Psychopharm

Question 1

Side effects of chlorpromazine in IM form?

Answer 1

Hypotension –> monitor BP

Question 2

Chlorpromazine has an FDA approval for?

Answer 2

Treatment of several behavioral problems (combativeness and explosive, hyperexcitable behavior) in children 6 months and older

Question 3

How is lithium excreted?

Answer 3

Unchanged through the kidney (lithium is not metabolized by the body)

Question 4

How does the volume of distribution of lithium in children differ from adults?

Answer 4

In children with NORMAL renal function, lithium has about a 20% greater volume of distribution

Question 5

When should lithium levels be drawn?

Answer 5

10-12 hours after an oral dose

Question 6

Mechanism of lithium

Answer 6

Inositol second messenger system

Question 7

Time to peak plasma concentration of IR melatonin

Answer 7

30 to 120 min

Question 8

Half life of oral melatonin

Answer 8

30-50 min, hence only useful for those with problems regarding sleep onset

Question 9

What age is atomoxetine approved for?

Answer 9

6 years or older

Question 10

Contraindications to atomoxetine? (3)

Answer 10

1) Concurrent use of MAO-Is
2) Glaucoma
3) Pheochromocytoma

Question 11

How long does it take atomoxetine to reach steady state?

Answer 11

2-4 weeks

Question 12

What agents are FDA approved to treat bipolar disorder in youth?

Answer 12

Aripiprazole, quetiapine, lithium, olanzapine (10-17), olanzapine/fluoxetine (10-17), risperidone, asenapine

Question 13

What is the mechanism of action of lamotrigine?

Answer 13

Inhibition of glutamate and voltage-gated sodium channels

Question 14

What antipsychotic side (both 1st and 2nd gen) effect occurs at higher rate in children than adults?

Answer 14

EPS

Question 15

Contraindications to propranolol (2)

Answer 15

Asthma, cardiac co-morbidity

Question 16

How does IR guanfacine differ from IR clonidine?

Answer 16

IR guanfacine has a shorter half life (12-14 hrs, dosed 2-3 times/day) vs clonidine (8-12 hrs, dosed 3-4 times/day, but behavioral effects last 3-6 hrs)

Question 17

What did the Multimodal Treatment of ADHD (MTA) study conclude about growth differences between stimulant and non-stimulant groups?

Answer 17

1) While they still grew, children receiving stimulants grew on average 2 cm shorter (over 14 months)
2) Weighed less (gained approx 3 kg less)

Question 18

Main conclusion of the MTA study

Answer 18

Carefully monitored medication management (monthly) is more effective than intensive behavioral treatment alone

Question 19

What are the three mechanisms of action of aripiprazole?

Answer 19

1) D2 partial agonist
2) 5-HT1A partial agonist
3) 5-HT2A antagonist

Question 20

In treatment of irritability associated with ASD, what ages are aripiprazole and risperidone approved for?

Answer 20

Aripiprazole (6-17 yo)
Risperidone (5-16 yo)

Question 21

How does tardive dyskinesia (TD) from risperidone compare to other atypical antipsychotics?

Answer 21

While the rate is still lower when compared to TYPICAL antipsychotics, risperidone has a higher rate of TD when HIGH-DOSES are used compared to other atypical antipsychotics

Question 22

Mechanism of propranolol

Answer 22

Non-selective beta-1 and beta-2 adrenergic antagonist

Question 23

What antipsychotic has the highest risk of hyperprolactinemia?

Answer 23

Risperidone

Question 24

What are the psychiatric FDA indications for propranolol? What are the off label uses?

Answer 24

NONE, off label it is used for performance anxiety (10-40 mg one hour before), aggression (ASD), and akathisia

Question 25

What has been shown to be the most efficacious treatment for nocturnal enuresis?

Answer 25

Bell pad treatment (classical conditioning)

Question 26

1) What is the approximate relapse rate in children with nocturnal enuresis after discontinuation of desmopressin (DDAVPP)? 2) How do you define relapse? 3) What is a step to take to prevent relapse?

Answer 26

1) 60-70% 2) More than 1 wet night per month after a period of dryness 3) Slowly taper medication rather than stop abruptly

Question 27

According to AACAP practice parameters, psychiatrists should consider alternative therapies if a QTc is what?

Answer 27

460 and above

Question 28

1) What is clomipramine FDA approved for in children? 2) What P540 enzyme is it metabolized by? 3) What are the life threatening side effects?

Answer 28

1) OCD in children 10 and older 2) 3A4 3) Seizure, arrhythmia (C/I in Qtc of 500), QTc prolongation, sudden death, hematological issues (neutropenia, agranulocytosis, thrombocytopenia), syncope.

Question 29

What effect does carbamazepine have on cardiac conduction?

Answer 29

Slows conduction (avoid in patients with sick sinus syndrome or AV blocks)

Question 30

What is the mechanism of lamotrigine?

Answer 30

Inhibits glutamate and voltage-gated sodium channels

Question 31

What is the gap between stopping an MAO-I and starting another anti-depressant? What is the exception??

Answer 31

2 week gap / 5 weeks for fluoxetine

Question 32

Carbamazepine is an inducer of which two (2) P450 enzymes?

Answer 32

- 3A4 (autoinducer) - 1A2

Question 33

Fluvoxamine is a potent inhibitor of which two (2) P450 enzymes?

Answer 33

- 1A2 - 3A4