BH E1- Drugs & Doses

Escitalopram (Lexapro) starting dose for MDD

10 mg

Duloxetine (Cymbalta) dose fibromyalgia

up to 120 mg

Selegiline (Emsam patch) lowest dose

6 mg

Lithium (Eskalith) starting dose for bipolar

300 mg BID then switch to q PM

Lamotrigine (Lamictal) starting dose for bipolar

25 mg for 2 weeks, double dose every 2 weeks until reaching therapeutic dose (100-200 mg)

What must you do if a patient misses 4-5 doses on lamotrigine?

Retitrate

What SEs are associated with lamotrigine?

SJS; consider HLA-B1502 testing in asian patients

What must you do to the dose of lamotrigine if also on VPA?

decrease dose by half

What should be avoided in OCD due to risk of long QT at high doses?

Escitalopram

What are CIs to bupropion (Wellbutrin)?

Seizure hx or active anorexia/bulimia due to seizure risk

At what doses of Bupropion would you need to monitor BP/HR?

≥ 300 mg

At what doses of venlafaxine would you need to monitor BP/HR due to risk of HTN & tachycardia?

≥ 225 mg

What class of drugs have risk of tyramine related SEs, such as hypertensive crisis?

MAOIs

Which SSRI has the longest half life and Is the most energizing?

Fluoxetine

What drug requires the following washout periods?

• atleast 7 days when switching from SSRI, SNRI, TCA, lithium

• 6 weeks when switching from fluoxetine

• 14 days when switching from MAOI

Phenelzine

When is a special diet (low tyramine) needed with selegiline (Emsam patch)?

High doses

What should be considered in patients with TRD & folate deficiency or MTHFR mutations?

Deplin (l-methylfolate)

What can be used as adjunctive therapy for TRD & enhances methylation for neurotransmitter synthesis?

SAMe

What drug is tardive dyskinesia MC in?

1st gen antipsychotics (haldol)

What is the treatment for tardive dyskinesia?

Switch to SGA, valbenazine, deutetrabenazine

What toxicity is associated with lithium?

ataxia, delirium, tremors (avoid dehydration)

What must be monitored while on lithium?

Trough (v narrow TI), TSH, CMP (BUN and Cr for kidneys)

5-7 days after initiation or dose change; every 6-12 mos if stable

What labs should be checked before starting lithium?

TSH, CBC, BUN, Cr, elytes, UA, pregnancy test, EKG

What drug is good for rapid cycling of bipolar disorder?

VPA

What is the starting dose of VPA (Depakote) for bipolar?

15-30 mg/kg - up to 60 mg/kg

What drug is category D due to neural tube defects?

VPA

What should be avoided in PPD breastfeeding patients?

Clonazepam, Diazepam

What are the safest SSRIs for pregnancy?

Fluoxetine & Sertraline

Which SSRIs are secreted the least into breastmilk?

Sertraline (>), Paroxetine

Which SSRI is the most antihistaminic (associated with most sedation & weight gain), and is also category D in pregnancy?

Paroxetine (Paxil)

What SEs are associated with anti-psychotics?

EPS, dystonia, akathisia, tardive dyskinesia

What SEs are associated with TCAs?

sedation, orthostatic hypotension, anticholinergic SEs, long QT, lethal in overdose

What is the treatment for acute dystonia caused by antipsychotics?

Benztropine, Diphenhydramine

What is the treatment for parkinsonian syndrome caused by antipsychotics?

Benztropine, amantadine

What is the treatment for akathisia caused by antipsychotics?

Propranolol, benztropine, low doze benzo

When should valerian be avoided?

hepatic disease and pregnancy

What is the usual dose of Ramelteon (Rozerem) for insomnia/circadian rhythm disorders?

8 mg (duration 8 hrs)

What are SEs of Ramelteon?

HA, depression, tachy, itching, avoid in pregnancy

What is the dose for Zolpidem (Ambien) for insomnia?

5-10 mg PO 30 min before HS (duration 5-8 hrs)

What adverse effects are associated with Zolpidem?

amnesia, addiction

When should zolpidem be avoided?

OSA

Zaleplon (Sonata) dose for insomnia

5-20 mg PO before HS (duration < 4 hrs)

Trazodone dose for depression induced insomnia

25-100 mg

When should antihistamines (Benadryl, unison) be avoided?

urinary retention, closed angle glaucoma

What are the doses for modafinil (provigil) and armodafinil (nuvigil) in narcolepsy treatment?

200-400 mg

What is the dose for Methylphenidate (Ritalin) in narcolepsy treatment?

5 mg BID, up to 50 mg QD

What is the dose of dexedrine for narcolepsy treatment?

5 mg QD or BID

What is the dose of melatonin for shift work disorder?

low dose 0.3-1 mg 3 hours prior to sleep

What is the dose for Prazosin (Minipress) in PTSD / nightmare treatment?

1 mg q HS

Ferrous sulfate dose for iron replacement in RLS

325 mg QD or QOD (+ vit C 100-200 mg)

What should be avoided in PTSD treatment?

benzos (may inc sx & highly addictive)

Paroxetine (paxil) dose for GAD

initial 10 mg daily, max 50 mg daily in AM

Venalfaxine ER dose for GAD

initial dose 37.5 mg, max 225 mg

Duloxetine (Cymbalta) dose for GAD

initial 60 mg, max 120 mg

Paroxetine IR dose for panic disorder treatment

initial 10 mg QAM, max 60 mg/day

Fluoxetine dose for panic disorder

initial 5-10 mg, max 60 mg

Sertraline dose for panic disorder

initial 25 mg, max 200 mg

Venlafaxine ER dose for panic disorder

37.5 mg, max 225

What is the dose for alprazolam (Xanax) ER tablet?

initial 0.5 mg - 1 mg, mean effective 3-6 mg, max 10 mg

What are CIs to alprazolam?

acute arrow angle glaucoma, ketoconazole, BEERS criteria

What BBW is associated with alprazolam?

sedation, resp depression, coma, death abuse, addiction, withdrawal

What SEs are seen with alprazolam?

anterograde amnesia, tolerance, withdrawal, paradoxical hyperactivity, CNS / cognitive dysfunction, sleep driving, etc

What drug interactions are seen with alprazolam?

enhance CNS depressants- alcohol, cannabis, methadone

theophylline decreases levels of xanax

What is the dose of paroxetine IR for SAD?

initial 10 mg, max 60 mg

What is the dose of venlafaxine for SAD?

initial 37.5 mg, max 75 mg

What is the dose of propranolol IR for performance anxiety?

10-20 mg 30-60 min before event, max 60 mg

What are CIs to propranolol?

asthma, CHF, heart block greater than 1st degree, severe bradycardia

What adverse reactions are seen with propranolol?

bronchospasm, mask or potentiate hypoglycemia, mask symptoms of hyperthyroidism, abrupt discontinuation causes tachycardia & rebound HTN

*long term use get labs- glucose, HgbA1c, renal function

What can decrease the level/effect of propranolol?

Alcohol, NSAIDs, tobacco

What drug interactions are seen with propranolol?

Hypoglycemia & increase effects of sulfonylureas & insulin

Decreases effects of theophylline

How is fluoxetine dosed for OCD?

10 or 20 mg/day, increase in 20 mg increments every week or every other week, max 120 mg/day