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A new drug ad for Letsfixit® ran on television last year called “Maya’s Excerpts from the ad transcript are written below.  In each blank, write the reason for the statement given, or the name of the syndrome or condition described. The ad begins: Actress: “I struggle with bipolar depression, and it’s tough.  It makes me feel sad and empty, or makes me do things I normally wouldn’t.  So I talked to my doctor, and she prescribed Letsfixit.”   Narrator: There are many forms of depression.  Letsfixit is FDA-approved to treat bipolar depression, which is different from other types of depression.  Letsfixit is approved to treat bipolar depression in adults, either on its own or with lithium or valproate.   Results may vary.   Elderly dementia patients on Letsfixit have an increased risk of fever, death or stroke. Call your doctor about fever, stiff muscles or confusion, as these might be signs of a life-threatening reaction:   _______ …or if you have uncontrollable muscle movements as these may be permanent: _______ Other side effects include abnormal milk production: _______ and dizziness upon standing: _______ Avoid grapefruit and grapefruit juice _______ Ask your doctor if once-daily Letsfixit is right for you.” Letsfixit is a member of what class of drugs? _______

BLOOD PRESSURE:  In the patient who received IV PHENYLEPHRINE, blood pressure will:

Jessica J. is a 23-year-old otherwise healthy female with newly diagnosed bipolar disorder. One good starting option for her treatment is:

URINE FLOW: If the patient decides to urinate at the time of the injection, IV ATROPINE will cause the urine flow to

(8 points) There is an endocrine disorder we did not get a chance to discuss called central diabetes insipidus, in which the pituitary gland does not make sufficient ADH (anti-diuretic hormone), leading to abnormally high amounts of urination.  The condition is treated using desmopressin (Minirin), a synthetic version of human ADH hormone.    Desmopressin is available as a nasal spray taken once daily.  It is not significantly metabolized.   Please answer both question A and B in the space provided (there is more than enough room)   A. (3 points) If a patient were to take this as an IV dose once daily, would the IV dose be much larger, much smaller, or about the same amount as the nasal spray dose?   B. (5 points) A potential side effect of desmopressin is hyponatremia (very low blood sodium levels).  Patients with very low plasma sodium levels are at high risk of brain seizures.  Explain the pathophysiologic mechanism by which hyponatremia lowers the threshold for a seizure in the brain.

URINE FLOW: If the patient decides to urinate at the time of the injection, IV PHENYLEPHRINE will cause the urine flow to

Which of the following drugs often cause constipation? Select All That Apply

(6 points) 43-year-old Charlize T. suffers from chronic GERD.  She’s been taking over-the-counter pantoprazole (Protonix) for the last four years under the supervision of a GI surgeon, even though the “Drug Facts” panel on the back of the package specifically states “do not take for more than 14 days unless directed by a doctor”.        Give ANY two (2) medical reasons why Charlize should not be taking specifically a drug like pantoprazole for four years except under the supervision of a healthcare professional (other than generalized things like “because the directions say not to” or “you need a doctor when you take medicine”).

What are possible sites of excretion for PO drugs? Select All That Apply

19-year-old Joffrey L. is brought to the emergency room unconscious with a respiratory rate of only 6 (this is very low).  His new roommate reports that Joffrey is otherwise totally healthy but says he saw Joffrey taking some medicine earlier.  He hands over the bottle of medicine he saw Joffrey use and you see it is a alprazolam (Xanax), a benzodiazepine used commonly for certain anxiety disorders.   Dr. Snow arrives, glances at the bottle and then elbows you aside.  He administers an IV dose of the benzodiazepine antagonist flumazenil.  Joffrey begins to have convulsions.    A. Explain in detail the mechanism by which the benzodiazepine antagonist flumazenil can potentially cause a seizure in a patient with no prior history of epilepsy.