Video Document for Exam 1

Question 1

What is meant by the column title “Activation”?

Answer 1

activation, a cluster of symptoms that represent a hyperarousal event characterized by impulsivity, restlessness, and/or insomnia.

Question 2

Agoraphobic/panic treatment times.

Answer 2

assign the longer time (24 months) to agoraphobic and 18 to all other panic disorders.

Question 3

Ramelteon (Rozerem) is confusing to me - so it is good for patients w/a hx of substance abuse, but it cannot be used in pts w/liver impairment, but aren’t those often times the same people? What do you do if you have a patient who has a hx of substance abuse and has impaired liver function? What would you prescribe for them?

Answer 3

It would also depend on the extent of liver disease, mild to moderate is likely to tolerate ramelteon with monitoring. Severe cases would be more likely to have issues.

Question 4

For diarrhea, do you start an antibiotic when one symptom is bloody diarrhea?

Answer 4

No, but it is a red flag. Generally, if fever plus bloody diarrhea then yes or if going on for 3 days with worsening symptoms. If blood is bright red will need to determine if they suffer from hemorrhoids or anal fissures before jumping to conclusions too.

Question 5

What about HRT and an intact uterus, I cannot remember

Answer 5

HRT should always include a progesterone component in women with an intact uterus to decrease the risk of endometrial cancer.

Question 6

SSRIs and suicidality:

Answer 6

Monitor weekly in first few weeks in patient with comorbid depression and pts under age 25.

Question 7

SSRIs and weight gain:

_________ is more likely to cause weight gain.

Answer 7

Paroxetine

Question 8

SSRIs and thrombocytopenia:

Reported with ______________.

Answer 8

citalopram

Question 9

SSRIs and QT prolongation.

Before starting ____________, consider EKG and measurement of QT interval in patients with cardiac disease.

Answer 9

citalopram

Question 10

SSRIs and discontinuation syndrome:

Avoid disrupt discontinuation in all but ____________.

Answer 10

fluoxetine

Question 11

SNRIs and elevated BP:

Answer 11

Monitor BP on initiation and regularly during treatment

Question 12

TCAs and anticholinergic effects:

Answer 12

Contraindicated with narrow-angle glaucoma, BPH, and urinary retention

Question 13

TCAs and sedation:

Answer 13

Administer at bedtime when feasible.

Question 14

TCAs and cholinergic rebound:

Answer 14

Avoid abrupt discontinuation; taper doses.

Question 15

BZDs and anterograde amnesia and memory impairment:

Answer 15

Risk of anterograde amnesia is worsened with concomitant intake of alcohol

Question 16

BZDs and withdrawal syndromes:

Answer 16

Taper doses on discontinuation

Question 17

BZDs and respiratory depression:

Answer 17

Avoid administering with other CNS depressants (opioids, alcohol, etc)

Question 18

MAOIs and hypertensive crisis:

Answer 18

Tyramin free diet and avoidance of drug interactions required.

Question 19

When would be the appropriate time to use misoprostol for NSAID induced ulcers?

Answer 19

As prevention only.

Question 20

When to choose an SNRI over an SSRI?

Answer 20

1. SSRI preferred primary
2. SNRI when can treat two or more conditions with one med
3. SNRIs should be avoided if uncontrolled HTN

Question 21

anything we should know specifically about taking ACE-I, ASA, and statins with DM?

and this is completely independent of any prior cardiac Hx?

Answer 21

1. It is the diabetic outcomes improving tri-fecta
2. Yes

Question 22

18. Can beta-blockers hide a potential thyroid storm?

Answer 22

1. No, but propranolol can be used during a thyroid storm to help treat it. Propranolol is the preferred BB for this.

Question 23

a side effect of alpha blockers are __________ dysfunction.

Answer 23

erectile

Question 24

20-35 grams of fiber needed per day.

Answer 24

-