Page 1
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 1
© Mark E. Damon - All Rights Reserved
APNA 2011
Clinical Psychopharmacology
Mary A. Gutierrez, PharmD, BCPP
Professor of Clinical Pharmacy & Psychiatry
Loma Linda University School of Pharmacy
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Welcome to
Who Wants to
be an APNA
Millionaire!
50:50
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
50:50
Page 2
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 2
© Mark E. Damon - All Rights Reserved
A: Accutane
C: Interferon
B: Flexeril
D: Larium
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following
medications is not likely to
cause or worsen depression?
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© Mark E. Damon - All Rights Reserved
A: Priapism
C: Anticholinergic
B: Orthostasis
D: Peripheral edema
50:50
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Other than sedation, which of
the following is a common
side effect of trazodone?
Page 3
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 3
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
© Mark E. Damon - All Rights Reserved
A: 5 hours
C: 5 weeks
B: 5 days
D: 5 months
50:50
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
When Prozac (fluoxetine)
is discontinued, it takes
approximately how long for
the drug to be washed
out of the system?
© Mark E. Damon - All Rights Reserved
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Page 4
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 4
© Mark E. Damon - All Rights Reserved
A: Sertraline
C: Mirtazapine
B: Bupropion
D: Venlafaxine
50:50
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which antidepressant has
antiemetic effects and
considered the best choice for
patients on chemotherapy with
nausea and vomiting ADRs?
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© Mark E. Damon - All Rights Reserved
A: Venlafaxine
C: Bupropion
B: Fluoxetine
D: Paroxetine
50:50
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following
antidepressants have a
higher incidence of serotonin
withdrawal syndrome
and should be tapered off?
(Select all that apply)
Page 5
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 5
© Mark E. Damon - All Rights Reserved
the $1,000
Milestone!
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
© Mark E. Damon - All Rights Reserved
A: Low libido
C: Premature ejaculation
B: Erectile dysfunction
D: Anorgasmia
50:50
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
What type of sexual dysfunction
can be improved with the
use of SSRIs?
Page 6
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 6
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
© Mark E. Damon - All Rights Reserved
A: Fluoxetine
C: Escitalopram
B: Fluvoxamine
D: Sertraline
50:50
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following
SSRIs can be used
for patients on warfarin?
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Page 7
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 7
© Mark E. Damon - All Rights Reserved
A: Fluoxetine
C: Duloxetine
B: Sertraline
D: Bupropion
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following
antidepressants has increased
absorption (by 40%)
when taken with food?
© Mark E. Damon - All Rights Reserved
151413121110987654321
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© Mark E. Damon - All Rights Reserved
A: Trazodone
C: Carbamazepine
B: Mirtazapine
D: Doxepine
50:50
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following is the
active drug for Silenor®?
Received FDA approval in 2010 for the
treatment of acute and chronic insomnia
in adult & geriatric patients
Page 8
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 8
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
© Mark E. Damon - All Rights Reserved
A: Fluoxetine
C: Sertraline
B: Paroxetine
D: Fluvoxamine
50:50
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which SSRI is not
recommended for children
and adolescents?
© Mark E. Damon - All Rights Reserved
the $32,000
Milestone!
Page 9
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 9
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
© Mark E. Damon - All Rights Reserved
A: Paroxetine
C: Duloxetine
B: Fluoxetine
D: Bupropion
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following
antidepressants can
decrease the efficacy of
tamoxifen for breast cancer?
(Select all that apply)
© Mark E. Damon - All Rights Reserved
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Page 10
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 10
© Mark E. Damon - All Rights Reserved
A: Lamictal
C: Topamax
B: Depakote
D: Tegretol
50:50
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following
anticonvulsants has
the highest risk of
Stevens-Johnson Syndrome?
© Mark E. Damon - All Rights Reserved
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© Mark E. Damon - All Rights Reserved
A: Risperidal
C: Reglan
B: Phenergan
D: EMSAM
50:50
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which medications can
cause gynecomastia with
long term use?
(Select all that apply)
Page 11
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 11
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
© Mark E. Damon - All Rights Reserved
A: Zoloft
C: Paxil
B: Prozac
D: Wellbutrin
50:50
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following is
commonly used for ADHD
in children and adolescents
and does not have a
FDA-approved indication?
© Mark E. Damon - All Rights Reserved
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Page 12
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 12
© Mark E. Damon - All Rights Reserved
A: Increase serotonin
C: Blocks adenosine
receptors
B: Increase NE
D: Blocks DA receptors
50:50
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
How does caffeine work to
increase wakefulness?
© Mark E. Damon - All Rights Reserved
YOU HAVE WON
$1 MILLION DOLLARS
IN PSYCHOPHARM IQ!
© Mark E. Damon - All Rights Reserved
APNA 2011 – Game II
Clinical Psychopharmacology
Mary A. Gutierrez, PharmD, BCPP
Professor of Clinical Pharmacy & Psychiatry
Loma Linda University School of Pharmacy
Page 13
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 13
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Welcome to
Who Wants to
be an APNA
Millionaire!
50:50
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
50:50
© Mark E. Damon - All Rights Reserved
A: Paroxetine
C: Mirtazapine
B: Venlafaxine
D: Bupropion
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following would
be the best choice for obese
patients with antidepressant
induced delayed ejaculation
or anorgasmia?
Page 14
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 14
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
© Mark E. Damon - All Rights Reserved
A: Bupropion 150 mg BID
C: Advil® PM 2C QHS
B: Pseudoephedrine
30 mg 2T QHS
D: Excedrin®
Migraine 2T QHS
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Your patient is asking for more
trazodone to help with his
nightly insomnia. Which of the
following can cause or worsen his
insomnia? (Select all that apply)
© Mark E. Damon - All Rights Reserved
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Page 15
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 15
© Mark E. Damon - All Rights Reserved
A: Valerian
C: St. Johns wort
B: Melatonin
D: Pseudoephedrine
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following OTC
products can decrease the
efficacy of oral contraceptives?
© Mark E. Damon - All Rights Reserved
A: Higher drug conc
C: Lower drug conc
for 5 weeks
B: Lower drug conc
D: No change in
drug conc
50:50
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Your patient is on fluoxetine and
6 other CYP450 metabolized meds.
What can happen with the CYP450
metabolized drug concentrations
when this patient is switched from
fluoxetine to sertraline?
© Mark E. Damon - All Rights Reserved
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Page 16
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 16
© Mark E. Damon - All Rights Reserved
A: < 2 yo
C: > 40 yo
B: < 18 yo
D: > 65 yo
50:50
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The Black Box Warning for
hepatoxicity for Depakote is
mostly associated with which of
the following age groups?
© Mark E. Damon - All Rights Reserved
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© Mark E. Damon - All Rights Reserved
A: HCTZ 25 mg
C: Amlodipine 5 mg
B: Lisinopril 20 mg
D: Furosemide 20 mg
50:50
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Your patient was stabilized on lithium for
years with steady-state levels around
0.9 mEq/L. He was started on an
antihypertensive agent last week and
his lithium levels increased to 2.7
mEq/L. Which of the following can
increase lithium levels by 200-300%?
Page 17
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 17
© Mark E. Damon - All Rights Reserved
the $1,000
Milestone!
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
© Mark E. Damon - All Rights Reserved
A: Tylenol PM
C: Melatonin
B: Unisom
D: Nyquil
50:50
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Your patient was scheduled to see you
next week for mild dystonic reactions
secondary to his risperidone. He started
taking an OTC agent nightly & his EPSE
sxs resolved before his appt. Which of
the following OTC agent can treat AP-
induced dystonia? (Select all that apply)
Page 18
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 18
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
© Mark E. Damon - All Rights Reserved
A: Ibuprofen 800 mg TID
C: Vicodin 2T Q6H
B: Tylenol #3 2T Q6H
D: Diclofenac 50 mg TID
50:50
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Your patient showed sxs of lithium
toxicity after a dental procedure &
was prescribed an analgesic agent
a few days ago. Which of the
following can increase lithium
levels? (Select all that apply)
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Page 19
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 19
© Mark E. Damon - All Rights Reserved
A: 2-gm sodium restriction
C: Theophylline
B: Grande Starbucks coffee
D: NS 0.9% infusion
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following can
increase lithium levels?
© Mark E. Damon - All Rights Reserved
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© Mark E. Damon - All Rights Reserved
A: Depakote
C: Lithium
B: Equetro
D: Abilify
50:50
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Your patient has sxs of wt gain, fatigue,
brittle hair, and cold intolerance after
starting on a psychotropic medication
for 6 months. Which of the following
psychotropic agents can
cause hypothyroidism?
Page 20
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 20
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
© Mark E. Damon - All Rights Reserved
A: Mylanta
C: Align
B: Gas-X
D: Prilosec
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following OTC
agent can increase GI
distress ADR risk for
patients on Depakote®?
(Select all that apply)
© Mark E. Damon - All Rights Reserved
the $32,000
Milestone!
Page 21
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 21
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
© Mark E. Damon - All Rights Reserved
A: Lithium
C: Risperidone
B: Bupropion
D: Selegiline
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following classes
of psychotropic medications
can cause hand tremor?
(Select all that apply)
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Page 22
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 22
© Mark E. Damon - All Rights Reserved
A: H1
C: M1
B: D2
D: 5HT2C
50:50
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Inhibition of which of the following
receptors can cause weight gain?
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© Mark E. Damon - All Rights Reserved
A: Amlodipine
C: Verapamil
B: Diltiazem
D: Felodipine
50:50
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Your patient has been on
carbamazepine for his Bipolar disorder
for many years. He was started on an
antihypertensive agent and caused CBZ
toxicity (ataxia, confusion, nystagmus).
Which of the following can increase CBZ
concentrations? (Select all that apply)
Page 23
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 23
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
© Mark E. Damon - All Rights Reserved
A: Depakote
C: Equetro
B: Paxil
D: Effexor
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following
psychotropic medications should
be tapered off and not stopped
abruptly after long-term use?
(Select all that apply)
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Page 24
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 24
© Mark E. Damon - All Rights Reserved
A: Fluoxetine
C: Amitriptyline
B: Paroxetine
D: Lorazepam
50:50
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following
psychotropic medications has the
most dangerous consequences
when stopped abruptly without
tapering after long term use?
© Mark E. Damon - All Rights Reserved
YOU WIN $1 MILLION
DOLLARS
IN PSYCHOPHARM IQ!
© Mark E. Damon - All Rights Reserved
APNA 2011 – Game III
Clinical Psychopharmacology
Mary A. Gutierrez, PharmD, BCPP
Professor of Clinical Pharmacy & Psychiatry
Loma Linda University School of Pharmacy
Page 25
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 25
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Welcome to
Who Wants to
be an APNA
Millionaire!
50:50
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151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
50:50
© Mark E. Damon - All Rights Reserved
A: Zoloft
C: Effexor
B: Wellbutrin
D: Paxil
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following
antidepressants is usually
not recommended for the
treatment of panic disorder?
Page 26
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 26
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
© Mark E. Damon - All Rights Reserved
A: Fluoxetine
C: Paroxetine
B: Citalopram
D: Sertraline
50:50
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which SSRI is not
recommended for your
70 year-old male patient with
BPH and chronic constipation?
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Page 27
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 27
© Mark E. Damon - All Rights Reserved
A: Bulimia
C: Alcohol w/d
B: ADHD
D: Use of Zyban
50:50
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following are
contraindications for the use
of bupropion?
(Select all that apply)
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© Mark E. Damon - All Rights Reserved
A: Lorazepam
C: Lithium
B: Diazepam
D: Sertraline
50:50
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Which of the following medication
has significant increase in the
its half-life and ADRs in
geriatric vs. adult patients?
(Select all that apply)
Page 28
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 28
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
© Mark E. Damon - All Rights Reserved
A: Alprazolam
C: Flurazepam
B: Lorazepam
D: Temazepam
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following
benzodiazepines have
pregnancy category X
(Select all that apply)
© Mark E. Damon - All Rights Reserved
the $1,000
Milestone!
Page 29
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 29
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
© Mark E. Damon - All Rights Reserved
A: Akathisia
C: Migraine prophylaxis
B: Lithium-induced
hand tremor
D: Asthma
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Propranolol can be used for
the treatment of which of the
following conditions?
(Select all that apply)
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Page 30
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 30
© Mark E. Damon - All Rights Reserved
A: Tylenol PM
C: Silenor
B: Flexeril
D: Aricept
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following
medications should be
avoided for patients with
memory impairment?
(Select all that apply)
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© Mark E. Damon - All Rights Reserved
A: antidepressant
C: antipsychotic
B: anxiolytic
D: anticonvulsant
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
"WARNING: This medicine is an _____.
It may increase the risk of death when
used to treat mental problems caused
by dementia in elderly patients. Most of
the deaths were linked to heart
problems or infection. “
Page 31
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 31
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
© Mark E. Damon - All Rights Reserved
A: E-Mycin
C: Cipro
B: Keflex
D: Zyvox
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Your patient on clozapine
experienced a seizure after taking
an antibiotic for a week.
Which of following antibiotics can
increase clozapine levels?
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Page 32
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 32
© Mark E. Damon - All Rights Reserved
A: E-Mycin
C: Cipro
B: Keflex
D: Zyvox
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following antibiotics
has monoamine oxidase inhibition
and can cause potential
problems with other MAOIs,
SSRIs, and SNRIs?
© Mark E. Damon - All Rights Reserved
the $32,000
Milestone!
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Page 33
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 33
© Mark E. Damon - All Rights Reserved
A: Ambien
C: Lunesta
B: Sonata
D: None of the above
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Among the three Z-hypnotic
agents, which one is
FDA-approved for long term
treatment of insomnia
© Mark E. Damon - All Rights Reserved
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© Mark E. Damon - All Rights Reserved
A: Sleep eating
C: Bitter taste upon
awakening
B: REM suppression
D: Tachycardia
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following is the
most common side effect
of Lunesta?
Page 34
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 34
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
© Mark E. Damon - All Rights Reserved
A: Trileptal
C: Abilify
B: Cymbalta
D: Ativan
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Your patient was noted to have N/V, HA,
confusion, c/o very fatigued. She was
started on a number of medications last
month. Which of following can cause
hyponatremia and associated sxs?
(Select all that apply)
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Page 35
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 35
© Mark E. Damon - All Rights Reserved
A: Caucasians
C: African Americans
B: Asians
D: Hispanics
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which ethnic group has the
highest deficiency in
CYP450 2Cs enzymes and
prone to higher ADRs from BZDs
metabolized by this enzyme?
© Mark E. Damon - All Rights Reserved
151413121110987654321
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© Mark E. Damon - All Rights Reserved
A: Alprazolam
C: Triazolam
B: Temazepam
D: Lorazepam
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following BZDs
are metabolized by CYP450
3A4 enzymes and should
avoid grapefruit juice?
(Select all that apply)
Page 36
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 36
© Mark E. Damon - All Rights Reserved
YOU HAVE WON
$1 MILLION DOLLARS
IN PSYCHOPHARM IQ!
© Mark E. Damon - All Rights Reserved
APNA 2011 – Game IV
Clinical Psychopharmacology
Mary A. Gutierrez, PharmD, BCPP
Professor of Clinical Pharmacy & Psychiatry
Loma Linda University School of Pharmacy
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Welcome to
Who Wants to
be an APNA
Millionaire!
50:50
Page 37
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 37
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
50:50
© Mark E. Damon - All Rights Reserved
A: Prolixin Dec Q2W
C: Risperdal Consta Q2W
B: Haldol Dec Q4W
D: Invega Sustenna Q4W
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following is an
option for long-acting injectable
antipsychotic agents for the
treatment of Schizophrenia
and Bipolar Disorder?
(Select all that apply)
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151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Page 38
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 38
© Mark E. Damon - All Rights Reserved
A: Resumed 1 ppd
cigarette smoking
C: Medication
noncompliance
B: Resumed his daily
tid MJ smoking
D: Started daily jogging
50:50
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Your patient was stabilized and
discharged from a non-smoking
psychiatric inpatient unit on an Zyprexa
20 mg QHS. Before his next month’s
outpatient appt, he had relapse sxs &
readmitted to the inpt unit. Which of the
following can cause his relapse?
(Select all that apply)
© Mark E. Damon - All Rights Reserved
151413121110987654321
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© Mark E. Damon - All Rights Reserved
A: Risperidone
C: Ziprasidone
B: Olanzapine
D: Quetiapine
50:50
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Patients on which atypical
antipsychotic should avoid
grapefruit juice?
Page 39
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 39
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
© Mark E. Damon - All Rights Reserved
A: Haloperidal
C: Olanzapine
B: Risperidal
D: Clozapine
50:50
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
What is the antipsychotic of
choice for Parkinson’s patients
with psychotic sxs?
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Page 40
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 40
© Mark E. Damon - All Rights Reserved
A: Benztropine
C: Amitriptyline
B: Diphenhydramine
D: None of the above
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following would
recommend for patients with
antipsychotic-induced
tardive dyskinesia?
© Mark E. Damon - All Rights Reserved
the $1,000
Milestone!
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151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Page 41
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 41
© Mark E. Damon - All Rights Reserved
A: Continue meds
& manage ADRs
C: Increase hydration
B: Stop all meds
D: Admit him to inpt unit
50:50
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Your patient on Seroquel 600mg/d
c/o increased sedation and
dizziness after he took
erythromycin for 7 days.
What would you recommend?
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151413121110987654321
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© Mark E. Damon - All Rights Reserved
A: Valium
C: Ativan
B: Librium
D: Klonopin
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which benzodiazepine
is better for IM injections?
Page 42
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 42
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
© Mark E. Damon - All Rights Reserved
A: Prazosin
C: Ginkgo biloba
B: Tamsulosin
D: Yohimbine
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following is a current
recommended medication for
PTSD nightmares?
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151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Page 43
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 43
© Mark E. Damon - All Rights Reserved
A: Oral Contraceptives
C: Ambien
B: Amlodipine
D: Omega-3
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Your female colleague at the medical
center was struggling with her night
shifts. She was prescribed Provigil for
her night shift sedation. Which of her
following medications can be affected
with Provigil? (Select all that apply)
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151413121110987654321
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© Mark E. Damon - All Rights Reserved
A: E-Mycin
C: Cipro
B: Keflex
D: Zyvox
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following antibiotics
has monoamine oxidase inhibition
and can cause potential
problems with other MAOIs,
SSRIs, and SNRIs?
Page 44
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 44
© Mark E. Damon - All Rights Reserved
the $32,000
Milestone!
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
© Mark E. Damon - All Rights Reserved
A: Lurasidone (Latuda)
C: Lloperidone (Fanapt)
B: Asenapine (Saphris)
D: Paliperidone (Invega)
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following are
FDA-approved
antipsychotic agents
in the U.S.?
Page 45
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 45
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
© Mark E. Damon - All Rights Reserved
A: Days
C: Months
B: Weeks
D: Years
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
How long does it usually take to
taper your patient on Xanax 6
mg/day for many years
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151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Page 46
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 46
© Mark E. Damon - All Rights Reserved
A: Caucasians
C: African Americans
B: Asians
D: Hispanics
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which ethnic group has a 10%
chance of being a CYP450 2D6
poor metabolizers leading to
increased risperidone concentrations
and ADRs at usual prescribed doses?
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© Mark E. Damon - All Rights Reserved
A: Bupropion
C: Mirtazapine
B: Trazodone
D: None of the above
50:50
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following
antidepressants can
block the sexual ADRs
of SSRIs and SNRIs?
Page 47
Session ID: 1011 June 18, 2011
Mary A. Gutierrez, PharmD, BCPP 47
© Mark E. Damon - All Rights Reserved
151413121110987654321
$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
© Mark E. Damon - All Rights Reserved
A: Where is my $million?
C: I have learn from
this session
B: I enjoyed these games
D: Please!...No more
millionaire game music
50:50
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$1 Million$500,000$250,000$125,000$64,000$32,000$16,000$8,000$4,000$2,000$1,000$500$300$200$100
Which of the following
statements apply to this
CE session?
(Select all that apply)
© Mark E. Damon - All Rights Reserved
YOU HAVE WON
$1 MILLION DOLLARS
IN PSYCHOPHARM IQ!