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Conflict of Interest Disclosures: Patient Case # 1
Conflict of Interest Disclosures: Patient Case # 1
Patient Case # 1
Which of the following common potential adverse
Carbamazepine Adverse Effects
effects of carbamazepine is best assessed through a
blood draw? Rash
SIADH
A. Leukopenia Aplastic anemia
B. Renal failure Th
Thrombocytopenia
b t i
Anemia
C. Congestive heart failure
Leukopenia
D. Hypercalcemia
D. Ethosuximide
D. Rash
Hepatotoxicity
Coarsening of facial
features
Patient Case # 9
Patient Case # 9 Which one of the following is the most accurate comparison of
carbamazepine and oxcarbazepine?
GZ, a 26-year-old woman, presents with a 6-
month history of “spells.” The spells are all
the same, and all of them start with a feeling A. Oxcarbazepine causes more liver enzyme induction
in the abdomen that is difficult for her to than carbamazepine
describe. This feeling rises toward the head.
The patient believes that she will then loose B Oxcarbazepine
B. O b i does
d nott cause rash
h
awareness. After a neurologic work-up, she
is given a diagnosis of focal seizures evolving
to a bilateral, convulsive seizure. The C. Oxcarbazepine does not cause hyponatremia
neurologist is considering starting either
carbamazepine or oxcarbazepine. D. Oxcarbazepine does not form an epoxide intermediate
in its metabolism
Does not form an epoxide intermediate in its When you see GZ 6 months later for follow-
metabolism up, she tells you that she is about 6 weeks
Enzyme inducer, but no autoinduction pregnant. She has had no seizures since
Hyponatremia more common than with g
beginningg drugg therapy.
py
carbamzepine
Blood dyscrasias less common than with
carbamazepine
C. Aspirin
D. Warfarin
Patient Case # 14
After encouraging him to discuss this with his doctor, which one of the
CHADS2 Score
following choices best describes what you should tell him?
D. 3.0
Patient Case # 16
Which one of the following choices best describes why streptokinase is or
Acute Stroke Treatment
is not an appropriate choice for acute therapy in this patient?
A. Streptokinase is not appropriate; steptokinase should
not be used in stroke treatment
Heparin
Good outcome data not available
B. Streptokinase is not appropriate; streptokinase must be Avoid in hemorrhagic stroke
used within 1 hour of symptom onset aPTT 1.5
1.5-2.0
2.0 times control
C. Streptokinase is appropriate; streptokinase must be Streptokinase
used within 3 hours of symptom onset Avoid due to excess mortality
Tissue plasminogen activator
D. Streptokinase is appropriate; it is the drug of choice
for the treatment of stroke not involving paralysis
You work as the clinical pharmacist in a small ASA + Placebo + RRR (95% CI)
hospital. Several of the physicians with Clopidogrel (n) Clopidogrel (n)
Primary 596 636 6.4% (-4.6-6.3)
whom you work want to use aspirin and outcome
p g together
clopidogrel g after stroke,, similar to Secondary outcomes
what they are doing for MI. You access the
MI 73 68 -7.7% (-8.5-
MATCH study and obtain the following 20.4)
results: Ischemic stroke 309 333 7.1% (-8.5-20.4)
Patient Case # 17
Which one of the following is the best interpretation of this information?
Relative Risk Reduction
A. Aspirin plus clopidogrel is more effective than placebo RRR of 1 indicates no difference between
plus clopidogrel only for the primary outcome
groups
B. Aspirin plus clopidogrel is more effective than placebo plus The 95% CI also cannot contain 1
clopidogrel
p g for all the secondaryy outcomes.
Dopaminergic Anticholinergic
Nausea/vomiting Dry mouth Six months later, LS returns to the clinic
Orthostatic Urinary retention concerned that his levodopa/carbidopa
hypotension Dry eyes dose is wearing off before his next dose
Hallucinations Constipation is due.
Confusion
Urine discoloration
50/200 orally 4 times/day. He recently
pleuropulmonary or
pleuropulmonary,
D. Decrease carbidopa/levodopa
A. Almotriptan
MK is a 44-year-old woman with right-
sided headaches of moderate intensity B. Naratriptan
that are accompanied by severe nausea C. Rizatriptan
and vomiting.
D. Sumatriptan
Drug NNT
One of the neurologists you work with Ergotamine + caffeine 6.6
recently read a meta-analysis of migraine
Eletriptan 80 mg 2.8
treatments. He is most interested in the
outcome of sustained relief at 24 hours, Rizatriptan
Ri t i t 10 mg 56
5.6
but he is confused by the number Sumatriptan 50 mg 6.0
needed to treat analyses. He shows you
the following table:
A. Eletriptan 80 mg is the most effective agent Way to express the number of patients it
would be necessary to treat to have one
B. Ergotamine plus caffeine is the most effective drug
patient with benefit/adverse effect
C. Eletriptan has the most adverse effects
S.F. elects to start beta interferon-1b and wants A. Always give the injection at the same time of day
to know whether there is any way she can
B. Lie down for 2 hours after the injection
prevent or minimize some of the adverse
effects. C. Rotate injection sites
103
Laboratory findings
107 108
109
Handout Page 1-380; Answer Page 1-415
Manic episode
Distinct period of abnormally and persistently
elevated, expansive or irritable mood, lasting at least 1 Mania
week (or any duration if hospitalization necessary)
Three or more* of following sx during mood
disturbance: 1) inflated self-esteem
self esteem or grandiosity
grandiosity, 2)
decreased need for sleep, 3) more talkative than usual Euthymic
or pressured speech, 4) flight of ideas or racing
thoughts (subjective), 5) distractibility, 6) increase in
goal-directed activity (either socially, occupationally,
sexually) or psychomotor agitation, 7) excessive
involvement in pleasurable activities that have
negative consequences (gambling, spending $$,
sexual activity) Depression
Oxcarbazepine
D. Discontinue ibuprofen because it interacts with lithium.
Antipsychotics
Handout Page 1-389; Answer Page 1-415 126
Schizophrenia Schizophrenia
Patient Case Page 1-393 Patient Case Page 1-393
L.M. is a 25-year-old man with recent He was given haloperidol in the psychiatry
diagnosis of schizophrenia, paranoid type. He unit and now presents with neck stiffness and
frequently hears voices telling him that he is feelings of extreme restlessness.
p and worthless” and that he should
“stupid Up to this point,
point he has not taken medications
“just jump off his apartment building.” His because he felt that he could control his
parents became very concerned over his symptoms on his own with vitamins and Red
isolative behavior and brought him to the Bull drinks.
hospital.
129
Handout Page 1-393 ; Answer Page 1-415 Handout Page 1-393; Answer Page 1-416
Low Potency
Risperidone Risperdal Benzisoxazole 2
Chlorpromazine Thorazine Aliphatic phenothiazine 100 Olanzapine Zyprexa Thienobenzodiazepine 5
Thioridazine Mellaril Piperidine phenothiazine 100 Quetiapine Seroquel Dibenzothiazepine 75
Mid-Potency Ziprasidone Geodon Benzothizolylpiperazine 60
Perphenazine Trilafon Piperazine phenothiazine 10
Aripiprazole Abilify Quinolinone derivative 7.5
Loxapine Loxitane Dibenzoxazepines 10
Paliperidone Invega Benzisoxazole --
High Potency
Asenapine Saphris Dibenzo-oxepino pyrroles --
Haloperidol Haldol Butyrophenone 2
Fluphenazine Prolixin Piperazine phenothiazine 2
Iloperidone Fanapt Piperidinyl-benzisoxazole --
Thiothixene Navane Thioxanthenes 4 Lurasidone Latuda Benzoisothiazole --
*Woods SW. Chlorpromazine equivalent doses for the newer atypical antipsychotics.
135 136
J Clin Psychiatry 2003;64(6):663-7
147 148
Insomnia Insomnia
Sedative hypnotics are differentiated by Drug Usual Dose (mg) Half-life (hrs) Duration
Pharmacokinetic properties Triazolam 0.125-0.25 2-6 Short
Temazepam 15-30 8-20 Intermediate
Efficacy in onset and duration
Estazolam 1-2 8-24 Intermediate
Adverse effects Flurazepam 15 30
15-30 48 120
48-120 Long
Drug interactions Quazepam 7.5-15 48-120 Long
Zolpidem 5-10 1.5-4.0 Short
Abuse potential
Zaleplon 5-10 1 Very Short
Cost Eszopiclone 2-3 6 Short
Ramelteon 8 1-3 Short
153 154
155 156
B Clonazepam.
B. Clonazepam B Diazepam.
B. Diazepam
C. Diazepam. C. Disulfiram.
D. Lorazepam. D. Naltrexone.
Handout Page 1-410; Answer Page 1-416 Handout Page 1-410; Answer Page 1-416
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