Pharm III, EXAM 2 "Potential" Questions

Which one of the following antipsychotics has been shown to be a partial agonist at the dopamine D2 receptor? A. Aripiprazole. B. Clozapine. C. Haloperidol. D. Risperidone. E. Prochlorperazine.

A. Aripiprazole. Note: both Aripiprozole AND Brexpiprazole are partial D2 agonists

A 21-year-old male has recently begun fluphenazine therapy for Tourette disorder. His parents bring him to the emergency department. They describe that he has been having "different-appearing tics" than before, such as prolonged contraction of the facial muscles. While being examined, he experiences opisthotonos (type of extrapyramidal spasm of the body in which the head and heels are bent backward and the body is bowed forward). Which of the following drugs would be beneficial in reducing these symptoms? A. Benztropine. B. Bromocriptine. C. Lithium. D. Prochlorperazine. E. Risperidone.

A. Benztropine. Because this patient has EPS and needs a med with anticholinergic effects like Benztropine

A 28-year-old woman is diagnosed with bipolar disorder after being brought to the ED for a manic episode. She has a positive pregnancy test and says that she's surprised to find out she is pregnant because she hasn't yet missed her period. Which of the following is the best medical management for her acute manic episode? A. Haloperidol B. Lithium C. Lamotrigine D. Valproate E. Carbamazepine

A. Haloperidol In the first trimester, Haloperidol is the drug of choice for acute mania. Lamotrigine is used for maintenance therapy in all the 3 trimesters. The other choices are all known teratogens (Lithium- Ebstein's abnormality and renal problems, Valproic acid and Carbamazepine - CNS defects).

You are treating a woman for Gluacoma with travoprost eye drops, you tell her to take it at night and to not administer with contacts lenses in. What do you want to warn her about possible side effects? -Changes in iris pigmentation (skin around eyes may darken) -Eyelash growth -Eye redness, tearing, eye pain or lid crusting -All of the above

All of the above Travoprost is a prostaglandin Eye drop (first line for glaucoma)

Adverse effects of intranasal antihistamines like azelastine include all the following EXCEPT: Epistaxis Bitter taste Dry mouth Anosmia

Anosmia

Which of the following would be the prefered choice for a child with ADHD AND anxeity, insomnia, or substance abuse discorders? -Amphetamines -Methylphenidate -Atomoxetine

Atomoxetine (Pointed out in the powerpoint slides) Also pointed out for Guanfacine and Clonidine

Ruben swam in a dirty lake and now his ears hurts. He thinks he has otitis media/swimmers ear. Poor Ruben. What ear drops is he going to prescribe himself? -Aurodex -Ciprofloxacin -Neomycin -Azithromycin

Aurodex (Antipyrine & Benzocaine) He may use this in combination with an oral antibiotic (like high-dose amoxicillin). Feel better soon Ruben.

All of the following are medications to avoid in Glaucoma EXCEPT: A. Antihistamines B. Anticholinergics C. Beta Agonists D. Carbonic Anydrase Inhibitors E. Corticosteroid Eye drops

D. Carbonic Anydrase Inhibitors (These are actually a treatment for Glaucoma)

Which of the following antipsychotic agents is most associated with the possibility of a hematological dyscrasia such as agranulocytosis in a patient being treated for schizophrenia? A. Chlorpromazine. B. Buspirone. C. Lithium. D. Clozapine. E. Asenapine.

D. Clozapine. Note: Pts recieving Clonzapine need their absolute neutrophil count (ANC) monitored prior to getting med dispensed.

An adolescent male is newly diagnosed with schizophrenia. Which of the following antipsychotic agents may have the best chance to improve his apathy and blunted affect? A. Chlorpromazine. B. Fluphenazine. C. Haloperidol. D. Risperidone. E. Thioridazine.

D. Risperidone. Because Risperidone works for both positive and neg symptoms of schizophrenia

First generation and second generation antipsychotics differ in terms of their common side effects. Which of the following would be more likely observed in a patient taking either clozapine or olanzapine? ? diabetes ? endocrine side effects ? extrapyramidal symptoms ? hyperprolactemia ? tardive dyskinesia

Diabetes Metabolic syndrome-related symptoms (diabetes, weight gain, dyslipidemia) are side effects associated with 2nd generation antipsychotics, and are believed to be primarily caused by antagonism of serotonin & histamine receptors.

Useful for Insomnia and for its anti-parkinsonism effects: Hydroxyzine Meclizine Promethazine Diphenhydramine

Diphenhydramine

Match the MOA Block H1 receptor-mediated response to histamine (GI, blood vessels and respiratory tract). Penetrates the CNS and causes sedation -Diphenhydramine, Hydroxyzine, -Cetirizine, Loratadine, -Cromolyn -Pseudoephedrine -Guaifenesin -Dextromethorphan

Diphenhydramine, Hydroxyzine, (First Gen Antihistamines) These Also interact with other receptors beside H1• - have Anti-cholinergic properties

Which receptors do first generation antipsychotic medications block? Acetylcholine receptors Dopamine receptors GABA receptors Glutamine receptors

Dopamine receptors

Match MOA Reduce aqueous humor production -Latanoprost -Levobunolol -Dorzolamide -Carbachol -Aurodex -Carbamide peroxide

Dorzolamide (Carbonic Anhydrase Inhibitor Drops)

All are effective for motion sickness prevention EXCEPT: Hydroxyzine Meclizine Doxylamine Diphenhydramine

Doxylamine

Lady is pregnant and very nauseous - what is the drug of choice to give her? Hydroxyzine Meclizine Desloratidine Doxylamine

Doxylamine MAKE SURE you give it with Vitamin B6

Risperidone has broad efficacy with little to no EPS at low doses, but may cause.... -Weight gain -Risk of agranulocytosis -QT prolongation -EPS and hypotension at high doses -Hypotension with dose adjustments

EPS and hypotension at high doses

A patient suffering from a seizure disorder is diagnosed by EEG to be suffering from a type of generalized seizure known to be caused by the abnormal activation of thalamic T-type Ca channels that produce a neuronal bursting activity that interferes with the transmission of sensory signals to the cortex necessary for staying awake. This abnormal bursting pattern results in a state of unconsciousness or sleep. Which of the following drugs is selective for treating this particular seizure disorder because it selectively blocks the channel subtype responsible for causing it? ? carbamazepine ? ethosuximide ? lamotrigine ? phenytoin

Ethosuximide This drug is a selective T-type Ca channel blocker. This is what makes it a drug specifically effective against absence seizures (it is not indicated for other types of seizures).

A 2nd grade teacher notices that one of her students, a 7-year-old girl has been having 5-10 second staring spells several times a day while in class. During these spells, the girl exhibits small amplitude hand motions, and yet becomes fully alert immediately afterwards. When examined by a neurologist, the young girl's EEG shows a 3 second spike-wave pattern in all leads while experiencing a similar staring spell. What would be a drug of first choice for treating this patient's seizure disorder? ? carbamazepine ? diazepam ? ethosuximide ? phenobarbital ? phenytoin

Ethosuximide This patient has an absence seizure, and ethosuximide is a drug of choice for this seizure type. At least two other drugs are also effective against absence seizures - valproate and clonazepam. Valproate (like ethosuximide) is non-sedating, but clonazepam is sedating and tolerance to its effects develop over time. Lamotrigine and topiramate may also be effective.

At what intervals should a client taking lithium have blood levels monitored? Every 5-7 days at the beginning and every 6-12 months thereafter Every 5-7 days at the beginning and every 2-3 months thereafter Every 2-3 months at the beginning and every 3-6 months thereafter Every 2-3 weeks at the beginning and every 6-12 months thereafter

Every 5-7 days at the beginning and every 6-12 months thereafter

A 23-year-old woman is brought to a psychiatric hospital in Palos Hills after being arrested for threatening to harm a family member. She has been hospitalized three times in the past year due to poor adherence to her prescribed medications, and has been hearing voices whenever she is off her medications for more than a few days. She states that she "hates" clozapine and olanzapine because of the 30 lbs of weight she gained while taking them. Her medical history indicates that she had responded well to haloperidol in the past, but had trouble taking it several times daily, as prescribed. After a long discussion with the patient regarding possible alternative treatments, she agrees to starting therapy with a long-acting i.m. depot formulation of haloperidol deconate, with the agreement that she return once a month for a maintenance dose. Two weeks later you learn that she appeared at a local emergency department complaining about drug side effects. Which of the following complaints would be LEAST likely caused by her antipsychotic medication? ? difficulty reading a book ? difficulty urinating ? dizziness upon standing up ? excessive salivation ? sedation

Excessive salivation Her hypersalivation, if real, must have another cause. Typical (1st generation) antipsychotics have wide-spread side effects due to blockade of D2, 5-HT1, muscarinic, histamine and alpha-1 receptors - attributed to the similar sequence homology of all these receptors that belong to the same serpatine receptor superfamily.Hypersalivation has been observed in ~31% of patients on clozapine (an atypical antipsychotic), and is believed to be caused by blockade of alpha-2 adrenergic receptors

Adverse effects of Pseudoephedrine include all of the following except: Hypotention Urinary retention Tachycardia Insomnia

Hypertension

A pregnant client is taking phenytoin for the treatment of seizures. What are the metabolic considerations for this drug? Decreased metabolism in the liver will decrease phenytoin clearance Reduced blood flow to the liver will decrease phenytoin clearance Increased blood flow to the liver will increase phenytoin clearance Increased metabolism in the liver will increase phenytoin clearance

Increased metabolism in the liver will increase phenytoin clearance

Which side effect of lithium is expected? Dystonia Increased urination Somnolence Hyperactivity

Increased urination

MOA Matching Noncompetitive antagonist AMPA glutamate receptor on postsynaptic neurons -Carbamazepine/Oxcarbazepine/Eslicarbazepine -Lamotrigine/Lacosamide -Ethosuximide -Levetiraceam/Brivaracetam -Ethosuximide -Valproate -Ezogabine -Gabapentin -Phenytoin -Pregabalin -Topiramate -Zonisamide -Clonzepam -Felbamate -Permapanel

Perampanel Also... Dosage adjustment required in renal/hepatic impairment Avoid in severe renal/hepatic impairment Class III substance

What med has a clinical use for absence seizures, but serious adverse effects of neutropenia, SJS, and Hepatotoxicity? -Valproic acid -Lorazepam -Phenobarbital -Buspirone

Phenobarbital

A dude comes in complaining that the medication he was prescribed for his nasal congestion initially helped, but 2 weeks later, now his symptoms are back and worse. What was he most likely prescribed initially? Phenylephrine Pseudoephedrine Loratadine Fluticasone nasal spray

Phenylephrine (also oxymetazoline) These are TOPICAL nasal decongestants that still go in your nose This question is describing REBOUND CONGESTION (rhinitis medicamentosa)

What is the difference between the nasal decongestants Phenylephrine and Pseudoephedrine? Pseudoephedrine is only a Alpha antagonist while Phenylephrine is a Alpha and Beta antagonist Phenylephrine is only a Beta antagonist while pseudoephedrine is a Alpha and Beta antagonist Phenylephrine is only a Alpha agonist while pseudoephedrine is a Alpha and Beta agonist Pseudoephedrine is only a Alpha agonist while Phenylephrine is a Alpha and Beta agonist Phenylephrine is only a Beta agonist while pseudoephedrine is a Alpha and Beta agonist

Phenylephrine is a Alpha agonist while pseudoephedrine is a Alpha and Beta agonist This sounds like a test question* ***Note: Phenylephrine is a less effective nasal decongestant than pseudoephedrine

You are treating a woman for Gluacoma with timolol eye drops, you tell her it can exacerbate respiratory conditions and requires shaking prior to use. What do you want to warn her about possible side effects? -Extended pupillary dilation -Prolonged lacrimation from lacrimal ducts -Photosensitivity -All of the above

Photosensitivity Also may cause changes in vision and burning/stinging

What over-the-counter medication is highly regulated and only sold behind the pharmacy counter with proof of identification? Fexofenadine Pseudoephedrine Azelastine Diphenhydramine

Pseudoephedrine

One of the challenges of treating patients with antipsychotics is patient tolerance for drug-related side effects. While not all antipsychotics exhibit the same side effect profile, there is one dose-dependent effect that represents a significant health risk that is unrelated to their antagonistic effect on D2 or 5-HT2A receptors. Which side effect fits this description? ? diabetes ? increased risk for infections :-) malignant hyperthermia ? osteoporosis ? QTc prolongation

QTc prolongation Both typical and of atypical antipsychotic drugs share a qualitatively similar, dose-related increased risk of QTc prolongation and sudden cardiac death

All are adverse effects of oral antihistamines (especially first gen) EXCEPT: Worsen urinary retention in BPH Decrease effectiveness of cholinesterase inhibitors used in Alzheimer's Interference with CYP3A4 substrates/inhibitors Reduce the CNS affect of alcohol

Reduce the CNS affect of alcohol (Benadryl will make you feel more drunk when you drink... yikes)

What is a possible mechanism of action of lithium? -Reduction in plasma GABA levels -Decreasing the availability of glutamate in post-synaptic neurons -Reduction in intracellular calcium -Inhibition of G protein-coupled receptors with increased production of cyclic AMP -Reduction of inositol triphosphate

Reduction of inositol triphosphate

Kara is checking Bryan's ears but cannot see the tympanic membrane. What should she do? -Amputate -Get a new career -Use Carbamide peroxide -Say she sees it anyways and move on

Use Carbamide peroxide breaks up ear wax.

A patient is diagnosed with having both absence seizures and concomitant generalized tonic-clonic seizures. Which of the following would be most effective in treating both types of seizures, yet not have significant sedating side effects? ? ethosuximide ? phenobarbital ? gabapentiin ? phenytoin ? valproate

Valproate The other answer options are either not indicated for treating absence seizures (e.g. gabapentin, phenytoin, phenobarbital), are sedating (phenobarbital), or are effective only against absence seizures (ethosuximide). Many patients with absence seizures eventually develop tonic-clonic seizures, and require a change in therapy.

The following have cautions with renal failure EXCEPT: -Valproic acid -Gabapentin -Topiramate -Pregabalin

Valproic acid Renal failure SHOULD be cautioned with use of Gabapentin, Topiramate, and Pregabalin

Olanzapine is effective with positive and negative symptoms with little or no EPS, but may cause... -Weight gain -Risk of agranulocytosis -QT prolongation -EPS and hypotension at high doses -Hypotension with dose adjustments

Weight gain

High blood concentrations of Phenytoin follow what Elimination kinetics? -Zero Order -First Order -Second Order -Third Order

Zero Order- Small increases in dose can result in large increases in concentration and lead to toxicity. NOTE: In LOW concentraions, phenytoin follows FIRST ORDER kinetics (dose-dependent)

Treatment of neuroleptic malignant syndrome? Pick two -Haloperidol -Dantrolene -Bromocriptine -Carbamazepine

dantrolene and bromocriptine

Use of this class of over-the-counter drugs has been associated with poor academic performance in children, an increased incidence of automobile accidents, increased work injuries & a significant decline in cognitive function in the elderly. A commonly used member of this drug class is: ? diphenhydramine ? fexofenadine ? loratadine ? nizatidine

diphenhydramine First generation H1-type antihistamines have significant side effects. These drugs are commonly used to treat the symptoms of allergies & colds, and to produce night time sedation.

Which type of clients should sympathomimetic decongestants be used with caution? Clients with psychiatric issues Clients with asthma Clients who are obese Clients with cardiac issues

Clients with cardiac issues

This medication requires submission of bloodwork prior to it being dispensed by pharmacist. -Clozapine -Risperidone -Olanzapine -Quetiapine -Ziprasidone -Aripiprazole

Clozapine

A 10-year-old boy is sent to a pediatric neurologist for an evaluation due to poor performance and inability to pay attention in school. He has also been fighting with other children. He is given a diagnosis of ADHD with impulsivity and irritability. Which is most appropriate for management of the ADHD? A. Clonidine B. Mirtazapine C. Dextroamphetamine D. Haloperidol

Correct answer = C. Dextroamphetamine is the only stimulant medication in the list that is approved for ADHD. Symptoms like fighting may improve with haloperidol, and hyperactivity may improve with clonidine, but these agents would not improve the patient's academic performance and the underlying problems

A 43-year-old heavy machine operator complains of seasonal allergies. Which medication is most appropriate for management of his allergy symptoms? A. Diphenhydramine B. Doxylamine C. Hydroxyzine D. Fexofenadine

Correct answer = D. The use of first-generation H1 antihistamines is contraindicated in the treatment of pilots and others who must remain alert. Because of its lower potential to induce drowsiness, fexofenadine may be recommended for individuals working in jobs in which wakefulness is critical.

Montelukast is a leukotriene receptor antagonist that works to decrease inflammation in the airways. What is the BLACK BOX warning associated with its use? Neuromuscular events in pediatric population Neuropsychiatric events in pediatric population Neuroleptic events in pediatric populations Neurodivergent events in pediatric populations

Neuropsychiatric events in pediatric population

Ciprofloxacin and Neomycin ear drops are often used to treat _____________ (usually in combination with a steroid) -Otitis media -Otitis interna -Otitis externa -Impacted Cerumen

Otitis externa

All are side effects of phenytoin EXCEPT: -Gingival Hyperplasia -Osteoporosis -Hair loss -Teratogenicity

-Hair loss Phenytoin can actually cause hirsuitism

Quetiapine is similar to risperidone and may cause less weight gain, but also may cause... -Weight gain -Risk of agranulocytosis -QT prolongation -EPS and hypotension at high doses -Hypotension with dose adjustments

-Hypotension with dose adjustments

If tritated rapidly, the following may cause significant cognitive impairment.... -Phenytoin -Phenobarb -Topirimate -All of the above

-All of the above

Match MOA Promotes the release of catecholamines (primarily DA and NE) from their storage sites in the presynaptic nerve terminals. -Triptans -Ergot alkaloids -Anti-CGRP therapy -Amphetamines -Methylphenidate -Atomoxetine

-Amphetamines

Match MOA Causes a moderate increase of DA and NE in the prefrontal cortex but no effect in subcortical brain structures. -Triptans -Ergot alkaloids -Anti-CGRP therapy -Amphetamines -Methylphenidate -Atomoxetine

-Atomoxetine

Match MOA Glycerin base that helps decrease middle ear pressure via osmosis -Latanoprost -Levobunolol -Dorzolamide -Carbachol -Aurodex -Carbamide peroxide

-Aurodex (Antipyrine & Benzocaine Drops)

PICK 2... BLACK BOX WARNING for Aplastic anemia... -Carbamazepine -Lamotrigine -Topiramate -Felbamate -Valproic acid

-Carbamazepine AND Felbamate

Match the MOA Block H1 receptor-mediated response to histamine (GI, blood vessels and respiratory tract). Minimal to negligible distribution into CNS. Specific for H1 receptors -Diphenhydramine, Hydroxyzine, -Cetirizine, Loratadine, -Cromolyn -Pseudoephedrine -Guaifenesin -Dextromethorphan

-Cetirizine, Loratadine, (Second Gen Antihistamines)

Match the MOA Prevents release/degranulation of histamines, leukotrienes, etc. AND secures the eosinophil plasma membrane. -Diphenhydramine, Hydroxyzine, -Cetirizine, Loratadine, -Cromolyn -Pseudoephedrine -Guaifenesin -Dextromethorphan

-Cromolyn (Mast cell stabilizers)

Match the MOA structurally related to codeine & depresses the medullary cough center -Diphenhydramine, Hydroxyzine, -Cetirizine, Loratadine, -Cromolyn -Pseudoephedrine -Guaifenesin -Dextromethorphan

-Dextromethorphan (Antitussives)

A child is RX'd intranasal cromolyn, what should you advise him and his parents about POSSIBLE side effects? -Rash, epistaxis, excessive salivation -Dry throat, burning in nose, bad taste in mouth -Dry throat, palpitations, bitter taste in mouth -Burning in nose, Rash, titinitus

-Dry throat, burning in nose, bad taste in mouth (From the power point slides)

Olivia is working her dream job in the ER and a concerned mother comes in with her child who has blepharitis (I know you don't know what that means: its an infected eyelid). What antibiotic eyedrop/ointment should she Rx this child? -Gentamicin -Ciprofloxacin -Erythromycin -Holy water drops

-Erythromycin Olivia saved the day again

Kara is treating a patient who has been having a non stop seizure for 15 minutes now. She gave him lorazepam but it did not stop the seizure. What should she try next? (2nd line?) -Diazepam -Fosphenytoin -Carbamazepine -8000mg of morphine

-Fosphenytoin This patient is in STATUS EPILEPTICUS First line= Benzodiazepines 2nd line= Fosphenytoin 3rd line= Phenobarbital

Lady in ER wants her migraine medication to work ASAP!, which triptan is not a good choice in this case? -Zolmitriptan -Rizatriptan -Sumatriptan -Almotriptan -Frovatriptan -Eletriptan

-Frovatriptan (most delayed onset of action) BUT HAS THE LONGEST HALF LIFE @ 25 HOURS

Match the MOA Thins airway mucus. Easier to bring up (expectorate) -Diphenhydramine, Hydroxyzine, -Cetirizine, Loratadine, -Cromolyn -Pseudoephedrine -Guaifenesin -Dextromethorphan

-Guaifenesin (Expectorants)

MOA Matching Bind to synaptic protein vesicle 2A (SV2A) that modulate NT release. Inhibition of voltage-dependent calcium channels -Carbamazepine/Oxcarbazepine/Eslicarbazepine -Lamotrigine/Lacosamide -Ethosuximide -Levetiraceam/Brivaracetam -Ethosuximide -Valproate -Ezogabine -Gabapentin -Phenytoin -Pregabalin -Topiramate -Zonisamide -Clonzepam -Felbamate -Permapanel

-Levetiraceam/Brivaracetam Levetiraceam also... Dosing adjustment required in renal impairment. Minimal metabolism (only ~24%). Also used to preventing seizures after subarachnoid hemorrhage. Brivaracetam also... CYP2C19 poor metabolizers may require less drug. Can be given IV. Excreted to a high degree in the urine (not recommended with severe renal impairment).

MOA matching Inhibits several enzymes involved in recycling of neuronal membrane phosphoinositides -Lithium -Typical Antipsychotics (Chlorpromazine, Haloperidol) -Second Gen Antipsychotics (Risperidone, Aripiprazole)

-Lithium

Match MOA Blocks the reuptake of DA and NE into the presynaptic neurons. -Triptans -Ergot alkaloids -Anti-CGRP therapy -Amphetamines -Methylphenidate -Atomoxetine

-Methylphenidate

Which eye drop does all of the following? Treatment of glaucoma, acute angle closure, to prevent post-op elevation of intraocular pressure, & to counteract mydriasis from sympathomimetics. -Pilocarpine -Betaxolol -Brimatoprost -Brinzolamide

-Pilocarpine

Match the MOA Stimulates both α and β adrenergic receptors. Induce the release of norepinephrine from nerve endings -Diphenhydramine, Hydroxyzine, -Cetirizine, Loratadine, -Cromolyn -Pseudoephedrine -Guaifenesin -Dextromethorphan

-Pseudoephedrine (Decongestants)

Ziprasidone causes perhaps less weight gain than clonzapine, But may cause... -Weight gain -Risk of agranulocytosis -QT prolongation -EPS and hypotension at high doses -Hypotension with dose adjustments

-QT prolongation

Clozapine is effective for treatment resistant cases with little EPS, what is a disadvantage of its use? -Weight gain -Risk of agranulocytosis -QT prolongation -Hypotension with dose adjustments

-Risk of agranulocytosis

A patient with high prolactin count should stay farthest away from which of the following? -Clozapine -Risperidone -Olanzapine -Quetiapine -Ziprasidone -Aripiprazole

-Risperidone

MOA matching Typically block the dopamine receptors to a lesser degree and blocks serotonin receptor activity to varying degrees -Lithium -Typical Antipsychotics (Chlorpromazine, Haloperidol) -Second Gen Antipsychotics (Risperidone, Aripiprazole)

-Second Gen Antipsychotics (Risperidone, Aripiprazole)

What -triptan has the slowest bioavailabitliy? -Zolmitriptan -Rizatriptan -Sumatriptan -Almotriptan -Frovatriptan -Eletriptan

-Sumatriptan (only about 14%)

What -triptan has the Fastest onset of action? (pick 2) -Zolmitriptan -Rizatriptan -Sumatriptan -Almotriptan -Frovatriptan -Eletriptan

-Sumatriptan & -Zolmitriptan (both about 1.5 hours) Specifically, Sumatripatin IM has a onset of action of 10 mins

This med might cause Oligohydrosis (in children) or Nephrolithiasis.... -Carbamazepine -Lamotrigine -Topiramate -Felbamate -Valproic acid

-Topiramate (AND Zonisamide)

Match MOA May activate 5-HT receptors on presynaptic trigeminal nerve endings to inhibit the release of vasodilating peptides - has vasoconstricting properties. -Triptans -Ergot alkaloids -Anti-CGRP therapy -Amphetamines -Methylphenidate -Atomoxetine

-Triptans AND Ergot alkaloids

MOA matching Blocks DA, muscarinic cholinergic, α-adrenergic, and H1-histaminergic receptors to differing degrees -Lithium -Typical Antipsychotics (Chlorpromazine, Haloperidol) -Second Gen Antipsychotics (Risperidone, Aripiprazole)

-Typical Antipsychotics (Chlorpromazine, Haloperidol)

Which drug is associated with BLACK BOX WARNING FOR Hepatotoxicity? (Different from just using caution in hepatic dysfunction) -Valproic acid -Carbamazepine -Topiramate -Phenytoin

-Valproic Acid (AND Felbamate)

Which of the following is associated with weight GAIN? -Levetiracetam -Valproic acid -Topiramate -Zonisamide

-Valproic acid Levetiracetam, Topiramate, and Zonisamide are actually associated with weight LOSS

Which of the following has a BLACK BOX WARNING for fetal pancreatitis? -Carbamazepine -Felbamate -Topiramate -Valproic acid

-Valproic acid keep this stuff far away from babies or pregnant ladies

A patient has very high lipid levels and needs a 2nd gen antipsychotic - what is the best choice? (Pick two) -Clozapine -Risperidone -Olanzapine -Quetiapine -Ziprasidone -Aripiprazole

-Ziprasidone and -Aripiprazole

Sarah has a KILLER migrane, is nauseous, and is terrified of needles. What -triptan would be best for her? -Zolmitriptan -Eletriptan -Frovatriptan -Amlotriptan

-Zolmitriptan an oral med is contraindicated in someone who may vomit. Zolmitriptan (and sumatriptan) both can come intranasaly.

Which of the following 3 -triptans are OK to use with MAO-inhibitors? 1. Sumatriptan, Zolmitriptan, Naratriptan 2. Frovatriptan, Zolmitriptan, Eletriptan 3. Frovatriptan, Eletriptan, Sumatriptan 4. Eletriptan, Frovatriptan, Naratriptan

4. Eletriptan, Frovatriptan, Naratriptan

You are treating a woman for Gluacoma with Brinzolamide eye drops, you tell her it reduces aqueous humor production and must be used 3 times a day. What do you want to warn her about possible side effects? -Eyelash growth -Photosensitivity -Bitter or unusual taste -All of the above

Bitter or unusual taste

According to some guidelines, lithium is contraindicated in which condition? In combination with antidepressants for major depressive disorder Bipolar disorder II Bipolar disorder I Breastfeeding In combination with antipsychotics for schizophrenia

Breastfeeding

Match MOA Lowers intraocular pressure by decreasing resistance to aqueous outflow -Latanoprost -Levobunolol -Dorzolamide -Carbachol -Aurodex -Carbamide peroxide

Carbachol (Cholinergic agonist Drops)

Which of the following anti-convulsant drugs can also be used as a mood stabilizer? Carbamazepine Gabapentin Clonazepam Diazepam Ethosuximide

Carbamazepine

A 17-year-old young man is brought to the emergency department after suffering from an apparent seizure. A friend who witnessed the episode states that the patient began acting strange immediately before suffering a series of convulsions. His right arm had began shaking before he fell to the ground and experienced a tonic-clonic seizure for several minutes. During the seizure he turned pale, suffered from urinary incontinence, and bit his tongue severely. Afterwards he had no memory of the events he suffered from during the seizure, but recalled having a strange feeling of "deja vu" before he lost consciousness. Shortly after obtaining his medical history, a neurology consult performed an EEG, which revealed focal epileptiform discharges in the patient's left temporal lobe. The patient stated that he had suffered from a head injury several months ago after being thrown off his bike when he hit a storm drain. He was not wearing a helmet. A diagnosis of a focal-onset seizure evolving into a bilateral convulsive seizure (also refered to as a secondarily generalized tonic-clonic seizure) was made. Based on this diagnosis, which of the following drugs would be the most appropriate choice for treating this seizure disorder, due to its ability to block Na channels in a frequency-dependent manner ? ? carbamazepine ? diazepam ? ethosuximide ? gabapentin ? phenobarbital

Carbamazepine Carbamazepine blocks Na channels in a frequency or rate-dependent manner, a mechanism that can prevent the development and spreading of high frequency discharges from an epileptic focus

PICK 2... BLACK BOX WARNING for skin rash/SJS... -Carbamazepine -Lamotrigine -Topiramate -Felbamate -Valproic acid

Carbamazepine AND Lamotrigine

MOA Matching Blocks voltage-gated Na+ channels Decreases synaptic release of glutamate (excitatory) -Carbamazepine/Oxcarbazepine/Eslicarbazepine -Levetiraceam/Brivaracetam -Ethosuximide -Valproate -Ezogabine -Gabapentin -Pregabalin -Clonzepam -Felbamate -Permapanel

Carbamazepine/Oxycarbazepine/Eslicarbazepine -Carbamazepine also a.... CYP3A4 substrate CYP1A2, 2C8, 2C9, and 3A4 INDUCER DOES undergo autoinduction Oxycarbazepine also a... Induces 3A4 Inhibits 2C19 Does NOT undergo autoinduction Eslicarbazepine also a... Induces 3A4 Inhibits 2C19 Does NOT undergo autoinduction

Match MOA Releases H2O2 and foaming action helps to soften cerumen -Latanoprost -Levobunolol -Dorzolamide -Carbachol -Aurodex -Carbamide peroxide

Carbamide peroxide

Your patient suffering from schizophrenia has not achieved adequate control of his symptoms after more than two years of monotherapy with three different antipsychotics. After three weeks of switching treatment to a 4th agent, your patient returns to your clinic complaining of being fatigued, and having episodes of fever that come and go. His lab results reveal the presence of a leukopenia and thrombocytopenia. What drug was this patient most likely taking that produced these side effects? ? aripiprazole ? chlorpromazine ? clozapine ? olanzapine ? risperidone

Clozapine Clozapine has the potential to cause agranulocytosis. Hence it is not considered a drug of first or 2nd choice, and the need for regular blood tests for patients taking this drug.

Which of the following antipsychotics is a partial agonist at the dopamine D2 receptor? A. Brexpiprazole B. Clozapine C. Haloperidol D. Risperidone

Correct answer = A. Brexpiprazole is the only agent listed that acts as a partial agonist at D2 receptors. Theoretically, the drug enhances action at these receptors when there is a low concentration of dopamine and blocks the actions of high concentrations of dopamine. All of the other drugs are antagonistic at D2 receptors.

Which histamine receptor antagonist is known to enter the central nervous system readily and cause sedation? A. Hydroxyzine B. Cetirizine C. Desloratadine D. Loratadine

Correct answer = A. Choices B, C, and D are all second-generation antihistamines that cross the blood-brain barrier to a much lesser extent than hydroxyzine. Hydroxyzine is the only drug that crosses the blood-brain barrier easily

Which statement concerning H1 antihistamines is correct? A. Second-generation H1 antihistamines are relatively free of adverse effects. B. Because of the established long-term safety of first-generation H1 antihistamines, they are the first choice for allergic rhinitis. C. The motor coordination involved in driving an automobile is not affected by the use of first-generation H1 antihistamines. D. H1 antihistamines can be used in the treatment of acute anaphylaxis.

Correct answer = A. Second-generation H1 antihistamines are preferred over first-generation agents because they are relatively free of adverse effects. Driving performance is adversely affected by first-generation H1 antihistamines. Epinephrine, not antihistamine, is an acceptable treatment for acute anaphylaxis. Second-generation H1 antihistamines penetrate the blood-brain barrier to a lesser degree than the first-generation drugs.

Which of the following antipsychotic agents is considered to be the most potent and thus have the highest risk of extrapyramidal symptoms? A. Thioridazine B. Haloperidol C. Quetiapine D. Chlorpromazine

Correct answer = B. Among the older, conventional, or typical antipsychotics on this list, haloperidol is the most potent and would thus be expected to have the highest incidence of EPS. The atypical antipsychotics listed (quetiapine) could be considered low potency based on their common dosing and are considered to have the lowest risk for EPS

Which category of allergic rhinitis medications is most likely to be associated with rhinitis medicamentosa (rebound nasal congestion) with prolonged use? A. Intranasal corticosteroid B. Intranasal decongestant C. Leukotriene antagonist D. Oral antihistamine

Correct answer = B. Intranasal decongestants should be used no longer than 3 days due to the risk of rebound nasal congestion (rhinitis medicamentosa). For this reason, the α-adrenergic agents should not be used in the long-term treatment of allergic rhinitis. The other agents may be used as chronic therapies

A 45-year-old man who has been injured in a car accident is brought into the emergency department. His blood alcohol level at admission is 275 mg/ dL. Hospital records show a prior hospitalization for alcohol-related seizures. His wife confirms that he has been drinking heavily for 3 weeks. What treatment should be provided to the patient if he goes into withdrawal? A. No pharmacological treatment is necessary. B. Lorazepam C. Phenytoin D. Buspirone

Correct answer = B. It is important to treat the seizures associated with alcohol withdrawal. Benzodiazepines such as chlordiazepoxide, diazepam, or the shortacting lorazepam are effective in controlling this problem. They are less sedating than phenytoin, have fewer adverse effects, and are cross-tolerant with alcohol. Buspirone will not prevent the seizures associated with alcohol withdrawal.

A 32-year-old man with a history of opioid addiction presents with cough due to a viral upper respiratory system infection. Which is appropriate symptomatic treatment for cough in this patient? A. Guaifenesin/dextromethorphan B. Guaifenesin/codeine C. Benzonatate D. Montelukast

Correct answer = C. Benzonatate suppresses the cough reflex through peripheral action and has no abuse potential. Dextromethorphan, an opioid derivative, and codeine, an opioid, both have abuse potential. Montelukast is not indicated for cough suppression

Which one of the following statements is correct regarding benzodiazepines? A. Benzodiazepines directly open chloride channels. B. Benzodiazepines show analgesic actions. C. Clinical improvement of anxiety requires 2 to 4 weeks of treatment with benzodiazepines. D. All benzodiazepines have some sedative effects.

Correct answer = D. Although all benzodiazepines can cause sedation, the drugs labeled "benzodiazepines" in Figure 9.1 are promoted for the treatment of sleep disorder. Benzodiazepines enhance the binding of GABAA to its receptor, which increases the permeability of chloride. The benzodiazepines do not relieve pain but may reduce the anxiety associated with pain. Unlike the tricyclic antidepressants and the monoamine oxidase inhibitors, the benzodiazepines are effective within hours of administration. Benzodiazepines do not produce general anesthesia and therefore are relatively safe drugs with a high therapeutic index.

Which agent is a preferred antihistamine for the management of allergic rhinitis? A. Chlorpheniramine B. Diphenhydramine C. Phenylephrine D. Cetirizine

Correct answer = D. Chlorpheniramine and diphenhydramine are first-generation antihistamines and are usually not a preferred treatment due to their increased risk of adverse effects, such as sedation, performance impairment, and other anticholinergic effects. Phenylephrine is short-acting α-adrenergic agonist ("nasal decongestant"). Cetirizine is a secondgeneration antihistamine and is generally better tolerated, making it a preferred agent for allergic rhinitis

Which antipsychotic agent is most associated with the possibility of a hematological dyscrasia such as agranulocytosis in a patient being treated for schizophrenia? A. Chlorpromazine B. Buspirone C. Lithium D. Clozapine

Correct answer = D. Clozapine is the only antipsychotic medication that has a black box warning and a risk of agranulocytosis in approximately 1% of the patients treated. This requires regular monitoring of white blood cell counts. Although other antipsychotics have case reports of blood dyscrasias, clozapine is considered to have the highest risk.

An adolescent male is newly diagnosed with schizophrenia. Which antipsychotic agent may have the best chance to improve his apathy and blunted affect? A. Chlorpromazine B. Fluphenazine C. Haloperidol D. Risperidone

Correct answer = D. Risperidone is the only antipsychotic on the list that has some reported benefit in improving the negative symptoms of schizophrenia. All of the agents have the potential to diminish the hallucinations and delusional thought processes (positive symptoms).

Due to this medication's BBW for aplastic anemia and hepatic failure, it is considered the last line agent for seizure treatment and requires informed consent prior to administering it: -Lacosamide -Brivaracetam -Tiagabine -Felbamate

Felbamate

Which of the following Drugs is NOT (strongly) associated with Teratogenicity? -Valproic acid -Carbamazepine -Topiramate -Felbamate -Phenytoin

Felbamate Valproic acid (worst one), Carbamazepine, Topiramate, and Phenytoin ARE associated with Teratogenicity

Out of the options, what is most preferred for treatment of Allergic Rhinitis and Urticaria? Cetirizine Fexofenadine Diphenhydramine Levocetirizine

Fexofenadine "Second-generation preferred due to less sedation• Loratadine, desloratadine, and fexofenadine best• Possible mild sedation with cetirizine, levocetirizine"

At which lithium level does lithium toxicity place a client at risk of death? Greater than 1.5 mEq/L 0-0.5 mEq/L Greater than 2.5 mEq/L 0.6-1.2 mEq/L

Greater than 2.5 mEq/L

Which first generation antipsychotic is considered high potency? Fluphenazine Levodopa Chlorpromazine Haloperidol

Haloperidol

Which of the following drugs is better at treating positive symptoms in a psychotic disorder? Olanzapine Risperidone Aripiprazole Ziprasidone Haloperidol

Haloperidol

A 19 -year-old man is brought to Parmer hall by the River Forest police after they found him running down the middle ground of Canal boulevard in his boxer shorts and combat boots on a freezing winter day. Besides his relative lack of clothing, his appearance indicates poor hygeine, and he seems to be suffering auditory hallucinations. Upon arrival he seems extremely suspicious of the medical staff, and claims that Richard Nixon will save us all once he becomes re-elected president of the United States. Amber gives him a single dose of i.m. diazepam to reduce his anxiety, before seeking a psychiatric consult. His physical exam, blood glucose and electrolytes are normal, and a panel of blood tests for drugs of abuse are negative. Amber makes a tentative diagnosis of schizophrenia and recommends a first generation (typical) antipsychotic be given i.m. to reduce his agitation, and stabalize his behavior. Which of the following drugs would be an appropriate choice? ? Aripiprazole ? Chlordiazepoxide ? Clozapine ? Haloperidol ? Olanzapine

Haloperidol This is a 1st generation antipsychotic commonly used in this clinical situation (to treat acute agitation). Droperidol is a haloperidol analog with a shorter half-life, and proven track record, that is also commonly used. While 2nd generation drugs might also be effective, the clinical evidence supporting their efficacy in this situation is not strong.

Which of the following is associated with the adverse effect of aseptic meningitis? -Carbamazepine -Lamotrigine -Topiramate -Felbamate -Valproic acid

Lamotrigine

Match MOA Increase aqueous outflow -Latanoprost -Levobunolol -Dorzolamide -Carbachol -Aurodex -Carbamide peroxide

Latanoprost (Prostaglandin eye drop) First line treatment of glaucoma

Match MOA Reduce aqueous humor production -Latanoprost -Levobunolol -Dorzolamide -Carbachol -Aurodex -Carbamide peroxide

Levobunolol (Non-Selective Beta Blocker Drops)

Which effects do second generation antipsychotic medications have a higher risk of causing? Respiratory effects Gastrointestinal effects Endocrine effects Metabolic effects

Metabolic effects

A patient suffering from schizophrenia was recently initiated on treatment with a different 2nd generation antipsychotic after having failed to respond to several other agents over the past two years. While taking this drug, the patient is required to have weekly blood counts during the 1st 6 months of therapy, and biweekly blood tests thereafter to screen for evidence of developing neutropenia. What other "unusual" side effect is also uniquely associated with this drug, in contrast to other 2nd generation antipsychotics? ? dry mouth ? insomnia ? prolonged QTc ? seizures ? weight loss

Seizures mongst the 2nd generation antipsychotics, clozapine is unique for having a dose-dependent risk for producing seizures.

A 25 year old male comes into the ER after drinking some lean (cough syrup and alcohol) at DISCO last night... He is tripping bad with tremor & fever... what are you specifically concerned about? Acute Liver failure Serotonin syndrome Medication induced coma Neuropsychiatric events

Serotonin syndrome ***Note: Too much serotonin causes signs and symptoms that can range from mild (shivering and diarrhea) to severe (muscle rigidity, fever and seizures). Severe serotonin syndrome can cause death if not treated.

Which of the following medications is most appropriate in migraine headache that does not respond to nonsteroidal anti-inflammatory drugs? Topiramate Intramuscular ketorolac Valproate Amitriptyline Sumatriptan

Sumatriptan

A 23 year old woman with a history of depression comes to your clinic seeking relief for a severe migraine headache that began 20 minutes ago. She is currently taking the SSRI citalopram for her depression and an estrogen/progesterone combined oral contraceptive. What medication would you avoid using for her acute treatment? ? Ergotamine ? Morphine ? Sumatriptan ? Topiramate

Sumatriptan Migraine is comorbid with depression- those suffering from migraines are 2-4 times more likely to have depression. Therefore it is no surprise that patients may try to take both a triptan and either an SSRI or SNRI at the same time. Since these different classes of medications both elevate serotonin levels, when combined they can "potentially" cause a serotonin syndrome which can produce hypertension, tachycardia & hyperthermia. Its best to avoid combining two serotonergic drugs whenever possible.

Jane is a 67 year-old woman with a history of mild hypertension and classic angina pectoris. She is seeking treatment for migraine headaches of moderate intensity. Her headaches are preceeded by bilateral light flashes and dizziness that last about 10 minutes prior to the onset of pain. Her headaches are also frequently accompanied by photophobia, severe nausea and occasional vomiting. What medication would be contraindicated for acute treatment of Jane's headaches? ? Acetaminophen ? Aspirin ? Caffeine ? Propranolol ? Sumatriptan

Sumatriptan Sumatriptan is a serontoninergic agonist that could produce vasoconstriction, and is therefore contraindicated in patients with a history of ischemic heart disease (as well as other peripheral vascular diseases, or pregnancy).

Which statement is true of first and second generation antipsychotic medications? They are equally effective but have different side effects. Side effects in first generation antipsychotics are much worse than in second generation antipsychotics. First generation antipsychotics work better than second generation antipsychotics. Second generation antipsychotics work better than first generation antipsychotics.

They are equally effective but have different side effects.

What is NOT a characteristic of classical antipsychotic medications? The most commonly used medication in the emergency setting is haloperidol. They have a high rate of extrapyramidal side effects. They easily cross the blood-brain barrier. They have a high affinity for both D1 and D2 receptors. Tardive dyskinesia is a side effect.

They have a high affinity for both D1 and D2 receptors.

MOA Matching Inhibits GABA reuptake (inhibitory neurotransmitter) -Carbamazepine/Oxcarbazepine/Eslicarbazepine -Lamotrigine/Lacosamide -Ethosuximide -Levetiraceam/Brivaracetam -Ethosuximide -Valproate -Ezogabine -Gabapentin -Phenytoin -Phenobarbital -Pregabalin -Topiramate -Tiagabine -Zonisamide -Clonzepam -Felbamate -Permapanel

Tiagabine

All the following drugs increase lithium levels, except: Diuretics ACE inhibitors Topical steroids Metronidazole NSAIDs

Topical steroids

A 27-year-old man with a history of paranoid schizophrenia is hospitalized after exhibiting severe symptoms attributed to non-adherence to therapy with haloperidol. During the taking of his history he states that he "stopped taking that damned drug" because it caused breast enlargement. He also complained about delayed ejaculations, which became much less of a problem after stopping haloperidol for two weeks. What mechanism was most likely responsible for causing this patient's side effects? ? autonomic side effects ? endocrine side effects ? extrapyramidal side effects ? hypoprolactemia

endocrine side effects Dopamine is the normal inhibitory regulator of prolactin release. As a result, potent D2 receptor antagonists produce "hyperprolactemia" which results in amenorrhea in women, infertility in both sexes, and breast development in men.

A 24 year-old patient presents on a bright sunny Spring morning with a constellation of signs & symptoms that include a stuffy runny nose, sneezing, red, itchy & watery eyes, and a cough related to postnasal drip. A diagnosis of allergic rhinitis is made. In addition to a decongestant or corticosteroid spray, what other medication could you recommend that would counteract the effects related to histamine release, but have the least impact on mental status? ? brompheniramine ? chlorpehniramine ? diphenhydramine ? fexofexadine ? ranitidine

fexofexadine This is a 2nd generation H1 antihistamine that is less lipid soluble and does not easily cross the BBB & cause the same degree of CNS side effects as the 1st generation antihistamines.

Several of the commonly used drugs for treating epilepsy are associated with significant side effects or risks for serious toxicity. For example, valproate has 3 black box warnings. Which of the following most accurately summarizes these 3 warnings? ? aplastic anemia, agranulocytosis, Stevens-Johnson syndrome ? ataxia, sedation, cognitive impairment ? gingival hyperplasia, hirsuitism, nystagmus ? hepatotoxicity, pancreatitis, spina bifida

hepatotoxicity, pancreatitis, spina bifida The other answer options are side effects and toxicities associated with other antiepileptic drugs

A 32-year-old man with a history of epilepsy is brought into the emergency department suffering from a tonic-clonic seizure that has lasted for more than 30 minutes. His blood pressure is 200/105 mm Hg, pulse 135/min, rectal body temp 37.6oC. He is placed on his side to prevent aspiration, and to allow drainage of saliva and mucus. An i.v. line is established using normal saline. A blood sample is taken for analysis of blood electrolytes, glucose, and a toxicology screen for pro-convulsant drugs. Which anticonvulsant drug should be given immediately to treat his seizure? ? ethosuximide ? gabapentin ? lamotrigien ? lorazepam

lorazepam This patient is suffering from status epilepticus. Both diazepam and lorazepam have been found to be most effective in treating this seizure subtype. They act primarily by enhancing the inhibitory effects of GABA on GABA-A receptors, which causes a chloride mediated membrane hyperpolarization that inhibits neuronal firing. The other drugs listed are not indicated for this clinical situation.

A patient who has been on combination therapy with carbamazepine and gabapentin continues to have occassional seizures, and the decision is made to add phenytoin to the daily drug regimen. What effect, if any, would this concomitant therapy be expected to have on drug plasma levels compared to patients on monotherapy alone? ? gabapentin plasma levels would be increased ? higher than normal phenytoin plasma levels ? lower than normal phenytoin plasma levels ? no difference compared to patients on monotherapy

lower than normal phenytoin plasma levels Carbamazepine is metabolized primarily by CYP 3A4, but is a wide spectrum inducer of several P-450 isoforms (3A4, 1A2, 2B6, 2C9 & 2C19), including the P-450 isozymes that metabolize phenytoin (CYP 2C9 and CYP 2C19). The enzyme-inducing effect of carabamazepine pretreatment will result in lower than expected phenytoin plasma levels at steady state. The other answer options are false. Gabapentin (an amino acid) is not metabolized, and is excreted unchanged in the urine

Your patient's seizure disorder is well controlled by carbamazepine once his dosage is adjusted to produce a steady-state plasma level of ~9 ug/ml. Two months later he develops an upper respiratory infection, for which he is prescribed a 14-day regimen of clarithromycin, a macrolide antibiotic. Five days later the symptoms associated with his infection have cleared, but he now complains of being tired, dizzy and having blurred vision. What is the best explanation for these new symptoms? ? decreased carbamazepine plasma levels ? increased macrolide plasma levels ? late-onset carbamazepine syndrome ? macrolide-induced inhibition of P-450

macrolide-induced inhibition of P-450 Clarithromycin ( & erythromycin) are inhibitors of Cyp 3A4, the enzyme responsible for metabolism of carbamazepine. This patient's symptoms are consistent with increased side effects associated with elevated plasma levels of carbamazepine

You are initializing treatment of a man suffering from a focal-onset seizure with 300 mg/day phenytoin. A blood sample confirms a steady-state plasma level of 9 ug/ml. However, lack of adequate seizure control requires a dosage elevation. If his daily drug dosage were doubled, what would be the most likely change in his drug plasma level? ? double his previous plasma level ? less than doubled ? more than doubled ? no change due to zero order clearance

more than doubled Phenytoin has dose-dependent clearance due to progressive saturation of its hepatic metabolism by cyt P-450 at normal therapeutic plasma levels, and ~10 ug/ml is considered the minimal effective plasma concentration for seizure control. Due to saturation of its metabolism, even small increases in maintenance dosage can cause large, unpredictable increases in plasma drug concentrations, which increases the risk of adverse effects such as ataxia, nystagmus, confusion, gingival hyperplasia, hirsuitism (and the list goes on). In addition, other drugs that either inhibit or induce P-450 can produce marked changes in phenytoin plasma levels

Antipsychotics are notorious for producing side effects, and the side effect profiles differ between 1st generation and 2nd (atypical) generation antipsychotics. Second generation drugs have a lower incidence of Extrapyramidal symptoms (EPS) and tardive dyskinesia (TD). Which of the following drugs is a representative of this drug class? ? buspirone ? chlorpromazine ? haloperidol ? quetiapine ? temazepam

quetiapine

Before initiating a patient on carbamazepine, you warn your patient about its most common side effects of dizziness, lethargy, and double vision. You also discuss other rare but more serious side effects for which the drug has black box warnings. One of these is aplastic anemia. What other black box warning should you also warn your patient about? ? serious dematologic reactions ? gingival hyperplasia ? hepatic failure ? hirsutism ? mania

serious dematologic reactions It has been estimated that 1 to 6 per 10,000 new users of carbamazepine develop potentially fatal dermatologic reactions, including toxic epidermal necrolysis and Stevens-Johnson syndrome. The highest risk for these reactions is in patients with the HLA-B 1502 inherited allelic variant of the HLA-B gene

Your patient is switched from haloperidol to quetiapine (Seroquel) because of its lower incidence of endocrine side effects. Other than having a weaker inhibitory effect on D2 receptors, blockade of which additional receptor subtype also contributes to the lower incidence of endocrine side effects seen with this new treatment? ? alpha 1 ? dopamine (D1) ? histamine (H2) ? muscarinic (M2) ? serotonin (5-HT2A)

serotonin (5-HT2A) The 5-HT2A subtype of serotonergic receptors stimulate the release of prolactin from the pituitary, while D2 receptor stimulation inhibits prolactin release. The relative balance between D2 & 5-HT2A antagonism seen with most atypical antipsychotics (with the exception of risperidone) results in little effect on prolactin release. Risperidone can produce a rise in prolactin release similar to 1st generation antipsychotics.