NAPLEX — CNS, Psychiatry and Pain flashcards
10 of 80 cards free to study here · 3 topics · the whole deck is built into Willys
Antiepileptics and status epilepticus, Parkinson and Alzheimer drugs, migraine, antidepressants and serotonin toxicity, antipsychotics with NMS, tardive dyskinesia and metabolic risk, lithium, ADHD, sleep drugs, alcohol and opioid use disorder, opioid safety and analgesic toxicity — with no doses.
Learn deck · part of PTCB PTCE / NAPLEX · written against: Top-drug lists and federal pharmacy law as of 2026; PTCE content outline effective 6 January 2026. Updated 2026-10-10.
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Which genetic test is recommended before starting carbamazepine in a patient of Asian ancestry, and why?HLA-B*15:02, because carriers have a much higher risk of Stevens–Johnson syndrome and toxic epidermal necrolysis, which is the subject of a boxed warning. Carriers should generally not start carbamazepine, and the same allele is linked to severe skin reactions with phenytoin and oxcarbazepine.Neurology › Antiepileptics
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Besides serious skin reactions, which hematologic and electrolyte problems does carbamazepine cause?Its boxed warning covers aplastic anemia and agranulocytosis, so a baseline and periodic CBC are taken. It also causes hyponatremia through an SIADH-like effect, especially in older adults, and oxcarbazepine does so even more often.Neurology › Antiepileptics
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Why do carbamazepine levels fall during the first weeks of therapy even though the dose has not changed?Carbamazepine induces CYP3A4, the enzyme that metabolizes it (autoinduction), so its clearance rises over the first several weeks. Doses are titrated up and levels rechecked once induction is complete.Neurology › Antiepileptics
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What do valproate's boxed warnings say about the liver and pancreas, and which patients face the highest hepatic risk?Valproate can cause fatal hepatotoxicity and life-threatening pancreatitis. The liver risk is highest in children under two on multiple antiepileptics and in patients with mitochondrial disease; it is contraindicated in POLG-related mitochondrial disorders.Neurology › Antiepileptics
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An 82-year-old started on sertraline becomes confused and nauseated within weeks. Which lab abnormality should be checked?Serum sodium, because SSRIs and SNRIs can cause hyponatremia from SIADH, most often in older adults and those on diuretics.Psychiatry › Antidepressants
Watch out: the risk is highest in the first weeks, so sodium is checked soon after starting in older or diuretic-treated patients. -
Why does an SSRI raise bleeding risk with NSAIDs or anticoagulants?Platelets cannot make serotonin and rely on uptake through the serotonin transporter, which SSRIs block. The depleted platelet serotonin impairs aggregation, adding to the bleeding risk of NSAIDs, aspirin and anticoagulants, especially in the GI tract.Psychiatry › Antidepressants
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What QT warning applies to citalopram, and which patients have lower ceilings?Citalopram causes dose-dependent QT prolongation, so labeling sets a maximum dose and a lower ceiling for adults over 60, patients with hepatic impairment, CYP2C19 poor metabolizers and those taking cimetidine or another CYP2C19 inhibitor. Escitalopram shares the concern to a lesser degree.Psychiatry › Antidepressants
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Which patients on opioids should be offered naloxone, and how can they get it?Patients at higher overdose risk: those on higher opioid doses, those also using benzodiazepines or other sedatives, and those with a history of overdose or opioid use disorder. Naloxone nasal spray is available over the counter, and family members are taught how to use it.Pain › Opioids
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Besides serotonin syndrome, which adverse effects of tramadol are easy to overlook?Seizures, even within the usual dose range and more so with other drugs that lower the seizure threshold, plus hypoglycemia and hyponatremia. Tramadol also depends on CYP2D6 to form its more potent active metabolite.Pain › Opioids
Watch out: CYP2D6 ultrarapid metabolizers make too much active metabolite, so tramadol, like codeine, is contraindicated in children under 12. -
Why does buprenorphine carry less risk of fatal respiratory depression than full opioid agonists?As a partial mu agonist with very high receptor affinity, it shows a ceiling effect on respiratory depression. The ceiling is lost when it is combined with benzodiazepines, alcohol or other CNS depressants.Pain › Opioids
Watch out: its tight receptor binding also means naloxone reverses it poorly, so higher or repeated naloxone doses may be needed.
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About these cards
Review status: Second-reader reviewed, with corrections applied.
Checked against:
- NABP NAPLEX competency statements (topic outline only; no text copied)
- Checked against FDA prescribing information and standard pharmacotherapy references (reference only; no text copied)
- Checked against the American Epilepsy Society 2016 guideline on convulsive status epilepticus, the 2026 AAN/AHS guideline on pharmacologic migraine prevention in adults, the 2004 ADA/APA consensus on antipsychotics and metabolic monitoring, and SAMHSA guidance on medications for opioid and alcohol use disorder (reference only; no text copied)
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