs)

Modafinil: decreases number of sleep attacks and improves psychomotor performance

Question 18

SNRI metabolism

Answer 18

Metabolized by P450. 5-10% of caucasions metabolize nortriptyline and desipramine slower and can develop toxic levels at low doses.

Question 19

Management of clozapine induced seizure

Answer 19

Temporarily d/c clozapine and start phenobarbitol. Then restart clozapine at 50% previous dose and gradually uptitrate.

Question 20

Antipsychotics and postural hypotension

Answer 20

Lowest risk with high potency FGAs which have fewer anticholinergic side effects

Question 21

MOAIs hypertensive crisis

Answer 21

Can be precipitated by tyramine or symphatomimetics

Question 22

Imipramine

Answer 22

Class: TCA
Uses: ADHD with comorbid anxiety or tics, nocturnal enuresis

Question 23

Most significant side effect of sildenafil

Answer 23

risk of MI due to increased O2 demand and stress on heart during sex (indirect effect)