Questions and Answers
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?
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?
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What should be considered regarding prescribing MAOIs?
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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?
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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?
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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?
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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?
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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)?
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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?
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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?
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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?
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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?
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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?
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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.
