Anti-depressan

1)selective serotonin reuptic inhepetor (SSRI) -xetine

Fluoxetine,paroxetine,sertraline,doluexitine
857 Antidepressants can be used with epilepsy patient?
paroxetine
Selective serotonin reuptake inhibitors is first choice but Fluoxetine is not recommended
because it has a long half-life, potentially carries a greater risk of seizures

Q- Serotonin norepinephrine reuptake inhibitor ? Venalvaxine • desvenlavaxine • duloxetin

991 What will happen if you give s john wort with fluoxetine?
Answer Concurrent use of ST JOHN'S WORT and SSRI may result in an increased risk
of serotonin syndrome (hypertension, hyperthermia, myoclonus, mental status changes).

148 What is the drug of choice for depression in obese patients?

Bupropion and venlafaxine are associated with weight loss.
they should avoided: paroxetine, mirtazapine, tricyclic antidepressants (tcas), and
monoamine oxidase inhibitors (maois).
498 Antidepressant should be avoided in seizures patient
Bupropion
449 What is the medication to treat neuropathic pain and depression
Answer
The ADA guidelines recommend duloxetine and pregabalin first-line. Other drugs
That can be considered include tricyclic antidepressants (TCAs), gabapentin, venlafaxine,
carbamazepine, tramadol and topical capsaicin.
466 Duloxetine?
Answer
SSRI
499 Drug used for treatment of premature ejaculation
Answer
Dapoxetine
551 Which antipsychotic drug is not given to pregnant
Answer
A-fluoxetine
B- fluvoxamine
C-Bupropion
2)monoamine oxide inhibitor(MAO)
Phenelzine

3) tricycilic antideprationt(TCA)
amitriptyline, imipramine

940 drug used for circadian rhythm

Answer
a- SSRI
b- SNRI
c- Amitriptyline
29-tertiary amine of TCA (tricyclic antidepressant) is
a-Amitriptylline and imipramine
b-desipramine and nortriptyline(secondry antidep.)
302-Which of the following drugs is not a Tricyclic Antidepressant?
a- Trimipramine b- Maprotiline (tetracyclic) c- Nortryptiline

4)heterocyclic antidepressentb
Amoxapine , maprotillne , trazodone ,venrfxine ,mirtrazapine ,nefazodone

346 Drug treat acute mania?

Lithium
544 Which one of these minerals its change will increase lithium toxicity?
Na – K - Ca - Mg > compete with lithium binding site
(explanation: sodium depletion (i.e. hyponatremia) can impair lithium excretion
resulting in lithium accumulation inside the body. This’s because the kidney mistake
lithium for Na.)
415Dantrolone mechanism of action
Dantrolene, a direct-acting skeletal muscle relaxant, inhibits the release of Ca ion from the
sarcoplasmic reticulum leading to decreased response to action potential and decreased
muscle contraction.
551 Which antipsychotic drug is not given to pregnant
A-fluoxetine
B- fluvoxamine
C-Bupropion
Q- Antidepressant act on which area in brain ? Postsynaptic

ANTI EPILEPTIC

206 Epileptic patient has skin rash after use of oxcarbazepine what is alternative therapy
Answer
Gabapentin ( NEURONTIN )
344 What is Antiepileptic for pregnant women?
Answer
Levetiracetam or lamotrigine
992 Patient with status epilepticus received lorazepam IV what is the second line?
Answer A-oral diazepama B-Oral phenobarbital
C-Iv phenobarbitals D- Iv phenytoin

402- ethosuximide is antiepileptic used in absence (petit mal) seizure

651What Is Lamotrigine Side Effects

Significant : rash, aseptic meningitis, blood dyscrasias, CNS depression, suicidal ideation
and behavior

18 Status epilepticus treatment

r Benzodiazepines are the first-line treatment for convulsive status epilepticus because
they control seizures rapidlyFor IV therapy, lorazepam is preferred in adults [6];
midazolam is preferred for intramuscular (IM), intranasal or buccal therapy; and diazepam
is preferred for rectal administration.
Lorazepam – Use of lorazepam as a first-line agent

130 Which one of antiepileptic drugs need renal adjustment ?

Answer
Topiramate – tiagabine – diazepam
279 1st option in treating status epilepticus
Answer
Stabilization: give D25, D50 (Dextrose)
THEN:
Initial treatment:
PR (rectal) Diazepam 0.2-0.5 mg/kg
Or
IN (intranasal) Midazolam 0.15-.3 mg/kg, IM 0.2 mg/kg up to 10 mg
IV/IM Benzodiazepines
653 Phenytoin Plasma Level. When To Take ?
level can be taken 2-4 hours following an IV loading or top-up dose (12-24 hours for oral
doses) and levels should then be monitored every 24 hours until control is achieved and
concentration has stabilized.
While vancomycin is achieved (ie, before fourth dose) Draw trough specimen immediately
before (≤30 min) the fourth dose.
24 What is test for phenytoin toxicity ?
Answer Total serum phenytoin concentration, and serum albumin. > blood culture The
level of unbound phenytoin may be calculated using the corrected winter-tozer formula:
Corrected phenytoin levels (mg/dl): serum phenytoin level (milligrams/liter) (0.25 x
albumin [grams/deciliter]) +0.1
55 What is adverse effect of phenytoin ?
Gingival hyperplasia
61 Patient used phenytoin and conc. Of phenytoin 13.5 what should u do ?

Normal range 10-20

278 What is the possible complications if Phenytoin level 200
Answer
At concentrations greater than 50 mcg/ml (200 μmol/L), phenytoin can exacerbate
Seizures.
Adverse Drug Reaction: Hypotension and cardiac arrhythmia; nystagmus
The infusion rate should be slowed if the QT interval widens or if hypotension or
arrhythmias develop; horizontal nystagmus suggests serum concentration above the
reference range and toxicity;
487 Phenytoin sodium equivalent to phenytoin base?
Answer
Each 100 mg of phenytoin sodium (salt) contain 92 mg of phenytoin base.
Q- Diazepam prescription is valid until ? 7 days , 14 days ,28 days

488 Doctor prescribe phenytoin 100 mg TID and then change dose after how many days
need monitoring
1- 1day
2- 3 days (5-10 dyes)
3- 7days
4- 30 days
566 old patient with seizure the physician prescribes diazepam what would you choose
A-Chlordiazepoxide
B-Midazolam
C-Alprazolam
611 Side effect of benzodiazepines
Drowsiness and confusion are the most common side effects of the benzodiazepines.
Ataxia occurs at high doses Cognitive impairment
821 Phenytoin
1hr after LD if IV 24 after oral LD
937women with uncontrolled seizures using phenytoin lab test showing that albumin 2.2
mg/dl
a- low efficacy of phenytoin due to hypoproteinemia
b- low efficacy of phenytoin due to Drug interaction
c- high efficacy of phenytoin due to hypoproteinemia
Q- Lamotrigine side effect ? Skin rash
Q- DOC breastfeeding with seizure ? Levetiracetam

Q- DOC pregnant with seizure ? lamotrigine

Q- Doctor prescribes phenytoin 100 mg tid and then change the dose how many days need to
monitoring ?
1 day - 3 days - 7 days - 3 days
Q- DRUG NEED monitoring ? Phenytoin
Q- WOMEN TAKE valproic acid AND PLAN TO BE PREGNANT KEEP IT ON OR
CHANGE ?
Change it
Q- A patient has status epilepticus , he received IV lorazepam , what is the second line to
treat him ? Phenytoin , phenobarbital
Q- which drug need monitoring and efficacy considerations?
Phenytoin, valproic acid, carbamazepine , aminoglycosides , digoxin

Q- One has a loss of appetite, while he has epilepsy, what do you think is the best thing for
him? Mirtazapine

Q- HTN +epilepsy which antidepressant

can be used ? Paroxetine = SSRI drug

benzodiazepine
Q- Bzd ‫يستخدم لي‬
Benzodiazepines possess: Psycholeptics, sedative, hypnotic, anxiolytic, anticonvulsant,
muscle relaxant

Q- Validity of diazepam prescription ? 7 days

Q- The maximum allowed amount of diazepam to dispense ? 30 days
Q- How many refill for Zolpidem ?
MAN: 3.5
WOMEN: 1.75
Q- Max Zolpidem dose in female ? 5
Q- Max dose of zolpidem IN MALE ?
a-5mg b-10mg c-15mg 20-mg
Q- Zolpidem MOA? benzodiazepines like action
Zolpidem is a type A GABA receptor agonist of the imidazopyridine class.
t works by increasing GABA effects in the central nervous system
by binding to GABAA receptors at the same location as benzodiazepines

Q- Get lag TTT zolpidem or melatonin ? Melatonin

Q- Symptoms on female 21 years old: mydriasis ....... she poisoned by ?
Heroine: over dose miosis
Benzodiazepines: over dose cause mydriasis
Q- Donepezil MOA ?
Donepezil binds reversibly to acetylcholinesterase and
inhibits the hydrolysis of acetylcholine, thus
increasing the availability of acetylcholine at the synapses,
enhancing cholinergic transmission

Parkinson’s disease

150 What is the best drug for Parkinson’s disease patient who has nausea?
Nausea is a common adverse effect of levodopa. However, carbidopa helps in reducing the
incidence of it. In patients on low doses, additional carbidopa may be adequate to relieve
nausea. If additional carbidopa is ineffective or unaffordable, domperidone is a good
option. Avoid metoclopramide and prochlorperazine.
710 levodopa/carbidopa absorption affected by
- fat meal increase absorption
- empty stomach
- decrease with protein
184 Which medication for parkinson causes dizziness?
Answer
Apomorphine, pramipexole, ropinirole, rotigotine

477 Counseling, levodopa/carbidopa ?

Answer The combination of levodopa and carbidopa is used to treat the symptoms of
Parkinson's disease
23 Amantadine MOA
Answer Pharmacologic Category
Anti-Parkinson Agent, Dopamine Agonist; Antiviral Agent; Antiviral Agent, Adamantane
Mechanism of Action
Amantadine and rimantadine interfere with the function of the viral M2 protein, possibly
blocking uncoating of the virus particle and preventing viral release within infected cells.
In Parkinson disease

86-amantadine(antiviral) used for treatment of parkinsonism

24The dose of levodopa /carbidopa depend on which one of them?

Answer
Carbidopa, a dopamine decarboxylase inhibitor, diminishes the metabolism of levodopa
in the periphery, thereby increasing the availability of levodopa to the CNS. The addition
Of carbidopa lowers the dose of levodopa needed by four- to fivefold and, consequently,
decreases the severity of the side effects arising from peripherally formed dopamine.
660 MOA of L-dopa
Levodopa increases dopamine levels in the brain leading to the stimulation of dopamine
receptors.

Q- Someone is taking medications for Parkinsonism and his limb was moving without control
what is this called?
Extrapyramidal side effects
Q- Which of the following is hepatotoxic ? Tolcapone
Q- What is the most important point to discuss with the patient regarding
Levodopa/Carbidopa ?
A) Take on empty stomach.
B) Highly-protein meals will decrease the absorption.

ALZHEIMER
DONEPEZIL ,GALANTAMINE ,RIVASTIGMINE (ANTICOLINESTERASE)
MEMANTINE (N-METHYL-D-ASPARTATE RESEPTOR ANTAGONIST)

203 What is drug of choice for severe Alzheimer?

Answer
Donepezil
Three cholinesterase inhibitors are commonly prescribed: Donepezil (Aricept) is approved
to treat all stages of Alzheimer's. Rivastigmine (Exelon) is approved to treat mild to
moderate Alzheimer's. Galantamine (Razadyne) is approved to treat mild to moderate
Alzheimer's.

632 What Is Benzodiazepines Used In Alzheimer

Answer
Benzodiazepine Use in Alzheimer’s Patients Increases Mortality Risk, but I think
Oxyzepam can use for a short time as the researchers urge only short-term use.

59 Mechanism of donepezil in Alzheimer?

Answer
Donepezil hydrochloride is a reversible acetylcholinesterase (ache) inhibitor. Its
therapeutic effect in Alzheimer's disease stems mainly from an increase in the
concentration of acetylcholine through the reversible inhibition of its hydrolysis by
acetylcholinesterase
Q- Alzheimer patient and have urinary urgency ? oxybutin

200 New drug for Alzheimer will be released so MOA will be?
Answer
Anticholine esterase- NMDA blocker –inhibit B amyloid peptide
Q- What is drug of choice for severe Alzheimer?
Donepezil - for all stages ( mild, moderate, sever)
Memantine - moderate to severe
Donepezil + memantine - moderate to severe

ANTIPSYCHOTIC
45 Mechanism of Action of chlorpromazine?
Answer
Trad name(thorazine)
Class(Aliphatic, Antiemetic, Antipsychotic, CNS Agent, Phenothiazine)
Mechanism of Action:
-Chlorpromazine hydrochloride is a dimethylamine derivative of phenothiazine which the
exact mechanism of action is unknown. It is a psychotropic agent that produces sedative
and antiemetic activities in the CNS, as well on other organ systems. It has weak
anticholinergic and strong antiadrenergic activity and also possesses slight ganglionic,
antihistaminic, and antiserotonin activity -Chlorpromazine is an aliphatic phenothiazine
antipsychotic which blocks postsynaptic mesolimbic dopaminergic receptors in the brain;
exhibits a strong alpha-adrenergic blocking effect and depresses the release of
hypothalamic and hypophyseal hormones; believed to depress the reticular activating
system, thus affecting basal metabolism, body temperature, wakefulness, vasomotor tone,
and emesis.
4 What Is treatment of mania ?
Answer
Lithium > chronic Antipsychotics like : chlorpromazine, haloperidol, risperidone,
olanzapine, quetiapine, ziprasidone, aripiprazole, and asenapine in acute mania
726 psychiatric patient use olanzapine - lab result high glucose Which alternative
Answer
- Clozapine
- Aripiprazole
- Quetiapine
- Haloperidol
851 Smoking with olanzapine
Answer This drug may cause somnolence and dizziness, if affected, avoid driving and
operating
machinery. Avoid cigarette smoking

687Clozapine + smoking
Increase Clozapine plasma
- Decrease clozapine plasma

860 Clozapine monitoring

White blood cells
261 Which medication need renal adjustments in antipsychotic?
Clozapine, paliperidone, risperidone, and lurasidone
922 Common side effect form Clozapine
Agranulocytosis
923 What do you need to check before starting Clozapine
WBC
502 Anxiolytic with least sedation and withdrawal symptoms
Buspirone
233 Patient obese has depression which antidepressant is best?
Buprobion – amitryptiline
979 Most effective medication in treating positive symptoms in schizophrenia
2nd generation

662 Patient develop involuntary movement face which drug patient take
Haloperidol

491 Fingolimod
Is used for treatment of multiple sclerosis (MS) it’s an oral drug that alters lymphocyte
migration resulting in fewer lymphocytes in the CNS

Q- Which of the following is the most likely to be associated with CNS side effects in
elderly?
A) Antacids
B) PPIs
C) H2-antagonists

Q- Interaction between lithium and thiazides ?

Thiazide diuretics have a significant potential to increase serum lithium concentrations.
These diuretics induce a natriuresis that leads to a compensatory increase in the
reabsorption
of sodium (and lithium) in the proximal tubule (5)
Q- when to take trough level of lithium ?
Trough: 30 min before dose
Peak: Drawn 8 – 12 hr post dose
Monitoring for: renal and thyroid every 6-12 month
Q- Symptoms on female 21 years old: mydriasis ....... she poisoned by ?
• Mydriasis:
(Anticholinergics): e.g. Atropine & Scopolamine
(Psychostimulant medications:) Dexamphetamine, Methylphenidate hydrochloride,
methamphetamine, cocaine.
Q- Antipsychotic for Parkinson patient ? Quetiapine
Q- Antiemetic in Parkinson ? Domperidone