ABLE PY2 Spring Med Quiz 3

What is the brand name of mirtazapine?

Remeron

What class is mirtazapine in?

antidepressant; alpha-2 antagonist

mirtazapine dosing

headache/panic disorder → ___ mg po daily HS

15

mirtazapine ADRs

-constipation

-increased ____

-somnolence

-xerostomia

-increased serum ____

-weight ____

appetite, cholesterol, gain

mirtazapine monitoring

-worsening of depression, suicidality, or unusual changes in behavior

-serum ____, CBC, lipid panel, body weight, renal function, and LFTs.

sodium

What is the brand name of the tricyclic antidepressant nortriptyline?

Pamelor

nortriptyline dosing

Depression →initiate at ___-____ mg po once daily at bedtime, max 150 mg/d

25-50

nortriptyline ADRs

-____

constipation

nortriptyline monitoring

-worsening of depression, suicidality, or unusual changes in behavior

-monitor ____ and ____

-BP, HR, weight, and Na (patients at risk for SIADH)

-Signs and symptoms of ____ syndrome.

ECG, LFTs, serotonin

What is the brand name of the SSRI paroxetine?

Paxil

paroxetine dosing

Depression:

→IR=____ mg po daily, may titrate to 50 mg po daily

→CR=___ mg po daily, may titrate to 62.5 mg po daily

20, 25

paroxetine dosing

Generalized anxiety disorder → ___-____ mg po daily, may titrate to 50 mg po daily

10-20

paroxetine ADRs

-abnormal _____

-asthenia

-constipation

-diarrhea

-headache

-insomnia

-nausea

-somnolence

-diaphoresis

-reduced _____

ejaculation, libido

paroxetine monitoring

-Monitor serum ____

-worsening of depression, suicidality, or unusual changes in behavior

-signs/symptoms of abnormal ____

-Review kidney and liver function prior to initiation.

sodium, bleeding

What is the brand name of olanzapine?

Zyprexa

What class is olanzapine in?

Thienobenzodiazepine, Atypical Antipsychotic

olanzapine dosing

BPD → __-___ mg/d po, may titrate in 5 mg/d increments (max 20 mg/d);

5-15

olanzapine MOA

-an atypical antipsychotic agent that is a potent ___ and ___ antagonist

5HT2, D2

olanzapine ADRs

-hyperglycemia, weight ____, increased appetite

-increased ____ levels

-increased triglycerides + ____

-akathisia, asthenia, dizziness, somnolence, tremor, xerostomia, orthostatic hypotension, increased LFTs

gain, prolactin, hypercholesterolemia

olanzapine monitoring

-FBG/HbA1c in patients with DM

-____, ___ profiles

-Check body weight and ___

-LFTs, electrolytes, and vital signs

-Symptoms of neuroleptic malignant syndrome and involuntary movements/Parkinsonian signs.

CBC, lipid, BMI

What is the brand name of lurasidone?

Latuda

What class is lurasidone in?

Second-Generation (Atypical) Antipsychotic

lurasidone dosing

Depressive episodes associated with bipolar disorder → ___ mg po daily, may titrate to max 120 mg po daily

20

lurasidone dosing

Schizophrenia → ____ mg po daily, may titrate to max 160 mg/d

40

lurasidone MOA

-an atypical antipsychotic agent (benzisothiazole derivative). It exhibits relatively high affinity for dopamine D2 receptor and serotonin ____ and ____ receptors

5-HT7, 5-HT2A

lurasidone ADRs

-akathisia

-______ effects

-headache

-nausea

-somnolence

extrapyramidal

lurasidone monitoring

-FPG, CBC, fasting lipid panel, renal function, LFTs, TSH, electrolyte

-Monitor ____ signs, body temperature, and weight

-Evaluate patients for extrapyramidal effects using vetted tool

-Obtain serum ____ if patient reported symptoms (eg, gynecomastia, galactorrhea, menstruation changes).

vital, prolactin

What are the brand names of lithium?

Eskalith, Eskalith-CR, Lithobid

What class is lithium in?

Antimanic

lithium dosing

Bipolar disorder

ER→ ____-1800 mg/d po in 2-3 divided doses

900

lithium dosing

Bipolar disorder

IR→ ____ mg po daily, may titrate to 900-1800 mg po in 3-4 divided doses

300

lithium ADRs

-cardiac ____

-fine ____

-hypothyroidism

-leukocytosis

-thrombocytosis

-xerostomia

dysrhythmias, tremor

lithium monitoring

-____ and ____ function, parathyroid function, hydration status, sodium levels, CBC

-Periodic EEG and ECG exams if medically warranted

-Monitor for signs/symptoms of lithium ____ (eg, confusion, diarrhea, vomiting, tremor, muscle weakness, drowsiness).

kidney, thyroid, toxicity

What are the brand names of methylphenidate?

Ritalin, Concerta, Daytrana, Metadate CD,

What class is methylphenidate in?

CNS stimulant

methylphenidate dosing

ADHD-Adults → __-___ mg/d po divided 2-3 times daily, preferably 30-45 min before meals

10-60

methylphenidate dosing

ADHD-Children ≥6 y of age → initial, ___ mg po bid, may titrate in increments of 5-10 mg at weekly intervals

5

methylphenidate MOA

-a stimulant that increases CNS activity by inhibiting reuptake of ___ and ____, increasing neuronal firing rate and stimulating the cerebral cortex and subcortical structures.

norepinephrine, dopamine

methylphenidate ADRs

-loss of ____

-headache

-insomnia

-irritability

-nausea

appetite

methylphenidate monitoring

-BP, HR, height, and ____

-CBC periodically during long-term treatment

-Seek medical attention if chest pain, seizures, heart palpitations, change in behavior or personality, or hostility

-Monitor _____ in children

weight, growth

What is the brand name of lisdexamfetamine?

Vyvanse

What class is lisdexamfetamine in?

Amphetamine, CNS Stimulant.

lisdexamfetamine dosing

ADHD → ___ mg po daily in the morning, may titrate in 10-20 mg/d increments at weekly intervals to max dose of 70 mg po daily;

30

lisdexamfetamine ADRs

-insomnia

-irritability

-loss of ____

-upper ____ pain

-xerostomia

appetite, abdominal

lisdexamfetamine monitoring

-____ evaluation at baseline if known or suspected cardiac disease

-BP and HR should be evaluated at baseline, during routine follow-up within 1-3 mo, and at follow-up visits every 6-12 mo

-Monitor ____ rate and weight in children.

cardiac, growth

What is the brand name of modafinil?

Provigil

What class is modafinil in?

CNS Stimulant

modafinil dosing

Narcolepsy/OSA → ___ mg po daily in the morning, max 400 mg

200

modafinil ADRs

-____

-insomnia

-nausea

headache

modafinil monitoring

-____ or ____ (may be indicative of a cardiac condition)

-weight, HR and BP

-Baseline HCG in females of childbearing age

-Monitor for change in behavior (depression, anxiety, aggression).

palpitations, syncope

What is the brand name of lorazepam?

Ativan

What class is lorazepam in?

Benzodiazepine, Short or Intermediate Acting.

lorazepam dosing

Anxiety →___-___ mg po q4-6h, max 10 mg/d

0.5-2

lorazepam MOA

-enhance the postsynaptic effect of the inhibitory neurotransmitter ___

GABA

lorazepam ADRs

-drowsiness

-impaired ____ coordination

-retrograde ____

motor, amnesia

lorazepam monitoring

-severe drowsiness

-thoughts of ____

-____

-monitor BP, HR, LFTs, CBC, LDH.

suicide, siezures

What are the brand names of phenobarbital?

Luminal, Sezaby

What class is phenobarbital in?

Long-Acting Barbiturate

phenobarbital dosing

Seizures → ___-___ mg po bid-tid

50-100

phenobarbital efficacy monitoring

-Control of seizures, achieving adequate sedation

-Therapeutic drug monitoring may be performed when used for seizures

-Phenobarbital levels should be drawn immediately prior to the next scheduled dose

-Phenobarbital serum levels: therapeutic __-__ mcg/mL; toxic >40 mcg/mL.

10-40

phenobarbital toxicity monitoring

-SCr, LFTs, and CBC annually

-Monitor for decreased ___ acuity, respiratory distress

-Monitor for breakthrough ____

-Monitor for ____ changes or rash

mental, seizures, skin

What are the brand names of phenytoin?

Dilantin, Phenytek

What class is phenytoin in?

Hydantoin Anticonvulsant

phenytoin dosing

Seizure→ ___ mg po tid, may titrate to 200 mg po tid;

100

phenytoin MOA

-suppresses the spread of seizure activity mainly by ___ synaptic posttetanic potentiation and ___ the propagation of electric discharge. Phenytoin might decrease sodium transport and block calcium channels at the cellular level to produce these actions.

inhibiting, blocking

phenytoin ADRs

-___ ____

gingival hyperplasia

phenytoin efficacy monitoring

-Reduction in the frequency and severity of seizures.

-Therapeutic drug monitoring of trough concentrations is recommended for monitoring

-Phenytoin ___ serum level range 10-20 mcg/mL

-Phenytoin ___ serum level range 1-2 mg/L.

total, free

phenytoin toxicity monitoring

-emergence or worsening of ____, suicidal behavior or ideation, or unusual changes in behavior

-monitor CBC and LFTs. Monitor vitamin ___ levels with prolonged use.

depression, D

What are the brand names of oxcarbazepine?

Trileptal, Oxtellar XR

What class is oxcarbazepine in?

Dibenzazepine Carboxamide, Anticonvulsant

oxcarbazepine dosing

Focal onset (partial seizure) → ___ mg po bid, may titrate to 1200-2400 mg/d po (depending on formulation)

300

oxcarbazepine ADRs

-somnolence

-____ pain

-headache

-____ (double vision)

-dizziness

abdominal, diplopia

oxcarbazepine monitoring

-Serum ____ during maintenance treatment, emergence or worsening of depression, suicidal behavior or ideation, or unusual changes in behavior

-____ screen and CBC periodically during treatment.

sodium, thyroid

What are the brand names of the opioid morphine ER?

MS Contin, Avinza, Kadian

morphine ER dosing

Chronic pain, moderate to severe → ___-___ mg po q12-24 h

10-20

morphine ADRs

-constipation

-nausea

-vomiting

-____

-dizziness

-sedation

-_____

-headaches

-depression

-xerostomia

hypotension, diaphoresis

morphine monitoring

-excessive drowsiness

-decreased ____

-severe ____

-chest pain

-dizziness

-vital signs

breathing, constipation

What are the brand names of the opioid oxycodone?

OxyContin, Roxicodone

oxycodone dosing

Pain, chronic, moderate to severe

IR→ __-___ mg po q4-6h prn pain

ER → ___ mg po q12h prn pain; titrate to response

5-15, 10

oxycodone ADRs

-constipation

-____ distress

-nausea

-sedation

-sweating

-pruritus

GI

oxycodone monitoring

-excessive _____

-severe skin ____

-decreased breathing

-severe constipation

-chest pain

-dizziness

-Monitor vital signs, specifically respiratory rate and BP.

drowsiness, rash

What is the brand name of the opioid methadone?

Dolophine

methadone dosing

Pain, chronic (moderate-severe) → __-__ mg po q8h-q12h, may titrate to response no more frequent than every 5-7 d

2.5-5

methadone ADRs

-constipation

-___ distress

-______

-dizziness

-sedation

GI, hypotension

methadone monitoring

-Monitor vitals including BP and respiratory rate

-Obtain baseline ____, renal function

-Consider checking ____ and hepatitis status in patients initiating opioids

-Seek medical attention if severe skin rash, excessive drowsiness, decreased breathing, severe constipation, chest pain, or dizziness; vital signs

-Consider ECG if increased risk for ____ prolongation (eg, taking other QTc-prolonging agents, CVD history, previous QTc >450 ms).

LFTs, HIV, QTc

naproxen, nabumetone, and meloxicam are all nonselective ____

NSAIDs

What are the brand names of the NSAID naproxen?

Naprosyn, Naprelan

naproxen dosing

OA/RA

IR→ ___-____ mg po bid

250-500

naproxen dosing

OA/RA

ER→ ___-___ mg po once daily

750-1000

naproxen ADRs

-headache

-____

dyspepsia

naproxen monitoring

-severe skin rash, allergic reactions, black ____ stools, chest pain

-____ of eyes or skin, edema, change in urination

-monitor CBC, LFTs, SCr, fecal occult blood tests, BP (if patient has HTN) if chronic use

-intermittent ____ exam with chronic use.

tarry, yellowing, ophthalmic

What is the brand name of the NSAID nabumetone?

Relafen

nabumetone dosing

OA/RA → __-___ mg po daily or divided bid

1000-2000

nabumetone ADRs

-elevated ____

-dyspepsia

-_____ pain

-diarrhea

LFTs, abdominal

nabumetone monitoring

-severe skin rash, black ____ stools, chest pain

-____ of eyes or skin, edema, change in urination

-monitor BP, CBC, LFTs, SCr, fecal occult blood tests if chronic use.

-intermittent ____ exam with chronic use.

tarry, yellowing, opthalmic

What is the brand name of the NSAID meloxicam?

Mobic

meloxicam dosing

OA/RA →___ mg po daily, may titrate to max 15 mg/d

7.5

meloxicam ADRs

-___ distress

GI

meloxicam monitoring

-CBC, LFTs, SCr, BP, fecal occult blood tests if chronic use

-Seek medical attention if severe skin rash, black ____ stools, chest pains, _____ of eyes or skin, or change in urination.

tarry, yellowing

What are the brand names of methocarbamol?

Robaxin, Tanlor