LMR - Georgette's/ 526 Questions with
Definitive Solution/ 2024-2025.
What drugs should be avoided with Kava Kava? - Answer: Alprazolam
CNS depressants (e.g., phenobarbital, zolpidem)
What is the normal range for TSH? - Answer: 0.5 - 5.0 mu/L
When do you administer clonidine on the COWS? - Answer: Definitely at score of >7; prior to
that (scores 5-6) it can be given
When do you administer buprenorphine (Suboxone) on the COWS? - Answer: moderate
symptoms (13-24)
What is a moderate range on the CIWA? - Answer: 16-20
Page 1 of 66
,When do you administer prn meds such as benzodiazepine or for N/V/D on the CIWA? -
Answer: Mild symptoms (8 or greater)
When do you administer scheduled benzodiazepine +PRN's on the CIWA? - Answer: moderate
symptoms (15 or higher)
If a patient has severe depression (over 18 on HAM-D) (over 14 on PHQ-9) (over 29 on BDI), how
do you treat it? - Answer: Medication and/or therapy
Assess for suicidal ideation
If a patient has moderate depression (14 - 18 on HAM-D) (10 - 14 on PHQ-9) (19 - 29 on BDI),
how do you treat it? - Answer: Medication and/or therapy
If a patient has mild depression (<14 on HAM-D) (<10 on PHQ-9) (<19 on BDI), how do you treat
it? - Answer: Therapy or nothing
If a patient has mild anxiety (<18 on HAM-A) (<10 on GAD-7), how do you treat? - Answer:
Therapy or nothing
If a patient has severe anxiety (>24 on HAM-A) (>14 on GAD-7) how do you treat? - Answer:
Medication and/or therapy
If a patient has moderate anxiety (18-24 on HAM-A) (10 - 14 on GAD-7) how do you treat it? -
Answer: Medication and/or therapy
What are 4 areas in the brain that can cause aggression, impulsivity, and difficulty with abstract
thinking? - Answer: Prefrontal cortex
Amygdala
Basal ganglia
Page 2 of 66
,Hippocampus
Abnormalities in the Prefrontal cortex, Amygdala, Basal ganglia, and
Hippocampus can cause what 3 symptoms? - Answer: Aggression
Impulsivity
Difficulty with abstract thinking
What are 6 symptoms of NMS? - Answer: *Extreme muscular rigidity
*Mutism
*Elevated labs CPK (creatine phosphokinase), LFT's and WBC's
Myoglobinuria
autonomic instability vBP, ^HR/RR
Fever
*= top 3 ways to differ from SS
Elevated CPK (creatine phosphokinase) in NMS is caused from - Answer: muscle contraction and
destruction
What are 2 differentiating symptoms (Key indicators) of Serotonin Syndrome? - Answer:
Hyperreflexia
Myoclonic jerks
S/S of serotonin syndrome include:
what are the 4 most often seen (in bold)? - Answer: "Shits and Shivers"
§ Diarrhea (shits)
§ Shivering,
§ Hyperreflexia/myoclonic jerks
§ Increased temperature
§ Vital sign instability
Page 3 of 66
, § Encephalopathy
§ Restlessness/anxiety
§ Sweating
How do you treat NMS? - Answer: DC offending agent
Bromocriptine or
Dantrolene
What does Dantrolene treat in NMS? - Answer: Muscle rigidity
How do you treat Serotonin Syndrome? - Answer: DC offending agent
Cyproheptadine: H1 antihistamine that acts to block
5-HT1A and 5-HT2A receptors
What combination of medications increases the risk of Serotonin Syndrome? What herbal
supplement also increases the risk?
What class of migraine medications raises the risk? - Answer: multiple antidepressants
(SSRI/SNRI/TCA/MOAI)
St John's wort --> with any of the above AD classes
Triptans --> with any of the above AD classes
When switching from an MAOI to SSRI/SNRI, how long should you wait? Why? - Answer: 2
weeks;
for the MAO to regenerate (remember MAO-I deplete MAO)
When switching from Prozac to any antidepressant (TCA, SNRA, or MAOI), how long should you
wait? - Answer: 5-6 weeks
Page 4 of 66
Definitive Solution/ 2024-2025.
What drugs should be avoided with Kava Kava? - Answer: Alprazolam
CNS depressants (e.g., phenobarbital, zolpidem)
What is the normal range for TSH? - Answer: 0.5 - 5.0 mu/L
When do you administer clonidine on the COWS? - Answer: Definitely at score of >7; prior to
that (scores 5-6) it can be given
When do you administer buprenorphine (Suboxone) on the COWS? - Answer: moderate
symptoms (13-24)
What is a moderate range on the CIWA? - Answer: 16-20
Page 1 of 66
,When do you administer prn meds such as benzodiazepine or for N/V/D on the CIWA? -
Answer: Mild symptoms (8 or greater)
When do you administer scheduled benzodiazepine +PRN's on the CIWA? - Answer: moderate
symptoms (15 or higher)
If a patient has severe depression (over 18 on HAM-D) (over 14 on PHQ-9) (over 29 on BDI), how
do you treat it? - Answer: Medication and/or therapy
Assess for suicidal ideation
If a patient has moderate depression (14 - 18 on HAM-D) (10 - 14 on PHQ-9) (19 - 29 on BDI),
how do you treat it? - Answer: Medication and/or therapy
If a patient has mild depression (<14 on HAM-D) (<10 on PHQ-9) (<19 on BDI), how do you treat
it? - Answer: Therapy or nothing
If a patient has mild anxiety (<18 on HAM-A) (<10 on GAD-7), how do you treat? - Answer:
Therapy or nothing
If a patient has severe anxiety (>24 on HAM-A) (>14 on GAD-7) how do you treat? - Answer:
Medication and/or therapy
If a patient has moderate anxiety (18-24 on HAM-A) (10 - 14 on GAD-7) how do you treat it? -
Answer: Medication and/or therapy
What are 4 areas in the brain that can cause aggression, impulsivity, and difficulty with abstract
thinking? - Answer: Prefrontal cortex
Amygdala
Basal ganglia
Page 2 of 66
,Hippocampus
Abnormalities in the Prefrontal cortex, Amygdala, Basal ganglia, and
Hippocampus can cause what 3 symptoms? - Answer: Aggression
Impulsivity
Difficulty with abstract thinking
What are 6 symptoms of NMS? - Answer: *Extreme muscular rigidity
*Mutism
*Elevated labs CPK (creatine phosphokinase), LFT's and WBC's
Myoglobinuria
autonomic instability vBP, ^HR/RR
Fever
*= top 3 ways to differ from SS
Elevated CPK (creatine phosphokinase) in NMS is caused from - Answer: muscle contraction and
destruction
What are 2 differentiating symptoms (Key indicators) of Serotonin Syndrome? - Answer:
Hyperreflexia
Myoclonic jerks
S/S of serotonin syndrome include:
what are the 4 most often seen (in bold)? - Answer: "Shits and Shivers"
§ Diarrhea (shits)
§ Shivering,
§ Hyperreflexia/myoclonic jerks
§ Increased temperature
§ Vital sign instability
Page 3 of 66
, § Encephalopathy
§ Restlessness/anxiety
§ Sweating
How do you treat NMS? - Answer: DC offending agent
Bromocriptine or
Dantrolene
What does Dantrolene treat in NMS? - Answer: Muscle rigidity
How do you treat Serotonin Syndrome? - Answer: DC offending agent
Cyproheptadine: H1 antihistamine that acts to block
5-HT1A and 5-HT2A receptors
What combination of medications increases the risk of Serotonin Syndrome? What herbal
supplement also increases the risk?
What class of migraine medications raises the risk? - Answer: multiple antidepressants
(SSRI/SNRI/TCA/MOAI)
St John's wort --> with any of the above AD classes
Triptans --> with any of the above AD classes
When switching from an MAOI to SSRI/SNRI, how long should you wait? Why? - Answer: 2
weeks;
for the MAO to regenerate (remember MAO-I deplete MAO)
When switching from Prozac to any antidepressant (TCA, SNRA, or MAOI), how long should you
wait? - Answer: 5-6 weeks
Page 4 of 66
