Pharm 7

Question 1

What SSRIs (2) increases TCA levels?

Answer 1

Paroxetine and Fluoxetine bc it is a potent CYP2D6 inhibitor

Question 2

What 8 medications should you classically AVOID in LIVER disease?

Answer 2

Antidepressant:
1. Cymbalta

SGA:

2. Iloperidone
3. Asenapine

FGA

4. Fluphenazine
5. Perphenazine
6. Trifluoperazine

Hypnotics

7. Zelaplon
8. Zolpidem

Question 3

What two medications do you want to classically avoid in RENAL disease?

Answer 3

Cymbalta

Lithium

Question 4

What pregnancy risk category is Isotretinoin?

Answer 4

Category X (known to cause harm.)

Question 5

Other than Epstein’s anomaly, what other effect does Lithium have for neonatal exposure?

Answer 5

Floppy baby syndrome (cyanosis, hypotonicity, due to Li exposure to baby)

Question 6

What are the teratogenic effects of VPA?

Answer 6

Organ dysgenesis:

• NT defect (1-5%)
• Craniofacial defects
• Cardiac abnormalities.

Behavioral/Neural:

• Lower IQ
• Autism spectrum disorder

Question 7

Is Lamotrigine safe in pregnancy?

Answer 7

Likely safe. Potential maintenance medication in pregnancy for BPAD.

Question 8

Which Cytochrome enzyme is induced by cigarette smoke to cause decrease in Clozaril level?

Answer 8

CYP 1A2

Question 9

What drug that is used to treat CO poisoning can cause Serotonin Syndrome?

Answer 9

Methylene Blue

Question 10

What are the classic medications that interact and cause the following and how:

1. Lamotrigine toxicity?
2. TCA toxicity ?
3. Warfarin, Theophylline, and Clozapine toxicity?
4. Carbamazepine Toxicity?
5. Decreased VPA and OCP

Answer 10

1. Lamotrigine toxicity
   - VPA (UGT 1A4 inhibition)
2. TCA toxicity:
   - Fluoxetine and Paroxetine (CYP 2D6 inhibition)
3. Warfarin, Theophylline and Clozapine toxicity:
   - Fluvoxamine (CYP 1A2)
4. Carbamazepine toxicity:
   - Erythromycin
5. Decease VPA and OCP:
   - Carbamazepine (CYP 3A4)