© Mark E. Damon - All Rights Reserved APNA 2011 Clinical...

Session ID: 1011 June 18, 2011

Mary A. Gutierrez, PharmD, BCPP 1

© Mark E. Damon - All Rights Reserved

APNA 2011

Clinical Psychopharmacology

Mary A. Gutierrez, PharmD, BCPP

Professor of Clinical Pharmacy & Psychiatry

Loma Linda University School of Pharmacy

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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

Welcome to

Who Wants to

be an APNA

Millionaire!

50:50


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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

50:50




A: Accutane

C: Interferon

B: Flexeril

D: Larium

50:50

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Which of the following

medications is not likely to

cause or worsen depression?


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A: Priapism

C: Anticholinergic

B: Orthostasis

D: Peripheral edema

50:50

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Other than sedation, which of

the following is a common

side effect of trazodone?




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A: 5 hours

C: 5 weeks

B: 5 days

D: 5 months

50:50

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When Prozac (fluoxetine)

is discontinued, it takes

approximately how long for

the drug to be washed

out of the system?


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A: Sertraline

C: Mirtazapine

B: Bupropion

D: Venlafaxine

50:50

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Which antidepressant has

antiemetic effects and

considered the best choice for

patients on chemotherapy with

nausea and vomiting ADRs?


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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100


A: Venlafaxine

C: Bupropion

B: Fluoxetine

D: Paroxetine

50:50

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antidepressants have a

higher incidence of serotonin

withdrawal syndrome

and should be tapered off?

(Select all that apply)




the $1,000

Milestone!


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A: Low libido

C: Premature ejaculation

B: Erectile dysfunction

D: Anorgasmia

50:50

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What type of sexual dysfunction

can be improved with the

use of SSRIs?




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A: Fluoxetine

C: Escitalopram

B: Fluvoxamine

D: Sertraline

50:50

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SSRIs can be used

for patients on warfarin?


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A: Fluoxetine

C: Duloxetine

B: Sertraline

D: Bupropion

50:50

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antidepressants has increased

absorption (by 40%)

when taken with food?


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A: Trazodone

C: Carbamazepine

B: Mirtazapine

D: Doxepine

50:50

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Which of the following is the

active drug for Silenor®?

Received FDA approval in 2010 for the

treatment of acute and chronic insomnia

in adult & geriatric patients




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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100


A: Fluoxetine

C: Sertraline

B: Paroxetine

D: Fluvoxamine

50:50

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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

Which SSRI is not

recommended for children

and adolescents?


the $32,000

Milestone!




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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100


A: Paroxetine

C: Duloxetine

B: Fluoxetine

D: Bupropion

50:50

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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100


antidepressants can

decrease the efficacy of

tamoxifen for breast cancer?



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A: Lamictal

C: Topamax

B: Depakote

D: Tegretol

50:50

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anticonvulsants has

the highest risk of

Stevens-Johnson Syndrome?


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A: Risperidal

C: Reglan

B: Phenergan

D: EMSAM

50:50

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Which medications can

cause gynecomastia with

long term use?





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A: Zoloft

C: Paxil

B: Prozac

D: Wellbutrin

50:50

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Which of the following is

commonly used for ADHD

in children and adolescents

and does not have a

FDA-approved indication?


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A: Increase serotonin

C: Blocks adenosine

receptors

B: Increase NE

D: Blocks DA receptors

50:50

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How does caffeine work to

increase wakefulness?


YOU HAVE WON

$1 MILLION DOLLARS

IN PSYCHOPHARM IQ!


APNA 2011 – Game II








151413121110987654321

$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

Welcome to

Who Wants to

be an APNA

Millionaire!

50:50


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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

50:50


A: Paroxetine

C: Mirtazapine

B: Venlafaxine

D: Bupropion

50:50

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Which of the following would

be the best choice for obese

patients with antidepressant

induced delayed ejaculation

or anorgasmia?




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A: Bupropion 150 mg BID

C: Advil® PM 2C QHS

B: Pseudoephedrine

30 mg 2T QHS

D: Excedrin®

Migraine 2T QHS

50:50

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Your patient is asking for more

trazodone to help with his

nightly insomnia. Which of the

following can cause or worsen his

insomnia? (Select all that apply)


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A: Valerian

C: St. Johns wort

B: Melatonin

D: Pseudoephedrine

50:50

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Which of the following OTC

products can decrease the

efficacy of oral contraceptives?


A: Higher drug conc

C: Lower drug conc

for 5 weeks

B: Lower drug conc

D: No change in

drug conc

50:50

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Your patient is on fluoxetine and

6 other CYP450 metabolized meds.

What can happen with the CYP450

metabolized drug concentrations

when this patient is switched from

fluoxetine to sertraline?


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A: < 2 yo

C: > 40 yo

B: < 18 yo

D: > 65 yo

50:50

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The Black Box Warning for

hepatoxicity for Depakote is

mostly associated with which of

the following age groups?


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A: HCTZ 25 mg

C: Amlodipine 5 mg

B: Lisinopril 20 mg

D: Furosemide 20 mg

50:50

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Your patient was stabilized on lithium for

years with steady-state levels around

0.9 mEq/L. He was started on an

antihypertensive agent last week and

his lithium levels increased to 2.7

mEq/L. Which of the following can

increase lithium levels by 200-300%?




the $1,000

Milestone!


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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100


A: Tylenol PM

C: Melatonin

B: Unisom

D: Nyquil

50:50

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Your patient was scheduled to see you

next week for mild dystonic reactions

secondary to his risperidone. He started

taking an OTC agent nightly & his EPSE

sxs resolved before his appt. Which of

the following OTC agent can treat AP-

induced dystonia? (Select all that apply)




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A: Ibuprofen 800 mg TID

C: Vicodin 2T Q6H

B: Tylenol #3 2T Q6H

D: Diclofenac 50 mg TID

50:50

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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

Your patient showed sxs of lithium

toxicity after a dental procedure &

was prescribed an analgesic agent

a few days ago. Which of the

following can increase lithium

levels? (Select all that apply)


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A: 2-gm sodium restriction

C: Theophylline

B: Grande Starbucks coffee

D: NS 0.9% infusion

50:50

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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

Which of the following can

increase lithium levels?


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A: Depakote

C: Lithium

B: Equetro

D: Abilify

50:50

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Your patient has sxs of wt gain, fatigue,

brittle hair, and cold intolerance after

starting on a psychotropic medication

for 6 months. Which of the following

psychotropic agents can

cause hypothyroidism?




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A: Mylanta

C: Align

B: Gas-X

D: Prilosec

50:50

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Which of the following OTC

agent can increase GI

distress ADR risk for

patients on Depakote®?



the $32,000

Milestone!




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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100


A: Lithium

C: Risperidone

B: Bupropion

D: Selegiline

50:50

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Which of the following classes

of psychotropic medications

can cause hand tremor?



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A: H1

C: M1

B: D2

D: 5HT2C

50:50

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Inhibition of which of the following

receptors can cause weight gain?


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A: Amlodipine

C: Verapamil

B: Diltiazem

D: Felodipine

50:50

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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

Your patient has been on

carbamazepine for his Bipolar disorder

for many years. He was started on an

antihypertensive agent and caused CBZ

toxicity (ataxia, confusion, nystagmus).

Which of the following can increase CBZ

concentrations? (Select all that apply)




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A: Depakote

C: Equetro

B: Paxil

D: Effexor

50:50

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psychotropic medications should

be tapered off and not stopped

abruptly after long-term use?



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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100




A: Fluoxetine

C: Amitriptyline

B: Paroxetine

D: Lorazepam

50:50

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psychotropic medications has the

most dangerous consequences

when stopped abruptly without

tapering after long term use?


YOU WIN $1 MILLION

DOLLARS

IN PSYCHOPHARM IQ!


APNA 2011 – Game III








151413121110987654321

$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

Welcome to

Who Wants to

be an APNA

Millionaire!

50:50


151413121110987654321

$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

50:50


A: Zoloft

C: Effexor

B: Wellbutrin

D: Paxil

50:50

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antidepressants is usually

not recommended for the

treatment of panic disorder?




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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100


A: Fluoxetine

C: Paroxetine

B: Citalopram

D: Sertraline

50:50

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Which SSRI is not

recommended for your

70 year-old male patient with

BPH and chronic constipation?


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A: Bulimia

C: Alcohol w/d

B: ADHD

D: Use of Zyban

50:50

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Which of the following are

contraindications for the use

of bupropion?



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A: Lorazepam

C: Lithium

B: Diazepam

D: Sertraline

50:50

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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

Which of the following medication

has significant increase in the

its half-life and ADRs in

geriatric vs. adult patients?





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A: Alprazolam

C: Flurazepam

B: Lorazepam

D: Temazepam

50:50

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benzodiazepines have

pregnancy category X



the $1,000

Milestone!




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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100


A: Akathisia

C: Migraine prophylaxis

B: Lithium-induced

hand tremor

D: Asthma

50:50

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Propranolol can be used for

the treatment of which of the

following conditions?



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A: Tylenol PM

C: Silenor

B: Flexeril

D: Aricept

50:50

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medications should be

avoided for patients with

memory impairment?



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A: antidepressant

C: antipsychotic

B: anxiolytic

D: anticonvulsant

50:50

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"WARNING: This medicine is an _____.

It may increase the risk of death when

used to treat mental problems caused

by dementia in elderly patients. Most of

the deaths were linked to heart

problems or infection. “




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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100


A: E-Mycin

C: Cipro

B: Keflex

D: Zyvox

50:50

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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

Your patient on clozapine

experienced a seizure after taking

an antibiotic for a week.

Which of following antibiotics can

increase clozapine levels?


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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100




A: E-Mycin

C: Cipro

B: Keflex

D: Zyvox

50:50

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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

Which of the following antibiotics

has monoamine oxidase inhibition

and can cause potential

problems with other MAOIs,

SSRIs, and SNRIs?


the $32,000

Milestone!


151413121110987654321

$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100




A: Ambien

C: Lunesta

B: Sonata

D: None of the above

50:50

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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

Among the three Z-hypnotic

agents, which one is

FDA-approved for long term

treatment of insomnia


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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100


A: Sleep eating

C: Bitter taste upon

awakening

B: REM suppression

D: Tachycardia

50:50

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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

Which of the following is the

most common side effect

of Lunesta?




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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100


A: Trileptal

C: Abilify

B: Cymbalta

D: Ativan

50:50

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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

Your patient was noted to have N/V, HA,

confusion, c/o very fatigued. She was

started on a number of medications last

month. Which of following can cause

hyponatremia and associated sxs?



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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100




A: Caucasians

C: African Americans

B: Asians

D: Hispanics

50:50

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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

Which ethnic group has the

highest deficiency in

CYP450 2Cs enzymes and

prone to higher ADRs from BZDs

metabolized by this enzyme?


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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100


A: Alprazolam

C: Triazolam

B: Temazepam

D: Lorazepam

50:50

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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

Which of the following BZDs

are metabolized by CYP450

3A4 enzymes and should

avoid grapefruit juice?





YOU HAVE WON

$1 MILLION DOLLARS

IN PSYCHOPHARM IQ!


APNA 2011 – Game IV






151413121110987654321

$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

Welcome to

Who Wants to

be an APNA

Millionaire!

50:50




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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

50:50


A: Prolixin Dec Q2W

C: Risperdal Consta Q2W

B: Haldol Dec Q4W

D: Invega Sustenna Q4W

50:50

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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

Which of the following is an

option for long-acting injectable

antipsychotic agents for the

treatment of Schizophrenia

and Bipolar Disorder?



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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100




A: Resumed 1 ppd

cigarette smoking

C: Medication

noncompliance

B: Resumed his daily

tid MJ smoking

D: Started daily jogging

50:50

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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

Your patient was stabilized and

discharged from a non-smoking

psychiatric inpatient unit on an Zyprexa

20 mg QHS. Before his next month’s

outpatient appt, he had relapse sxs &

readmitted to the inpt unit. Which of the

following can cause his relapse?



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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100


A: Risperidone

C: Ziprasidone

B: Olanzapine

D: Quetiapine

50:50

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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

Patients on which atypical

antipsychotic should avoid

grapefruit juice?




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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100


A: Haloperidal

C: Olanzapine

B: Risperidal

D: Clozapine

50:50

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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

What is the antipsychotic of

choice for Parkinson’s patients

with psychotic sxs?


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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100




A: Benztropine

C: Amitriptyline

B: Diphenhydramine


50:50

151413121110987654321

$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

Which of the following would

recommend for patients with

antipsychotic-induced

tardive dyskinesia?


the $1,000

Milestone!


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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100




A: Continue meds

& manage ADRs

C: Increase hydration

B: Stop all meds

D: Admit him to inpt unit

50:50

151413121110987654321

$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

Your patient on Seroquel 600mg/d

c/o increased sedation and

dizziness after he took

erythromycin for 7 days.

What would you recommend?


151413121110987654321

$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100


A: Valium

C: Ativan

B: Librium

D: Klonopin

50:50

151413121110987654321

$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

Which benzodiazepine

is better for IM injections?




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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100


A: Prazosin

C: Ginkgo biloba

B: Tamsulosin

D: Yohimbine

50:50

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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

Which of the following is a current

recommended medication for

PTSD nightmares?


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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100




A: Oral Contraceptives

C: Ambien

B: Amlodipine

D: Omega-3

50:50

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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

Your female colleague at the medical

center was struggling with her night

shifts. She was prescribed Provigil for

her night shift sedation. Which of her

following medications can be affected

with Provigil? (Select all that apply)


151413121110987654321

$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100


A: E-Mycin

C: Cipro

B: Keflex

D: Zyvox

50:50

151413121110987654321

$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

Which of the following antibiotics

has monoamine oxidase inhibition

and can cause potential

problems with other MAOIs,

SSRIs, and SNRIs?




the $32,000

Milestone!


151413121110987654321

$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100


A: Lurasidone (Latuda)

C: Lloperidone (Fanapt)

B: Asenapine (Saphris)

D: Paliperidone (Invega)

50:50

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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

Which of the following are

FDA-approved

antipsychotic agents

in the U.S.?




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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100


A: Days

C: Months

B: Weeks

D: Years

50:50

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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

How long does it usually take to

taper your patient on Xanax 6

mg/day for many years


151413121110987654321

$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100




A: Caucasians

C: African Americans

B: Asians

D: Hispanics

50:50

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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100

Which ethnic group has a 10%

chance of being a CYP450 2D6

poor metabolizers leading to

increased risperidone concentrations

and ADRs at usual prescribed doses?


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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100


A: Bupropion

C: Mirtazapine

B: Trazodone


50:50

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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100


antidepressants can

block the sexual ADRs

of SSRIs and SNRIs?




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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100


A: Where is my $million?

C: I have learn from

this session

B: I enjoyed these games

D: Please!...No more

millionaire game music

50:50

151413121110987654321

$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100


statements apply to this

CE session?



YOU HAVE WON

$1 MILLION DOLLARS

IN PSYCHOPHARM IQ!

© Mark E. Damon - All Rights Reserved APNA 2011 Clinical...

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