1
Q
what dose suboxone must one be on for sublocade?- the SQ injection- for how long?
A
8-24mg for at least 7d
2
Q
what dose of buprenorphine must one be on to use probuphine (the subdermal implant)?
A
=<8mg/d
3
Q
how should methadoen be administered
A
10mg methadone/mL diluted to make a 100mL solution in orange drink
4
Q
which has a max dose? methadone or buprenorphine
A
buprenorphine
5
Q
which has higher tx retention? methadone or buprenorphine
A
methadone
6
Q
if a methadone pt misses 3d of tx, what should be done?
A
contact MD (always even if <3d)
MD will decrease dose by 50%
7
Q
what should be done if a methadone pt misses 4 or more days of their methadone?
A
contact MD (always)
restart at low initial dose ~30mg
8
Q
what happens if methadone pt vomits dose
A
offer no more than 50% replacement only if vomited within 15 min and witnessed
9
Q
when should a naloxone dose be repeated
A
3min
10
Q
acamprosate is preferred for patients with ____ insufficiency
A
hepatic
11
Q
how long do you hve to be abstinent from alcohol before starting acamprosate
A
14d
12
Q
How long do you have to be abstinent from alcohol and opioids before starting naltrexone
A
alcohol = can start while still drinking
opioids = 7d
13
Q
how long do you have to be abstinent from alcohol before starting disulfiram
A
48hrs
14
Q
what are some complications of AUD
A
thiamine (B1) deficiency
low electrolytes
liver disease
wernicke’s encephalopathy
15
Q
what should be nutritionally supplemented in all alcoholics
A
B1, glucose w/ B1, multivitamins
16
Q
what is 1st line tx for alcohol w/d
A
BZDs
17
Q
which BZDs are more preferred for elderly w/ AWS
A
lorazepam or oxazepam -intermediate acting BZDs
18
Q
if the response to BZDs for AWD is not adequate, what can be added
A
phenobarbital
19
Q
in short acting opioids, w/d starts in
A
8-24h
20
Q
what are the long acting BZDs
A
diazepam
chlordiazepoxide
flurazepam
21
Q
what are the short acting BZDs
A
ATM-alprazolam, triazolam, midazolam
22
Q
in those on prolonged BZDs tx, taper should be over
A
6-12wks
23
Q
T or F: there is currently no approved meds for CNS stimulant withdrawal
A
T- may use methylphenidate as maintenance
24
Q
what is the pharm tx rec for chronic fatigue sx
A
supplementation
short trial of sedating AH or low dose hypnotics
25
what is a common condition w/ restless leg syndrome
iron deficiency
26
what is used to tx intermittent RLS
levodopa preps - carbidopa/ levodopa
BZDs
low potency opioids
27
what is used to tx chronic persistent RLS
GABA derivatives (gabapentin, pregabalin)
nonergot dopamine agonists (pramiprzole, ropinirole, rotigotine)
28
what may be used for severe refractory RLS in pregnant pts
opioids, BZDs, levodopa/ carbidopa (same as intermittent in normal pt)
29
THC is a _______ at CB1 and CB2
partial agonist = releases dopamine
30
CB2 is found ______ aand ____ and is involved in______
throughout immune system and blood cells
involved in immune and inflammatory functions
31
when does smoking/ vaporising cannabis onset
30s-5min
32
adults can possess or share ___g legal cannabis aand own up to ___ plants
30g
4 plants
33
1g dried cannabis = ___g fresh
5
34
avoid driving for __hrs after eating cannabis, ___ hsr after smoking
8hrs PO, 6hrs INH
35
what are the 4 conditions cannabis may be used for
neuropathic pain
MS spasticity
CINV
palliative cancer pain
36
how many neuropathic pain drugs or palliative cancer pain drugs must the pt have tried before cannabis
3 neuropathic
2 cancer
37
what is the suggested starting dose for cannabis
0.5g/d
38
1mg nabilone = ___mg THC
10mg
39
which approved cannabis product in Canada is metabolized by CYP enzymes
nabiximols spray
40
nabilone is approved for
severe N/V from cancer chemo
41
migraines have at least 2 of:
nausea, light sensitivity, itnerference w/ activities
42
MOA can occur with ____ d of simple analgesics or _____ days of opioids/ triptans
15d of simple analgesics
10d of opioids/ triptans
43
COC with ___ E content may precipitate migraines, ____ E may decrease the frequency
higher E = precipitate
lower E = decrease
44
what is the algorithm for acute migraines
if causing bed rest = triptans first, then may add NSAIDs
then may trial DHE +/- antiemetic and CGRP inhibitors
if not causing bed rest = simple analgesics with triptans as rescue prn
45
what is the onset of triptans
30-60min
46
should you ever repeat a triptan dose
you can after 2hrs, but 2nd dose is unlikely to be helpful if first didn't provide relief within 2hrs
never mix 2 triptan types within 24hrs
47
which triptans come as an oral wafer
riza and zolmi
48
triptans are CI in pts with:
heart disease, cardiac sx, within 24hrs of another triptan, pregnancy
49
how many types of triptans should you trial
3
50
which triptan has a clear dose-response relationship
sumatriptan
51
which triptan has the slowest onset but the least AEs
naratriptan
52
which triptan should be used with caution in those taking proptanolol and avoided with MAOis
frovatriptan and rizatriptan
53
which triptan is CI within 72hrs of a potent CYP3A4 inhibitor
eletriptan
54
CGRP injections are used for _________, while PO are used for __________
inj = prevention
oral = treatment
55
when should migraine prophylaxis be considered
if migraines are having a significant impact on QoL despite appropriate abortive tx
risk fo MOH
=>4x/mth
56
how long should migraine prophylaxis be for? how long for benefit?
2mths for benetif
prophylax for 6-12mths
57
what is considered successful migraine prophylaxis
decrease in at least 50% frequency of days
58
what is preferred migraine prophylaxis in pts w/ comorbid mood disorder
TCAs (amitriptyline, nortriptyline), venlafaxine
59
what is preferred migraine prophylaxis in pts w/ comorbid HPTN
BB (propranolol)
candesartan
verapamil (best for cluster)
60
waht is 1st line for TTH prophylaxis
amitrpytline, nortrityline
61
what is prophylaxis for pregnancy/ BF Hs
propranolol
62
which triptan is ok in breastfeeding
sumatriptan
63
which seizure types have impaired consciousness (5)
complex partial seizures
secondary generalized tonic/ clonic
absence
generalized tonic/clonic
atonic
64
what are 7 1st line tx for focal seizures
LTG, LEV, LAC, LTG, BRI, OXC, CBZ
(LLLV Boc (LV box))
65
what is 1st line tx for absence seizures
ETHO
66
what is 1st line tx for generalized tonic clonic
VPA, LEV, LTG
67
what is 1st line for atonic seizures
VPA
68
what is 1st line for myoclonic seizures
VPA, LEV
69
which AEDs are enzyme inducers
CBZ, eslicarbazepine, oxazepine, PHT, PB, PHT, PRM, rufinamide, topiramate, clobazem
70
which contraceptive methods are not affected by enzyme inducing AEDs
barrier, IUD, depot progesterone
71
which AED most likely to cause CNS and GI dose dependent effects
CBZ, LTM, PRN, TOP, VPA
72
which AED most likely to cause skin rash
LTG, CBZ, PHT
73
what to do if AED causes skin rash in 1st 6wks
stop and use one that is not LTG, CBZ, PHT
74
which AED causes neutropenia, which causes thrombocytopenia?
CBZ = neutropenia
VPA = thrombocytopenia
75
which ED levels decrease in preg
TOLLL
topiramate, oxazepam, LAV, LEV, LTG
76
____ levels can drop =>50% in pregnancy during 2nd and 3rd trim = 100% dose increase and back to normal dose immed after delivery
LTG
77
pts on AEDs trying to conceive should take
1mg folic acid from preconception until end of 1st trimester
then 0.4mg/d to prevent neural tube defects
78
___________ is metabolized into ________
primidone or phenobarb
primidone is metabolized to phenobarb
79
what is clobazem typiclaly used for in seizures
add on for pts who are nearly seizure free due to broad spectrum + fast onset
80
what is a AE limiting vigabatrin's use
permanent vision loss
81
wha tis a chronic AE of ETHO
behavioural problems
82
LEV should be avoided in pts w/ a history of ______
psychosis
83
which ED is associated with SJS and requires very slow titration
LTG
84
what should be done with LTG after a COC is started
2x LTG dose
85
which AED is associated with word finding difficulties
topiramate
86
aim to reduce/ eliminate seizures within ___
1-4wks
87
when may AED be stopped (typically life long)
seizure free for 2-4yrs or complete control within 1yr
onset between 2-35yrs
normal neuro exam and ECG
88
which ED requires HLA testing to decrease risk of rash
CBZ
89
which AED causes hyponatremia and induces its own metabolism
CBZ
90
Topiramate effect on weight
weight loss
91
VPA/DVP is ___toxic
hepatotoxic
92
which NSAIDs should be used if GI risk is high
celecoxib + PPI
93
which NSAIDs should be used if CV risk is high
naproxen + PPI
94
what meds are 1st like for neuropathic pain
TCAs, gabepentin/ pregabalin, duloxetine
95
duloxetine is 1st line for which kinds of pain
peripheral diabetic neuropathy, fibromyalgia
96
morphine should be avoided in CrCL <
60
97
which opioids should be avoided in CKD
morphine, codeine, meperidine
98
which opioids are good for CKD
hydromorphone, methadone
99
a fentanyl patch should be placed every ____ days
3
100
how often should methadone be titrated
q3-7d
101
in opioid management, how much of a decrease in pain intensity indicates efficacious tx
decrease by 30%
102
how to dose breakthrough pain doses?
when would you increase the TDD instead of adding more breakthrough doses?
10-20% of TDD q1-2hrs if injection, q3-4h if PO
increase schedule doses if pt is using >4-6x/d
103
how to switch opioids
incomplete cross tolerance = decrease dose by 25-50%
decrease dose by 50% if MEQ >90mg
104
what is the conversion from codeine to morphine
x0.15
105
what is the conversion from oxycodone, or hydromorphone to morphine
oxycodone = x1.5
hydromorphone = x5
106
what MS drug is used for PPMS
ocrclizumab
107
what deficiency may mimic sx of MS
vit B12 deficiency
108
MS sx may be worsened by
extremes of temperature
109
when should a MS pt switch to antoher DMT agent
if =>2 relapses after 6-12mths of tx with a DMT
110
how long do DMTs take to show benefit
2-6mths
111
siponimod is used for __________ to delay progression of physical disability
SPMS
112
what are the 1st line DMTs
T-DIG
teriflunomide, dimethyl fumerate, interferon beta, glatiramer acetate
113
what is standard 1st line tx for MS
interferon beta
114
how long for interferon beta to take effect
3mths
115
glatiramer acetate takes ____ months for effect
6
116
what to monitor when using dimethyl fumerate
CBC, liver fxn, urinalysis
117
which of the following should concomitant live vaccines be avoided:
1. interferon beta
2 .glatiramer acetate
3. dimethyl fumerate
4. all of the above
3
118
teriflunomide has teratogenic effects that may alst up to
2yrs after d/c
119
how long for teriflunomide to take effect
3mths
120
in those who become pregnant while on teriflunomide, what should be done
washout with cholestyramine
121
fampridine is used in MS to
improve walking ability
122
how long does fampridine take to improve walking ability
4wks
123
what may be given in acute relapse of MS
methylprednisolone for 3-5d then PO prednisone to decrease length and severity of relapse
124
what supplementation should be given to all MS pts
vit D (min 1000 IU/d)
125
fingolimod is for
very active MS disease
126
natalizumab is for
very active RRMS
127
how long to try a DMT before switching
6-12 mths
128
which DMT is most likely to increase QTc
fingolimod
129
____ (gender) are more likely to get MS and ____ (gender) are more likely to get PD
F = MS
M = PD
130
waht are the 4 sx of PD
TRAP
tremor, rigidity, akinesia/ bradykinesia, postural instability
131
T or F: there is no drug that helps with freezing in PD
T
132
what is a differentiating factor for drug induced PD vs actual PD
drug induced = bilateral and symmetrical
does not or poorely response to L-dopa
133
when to start tx for PD
when disease starts interfering with QoL
134
which tx to choose in mild/ early PD
dopamine percursor + dopa decarboxylase inhibitor
MAOBi (in mild)
dopamine agonist
135
which MAOBi has an amphetamine metabolite
selegiline
136
which MAOBi has lowered bioavailability w/ high fat meals
rasagiline
137
anticholinergics are used in PD to
decrease tremor
138
amantadine is a
NMDA antagonist
139
what is amantadine used for
used in later stages of PD to reduce L-dopa induced dyskinesias
140
livedo reticularis is an AE of which PD drug
amantadine
141
pramipexole, ropinirole, rotigotine are all
nonergot dopamine agonists
142
dopamine agonists are not recommended in
>70yrs, hx compulsive behaviours
143
which dopamine agonist causes pulmonary fibrosis
bromocriptine
144
levodopa in DP must be (select all that apply)
1. in combo with MAO-Bi to cross BBB
2. in combo with peripheral decarboxylase inhibitor to cross BBB
3. initial tx for >70yrs
4. taken separately from protein meals
5. given as CR dose for freezing
2, 3, 4
145
what is the purpose of entacapone
a COMTi to extend L-dopa duration to manage wearing off
146
which PD drug has AE of orange urine discoloration
entacapone
147
what is used for severe "off" periods in PD
apomorphine
148
how to manage end of dose wearing off for PD levodopa
increase levodopa dose or frequency
+ DA or COMTi
bedtime admin of levodopa CR or dopamine agonists
change to levodopa CR
MAOBi to reduce fof time
149
how to reduce peak dose dyskinesias in PD
decrease dose of levo and increase frequency or + dopamine agonist
stop MAO-Bi
decrease dose and + COMTi
add amantadine
150
which N/V drug may be used in PDs
domperidone
151
what is the order to stop PD drugs in drug induced psychosis
anticholinergics, TCAs, AH, Anxiolytics, sedatives
Amantadine
DA
COMTi, MAOBi
L-dopa
152
which antipsychotics may be used in DP
quetiapine, clozapine
PEBC
flashcards
Decks in class (9)
# Cards
