Here we go

Question 1

What’s the difference between LEGAL and ETHICAL requirements?

What are the 5 bioethical principles?

What to know about the APhA code of ethics?

Answer 1

Legal- Things you MUST or MUSTN’T do. Ethical- Things you SHOULD or SHOULDN’T do.

Autonomy, Non-maleficence, Beneficence, Justice. Fidelity.

This code, prepared and supported by pharmacists.

Question 2

What are the 8 principles of the APhA code of ethics?

What’s the difference between a living will and durable power of attorney?

What are the 5 steps to ethical problem solving?

Answer 2

Covenental relationship, promote good, Autonomy, Honesty and Integrity, Competence, Respect of Colleagues, Service, Justice.

Living will- signed form legal document stating intent to refuse treatment. Durable power of attorney transfers power to others.

Clarify the facts of the case–> Analyze ethical issues–> Address psychosocial issues–> Negotiate to reach agreement–> Seek additional assistance if needed.

Question 3

What are the different ethics committees?

What are the five priorities of public health goals?

What is the culturally competent model of care?

Answer 3

Institutional Review Board, Institutional Ethics Committee, Infant Care Review Committee, Pharmacy and Therapeutics committee.

Health Equity, Primary Care and Public Health, Research, evaluation, and data, workforce, collaboration.

Awareness, Knowledge, Skills, Encounter

Question 4

What are 6 types of major interview formats?

What are the 4 P’s of marketing?

What is on an income statement?

Answer 4

Behavioral, Stress, Group, Directive, Case Study, Luncheon or Dinner Interview.

Product/Service, Place, Promotion, Price

Revenue, COGS, Gross profit/margin, Payroll and related expenses, operating expenses, fixed expenses, income tax expense, net income or loss.

Question 5

What are the core elements of MTM service?

What else should MTM include?

How much is MTM billing?

Answer 5

MTR, PMR, MAP, Intervention or referral, Documentation and follow up.

Pharmacist provided patient care, face to face opportunities, payment, outcome driven.

$2-$3 per minute, billed as fee for service.

Question 6

What does the MMA do?

What part of medicare covers MTM?

Do you need a contract?

Should you ever provide MTM for free?

Answer 6

provide MTM services

Medicare part D. Each one maintains it’s own formulary.

Yes, MTM services billed to a third party payer may not be paid unless you have a contract to provide such services.

NO.

Question 7

What are the elements of an SOP?

What are the 5 axis’s and their classifications?

What are the changes from IV-TR to 5?

Answer 7

Purpose, Scope, responsibility, etc.

1-Cliniclal psychiatric disorders. 2- Personality and developmental disorders. 3- General medical conditions. 4- Psychosocial and environmental problems. 5- Global assessment of functioning(score).

Elimination of Axis, elimination of mental retardation classification, establishment of Autism disorders, PTSD and OCD no longer lumped with Anxiety, Removed NOS and added DMDD.

Question 8

What are Noradrenaline and Dopamine made from? Seratonin?

What are the 4 dopamine pathways?

What are the 3 sleep promoting substances?

Answer 8

Tyrosine. Tryptophan.

CLNT, mesoCortical, mesoLimbic, Nigrostriatal, Tuberoinfundibular.

GABA, Adenosine, Melatonin

Question 9

What are the 3 types of insomnia?

What are the benzo’s and what are important things to note?

A/E’s of Benzos?

What are the Benzo’s for the elderly?

Answer 9

Sleep onset, Sleep maintenance, Late insomnia.

Temazepam, estazolam, triazolam. They reduce Delta sleep, increase stage 2 and total sleep time.

Sedation, Fatigue, Depression, Confusion, etc.

Oxazepam, Temazepam, Lorazepam.(Outside the liver).

Question 10

How can Benzodiazepene dependence occur?

What therapy are benzo’s indicated for?

What are the NBRA’s?

Answer 10

All are C-4’s, physical dependence develops over 40mg.

7-10 days.

Eszopiclone, Zaleplon, Zolpidem.

Question 11

What are the random facts to know about NBRA’s?

What are NBRA’s adverse effects?

NBRA pearls?

Answer 11

Purely sedative, work at GABAa, work mainly on stage 3 and 4.

Tolerance, sedation, rebound insomnia, next day impairment, headache, dry mouth, unpleasant taste(eszopiclone), sleep behaviors.

Taken on an empty stomach, physical dependence doesn’t occur, Women and elderly typically clear less.

Question 12

Best NBRA for sleep onset insomnia?

Overlapping by sleep pattern drugs?

What to know about Ramelteon?

Answer 12

Zaleplon, Zolpidem IR.

Zolpidem, Eszopiclone.

Do not use with Fluvoxamine, Melatonin M1 and M2 agonist,

Question 13

What to know about Suvorexant?

what to know about Antihistamines?

What about TCA’s?

Answer 13

Highly selective antagonist at OX1R and OX2R. Control, dose dependent suicide idiality.

Diphenhydramine, doxylamine, caution in the elderly, do not use in BPH, Narrow Angle Glaucoma, Urinary obstructions, tolerance develops quickly.

Amitriptyline, Doxepin, low doses help. Overdose potential, anticholinergic side effects, fall risk, little tolerance or rebound insomnia.

Question 14

Sedating Antidepressants?

Gabapentin?

Antipsychotics?

Counseling points for sleep medications?

Answer 14

Trazodone, Mirtazapine(only use in patients with depression), Mirtazapine is more sedating at lower doses.

Only use if they have another reason to use gabapentin(alcohol use disorder, chronic pain).

Not recommended for primary insomnia, metabolic side effects, sedation from antihistamine, use in patients who need anti psychotics.

Take immediately before bed(except melatonin), empty stomach, do not combine with alochol or other CNS depressants, do not drive, watch for unusual behaviors, use with caution if you have COPD. Asthma, and OSA, if no improvement in 7-10 days contact prescribor.

Question 15

How to treat narcolepsy with cataplexy?

Without cataplexy?

Pediatrics with narcolepsy?

Answer 15

Sodium Oxybate(Xyrem)–> Two doses per night. like GHB then TCA’s and venlafaxine.

Modafinial, Armodafinil then other stimulates

Dextroamephetamine for 6-12, Modafinil for >16.

Question 16

What are the 3 personality disorder clusters?

Paranoid personality disorder acronym?

Schizoid personality disorder acronym?

Schizotypical personality disorder acronym?

Answer 16

A–> weird, B–> Wild or wacky, C–> Wimpy.

SUSPECT

DISTANT

ME PECULIAR

Question 17

Borderline personality disorder acronym?

Antisocial personality disorder acronym?

Histronic personality disorder acronym??

Answer 17

AM SUICIDE

CORRUPT

ACTRESSS

Question 18

Narcissistic personality disorder acronym?

Avoidant Personality disorder?

Dependant personality disorder?

Answer 18

GRANDIOSE

CRINGES

RELIANCE

Question 19

Obsessive compulsive personality disorder acronym?

What is Cost Minimization Analysis?

What is Cost Benefit Analysis?

Answer 19

SCRIMPER

Input in dollars, output in dollars, used to minimize costs

Costs and benefits of treatment alternative.

Question 20

What is Cost Effectiveness Analysis?

What is Cost Utility Analysis?

Answer 20

Used to optimize benefits and costs.

Used to compare alternatives, output in quality adjusted life years.

Question 21

What are some risk factors/pathophysiology for ADHD?

1st line treatment for a 4-5 year old? 2nd?

6-18 years old?

Answer 21

Genetics/family history, tramatic brain injury, Adverse parent child relationships, low birth weight, Dopamine and Norepinephrine deficits.

Behavioral therapy, methylphenidate

MPH or AMP, Atomoxetine, guanfacine, clonidine.

Question 22

Main difference in MOA between MPH or AMP?

What are the short acting MPH’s? Intermediate acting? Extended acting?

What are the AMP formula’s?

Answer 22

MPH is mainly CNS effects, AMP has peripheral effects, stimulates DA and NE vesicles to release.

Methylin, Ritalin, Focalin. Metadate, Aptensio, Concerta, Quillivant, Daytrana.

Dexedrine, Adderall, Vyvanse, Eveko, Dexedrine, Zenzedi, Adzenys, Dynavel, Procentra.

Question 23

What to know about short acting MPH’s? What about short acting AMP?

Extended-acting MPH?

How long does a daytrana patch stay on?

Benefits of extended acting?

Answer 23

Typically does BID, 4-6 hour duration, can have rebound effects. Same, may require a 3rd dose.

Concerta- ghost tablet, TID dosing. Metadate CD and Ritalin LA(50/50)–> BID dosing.

9 hours, takes 2 hours to work.

Once daily dosing.

Question 24

What are some A/E’s of stimulants?

How to manage A/E’s?

Drug holidays?

Answer 24

Tend to be worse with AMP, anorexia, insomnia, irritability, weight loss, psychiatric symptoms, stomach pain, headache, growth suppression.

Start with low doses, titrate every 3-7 days, Anorexia- give dose after meals, a large/high fat meal can help with calorie catchup, Insomnia- use shorter acting formula, Irritability- lower dose, split dose, different formula.

A period of time when patients don’t take medicine, Can help limit adverse effects, no need to taper, not used for non stimulants.

Question 25

Monitoring parameters for stimulants?

Stimulant CI’s?

Blackbox warning of Atomoxetine(straterra)?

Answer 25

Growth, Appetite, Blood pressure and HR, Tolerability, Efficacy.

History of tourettes and motor tics, Cardiovascular Disease, moderate-severe hypertension, agitation and anxiety, History of substance abuse, ethanol use with mph, concurrent or recurrent use of an MAOI.

Increased suicidal thought.

Question 26

What are the stimulant abuse deterrent formulas?

Non stimulant ADHD treatments?

Benefits/ drawbacks to non stimulants?

Answer 26

Daytrana patch, Concerta, Vyvanse(prodrug, hydrolized by red blood cells),Adderall Xr(bead formula, difficult to crush).

SNRI(atomoxetine, straterra),Central Alpha 2 agonist(Gunafacine, Clonidine), Buproprion, TCA’s, Modafinil.

non addicting, not controlled, generally better tolerated./ Less effective, longer time to effect, must taper to discontinue.

Question 27

Atomoxetine A/E’s?

Guanfacine and Clonodin A/E’s?

Atomoxetine C/I’s?

Clonodine C/I’s?

Answer 27

Fatigue, Sedation, Dizziness, Headache, Abdominal pain, Black box warning for suicidal ideation.

Sedation(Clonidine> guanfacine), Constipation, Hypotension, hypertensive crisis if stopped abruptly.

should not be used concurrently with MAOI’s, severe cardiovascular disease, pheochromocytoma, narrow angle glaucoma.

do not stop abruptly

Question 28

What is the clinical course of anorexia?

Treatment approach for anorexia?

Inpatient vs outpatient treatment?

Answer 28

Peak age of onset is around 19-20 years old, average episode lasts 8 months, mental duration of illness lasts 9-15 years, Highest mortality rate of any psychiatric disorder.

Multidisciplinary approach, Nutritional rehab(must be slow to avoid refeeding syndrome), family based psychotherapy is very effective, pharmacotherapy

inpatient more severe.

Question 29

Nutritional rehabilitation for anorexia?

What is refeeding syndrome?

Pharmacologic treatment for anorexia?

Answer 29

Caloric intake is 30-40 kcal/kg/day. May need to advance to 70-100. Some may require NG tube for feeding, monitoring for refeeding syndrome is crucial.

Typically happens during first 4 days, hallmark signs are hypokalemia,phosphatemia,magnesemia. Risk factors are <70% of IBW, low baseline levels of electrolytes, little or
no intake in previous 5-10 days

Metoclopramide for GI discomfort, SSRI’s are firstline, NO bupropion(seizure) and NO TCAs(cardiac, overdose).

Question 30

SSRI’s in Anorexia?

Antipsychotics and Mirtazapine?

What are the SSRI’s?

Answer 30

Used if depression, anxiety, obsessions persist once weight is normalized. Fluoxetine has most data but not FDA approved. Typically treat for 6-12 months.

May improve weight gain, Seroquel demonstrated reduction in anxiety symptoms, may help with weight gain.

escitalopram, citalopram, paroxetine, fluoxetine, sertraline, vilazodone.

Question 31

BN severity ratings?

clinical course of belemia?

Pharmacologic treatment for Bulemia?

Answer 31

extreme is more or equal to 14 episodes per week. severe 8-13, moderate is 4-7. mild is 1-3.

mortality is 1%, peak age is 16-20, episodes last around 3 months. Illness lasts 8-12 years. 50% of patients recover with treatment.

Multivitamin, correct electrolyte abnormalities, constipation(doxusate, bulk forming laxatives), SSRI’s Avoid bupropion, topiramate(short term efficacy).

Question 32

Pharmacologic treament of binge eating disorder?

Answer 32

Lisdexamfetamine(FDA approved), Antidepressants can help. Anticonvulsants(topiramate, zonisamide) but avoid divalproex), Antiobesity–> can help with weight loss but not recommended normally.