CMN 548 TEST 4 COMPREHENSIVE
EXAMINATION TEST SOLVED QUESTIONS
AND ACCURATE ANSWERS FULL REVIEW
RESOURCE
⩥ In utero VPA exposure and effects on IQ in offspring:
Answer: Lower IQ scores with VPA vs. other AEDs in (up to age 6);
associated was independent of maternal IQ; supplementation with folic
acid may protect against neurocognitive effects
⩥ Dose-dependent neurodevelopmental outcomes with VPA:
Answer: increased risk above 1000 mg daily
⩥ Risks for neurodevelopmental disorders with VPA:
Answer: poor adaptive functioning, ADHD, PDD spectrum diosrders (up
to age 6); "austistic traits" (up to age 4)
⩥ Recommended lab tests during VPA for work up:
Answer: 1) CBC including platelets and differential
2) Liver function
3) Total and HDL cholesterol and triglycerides
4) Body weight/BMI
,5) Menstrual history
6) Bone density
⩥ Follow up Labs with pt. on VPA:
Answer: Repeat test CBC with diff and LFT monthly for 2 months, then
2-3 times a year. Can also do every 6-24 months if no abnormalities are
found.
Body weight and menstrual hx Q3 months for first year, then annually.
Ammonia level in event of lethargy, mental status changes
⩥ VPA Plasma level monitoring:
Answer: Two levels to establish therapeutic dose (at least 3-5 days after
start of therapy) and 5 days after change in dose or addition/deletion of
interacting drug
⩥ What do you do if LFTs become abnormal with a person is taking
VPA?
Answer: Mild transaminase elevation (less than 3 times normal):
monitoring every 1-2 weeks; if stable and patient is responding to VPA,
results are monitored monthly to every 3 months.
Pronounced transaminase elevation (more than 3 times normal): dosage
reduction or discontinuation of VPA; increase dose or rechallenge if
transaminases normalize and if the pt. is a VPA responder.
,⩥ What are the advantages of benzodiazepines that have a long half-life
versus those with short half-lives?
Answer: •Less frequent dosing, less variation in plasma concentration, &
less severe withdrawal phenomena
⩥ What are the disadvantages of benzodiazepines that have a long half-
life versus those with short half-lives?
Answer: •Drug accumulation, increased risk of daytime psychomotor
impairment, & increased daytime sleepiness
⩥ What can be the result of frequent dosing of diazepam (Valium) and
flurazepam (Dalmane)?
Answer: •Drug accumulation because its being administered quicker
than elimination half life
⩥ What are the therapeutic indications for benzodiazepines and GABA
Receptor drugs?
Answer: • Insomnia
• GAD
• Panic disorder
• Social phobia
• BP 1 & 2
• Catanonia
• Akathisia
, • Parkinsons
⩥ List the differences between the "Z drugs" indicated for insomnia and
the benzodiazepines indicated solely for insomnia.
Answer: •Differ primarily in their half lives
⩥ What are the advantages of using high potency benzodiazepines over
SSRIs for the treatment of panic disorder?
Answer: Work quickly and don't have side effects of sexual dysfunction
and wt gain. Alprazolam and clonazepam are commonly used for Panic
disorder without agoraphobia.
⩥ For patients with bipolar I and II, what are the advantages of using
clonazepam (Klonopin), lorazepam (Ativan), or alprazolam (Xanax)
over antipsychotics?
Answer: They are as effective. Clonazepam may result in an increased
time between cycles and fewer depressive episodes. Benzos also help
bipolar patients sleep better.
⩥ Which benzodiazepine is effective when administered IM to manage
substance induced and psychotic agitation in the emergency department?
Answer: IM Lorazepam
⩥ Review the use of Flumazenil for Benzodiazepine overdose
EXAMINATION TEST SOLVED QUESTIONS
AND ACCURATE ANSWERS FULL REVIEW
RESOURCE
⩥ In utero VPA exposure and effects on IQ in offspring:
Answer: Lower IQ scores with VPA vs. other AEDs in (up to age 6);
associated was independent of maternal IQ; supplementation with folic
acid may protect against neurocognitive effects
⩥ Dose-dependent neurodevelopmental outcomes with VPA:
Answer: increased risk above 1000 mg daily
⩥ Risks for neurodevelopmental disorders with VPA:
Answer: poor adaptive functioning, ADHD, PDD spectrum diosrders (up
to age 6); "austistic traits" (up to age 4)
⩥ Recommended lab tests during VPA for work up:
Answer: 1) CBC including platelets and differential
2) Liver function
3) Total and HDL cholesterol and triglycerides
4) Body weight/BMI
,5) Menstrual history
6) Bone density
⩥ Follow up Labs with pt. on VPA:
Answer: Repeat test CBC with diff and LFT monthly for 2 months, then
2-3 times a year. Can also do every 6-24 months if no abnormalities are
found.
Body weight and menstrual hx Q3 months for first year, then annually.
Ammonia level in event of lethargy, mental status changes
⩥ VPA Plasma level monitoring:
Answer: Two levels to establish therapeutic dose (at least 3-5 days after
start of therapy) and 5 days after change in dose or addition/deletion of
interacting drug
⩥ What do you do if LFTs become abnormal with a person is taking
VPA?
Answer: Mild transaminase elevation (less than 3 times normal):
monitoring every 1-2 weeks; if stable and patient is responding to VPA,
results are monitored monthly to every 3 months.
Pronounced transaminase elevation (more than 3 times normal): dosage
reduction or discontinuation of VPA; increase dose or rechallenge if
transaminases normalize and if the pt. is a VPA responder.
,⩥ What are the advantages of benzodiazepines that have a long half-life
versus those with short half-lives?
Answer: •Less frequent dosing, less variation in plasma concentration, &
less severe withdrawal phenomena
⩥ What are the disadvantages of benzodiazepines that have a long half-
life versus those with short half-lives?
Answer: •Drug accumulation, increased risk of daytime psychomotor
impairment, & increased daytime sleepiness
⩥ What can be the result of frequent dosing of diazepam (Valium) and
flurazepam (Dalmane)?
Answer: •Drug accumulation because its being administered quicker
than elimination half life
⩥ What are the therapeutic indications for benzodiazepines and GABA
Receptor drugs?
Answer: • Insomnia
• GAD
• Panic disorder
• Social phobia
• BP 1 & 2
• Catanonia
• Akathisia
, • Parkinsons
⩥ List the differences between the "Z drugs" indicated for insomnia and
the benzodiazepines indicated solely for insomnia.
Answer: •Differ primarily in their half lives
⩥ What are the advantages of using high potency benzodiazepines over
SSRIs for the treatment of panic disorder?
Answer: Work quickly and don't have side effects of sexual dysfunction
and wt gain. Alprazolam and clonazepam are commonly used for Panic
disorder without agoraphobia.
⩥ For patients with bipolar I and II, what are the advantages of using
clonazepam (Klonopin), lorazepam (Ativan), or alprazolam (Xanax)
over antipsychotics?
Answer: They are as effective. Clonazepam may result in an increased
time between cycles and fewer depressive episodes. Benzos also help
bipolar patients sleep better.
⩥ Which benzodiazepine is effective when administered IM to manage
substance induced and psychotic agitation in the emergency department?
Answer: IM Lorazepam
⩥ Review the use of Flumazenil for Benzodiazepine overdose
