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148 Cards in this Set
- Front
- Back
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Stroke - CT scan is used to determine what?
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Hemorrhagic vs. ischemic stroke
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Stroke - Carotid ultrasound is used to determine what?
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Carotid stenosis
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Stroke - EKG is used to determine what?
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Cardioembolic source of stroke
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What are the three components to secondary prevention in stroke?
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Antiplatelets/anticoagulants
Statins BP medications (diuretic, ACEI) |
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What is the BP goal after a stroke?
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< 120/80
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What are the BP meds used after stroke?
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Thiazides +/- ACE inhibitors
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What is the LDL goal after a stroke?
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< 100
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What % of the carotid artery needs to be blocked to perform CEA?
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50-99%*
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What medication is indicated in secondary prevention of stroke with cardioembolic source?
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Warfarin
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Stroke - When dosing warfarin, what is the target INR?
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2.5
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What medications are indicated in secondary prevention of stroke that's non-cardioembolic?
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aspirin 81-325mg
plavix 75mg aspirin + ER dipyridamole (25/200) |
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What medication is given to a stroke patient within 4.5 hours of stroke onset?
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tPA
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When is the only time to use heparin for stroke patients?
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DVT prophylaxis in hospitalized patients at least 24 hours after tPA has been given
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Do not lower BP within first 7 days of stroke unless BP is greater than what?
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> 200/120
(or > 180/105 after tPA) |
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What agents can be used to lower BP acutely after stroke?
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labetalol
nicardipine nitroprusside (short-acting agents) |
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What is the age range for tPA?
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18-80
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What NIH stroke scale is exclusion criteria for tPA?
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> 22 (or 25)
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What platelet count is exclusion criteria for tPA?
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< 100,000
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What aPTT is exclusion criteria for tPA?
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45-70 seconds
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What PT is exclusion criteria for tPA?
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> 15 seconds
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What INR is exclusion criteria for tPA?
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> 1.7
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True or False - Patient is eligible for tPA even if stroke is accompanied by seizure
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False - seizure is exclusion criteria
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What BP values are exclusion criteria for tPA?
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> 185/110
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What glucose values are exclusion criteria for tPA?
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> 400
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When should anticoagulation or antiplatelet therapy begin after tPA?
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24-48 hours
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What is the treatment for hemorrhagic stroke?
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Nimodipine (days 1-21)
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What three drugs are first-line for partial seizures?
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Carbamazepine
Phenytoin Topiramate |
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What four drugs are first-line for generalized seizures?
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Carbamazepine
Oxcarbazepine Phenytoin Valproate |
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What drugs are indicated for absence seizures?
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Ethosuximide
Valproate |
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What is the dosage range for Carbamazepine?
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400-2,400mg
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What is the target serum concentration for carbamazepine?
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4-12 mcg/mL
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What is the dosage range for phenytoin?
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3-5 mg/kg
(max 600mg) |
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What is the target serum concentration for phenytoin?
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10-20 mcg/mL
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What is the dosage range for valproate?
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15-60 mg/kg
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What is the target serum concentration for valproate?
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50-100 mcg/mL
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What is the dosage range for topiramate?
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25-1,000 mg/kg
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What is the target serum concentration for topiramate?
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5-20 mcg/mL
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What are the side effects of carbamazepine?
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hyponatremia
neutropenia |
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What are the side effects of phenytoin?
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gingival hyperplasia
rash |
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What are the side effects of phenobarbital?
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rash
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What are the side effects of primidone?
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rash (phenobarbital)
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What are the side effects of valproate?
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weight gain
alopecia thrombocytopenia |
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What are the side effects of gabapentin?
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weight gain
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What are the side effects of lamotrigine?
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rash
stevens-johnson syndrome |
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What are the side effects of topiramate?
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weight loss
renal calculi |
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What are the side effects of zonisamide?
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weight loss
renal calculi |
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What are the side effects of felbamate?
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Aplastic anemia (BBW)
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What is first line for status epilepticus?
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IV benzo
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What is second line for status epilepticus?
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Fosphenytoin
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What is third line for status epilepticus?
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phenobarbital
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What are the four cardinal symptoms of Parkinson's?
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resting tremor
rigidity postural instability bradykinesia |
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Parkinson's results from loss of dopaminergic neurons in the _______________
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substantia nigra
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This stage of Parkinson's is classified by unilateral disease
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Stage 1
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This stage of Parkinson's is classified by mild bilateral disease, good balance
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Stage 2
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This stage of Parkinson's disease is classified by mild/moderate bilateral disease, some posturable instability, still independent
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Stage 3
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This stage of Parkinson's is classified by severe disability, unable to function
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Stage 4
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This stage of Parkinson's is classified by wheelchair bound
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Stage 5
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Which Parkinson's drugs are used for tremor?
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amantadine
anticholinergics |
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Which Parkinson's drugs are used for bradykinesia and rigidity?
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dopamine agonists
carbidopa/levodopa |
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What are the three criteria for surgery in Parkinson's?
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severe motor fluctuations
dopa-induced dyskinesias tremor unresponsive to medication |
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What type of side effects are seen with anticholinergics in Parkinson's?
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anti-SLUDD
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Which age group of patients cannot tolerate anticholinergic side effects of Parkinson's medicine?
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patients > 65
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What is the most effective drug in Parkinson's?
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levodopa
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Which MAOI has amphetamine-like side effects?
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Selegeline
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(increased/reduced) serotonergic levels are anxiogenic
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reduced
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Antidepressant symptom relief for anxiety may be delayed for how long?
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2-4 weeks
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Full response from antidepressants for anxiety may take how long?
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12+ weeks
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How often should you titrate up benzodiazepine dosage for anxiety disorders?
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weekly basis
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What benzodiazepines are preferred in the elderly for treatment of anxiety disorders?
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alprazolam
lorazepam oxazepam temazepam |
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Alprazolam has a (rapid/intermediate) onset
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rapid
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Clonazepam has a (rapid/intermediate) onset
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intermediate
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Lorazepam has a (rapid/intermediate) onset
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intermediate
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Oxazepam has a (rapid/slow) onset
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slow
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Diazepam has a (rapid/intermediate) onset
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rapid (with long metabolite half-life)
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How should you taper someone off benzodiazepines?
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25% each week until 50% reduced, then by 12.5% every 4-7 days
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If patient has been on benzodiazepine for more than 8 weeks, how long should it take to taper off?
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2-3 weeks
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If patient has been on benzodiazepine for more than 6 months, how long should it take to taper off?
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1-2 months
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If patient has been on benzodiazepine for more than 1 year, how long should it take to taper off?
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2-4 months
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What drug is a non-benzo anxiolytic?
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buspirone
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What is the initial dose for buspirone?
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7.5mg BID
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What is the dosing for alprazolam?
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0.75-4 mg/day
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What is the dosing for clonazepam?
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1-4 mg/day
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What is the dosing for diazepam?
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2-40 mg/day
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What is the dosing for lorazepam?
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0.5-10 mg/day
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What is the dosing for duloxetine?
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30-120 mg/day
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What is the dosing for escitalopram?
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10-20 mg/day
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What is the dosing for paroxetine?
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20-50 mg/day
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What is the dosing for sertraline?
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50-200 mg/day
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What is the dosing for venlafaxine XR?
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37.5-225 mg/day
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What is the dosing for citalopram?
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10-60 mg/day
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What is the dosing for fluoxetine?
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10-60 mg/day
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What percent of D2 receptors must be blocked for EPS?
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80%
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What percent of D2 receptors must be blocked for antipsychotic effects?
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60%
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D2 blockade in the nigrostriatal pathway (increases/decreases) EPS
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increases
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5HT2a antagonism in the nigrostriatal pathway (increases/decreases) EPS
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decreases
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What pathway is associated with positive symptoms of schizophrenia?
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mesolimbic
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What pathway is associated with negative symptoms of schizophrenia?
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mesocortical
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What pathway is associated with increased serum prolactin in schizophrenia?
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tuberoinfundibular
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2nd generation antipsychotics have better effects on (positive/negative) symptoms
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negative
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1st generation antipsychotics have better effects on (positive/negative) symptoms
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positive
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(1st/2nd) generation antipsychotics cause less EP side effects
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2nd generation
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True or False - All antipsychotics are equally effective (clozapine may be superior)
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True
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Which antipsychotic may be superior in schizophrenia?
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clozapine
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Clozapine has what intolerable side effect?
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seizures
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Quetiapine has what intolerable side effects?
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orthostatic hypotension
sedation |
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Olanzapine has what intolerable side effect?
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sedation
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What drugs have less EPS in schizophrenia?
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quetiapine, clozapine
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What drug has less orthostatic hypotension in schizophrenia?
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haloperidol
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What drug has less anticholinergic side effects in schizophrenia?
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lurasidone
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What drugs have less weight gain in schizophrenia?
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aripiprazole, molindone
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What drugs have less glucose intolerance in schizophrenia?
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ziprasidone
aripiprazole lurasidone |
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What drugs have less dyslipidemia in schizophrenia?
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ziprasidone
aripiprazole |
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What drugs have less QT prolongation in schizophrenia?
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olanzapine
lurasidone aripiprazole |
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Initiation of clozapine requires WBC/ANC levels of what?
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WBC > 3500
ANC > 2000 |
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Interrupt treatment with clozapine when WBC/ANC levels become what?
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WBC 2000-3000
ANC 1000-1500 |
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Do not rechallenge clozapine when WBC/ANC levels become what?
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WBC < 2000
ANC < 1000 |
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Fluphenazine depot dose for schizophrenia
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25-100mg Q2-4 weeks
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Haloperidol depot dose for schizophrenia
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50-200mg IM Q4 weeks
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Which drugs don't require PO overlap when converting to depot (schizophrenia)?
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Haloperidol (if given loading dose)
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Risperidone depot dose for schizophrenia
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25mg IM Q2 weeks
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Risperidone depot PO overlap
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3 weeks
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Which drug doesn't have conversion from PO to IM in schizophrenia depot dosing?
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Risperidone
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Olanzapine depot dose
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150-300mg IM Q2 weeks
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Which drug must be monitored after injection for schizophrenia depot dosing?
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Olanzapine
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What is the depot maintenance dose for paliperidone?
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39-324mg
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Selection of olanzapine is based on what two guidelines?
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APA guidelines
CATIE trial |
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Fasting lipid panel and fasting glucose at 1st outpatient visit after taking antipsychotics for schizophrenia - 2 reasons why?
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atypicals may cause increase in blood glucose
consensus guidelines published by ADA |
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Antipsychotic less likely to cause QTc prolongation?
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aripiprazole
(olanzapine, lurasidone) |
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Dystonia is associated with D2 blockade in the __________ pathway and more responsive to __________ therapy
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nigrostriatal
anticholinergic |
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What is the black box warning for antidepressants?
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increased risk of suicidality in children and adolescents
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What are the two drug classes used as first-line agents for major depressive disorder?
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SSRIs
TCAs (secondary amines, heterocyclics) |
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SSRIs interact with what 5 drugs/classes?
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TCAs
MAOIs (serotonin syndrome) CCBs Warfarin Phenytoin (SSRIs) |
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What drug inhibits venlafaxine metabolism?
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cimetidine
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What drug induces venlafaxine metabolism?
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cyproheptadine
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What antidepressant increases the INR?
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venlafaxine
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What are the two primary SNRIs?
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venlafaxine
duloxetine |
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What antidepressant is not associated with sexual dysfunction?
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bupropion
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What antidepressant can cause elevated LFTs, increase in TGs, small risk of agrnulocytosis or neutropenia?
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mirtazapine
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What are some potential side effects for TCAs?
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anticholinergic side effects
cardiovascular side effects multiple drug interactions weight gain sedation poor compliance |
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MAOIs should be avoided with foods containing what ingredient?
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tyramine
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Tyramine-containing foods should be avoided with what drug class?
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MAOIs
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When switching fluoxetine to another SSRI, should you
(a) directly switch (b) cross-taper (c) washout |
washout
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When switching antidepressants it is usually safe to directly switch, with the exception of fluoxetine and other SSRIs. What other drug requires a cross-taper?
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mirtazapine
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What is the PO to IM conversion for fluphenazine?
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10mg PO Qday = 12.5mg IM Q3weeks
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What is the PO to IM conversion for haloperidol?
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10-15x PO dose = IM dose
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What is the maximum first dose for haloperidol depot injection?
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100mg
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What is the maximum dose/month of haloperidol depot injection?
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450mg
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What antipsychotic depot injection has a max initial dose of 100mg and max monthly dose of 450mg?
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haloperidol
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