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What lab tests should be ordered prior to initiating lithium therapy?
- Thyroid function
- Electrolytes
- Renal function
- ECG (when over 45 yrs)
List the trade name, medication class and action of quetiapine.
Seroquel

Atypical antipsychotic

DA & 5-HT antagonist
List the trade name, medication class and action of olanzapine.
Zyprexa

Atypical antipsychotic

DA & 5-HT antagonist
List the trade name, medication class, action and two primary indications of venlafaxine.
Effexor

Antidepressant

SNRI

Depression, generalized anxiety disorder
List the trade name, medication class and action of amitriptyline.
Elavil

Antidepressant

TCA (5-HT & NE RI)
List the trade name, medication class, action and additional indications of mirtazapine.
Remeron

Antidepressant

Alpha-2 & 5-HT2 antagonist (NaSSA)

Panic disorder, insomnia
List the trade name, medication class and action of citalopram.
Celexa

Antidepressant

SSRI
List the trade name, medication class, action and primary indications of paroxetine.
Paxil

Antidepressant

SSRI

Depression, OCD, panic disorder, social anxiety disorder
List at least seven side effects of lithium therapy. ("LITHIUM")
L - Leukocytosis (benign)
I - Increased weight
T - Tremor
H - Hypothyroidism
I - Insipidus, diabetes (polyuria/dipsia)
U - Vomiting / GI disturbances
M - Misc (arrhythmias, alopecia)
List the trade name, medication class, action and primary indications of sertraline.
Zoloft

Antidepressant

SSRI

Depression, panic disorder, OCD, PTSD
List the following benzodiazepines in order of increasing onset of action: lorazepam, oxazepam, clonazepam, diazepam.
Diazepam (Valium) - Fast

Clonazepam (Rivotril) - Intermediate

Lorazepam (Ativan) - Intermediate

Oxazepam (Serax) - Slow
For which two antipsychotics must you order baseline CBC values before initiating treatment?
- Carbamazepine (Tegretol)

- Valproate
What pharmaceutical class reduces symptoms in 50% of patients with body dysmorphic disorder?
SSRIs
What is the classic triad of opioid overdose? ("Rebels Admire Morphine")
Respiratory depression

Altered mental status

Miosis (constricted pupils)

Exception: demerol dilates pupils
Which is more dangerous: withdrawal from stimulant drugs, or withdrawal from sedative drugs?
Withdrawal from sedative drugs often causes autonomic hyperactivity, which can be life-threatening.

Of note: withdrawal from opiates is not life-threatening
What should be given immediately to patients who present with altered mental status?
Thiamine
Glucose
Naloxone
What pharmaceutical class is used to treat Tourette's and tic disorders?
Antipsychotics (dopamine receptor antagonists)
What are the first and second-line pharmaceutical classes used to treat obsessive-compulsive disorder?
1st: SSRIs (high doses)
2nd: TCAs
Of anorexia nervosa and bulimia nervosa, in which are SSRIs considered part of first-line treatment?
Bulimia nervosa
What is the hallmark of TCA toxicity?
Widened QRS complex (>100 ms)
What is the primary treatment of TCA toxicity?
Sodium bicarbonate.
Given that SSRIs are now the first-line treatment for depression, what are MAOIs now most used for?
Refractory depression
Refractory panic disorder
What are two serious side effects of MAOI therapy?
Serotonin syndrome (occurs when SSRIs and MAOIs are taken together: immediately d/c medication)

Hypertensive crisis (occurs when MAOIs are taken with tyramine-rich foods or with sympathomimetics (such as found in OTC cold remedies))
Buproprion should be used with caution in patients with which disorder?
Epilepsy (lowers seizure threshold)
List up to nine side effects of typical antipsychotics.
- Antidopaminergic effects (EPS, hyperprolactinemia)

- Anti-HAM effects (histamine, alpha-adrenergic, muscarinic)

- Tardive dyskinesia

- Neuroleptic malignant syndrome

- Also: weight gain, elevated liver enzymes, retinal pigmentation, rash, seizures
List the primary anti-histaminic, anti-alpha-adrenergic, and anti-muscarinic effects (often seen with antipsychotic use).
Anti-histaminic: sedation

Anti-a-adrenergic: orthostatic hypotension, sexual dysfunction

Anti-muscarinic: dry mouth, tachycardia, urinary retention, blurry vision, constipation
What atypical antipsychotic is associated with a 1% incidence of agranulocytosis and 2-5% incidence of seizures?
Clozapine
List the trade name, pharmaceutical class, primary indication and important side effects of carbamazepine.
Tegretol

Anticonvulsant

Rapid-cycling bipolar disorder

Leukopenia, aplastic anemia, agranulocytosis, NTDs
List the various extrapyramidal side effects.
Parkinsonism - masklike face, cogwheel rigidity, pill-rolling tremor

Akathisia - restlessness and agitation

Dystonia - sustained contraction of muscles of neck, tongue and eyes
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