Final Exam

Question 1

Which Antidepressant is helpful with neuropathic pain?

A. Wellbutrin

B. Mirtazapine

C. Tricyclic Antidepressants (TCAs)

D. Selective Serotonin Reuptake Inhibitors (SSRIs)

Answer 1

Answer: C TCAs are good for treating depression and neuropathic pain.

MOA: Increase the synaptic concentration of serotonin and/or norepinephrine by inhibition of their reuptake by the presynaptic neuronal membrane pump.

Also good for when patients do not respond to SSRIs

Question 2

Which Antidepressant is also helpful for smoking cessation?

A. Wellbutrin

B. Mirtazapine

C. Tricyclic Antidepressants (TCAs)

D. Selective Serotonin Reuptake Inhibitors (SSRIs)

Answer 2

Answer: A

Wellbutrin is marketed as Zyban for smoking cessation

Question 3

The following is TRUE for Wellbutrin:

A. It is used primarily for smoking cessation

B. It carries the risk for weight gain

C. It carries the risk for sexual dysfunction

D. It is used for depression, but also works well for smoking cessation.

Answer 3

Answer: D

It is used for depression, but also works well for smoking cessation.

Question 4

Which phase of depression is defined as the first 12 weeks following diagnosis, relapse, or recurrence or until remission?

A. First phase

B. Continuation phase

C. Maintenance phase

D. None of the above.

Answer 4

Answer: D

The phase responsible for the first 12 weeks following diagnosis, relapse, recurrence, or until remission is the Acute phase.

Goal of the Acute phase of depression: To induce remission

Question 5

Which phase of depression is responsible for months 4-9 with the goal to preserve remission and prevent relapse?

A. Acute phase

B. Continuation phase

C. Maintenance phase

D. None of the above.

Answer 5

Answer: B Continuation phase

The continuation phase is responsible for months 4-9 with the goal to preserve remission and prevent relapse.

Question 6

Which phase of depression pertains to patients with greater than 3 major depressive episodes; chronic major depressive disorder, other risk factors or co-occurring conditions with the goal to prevent recurrence?

A. Acute phase

B. Continuation phase

C. Maintenance phase

D. Remission

Answer 6

Answer: C Maintenance phase

Question 7

Define Remission

Answer 7

Remission is at least 3 weeks without sad mood or reduced interest, and less than 3 remaining symptoms of major depressive disorder.

Question 8

Which of the following is not an appropriate intervention for individuals experiencing acute psychotic behaviors with severe MDD?

A. Pharmacotherapy

B. Psychotherapy

C. Pharmcotherapy/psychotherapy

D. Electroconvulsive therapy (ECT)

Answer 8

Answer: B. Psychotherapy

Question 9

Which of the following disorders is NOT appropriate for ECT therapy?

A. Acute mild to moderate depression

B. Acute severe (no psychotic behaviors)

C. Acute severe (with psychotic behaviors)

D. None of the above

Answer 9

Answer: D. None of the above

A, B, and C are all appropriate for ECT.

Question 10

Treatment for the continuation phase of MDD includes?

Answer 10

Continuation of treatment from acute phase and monitor for signs of relapse.

Question 11

Treatment for the maintenance phase of MDD includes?

Answer 11

Determine if treatment is still needed. May continue previous phase treatment modalities.

Question 12

Important considerations for the initiation of antidepressant therapy include

Answer 12

• Titrate the dose over the first few weeks, as tolerated, until therapeutic dose or remission is achieved.
• Maximal response usually noticed in 4-6 weeks. Will take longer when titrating doses slowly.
• Slower titration necessary when patients are elderly, medically compromised, have renal/hepatic impairment and/or decreased metabolism.

Question 13

Important considerations for when patients have inadequate response to antidepressant therapy include:

Answer 13

• Ensure that you have maximized initial treatment (Trial for at least 4-8 weeks (up to 12 weeks in elderly).
• Switch to another treatment option, but be aware some medications such as MAOIs and SSRIs require a washout period between treatment therapies to avoid serotonin syndrome.
• Combine treatment/augment therapy with the addition of another medication

Question 14

Important considerations for discontinuation of antidepressant therapy include:

Answer 14

• DO NOT STOP ABRUPTLY -Taper dose over several weeks to avoid discontinuation syndrome (withdrawal) Withdrawal symptoms most common with paroxetine and venlafaxine; and least common with fluoxetine (due to longer half life).
• Withdrawal symptoms include: Anxiety, dizziness, insomnia, bodyaches, fatigue, nausea, diarrhea, headach, parethesia.

Question 15

Nonpharmacologic Therapy choices for major depressive disorder include everything, EXCEPT:

A. ECT

B. Transcranial Magnetic Stimulation

C. Vagus Nerve Stimulation

D. Psychotherapy

E. Dark therapy

F. Accupuncture

Answer 15

Answer:

E. Dark therapy

Because…Light therapy is a complementary nonpharmacologic therapy for MDD.

Question 16

The SSRI used in antidepressant therapy with CYP interactions (CYP1A2 & CYP2C19) is:

A. Escitalopram

B. Citalopram

C. Fluvoxamine

D. Paroxetine

Answer 16

Answer:

C. Fluvoxamine

Question 17

Which SSRI is not used for patients over the age of 65 because of its anticholinergic effects?

A. Citalopram

B. Paroxetine

C. Escitalopram

D. Sertraline

Answer 17

Answer:

B. Paroxetine

Question 18

Which medication has a warning to keep the dosage below 20mg/day in elderly patients because of its QT prolongation?

A. Citalopram

B. Escitalopram

C. Paroxetine

D. Sertraline

Answer 18

Answer:

A. Citalopram

Citalopram is not recommended to exceed a dosage of 20mg/day in the elderly patients because of the QT prolongation.

Question 19

Which SSRI will have the least withdrawal symptoms when discontinuing antidepressant therapy?

A. Fluoxetine

B. Wellbutrin

C. Paroxetine

D. Sertraline

Answer 19

Answer:

A. Fluoxetine has the longest half-life of all SSRIs, and therefore has the least risk for withdrawal symptoms. However, drug to drug interactions and longer half-life may not be preferred in elderly patients. Dose adjustment required for hepatic insufficiency.

Question 20

Which are the two most expensive SNRIs?

A. Fluoxetine and Duloxetine

B. Desvenlafaxine and Leomilnacipran

C. Venlafaxine and Milnacipran

D. Levomilnacipran and Duloxetine

Answer 20

Answer:
B. Desvenlafaxine and Leomilnacipran

Question 21

Which SNRIs carry the highest risk for hypertension?

A. Desvenlafaxine

B. Venlafaxine

C. Venlafaxine ER

D. Milnacipran

E. Both B & C

Answer 21

Answer:
E. Both B & C

Venlafaxine and venlafaxine ER have a special consideration for hypertension.

Question 22

Which SNRI is not approved by the FDA for treatment of depression?

A. Milnacipran

B. Levomilnacipran

C. Desvenlafaxine

D. None of the above

Answer 22

Answer:

A. Milnacipran

Milnacipran is not FDA approved for the treatment of depression.

Question 23

Which SNRI medication has the special consideration for its interactions with CYP2D6?

A. Desvenlafaxine

B. Duloxetine

C. Levomilnacipran

D. Milnacipran

Answer 23

Answer:
B. Duloxetine has special considerations for CYP2D6 interactions.

Question 24

True or False: Individuals taking SNRIs have a higher risk for sexual dysfunction than individuals taking other antidepressants.

Answer 24

False:

SSRIs (not SNRIs) have a higher risk of sexual dysfunction than some other antidepressants.

Note: An exception to this is the SNRI Venlafaxine. Venlafaxine also carries the risk of sexual disfunction similar to that of SSRIs.

Question 25

What is Mirtazapine?

Answer 25

It is an antidepressant with the mechanism of action of being a central alpha 2-receptor antagonist. Special considerations: May be desirable when sedation and weight gain are desired. Mirtazapine causes sedation and weight gain. Works by causing 5HT and NE to be released into the synapse, is an antagonist of 5-HT2 and 5-HT3 receptors, and is an antagonist at histamine 1 receptors.

Question 26

Which tricyclic antidepressant medication requires dose adjustment in hepatic insufficiency? ## Footnote A. Amitryptyline B. Imipramine C. Desipramine D. Doxepin

Answer 26

Answer: D. Doxepin

Question 27

Vilazodone, a dual SSRI and partial 5-HT 1A receptor agonist, is not recommended for individuals with existing... ## Footnote A. Depression B. Hypertension C. Obesity D. Bipolar disorder

Answer 27

Answer: D. Bipolar Disorder Vilazodone is known to induce mania/hypomania in individuals with bipolar disorder. Also, precautioned (not recommended) for individuals with seizure disorder.

Question 28

Which Serotonin antagonist/reuptake inhibitor has a BBW for hepatotoxicity? A. Trazadone B. Nefazodone C. None of the above

Answer 28

Answer: B. Nefazodone Nefazodone has caution for use in individuals with hepatic impairment. Note: nefazodone also has higher intensity for anticholinergic effects (not recommended for elderly).

Question 29

Why are MAOIs not used as often as 1st line antidepressants? A. They cost too much. B. They cause too much weight gain. C. They cause too many side effects. D. They don't work as well.

Answer 29

Answer: C They cause too many side effects. MAOIs are known for causing side effects of myoclonic jerking, insomnia/aggitation, orthostatic hypotension and sexual dysfunction. Additionally, MAOIs interact with many other medications and foods having interactions. Serotonergic drugs=serotonin syndrome Sympathomimetic drugs=Hypertensive crisis Tyramine containing foods=Hypertensive crisis

Question 30

Fluoxetine requires how long of a washout period before someone can start an MAOI? A. 2 week B. 3 weeks C. 4 weeks D. 5 weeks

Answer 30

Answer: D. 5 weeks NOTE: page 224 of Woo and Robinson states "at least a 21-day washout period". However, Professor Emma's notes state "5 weeks".

Question 31

MAOIs require a washout period of how long before starting an SSRI to prevent serotonin syndrome? A. 1 week B. 2 weeks C. 3 weeks D. 1 month

Answer 31

Answer: B. 2 weeks (See page 224 of Woo and Robinson under: Drug Interactions).

Question 32

Which antidepressant medication requires bone monitoring and specific treatment to reduce bone loss? A. Buproprion B. SSRIs C. TCAs D. SNRIs

Answer 32

Answer: B. SSRIs SSRIs have a higher risk of causing osteopenia. Therefore, they require bone density monitoring and possible additional treatment to reduce bone loss.

Question 33

Which antidepressant is associated with activation/insomnia and nausea/vomiting? (choose all that apply) ## Footnote A. TCAs B. SSRIs, C. Bupropion D. SNRIs

Answer 33

Answer(s): B, C, and D Bupropion, SSRIs and SNRIs are associated with activation/insomnia and nausea vomiting. Ways to manage insomnia is with AM dosing and to manage n/v is to administer with food or in divided doses.

Question 34

Which antidepressant medication is associated with sedation, dry mouth and constipation? ## Footnote A. TCAs B. Bupropion C. SNRIs D. SSRIs

Answer 34

Answer: A. TCAs TCAs are the only antidepressant medication associated with sedation, dry mouth and constipation. Additional medications associated with sedation include: trazodone, nefazodone and mirtazapine. Managed by administering before bed. Additional medications associated with dry mouth include SNRIs and bupropion. Dry mouth managed with sugar-free gum or candy.

Question 35

True or false: Weight gain is associated with all antidepressant medications.

Answer 35

FALSE ## Footnote SSRIs, mirtazapine, TCAs and MAOIs are associated with weight gain, but not ALL antidepressants are associated with weight gain. Management for weight gain would be to encourage exercise and possibly change antidepressants if weight gain is a concern.

Question 36

Which medication is associated with raising cholesterol? ## Footnote A. TCAs B. Bupropion C. MAOIs D. Mirtazapine

Answer 36

Answer: D ## Footnote Mirtazapine is associated with increased cholesterol. Can be managed with adding a statin medication. Bupropion is associated with hypertension. MAOIs are associated with orthostatic hypotension. TCAs can cause QT prolongation.

Question 37

Which medication is associated with the highest risk for lethal overdose? A. TCAs B. Bupropion C. MAOIs D. Mirtazapine

Answer 37

Answer: A. TCAs ## Footnote TCAs should **NOT** be prescribed for acutely suicidal individuals because overdose of TCAs is most likely to be lethal than any other antidepressant medication.

Question 38

TRUE or FALSE? Trazodone has the rare side effect of causing priapism?

Answer 38

Answer: TRUE Trazadone can cause priapism (prolonged erection). Additional side effects include dizziness and sedation.

Question 39

What is Vortioxetine?

Answer 39

An SSRI agonist of 5HT1A receptors; antagonist at 5-HT3 receptors. Dose: 10 mg initial dose, up to 20 mg daily Dosage adjustment?: None Adverse Effects: GI upset Special considerations: Cost

Question 40

Why are MAOIs not used very often? (choose all that apply). ## Footnote A) They cost too much B) They cause significant weight gain C) They cause too many side effects D) They have too many drug-drug and drug-food interactions

Answer 40

Answer: C & D ## Footnote MAOIs have the side effects of myoclonic jerking, insomnia/aggitation, orthostatic hypotension, and sexual dysfunction. MAOIs have many drug-drug and drug-food interactions. Serotonergic drugs with MAOIs=risk for serotonin syndrome Sympathomimetic drugs with MAOIs=hypertensive crisis Tyramine containing foods with MAOIs=hypertensive crisis

Question 41

TRUE or FALSE? SSRIs and SNRIs inhibit platelet aggregation, putting individuals at an increased bleeding risk.

Answer 41

True: SSRIs and SNRIs increase risk for bleeding by inhibiting platelet aggregation.

Question 42

Other than an increased bleeding risk, SSRIs and SNRIs are on the Beers Criteria for what condition? A) Constipation B) Hypertension C) Weight gain D) SIADH

Answer 42

Answer: D SSRIs and SNRIs are on the Beers Criteria for syndrome of inappropriate antidiuretic hormone (SIADH) and hyponatremia.

Question 43

1st Line treatment for anxiety includes: (choose all that apply) ## Footnote A) SSRIs B) Wellbutrin C) SNRIs D) Beta-blockers

Answer 43

Answer(s): A & C SSRIs, SNRIs, and other antidepressants are the 1st line choice. Wellbutrin, not a 1st line choice due to its activating effects/ insomnia=worsening of anxiety symptoms. Beta-Blockers are not a first line choice for anxiety treatment.

Question 44

Buspirone, hydroxyzine, and beta-blockers are... ## Footnote A) First-line therapy for anxiety B) Second-line therapy for anxiety C) Not used in the treatment of anxiety

Answer 44

Answer: B ## Footnote Buspirone: 2nd line therapy for generalized anxiety disorder. Contraindicated for use with MAOIs. Adverse Effects: dizziness, nausea, HA Hydroxyzine: Augmented therapy for anxiety, 1st generation antihistamine. Helpful for co-occurring insomnia. Adverse effects: Anticholinergic effects, sedation. Note: Avoid in elderly due to anticholinergic effects Beta-blockers: Used for performance-related social anxiety. Adverse effects: orthostatic hypotension, bradycardia

Question 45

Treatment for generalized anxiety disorder:

Answer 45

1st line: SSRIs, SNRIs, CBT (cognitive behavioral therapy) 2nd line: Switch SSRI or SNRI, tricyclic antidepressants, buspirone, gabapentin/pregbalin, hydroxyzine Re-evaluate in 12 months. Info about GAD: Characterized by excessive worry occurring more days than not for at least 6 months (restlessness, easily fatigued, poor concentraion or mind going blank, irritiability, muscle tension, insomnia. Generally causes significant distress or fuctional impairment.

Question 46

Treatment for Panic Disorder

Answer 46

1st line: SSRIs, SNRIs, CBT 2nd line/Adjunct: Benzodiazepines-short term if immediate response required, tricyclic antidepressants Re-evaluate: 12-24 months Panic Disorder: Characterized by recurrent, unexpected panic attacks (abrupt surge of intense fear or discomfort/ peaking within minutes). Symptoms: palpitations, sweating, trembling, SOB, feeling of choking, chest pain, fear.

Question 47

Treatment for Social Anxiety Disorder:

Answer 47

1st line therapy: CBT (psychoeducation, self-monitoring, countering anxious thought beliefs, exposure to fear cues, modification of anxiety maintaining behaviors). 10-15 weekly sessions. -Relaxation training, meditation, avoid caffeine and alcohol Pharmacologic: 1st line: SSRIs & SNRIs, benzodiazepines (short-term) if immediate response required. 2nd line: Switch to another 1st line agent, augment with buspirone or gabapentin/pregbalin Performance related SAD: betablockers Re-evaluate: 12 months SAD: Marked fear or anxiety about one or more social situations (e.g., public speaking, talking to strangers, etc). Symptoms: fear acting in a way or showing anxiety that will be negatively evaluated, fear/anxiety is out of proportion persistent 6 months or longer and causes significant distress

Question 48

How do you treat new onset acute manic bipolar disorder:

Answer 48

Initial therapy: New Onset ## Footnote Lithium, valproate or antipsychotics -Alternatives: carbamazepine or oxcarbazepine -Combination if severe Short-term adjunctive treatment with a benzodiazepine Taper and discontinue antidepressants

Question 49

How to treat breakthrough manic episodes of bipolar disorder:

Answer 49

Optimize medication dose; ensure levels in therapeutic range Antipsychotic Short-term benzodiazepine

Question 50

Treatment of Psychosis during manic or mixed episode of bipolar disorder:

Answer 50

Antipsychotic & ECT Patients in manic episodes should DC antidepressants, because they may increase/exacerbate symptoms.

Question 51

Initial treatment of acute depressive episode of bipolar disorder:

Answer 51

New Onset: --Lithium or lamotrigine +/- antidepressant (for severe illness) --ECT for life-threatening inanition, suicidality, psychosis, or severe depression during pregnancy. Antipsychotic for psychotic features (not 1st line) Breakthrough depressive episode: Optimize medication dosage (ensure levels are therapeutic).

Question 52

What to do if individual fails to respond to acute depressive episode therapy for bipolar disorder:

Answer 52

Add lamotrigine, bupropion, or paroxetine - Alternative: SSRI, venlafaxine, or an MAOI - TCAs ***_NOT_*** recommended, may precipitate a switch ECT for severe or treatment-resistant depression, psychotic features or catatonic features.

Question 53

What is the treatment for Rapid Cycling in Cyclothymic Disorder?

Answer 53

First ID and treat medical conditions such as **hypothyroidism, drugs, or alcohol use** that may be contributing -Taper and discontinue if possible INITIAL TREATMENT: Lithium or valproate -Alternative: lamotrigine

Question 54

What is the maintenance therapy for all individuals following a manic or depressive episode?

Answer 54

Goals: * Prevent relapse * Reduce subthreshold of symptoms * Reduce suicide risk * Reduce cycling frequency or milder degrees of mood instablility * Improve overall function INITIAL TREATMENT OPTIONS: * Lithium or Valproate - Alternatives: lamotrigine, carbamazepine, oxcarbazepine - Maintenance ECT (if helped in actue illness) * Discontinue antipsychotics in most cases - May consider second generation antipsychotics if needed, but less evidence of efficacy * Psychological Interventions

Question 55

What are the two medications used in both Manic and Depressive Bipolar Disorder management?

Answer 55

Lithium and Antipsychotics Lithium and antipsychotics are used in both the manic and depressive management of bipolar disorder.

Question 56

Medications used for the management of Mania in bipolar disorder:

Answer 56

* **Lithium** * Divalproex Sodium * Carbamazepine * Oxcarbazepine * **Antipsychotics** * Short-term benzodiazepines

Question 57

Medications used in the management of depressive bipolard disorder:

Answer 57

* **Lithium** * Lamotrigine * **Antipsychotics** * Antidepressants

Question 58

What medications may alter lithium levels in patients with bipolar disorder?

Answer 58

**INCREASED LITHIUM LEVELS WITH:** * Thiazide Diuretics * NSAIDS * ACE Inhibitors * Tetracycline * Metronidazole **DECREASED LITHIUM LEVELS WITH:** * Potassium-Sparing diuretics * Theophylline **INCREASED OR DECREASED LITHIUM LEVELS WITH:** * **LOOP DIURETICS** * **THEOPHYLLINE**

Question 59

Contraindications and Precautions for use of Lithium for individuals with bipolar disorder:

Answer 59

**LITHIUM CONTRAINDICATED:** * Significant Renal impairment * Sodium Depletion * Dehydration * Significant Cardiovascular Disease **PRECAUTIONS:** * **BBW for toxicity** * Takes 4-5 days to reach stead state (1/2 life 18-36 hours) * **Narrow ​**Therapeutic index * Drug-drug interactions * Pregnancy Category D

Question 60

Contraindications and precautions for valproate use in individuals treated for bipolar disorder:

Answer 60

CONTRAINDICATIONS: * Hepatic disease or significant impairment * Pregnancy PRECAUTIONS: * Hepatotoxicity * Leuknopenia and thrombocytopenia (reversible) * Pregnancy * Pancreatitis Adverse effects: GI distress, hepatic transaminase elevations, osteoporosis, tremor, sedation, hair loss, increased appetite

Question 61

A treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual's life experiences. People with it use substances or engage in behaviors that become compulsive and often continue despite harmful consequences. A) Addiction B) Tolerance C) Dependence D) None of the above

Answer 61

Answer: A Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual's life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.

Question 62

Which term refers to when the neurons of the brain adapt to repeated drug exposure and only function normally in the presence of the drug? ## Footnote A) Addiction B) Dependence C) Withdrawal D) Tolerance

Answer 62

Answer: B ## Footnote Dependence refers to when the neurons adapt to repeated drug exposure and only function normally in the presence of the drug. Dependence is measured by how well the patient can meet the function goals when using the medication and when not using it. (Woo & Robinson, p. 1250).

Question 63

Which term refers to needing more of a medication over a period of time, and the body no longer responding to the drug in the way the person initially responded? ## Footnote A) Addiction B) Withdrawal C) Dependence D) Tolerance

Answer 63

Answer: D ## Footnote Tolerance refers to over time, a gradual increase in the medication dose is required to achieve the same level of control and functional ability. When a person develops a tolerance to a medication they no longer responds to the drug in the way they initially responded (e.g., analgesia).

Question 64

The following include all of maintenance treatment options for alcohol use disorder, **except**: ## Footnote A) Benzodiazepines B) Naltrexone C) Disulfiram D) Acamprosate

Answer 64

Answer: A) Benzodiazepines Benzos are used as short-term 1st line therapy in acute alcohol use disorder, but are not used as a maintenance drug.

Question 65

Precautions for nicotine replacement therapy include: A) Pregnancy or breastfeeding B) Recent MI or serious angina C) Those with arrhythmias D) All of the above

Answer 65

Answer: D. All of the above

Question 66

If a person is smoking over 25 cigarettes a day, they should use what for nicotine replacement? ## Footnote A) 4 mg of Nicotine Gum B) 2 mg of Nicotine Gum C) nothing, they should stop "cold turkey"

Answer 66

Answer: A) 4 mg of Nicotine Gum If a person is smoking less than 25 cigarettes/day, it is recommended they start on 2 mg of Nicotine gum. Schedule is as follows: Weeks 1-6: 1 piece every 1-2 hours Weeks 7-9: 1 piece every 2-4 hours Weeks 10-12: 1 piece every 4-8 hours

Question 67

The Nicotine Patch is dosed based on: ## Footnote A) Patient age B) Patient weight C) Number of cigarettes smoked per day D) Time of 1st cigarette from time of waking up

Answer 67

Answer: C) # of cigarettes per day Dosing/Schedule: If greater than 10 cig/day=Start with 21 mg. Weeks 1-6=21mg Weeks 7-8=14 mg Weeks 9-10=7mg If less than 10 cig/day=Start with 14 mg Weeks 1-6=14 mg Weeks7-8=7 mg

Question 68

Describe the CIWA-Ar score and how it can be used in patients with alcohol withdrawal.

Answer 68

Question 69

Naltrexone is used for maintenance alcohol use disorder to ## Footnote A) Replace the alcohol B) Reduce cravings C) Prevent seizures D) Provide nutrients

Answer 69

Answer: B) Reduce cravings Specials considerations with Naltrexone: Contraindicated if person is using opioid medication as naltrexone can induce opioid withdrawal. Precautions include: hepatotoxicity and suicidal ideation

Question 70

True or False: Disulfiram causes an aversive reaction to help people avoid drinking alcohol.

Answer 70

True. Drinking alcohol while taking disulfiram will cause aversive effects or side effects that are not well tolerated, helping individuals stay sober through aversion. Note: this medication is better for individuals who are highly motivated to avoid drinking, who do not have impulsive tendencies. If someone continues to drink while taking this medication, they will experience severe side effects of copius vomiting, palpitations (imagine the worst hangover of your life x10). **CONTRAINDICATED:** - Pts using alcohol, metronidazole, paraldehyde, or alcohol-contining preparations (e.g. cough syrup, etc.) - Psychosis - Pts with severe myocardial disease or coronary occlusion ***BBW never give to anyone in active state of alcohol consumption***. May result in seizures, liver dysfunction, MI, respiratory depression, arrhythmias, and possibly death.

Question 71

MEDICATIONS that worsen insomnia include:

Answer 71

* Oral Decongestants (pseudoephedrine, phenylephrine) * Stimulants (amphetamine, methylphenidate) * Theobromines (theophylline, caffeine) * Antidepressants (SSRIs, SNRIs, MAOIs) * Cardiovascular agents (Beta-blockers, alpha-receptor agonists)