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Question 1

ALPRAZOLAM

Answer 1

Brand: Xanax
Class: Benzodiazepine
Indication: Anxiety or Panic Disorder
Contraindication: Hypersens, Glaucoma, Ketoconazole/Itraconazole use
MOA: Enhances the postsynaptic effect of GABA
Black Box: Don’t use with Opioids
Preg/BB: Risk/Toxicity
Counseling: Drowsiness, avoid driving, alcohol, don’t abruptly discontinue, can administer mixed in liquid or semisolid food. If only 1/2 tab taken, discard other half.

Question 2

AMYTRIPTYLINE

Answer 2

Brand: Elavil
Class: Tricyclic Antidepressant
Indication: Migraine, PTSD, Fibromyalgia, Chronic pain/fatigue
Contraindication: Hypersens, concurrent MAOI use, acute recovery after Myocardial Infarction, Coadministration of Cisapride
MOA: Blocks presynaptic reuptake of serotonin/norepinephrine with adrenergic downregulation
Black Box: Suicidality & < 12y/o
Preg/BB: Low risk/Potential Toxicity
Counseling Pts: Avoid operating heavy machinery, alcohol, CNS depressants, sudden discontinuation. Symptoms may take weeks to improve.

Question 3

BUPROPRION

Answer 3

Brand: Wellbutrin
Class: Monocyclic Antidepressant
Indication: Depression, Season Affective Disorder, Smoking cessation assistance.
Contraindication: history of anorexia/bulimia, seizure disorder, use of MAOI within 14d, undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, antileptics
MOA: Mild Dopamine & Norepinephrine reuptake inhibitor with no direct effect on serotonin receptors or MAO
Black Box: Suicidality, Neuropsychiatric reactions
Preg/BB: Low Risk/Potential Toxicity
Counseling Pts: Avoid CNS Depressants, Alcohol, operating heavy machinery. Take at the same time each day, preferably at bedtime. ER form may be visible in stool.

Question 4

CITALOPRAM

Answer 4

Brand: Celexa
Class: Bicyclic SSRI Antidepressant
Indications: Depression
Contraindications: Hypersens, Pimozide and MAOI use.
MOA: Selective inhibitor of presynaptic reuptake of serotonin. Lack of affinity for serotonin receptors.
Black Box: Suicidal Ideation, Pediatrics (not approved)
Preg/BB: Risk in 3rd Trimester/Potenial Toxicity
Counseling Pts: Avoid operating heavy machinery, alcohol, NSAIDS, aspirin, abrupt discontinuation. Report worsening symptoms or change in behavior.

Question 5

CLONAZEPAM

Answer 5

Brand: Klonopin
Class: Benzodiazepine C-4
Indication: Panic Disorder & Seizure
Contraindication: Hypersens, Glaucoma, liver disease
MOA: Enhances the postsynaptic effect of GABA
Black Box: Concurrent use with opioids, abuse/addiction, withdrawal reactions
Preg/BB: Low Risk/Compatible
Counseling Pt: Drowsiness, Avoid operating heavy machinery, alcohol. ODT dissolves on tongue

Question 6

DEXTROAMPHETAMINE

Answer 6

Brand: Dexedrine
Class: CNS Stimulant, C2
Indication: ADHD
Contraindication: Hypersens, MAOI use, drug dependence, glaucoma, tics, Tourette’s.
MOA: Inhibiting reuptake of norepinephrine and dopamine, increasing neuronal firing rate and stimulating the cerebral cortex and subcortical structures.
Black Box: Abuse/Dependence
Preg/BB: Low Risk/Potential Toxicity
Counseling Pts: Take in morning (insomia @ night), If you cannot swallow the extended-release capsule, you may open it and pour the medicine into a small amount of soft food such as applesauce. Stir this mixture well and swallow it without chewing.

Question 7

DULOXETINE

Answer 7

Brand: Cymbalta
Class: Serotonin/Noepinephrine Reuptake inhibitor
Indication: Anxiety, Depression, Diabetic neuropathy pain
Contraindication: Hypersens, MAOI, tricyclic antidepressants (Amitriptyline)
MOA: potentiates the serotonergic/ noadrenergic activity in the CNS. No inhibition of MAO
Black Box: Suicidality. Pediatrics (not approved)
Preg/BB: 3rd Trimester Risk/Potential Toxicity
Counseling Pts: Report worsening symptoms or changes in behavior. May require 1-4 wks to improve symptoms. Possible hepatoxicity and GI Bleed. Avoid alcohol and abrupt discontinuation.

Question 8

ESCITALOPRAM

Answer 8

Brand: Lexapro
Class: SSRI Antidepressant
Indication: Depression, Generalized Anxiety Disorder
Contraindication: Hypersens, Concurrent MAOI use
MOA: inhibitor of presynaptic reuptake of serotonin. Lack of affinity for serotonin receptors.
Black Box: Suicidality
Preg/BB: 3rd Trimester Risk/Potential Toxicity
Counseling Pts: Avoid operating heavy machinery until drug effects kick in, systematic improvement may take 4-6 wks, Report worsening symptoms. Avoid alcohol, NSAIDs, aspirin, abrupt discontinuation.

Question 9

FLUOXETINE

Answer 9

Brand: Prozac
Class: SSRI Antidepressant
Indication: Depression, OCD, Panic Disorder, Premenstrual dysphoric disorder, bulimia nervosa
Contraindication: Hypersens, Concomitant primozide/thiodidazine/MAOIs
MOA: Selective inhibitor of presynaptic reuptake of serotonin
Box Warnings: Suicidality, Approved in children >7y/o (>8 if OCD)
Preg/BB: 3rd Trimester Risk/Potential Toxicity
Counseling Pt: Take w/o meals AM. Avoid operating heavy machinery, alcohol, NSAIDs, aspirin. Symptoms may take several weeks to improve. Adverse effects present in 1st week of therapy. Report worsening symptoms and unusual behavior.

Question 10

LAMOTRIGINE

Answer 10

Brand: Lamictal
Class: Phenytriazine Anticonvulsant
Indication: Bipolar Disorder, Partial Seizure
Contraindication: Hypersens
MOA: Inhibits voltage-dependent sodium channels which stabilizes neuronal membranes and reduces the release of glutamate and aspartate.
Black Box: Serious Skin Reactions
Preg/BB: Compatible/Potential Toxicity
Counseling Pts: Seek medical attention if blistering rash develops or yellowing of skin or eyes, unusual bruising/bleeding, SOB, suicidal thoughts occur. Slow titration necessary to minimize side effects. Avoid alcohol. Review driving restrictions due to seizures.

Question 11

LISDEXAMFETAMINE

Answer 11

Brand: Vyvanse
Class: Amphetamine, CNS Stimulant, C2
Indication: ADHD, Binge Eating Disorder
Contraindication: Hypersens, MAOIs, Symptomatic Cardiovascular, Advanced arteriosclerosis, HTN, hyperthyroidism, glaucoma, drug dependence
MOA: Prodrug converted to dextroamphetamine, release of dopamine and norepinephrine at presynaptic nerve terminals and block the reuptake of them via competitive inhibition.
Black Box: Abuse
Preg/BB: Risk/Potential Toxicity
Counseling pts: Take AM with(out) food. If capsule opened: dissolve in water/juice and consumed immediately. Monitor growth/weight in children. Report new/worsening psychiatric symptoms, chest pain, palpations dyspnea, dysrhythmia, AMI, cerebrovascular accident.

Question 12

LORAZEPAM

Answer 12

Brand: Ativan
Class: Benzodiazepine C4
Indication: Anxiety, Insomnia
Contraindication: Hypersens, Glaucoma
MOA: Enhance postsynaptic effect of GABA
Black Box: Don’t use with opioids
Preg/BB: 1st/3rd Trimester Risk/Probably Compatible
Counseling Pts: Drowsiness, avoid alcohol, operating heavy machinery.

Question 13

METHYLPHENIDATE

Answer 13

Brand: Ritalin
Class: CNS Stimulant, C2
Indication: ADHD, Narcolepsy
Contraindication: Hypersens, Anxiety, Agitation, MAOI use, Drug dependence, glaucoma, tics, Tourette’s, HTN, Angina, heart failure, concurrent halogenated anesthetics.
MOA: Inhibiting reuptake of norepinephrine and dopamine, increasing neuronal firing rate and stimulating the cerebral cortex and subcortical structures.
Black Box: Abuse/Dependence
Preg/BB: Moderate Risk/ Potential Toxicity
Counseling Pts: Don’t take at night (insomnia),If you cannot swallow the extended-release capsule, you may open it and pour the medicine into a small amount of soft food such as pudding, yogurt, or applesauce. Stir this mixture well and swallow it without chewing. Avoid abrupt discontinuation. For the patch, apply same time each day, alternating hips. Remove after 9 h.

Question 14

PAROXETINE

Answer 14

Brand: Paxil
Class: SSRI Antidepressant
Indication: Depression, General/Social Anxiety Disorder, Panic Disorder, OCD, PTSD, Premenstrual syndrome, vasomotor symptoms of menopause
Contraindication: Hypersens, concomitant use of thioridazine or MAOIs, pregnancy
MOA: Selective & Potent Serotonin reuptake inhibitor
Black Box: Suicidality
Preg/BB: Risk/Potential Toxicity
Counseling Pts: Don’t chew/crush ER form, shake suspension form before using, avoid operating heavy machinery till drug effects kick in, may take 6-8 weeks to improve symptoms

Question 15

QUETIAPINE

Answer 15

Brand: Seroquel
Class: Atypical Antipsychotic
Indication: Bipolar Disorder, Schizophrenia, Major depressive disorder
Contraindication: Hypersens
MOA: Antagonizes serotonin, dopamine, histamine, adrenergic receptors
Black Box: Mortality in the elderly, suicidality, <10 y/o
Preg/BB: Compatible/Potential Toxicity
Counseling Pts: W/ Food. Avoid alcohol, operating heavy machinery, high temperature. Rise slowly when getting up. Report worsening heart conditions.

Question 16

SERTRALINE

Answer 16

Brand: Zoloft
Class: SSRI Antidepressant
Indication: Depression, OCD (children 6-12), PTSD/Panic disorder, Premenstrual disorder
Contraindication: Hypersens, concomitant use of pimozide, thioridazine, or MAOIs.
MOA: Serotonin reuptake inhibitor that also indirectly downregulates beta-adrenergic receptors
Black Box: Suicidality, <6 y/o
Preg/BB: Risk in 3rd trimester, Potential toxicity
Counseling Pt: Avoid alcohol, operating heavy machinery till drug effects kick in, abrupt discontinuation, NSAIDs, aspirin. Report worsening symptoms/unusual behaviors or bleeding. Symptoms may take weeks to improve

Question 17

TOPIRAMATE

Answer 17

Brand: Topamax
Class: Anticonvulsant
Indication: Partial/Tonic Seizure
Contraindication: Migraine prophylaxis
MOA: Topiramate blocks voltage-dependent sodium channels, augments the activity of the neurotransmitter gamma-aminobutyrate at some subtypes of the GABA-A receptor, antagonizes the AMPA/kainate subtype of the glutamate receptor, and inhibits the carbonic anhydrase enzyme, particularly isozymes II and IV
Black Box: N/A
Preg/BB: Risk/Potential Toxicity
Counseling Pt: Avoid operating heavy machinery until drug effects kick in, Drug may cause dizziness and somnolence, especially if taken with alcohol or other CNS depressants. May cause diplopia, nervousness, confusion, and many other CNS effects. Do not discontinue drug abruptly, as this may cause increased seizure activity. Seek medical attention for new eye problems or high body temperature. May decrease sweating; avoid hot temperatures (including hot tubs and saunas). Maintain adequate fluid intake to minimize the risk of kidney stones. Instruct females on estrogen-progestin contraceptives to use an additional form of contraception due to decreased effectiveness of oral contraceptives. Take a missed dose as soon as possible, if more than 1 dose is missed, consult HCP.

Question 18

TRAZODONE

Answer 18

Brand: Desyrel
Class: Antidepressant
Indication: Depression
Contraindication: Hypersens, MAOI
MOA: The mechanism of antidepressant action is not fully understood but suspected to be related to its potentiation of serotonergic activity in the CNS by inhibiting reuptake of serotonin. Trazodone also significantly blocks histamine (H1) and α1-adrenergic receptors.
Black Box: Suicidal Ideation, Not in children
Preg/BB: Low Risk/Potential Toxicity
Counseling Pt: Avoid driving and other activities requiring mental alertness or coordination until drug effects are realized, as this medicine may cause dizziness or somnolence. Report signs/symptoms of priapism immediately. Avoid use of MAOI within the past 14 d. Avoid sudden discontinuation of drug. Do not drink alcohol, or use barbiturates or other CNS depressants while taking this drug.

Question 19

VENLAFAXINE

Answer 19

Brand: Effexor
Class: Antidepressant, Serotonin/ Norepinephrine Reuptake Inhibitor
Indication: Generalized Anxiety Disorder, Depression, Panic Disorder, Social Anxiety Disorder
Contraindication: Hypersens, MAOI
MOA: Potent reuptake inhibitor of serotonin and norepinephrine.
Black Box: Suicidal Ideation
Preg/BB: 3rd Trimester Risk/ Potential Toxicity
Counseling Pt: W/ Food. Swallow ER tablets whole. Avoid alcohol, abrupt discontinuation, operating heavy machinery. May take weeks for symptoms to improve.

Question 20

ZOLPIDEM

Answer 20

Brand: Ambien
Class: Nonbarbiturate Hypnotic C4
Indication: Insomnia
Contraindication: Hypersens, Complex sleep behavior
MOA: Binds the benzodiazepine receptor but is structurally different from a benzodiazepine. Sedative and hypnotic effects are due to increased chloride conductance, neuronal hyperpolarization, inhibition of action potential, and decrease in neuronal excitability.
Black Box: Risk of complex sleep behaviors (sleepwalking/driving, etc)
Preg/BB: Risk/Probably compatible
Counseling Pt: Take on empty stomach. Avoid alcohol, operating heavy machinery. Warn patient of sleep walking and other actions when not awake.