Neurologic

Question 1

What is Namzaric?

Answer 1

Donepezil + memantine once daily capsule

Question 2

What is Adlarity?

Answer 2

Donepezil once weekly patch

Question 3

What is the maximum daily dose of galantamine in a patient with creatinine clearance less than 60 mL/min?

Answer 3

16 mg/ day

Question 4

Which acetylcholinesterase inhibitor is FDA approved for Parkinson’s disease dementia?

Answer 4

Rivastigmine

Question 5

What is the maximum dose of memantine for a patient w creatinine clearance less than 30 mL/min?

Answer 5

5 mg bid (XR 14 mg/day)

Question 6

What is the indication for Aduhelm?

Answer 6

Mild cognitive impairment with beta-amyloid positive PET or CSF findings

Question 7

What is the dose of aducanumab?

Answer 7

10 mg/kg IV every four weeks after titration

Question 8

What is the clinical efficacy of Leqembi?

Answer 8

Lower brain levels of beta amyloid and moderately slow cognitive and functional decline in early stage Alzheimer’s disease

Question 9

What are the target serum levels for Carbamazepine?

Answer 9

4-12 mcg/mL

Question 10

Carbamazepine is a potent inducer of which enzymes?

Answer 10

CYP3A4, CYP2C9, UGT

Question 11

What are the target serum levels for phenobarbital?

Answer 11

15-40 mcg/mL

Question 12

What are the target serum levels for phenytoin?

Answer 12

10-20 mcg/mL (free: 1-2 mcg/mL)

Question 13

What percent dose reduction is needed for topiramate in a patient with creatinine clearance less than 70 mL/min?

Answer 13

50%

Question 14

What are the target serum levels for valproic acid?

Answer 14

50-100 mcg/mL

Question 15

Carbipenems decrease Serum concentrations of which anticonvulsant?

Answer 15

Valproic acid

Question 16

Which enzyme systems does valproic acid inhibit?

Answer 16

UGT and Epoxide hydrolase

Question 17

Which three antipsychotics may be used in Parkinson’s disease?

Answer 17

Pimavanserin, clozapine, quetiapine

Question 18

Which antipsychotic is a CYP3A4 substrate?

Answer 18

Pimavanserin

Question 19

What dosing conversion ratio is used to switch from oral tabs to intestinal gel of levodopa/carbidopa?

Answer 19

1:1

Question 20

Which medication for Parkinson’s disease interacts with ondansetron?

Answer 20

Apomorphine

Question 21

How many PD rescue doses per day can be used?

Answer 21

5

Question 22

What rescue treatments are available for Parkinson’s disease?

Answer 22

1) Apomorphine subcutaneous pen
2) Apomorphine sublingual film
3) levodopa inhalation powder

Question 23

Is the onset of action of PD rescue therapy?

Answer 23

15-20min

Question 24

What is the most effective medication in PD for control of motor symptoms?

Answer 24

Levodopa/carbidopa

Question 25

What are the three non-ergot dopamine agonists?

Answer 25

Pramipexole, ropinirole, rotigotine

Question 26

What is the only FDA approved non-oral rescue therapy for PD?

Answer 26

Apomorphine

Question 27

What are management strategies for off periods in PD (involving how CD/LD is used)? (3)

Answer 27

1) Separate CD/LD from high-protein meals 2) Change CD/LD dose, dose frequency or timing 3) change CD/LD formulation to more continuous release

Question 28

What are management strategies for off periods in PD (other than CD/ LD dosing)? (4)

Answer 28

1) Include medications that increase levodopa brain bioavailability 2) Add another oral medication 3) Add rescue therapy or switch to non-oral formulations 4) Deep brain simulation

Question 29

How is peak dose dyskinesia managed? (CD/LD adjustments-3)

Answer 29

1) Reduce CD/LD dosing (maintain frequency) 2) switch to longer acting (CR) 3) switch oral CD/LD to parenteral

Question 30

How is peak dose dyskinesia managed? (Non CD/LD strategies-3)

Answer 30

1) add Amantadine 2) add clozapine 3) deep brain stimulation

Question 31

In a patient with PD who develops dementia, what is the order of stepwise discontinuation of PD drugs?

Answer 31

Anticholinergics -> amantadine -> MAO-B inhibitors - > dopamine agonists -> COMT inhibitors - > CD/LD

Question 32

Top 6 medications that reduce the Seizure threshold

Answer 32

Diphenhydramine, tramadol, bupropion, meperidine, clozapine, haloperidol

Question 33

Which of the three preferred Anti-seizure medications in older adults?

Answer 33

Lamotrigine, levetiracetam, gabapentin

Question 34

Which anticonvulsant requires an ECG prior to initiation and interacts with PR interval, prolonging agents?

Answer 34

 Lacosamide

Question 35

Which anticonvulsant is a sulfonamide?

Answer 35

Zonisamide

Question 36

Which anticonvulsants have the highest risk of osteoporosis?

Answer 36

Carbamazepine, phenytoin, phenobarbital, primidone, valproic acid > oxcarbazepine

Question 37

What is the target vitamin D (25(OHD) level? 

Answer 37

> = 30 ng/mL

Question 38

Which Anticonvulsant should be avoided in patients with depression?

Answer 38

Levetiracetam

Question 39

What daily dose of carbidopa saturates dopa decarboxylase?

Answer 39

70-100mg

Question 40

Predisposing factors for levodopa – induced dyskinesia

Answer 40

Younger age at disease onset Lower body weigh female sex Increased disease severity

Question 41

Predisposing patient characteristics for impulse control disorder

Answer 41

Male sex Younger age History of Impulse control disorder History of mood disorders Apathy Family history of impulse control disorder & Addiction