Psych Pharm (not covered in other categories)

Question 1

(PPP 571)

what is the only antidepressant approved for treatment of bulimia?

Answer 1

fluoxetine

Question 2

(RoshReview)

what SSRI has the longest half-life?

Answer 2

fluoxetine

Question 3

(Rosh Review)
if a pt has a hx of chronic kidney disease, which is a contraindication for lithium, then ________________ is the recommended antimanic (mood-stabilizing) medication.

Answer 3

valproate

Question 4

(RoshReview)

what mood stabilizer is contraindicated in pts with CKD?

Answer 4

lithium

Question 5

(RoshReview)

what are rare adverse effects that may occur due to valproate use?

Answer 5

hepatotoxicity,
thrombocytopenia,
and pancreatitis

Question 6

(RoshReview)

pts who take valproate have to have what labs checked? and how often?

Answer 6

liver enzymes (AST, ALT)
platelets

every 6-12 months

Question 7

(RoshReview)

valproate is contraindicated for….who?

Answer 7

women who could possibly become pregnant due to the possibility of teratogenicity

Question 8

(RoshReview)

four uses for valproate

Answer 8

mania
TBI-related agitation (off-label)
sz
status epilepticus

Question 9

(RoshReview)
if a pt presents with s/s of OCD and would prefer pharmacologic therapy rather than CBT, what would be the most appropriate first-line agent?

Answer 9

sertraline

initial pharm treatment is a SSRI (fluoxetine, sertraline, paroxetine, citalopram, escitalopram)

Question 10

(RoshReview)

“How long should patients with OCD and a positive response to pharmacologic therapy remain on medication?”

Answer 10

“at least 1 year”

Question 11

(RoshReview)

define serotonin syndrome

Answer 11

rapid onset

combination of 2+ serotonin agonists or dosage changes

Question 12

(RoshReview)

three common categories of serotonin syndrome symptoms:

Answer 12

MENTAL STATUS CHANGES (agitation, pressured speech)

AUTONOMIC INSTABILITY (tachycardia, diarrhea, shivering, diaphoresis, mydriasis (WIDE OPEN PUPILS)

NM ABNORMALITIES (clonus, hyperreflexia (lower > upper), tremor, seizure

Question 13

(RoshReview)

what is the tx for serotonin syndrome?

Answer 13

benzos
hydration/cooling
cyproheptadine
(in that order)

Question 14

(RoshReview)

“what is the mechanism of action of buspirone?”

Answer 14

blocking 5HT1A autoreceptors

“it affects the serotonergic system by blocking 5HT1A autoreceptors”

Question 15

(RoshReview)

key differences between NMS and serotonin syndrome?

Answer 15

NMS: more gradual, usually develops over 24 hrs; associated w/ slow NM activity, rather than NM hyperactivity

SS: NM abnormalities = clonus, hyperreflexia, tremor, sz; rapid onset

Question 16

(RoshReview)

“which SSRI is best tolerated?”

Answer 16

escitalopram