EOR #4 pharm part 1

Question 1

Dosage forms of duloxetine

Answer 1

20 mg, 30 mg, 60 mg

Question 2

Average daily dosages of duloxetine

Answer 2

MDD: 40-60 mg/day
Peripheral neuropathy: 60 mg/day
GAD: 60-120 mg/day

Question 3

Common indications of duloxetine

Answer 3

MDD
Neuropathic pain associated with diabetic peripheral neuropathy
GAD

Question 4

MOA of duloxetine

Answer 4

Inhibits neuronal reuptake of serotonin and norepinephrine primarily, and dopamine to a slight extent

Question 5

Common AEs of duloxetine

Answer 5

Nausea
Dry mouth
Constipation
Insomnia
Dizziness

Question 6

Renal or hepatic dose adjustments of duloxetine

Answer 6

CrCl <30: use not recommended
Mild-mod renal impairment use low dosing
Not recommended in hepatic impairment

Question 7

BBW for duloxetine

Answer 7

Antidepressants increase risk of suicidal thinking and behavior in children, adolescents, and young adults with MDD and other psychiatric d/os

Question 8

Clinically significant drug interactions of duloxetine

Answer 8

CI-ed with MAOIs, inhibitors of CYP1A2 and CYP2DC increase levels of duloxetine. Chronic use of NSAIDs increases risk of GI bleeds.

Question 9

Major counseling points of duloxetine

Answer 9

Pay close attention to mood or behavioral changes- this drug may increase suicidal thoughts or actions.
Benefits may not be seen before 2 wks of continued drug therapy;
May cause drowsiness; Avoid alcohol while taking this medication
Do not abruptly d/c
Store in a cool, dry place…
If a dose is missed, skip it and return to nl dosing schedule

Question 10

Monitoring parameters of duloxetine

Answer 10

Improvement in S/sx of anxiety/depression/pain

Abrupt changes in mood

Question 11

Dosage forms of risperidone

Answer 11

Orally disintegrating tabs: 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg
Powder for injection
Oral solution

Question 12

Average daily dosages of risperidone

Answer 12

Oral: 1 mg BID on day 1, 2 mg BID on day 2, 3 mg BID on day 3, then titrate on a weekly basis
Max dose: 16 mg
Injection: 25 mg IM q2w

Question 13

Common indications for risperidone

Answer 13

Bipolar mania
Bipolar I maintenance
Shizophrenia
PTSD
Tourette's syndrome
Agitation

Question 14

MOA of risperidone

Answer 14

Dopamine and serotonin antagonism

Question 15

Common AEs of risperidone

Answer 15

EPS
Tachycardia
Priapism
Rash
Somnolence
Agitation/anxiety

Question 16

Renal or hepatic dose adjustments for risperidone

Answer 16

Recommended

Question 17

BBW for risperidone

Answer 17

Increased mortality in elderly pts with dementia-related psychosis

Question 18

Clinically significant drug interactions of risperidone

Answer 18

Fluoxetine, carbamazepine, and clozapine may increase risperidone

Question 19

Major counseling points of ripseridone

Answer 19

May cause fainting during initial doses,
May impair judgement
Avoid EtOH
Avoid excessive exposure to sunlight and heat during therapy

Question 20

Monitoring parameters

Answer 20

Decrease of S/sx of bipolar, schizophrenia, PTSD and Tourette’s syndrome

Question 21

Dosage forms of alprazolam

Answer 21

IR tabs: 0.25 mg, 0.5 mg, 1 mg, 2 mg
ER tabs: 0.5 mg, 1 mg, 2 mg, 3 mg
Oral solution concentrate: 1 mg/mL

Question 22

Average daily dosages for alprazolam

Answer 22

Anxiety: 0.25 mg to 0.5 mg IR tabs initially 3x/day, titrate to individual needs
Panic d/o: IR tabs: 5-6 mg/day. ER tabs: 3-6 mg/day

Question 23

MOA of alprazolam

Answer 23

Facilitates the inhibitory neurotransmitter action of GABA in pre- and post-synapse

Question 24

Common AEs of alprazolam

Answer 24

Drowsiness

Xerostomia

Question 25

Renal or hepatic dose adjustments of alprazolam

Answer 25

Caution in advanced liver dz

Question 26

Clinically sig drug interactions for alprazolam

Answer 26

Taking other CNS depressants along with alprazolam can increase drowsiness and risk of respiratory depression

Question 27

Major counseling points of alprazolam

Answer 27

``` May cause drowsiness Avoid taking with EtOH May be habit-forming XR tabs should be swallowed whole This med should not be abruptly d/c-ed ```

Question 28

Monitoring parameters of alprazolam

Answer 28

Anxiety/panic/depression sx | Misuse/abuse

Question 29

Dosage forms of bupropion

Answer 29

IR tabs: 75 mg, 100 mg SR tabs: 100 mg, 150 mg, 200 mg XL tabs: 150 mg, 300 mg Zyban: 150 mg

Question 30

Average daily dose for bupropion

Answer 30

300 mg/day

Question 31

Common indications for bupropion

Answer 31

Depression Anxiety Aid in smoking cessation

Question 32

MOA of bupropion

Answer 32

Weak inhibitor of neuronal uptake or norepinephrine, serotonin, and dopamine

Question 33

Common AEs of bupropion

Answer 33

Tremor Wt loss Insomnia

Question 34

Renal or hepatic dose adjustments of bupropion

Answer 34

Hepatic/renal: consider reducing dose and frequency

Question 35

BBW for bupropion

Answer 35

Suicidality

Question 36

Clinically sig drug interactions of bupropion

Answer 36

EtOH may lower seizure threshold Toxicity is increased by monoamine oxidase inhibitors Chronic use with NSAIDs increases risk of GI bleeds

Question 37

Major counseling points of bupropion`

Answer 37

Swallow XL and SR tabs whole Avoid EtOH Wt loss or gain may be temporary May need up to 2 wks to show noticeable improvement Pay attention to sudden mood/thought change Do not abruptly d/c

Question 38

Monitoring parameters for bupropion

Answer 38

Improvement in mood/smoking frequency | Unusual changes in behavior/suicidality

Question 39

Dosage forms of diazepam

Answer 39

Tabs: 2 mg, 5 mg, 10 mg Injection: 5 mg/mL Rectal gel: 2.5 mg/0.5 mL

Question 40

Average daily doses of diazepam

Answer 40

2-10 mg 2-4 times daily

Question 41

Common indications for diazepam

Answer 41

``` Acute EtOH withdrawal Anticonvulsant Anxiety Muscle spasm Sedation Status epilepticus ```

Question 42

MOA of diazepam

Answer 42

Enhances the inhibitory effect of GABA

Question 43

Common AEs of diazepam

Answer 43

``` Drowsiness Ataxia Fatigue Sedation Cognitive impairment ```

Question 44

Renal or hepatic dose adjustments for diazepam

Answer 44

Daily 50% reduction of dose for cirrhosis pts

Question 45

Clinically sig drug interactions with diazepam

Answer 45

Additive effect with other CNS depressants Cimetidine delays clearance Grapefruit juice may increase plasma level

Question 46

Major counseling points of diazepam

Answer 46

May cause drowsiness May be habit forming Avoid EtOH while taking this medication Do not abruptly d/c

Question 47

Monitoring parameters for diazepam

Answer 47

Improvement in S/sx of anxiety Muscle spasticity Seizure control Abuse, misuse