Cns 2 - Test #3

Front 1

Onset of ADHD is @ ___ years, must occur by age ___

Back 1

Onset of ADHD is @ *3* years old, must occur by age *7*

Front 2

Diagnosis of ADHD: ___ number of symptoms must be present for ___ months

Back 2

Diagnosis of ADHD: *6* or more of the symptoms must be presnt for *6* months

Front 3

Prevailing explanation of ADHD: what brain regions is responsible for inability to control thier behavior, resist distractions, & develop an awareness of space & time?

Back 3

Prevailing explanation of ADHD: *the prefrontal cortex* is responsible for inability to control thier behavior, resist distractions, & develop an awareness of space & time?

Front 4

Effective treatment for ADHD involved the modulation of which 2 neurotransmitters?

Back 4

Effective treatments for ADHD involve *DA & NE* modulations to improve executive function & regulate arousal

Front 5

ADHD treatment:

1st line treatment: ?
2nd line treatment: ?
3rd line treatment: ?
4th line treatment: ?

Back 5

ADHD treatment:

1st line treatment: stimulants (methylphenidate & amphetamines)
2nd line treatment: atomoxetine or buproprion
3rd line treatment: TCA
4th line treatment: alpha2-agonist

Front 6

What type of behavioral intervention for ADHD is the following scenerio?

Child completes an assignment & is permitted to play on the computer.

Back 6

Child completes an assignment & is permitted to play on the computer.

Positive reinforcement

Front 7

What type of behavioral intervention for ADHD is the following scenerio?

Child hits sibling impulsively & is required to sit for 5 minutes in the corner of the room.

Back 7

Child hits sibling impulsively & is required to sit for 5 minutes in the corner of the room.

Time-out

Front 8

What type of behavioral intervention for ADHD is the following scenerio?

Child loses free-time privileges for not completed hmwk.

Back 8

Child loses free-time privileges for not completed hmwk.

Response cost

Front 9

What type of behavioral intervention for ADHD is the following scenerio?

Child earns starts for completing assignments & loses stars for getting out of seat. The child cashes the sum of starts at the end of the week for a prize.

Back 9

Child earns starts for completing assignments & loses stars for getting out of seat. The child cashes the sum of starts at the end of the week for a prize.

Token economy

Front 10

MAO of methylphenidate & amphetamines:

block reuptake of which 2 neurotransmitters?

amphetamine also increases ___>

Back 10

Methylphenidate & amphetamines block *DA & NE* reuptake.

Amphetamines also increase *catecholamine release*

Front 11

Adverse effects of stimulants:

height deficit of ___ inches/year during 1-3 years of treatment

Back 11

Adverse effects of stimulants:

height deficit of *0.4* inches/year during 1-3 years of treatment

Front 12

Adverse effects of stimulants:

Average weight decrease of ___ lbs during 1st year & ___ lbs in 2nd year.

Back 12

Adverse effects of stimulants:

Average weight decrease of *6.6* lbs during 1st year & *2.6* lbs in 2nd year.

Front 13

Atomoxtine is a ______ (MOA) & the first nonstimulant FDA approved for ADHD.

Back 13

Atomoxtine is a *selective NE reuptake inhibitor* (MOA) & the first nonstimulant FDA approved for ADHD.

Front 14

Metabolism of atomoxetine?

Back 14

Atomoxetine

metabolized by CYP 2D6

Front 15

Tourette's Disorder:

Most notable brain regions?

Back 15

Tourette's Disorder:

Most notable brain regions?

basal ganglia & caudate nucleus

Front 16

Tourette's Disorder:

What is the most widely prescribed agent?

Back 16

Tourette's Disorder:

What is the most widely prescribed agent?

Clonidine

Front 17

Tourette's Disorder:

___ (atypical antipsychotic) was reported NOT to be effective

Back 17

Tourette's Disorder:

*Clozapine* (atypical antipsychotic) was reported NOT to be effective

Front 18

____ (drug class) should be used before haloperidol & pimozide (for safety reasons)

Back 18

*Atypical antipsychotics* (drug class) should be used before haloperidol & pimozide (for safety reasons)

Front 19

Metabolism of haloperidol & pimozide?

Back 19

Metabolism of haloperidol & pimozide?

CYP 3A4

Front 20

Oral tablet used for nocturnal enureses?

Back 20

Desmopressin

Front 21

Hyponatremia is an adverse effect of _____ & defined as _____.

Back 21

Hyponatremia is an adverse effect of *desmopressin* & defined as *<135 mEq/L*.

Front 22

What is: abnormality in the amount, quality, or timing of sleep?

Back 22

Dyssomnias: abnormality in the amount, quality, or timing of sleep?

Front 23

Sleep cycle: consists of two major phases - REM (___%) & NREM (___%)

One cycle is about ____ min

Back 23

Sleep cycle: consists of two major phases - REM (25%) & NREM (75%)

One cycle is about 70-120 min

Front 24

___ (neurotransmitter): maintains normal sleep pattern

Back 24

NE: maintains normal sleep patterns

Front 25

___ (neurotransmitter): sleep regulation

Back 25

serotonin: sleep regulation

Front 26

___ (neurotransmitter): has an alterting effect

Back 26

DA: has an alterting effect

Front 27

Diphenhydramine metabolism?

Back 27

Diphenhydramine is a potent CYP 2D6 inhibitor (Inc conc of other drugs)

Front 28

Zolpidem metabolism?

Back 28

Zolpidem is metabolized by CYP 3A4

(interaction with ketoconazole & rifampin)

Front 29

Zaleplon metabolism?

Back 29

Zaleplon metabolized by aldehyde oxidase

Front 30

Zaleplon drug interactions?

Back 30

Zaleplon drug interactions:

Cimetidine INC Cpss

Rifampin DEC Cpss

Front 31

Eszopiclone metabolism?

Back 31

Eszopiclone metabolized by CYP 3A4 & 2E1 (interaction with alcohol)

Front 32

Ramelteon metabolism?

Back 32

Ramelteon metabolized by CYP 1A2 (major) & 2C & 3A4 (minor)

*Do not take with food!

Front 33

Ramelteon drug interactions?

Back 33

fluvoxamine INC AUC

fluconazole INC AUC (2C inhibitor)

ketoconazole INC AUC

rifampin DEC AUC (enzyme inducer)

Front 34

Benzo's effect on sleep stages?

Back 34

Benzo's increase stage 2 sleep, decreases durations of stages 1, 2, & 4.

BZ's do not decrease REM.

Front 35

Benzo's with clinically significant metabolites

Back 35

Benzo's with clinically significant metabolites:

Flurazepam (Dalmane)

Quazepam (Doral)

Front 36

Treatment for narcolepsy?

Back 36

Treatment for narcolepsy:

- stimulants
- antidepressants
- GHB

Front 37

Modafinil metabolism?

Back 37

Modafinil metabolism:

CYP 2C19 inhibitor (inc other drug conc)

CYP 3A4 inducer (dec other drug conc)

Front 38

Drug FDA approved in 2002 for cataplexy

Back 38

GHB (as sodium oxybate - Xyrem)

FDA approved n 2002 for cataplexy

Front 39

Treatment of sleepwalking & sleep terrors

Back 39

Treatment of sleepwalking & sleep terrors:

BZ's, SSRI's, & TCA's

Front 40

Treatment of sleep-related eating disorder

Back 40

Treatment of sleep-related eating disorder:

Tx with opiates, l-dopa, or topiramate

Front 41

Core features of anorexia nervosa (AN)

Back 41

Core features of anorexia nervosa (AN)

refusal to maintain minimal body weight (>85% normal body weight or BMI >17.5kg/m2)

Amenorrhea for the last 3 cycles

Front 42

BMI calculation?

Back 42

BMI = [(weight (lbs) x 703) / (height squared [in])] x 703

Front 43

Which 3 neurotransmitters contribute to eating behavior?

Back 43

5-HT, NE, & DA contribute to eating behavior

Front 44

Preferred agents for anorexia nervosa (AN)?

Back 44

SSRI's are preferred agents due to safety (TCA's & MAOI's have anticholinergic & cardiovascular issues)

Front 45

True/False: Antipsychotics & appetite suppressants have a role in BN.

Back 45

FALSE: Antipsychotics & appetite suppressants have NO role in BN.

Front 46

AED serum concentration ranges:

Phenobarbital

Back 46

AED serum concentration ranges:

Phenobarbital = 10-40 mcg/mL

Front 47

AED serum concentration ranges:

Phenytoin

Back 47

AED serum concentration ranges:

Phenytoin = 10-20 mcg/mL

Front 48

AED serum concentration ranges:

Ethosuximide

Back 48

AED serum concentration ranges:

Ethosuximide = 40-80 mcg/mL

Front 49

AED serum concentration ranges:

Valproic acid

Back 49

AED serum concentration ranges:

Valproic acid = 50-150 mcg/mL

Front 50

AED serum concentration ranges:

Carbamazepine

Back 50

AED serum concentration ranges:

Carbamazepine = 4-14 mcg/mL

Front 51

Fetal malformations:

Carbamazepine & Valproic acid can cause ___

___ & ___ can cause congenital heart malformations

Back 51

Fetal malformations:

Carbamazepine & Valproic acid can cause *spina bifida*

*barbituates & phenytoin* can cause congenital heart malformations

Front 52

Drugs with non-linear PK:

Back 52

Drugs with non-linear PK:

phenytoin
VPA (dose > 2.5 gm/day)
ethosuximide
gabapentin
pregabalin
carbamazepine