Anxiolytics/Lithium

Question 1

is tolerance and abuse an issue for prescribed benzodiazepines

Answer 1

no

Question 2

what are the relative contraindications to use of benzodiazepines for treatment of anxiety

Answer 2

hx of alcohol abuse or substance abuse

Question 3

for situational anxiety or generalized anxiety includes what drug and dose is used to minimize sedation?
- how long does sedation usually last

Answer 3

diazepam 2-5mg TID

last around 2 weeks

Question 4

what group of individuals experience greater sedation and greater impairment of psychomotor performance when taking benzodiazepines

Answer 4

elderly patients

Question 5

this drug is a nonbenzodiapexpine effective in the treatment of generalized anxiety disorder

Answer 5

buspirone

Question 6

MOA of buspirone

Answer 6

partial agonist at serotonin receptors resulting in decreased serotonin turnover

Question 7

what is the principle disadvantage of buspirone

Answer 7

slow onset of effect 1-2 weeks. which may be interpreted as ineffectiveness by patients experiencing anxiety

Question 8

____ anticonvulsants and antipsychotics are considered drugs of choice for the treatment of bipolar disorder

Answer 8

lithium

Question 9

Lithium MOA

Answer 9

inhibits second messenger system leading to release of calcium ions from intracellular storage sites- repeated firing causes the neuron to be depleted of second messenger

Question 10

what is the plasma lithium concentrations goal

Answer 10

1.0-1.2mEq/L

Question 11

when do we draw lithium levels

Answer 11

10-12 hrs after last dose

Question 12

after a lithium dose change when should levels be rechecked

Answer 12

4-5 days

Question 13

the most common serious side effects of lithium

Answer 13

polydipsia and polyuria

Question 14

which diuretics facilitate the excretion of lithium

Answer 14

potassium sparing triamtere, spironolactone

Question 15

which diuretics facilitate increased plasmas concentrations

Answer 15

loop and thiazide

Question 16

NSAIDS can do what to lithium concentrations

Answer 16

decrease renal blood flow and may produce marked increases in plasma concentration of lithium

Question 17

This certain potassium sparing diuretic is effective in deceasing urine volume without affecting the plasma concentrations of either lithium or potassium

Answer 17

amiloride

Question 18

if a patient is on lithium how often do we check BUN and CR

Answer 18

every 6months

Question 19

patient with sick sinus syndrome should have what in place prior to lithium therapy

Answer 19

artificial cardiac pacemaker in place

Question 20

this side effect of lithium therapy is more common in women than men develop around 5% of the time

Answer 20

hypothyroidism

Question 21

what is the response to depolarizing and non depolarizing drugs while on lithium

Answer 21

prolonged in the presence of lithium as well as anesthetics

Question 22

what is the effect of ACE inhibitors to lithium concentrations

Answer 22

may increase plasma lithium concentrations

Question 23

why are beta blockers used during lithium therapy

Answer 23

decrease lithium induced tremor

Question 24

valporic acid off label use

Answer 24

migraine