PEBC Exam with complete solutions

1-1.2, 0.5-0.8 - ANSWER-serum level target (mmol/L) for Lithium in Adults and Elderly thyroid, renal - ANSWER-Which 2 parameters should be monitored at least Q6months for patients taking Lithium? lithium - ANSWER-which drug used for bipolar requires the patient to have a stable salt and caffeine intake? induce - ANSWER-carbamazepine effect on CYP enzymes (induce/inhibit) Lewy body - ANSWER-psychosis due to _________ dementia is worsened by use of antipsychotics rivastigmine - ANSWER-which acetycholinesterase inhibitor showed slight benefit for Lewy body dementia and Parkinson's diease dementia? hypo - ANSWER-SSRI's can cause (hyper/hypo)natremia antipsychotic - ANSWER-____________ sensitivity is seen with Lewy body dementia, characterized by rigidity, autonomic dysregulation, and cognitive deterioration 2 weeks - ANSWER-symptoms of major depressive episode must last for at least __________ (length of time) persistent depressive disorder (dysthymia) - ANSWER-depressed mood for most of the day, for most days, for at least 2 years with at least 2 other symptoms = what kind of psychiatric disorder? escitalopram, sertraline - ANSWER-based on the best available evidence, which 2 antidepressants have the best efficacy and safety profile? second - ANSWER-according to CANMAT guidelines, trazodone is considered _________ line therapy for depression seizures, anorexia, head trauma - ANSWER-3 common contraindications to bupropion are: sexual, GI - ANSWER-compared to SSRI's, bupropion and mirtazapine has fewer _____ and ____ side effects >150 mg - ANSWER-at dose of __________, venlafaxine also inhibits norepinephrine reuptake SNRI - ANSWER-high doses of which class of antidepressants can cause hypertension? irreversible MAOI inhibitor - ANSWER-phenelzine and tranylcypromine are classified as what class of drug? reversible MAOI inhibitor - ANSWER-moclobemide is classified as what class of drug? 2 weeks - ANSWER-switching from irreversible MAOI inhibitors to another agent requires a washout period of _______ (lenght of time) 5 days - ANSWER-switching from reversible MAOI inhibiotrs to another agent requires a washout period of ______ (length of time) T - ANSWER-T/F: electroconvulsive therapy is 80-90% effective for depression paroxetine, sertraline - ANSWER-which 2 SSRI's are preferred for breastfeeding? domperidone - ANSWER-which prokinetic agent has lower incidence of EPS anorexia nervosa - ANSWER-zinc gluconate is used for fluoxetine - ANSWER-which antidepressant has the most evidence for bulimia nervosa 3,3 - ANSWER-the diagnosis of insomnia = sleep disturbance for at least ____ nights per week for at least ____months oxazepam - ANSWER-which BZD must be taken at least 1 hour before bed for hypnosis due to slow absorption zopiclone - ANSWER-preferred hypnotic in pregnancy SSRI,SNRI - ANSWER-besides CBT, what are 2 first line options for OCD 6,1 - ANSWER-definition of schizophrenia = illness for ___ months and psychotic symptoms for ____ months ziprasidone, quetiapine XR - ANSWER-which 2 antipsychotics should be titrated rapidly to target dose T - ANSWER-T/F: risk of relapse over 5 years after first episode psychosis is 70-90% equal - ANSWER-long acting injectables are (more/less/equal) effective than oral antipsychotics 20, 2-4 - ANSWER-when discontinuing antipsychotics, decrease dose by _____% or less over _________ weeks 20 - ANSWER-compared to the general population, schizophrenics have ____% shorter life expectancy clozapine, olanzapine - ANSWER-smoking induces metabolism of which 2 antipsychotics neuroleptic malignant syndrome - ANSWER-muscle rigidity, fever, autonomic disturbance, labile BP, fluctuating LOC, increased CK and WBC = ______ lurasidone, ziprasidone - ANSWER-which 2 antipsychotics need to be taken with food propranolol - ANSWER-DOC for akathisia benztropine, diphenhydramine - ANSWER-DOC (2) for acute dystonia parkinsonism - ANSWER-EPS characterized by dysphoria, decreased concentration, and slow cognition quetiapine, clozapine - ANSWER-which 2 antipsychotics have equal incidence of TD compared to placebo ziprasidone, lurasidone, arsenapine (LAZy) - ANSWER-which 3 antipsychotics have the lowest weight gain? F - ANSWER-T/F: decreasing dose of antipsychotic can decrease extent of weight gain SGA - ANSWER-(SGA/FGA) have higher incidence of diabetes 450 - ANSWER-a QTc of _______ or higher is clinically concerning ziprasidone - ANSWER-which SGA causes the most QT prolongation T - ANSWER-T/F: reducing the dose is the 1st line treatment for FGA-associated hyperprolactinemia low - ANSWER-methotrimeprazine and chlorpromazine are (low/med/high) potency med - ANSWER-loxapine, perphenazine, zuclopenthixol are (low/med/high) potency high (all the FLU's and PI's) - ANSWER-flupenthixol, fluphenazine, pimozide, pipotiazine decanoate, trifluoperazine, thiothixene, haloperidol are (low/med/high) potency palliperidone, risperidone - ANSWER-which 2 SGA are contraindicated in patients who have undergone cataract surgery (risk of floppy iris syndrome) F - ANSWER-T/F: dopamine agonists have shown benefit for cocaine/amphetamine withdrawal neonatal opioid withdrawal - ANSWER-what is diluted tincture of opioium +/- phenobarbital used for thiamine - ANSWER-administer __________ to all alcoholic withdrawal cases to reduce risk of Wernicke's encephalopathy diazepam, clonazepam - ANSWER-which 2 BZDs are used for BZD withdrawal syndrome 2-4 weeks - ANSWER-initial tapering of BZD dose (clonazepam/diazepam) during BZD withdrawal treatment by 50% of original BZD dose can occur as soon as _____________ (length of time). The remaining 50% takes several weeks to months though. 1, 5, 0.25 - ANSWER-equivalencies of lorazepam, diazepam, clonazepam varenicline - ANSWER-which smoking cessation drug cannot be combined with NRT Nicorette - ANSWER-which NRT patch can be cut? Nicoderm - ANSWER-which NRT patch can be worn while exercising 3rd - ANSWER-NSAID use in which trimester can prematurely closes the fetal ductus arteriosis prednisone (1mg/kg PO daily) - ANSWER-DOC for Bell's palsy T - ANSWER->80% of patients with Bell's palsy have spontaneous recovery w/o treatment baclofen, tizanidine - ANSWER-DOC (2) for general spasticity Sativex - ANSWER-officially indicated drug for spasticity in MS patients dantrolene - ANSWER-inhibits Ca release from the SR, thereby no muscle contraction. Widely used in spasticity inhibits, CYP3A4 - ANSWER-ketoconazole potenly ______ (inhibits/induces) the enzyme _______ 15, 10 - ANSWER-to avoid medication overuse HA, non-opioid analgesics should be used less than _____ days/month and opioid analgesics should be used less than ____ days/month 10 days - ANSWER-rebound headaches can occur with continuous use of ergot derivatives for __________ (length of time) T - ANSWER-T/F: ergot derivatives produce no dependence F (contraindicated) - ANSWER-T/F: ergot derivatives and triptans can be used together sumatriptan SC - ANSWER-which agent and route of administration is most effective for severe migraine attack almotriptan, naratriptan - ANSWER-which 2 triptans have least adverse effects rizatriptan - ANSWER-which triptan has the fastest PO onset of action basilar, hemiplegic - ANSWER-which 2 type of migraines are triptans NOT indicated for metoclopramide - ANSWER-which anti-nauseant has the best evidence in headache disorders beta blockers (propranolol, metoprolol, nadolol) - ANSWER-which class of medications is commonly used for migraine prophylaxis amitriptyline, nortriptyline - ANSWER-which 2 TCA's are effective analgesics for migraines verapamil - ANSWER-which agent acts as an effective cluster headache prophylaxis and also to a lesser extent, migraines lisinopril - ANSWER-which ACE-inhibitor may reduce headache frequency candersartan - ANSWER-which ARB may reduce frequency of migraines depression - ANSWER-flunarazine should be avoided as migraine prophylaxis in patients with Hx of _________________ TPM, VPA, DVP - ANSWER-which 3 anti-epileptics are effective for migraine prophylaxis frovatriptan - ANSWER-which triptan can be used short-term for prevention of menstrually associated migraines chronic cluster - ANSWER-lithium can help prevent what type of headache disorder 0.4-1 mg daily - ANSWER-dose of folate for women with history of migraine and do not currently use folate-depleting medications 5 mg daily - ANSWER-dose of folate for women with history of migraine and use folate-depleting medications restrict uterine blood flow, postpartum stroke - ANSWER-what potential adverse effects can ergot derivatives have during pregnancy T - ANSWER-T/F: triptans are contraindicated in pregnancy propranolol - ANSWER-DOC for migraine prophylaxis during pregnancy T - ANSWER-T/F: beta blockers are associated with intrauterine growth retardation and reduced placental weight DVP, VPA - ANSWER-which 2 antiepileptic migraine prophylaxis agents are compatible with lactation? serotonin syndrome - ANSWER-interaction between triptans x SSRI F (contraindicated) - ANSWER-T/F: patients with cardiovascular issues can take triptans safely eletriptan - ANSWER-which tripan is contraindicated within 72 hours of using a potent CYP3A4 inhibitor frovatriptan - ANSWER-which triptan has increased serum concentrations if used with propranolol or oral contraceptives nasal sumatriptan, almotriptan - ANSWER-which 2 triptans are used for migraine in children (>12 yo) flunarazine - ANSWER-which agent has evidence for migraine prophylaxis in children walking ability in MS - ANSWER-what is fampridine (4-aminopyridine) approved in Canada for? T - ANSWER-T/F: MS disease activity is decreased during pregnancy RRMS - ANSWER-what type of MS is most common and most likely going to respond to immunomodulator therapy vitamin D 1000 IU daily - ANSWER-what supplementation should MS patients be taking? glatiramer, interferon beta - ANSWER-which 2 MS disease modifying drugs decrease frequency of relapse and number of lesions? T - ANSWER-T/F: alemtuzumab has a 50% greater reduction in relapse rates than interferon beta RRMS - ANSWER-what is dimethyl fumarate used for fingolimod - ANSWER-sphingosine-1-phosphate receptor which blocks autoimmune lymphocyte from circulating in the bloodstream natalizumab - ANSWER-which MS drug is associated with a 0.5% of progressive multifocal leukoencephalopahty (PML) T - ANSWER-T/F: there is no evidencec that antiviral use during shingles will prevent post-herpetic neuralgia trigeminal neuralgia - ANSWER-which type of neuropathic pain is treated both pharmacologically and surgically? unilateral - ANSWER-trigeminal neuralgia presents as (unilateral/bilateral) face pain carbamazepine - ANSWER-DOC for trigeminal neuralgia (effective for the "electric shock" oxcarbazepine - ANSWER-which drug for trigminal neuralgia is given BID and has fewer side effects than the current DOC? baclofen, phenytoin - ANSWER-what are 2 adjunct therapies for trigeminal neuralgia if the primary agent is not sufficient CRPS type 1 (complex regional pain syndrome) - ANSWER-burning pain, hyperalgesia, hyperathia, allodynia, sweating, rubor, and coldness in the affected limb. Results from crush injuries to nerves or post-stroke or MI F (although thought to be due to upregulation of adrenergic receptors, treat CRPS 1 as you would other neuropathic pain) - ANSWER-T/F: CRPS type 1 is well managed by sympathetic blockers TCA, gabapentinoids, SNRI - ANSWER-what are the (3) first line agents for peripheral neuropathic pain tramadol, opioids - ANSWER-what are the (2) 2nd line agents for peripheral neuropathic pain cannabinoids - ANSWER-what is 3rd line agent for peripheral neuropathic pain PHN - ANSWER-topical lidocaine is *2nd line* for which type of peripheral neuropathic pain CYP2D6 - ANSWER-enzyme which converts codeine to morphine TCA (note: unknown effects in lactation) - ANSWER-DOC for neuropathic pain in pregnancy tremor, bradykinesia, rigidity - ANSWER-3 cardinal signs of Parkinson's Disease 60 - ANSWER-patients less than ____ years of age with PD should be started on DA agonists lower - ANSWER-compared to levodopa, DA agonists have a (lower/higher) incidence of motor complications pulmonary fibrosis - ANSWER-what adverse effect caused by ergot-related DA agonists limits its usefulness compared to other DA agonists DA agonists - ANSWER-PD agents that can cause sleep attacks, impulsive behavior, GI upset, orthostasis amantadine - ANSWER-which PD drug can commonly cause livedo reticularis and leg edema amantadine - ANSWER-this drug has mild-moderate improvement in levodopa-induced dyskinesia tremor - ANSWER-what is the only cardinal symptom of PD that anticholinergics alleviate rasagiline, selegiline - ANSWER-MAO-B inhibitors used in PD entacapone - ANSWER-COMT inhibitors used in PD T (it prevents levodopa metabolism) - ANSWER-T/F: entacapone has NO EFFECT if not used with levodopa diarrhea, urine discolouration - ANSWER-what are 2 common counselling points for entacapone worsens - ANSWER-drugs used to treat motor symptoms of PD also (worsen/improve) psychosis in a dose-dependent manner clozapine - ANSWER-which antipsychotic has shown clear benefit for psychosis in PD? quetiapine - ANSWER-which antipsychotic is usually used 1st line for psychosis in PD despite weak evidence for effectiveness domperidone - ANSWER-which adjunct drug can be started when initiating a patient on levodopa or DA agonist to minimize the GI adverse effects Parkinsonism hyperpyrexia syndrome - ANSWER-this syndrome occurs when dopaminergic drugs are abruptly reduced or stopped, and has similar symptoms to neuroleptic malignant syndrome iron - ANSWER-restless legs syndrome is in part caused by low brain stores of ______________ levodopa, BZD, opioids - ANSWER-DOC (3) for intermittent RLS (besides iron supplementation)