Pseudobulbar Affect (PSA)

  1. What are treatment options for PSA?

    1. Antidepressants or Dextromethorphanquinidine

  2. What classes of antidepressants are used for PBA?

    1. TCAs, SSRIs, Mirtazepine

  3. What are the names of the TCAs used for PBA?

    1. Amitriptyline, Nortriptyline, Imipramine and Clomipramine

  4. What are the names of the SSRIs used for PBA?

    1. Citalopram, Escitalopram, Sertraline, Paroxetine, and Fluvoxamine

  5. What is Nudexta?

    1. Dextromethorphan/quinidine taken po daily for 7 days then BID

  6. What are common ADEs for Dextromethorphanquinidine?

    1. Peripheral, edema, Diarrhea, Vomiting, Asthenia, Dizziness, & Cough

  7. What are severe ADEs for Dextromethorphanquinidine?

    1. Prolonged QT interval, Hepatitis Immune thrombocytopenia, and Systemic lupus erythematosus

  8. What is the brand name for Dextromethorphanquinidine?

    1. Nuedexta®

  9. Dextromethorphanquinidine (Nuedexta) is contraindicated in:

    1. pts with AV block without a pacemaker, prolonged QTc, use of MAOis or Heart failure

  10. What do we want to monitor in patients Taking Nuedexta?

    1. Magnesium and potassium levels

  11. When do we see improvements in DX/Q groups?

    1. over 12 weeks of use

  12. RM is a 65 year old patient with recent onset of PBA, following a stroke. PMH including opioid disorder, BP, and hypothyroidism

    Meds include:

    1. Levothyroxine

    2. Methadone

    3. Multivitamin daily

    4. Quetiapine 600mg nightly

  13. Which of the following is the best first line treatment option for RM’s PDA?

    1. escitalopram