Medications

Most of the medication questions are covered as part of specific Disorders. The following

are some outside Disorders.As of 15January2012. Main source, Stahl’s: The Prescribers Guide.2009

This PowerPoint Section

This PowerPoint Section only addresses a few meds as most meds are covered in the psychiatric management parts of the PowerPoints devoted to specific Disorders.

Gabapentin

Q. Gabapentin is FDA approved for?

Benzodiazepines

Q. How do benzodiazepines work?

Benzodiazepines

Ans. Binds to benzodiazepine receptors at the GABA-A ligand-gated chloride channel complex.

Gabapentin

Ans.

1] partial seizures

2] post-herpetic neuralgia

[So, much as many of us have had good results with gabapentin, it will frequently be the wrong answer on exams where FDA approval is implied.]

Clozapine

Q. FDA approves clozapine for?

Clozapine

Ans.

1] “Resistant” schizophrenia

2] People with schizophrenia who are high suicide risk.

SSRIs

Q. List the SSRIs.

SSRIs

Ans.

Citalopram

Escitalopram

Fluoxetine

Fluvoxamine

Paroxetine

Sertraline

Flumazenil

Q. FDA approves flumzenil for?

Flumazenil

Ans. Reversal of sedative side effects of benzodiazepines, such as overdose, including such a need in children.

Risperidone

Q. Risperidone’s notable side effects?

Risperidone

Ans. Stahl lists four:

Increase risk for diabetes

Increase risk for dyslipidemia

Dose-related hyperprolactinemia

Modafinil

Q. Modafinil is FDA approved for?

Modafinil

Ans.

Reducing excessive sleepiness associated with:

-- narcolepsy

-- shift-work sleep disorder

-- obstructive sleep apnea

Acamprosate

Q. Acamprosate is thought to work on which receptor sites?

Acamprosate

Ans. Stabilize glutamatergic function.

Carbamazepine – lab tests

Q. What lab tests are needed when using carbamazepine?

Carbamazepine – lab tests

Ans.

Blood count: every two weeks for 2 months, then every three months.

Liver, kidney and thyroid function: every 6 to 12 months

Consider monitoring sodium

Carbamazepine – lifethreatening

Q. What are the life-threatening conditions to worry about when using carbamazepine?

Carbamazepine – lifethreatening

Ans.

1. Rare, aplastic anemia, agranulocytosis

2. Rare, Stevens-Johnson syndrome

3. Rare, SIADH = syndrome of inappropriate antidiuretic hormone secretion with hyponatremia

Clozapine – tests/monitoring

Q. What tests are to be run with clozapine?

What do you want to monitor in addition to the lab test and physical findings

Clozapine – tests - 1

Ans.Complete blood count:

-- before treatment-- weekly for 6 months-- then biweekly for months 6-12-- after one year, then every four weeks-- then 4 weeks after treatment discontinued

See next screen

Clozapine – tests - 2

Ans. Continued:Track:

weight, q 3 monthsBMI, q 3 monthswaist circumference, q 3 monthsfasting glucose, q 3 monthslipids, q 3 months

Clozapine – monitoring - 3

Ans. Vigilant for diabetic ketoacidosis by monitoring: rapid onset of polyuriarapid onset of polydipsiaweight lostnausea or vomitingdehydrationincreased Rweaknessclouding of sensorium, [including, of course, coma]

Valproate – tests and monitoring

Q. What to test and monitor for when prescribing valproate?

Valproate – tests andmonitoring

Ans. Lab tests before beginning treatment:

platelet countcoagulation testliver function tests

Also monitorweight

Follow above frequently, especially in first six months, then once or twice a year.

Prazosin

Q. Use of prazosin [Minipress] in psychiatry?

Prazosin

Ans: PTSD’s nightmares.

Bupropion’s use in anorexia nervosa

Q. Discuss bupropion’s use in anorexia nervosa.

Bupropion’s use in anorexia nervosa

Ans. Has FDA black box because of increased of seizures in pts with eating disorders.

Warfarin

Q. What should not be used with warfarin [Coumadin]?

Warfarin

Ans. bupropioncitalopramdisulfirammifeprestone [RU 486

[may not be complete][answer may be to use with caution, rather

than not at all]

Anticholinergic signs

Q. What are the untoward anticholinergic signs?

Anticholinergic signs

Ans.1. dry mouth2. blurred vision3. constipation4. tachycardia5. urinary retention6. hyperthermia 7. decreased cognition8. [also, bad for narrow-angle glaucoma]