A patient gave the pharmacist a prescription for Klonopin 0.25 mg BID as-needed #60. Which of the following is an appropriate generic substitution for Klonopin?
A. The generic name of Klonopin is clonazepam.
A middle-aged man was in a motor vehicle accident and was out of work for about twelve months. Eventually, he returned to work but during the time he was recuperating at home he lost his usual enjoyment of living and felt sad most of the time. He is able to function at work, but he has anxiety about losing the job, being in another auto accident and other (largely baseless) fears. Which of the following therapies are most likely to help this patient?
A. A hypnotic
B. An antidepressant
C. An antipsychotic
B. This patient appears to be clinically depressed. Anxiety is expected with a depressive state. The best way to treat him is to use an antidepressant, hopefully along with some type of counseling. A benzodiazepine will temporarily "dull" or "dope" him up, but will not treat any underlying problem.
What is the mechanism of action of the benzodiazepines?
A. They act as agonists at the mu endorphin receptor.
B. They potentiate glutamate, an inhibitory neurotransmitter, resulting in CNS activation.
C. They potentiate glutamate, an excitatory neurotransmitter, resulting in CNS depression.
D. They potentiate GABA, an inhibitory neurotransmitter, resulting in CNS depression.
E. They potentiate GABA, an excitatory neurotransmitter, resulting in CNS depression.
D. Benzodiazepines enhance the inhibitory effect of GABA.
Mabel has been using alprazolam on a daily, scheduled basis for the past ten years. She is now 44 years old and pregnant with her first child. The use of benzodiazepines in pregnancy puts the child at risk for the following birth defect:
A. Delayed growth
B. Premature delivery
C. Cleft lip/palate, and floppy infant syndrome if taken prior to delivery
D. Low birth weight
E. Hip dysplasia
C. Benzodiazepines and barbiturates increase the risk of cleft lip and palate. Barbiturates can also cause cardiac abnormalities and neural tube defects. Benzodiazepine use shortly before birth can cause floppy infant syndrome.
A patient gave the pharmacist a prescription for Valium 5 mg BID as-needed #45. Which of the following is an appropriate generic substitution for Valium?
C. The generic name of Valium is diazepam.
Which of the following statements correctly describes the anxiolytic buspirone? (Select ALL that apply.)
A. It is a C IV drug
B. The use of buspirone can result in abuse, tolerance or physiological dependence.
C. If switching from a benzodiazepine to buspirone, it is still necessary to (very) slowly taper the benzodiazepine off.
D. It make take 2-4 weeks for the patient to notice the maximum effect from this drug.
E. It is available PO and IV.
C, D. Buspirone is not controlled and has no potential for abuse, tolerance or physiological dependence. Buspirone is used by itself, or is commonly used in addition to other psychiatric medications when there is residual anxiety.
Benjamin is an older gentleman who was in a motor vehicle accident. Previously, Benjamin's daily medications included nifedipine, simvastatin, aspirin and tramadol (for generalized arthritis pain). Cyclobenzaprine was added at the time of the accident. Due to the accident and injury, Benjamin has experienced anxiety and was given a prescription for lorazepam to use as-needed. He has one drink of whiskey at bedtime. Benjamin is facing significant risk of the following additive drug interaction problem:
C. Bleeding risk
D. Central nervous system stimulation
E. Central nervous system depression
E. A top drug interaction problem, particularly among elderly patients, is additive CNS (central nervous system) depression (dizziness, confusion, somnolence). This patient is using several drugs that would contribute to this problem: a pain agent, cyclobenzaprine, lorazepam and alcohol.
Buspirone comes in a Dividose tablet designed to make dose adjustments easy. Choose the correct statement regarding this type of formulation:
A. Each tablet is scored and can be broken accurately on the score lines into thirds; it snaps into pieces with finger pressure.
B. Dissolve the tablet in water and measure out the amount of fluid as directed by your doctor.
C. The Dividose tablet is divided into 50 mg increments.
D. This formulation allows for a biphasic release.
E. This formulation reduces side effects.
A. Buspirone is started at 7.5 mg BID and can be increased by 5 mg/day Q 2-3 days until 30 mg/day, if needed. Adjustments are simple to make with the Dividose formulation.
Benjamin found that the lorazepam he was prescribed for anxiety was effective, but after about 4 months it was no longer working as well as it had previously. He initially used 0.5 or 1 mg. He increased his dose to 2 mg, and this worked for a while. He eventually was using 4 mg to get the same effect. What is the correct description to describe what has most likely happened to Benjamin?
A. He has developed addiction.
B. He has developed physiological adaptation.
C. He has developed pseudo-addiction.
D. He has developed tolerance.
E. He has impaired GI absorption of lorazepam.
D. Instruct patients that when used for an extended time, the medication may not work as well and may require different dosing. This is called "tolerance." They should discuss with their doctor if the medication stops working well. (Do not increase the dose yourself.)
Candace is a 76 year-old female who experienced the loss of her spouse this past week. She has not been able to sleep and is acting erratic. Her family is coming for a gathering and Candace is worried about behaving properly. Choose the best therapeutic option among the following benzodiazepines for Candace to use during the day that will calm her and help her survive the family gathering:
A. For elderly patients, it is considered safest to choose the "L-O-T" agents (lorazepam, oxazepam, and temazepam) as these are considered less potentially harmful for elderly or with liver impairment since they are metabolized to inactive compounds. Temazepam is longer acting and is not indicated for anxiety; it is a hypnotic (sleep agent).
A patient gave the pharmacist a prescription for Xanax 0.25 mg TID as-needed #30. Which of the following is an appropriate generic substitution for Xanax?
D. The generic name of Xanax is alprazolam.
When dispensing a benzodiazepine, the following auxiliary labels that have this approximate information should be placed on the bottle? (Select ALL that apply.)
A. Controlled substance-dangerous unless used as directed, do not transfer to any person other than the person for whom it was prescribed.
B. May cause anxiety and agitation; use with caution.
C. Alcohol use should be in moderation with the use of this medication.
D. This drug may impair the ability to drive or operate machinery.
E. May cause the skin to burn more easily.
A, D. Alcohol should not be used with this medication.
A patient gave the pharmacist a prescription for Ativan 1 mg TID, take one tablet as-needed #20. Which of the following is an appropriate generic substitution for Ativan?
A. The generic name of Ativan is lorazepam.
Edgar enters the pharmacy with a prescription for alprazolam. What is the controlled category for alprazolam?
D. Benzodiazepines, barbiturates and the non-benzodiazepine hypnotics (sleeping pills) such as zolpidem are C-IV.
The buspirone dose must be lowered with concurrent use of the following drugs/foods: (Select ALL that apply.)
A, C, E. The buspirone dose should be lowered with any significant CYP 450 3A4 inhibitor; buspirone is a 3A4 substrate.