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Medications
Most of the medication questions are covered as part of specific Disorders. The following
are some outside Disorders.As of 15January2012. Main source, Stahl’s: The Prescribers Guide.2009
This PowerPoint Section
This PowerPoint Section only addresses a few meds as most meds are covered in the psychiatric management parts of the PowerPoints devoted to specific Disorders.
Gabapentin
Q. Gabapentin is FDA approved for?
Benzodiazepines
Q. How do benzodiazepines work?
Benzodiazepines
Ans. Binds to benzodiazepine receptors at the GABA-A ligand-gated chloride channel complex.
Gabapentin
Ans.
1] partial seizures
2] post-herpetic neuralgia
[So, much as many of us have had good results with gabapentin, it will frequently be the wrong answer on exams where FDA approval is implied.]
Clozapine
Q. FDA approves clozapine for?
Clozapine
Ans.
1] “Resistant” schizophrenia
2] People with schizophrenia who are high suicide risk.
SSRIs
Q. List the SSRIs.
SSRIs
Ans.
Citalopram
Escitalopram
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline
Flumazenil
Q. FDA approves flumzenil for?
Flumazenil
Ans. Reversal of sedative side effects of benzodiazepines, such as overdose, including such a need in children.
Risperidone
Q. Risperidone’s notable side effects?
Risperidone
Ans. Stahl lists four:
Increase risk for diabetes
Increase risk for dyslipidemia
Dose-related hyperprolactinemia
Modafinil
Q. Modafinil is FDA approved for?
Modafinil
Ans.
Reducing excessive sleepiness associated with:
-- narcolepsy
-- shift-work sleep disorder
-- obstructive sleep apnea
Acamprosate
Q. Acamprosate is thought to work on which receptor sites?
Acamprosate
Ans. Stabilize glutamatergic function.
Carbamazepine – lab tests
Q. What lab tests are needed when using carbamazepine?
Carbamazepine – lab tests
Ans.
Blood count: every two weeks for 2 months, then every three months.
Liver, kidney and thyroid function: every 6 to 12 months
Consider monitoring sodium
Carbamazepine – lifethreatening
Q. What are the life-threatening conditions to worry about when using carbamazepine?
Carbamazepine – lifethreatening
Ans.
1. Rare, aplastic anemia, agranulocytosis
2. Rare, Stevens-Johnson syndrome
3. Rare, SIADH = syndrome of inappropriate antidiuretic hormone secretion with hyponatremia
Clozapine – tests/monitoring
Q. What tests are to be run with clozapine?
What do you want to monitor in addition to the lab test and physical findings
Clozapine – tests - 1
Ans.Complete blood count:
-- before treatment-- weekly for 6 months-- then biweekly for months 6-12-- after one year, then every four weeks-- then 4 weeks after treatment discontinued
See next screen
Clozapine – tests - 2
Ans. Continued:Track:
weight, q 3 monthsBMI, q 3 monthswaist circumference, q 3 monthsfasting glucose, q 3 monthslipids, q 3 months
Clozapine – monitoring - 3
Ans. Vigilant for diabetic ketoacidosis by monitoring: rapid onset of polyuriarapid onset of polydipsiaweight lostnausea or vomitingdehydrationincreased Rweaknessclouding of sensorium, [including, of course, coma]
Valproate – tests and monitoring
Q. What to test and monitor for when prescribing valproate?
Valproate – tests andmonitoring
Ans. Lab tests before beginning treatment:
platelet countcoagulation testliver function tests
Also monitorweight
Follow above frequently, especially in first six months, then once or twice a year.
Prazosin
Q. Use of prazosin [Minipress] in psychiatry?
Prazosin
Ans: PTSD’s nightmares.
Bupropion’s use in anorexia nervosa
Q. Discuss bupropion’s use in anorexia nervosa.
Bupropion’s use in anorexia nervosa
Ans. Has FDA black box because of increased of seizures in pts with eating disorders.
Warfarin
Q. What should not be used with warfarin [Coumadin]?
Warfarin
Ans. bupropioncitalopramdisulfirammifeprestone [RU 486
[may not be complete][answer may be to use with caution, rather
than not at all]
Anticholinergic signs
Q. What are the untoward anticholinergic signs?
Anticholinergic signs
Ans.1. dry mouth2. blurred vision3. constipation4. tachycardia5. urinary retention6. hyperthermia 7. decreased cognition8. [also, bad for narrow-angle glaucoma]