Will be on exam 3 Flashcards
In 2011, the Office of Inspector General released its “Medicare Atypical Antipsychotic Drug Claims for Elderly Nursing Home Residents” report, which described that the majority (83%) of ___________________ drug claims were for residents without _____________ indications for use
will be on exam
atypical antipsychotic; FDA-approved
In 2005, the FDA mandated the addition of a “black box warning” to all atypical antipsychotics. Why?
will be on exam
Due to increased risk of mortality in older adults with dementia-related psychosis
In 2005, the FDA mandated the addition of a “black box warning” to all atypical antipsychotics due to increased risk of mortality in older adults with dementia-related psychosis.
What happened regarding this warning in 2008?
will be on exam
Was expanded in 2008 to include all typical antipsychotics as well
List the drugs that can induce seizures
will be on exam
BATHMIC
1) Bupropion
2) Alcohol, benzodiazepine or barbiturate withdrawal
3) Theophylline
4) Haloperidol and clozapine
5) Meperidine (opioid)
6) Illegal drug overdose (i.e., cocaine)
7) Carbapenem/ imipenem
Medications that induce lamotrigine glucuronidation include what?
Will be on exam
1) Carbamazepine
2) Phenobarbital
3) Phenytoin
4) Primidone
5) Rifampin
6) Lopinavir/ ritonavir
7) Atanazivir/ ritonavir
8) Estrogen
What is the one med that inhibits lamotrigine glucuronidation?
will be on exam
Valproic acid
1) Oral contraceptives do what to lamotrigine metabolism?
2) What does this mean you need to do?
“big exam thing” (pretty sure this is on there since he emphasizes this drug so much)
1) Estrogen induces UGT and increases lamotrigine metabolism
2) Increase lamotrigine dose; may see doses of 150 mg to 200 mg PO BID
Lamictal
1) Must be re-titrated if a patient misses more than ____ half-lives duration of medication.
2) Consider titration after missing _____ days of therapy w/ phenytoin, phenobarbital, primidone or carbamazepine
3) Consider after missing _______ days of therapy w/out valproic acid or an inducer
4) Consider after missing ______ days of therapy w/ valproic acid
He said “know if you need to re-titrate” when talking abt this section, so sounds like on exam
1) 5
2) 2.5
3) 5
4) 10
What drug has a boxed warning for aggression, hostility, irritability, anger, and homicidal ideation?
“know this”
Perampanel
Rufinamide (Banzel):
1) Is contraindicated in what?
2) When should you use caution?
“unique”
1) Severe liver impairment or in familial short QT syndrome
2) With other drugs that shorten QT interval
Why lorazepam at hospital and diazepam at home?
this is a test question
Lorazepam has the longest half life and longest efficacy. Also lipophilic and rapid acting.
Monoamine oxidase B (MAO-B) inhibitors:
1) What from foods may reach excessive systemic levels and increase the pressor response following MAOi ingestion?
2) Give examples of these foods
will be on exam
1) Tyramine
2) Avocado, cheeses, cured meats, beer
MAOB inhibitors: Rasagiline, selegiline, safinamide
For each of the following nonmotor Sx of Parkinson’s, list possible Txs:
1) Anxiety
2) Cognitive impairment
3) Depression
4) Drooling
“memorize this”
1) Venlafaxine, SSRIs
2) Eliminate anticholinergic agents, add cholinesterase inhibitor
3) Newer generation SNRI
4) Atropine SL drop, glycopyrrolate, ipratropium SL spray
For each of the following nonmotor Sx of Parkinson’s, list possible Txs:
1) Dysphagia
2) Fatigue
3) Hallucinations/ psychosis
“memorize this”
1) Avoid anticholinergic meds
2) Armodafinil, modafinil
3) Dose reduction and/ or elimination of adj. meds, esp. anticholinergics. Consider adding pimavanserin (FDA approved for psychosis in PD too)
For each of the following nonmotor Sx of Parkinson’s, list possible Txs:
1) Insomnia
2) Overactive bladder
3) RLS
“memorize this”
1) Non-benzo GABA-A agonists
2) Antimuscarinics
3) Gabapentin; dopamine agonist at bedtime
Carbidopa/ldopa has what 3 adverse effects?
“specific”
1) Drowsiness
2) Dyskinesias
3) Nausea
Only __________________ has an FDA-approved indication for PD psychosis
“This will be a test question”
Pimavanserin
True or false: The first dose of antibiotics should not be withheld, even when lumbar puncture is delayed or neuroimaging is being performed.
“will be on exam”
True
It is strongly recommended that the time from suspected diagnosis to initiation of antibiotic treatment should not exceed how long?
1 hour
“will be on exam”
Out of all the carbapenems, ____________ is preferred for for S. pneumoniae meningitis
meropenem
(imipenem not preferred bc it causes seizures)
Generally meningitis should be treated for about 2-3 weeks, but what are the exceptions?
If G negative or Listeria (listeria like 21+ days; G- can be 7-10 days)
List 3 anticholinergic drugs used for Parkinson’s
(exam will make you identify a drug as anticholinergic)
1) Pimavanserin (approved for psychosis in PD)
2) Benztropine
3) Trihexyphenidyl
Which of the following is a strong CYP inhibitor?: phenobarbital, lamotrigine, divalproex, oxcarbazepine
Divalproex (might need QOD dosing, 10 day buffer)
Divalproex (valproic acid): does it inhibit or induce?
Inhibit [CYP2C9] (“super inhibitor”)
When the HLA-B 1502 allele in Asian patients is mentioned, you should think of what epilepsy drug?
carbamazepine
1) Aricept is the brand name for what?
2) How is this drug dosed?
1) Donepezil [AD drug, cholinesterase inhibitor]
2) 5mg Qday at night (but start w. morning)
What is the brand name of memantine?
Namenda/ Namenda XR
[NMDA antagonist; AD drug]
Explain how to dose memantine
1) Reg: start at 5mg Qday, then titrate weekly in 5mg intervals until you get to 10mg BID
2) XR: start at 7mg Qday, then titrate weekly in 7mg intervals until you get to 28mg Qday
3) If severely renally impaired (cl/cr 5-29): Use 5mg BID for Reg
-14mg Qday for XR
When should you use ethosuximide?
DOC for absence seizures; do NOT use for general tonic-clonic
1) Which benzo is most appropriate for inpatient use for status epilepticus?
2) What abt outpatient?
1) IV lorazepam
2) Diazepam (Diastat PR, Valtoco NAS)
Describe how to dose Lamictal (if not taken with valproate) for epilepsy
Wks 1-2: 50 mg Qday
Wks 3-4: 50 mg BID
Wks 5-maintenance: increase by 25-50 mg every 1-2 wks
Maintenance dose: 50-100 mg BID
1) What is a side effect of memantine?
2) What are side effects of cholinesterase inhibitors?
1) Hallucinations
2) Nausea, diarrhea, WL, GI issues, insomnia, vivid dreams, etc
-Cholinergic toxicity: salivation, tearing and sweating, bronchoconstriction, tightness in the chest, wheezing, bradycardia, vomiting, increased gastrointestinal motility, abdominal tightness, diarrhea, and cramp
-Donzepil can esp. cause nightmares
List the standard doses for the following PD drugs:
1) Pramipexole (non-ergot dopamine agonist)
2) Ropinirole (practically the same as pramipexole)
3) Carbidopa/L-dopa
1) 0.125 mg TID, req. renal adjustments
2) 0.25 mg PO TID (titrate to effect; max dose 24 mg / day)
3) 25/100 mg TID
List 2 monoclonal antibodies (for AD) and their adverse effects
1) Aducanumab (Aduhelm): microhemorrhage, brain edema (req. MRI)
2) Lecanemab (Leqembi): Same concerns for edema and microhemorrhage
1) How would you Tx mild-to-moderate AD? (MMSE 10-26)
2) What 2 medications can work for any severity of AD?
3) What should you do for moderate-to-severe AD? (MMSE 0-20)
1) Galantamine or rivastigmine
2) Donepezil and Transdermal rivastigmine
3) Add memantine
Generally ________________ plus any cholinesterase inhibitor are more effective for AD, but you don’t start that until you get to a MMSE score of 20 or less.
memantine
When do you add memantine for AD?
Score of 20 or less on MMSE
Alzheimer’s:
1) What MMSE score is mild?
2) What is moderate?
3) What is severe?
1) 21-26
2) 10-20
3) 9-0
Which 2 drugs are assoc. with gambling?
Ropinirole and pramipexole
[Non-ergot dopamine agonists]
How do you dose ceftriaxone?
125mg in kids, 250mg in adults IM
1) What drug was grandfathered in? Explain what this means
2) What is the orphan drug act?
1) Phenobarbital (Lumina, C3); was automatically FDA approved bc it’s an old drug
2) Congress passed the Orphan Drug Act of 1983 to stimulate the development of drugs for rare diseases (7yr market exclusivity, 50% tax credit, etc) (ex: Cannabidiol)
What is the goal with epilepsy meds?
Ideally we want you on just one drug, if you’re on one drug and it’s not working, you want to increase the dose unless you’re maxed out, then you can consider dual therapy.
