PresIllPreg- 20C

Question 1

Under what conditions should one be cautious about prescribing DULOXETINE

Answer 1

• hepatic and renal disease

- Alcohol Use Disorder

Question 2

Medications to avoid in severe liver disease

Answer 2

• Duloxetine
• Iloperidone, Asenapine
• Fluphenazine, perphenazine, trifluoperazine
• Zaleplon, Zolpidem

Question 3

Medications to avoid in severe renal disease

Answer 3

• Duloxetine

- Lithium

Question 4

What are the risks in pregnant women with mental illness not on medications

Answer 4

• lower adherence to prenatal care
• inadequate nutrition
• higher alcohol and drug use
• adverse neonatal outcomes

Question 5

General statement about psychotropics and pregnancy

Answer 5

-all psychotropics cross the placenta, are present in amniotic fluid, and present in breast milk

Question 6

Name the benzodiazepines unsafe for use in pregnancy

Answer 6

• Triazolam
• Estazolam
• Flurazepam
• Quazepam

Question 7

Lithium effects in pregnancy

Answer 7

• Ebstein’s anomaly
• baseline 1/20,000; lithium risk 1/2000-1/1000
• prior to delivery, decrease dose to 1/2 or stop temporarily

Question 8

Valproic acid effects in pregnancy

Answer 8

• neural tube defects, craniofacial defects, cardiac anomalies
• Lower IQ, possible intellectual disability, autism
• AVOID USE IN PREGNANCY IF AT ALL POSSIBLE

Question 9

What does national guideline clearing house say about pregnancy and

• Lithium
• Valproate
• Benzodiazepines
• Paroxetine
• Lamotrigine

Answer 9

• Lithium: associated with small increase of congenital cardiac anomaly
• Valproate: avoid use in pregnancy
• Benzo: increase risk of oral cleft palate by 0.01%
• Paroxetine: avoid, consider fetal echocardiogram when exposure occurred
• Lamotrigine: potential maintenance med

Question 10

Connection between cigarette smoke and clozapine

Answer 10

-cigarette smoke induces1A2

Question 11

Connection between Fluvoxamine and caffeine

Answer 11

-fluvoxamine inhibits 1A2 metabolism of caffeine

Question 12

Interactions that cause Lithium toxicity

Answer 12

Lithium and

• NSAIDS
• diuretics
• ACE inhibitors
• ACE II antagonists

Question 13

Interaction that causes Lamotrigine toxicity

Answer 13

-interaction with Valproate UGT1A4

Question 14

Interactions that cause TCA toxicity

Answer 14

• Fluoxetine
• Paroxetine
• inhibitors of 2D6

Question 15

Interactions with fluvoxamine that causes toxicities

Answer 15

• Fluvoxamine inhibition 1A2

- toxicity of warfarin, theophylline, clozapine

Question 16

Interaction that causes Carbamazapine toxicity

Answer 16

-Erythromycin

Question 17

Carbamazepine decreases levels of

Answer 17

• Valproate

- OCPs

Question 18

Medications that can cause Hypertensive (norandrenergic) Crises

Answer 18

-MAOI, bupropion, L-dopa, guanethidine, methyphenidate, amphetamine, pseudoephedrine, tyramine-rich foods

Question 19

Opiates with SNRI activity

Answer 19

• methadone
• meperidine
• fentanyl
• tramadol

Question 20

Serotonin syndrome

Answer 20

• MAOI, TCA, SSRI, SNRI, mirtazapine
• Linezolid interaction with MAOI
• Methylene blue

Question 21

Question clue: antidepressant + opioid =

Answer 21

SEROTONIN SYNDROME

Question 22

What are the three CYP450 enzyme systems are inhibited by SGA + FGA

Answer 22

• 1A2
• 2D6
• 3A4

Question 23

Fluvoxamine inhibits which CYP450

remember it’s dirty

Answer 23

• 1A2
• 2C9
• 2C19

Question 24

Fluoxetine and Paroxetine both inhibitors of

Answer 24

-2D6