ABLE PY2 Spring Med Quiz 1

What is the brand name of Amitriptyline?

Elavil

What class is Amitriptyline in?

tricyclic antidepressant

Amitriptyline

-dosing for depression is __-__ mg po daily divided into 1-2 daily doses, titrate to max 300 mg/d;

25-50

Amitriptyline

-MOA: blocks presynaptic reuptake of ___ and ___ with subsequent downregulation of adrenergic receptors.

serotonin, norepinephrine

Amitriptyline Common Adverse Effect

-____

sedation

Amitriptyline Toxicity Monitoring

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

-Altered mentation

-seizures

-autonomic dysregulation

-muscle ___

-___ symptoms.

-Monitor LFTs, blood glucose, ECG, BP, and HR.

spasms, GI

What are the brand names of Bupropion?

Aplenzin, Forfivo XL, Wellbutrin SR/XL

What class is Bupropion in?

Monocyclic Antidepressant

Bupropion

-dosing for depression-Immediate release: __ mg po bid × 3 d, increase to 100 mg po tid (max 450 mg/d)

100

Bupropion

-dosing for depression-Extended release 12 h: ___ mg po daily in the morning × 3 d, then increase to 150 mg po bid (max 200 mg bid);

150

Bupropion

-MOA: mild ___ and ___ uptake inhibitor with no direct effect on serotonin receptors or MAO.

dopamine, norepinephrine

Bupropion Common Adverse Effects:

-agitation

-____

-dizziness

-headache

-____

-nausea

-_____

-tremor

-____

constipation, insomnia, tachyarrhythmia, xerostomia

Bupropion Toxicity Monitoring:

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

-BP and heart rate in patients using concomitant nicotine replacement therapy

-Incidence of ____

LFTs and SCr at baseline and periodically

-Monitor body ____ during treatment.

seizure, weight

What is the brand name of Citalopram?

Celexa

What class is Citalopram in?

SSRI antidepressant

Citalopram

-dosing for depression is __ mg po daily, may titrate to 40 mg po daily

20

Citalopram

-MOA: a bicyclic antidepressant that is a selective and potent inhibitor of ____ reuptake of serotonin (an SSRI)

presynaptic

Citalopram Adverse Effects:

-dizziness

-____

-headache

-____

-nausea

-sedation

-____

diaphoresis, insomnia, xerostomia

Citalopram Toxicity Monitoring

-Worsening of mental health symptoms, suicidality, or unusual changes in behavior

-signs/symptoms of abnormal ___

-Monitor serum ___

Monitor ECG if concomitant QTc-prolonging medications or at increased risk for prolongation.

bleeding, sodium

What are the brand names of Desvenlafaxine?

Pristiq, Khedezla

What class is Desvenlafaxine in?

Serotonin/Norepinephrine Reuptake Inhibitor

Desvenlafaxine

-dosing for depression is __ mg po daily, may increase to 100 mg po daily if no response after 6 weeks

50

Desvenlafaxine

-MOA: a potent reuptake inhibitor of ___ and ____ but lacks effects on muscarinic, α-adrenergic, or histamine receptors.

serotonin, norepinephrine

Desvenlafaxine Adverse Effects

-____

-dizziness

-headache

-___

-nausea

-___

Diaphoresis, insomnia, xerostomia

Desvenlafaxine Toxicity Monitoring

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

-signs/symptoms of abnormal ____

-monitor BP, LFT, serum sodium, and serum cholesterol levels, in case of severe impairment at baseline and periodically during therapy

-signs/symptoms of ____, especially in patients on concomitant diuretics, volume-depleted patients, and elderly

-monitor ____ function.

bleeding, hyponatremia, renal

What is the brand name of Alprazolam?

Xanax

What class is Alprazolam in?

Benzodiazepine

Alprazolam is a controlled substance class ___

4

Alprazolam

-dosing for anxiety-immediate-release, orally disintegrating tablet or solution: ___mg po tid; max 10 mg/d in divided doses

0.25

Alprazolam

-MOA: enhances the postsynaptic effect of the inhibitory neurotransmitter, γ-aminobutyric acid (____)

GABA

Alprazolam Adverse Effects

-____ (loss of muscle control)

-lethargy

-retrograde ____

-somnolence

-weight gain/change in appetite

-constipation

-fatigue

-cognitive dysfunction

-decreased ____

-rash

ataxia, amnesia, libido

Alprazolam Toxicity Monitoring

-Severe drowsiness

-thoughts of ____

-seizures

-slow or irregular ____; monitor BP, HR.

suicide, heartbeat

What is the brand name of Buspirone?

Buspar

What class is Buspirone in?

Antianxiety

Buspirone

-dosing for anxiety is ___ mg po bid-tid or 7.5 mg po bid, may titrate to __-___ mg/d in 2-3 divided doses (max 60 mg/d)

5, 20-30

Buspirone

-MOA is selective serotonin-5-HT1A receptor partial ___. It also has some effect on dopamine-D2 auto-receptors and, like antidepressants, can downregulate β-adrenergic receptors.

agonists

Buspirone Adverse Effects

-____

dizziness

Buspirone Toxicity Monitoring

-Signs and symptoms of withdrawal upon abrupt dose reduction or discontinuation

-_____ movements

-altered ___ status

-seizures

-tremors or myoclonus.

involuntary, mental

What are the brand names of Clobazam?

Onfi, Sympazan

What class is Clobazam in?

Anticonvulsant

Clobazam is a controlled substance class __

4

Clobazam

-dosing for anxiety is __ mg po bid or tid, max 80 mg/d

10

Clobazam

-MOA is not known but is thought to involve potentiation of neurotransmission resulting from binding at the ____ site of the GABAa receptor.

benzodiazepine

Clobazam Adverse Effects

-_____

-lethargy

-______ infections

-___

-___

drooling, respiratory, somnolence, fever

Clobazam Toxicity Monitoring

-Signs and symptoms of ___ depression, suicidal thoughts or behaviors, unusual changes in mood or behavior.

-Seek medical attention immediately if ___ occurs, as significant risk of Stevens-Johnson syndrome.

CNS, rash

What is the brand name of Clonazepam?

Klonopin

What class is Clonazepam in?

Benzodiazepine

Clonazepam is a controlled substance class ___

4

Clonazepam

-dosing for seizure in adults is ___-___ mg/d in 1-2 divided doses, may titrate to max 20 mg/d

2-8

Clonazepam

-MOA is enhances the postsynaptic effect of the inhibitory neurotransmitter, γ-aminobutyric acid (____).

GABA

Clonazepam Adverse Effects

-____ (loss of muscle control)

-agitation

-lethargy

-____

-weight ___

ataxia, somnolence, gain

Clonazepam Toxicity Monitoring

-Severe ____

-thoughts of suicide

-seizures

-slow or irregular heartbeat--monitor ___, ___

drowsiness, BP, HR

What is the brand name of Diazepam?

Valium

What class is Diazepam in?

benzodiazepine

Diazepam is a controlled substance class ___

4

Diazepam

-dosing for anxiety is __-__ mg po bid-qid, max 40 mg/d;

2-10

Diazepam

MOA is enhanced postsynaptic effect of the inhibitory neurotransmitter, γ-aminobutyric acid (___).

GABA

Diazepam Adverse Effects

-____

-impaired ___ coordination

drowsiness, motor

Diazepam Toxicity Monitoring

-Severe drowsiness

-thoughts of ____

-___ of eyes

-seizures

-SCr, LFT changes, HR, BP

-diminished ___ rate.

suicide, yellowing, respiration

What are the brand names of Aripiprazole?

Abilify, Opipza

What class is Aripiprazole in?

Second generation antipsychotic

Aripiprazole

-dosing for BPD is __-___ mg po daily, may titrate to 15-30 mg po daily;

10-15

Aripiprazole

-dosing for schizophrenia is __-__ mg po daily, may titrate to max 30 mg/d;

5-15

Aripiprazole

-MOA is partial ____ activity at dopamine D2 and D3 receptors and serotonin 5-HT1A receptors and ___ activity at 5-HT2A receptors.

agonist, antagonist

Aripiprazole Adverse Effects

-____ (restlessness)

-extrapyramidal effects

-headache

-increased appetite/weight gain

-somnolence

-____ and ____

Akathisia, hypercholesteremia, hypertriglyceridemia

Aripiprazole Toxicity Monitoring

-FPG and CBC in patients with risk factors for diabetes.

-Patients at high risk for suicide should be closely supervised

-Monitor ____ at baseline and periodically during therapy.

-Monitor for abnormal or involuntary _____.

-_____ assessment at weeks 4, 8, and 12 of treatment, then quarterly.

ECG, movements, weight

What is the brand name of Atomoxetine?

Strattera

What class is Atomoxetine in?

SNRI, CNS Stimulant

Atomoxetine

-dosing for ADHD in children ≥6 y of age and adults is __ mg po daily, may titrate to ___ mg/d

40, 100

Atomoxetine

-MOA is a selective ____ reuptake inhibitor that produces therapeutic effects in patients with ADHD. The exact mechanism of how selective inhibition of presynaptic norepinephrine exerts effects in ADHD has not been determined.

norepinephrine

Atomoxetine Adverse Effects

-_____ pain

-headache

-insomnia

-loss of _____

-weight loss

-nausea

-_____

abdominal, appetite, xerostomia

Atomoxetine Toxicity Monitoring

-____ and ____

-Signs of clinical worsening, suicidality, or unusual changes in behavior

-Aggressive behavior or hostility, new onset or worsening; in pediatric patients at start of treatment

-Monitor serum _____ and LFTs.

BP, HR, sodium

What is the brand name of Dexmethylphenidate?

Focalin

What class is Dexmethylphenidate in?

CNS stimulant

Dexmethylphenidate is a controlled substance class __

2

Dexmethylphenidate

-dosing for ADHD in methylphenidate-naive adult patients: -IR ____ mg po bid (max 20 mg po daily) or ER __ mg po daily (max 40 mg/d);

2.5, 10

Dexmethylphenidate

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

norepinephrine, dopamine, firing

Dexmethylphenidate Adverse Effects

-weight loss

-loss of _____

-headache

-insomnia

-restlessness

appetite

Dexmethylphenidate Toxicity Monitoring

-Monitor ___, ___, ___, ___.

-Monitor growth rate and appetite change in children.

-Intraocular pressure if pre-existing glaucoma.

BP, HR, weight, CBC

What are the brand names of Carbamazepine?

Tegretol, Carbatrol

What class is Carbamazepine in?

Anticonvulsant

Carbamazepine

-dosing for focal-onset and generalized-onset seizures in adults is ____ mg po bid, may titrate to ___ mg po daily;

200, 1200

Carbamazepine

-dosing for BPD is ___-___ mg po daily in 2-4 divided doses, may titrate by 200 mg/d every 1-4 d, max 1600 mg/d

100-400

Carbamazepine

-MOA is acts presynaptically to block ___ of ___ potentials, which decreases the release of excitatory neurotransmitters, and postsynaptically by blocking high-frequency repetitive discharge initiated at cell bodies.

firing, action

Carbamazepine Adverse Effects

-_____

-drowsiness

-dizziness

-nausea

ataxia

Carbamazepine Toxicity Monitoring

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

-baseline CBC, serum sodium, LFTs, complete urinalysis, and ___

-___ function test at baseline and during therapy

-____ examinations at baseline and during therapy.

BUN, thyroid, eye

What is the brand name of Divalproex?

Depakote

What class is Divalproex in?

Anticonvulsant

Divalproex

-dosing in adults for absence seizure, simple and complex: ___ mg/kg/d po, may titrate to 60 mg/kg/d; delayed-release products are dosed bid, extended-release 24 h products are dosed daily

15

Divalproex

-dosing in adults for complex partial epileptic seizure: ___-___ mg/kg/d po, may titrate to 60 mg/kg/d; delayed-release products are dosed bid, extended-release 24 h products are dosed daily

10-15

Divalproex

-MOA is the dissociation of divalproex to valproate occurs in the stomach. ____ ___ is a carboxylic acid compound whose anticonvulsant activity might be mediated by ____. Valproic acid might increase GABA levels by inhibiting GABA metabolism or enhancing postsynaptic GABA activity. Valproic acid also limits repetitive neuronal firing through voltage- and usage-dependent sodium channels.

valproic acid, GABA

Divalproex Adverse Effects

-abdominal pain

-____ (hair loss)

-___ (lack of energy)

-____ (double vision)

-dizziness

alopecia, asthenia, diplopia

Divalproex Adverse Effects

-headache

-____

-____

-nausea, vomiting, diarrhea

-somnolence

-tremor

infection, insomnia

Divalproex Toxicity Monitoring

-signs/symptoms of peripheral ____

-increased HR

-weight changes

-______ (abdominal pain, nausea, vomiting)

-monitor LFTs, ammonia levels, and CBC; emergence or worsening of depression, suicidal behavior or ideation, or unusual changes in behavior

-serum HCG in women of childbearing age.

edema, pancreatitis

What is brand name of Codeine?

Tylenol with Codeine

What class is Codeine in?

Opiod

When combined with acetaminophen, codeine is a controlled substance class ___

2

When combined with tablets, codeine is a controlled substance class ___

3

When combined with liquid, codeine is a controlled substance class ___

5

Codeine

-dosing for pain is ___-___ mg po q4h prn; with acetaminophen 300-1000 mg (max 4000 mg/d)

15-60