CMN 548 UNIT 5 EXAM QUESTIONS
WITH CORRECT ANSWERS
What are the clinical indications for trazodone? - Answer--MDD
-Insomnia
-ED
-@ low doses, can control severe agitation in children w/developmental d/o or elderly
with dementia
-GAD at higher doses (250mg/day)
-depression in pts with schizophrenia
-reducing nightmares in those with PTSD
Discuss the possible complications of taking trazodone concurrently with an
antihypertensive? - Answer-orthostatic hypotension 4-6 hrs after dose is taken.
What are the s/s of OD on trazodone? What is the tx for OD? - Answer-lethargy,
vomiting, drowsiness, HA, orthostasis, dizziness, dyspnea, tinnitus, myalgias,
tachycardia, incontinence, shivering, coma
TX: emesis or gastric lavage + supportive care.
Forced diuresis may enhance elimination
Discuss Trazodone induced priapism: when would it occur? At what dose? indications
for d/c ing trazodone? - Answer-causes priapism in 1 : 10,000 men
usually appears in the first 4 weeks of tx but may also occur as late as 18 months into
tx. It can appear at any dose. Trazodone should be immediately discontinued.
Trazodone can INCREASE the plasma concentration of ______ and _______? -
Answer-Digoxin and phenytoin
What are the indications for nefazodone? - Answer-MDD
panic d/o
GAD
premenstrual dysphoric d/o
chronic pain
PTSD
chronic fatigue syndrome
A pt reports SE of "visual trails". What does this mean? - Answer-Visual trails: seeing an
after image when looking at moving objects or when moving one's head quickly
Monitor what lab d/t safety concerns with the use of nefazodone? - Answer-serial
hepatic function test
,What are the clinical indications for mirtazapine? - Answer-Depression
augmentation of antidepressants
counteract serotonergic SE
What are the TWO characteristic SE of mirtazapine? - Answer-INCREASED appetite
and sedation
What are the most common AE of mirtazapine? - Answer-somnolence
Monitoring of WBCs for pts who develop signs of infection is needed as mirtazapine is
associated with _____ and ___________? - Answer--febrile neutropenia
-agranulocytosis
What are the symptoms of discontinuation syndrome with abrupt withdrawal of
mirtazapine? When would this most likely occur? How long does this typically last? -
Answer-dizziness, lethargy, N/V/D, HA, fever, sweating, chills, malaise, incoordination,
insomnia, vivid dreams, myalgia, paresthesias, dyskinesias, "electric shock like
sensations" visual discoordination, anxiety, irritability, confusion, slow thinking,
hypomania, depersonalization
-most likely occur within 1-7 days after drug stopped. Typically disappears within 3
weeks
Bupropion (Wellbutrin) action? - Answer-bupropion inhibits the reuptake of NE and at
higher doses, DA. This class of medication does not act upon the 5-HT system.
-MOA may involve the presynaptic release of NE and DA
What are the therapeutic indications for bupropion? - Answer-depression
smoking cessation
bipolar d/o
ADHD
cocaine detoxification
hypoactive sexual desire d/o
Discuss the risk of sexual dysfunction, sedation, and discontinuation syndrome for
bupropion? - Answer-Bupropion has a SE profile characterized by a LOW risk of sexual
dysfunction and sedation. NO withdrawal syndrome has been linked to discontinuation
of bupropion.
-bupropion is often added to drugs, such as SSRIs, to counteract sexual SE and may be
helpful as a tx for non-depressed pts with hypoactive sexual desire d/o.
Why is it NOT recommended to prescribe bupropion to pts with severe anxiety or panic
d/o? - Answer-AE include agitation, ANXIETY, irritability, dysphoria, aggression,
hostility, depersonalization, coupled with urges of self-harm or harm to others.
, -pts with severe anxiety + panic d/o should NOT be prescribed bupropion b/c its
potentiating effects on dopaminergic neurotransmission, bupropion can cause psychotic
symptoms including hallucinations, delusions, catatonia, delirium
Discuss potential SE on plasma concentrations with concurrent use of bupropion and
carbamazepine (Tegretol); discuss potential plasma concentration effects with
concurrent use of bupropion and valproic acid (depakene)? - Answer-
carbamazepine(Tegretol) may INCREASE plasma concentrations of bupropion.
bupropion may INCREASE plasma concentrations of valproic acid (depakene)
Dopamine receptor antagonists (DRAs), also known as first generation antipsychotics
(FGAs) and neuroleptics include all of the antipsychotics in which chemical classes? -
Answer-DRAs include all of the antipsychotics in the following groups:
-phenothiazines
-butyriohenones
-thioxanthenes
-dibenzoxazepines
-dihydroindoles
-diphenylbultylpiperidines
Although typical antipsychotics are associated w/ EPS syndromes, their use is still
considered as they differ from newer atypical agents in that they do not have what risk
associated with them? - Answer-A reason to still consider DRAs is their lower risk of
causing significant metabolic abnormalities, such as weight gain, lipid elevations and
diabetes
Discuss the general peak plasma concentrations for both oral and parenteral
administrations of DRAs. How long will it take to reach steady-state levels? What are
the differences in bioavailability between oral and parental administration? - Answer--
peak plasma concentrations are 1-4 hrs after oral administration. 30-60 minutes after
parenteral administration.
-Steady-state levels reached in 3-5 days.
-Bioavailability is tenfold higher with parenteral administration
Why would oral administration of DRAs need to continue if a patient is placed on a
depot parenteral formulation? How long should oral therapy be continued? - Answer-It
can take 6 months of tx with a depot formulation to reach steady-state plasma levels,
indicating that oral therapy should be continued during the first month FIRST MONTH or
so of depot antipsychotic tx.
Discuss the meaning of potency when referring to a DRA, including the risks associated
with high potency agents? - Answer-potency refers to the amount of drug that is
required to achieve therapeutic effects.
-low potency drugs such as chlorpromazine and thioridazine (Mellaril) given in doses of
several 100 mg/day, typically produce more weight gain and sedation than high potency
