LMR UPDATED ACTUAL EXAM QUESTIONS AND
ANSWERS SURE A+
✔✔Kava and Alcohol - ✔✔Increases the risk for liver damage
✔✔Kava and BZOs - ✔✔May potentiate sedative effects and increase the risk of
drowsiness and impairment
✔✔Metoprolol and SSRIs - ✔✔Namely Paroxetine and Fluoxetine
Can cause hypotension and bradycardia
✔✔Vit B12, B6, Folate (B9), Omega 3 Fatty acid - ✔✔Can improve depressive
symptoms
✔✔Which antipsychotics can cause QT prolongation? - ✔✔Ziprasidone (Geodon)
Quetiapine (Seroquel)
Haloperidol
SSRI: Citalopram (also can cause QT prolongation)
✔✔Which antipsychotics are less likely to cause QT prolongation? - ✔✔Aripiprazole
(Abilify)
Lurasidone (Latuda)
Olanzapine (Zyprexa)
✔✔Which SSRIs are least sedating? - ✔✔Escitalopram (Lexapro) and Fluoxetine
(Prozac)
**These are first line for adolescents
✔✔What is the safest SSRI for patients with heart issues? - ✔✔Sertraline (Zoloft)
✔✔Which medications contribute to delayed gastric emptying? - ✔✔Ranitidine (Zantac)
Famotidine (Pepcid)
Omeprazole (Prilosec)
**If an adolescent with anorexia reports pain, bloating, or feeling full despite not eating,
this may be due to delayed gastric emptying.
✔✔PPIs and Antipsychotics - ✔✔Antacids and proton pump inhibitors can reduce the
absorption of antipsychotic medications (which increase serum concentrations of the
drugs)
,**Do not take within 2 hours of psychotropic drugs
✔✔SSRIs and Older Adults - ✔✔Can increase anxiety
Can also cause hyponatremia
✔✔Serotonin Discontinuation Syndrome - ✔✔Muscle soreness, achiness, nausea,
vomiting, fatigue, lethargy, agitation
**Intervention**: Continue antidepressant at previously prescribed dose (sxs should go
away within 24 hours)
✔✔Lamotrigine (Lamictal) side effects - ✔✔This mood stabilizer causes the least
amount of weight gain
Steven Johnson's (fever, body aches, red rash, peeling skin, facial and tongue swelling)
**Tramadol can cause SJS as well
✔✔Carbamazepine (Tegretol) side effects - ✔✔BLACK BOX WARNING:
Agranulocytosis (decrease WBCs) and aplastic anemia (pallor, fatigue, headache,
fever, nosebleeds, bleeding gums, skin rash, SOB)
Steven Johnson Syndrome (more common in Asians - screen for HLAB-1502 allele)
✔✔Antiepileptics and Oral Contraceptives - ✔✔Carbamazepine (Tegretol), Topiramte
(Topamax), and Phenytoin (Dilantin) decrease effectiveness of OCPs
✔✔Agranolocytosis - ✔✔Associated with Carbamazepine and Clozaril
Monitor for signs of infection (sudden fever, chills, sore throat, weakness)
DC if ANC <1000 or WBC <3000
✔✔Which antipsychotics cause the LEAST amount of weight gain? - ✔✔ZAL
Ziprasidone (Geodon) - Take with at least 500 calories
Aripiprazole (Abilify) - Least sedating
Lurasidone (Latuda) - Take with at least 350 calories
✔✔Which antipsychotics cause the MOST amount of weight gain? - ✔✔Olanzapine
(Zyprexa)
Clozapine (Clozaril)
Then Quetiapine (Seroquel), Risperidone (Risperdal), Paliperidone (Invega)
,✔✔Antipsychotic-Induced Weight Gain (AIWG) - ✔✔Routine labs: BMI, Hip-to-Waist
ratio (measures abdominal obesity), Glucose, Lipid Panel
Management: Exercise and nutritional counseling
**Intervention**: Switch to a ZAL
✔✔Most important (life-threatening) adverse effect of antipsychotics? - ✔✔Neuroleptic
Malignant Syndrome (NMS)
> Fever, rigidity, AMS, autonomic instability
> ↑ CK
**Intervention**: Medical emergency → stop med immediately
✔✔Classic features of Neuroleptic Malignant Syndrome (NMS)? - ✔✔"Lead-pipe"
rigidity
Hyperthermia
Altered mental status
Autonomic instability (BP, HR, diaphoresis)
✔✔First step in management of suspected NMS? - ✔✔STOP antipsychotic immediately
Hospitalize
Treat with dantrolene or bromocriptine
✔✔NMS vs serotonin syndrome (key difference)? - ✔✔NMS → slow onset, rigidity, no
clonus
Serotonin syndrome → rapid onset, hyperreflexia + clonus
✔✔Which antipsychotic is associated with urinary incontinence? - ✔✔Clozapine
Due to anticholinergic + sedating effects
Other notable side effects of clozapine:
Sialorrhea
Weight gain
Sedation
Myocarditis **Can be fatal**
Cardiomyopathy
✔✔Most important adverse effect of clozapine? - ✔✔Agranulocytosis
**Requires regular ANC monitoring
✔✔Which antipsychotic reduces suicide risk in patients diagnosed with schizophrenia? -
✔✔Clozaril
, ✔✔Lithium - ✔✔Therapeutic range: 0.6-1.2 mEq/dL
Gold standard for mania
Neuroprotective treatment choice (protects nerve cells from damage)
Evidence of anti-suicidal effects
✔✔Lithium side effects - ✔✔Hypothyroidism
Fine hand tremors
Maculopapular rash
GI upset (diarrhea, vomiting, cramps, anorexia)
Diabetes insipidus (polyuria, polydipsia)
T-wave inversions
Leukocytosis (increased WBCs)
Ebstein anomaly (congenital heart defect)
✔✔Lithium toxicity - ✔✔Severe Nausea, Diarrhea, Vomiting, Confusion, Drowsiness,
Muscle Weakness, Heart Palpitations, Coarse Hand Tremors, Unsteadiness while
standing or walking (ataxia)
Toxicity occurs at 1.5 mEq/L or higher
If between 1.3-1.4 mEq/L and no signs of toxicity continue to monitor
If between 1.3-1.4 mEq/L and signs of toxicity, discontinue lithium
✔✔Lithium labs to monitor - ✔✔TSH
Serum Creatinine (0.6-1.2mg/dL)
BUN (10-20mg/dL)
UA (if 4+ protein, may indicate kidney disease)
Urine hCG
✔✔Lithium and Sodium - ✔✔Dehydration can increase lithium level
Lower sodium levels (hyponatremia) can reduce lithium clearance thereby increasing
risk for lithium toxicity
✔✔Olanzapine and Prozac is used for which condition? - ✔✔In combination it is called
Symbyax
used for bipolar depression
✔✔What other medications are used for bipolar depression? - ✔✔Lurasidone (Latuda)
ANSWERS SURE A+
✔✔Kava and Alcohol - ✔✔Increases the risk for liver damage
✔✔Kava and BZOs - ✔✔May potentiate sedative effects and increase the risk of
drowsiness and impairment
✔✔Metoprolol and SSRIs - ✔✔Namely Paroxetine and Fluoxetine
Can cause hypotension and bradycardia
✔✔Vit B12, B6, Folate (B9), Omega 3 Fatty acid - ✔✔Can improve depressive
symptoms
✔✔Which antipsychotics can cause QT prolongation? - ✔✔Ziprasidone (Geodon)
Quetiapine (Seroquel)
Haloperidol
SSRI: Citalopram (also can cause QT prolongation)
✔✔Which antipsychotics are less likely to cause QT prolongation? - ✔✔Aripiprazole
(Abilify)
Lurasidone (Latuda)
Olanzapine (Zyprexa)
✔✔Which SSRIs are least sedating? - ✔✔Escitalopram (Lexapro) and Fluoxetine
(Prozac)
**These are first line for adolescents
✔✔What is the safest SSRI for patients with heart issues? - ✔✔Sertraline (Zoloft)
✔✔Which medications contribute to delayed gastric emptying? - ✔✔Ranitidine (Zantac)
Famotidine (Pepcid)
Omeprazole (Prilosec)
**If an adolescent with anorexia reports pain, bloating, or feeling full despite not eating,
this may be due to delayed gastric emptying.
✔✔PPIs and Antipsychotics - ✔✔Antacids and proton pump inhibitors can reduce the
absorption of antipsychotic medications (which increase serum concentrations of the
drugs)
,**Do not take within 2 hours of psychotropic drugs
✔✔SSRIs and Older Adults - ✔✔Can increase anxiety
Can also cause hyponatremia
✔✔Serotonin Discontinuation Syndrome - ✔✔Muscle soreness, achiness, nausea,
vomiting, fatigue, lethargy, agitation
**Intervention**: Continue antidepressant at previously prescribed dose (sxs should go
away within 24 hours)
✔✔Lamotrigine (Lamictal) side effects - ✔✔This mood stabilizer causes the least
amount of weight gain
Steven Johnson's (fever, body aches, red rash, peeling skin, facial and tongue swelling)
**Tramadol can cause SJS as well
✔✔Carbamazepine (Tegretol) side effects - ✔✔BLACK BOX WARNING:
Agranulocytosis (decrease WBCs) and aplastic anemia (pallor, fatigue, headache,
fever, nosebleeds, bleeding gums, skin rash, SOB)
Steven Johnson Syndrome (more common in Asians - screen for HLAB-1502 allele)
✔✔Antiepileptics and Oral Contraceptives - ✔✔Carbamazepine (Tegretol), Topiramte
(Topamax), and Phenytoin (Dilantin) decrease effectiveness of OCPs
✔✔Agranolocytosis - ✔✔Associated with Carbamazepine and Clozaril
Monitor for signs of infection (sudden fever, chills, sore throat, weakness)
DC if ANC <1000 or WBC <3000
✔✔Which antipsychotics cause the LEAST amount of weight gain? - ✔✔ZAL
Ziprasidone (Geodon) - Take with at least 500 calories
Aripiprazole (Abilify) - Least sedating
Lurasidone (Latuda) - Take with at least 350 calories
✔✔Which antipsychotics cause the MOST amount of weight gain? - ✔✔Olanzapine
(Zyprexa)
Clozapine (Clozaril)
Then Quetiapine (Seroquel), Risperidone (Risperdal), Paliperidone (Invega)
,✔✔Antipsychotic-Induced Weight Gain (AIWG) - ✔✔Routine labs: BMI, Hip-to-Waist
ratio (measures abdominal obesity), Glucose, Lipid Panel
Management: Exercise and nutritional counseling
**Intervention**: Switch to a ZAL
✔✔Most important (life-threatening) adverse effect of antipsychotics? - ✔✔Neuroleptic
Malignant Syndrome (NMS)
> Fever, rigidity, AMS, autonomic instability
> ↑ CK
**Intervention**: Medical emergency → stop med immediately
✔✔Classic features of Neuroleptic Malignant Syndrome (NMS)? - ✔✔"Lead-pipe"
rigidity
Hyperthermia
Altered mental status
Autonomic instability (BP, HR, diaphoresis)
✔✔First step in management of suspected NMS? - ✔✔STOP antipsychotic immediately
Hospitalize
Treat with dantrolene or bromocriptine
✔✔NMS vs serotonin syndrome (key difference)? - ✔✔NMS → slow onset, rigidity, no
clonus
Serotonin syndrome → rapid onset, hyperreflexia + clonus
✔✔Which antipsychotic is associated with urinary incontinence? - ✔✔Clozapine
Due to anticholinergic + sedating effects
Other notable side effects of clozapine:
Sialorrhea
Weight gain
Sedation
Myocarditis **Can be fatal**
Cardiomyopathy
✔✔Most important adverse effect of clozapine? - ✔✔Agranulocytosis
**Requires regular ANC monitoring
✔✔Which antipsychotic reduces suicide risk in patients diagnosed with schizophrenia? -
✔✔Clozaril
, ✔✔Lithium - ✔✔Therapeutic range: 0.6-1.2 mEq/dL
Gold standard for mania
Neuroprotective treatment choice (protects nerve cells from damage)
Evidence of anti-suicidal effects
✔✔Lithium side effects - ✔✔Hypothyroidism
Fine hand tremors
Maculopapular rash
GI upset (diarrhea, vomiting, cramps, anorexia)
Diabetes insipidus (polyuria, polydipsia)
T-wave inversions
Leukocytosis (increased WBCs)
Ebstein anomaly (congenital heart defect)
✔✔Lithium toxicity - ✔✔Severe Nausea, Diarrhea, Vomiting, Confusion, Drowsiness,
Muscle Weakness, Heart Palpitations, Coarse Hand Tremors, Unsteadiness while
standing or walking (ataxia)
Toxicity occurs at 1.5 mEq/L or higher
If between 1.3-1.4 mEq/L and no signs of toxicity continue to monitor
If between 1.3-1.4 mEq/L and signs of toxicity, discontinue lithium
✔✔Lithium labs to monitor - ✔✔TSH
Serum Creatinine (0.6-1.2mg/dL)
BUN (10-20mg/dL)
UA (if 4+ protein, may indicate kidney disease)
Urine hCG
✔✔Lithium and Sodium - ✔✔Dehydration can increase lithium level
Lower sodium levels (hyponatremia) can reduce lithium clearance thereby increasing
risk for lithium toxicity
✔✔Olanzapine and Prozac is used for which condition? - ✔✔In combination it is called
Symbyax
used for bipolar depression
✔✔What other medications are used for bipolar depression? - ✔✔Lurasidone (Latuda)
