8 Integrated CNS Medication Cases Free Online FlashCards

How long after stopping an MAOI should sertraline generally be delayed?

Wait at least 14 days after stopping an MAOI before starting sertraline; a shorter interval can increase the risk of serotonin syndrome.

What reaction is suggested by agitation, sweating, diarrhea, tremor, and brisk reflexes?

Agitation, sweating, diarrhea, tremor, and unusually brisk reflexes suggest serotonin syndrome. Seek urgent clinical assessment; severe or rapidly worsening symptoms require emergency care.

What test is important when a patient taking clozapine develops fever and sore throat?

Fever and sore throat may signal clozapine-related severe neutropenia. Prompt assessment and an absolute neutrophil count (ANC) are important; ANC monitoring is required during treatment.

Why is clozapine not a routine choice for dementia-related psychosis?

Antipsychotics, including clozapine, carry an increased mortality warning for older adults with dementia-related psychosis and are not approved for that condition.

How can hydrochlorothiazide or ibuprofen affect lithium levels?

Hydrochlorothiazide and NSAIDs such as ibuprofen can raise lithium concentrations, increasing the risk of toxicity.

What do worsening tremor, gait instability, and confusion suggest in a patient taking lithium?

Worsening tremor, unsteady walking, and confusion raise concern for lithium toxicity. Urgent assessment should include a lithium concentration and renal function; fluid and electrolyte status may also need assessment.

Why is rapid lamotrigine titration concerning when combined with valproate?

Valproate can increase lamotrigine exposure, and rapid lamotrigine dose escalation raises the risk of serious rash, including Stevens–Johnson syndrome or toxic epidermal necrolysis.

What major concern should be discussed when considering valproate for someone who could become pregnant?

Valproate exposure during pregnancy can cause major congenital malformations, including neural tube defects, and neurodevelopmental harm. Pregnancy intentions and alternatives require careful discussion.

What serious risk arises from combining opioids with benzodiazepines or other sedatives?

Combining opioids with benzodiazepines, zolpidem, alcohol, or other CNS depressants can cause profound sedation and respiratory depression, potentially leading to coma or death.

What should happen after sleep-driving while taking zolpidem?

Sleep-driving is a complex sleep behavior associated with zolpidem. Discontinue it and contact the prescriber promptly; do not take another dose unless a clinician has reassessed the situation.

Why should regular benzodiazepine use not be stopped abruptly?

Regular benzodiazepine use can cause physical dependence. Abrupt discontinuation may trigger serious withdrawal, including seizures; any reduction should be planned with a clinician and generally tapered.

How can haloperidol affect Parkinson’s symptoms and levodopa response?

Haloperidol blocks dopamine D2 receptors and can worsen rigidity and bradykinesia in Parkinson’s disease; dopamine antagonists can also reduce levodopa’s therapeutic effect.