QUESTIONS FOR REVIEW

What are the most common medications that lower the seizure threshold?
What AEDs are inducers?
What AEDs are inhibitors?
What is difference between partial and generalized seizures?
Which AEDs lower efficacy of oral contraceptives, and how do you handle this?
Which AEDs can cause neural tube defects?
What is folate requirement for women with epilepsy before conception?
What are dermatological effects of phenytoin?
Describe the cognitive effects of topirimate?
Why is phenobarbital not used as much as it was in the past, especially in children?
Who is most at risk of hepatotoxicity from valproic acid?
Why is it important to measure free levels of phenytoin?
Which AEDs should not be used in patients with h/o kidney stones?
Which AEDs can cause hyperthermia?
Which AEDs cause anorexia, which ones cause weight gain?
Know hematologic effects of the AEDs and monitoring parameters.
Know which AEDs effect sodium balance.
Explain issues of metabolism with carbamazepine, including autoinduction.
Drug of choice for partial, absence, tonic clonic, myoclonic.
When do you try to discontinue AED therapy... good/bad prognosis?
Effects of AEDs on bone metabolism.
Review basic drug interactions (inhibition/induction.. like the erythromycin and cimetidine case)
Therapeutic ranges of phenytoin, carbamazepine, valproic acid
Calculation of adjusted phenytoin level given Cp and albumin
Explain kinetic principles associated with phenytoin and how you adjust dosage.
Goals of therapy in epilepsy.
Which AEDs are "broad spectrum" (cover a variety of seizure types)?
Pregnancy/breast feeding issues

CHRONIC PAIN
Differences between acute and chronic pain
Assessment with PPQRST U method
Clinical presentation of chronic pain
NSAIDs - adverse effects, monitoring parameters, contraindications
Opiates - know the differences between short-acting and long-acting and when you use both, which not to use in renal failure, other contraindications, specifics re:methadone and fentanyl patch what is partial agonist/antagonist, adverse effects and how you treat, how to do coversion from oral to oral or oral to iv or iv to oral (chart provided- bring calculator)
Tolerance/dependence/addiction/pseudoaddiction
Role of adjuvant agents
Goals of therapy in patient with chronic pain; education of patient on opioid or NSAID therapy
Prescription Monitoring Program

Status Epilepticus
Why is lorazepam the DOC for SE vs. diazepam?
Compare phenytoin vs. fosphenytoin

Evaluation of the Patient with Psychiatric Disorders
Know 5 axes
Most commonly used rating scales for disorders
Vocabulary
Components of the mental status exam

Eating Disorders
Anorexia vs. Bulimia diagnosis
Treatment of each.. which responds to drug therapy
Complications of each disorder

Depression
Target sx (D SIG E CAPS)
All ADs ADRs (transient and chronic and how to handle) for SSRIs, SNRIs, bupropion, mirtazapine, trazodone, nefazodone, TCAS, MAOIs,
Onset of effect, duration of therapy, how to discontinue therapy
Patient counseling regarding drug therapy, nonpharmacological tpy and disease state
STEP-D conclusion, study from Lancet results
Meds that can exacerbate depressive sx
Black box warning on AD package insert - what does it say, how do you counsel?
MAOI drug interactions and dietary restrictions
SDC monitoring of TCAs
Assesing response, remission, etc.
Serotonin syndrome
How to handle sexual dysfunction
How to assess a patient for suicidality
Phases of therapy (acute, continuation, maintenance)
Specia pops: special factors with pregnancy (drug of choice in preg/breast feeding), adolescents, elderly

Anxiety
Differentiate between disorders (focus of fear/anxiety)
Treatment of choice for disorders
When do we use benzos?
Role of atypical antipsychotics in anxiety
Benzo PK.. onset of action, duration of action, conjugation vs. oxidation (elderly -LOT)
Monitoring response, remission
Adjunctives with PTSD for specific sx
How to taper benzos depending on length of tmt
Tolerance/dependence/addiction
Benzo discontinuation: relapse, rebound anxiety, withdrawal
Monitoring for efficacy and toxicity for all meds that we use to treat anxiety
Meds that exacerbate anxiety, medical conditions that resemble anxiety
Activation syndrome
Duration of therapy for each disorder, how do you discontinue?
Review clomipramine for OCD
Rating scales commonly used in anxiety

SLEEP DISORDERS
Types of insomnia (transient, short-term and chronic)
Common causes of insomnia (diseases/medications)\
Principles of good sleep hygiene (be able to counsel)
PK properties of benzos/non-benzodiazepines (which are good for sleep onset, sleep maintenance/daytime anxiety)
Adverse effects of the benzos, non-benzos, ralmelteon, trazodone, OTCs
Educate a patient on tolerance, dependence and rebound insomnia
Sleep apnea - risk factors, treatment, contraindicated medications
Narcolepsy.. know common symptoms including cataplexy, hypnogogic hallucinations, treatments (esp. stimulants and Xyrem)
Restless legs.. treatments

SCHIZOPHRENIA
Clinical presentation/diagnostic criteria (positive/negative/cognitive sx)
Adverse effect profiles of 1st and 2nd generation antipsychotics - know mechanisms of what causes the ADRs
Endocrine/CV/Lipids/ANS/CNS (EPS: dystonia, akathisia, TD, NMS),hematolgic, hepatic. Also know how to treat EPS, akathisia, TD, NMS.
Know all monitoring parameters for antipsychotics
Role of long acting/depot injectable APs.. how do you convert from oral?
Clozapine ADRs and monitoring requirements
Given a short case, recommend antipsychotic treatment including dose and schedule (atypicals)

BIPOLAR DISORDER
Clinical presentation (mania (DIG FAST) and depression)
What drugs/medical conditions can induce mania?
Rapid cycling
Why is it frequentlly not recognized/diagnosed?
Goals of therapy/monitoring
What are the approved mood stabilizers?
Lithium (pk, adrs, interactions, dosing, monitoring levels)
Carbamazepine, VPA, oxcarbazepine, lamotrigine - review all adrs, interactions
STEP-BP trial outcomes

ADDICTION: focus on ETOH and opiates
Signs and sx of alcohol and opiate withdrawal and intoxication
How to treat withdrawal of both and maintentace therapy for dependence
Focus on benzos with withdrawal from ETOH, monitoring
Tolerance/dependence/addiction
Medical complications of intoxication and withdrawal
Methadone/buprenorphine
Disulfiram/Naltrexone/Acamprosate
How brain gets hijacked....
Investigational agents discussed in class

Delirium
Differentiate delirium from depression and dementia
Drug induced causes
How to treat
Risk factors for delirium