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TOP 200 II > Week 7 Mental health part 4 > Flashcards

Week 7 Mental health part 4 Flashcards

1
Q

Amphetamine/Dextroamphetamine

A

Adderall

Adderall XR

Dosed once daily – can sprinkle on applesauce

Central Nervous System

Stimulant

CNS Stimulant

ADHD; narcolepsy,

Weight loss/loss of appetite; insomnia; irritability/restlessness; headache; xerostomia; (rare but serious: mania/psychotic disorder; cardiac issues; seizure; drug dependence)

TCAs; MAOIS

BW: Abuse/dependence potential; BW: unmasking depression during withdrawal; BW: Serious cardiac events

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2
Q

Dexmethylphenidate

A

Focalin

Central Nervous System

Stimulant

CNS Stimulant

ADHD

Weight loss/loss of appetite; insomnia; irritability/restlessness; headache; xerostomia; (rare but serious: mania/psychotic disorder; cardiac issues; seizure; drug dependence)

TCAs; MAOIS

BW: Abuse/dependence potential; BW: unmasking depression during withdrawal; BW: Serious cardiac events

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3
Q

Divalproex

A

Depakote

Depakene

Central Nervous System

Anticonvulsant

Anticonvulsant/Anti-epileptic

Seizures; Manic bipolar; Migraine prophylaxis

Alopecia; Tremor; Vision Disturbances; GI issues; Thrombocytopenia

Warfarin (increased bleeding risk) ; Olanzapine; Phenytoin; Carbamazepine; Lamotrigine; Contraceptives (decrease divalproex levels)

BW: Hepatotoxicity; Mitochondrial disease; Fetal risk; Pancreatitise

Pregnancy category: D/X

• Patient Counseling
o Discuss the importance of contraception with this medication
o Watch for signs of bleeding and report if they occur
o Contact provider is lethargy, N/V, anorexia or jaundice occur  liver problems

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4
Q

Gabapentin

A

Neurontin

Central Nervous System

Anticonvulsant

Anticonvulsant/Anti-epileptic

Seizure; Diabetic peripheral neuropathy; Postherpetic neuralgia; Restless Leg Syndrome

Peripheral edema; Dizziness; Somnolence; Weight gain/increased appetite

Antacids; Alcohol; CNS depressants

BW: Increased risk of suicidal ideation; Risk of seizure with abrupt withdrawal

Pregnancy category: C

• Patient Counseling
o Pregabalin liquid BUD is 45 days from opening, all remaining should be discarded
o Do not discontinue abruptly; risk of withdrawal and seizure
o Gabapentin ER should be taken with bedtime
o Separate antacids by 2 hours

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5
Q

Lamotrigine

A

Lamictal

Central Nervous System

Anticonvulsant

Anticonvulsant/Anti-epileptic

Seizure; bipolar disorder

Rash; Diplopia; Stevens
Johnson Syndrome/Toxic Epidermal Necrolysis; N/V; Sedation/insomnia

Oral contraceptives ( Decreases levels of lamotrigine) ; Valproate (  Increases lamotrigine levels); Carbamazepine ( Decreased lamotrigine levels)

BW: Skin reaction; Precautions: aseptic meningitis, blood dyscrasias

Pregnancy category: C

• Patient Counseling
o Screen female patients for oral contraceptive use
o Discuss risks of severe dermatologic issues and to screen for these symptoms
 Immediately report

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6
Q

Lisdexamfetamine

A

Vyvanse

Dosed once daily – can dissolve contents in water

Central Nervous System

Stimulant

CNS Stimulant

ADHD; binge eating disorder

Weight loss/loss of appetite; insomnia; irritability/restlessness; headache; xerostomia; (rare but serious: mania/psychotic disorder; cardiac issues; seizure; drug dependence)

TCAs; MAOIs

BW: Abuse/dependence potential; BW: unmasking depression during withdrawal; BW: Serious cardiac events

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7
Q

Methylphenidate ER

A

Concerta

Ritalin (IR, LA, SR); Metadate; Methylin

Dosed once daily – must swallow whole
Lasts 12 hours (longest oral)

Central Nervous System
Stimulant

CNS Stimulant

ADHD; narcolepsy

Weight loss/loss of appetite; insomnia;
irritability/restlessness; headache; xerostomia; (rare but serious: mania/psychotic disorder; cardiac issues; seizure; drug dependence)

TCAs; MAOIS; SSRIs/SNRIs

BW: Abuse/dependence potential; BW: unmasking depression during withdrawal; BW: Serious cardiac events

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8
Q

Pregabalin

A

Lyrica

Central Nervous System

Anticonvulsant

Anticonvulsant/Anti-epileptic

Seizure; Diabetic peripheral neuropathy; Postherpetic neuralgia; Restless Leg Syndrome; Fibromyalgia

Peripheral edema; Dizziness; Somnolence; Weight gain/increased appetite

Alcohol; CNS depressants

BW: Increased risk of suicidal ideation; Risk of seizure with abrupt withdrawal

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9
Q

Topiramate

A

Topamax

Qsymia (w/phentermine)
Central Nervous System
Anticonvulsant

Anticonvulsant/Anti-epileptic w/ carbonic anhydrase inhibition

Seizure; Migraine prophylaxis; Weight loss (w/phentermine); Alcohol dependence (off-label); Binge eating (off-label)

Loss of appetite; word-finding difficulty; impaired psychomotor performance; low serum bicarbonate; nephrolithiasis, KIDNEY STONES

TCA (Amitriptyline); Oral contraceptives

CI: Metabolic Acidosis; Precautions: Liver and kidney disease

Pregnancy category: D

• Patient Counseling
o Do not discontinue abruptly; risk of withdrawal and seizure

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10
Q 
Which of the following Week 9 Medications
is an anticonvulsant?
A. Adderall®
B. Concerta®
C. Topamax®
D. Focalin®
A

C. Topamax®

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11
Q

Which of the following medications can patients
be counseled that they can empty contents into
water?
A. Vyvanse®
B. Ritalin®
C. Adderall® XR
D. Daytrana®

A

C. Adderall® XR

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12
Q 
What controlled substance class do you
think CNS stimulants fall into?
A. No class, they are not
controlled substances
B. Schedule I
C. Schedule II
D. Schedule III
E. Schedule IV
F. Schedule V
A

C. Schedule II

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13
Q 
What is the branded medication name for
gabapentin?
A. Neurontin®
B. Lyrica®
C. Amaryl®
D. Ambien®
A

A. Neurontin®

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14
Q 
How should a female taking a hormonal
contraceptive be counseled about dual use with
topiramate?
A. Taking these medications together
is okay, it will not affect your risk of
pregnancy
B. Taking these medications together
will increase your risk of blood
clots
C. Taking these medications together
will decrease the effectiveness of
your birth control
D. Taking these medications together
will decrease the effectiveness of
your seizure medication
A

C. Taking these medications together
will decrease the effectiveness of
your birth control

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15
Q 
How should a female taking a hormonal
contraceptive be counseled about dual use with
lamotrigine?
A. Taking these medications together
is okay, it will not affect your risk of
pregnancy
B. Taking these medications together
will increase your risk of blood
clots
C. Taking these medications together
will decrease the effectiveness of
your birth control
D. Taking these medications together
will decrease the effectiveness of
your seizure medication
A

D. Taking these medications together
will decrease the effectiveness of
your seizure medication

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16
Q 
Which anticonvulsant should patients be
monitored for/counseled about the kidney
stones?
A. Topiramate
B. Divalproex
C. Gabapentin
D. Lisdexamfetamine
A

A. Topiramate

17
Q

Patient counseling

A

• Patient Counseling
o Take in the morning (once a day); twice a day: second dose in the afternoon or evening (i.e. to help with homework)
o Avoid evening/late afternoon doses due to insomnia
o Do not abruptly stop taking the medication
o Generally, extended release products can be opened and sprinkled into food; pour into a small amount of soft food (i.e. applesauce); stir well and swallow without chewing
o Need to warn patients about serious adverse effects (e.g. sleep, mood, appetite, addiction, cardiac events) and what to do

18
Q

General Anticonvulsant Points

A
  • Most contain a Boxed Warning for suicidal ideation or have reports of increased risk; should monitor for signs and symptoms of this like with antidepressants
  • Risk of seizures increases when abruptly stopped
  • Special considerations should be made in women of child-bearing potential due to interactions with contraceptives and teratogenic risk of some of these medications
  • SIGNIFICANT impact of enzymes in the liver (CYP P450); always check for drug interactions when patients are starting/stopping new medications

TOP 200 II (14 decks)

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