CPJE Preparation Flashcards

Max
Terms Definitions
What is recommended for chronic anxiety?
SSRI's
What are the short-acting Benzodiazepines?
Alprazolam (Xanax), 3A4 subs.
Oxazepam (Serax)
Which Benzos can be used by the elderly patients?
Lorazepam (Ativan)
Oxazepam (Serax)
Temazepam (Restoril)
What is Librium?
Chlordiazepoxide, for alcohol withdrawal
What is Buspar? Dosing? Max?
Buspirone
Dose: 15mg/day, titrate by 5mg
Max: 60mg/day
What drug interactions would you look out for with Buspirone?
Avoid use with MAOi & inhibitors (3A4 substrate)
What is Celexa? Dose?
Citalopram, 10-60mg/day
What is Lexapro?
Escitalopram
What is Flouxetine? Dosing?
Prozac, Sarafem
10-80mg QAM
What is Luvox? Dosing?
Fluvoxamine, for OCD
QHS
What is Paxil? Dosing?
Paroxetine
10-80mg QAM
Don't DC abruptly = severe anger
What is Zoloft? Dose?
Sertraline
Max: 200mg QD
Major SE for SNRI's?
Hypertension
What is Venlafaxine?
Effexor
What is Pristiq? Max dose?
Desvelanfaxine
Max: 400mg
What is the Pristiq dose for renal patients (CrCl <30mL/min)?
50mg QOD
What is Cymbalta? Dose?
Duloxetine
Dose: 60mg QD/BID
What is the dose for Cymbalta for renal patients (CrCl<30mL/min)?
Avoid in patients with renal, hepatic & high alcohol use.
What is Savella? Indication?
Milnacipram, for fibromyalgia
List the meds approved for fibromyalgia (3)
Savella (milnacipram)
Cymbalta (duloxetine)
Lyrica (pregabalin)
What is the max dose for regular Bupropion? Bupropion ER?
450mg/day
ER: 300mg/day
What is Desyrel?
Trazodone
What is Desyrel indicated for and dose?
MDD
Sleep: 25-50mg
What does Bupropion work on?
Dopamine agonist
Norepinephrine agonist
What is Serzone?
Nefazodone
What is Remeron?
Mirtazipine
Remeron SE?
Weight gain
Somnolence
What is Tofranil?
Imipramine (TCA)
What is Elavil?
Amitriptylline (TCA)
What is Sinequan?
Doxepin (TCA)
What is Anafranil? Indication?
Clomipramine (TCA), for OCD
What is Norpramine? Indication?
Desipramine, for ADHD
What is Nortriptyline?
Pamelor
Aventyl
SE of TCA's?
Anti-cholinergic effects
CV effects
Arrythmia
What is Parnate?
Tranylcylpramine (MAOi)
What is Nardil?
Phenelzine (MAOi)
What is Marplan?
Isocarboxazid (MAOi)
Why should Tyramine be avoided when on MAOi meds?
Tyramine releases catecholamines (NE) which results to HTN crisis when combined with MAOi's.
What is Emsam?
Selegiline (MAOi) patch, QD
What are the anti-psychotics approved for MDD (3)?
Abilify: <15mg
Symbyax (Olanzapine + Fluoxetine)
Lithium
Dosing for Symbyax?
QHS, very sedating
What is Bipolar?
Characterized by alternating episodes of Mania (euphoria) and Depression
What is Depakote? Indication?
VaLProic acid
Indications: migraine, seizure, bipolar
What is Zyprexa? Indication? Max dose?
Olanzapine, for bipolar
Max: 20mg QD, very long acting
What is Equeto?
Carbamazepine, for bipolar & seizure
What is Lamictal? Monitor what?
Lamotrigine
Monitor liver and watch out for rash!
What is Topamax? Indication?
Topiramate, used for seizure and unapproved for bipolar
What is Risperdal?
Risperidone
What is Ziprasidone? Dose?
Geodon, 80mg BID with food
What is Abilify?
Aripiprazole
What is Saphris?
Asenaphine, ODT
What is the dose of Olanzapine for acute mania?
10mg IM
What is Stavzor?
Valproic Acid
Production of _______ goes up with the use of Lithim.
WBC, similar in action to steroids
Lithium serum concentrations should be between _________
0.6 - 1.2 mmol/L
What is the Lithium dose?
900 - 1800mg div into 3 doses
What is the Lithium dose for the Elderly and renally impaired? Serum concentration?
Start: 300mg QD
Serum: 0.4 - 0.6mmol/L
Therapeutic levels for Lithium?
Acute: 0.8 - 1.5 meq/L
Maintenance: 0.6 - 1.2 meq/L
Lithium Toxicity S/S?
>1.5 meq/L = tremor, vomiting, ataxia,slurred speech, confusion

>2 meq/L = arrhythmias, seizures, coma
Monitoring parameters for Lithium
Bun & CrCl
Urine specific gravity
CBC
Electrolytes
TSH
EKG
Glucose
What is schizophrenia?
There is too much Dopamine which results to a mental disorder.
Diagnostic criteria for Schizophrenia
2 of the following 5 symptoms
- hallucinations
- delusions
- disorganized speech
- disorganized behavior
- negative symptoms (symptoms you can see)
SE of Anti-psychotics?
Weight gain
Anti-cholinergic effects
Sedation
Hypotension
Movement disorders (Tardive Dyskenisia)
EPSE
Neuroleptic Malignant Syndrome (NMS)
What are the EPS?
Dystonia
Akathisia
Pseudoparkinsonism
What is Dystonia? Treatment?
Painful muscle spasm - laryngospasm
Benadryl IV 25-50mg
What is Akathisia? Treatment?
Restlessness
Tx: propranolol 30-100mg
What is the treatment for Pseudoparkinsonim?
Increase dopamine or decrease acetylcholine
What is Tardive Dyskinesia?
Hypersensitivity due to prolonged blockage of dopamine. Characterized by tongue, lip, jaw & extremity movement
What is Neuroleptic Malignant Syndrome?
Depletion of DA in the CNS resulting to RIGIDITY, FEVER, DIAPHORESIS, altered consciousness, INCREASE IN BP & HR
What labs do you monitor with NMS?
inc. CPK (muscle breakdown)
LFT
inc. WBC (CBC)
What is Dantrolene?
A muscle relaxant to treat malignant hyperthermia in NMS
Tx: 1mg/kg rapid IV push
What is Thorazine?
Chlorpromazine
What is Mellaril
Thioridazine
That is Trilafon?
Perphenazine
What is Stelazine?
Triflouperazine
What is Navane?
Thiothixene (Typical)
What is Prolixin?
Fluphenazine (Typical)
What is Haldol?
Haloperidol (Typical)
What anti-psychotics have an IM form?
Haldol
Aripiprazole (Abilify)
Ziprasidone (Geodon)
Olanzapine (Zyprexa)
What anti-psychotics have a decanoate form?
Haldol
Fluphenazine (Prolixin)
Risperidone (Consta)
Paliperidone (Invega)
Max dose for Zyprexa IM?
30mg
Max dose for Abilify IM?
30mg
Max dose for Geodon IM?
40mg
What is the dose for Haldol decanoate?
10-15x oral dose Qmonth
What is the dose for Prolixin decanoate?
oral dose/25 Q2 weeks
What is the dose for Consta?
IM Q2 weeks for >18 yo
What is the dose for Invega?
day 1: 234mg IM
1 week later: 156mg
Maintenance: IM Qmonth (117mg recommended)
What is Clozaril?
Clozapine, atypical
What is Risperidone? SE?
Risperdal
SE: increases prolactin, most EPS
What is Seroquel? Dosing?
Quetiapine, QHS
What is Fanapt?
Iloperidone
What is Geodon? Dosing?
Ziprasidone, BID with food
What is Saphris?
Asenaphine - SL only
SE of Clozapine?
Agranulocytosis
Cholinergic effects (sweating & hypersalivation)
Seizure (>600mg QD)
Hyperglycemia, hyperlipidemia, weight gain.
Fanapt dosing?
1mg BID
Max: 12mg BID
- reduce does by 1/2 when given with inhibitors
Invega dosing?
Mild renal impairment: 6mg
Severe renal: 3mg
Cause of Parkinson's?
Depletion of Dopamine, which results to high acetylcholine in the body.
Symptoms of Parkinsons?
Tremor
Rigidity
Akinesa (initiation of movement is difficult)
Mask face
Pill rolling
Meds that cause pseudoparkinsonism?
Haldol
Reglan
List anti-cholinergics used for Parkinson's (4)
Trihexyphenyldil (Artane)
Benztropine (Cogentin)
Biperidone (Akineton)
Diphenhydramine
MoA of Levodopa?
Dopamine precursor
What is Larodopa?
Levodopa
What is Sinemet?
Levodopa - Carbidopa
SE for Levodopa?
Hypotension
Akinesia
N/V
Psychosis
Aprodisiac
Dyskinesia
How much Carbidopa is needed to absorb Levodopa?
75mg/day
How do you change dosing from non-CR to CR?
Increase levodopa by 10%
What is Eldepryl?
Selegiline - 5mg tabs (parkinsonism)
What is Zelapar?
Selegiline - 1.25mg ODT (parkinsonism)
What is Azilect?
Rasagiline (parkinsonism)
Dosing for Eldepryl?
5mg BID
Max: 10mg QD
-don't give later than 2 PM bec it turns to amphetamine
Contraindications for Azilect?
Liver disease
Pheochromocytoma
14 days before surgery
What is Symmetrel? Dose?
Amantadine
Dose: 100mg BID, dose adjust in renal patients
What is Parlodel?
Bromocriptine
What is Permax?
Pergolide
What is Mirapex?
Pramipexole
What is Requip?
Ropinirole
What is Apokyn?
Apomorphine - SC injection
Dopamine agonist SE
Major orthostasis due to alpha-blocking activity
Indications for Parlodel?
Hyperprolactinemia
Parkinsonism
Is Bromocriptine okay to use in renal patients
Yes
What do you have to remember when using Permax?
Titrate to avoid hypotension
Caution in Liver disease
Dosing for Mirapex?
Titrate to avoid hypotension
Decrease dose in renal patients.
Requip is a good option for what kind of patients?
Patients with a high susceptibility to hypotension or falls.
Caution with liver dysfunction
What do you give to prevent nausea and vomiting due to Apokyn?
Tigan (trimethobenzamide)
- start 3 days before initiating APOKYN
What is Comtan?
Entacapone
What is Tasmar? Warning?
Tolcapone
- fatal hepatic failure!!!
What is Stalevo?
Carbidopa + Levodopa + Entacapone
First line treatment for Partial seizure (4)
Carbamazepine
Phenytoin
Phenobarbital
Primidone
First line treatment for Absence/Petit Mal (2)
Ethosuximide (DoC)
Valproic Acid
First line treatment for Myoclonic seizure (2)
Valproic Acid
Clonazepam
DoC for Lennox-Gastaut Syndrome
Valproic Acid
Benzos
Felbamate
What do you give to patient with Status Epilepticus?
100mg thiamine or Vit B complex
25gm of Glucose in 50mL of 50% dextrose
Medication for Status Epilepticus?
Lorazepam
Phenytoin
Fosphenytoin
SE for Phenobarbital?
Bone disease/Bradycardia
Ataxia
Rash/Respiratory depression
Behavior changes
What is Luminal? Forms?
Phenobarbital
tabs, elixir, injection
How do you give Luminal IV?
IV (Avoid >50mg/min)
IM
SC
Phenobarbital is an inducer, inhibitor or substrate?
Inducer
What is the serum concentration for Phenobarbital?
15-40mcg/mL
What do you monitor when using PhenobarbiTaL?
CBC
LFT's
What is Mysoline? Max dose?
Primidone, metabolized to Phenobarbital
Max: 2g/day
Therapeutic range for Mysoline?
5-12mcg/mL
What is Diastat?
Diazepam rectal gel
Diazepam dose for Status Epilepticus? Max dose?
5-10mg IV repeat 5-10min
Max: 30mg
What diluent do you use with Phenytoin? How is it administered?
Normal saline
<50mg/min with in-line filter
What is the max dose for Phenytoin? Maintenance dose?
Max: 500-600mg/day
Maintenance: 300mg/day if ER
What is the therapeutic range for phenytoin?
10-20mg/L
What is Cerebyx? How is it given?
Fosphenytoin (L)
IV/IM
What is the equivalent dose to Fosphenytoin to Phenytoin?
1.5mg Fosphenytoin = 1mg Phenytoin
Dosing with Fosphenytoin?
Load: 15-20mg PE/kg
Maintenance: 4-6mg PE/kg/day
DON'T EXCEED RATE OF 150mg PE/min
Phenytoin/Fosphenytoin SE?
Ataxia
Rash
Hirsutism
Osteomalacia
Gingival hyperplasia
Monitoring parameters with Phenytoin?
BP
CBC
LFT's
Patient counseling with Phenytoin?
Take with food
Susp: shake well
Susp: don't give with tube feedings
Nurse counseling with Phenytoin?
Infusion rate <50mg/min
What is Peganone? Dose? With or without food?
Ethotoin
Dose: 1g/d div 4-6 doses with food to reduce GI effects
Therapeutic range for Valproic Acid?
50-100mcg/mL
Valproic acid: substrate, inhibitor or inducer?
Substrate and inhibitor
SE for vaLProic acid?
Hepatotoxicity
Pancreatitis
Thrombocytopenia
SIADH
What happens when you give aspirin with Valproic acid?
Aspirin displaces VA therefore increasing its concentration
Carbamazepine therapeutic level?
4-12mcg/mL
Carbamazepine is contraindicated with (3)?
Hypersensitivity to TCA
within 14 days of MAOi
Bone marrow suppression
Carbamazepine SE?
Hepatotoxicity
Agranulocytosis
Anemia
Anticholinergic effects
Rash
Check the eyes
Asians should be tested for what gene before using Carbamazepine?
HLA-B*1502
What is Trileptal? Therapeutic range?
Oxcarbazepine
Therapeutic range: 12-30mcg/mL
SE of Trileptal? Can you use this with renal patients?
Hyponatremia
Stevens-Johnson
Reduce dose in CrCl<30
What is Zarontin? Therapeutic range?
Ethosuximide
TR: 40-100mcg/mL
What is Celontin?
Methsuximide
What is Zonegran?
Zonisamide
SE of Zonisamide?
Stone (kidney)
Stevens-Johnson syndrome
Aplastic anemia
Zonegran is contraindicated in what allergy?
Sulfa allergy
What is Felbatrol? SE?
FeLbAmate
SE: hepatotoxicity & aplastic anemia
Max dose for Neurontin?
Max: 3,600mg div TID/QID
Can you give Neurontin to renal patients?
Decrease dose if CrCl <60mL/min
What is Lyrica? Dosage? Max?
Pregabalin for >18 yo
Max: 600mg/day, decrease dose in renal patients
What's the difference between Neurontin & Lyrica?
Lyrica can be titrated faster
What is the initial dosing for Lamictal?
25-50mg QHS
Dosage for Keppra? Can you give it to renal patients?
500mg BID, max: 3g/day
Decrease dose in renal patients
What is Gabitril? Dosing? Max?
Tiagabine, LIVER
Start 4mg/day, TAKE WITH FOOD
Max: 56mg/day
What is the max dose for Topamax? Okay to use with renal patients?
Max: 200mg
Renal patients: 1/2 dose if CrCl<70mg/mL
Which seizure meds are carbonic anhydrase inhibitors?
Topamax
Zonegran
- incrase bicarb excretion which leads to metabolic acidosis
What is Vimpat? Age limit?
Lacosamide for >17 yo.
Vimpat is what Schedule? Initial and max dose?
Control V
Start: 50mg BID
Max: 200mg BID
What is Banzel? Max dose? With or without food?
Rufinamide
Max: 3200mg/day div BID
TAKE WITH FOOD
What's the age restriction for Banzel?
>4 yo
What is Sabril? Max?
Vigabatrin, only qualified physicians can prescribe this.
Max: 3g/day
Sabril dosing for renal patients?
CrCl 50-80: decrease dose by 25%
CrCl 30-50: decrease dose by 50%
CrCl 10-30: decrease dose by 75%
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