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Questions and Answers
What is the appropriate blood level range for lithium during maintenance treatment?
What is the appropriate blood level range for lithium during maintenance treatment?
What is a significant adverse effect of tricyclic antidepressants (TCAs) in cases of overdose?
What is a significant adverse effect of tricyclic antidepressants (TCAs) in cases of overdose?
Which of the following medications should be avoided in patients with a risk of seizures?
Which of the following medications should be avoided in patients with a risk of seizures?
Which drug interaction should be monitored closely when a patient is on lithium?
Which drug interaction should be monitored closely when a patient is on lithium?
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What should be considered regarding prescribing MAOIs?
What should be considered regarding prescribing MAOIs?
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What is an important patient education point regarding St. John's Wort?
What is an important patient education point regarding St. John's Wort?
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What is a key consideration when prescribing TCAs to depressed patients?
What is a key consideration when prescribing TCAs to depressed patients?
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Which assessment should be performed periodically while a patient is taking lithium?
Which assessment should be performed periodically while a patient is taking lithium?
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What is the first-line treatment for acute dystonia?
What is the first-line treatment for acute dystonia?
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Which of the following medications is most likely to cause serotonin syndrome?
Which of the following medications is most likely to cause serotonin syndrome?
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When considering the discontinuation of a medication, which factor is most critical for SSRIs with a short half-life?
When considering the discontinuation of a medication, which factor is most critical for SSRIs with a short half-life?
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What is a key consideration for monitoring patients on SNRIs, particularly venlafaxine?
What is a key consideration for monitoring patients on SNRIs, particularly venlafaxine?
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Which atypical antidepressant is considered first-line for patients experiencing sexual dysfunction?
Which atypical antidepressant is considered first-line for patients experiencing sexual dysfunction?
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What specific drug interactions should be cautiously monitored when prescribing venlafaxine?
What specific drug interactions should be cautiously monitored when prescribing venlafaxine?
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Which of the following symptoms is indicative of neuroleptic malignant syndrome (NMS)?
Which of the following symptoms is indicative of neuroleptic malignant syndrome (NMS)?
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What should elderly patients be advised when taking SSRIs?
What should elderly patients be advised when taking SSRIs?
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Which medication is primarily used for acute management in Parkinson's disease and can lead to confusion and hallucinations as an adverse effect?
Which medication is primarily used for acute management in Parkinson's disease and can lead to confusion and hallucinations as an adverse effect?
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What is a significant consideration when prescribing MAO-B inhibitors like selegyline?
What is a significant consideration when prescribing MAO-B inhibitors like selegyline?
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Which medication should always be combined with levodopa-carbidopa for optimal function in Parkinson's disease?
Which medication should always be combined with levodopa-carbidopa for optimal function in Parkinson's disease?
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Which adverse effect is commonly associated with the use of phenytoin or fosphenytoin?
Which adverse effect is commonly associated with the use of phenytoin or fosphenytoin?
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What is a crucial aspect of monitoring patients on cholinesterase inhibitors like rivastigmine?
What is a crucial aspect of monitoring patients on cholinesterase inhibitors like rivastigmine?
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Which drug interaction should healthcare professionals be cautious of when prescribing entacapone?
Which drug interaction should healthcare professionals be cautious of when prescribing entacapone?
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When using NMDA antagonists like memantine, what key consideration is relevant for dosing?
When using NMDA antagonists like memantine, what key consideration is relevant for dosing?
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Two significant side effects of phenytoin overdose include nystagmus and which of the following?
Two significant side effects of phenytoin overdose include nystagmus and which of the following?
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What is an important aspect of prescribing anticholinergics like benztropine in the treatment of Parkinson's disease?
What is an important aspect of prescribing anticholinergics like benztropine in the treatment of Parkinson's disease?
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Study Notes
Parkinson's Disease (PD) Medications
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Levodopa/Carbidopa (Sinemet)
- Primary treatment for PD, enhances dopamine availability in the CNS.
- Common side effects include dyskinesias; dose reduction may alleviate this.
- Notable drug interactions: pyridoxine reduces effectiveness; MAO inhibitors can cause hypertensive crises.
- Full therapeutic effect may take several months.
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Dopamine Agonists (Pramipexole, Apomorphine)
- Apomorphine is used for acute PD episodes.
- Adverse effects: confusion, hallucinations, orthostatic hypotension, sleep attacks, and impulsive behavior.
- First-line treatment for younger patients with mild to moderate symptoms; dosing adjustment needed for renal impairment.
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COMT Inhibitors (Entacapone)
- Increases the amount of levodopa reaching the brain.
- Drug interactions include methyldopa and isoproterenol.
- Always prescribed in combination with levodopa/carbidopa for enhanced effectiveness.
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MAO-B Inhibitors (Selegiline)
- Early intervention can help delay the need for levodopa/carbidopa.
- Risk of serotonin syndrome and hypertensive crisis with concomitant medications.
- Max dose is 10mg; should be taken early to minimize insomnia.
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Anticholinergics (Benztropine)
- Used primarily for treating tremors in later stages of PD.
- Interactions with acetylcholinesterase inhibitors and cholinergic medications.
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Cholinesterase Inhibitors (Rivastigmine, Galantamine)
- Rivastigmine is 1st line for mild to moderate Alzheimer's disease (AD).
- Galantamine affects glutamate and serotonin levels; not first choice.
- Rivastigmine has unique dosing forms (oral vs. patch) that require careful handling.
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NMDA Antagonists (Memantine)
- Indicated for moderate to severe AD.
- Renal dosing necessary; adjustments may be made weekly.
General Considerations for PD Management
- Monitoring patient on/off time, sleep patterns, and mental health status is critical.
- Falls risk assessment is essential; avoid high-protein meals that may affect medication absorption.
Epilepsy Medications
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Phenytoin/Fosphenytoin
- Utilized for generalized tonic-clonic and partial complex seizures; fosphenytoin can be administered IV.
- Contraindications include pregnancy and renal/hepatic issues.
- Side effects involve skin reactions and cardiac dysrhythmias; toxic levels can lead to nystagmus and coma.
- Mirtazapine has no significant drug interactions.
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Tricyclic Antidepressants (TCAs, Nortriptyline, Amitriptyline)
- Potentially lethal in overdose; special care needed in dosing.
- Contraindicated in patients with epilepsy or cardiovascular diseases.
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MAO Inhibitors (Phenelzine)
- Third-line treatment option; interactions with other antidepressants are critical.
- Patients must avoid high-tyramine foods.
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St. John's Wort
- Potential for drug interactions as a CYP450 enzyme inducer.
- Considered ineffective due to evidence limitations.
General Concepts in Epilepsy
- Importance of understanding phases of treatment and the duration of therapy.
- Differentiating first-line from second and third-line medications.
- Education and monitoring patient's response to therapy are crucial.
Bipolar Disorder Medications
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Lithium
- Renally eliminated; sodium and fluid levels impact lithium toxicity.
- Therapeutic range: 0.8-1.4 for acute; 0.6-1.2 for maintenance; monitor levels every 3-6 months.
- Toxicity can manifest as tremors, ECG changes, and severe symptoms (>2.5 might lead to seizures or death).
General Considerations for Bipolar Disorder
- Understanding manic, depressive phases, and appropriate drug treatments.
- Management of adverse effects such as EPS and NMS with timely interventions.
Major Depressive Disorder Medications
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SSRIs (Fluoxetine, Sertraline, Citalopram)
- Considered first-line therapies; monitor for serotonin syndrome.
- Specific interactions include potent effects on CYP2D6 and CYP3A4.
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SNRIs (Venlafaxine)
- Effective for serotonin-norepinephrine reuptake; dosing considerations for hypertension and liver dysfunction.
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Atypical Antidepressants (Bupropion, Mirtazapine)
- Bupropion is preferred for patients experiencing sexual side effects; mirtazapine beneficial for older patients with appetite concerns.
Monitoring and Patient Education
- Emphasize the need for patient education on dosage adjustments, potential side effects, and the importance of adherence to prescribed regimens.
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Description
Prepare for Exam #4 on Pharmacology focusing on Parkinson's Disease and Alzheimer's Disease medications. This quiz covers drug mechanisms, adverse effects, drug-drug interactions, and prescribing considerations for key therapies like Levodopa/Carbidopa. Test your knowledge on strong inhibitors and inducers with around 65 questions.
