Pharmacology

Question 1

Mesocortical pathway

Answer 1

Negative symptoms

Question 2

Mesolimbic pathway

Answer 2

Positive symptoms

Question 3

Tuberoinfundibular pathway

Answer 3

Prolactin increase (due to loss of inhibition by dopamine)

Question 4

Nigrostriatal

Answer 4

EPS

Question 5

Most loose binding @ D2?

Answer 5

Clozapine

Seroquel

Question 6

D2 blockade needed for efficacy?

Answer 6

68%

Question 7

D2 blockade needed for hyperprolactinemia?

Answer 7

72%

Question 8

D2 blockade needed for EPS?

Answer 8

80%

Question 9

Abilify mechanism?

Answer 9

Partial agonist 5HT1A

Antagonist 5HT2A

Question 10

Receptors associated with weight gain?

Answer 10

5HT2C

Histamine

Question 11

Alpha 1 antagonism

Answer 11

Tachycardia
Increased salvation
Urinary incontinence
Priapism

Question 12

Alpha 2 antagonism

Answer 12

Sexual dysfunction

Question 13

Which antipsychotic does not cause QT prolongation?

Answer 13

LATUDA

Question 14

Anticholinergic effect of antipsychotics?

Answer 14

Dopamine INHIBITS acetylcholine.

LOW potency APs are more ANTICHOLINERGIC (Clozapine, Seroquel)

The MORE anticholinergic you are, the LESS your risk for NMS

Question 15

Serious side effect of Flumazenil (benzo intox treatment)?

Answer 15

SEIZURE

Question 16

Lithium tremor

Answer 16

Fine, rapid
Increases with fine movements and when maintaining posture

Treat with BETA-BLOCKER

Question 17

Akathisia most common with which AP?

Answer 17

ABILIFY

Question 18

Which antidepressants don’t cause SIADH?

Answer 18

Mirtazapine

Wellbutrin

Question 19

No anticholinergics for?

Answer 19

AKATHISIA

TD

Question 20

No beta-blockers for?

Answer 20

DYSTONIA

Question 21

Which medication can you not take while on Clozapine?

Answer 21

CARBAMAZEPINE

combined myeloproliferative disease

Question 22

Agranulocytosis

Answer 22

1%
1st year of treatment
NOT dose dependent

Question 23

Myocarditis

Answer 23

0.06%

Highest risk during 1st month of treatment

Question 24

Clozapine missed dose

Answer 24

> 48 hours, have to re-start progressive dosing but can go faster

Question 25

Clozapine level

Answer 25

350-550ng/ml | 306-1836nmol/L

Question 26

Clozapine flag

Answer 26

GREEN WBC > 3.5 ANC > 2.0 YELLOW WBC 3.5 - 2 (fall > 3.0 in 4 weeks and < 4.0) ANC 2 - 1.5 (fall > 1.5 in 4 weeks and < 2.5) **CBC 2x per week until green evaluate for flu-like sx** ``` RED WBC < 2 ANC < 1.5 **STOP RX, confirm results within 24 hours** Continue CBC weekly x 4 weeks Patient non-rechallengeable ``` ISOLATION WBC < 1 ANC < 0.5

Question 27

Invega loading dose timing?

Answer 27

Day 8 (+/- 4 days)

Question 28

Invega monthly dose timing?

Answer 28

+/- 7 days If missed dose 4-6 weeks, can give usual. More than that, have to re-start with loading dose. > 6 months, have to re-start at beginning dose.

Question 29

How long Abilify PO needed with Maintena?

Answer 29

2 weeks after starting IM

Question 30

Maintena missed dose?

Answer 30

More than 5-6 weeks, need PO x 2 weeks again

Question 31

How long Risperdal PO needed with Consta?

Answer 31

3 weeks after starting IM

Question 32

Consta missed dose?

Answer 32

Missed 2nd dose or > 6 weeks any other dose, need PO x 3 weeks again

Question 33

Benzo taper at what rate?

Answer 33

25%/week

Question 34

Latuda needs to be taken with how many calories?

Answer 34

350

Question 35

Pregabalin (Lyrica)

Answer 35

Better tolerated than Neurontin (Gabapentin) No medication interactions Renally excreted

Question 36

Ziprasidone

Answer 36

``` Anti-histaminic Give with 500 calories > 120mg more efficacious Little weight gain ++ QT prolongation Moderate increase in prolactin ```

Question 37

Which Rx can commonly give alopecia?

Answer 37

Epival!

Question 38

Which Rx can give pancreatitis?

Answer 38

Epival

Question 39

Epival and Lamictal interaction?

Answer 39

Epival INCREASES Lamictal by 50% Lamictal DECREASES Epival by 25% Through glucuronidation

Question 40

Lamictal missed dose?

Answer 40

> 5 days need to re-start titration

Question 41

OCP decreases the efficacy of which Rx?

Answer 41

LAMICTAL

Question 42

Lamictal rash?

Answer 42

8% benign | 1% severe

Question 43

Normal amount of urine in 24 hours?

Answer 43

1-2 liters

Question 44

Lithium common side effects?

Answer 44

HYPOthyroidism HYPERcalcemia via HYPERparathyroidism ``` Polyuria/polydipsia Diabetes insipidus (nephrogenic, decreased response to ADH = HYPONATREMIA ``` Worsening of psoriasis Leukocytosis Tremors Myasthenia gravis symptoms Exophthalmia

Question 45

Lithium changes in renal morphology?

Answer 45

Interstitial fibrosis | SINGLE dose is better

Question 46

What decreases Lithium levels?

Answer 46

``` Coffee High salt diet Pregnancy Mannitol Theophylline Acetazolamide Spironolactone ```

Question 47

What increases Lithium levels?

Answer 47

``` Thiazide diuretics ACEI ARBs NSAID, Coxed Propranolol Dehydration Age No salt diet ```

Question 48

Which medications have no interaction with Lithium?

Answer 48

``` Amiloride Lasix ASA Tylenol Calcium channel blocker ```

Question 49

Mild lithium toxicity symptoms?

Answer 49

1.5-2.0 | Ataxia, tremor, nystagmus, dysarthria

Question 50

Moderate lithium toxicity symptoms?

Answer 50

``` 2-2.5 HYPERreflexia seizures delirium hallucinations ```

Question 51

What's not helpful for treating lithium toxicity?

Answer 51

ACTIVATED CHARCOAL (not absorbed).

Question 52

How many half-lives needed to get to steady state?

Answer 52

5

Question 53

Pharmacokinetics factors?

Answer 53

What body does to drug: 1. Absorption 2. Distribution 3. Metabolism 4. Excretion

Question 54

Pharmacodynamics factors?

Answer 54

What drug does to body: 1. Efficiency (INDEPENDENT OF CONCENTRATION) 2. Power 3. Affinity

Question 55

Which medications need 2D6 activation?

Answer 55

Tamoxifen Tramadol Hydrocodone Codeine