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185 Cards in this Set
- Front
- Back
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What is recommended for chronic anxiety?
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SSRI's
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What are the short-acting Benzodiazepines?
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Alprazolam (Xanax), 3A4 subs.
Oxazepam (Serax) |
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Which Benzos can be used by the elderly patients?
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Lorazepam (Ativan)
Oxazepam (Serax) Temazepam (Restoril) |
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What is Librium?
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Chlordiazepoxide, for alcohol withdrawal
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What is Buspar? Dosing? Max?
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Buspirone
Dose: 15mg/day, titrate by 5mg Max: 60mg/day |
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What drug interactions would you look out for with Buspirone?
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Avoid use with MAOi & inhibitors (3A4 substrate)
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What is Celexa? Dose?
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Citalopram, 10-60mg/day
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What is Lexapro?
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Escitalopram
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What is Flouxetine? Dosing?
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Prozac, Sarafem
10-80mg QAM |
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What is Luvox? Dosing?
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Fluvoxamine, for OCD
QHS |
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What is Paxil? Dosing?
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Paroxetine
10-80mg QAM Don't DC abruptly = severe anger |
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What is Zoloft? Dose?
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Sertraline
Max: 200mg QD |
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Major SE for SNRI's?
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Hypertension
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What is Venlafaxine?
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Effexor
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What is Pristiq? Max dose?
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Desvelanfaxine
Max: 400mg |
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What is the Pristiq dose for renal patients (CrCl <30mL/min)?
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50mg QOD
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What is Cymbalta? Dose?
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Duloxetine
Dose: 60mg QD/BID |
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What is the dose for Cymbalta for renal patients (CrCl<30mL/min)?
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Avoid in patients with renal, hepatic & high alcohol use.
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What is Savella? Indication?
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Milnacipram, for fibromyalgia
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List the meds approved for fibromyalgia (3)
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Savella (milnacipram)
Cymbalta (duloxetine) Lyrica (pregabalin) |
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What is the max dose for regular Bupropion? Bupropion ER?
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450mg/day
ER: 300mg/day |
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What is Desyrel?
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Trazodone
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What is Desyrel indicated for and dose?
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MDD
Sleep: 25-50mg |
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What does Bupropion work on?
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Dopamine agonist
Norepinephrine agonist |
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What is Serzone?
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Nefazodone
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What is Remeron?
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Mirtazipine
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Remeron SE?
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Weight gain
Somnolence |
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What is Tofranil?
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Imipramine (TCA)
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What is Elavil?
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Amitriptylline (TCA)
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What is Sinequan?
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Doxepin (TCA)
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What is Anafranil? Indication?
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Clomipramine (TCA), for OCD
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What is Norpramine? Indication?
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Desipramine, for ADHD
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What is Nortriptyline?
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Pamelor
Aventyl |
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SE of TCA's?
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Anti-cholinergic effects
CV effects Arrythmia |
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What is Parnate?
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Tranylcylpramine (MAOi)
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What is Nardil?
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Phenelzine (MAOi)
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What is Marplan?
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Isocarboxazid (MAOi)
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Why should Tyramine be avoided when on MAOi meds?
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Tyramine releases catecholamines (NE) which results to HTN crisis when combined with MAOi's.
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What is Emsam?
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Selegiline (MAOi) patch, QD
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What are the anti-psychotics approved for MDD (3)?
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Abilify: <15mg
Symbyax (Olanzapine + Fluoxetine) Lithium |
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Dosing for Symbyax?
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QHS, very sedating
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What is Bipolar?
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Characterized by alternating episodes of Mania (euphoria) and Depression
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What is Depakote? Indication?
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VaLProic acid
Indications: migraine, seizure, bipolar |
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What is Zyprexa? Indication? Max dose?
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Olanzapine, for bipolar
Max: 20mg QD, very long acting |
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What is Equeto?
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Carbamazepine, for bipolar & seizure
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What is Lamictal? Monitor what?
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Lamotrigine
Monitor liver and watch out for rash! |
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What is Topamax? Indication?
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Topiramate, used for seizure and unapproved for bipolar
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What is Risperdal?
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Risperidone
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What is Ziprasidone? Dose?
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Geodon, 80mg BID with food
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What is Abilify?
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Aripiprazole
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What is Saphris?
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Asenaphine, ODT
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What is the dose of Olanzapine for acute mania?
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10mg IM
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What is Stavzor?
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Valproic Acid
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Production of _______ goes up with the use of Lithim.
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WBC, similar in action to steroids
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Lithium serum concentrations should be between _________
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0.6 - 1.2 mmol/L
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What is the Lithium dose?
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900 - 1800mg div into 3 doses
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What is the Lithium dose for the Elderly and renally impaired? Serum concentration?
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Start: 300mg QD
Serum: 0.4 - 0.6mmol/L |
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Therapeutic levels for Lithium?
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Acute: 0.8 - 1.5 meq/L
Maintenance: 0.6 - 1.2 meq/L |
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Lithium Toxicity S/S?
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>1.5 meq/L = tremor, vomiting, ataxia,slurred speech, confusion
>2 meq/L = arrhythmias, seizures, coma |
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Monitoring parameters for Lithium
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Bun & CrCl
Urine specific gravity CBC Electrolytes TSH EKG Glucose |
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What is schizophrenia?
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There is too much Dopamine which results to a mental disorder.
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Diagnostic criteria for Schizophrenia
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2 of the following 5 symptoms
- hallucinations - delusions - disorganized speech - disorganized behavior - negative symptoms (symptoms you can see) |
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SE of Anti-psychotics?
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Weight gain
Anti-cholinergic effects Sedation Hypotension Movement disorders (Tardive Dyskenisia) EPSE Neuroleptic Malignant Syndrome (NMS) |
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What are the EPS?
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Dystonia
Akathisia Pseudoparkinsonism |
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What is Dystonia? Treatment?
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Painful muscle spasm - laryngospasm
Benadryl IV 25-50mg |
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What is Akathisia? Treatment?
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Restlessness
Tx: propranolol 30-100mg |
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What is the treatment for Pseudoparkinsonim?
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Increase dopamine or decrease acetylcholine
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What is Tardive Dyskinesia?
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Hypersensitivity due to prolonged blockage of dopamine. Characterized by tongue, lip, jaw & extremity movement
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What is Neuroleptic Malignant Syndrome?
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Depletion of DA in the CNS resulting to RIGIDITY, FEVER, DIAPHORESIS, altered consciousness, INCREASE IN BP & HR
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What labs do you monitor with NMS?
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inc. CPK (muscle breakdown)
LFT inc. WBC (CBC) |
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What is Dantrolene?
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A muscle relaxant to treat malignant hyperthermia in NMS
Tx: 1mg/kg rapid IV push |
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What is Thorazine?
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Chlorpromazine
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What is Mellaril
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Thioridazine
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That is Trilafon?
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Perphenazine
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What is Stelazine?
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Triflouperazine
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What is Navane?
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Thiothixene (Typical)
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What is Prolixin?
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Fluphenazine (Typical)
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What is Haldol?
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Haloperidol (Typical)
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What anti-psychotics have an IM form?
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Haldol
Aripiprazole (Abilify) Ziprasidone (Geodon) Olanzapine (Zyprexa) |
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What anti-psychotics have a decanoate form?
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Haldol
Fluphenazine (Prolixin) Risperidone (Consta) Paliperidone (Invega) |
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Max dose for Zyprexa IM?
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30mg
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Max dose for Abilify IM?
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30mg
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Max dose for Geodon IM?
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40mg
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What is the dose for Haldol decanoate?
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10-15x oral dose Qmonth
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What is the dose for Prolixin decanoate?
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oral dose/25 Q2 weeks
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What is the dose for Consta?
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IM Q2 weeks for >18 yo
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What is the dose for Invega?
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day 1: 234mg IM
1 week later: 156mg Maintenance: IM Qmonth (117mg recommended) |
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What is Clozaril?
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Clozapine, atypical
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What is Risperidone? SE?
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Risperdal
SE: increases prolactin, most EPS |
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What is Seroquel? Dosing?
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Quetiapine, QHS
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What is Fanapt?
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Iloperidone
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What is Geodon? Dosing?
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Ziprasidone, BID with food
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What is Saphris?
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Asenaphine - SL only
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SE of Clozapine?
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Agranulocytosis
Cholinergic effects (sweating & hypersalivation) Seizure (>600mg QD) Hyperglycemia, hyperlipidemia, weight gain. |
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Fanapt dosing?
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1mg BID
Max: 12mg BID - reduce does by 1/2 when given with inhibitors |
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Invega dosing?
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Mild renal impairment: 6mg
Severe renal: 3mg |
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Cause of Parkinson's?
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Depletion of Dopamine, which results to high acetylcholine in the body.
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Symptoms of Parkinsons?
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Tremor
Rigidity Akinesa (initiation of movement is difficult) Mask face Pill rolling |
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Meds that cause pseudoparkinsonism?
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Haldol
Reglan |
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List anti-cholinergics used for Parkinson's (4)
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Trihexyphenyldil (Artane)
Benztropine (Cogentin) Biperidone (Akineton) Diphenhydramine |
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MoA of Levodopa?
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Dopamine precursor
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What is Larodopa?
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Levodopa
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What is Sinemet?
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Levodopa - Carbidopa
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SE for Levodopa?
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Hypotension
Akinesia N/V Psychosis Aprodisiac Dyskinesia |
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How much Carbidopa is needed to absorb Levodopa?
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75mg/day
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How do you change dosing from non-CR to CR?
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Increase levodopa by 10%
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What is Eldepryl?
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Selegiline - 5mg tabs (parkinsonism)
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What is Zelapar?
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Selegiline - 1.25mg ODT (parkinsonism)
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What is Azilect?
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Rasagiline (parkinsonism)
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Dosing for Eldepryl?
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5mg BID
Max: 10mg QD -don't give later than 2 PM bec it turns to amphetamine |
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Contraindications for Azilect?
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Liver disease
Pheochromocytoma 14 days before surgery |
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What is Symmetrel? Dose?
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Amantadine
Dose: 100mg BID, dose adjust in renal patients |
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What is Parlodel?
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Bromocriptine
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What is Permax?
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Pergolide
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What is Mirapex?
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Pramipexole
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What is Requip?
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Ropinirole
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What is Apokyn?
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Apomorphine - SC injection
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Dopamine agonist SE
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Major orthostasis due to alpha-blocking activity
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Indications for Parlodel?
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Hyperprolactinemia
Parkinsonism |
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Is Bromocriptine okay to use in renal patients
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Yes
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What do you have to remember when using Permax?
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Titrate to avoid hypotension
Caution in Liver disease |
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Dosing for Mirapex?
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Titrate to avoid hypotension
Decrease dose in renal patients. |
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Requip is a good option for what kind of patients?
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Patients with a high susceptibility to hypotension or falls.
Caution with liver dysfunction |
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What do you give to prevent nausea and vomiting due to Apokyn?
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Tigan (trimethobenzamide)
- start 3 days before initiating APOKYN |
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What is Comtan?
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Entacapone
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What is Tasmar? Warning?
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Tolcapone
- fatal hepatic failure!!! |
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What is Stalevo?
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Carbidopa + Levodopa + Entacapone
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First line treatment for Partial seizure (4)
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Carbamazepine
Phenytoin Phenobarbital Primidone |
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First line treatment for Absence/Petit Mal (2)
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Ethosuximide (DoC)
Valproic Acid |
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First line treatment for Myoclonic seizure (2)
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Valproic Acid
Clonazepam |
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DoC for Lennox-Gastaut Syndrome
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Valproic Acid
Benzos Felbamate |
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What do you give to patient with Status Epilepticus?
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100mg thiamine or Vit B complex
25gm of Glucose in 50mL of 50% dextrose |
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Medication for Status Epilepticus?
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Lorazepam
Phenytoin Fosphenytoin |
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SE for Phenobarbital?
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Bone disease/Bradycardia
Ataxia Rash/Respiratory depression Behavior changes |
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What is Luminal? Forms?
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Phenobarbital
tabs, elixir, injection |
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How do you give Luminal IV?
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IV (Avoid >50mg/min)
IM SC |
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Phenobarbital is an inducer, inhibitor or substrate?
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Inducer
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What is the serum concentration for Phenobarbital?
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15-40mcg/mL
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What do you monitor when using PhenobarbiTaL?
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CBC
LFT's |
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What is Mysoline? Max dose?
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Primidone, metabolized to Phenobarbital
Max: 2g/day |
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Therapeutic range for Mysoline?
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5-12mcg/mL
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What is Diastat?
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Diazepam rectal gel
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Diazepam dose for Status Epilepticus? Max dose?
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5-10mg IV repeat 5-10min
Max: 30mg |
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What diluent do you use with Phenytoin? How is it administered?
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Normal saline
<50mg/min with in-line filter |
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What is the max dose for Phenytoin? Maintenance dose?
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Max: 500-600mg/day
Maintenance: 300mg/day if ER |
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What is the therapeutic range for phenytoin?
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10-20mg/L
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What is Cerebyx? How is it given?
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Fosphenytoin (L)
IV/IM |
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What is the equivalent dose to Fosphenytoin to Phenytoin?
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1.5mg Fosphenytoin = 1mg Phenytoin
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Dosing with Fosphenytoin?
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Load: 15-20mg PE/kg
Maintenance: 4-6mg PE/kg/day DON'T EXCEED RATE OF 150mg PE/min |
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Phenytoin/Fosphenytoin SE?
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Ataxia
Rash Hirsutism Osteomalacia Gingival hyperplasia |
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Monitoring parameters with Phenytoin?
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BP
CBC LFT's |
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Patient counseling with Phenytoin?
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Take with food
Susp: shake well Susp: don't give with tube feedings |
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Nurse counseling with Phenytoin?
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Infusion rate <50mg/min
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What is Peganone? Dose? With or without food?
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Ethotoin
Dose: 1g/d div 4-6 doses with food to reduce GI effects |
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Therapeutic range for Valproic Acid?
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50-100mcg/mL
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Valproic acid: substrate, inhibitor or inducer?
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Substrate and inhibitor
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SE for vaLProic acid?
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Hepatotoxicity
Pancreatitis Thrombocytopenia SIADH |
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What happens when you give aspirin with Valproic acid?
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Aspirin displaces VA therefore increasing its concentration
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Carbamazepine therapeutic level?
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4-12mcg/mL
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Carbamazepine is contraindicated with (3)?
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Hypersensitivity to TCA
within 14 days of MAOi Bone marrow suppression |
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Carbamazepine SE?
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Hepatotoxicity
Agranulocytosis Anemia Anticholinergic effects Rash Check the eyes |
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Asians should be tested for what gene before using Carbamazepine?
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HLA-B*1502
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What is Trileptal? Therapeutic range?
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Oxcarbazepine
Therapeutic range: 12-30mcg/mL |
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SE of Trileptal? Can you use this with renal patients?
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Hyponatremia
Stevens-Johnson Reduce dose in CrCl<30 |
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What is Zarontin? Therapeutic range?
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Ethosuximide
TR: 40-100mcg/mL |
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What is Celontin?
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Methsuximide
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What is Zonegran?
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Zonisamide
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SE of Zonisamide?
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Stone (kidney)
Stevens-Johnson syndrome Aplastic anemia |
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Zonegran is contraindicated in what allergy?
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Sulfa allergy
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What is Felbatrol? SE?
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FeLbAmate
SE: hepatotoxicity & aplastic anemia |
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Max dose for Neurontin?
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Max: 3,600mg div TID/QID
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Can you give Neurontin to renal patients?
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Decrease dose if CrCl <60mL/min
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What is Lyrica? Dosage? Max?
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Pregabalin for >18 yo
Max: 600mg/day, decrease dose in renal patients |
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What's the difference between Neurontin & Lyrica?
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Lyrica can be titrated faster
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What is the initial dosing for Lamictal?
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25-50mg QHS
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Dosage for Keppra? Can you give it to renal patients?
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500mg BID, max: 3g/day
Decrease dose in renal patients |
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What is Gabitril? Dosing? Max?
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Tiagabine, LIVER
Start 4mg/day, TAKE WITH FOOD Max: 56mg/day |
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What is the max dose for Topamax? Okay to use with renal patients?
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Max: 200mg
Renal patients: 1/2 dose if CrCl<70mg/mL |
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Which seizure meds are carbonic anhydrase inhibitors?
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Topamax
Zonegran - incrase bicarb excretion which leads to metabolic acidosis |
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What is Vimpat? Age limit?
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Lacosamide for >17 yo.
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Vimpat is what Schedule? Initial and max dose?
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Control V
Start: 50mg BID Max: 200mg BID |
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What is Banzel? Max dose? With or without food?
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Rufinamide
Max: 3200mg/day div BID TAKE WITH FOOD |
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What's the age restriction for Banzel?
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>4 yo
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What is Sabril? Max?
|
Vigabatrin, only qualified physicians can prescribe this.
Max: 3g/day |
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Sabril dosing for renal patients?
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CrCl 50-80: decrease dose by 25%
CrCl 30-50: decrease dose by 50% CrCl 10-30: decrease dose by 75% |
