Which of the following statements is/are TRUE about postnatal depression (PND)? [Select All That Apply]
 
a. About 10% of women experiencing a mental health problem during pregnancy or postpartum.
b. PND can begin at any time within one year after delivery.
c. Patients may experience a persistent low mood, lack of interest and enjoyment in usual activities, low self-esteem or lack of energy
d. PND can also occur following miscarriage, stillbirth or in parents who adopt a child.
e. Asian women and women from a non-English speaking background may be affected to a greater extent to PND.

Which of the following statements is/are TRUE about postnatal depression (PND)? [Select All That Apply]
 
a. About 10% of women experiencing a mental health problem during pregnancy or postpartum.
b. PND can begin at any time within one year after delivery.
c. Patients may experience a persistent low mood, lack of interest and enjoyment in usual activities, low self-esteem or lack of energy
d. PND can also occur following miscarriage, stillbirth or in parents who adopt a child.
e. Asian women and women from a non-English speaking background may be affected to a greater extent to PND.

Answer: (a,b,c,d,e).  All.
 
Pharmacists are likely to encounter patients affected by postnatal depression, therefore the ability to identify signs of this under-recognised disorder is essential for appropriate and prompt referral for help and support.
 
Maternal suicide remains the leading cause of death from a direct cause in the postnatal period, accounting for around 22% of maternal deaths reported in the UK between 2014 and 2016. With around 10% of women experiencing a mental health problem during pregnancy or postpartum, it is important for all healthcare professionals to understand and recognise the risk factors for perinatal mental health problems and know where to refer patients.
 
Postnatal depression (PND) can begin at any time within one year after delivery. It is a relatively common condition that occurs in around 10–15% of women following childbirth and around 10% of new fathers, although it is thought that the true prevalence is higher than this.
 
PND can also occur following miscarriage, stillbirth or in parents who adopt a child. In England, it is thought that particular ethnic groups (e.g. Asian women and women from a non-English speaking background) may be affected to a greater extent. This is possibly owing to cultural beliefs around depression, lack of integration and language barriers making it difficult to express difficulties in the postnatal period.
 
Many women will be emotional or experience mild mood changes in the first week after having a baby (referred to as the ‘baby blues’), but these feelings should be self-limiting.
 
In PND, these feelings last longer. Similar to depression, patients may experience a persistent low mood, lack of interest and enjoyment in usual activities, low self-esteem or lack of energy. In addition, they may feel as though they are a bad parent, are unable to cope with their baby or may feel indifferent to their baby.
 
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Citation: https://www.pharmaceutical-journal.com/cpd-and-learning/learning-article/postnatal-depression-recognition-and-diagnosis/20207360.article?firstPass=false

Lynparza (Olaparib) is indicated for treatment(s) of:

I. Ovarian Cancer
II. Metastatic Breast Cancer
III. Pancreatic cancer

a. I only
b. III only
c. I and II only
d. II and III only
e. All

Lynparza (Olaparib) is indicated for treatment(s) of:

I. Ovarian Cancer
II. Metastatic Breast Cancer
III. Pancreatic cancer

a. I only
b. III only
c. I and II only
d. II and III only
e. All

Answer: (e). All. Lynparza (Olaparib) is an inhibitor of the mammalian polyadenosine 5'-diphosphoribose polymerase (PARP) enzyme. Lynparza (Olaparib) tablets for oral administration contain 100 mg or 150 mg of Olaparib.

It is indicated for treatments of:
1. First-Line Maintenance Treatment Of BRCA-Mutated Advanced Ovarian Cancer
2. Maintenance Treatment Of Recurrent Ovarian Cancer
3. Advanced gBRCA-Mutated Ovarian Cancer After 3 Or More Lines Of Chemotherapy
4. Germline BRCA-Mutated HER2-Negative Metastatic Breast Cancer
5. Maintenance Treatment Of gBRCA-Mutated Pancreatic cancer

The recommended dose of Lynparza (Olaparib) is 300 mg (two 150 mg tablets) taken orally twice daily, with or without food, for a total daily dose of 600 mg.

Myelodysplastic Syndrome, Acute Myeloid Leukemia, Pneumonitis, fatigue, nausea, vomiting and fatal toxicity are reported side effects of drug.

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Ubrelvy (Ubrogepant) is indicated for the treatment of:

a. Hypertension
b. Migraine
c. Diabetes mellitus
d. Parkinsonism
e. Generalized anxiety

Ubrelvy (Ubrogepant) is indicated for the treatment of:

a. Hypertension
b. Migraine
c. Diabetes mellitus
d. Parkinsonism
e. Generalized anxiety

Answer: (b) Ubrelvy (Ubrogepant) is indicated for the acute treatment of migraine with or without aura in adults. It is the first and only orally-administered calcitonin gene-related peptide (CGRP) receptor antagonist (gepant) for the treatment of migraine attacks once they start.

Ubrelvy (Ubrogepant) provided lasting relief up to 24 hours as well. It works in a new way by blocking CGRP, a protein that is released during a migraine attack, from binding to its receptors. It works without constricting blood vessels, which some older treatments are known to do. It is non-narcotic, not scheduled, and does not have addiction potential. It has been approved with two dose strengths, 50 mg and 100 mg.

The recommended dose is 50 to 100 mg by mouth for acute migraine. If needed, a patient may take second dose at least 2 hr after initial dose. Do not exceed 200 mg within 24 hours.

Safety of treating greater than 8 migraines/30-day period is not established.

Nausea, somnolence and dry mouth are currently reported side effects of the drug.

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Dayvigo (Lemborexant) is indicated for the treatment of insomnia. The probable mechanism of action of Dayvigo (Lemborexant) is:

a. benzodiazepine receptor agonist
b. benzodiazepine receptor antagonist
c. Melatonin receptor agonist
d. Orexin receptor antagonist
e. Histamine H2 receptor antagonist

Dayvigo (Lemborexant) is indicated for the treatment of insomnia. The probable mechanism of action of Dayvigo (Lemborexant) is:

a. benzodiazepine receptor agonist
b. benzodiazepine receptor antagonist
c. Melatonin receptor agonist
d. Orexin receptor antagonist
e. Histamine H2 receptor antagonist

Answer: (d) The active ingredient found in Dayvigo (Lemborexant) is Lemborexant. Each film coated tablet contains 5 mg or 10 mg of Lemborexant.

Dayvigo (Lemborexant) is indicated for the treatment of adult patients with insomnia, characterized by difficulties with sleep onset and/or sleep maintenance.

The recommended dosage of Dayvigo (Lemborexant) is 5 mg taken no more than once per night, immediately before going to bed, with at least 7 hours remaining before the planned time of awakening.

The dose may be increased to the maximum recommended dose of 10 mg based on clinical response and tolerability. Time to sleep onset may be delayed if taken with or soon after a meal.

The mechanism of action of Dayvigo (Lemborexant) in the treatment of insomnia is presumed to be through antagonism of orexin receptors. The orexin neuropeptide signaling system plays a role in wakefulness.

Blocking the binding of wake-promoting neuropeptides orexin A and orexin B to receptors OX1R and OX2R is thought to suppress wake drive. Dayvigo (Lemborexant) binds to orexin receptors OX1R and OX2R and acts as a competitive antagonist.

Somnolence, headache, fatigue and abnormal dreams are reported side effects of drug.


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Conjupri is the pharmacologically active enantiomer of:

a. Cyclosporine
b. Amlodipine
c. Pregabalin
d. Carbamazepine
e. Cisplatin

Conjupri is the pharmacologically active enantiomer of:

a. Cyclosporine
b. Amlodipine
c. Pregabalin
d. Carbamazepine
e. Cisplatin

Answer: (b) The active ingredient found in Conjupri is Levoamlodipine. It is the pharmacologically active enantiomer in Amlodipine (a racemic mixture of (R)- and (S)-Amlodipine), for the treatment of hypertension. Amlodipine is a third-generation calcium channel blocker first developed and marketed by Pfizer as Norvasc (Amlodipine besylate) tablets in 2.5 mg, 5.0 mg, and 10.0 mg in 1992. The approved Conjupri (Levoamlodipine maleate) tablets come in 1.25 mg, 2.5 mg and 5.0 mg.

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Avoid initiation or interrupt __________if absolute lymphocyte count is less than 500 cells/mm3, absolute neutrophil count is less than 1000 cells/mm3, or hemoglobin level is less than 8 g/dL.

a. Rheumatrex
b. Prograf
c. Rinvoq
d. Xcopri
e. Carboplatin

Avoid initiation or interrupt __________if absolute lymphocyte count is less than 500 cells/mm3, absolute neutrophil count is less than 1000 cells/mm3, or hemoglobin level is less than 8 g/dL.

a. Rheumatrex
b. Prograf
c. Rinvoq
d. Xcopri
e. Carboplatin

Answer: (c) Rinvoq (Upadacitinib) is a Janus kinase (JAK) inhibitor indicated for the treatment of adults with moderately to severely active rheumatoid arthritis who have had an inadequate response or intolerance to methotrexate.

Use of Rinvoq (Upadacitinib) in combination with other JAK inhibitors, biologic DMARDs, or with potent immunosuppressants such as azathioprine and cyclosporine is not recommended.

Rinvoq (Upadacitinib) may be used as monotherapy or in combination with methotrexate. The recommended dose of Rinvoq (Upadacitinib) is 15 mg once daily. It is available as extended release tablet form.

It should be used with caution in patients receiving chronic treatment with strong CYP3A4 inhibitors (e.g., ketoconazole). Coadministration of Rinvoq (Upadacitinib) with strong CYP3A4 inducers (e.g. rifampin) is not recommended.

Serious infections leading to hospitalization or death, including tuberculosis and bacterial, invasive fungal, viral, and other opportunistic infections, have occurred in patients receiving Rinvoq (Upadacitinib).

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Which of the following statements is NOT TRUE about Xeljanz?

a. It is a Janus kinase (JAK) inhibitor.
b. It is indicated for the treatment of ulcerative colitis.
c. The active ingredient found in Xeljanz is Tofacitinib.
d. It should always prescribe with Cyclosporine to increase its efficiency.
e. If a serious infection develops, interrupt Xeljanz/Xeljanz XR until the infection is controlled.

Which of the following statements is NOT TRUE about Xeljanz?

a. It is a Janus kinase (JAK) inhibitor.
b. It is indicated for the treatment of ulcerative colitis.
c. The active ingredient found in Xeljanz is Tofacitinib.
d. It should always prescribe with Cyclosporine to increase its efficiency.
e. If a serious infection develops, interrupt Xeljanz/Xeljanz XR until the infection is controlled.

Answer: (d) Use of Xeljanz/Xeljanz XR in combination with biologic DMARDs or with potent immunosuppressants such as azathioprine and cyclosporine is not recommended.

The active ingredient found in Xeljanz is Tofacitinib. It is a Janus kinase (JAK) inhibitor. It is indicated for treatments of:
1. Rheumatoid Arthritis
2. Psoriatic Arthritis
3. Ulcerative Colitis

The recommended dose is 5 mg twice daily or 11 mg once daily. It can be taken with or without food. It is available in tablet and extended release tablet forms.

Do not initiate Xeljanz/Xeljanz XR in patients with an absolute lymphocyte count less than 500 cells/mm³, an absolute neutrophil count (ANC) less than 1000 cells/mm³ or who have hemoglobin levels less than 9 g/dL.

Patients treated with Xeljanz/Xeljanz XR are at increased risk for developing serious infections that may lead to hospitalization or death. Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. If a serious infection develops, interrupt Xeljanz/Xeljanz XR until the infection is controlled.

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In which way is Tolsura (Itraconazole) different from Sporanox (Itraconazole)?

a. Different dosing frequency
b. Less side effects
c. Different indication
d. Different dosage form
e. No difference

In which way is Tolsura (Itraconazole) different from Sporanox (Itraconazole)?

a. Different dosing frequency
b. Less side effects
c. Different indication
d. Different dosage form
e. No difference

Answer: (c) different indication.

Tolsura (itraconazole capsules) and Sporanox (itraconazole) are azole antifungals used to treat different types of infections. Tolsura is used to treat blastomycosis, pulmonary and extrapulmonary; histoplasmosis, including chronic cavitary pulmonary disease and disseminated, non-meningeal histoplasmosis; and aspergillosis, pulmonary and extrapulmonary, in patients who are intolerant of or who are refractory to amphotericin B therapy.

Sporanox is used to treat fungal infections of the lungs, mouth or throat, toenails, or fingernails.

The dose of Tolsura to treat blastomycosis and histoplasmosis is 130 mg to 260 mg daily. The dose of Tolsura to treat aspergillosis is 130 mg to 260 mg daily.

Dosage of Sporanox depends upon the condition for which it is being used to treat.

Side effects of Tolsura and Sporanox that are similar include nausea, vomiting, skin rash, headache, diarrhea, itching, and dizziness.

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A 35-year-old man who is a regular patient of yours comes to your pharmacy counter with a new prescription. His shoulders appear tense and his eyebrows are knit tightly.

He says to you, "I can't believe I have to fill another prescription today. I was just in three weeks ago and spent $75 dollars on some fancy new medication that didn't do a darn thing!" What might be an appropriate active listening response to this patient?

a. It must be very frustrating to have to try something new.

b. It's too bad we can't take a prescription back for a refund.

c. I can provide you with a smaller quantity this time.

d. Your doctor is trying to find the best medication for you.

A 35-year-old man who is a regular patient of yours comes to your pharmacy counter with a new prescription. His shoulders appear tense and his eyebrows are knit tightly.

He says to you, "I can't believe I have to fill another prescription today. I was just in three weeks ago and spent $75 dollars on some fancy new medication that didn't do a darn thing!" What might be an appropriate active listening response to this patient?

a. It must be very frustrating to have to try something new.

b. It's too bad we can't take a prescription back for a refund.

c. I can provide you with a smaller quantity this time.

d. Your doctor is trying to find the best medication for you.

Answer (a). It must be very frustrating to have to try something new. Answer "b" does not acknowledge the patient's feelings; answer "c" moves to finding a solution without acknowledging the patient's feelings and "d" is placating.

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Which of the following information is/are TRUE ABOUT Naloxone? [Select All That Apply].

a. Naloxone hydrochloride is a pure opioid antagonist that competitively binds to μ-opioid receptors only when opioids are present.

b. No tolerance or dependence is associated with naloxone use

c. When comparing the μ-opioid receptor affinity of naloxone with that of most opioids, including heroin, naloxone has a greater affinity to bind to the receptor site.

d. Naloxone has a short duration of activity about 30 to 90 minutes.

Which of the following information is/are TRUE ABOUT Naloxone? [Select All That Apply].

a. Naloxone hydrochloride is a pure opioid antagonist that competitively binds to μ-opioid receptors only when opioids are present.

b. No tolerance or dependence is associated with naloxone use

c. When comparing the μ-opioid receptor affinity of naloxone with that of most opioids, including heroin, naloxone has a greater affinity to bind to the receptor site.

d. Naloxone has a short duration of activity about 30 to 90 minutes.

Answer: (a, b, c and d). Naloxone was patented in 1961, was first approved by the Food and Drug Administration (FDA) in 1971, and is currently on the World Health Organization's List of Essential Medicines.

Naloxone hydrochloride is a pure opioid antagonist that competitively binds to μ-opioid receptors only when opioids are present and bound at the receptor site. Naloxone demonstrates no effect on mu, kappa, or delta receptors in a person who has not taken opioids. No tolerance or dependence is associated with naloxone use.

The reversal of opioid toxicity with naloxone is dose dependent. Individuals who have used a particularly potent opioid (e.g., fentanyl), have high concentration of opioids in their system, or have used a long-acting opioid may require more frequent and/or larger doses of naloxone to reverse symptoms.

When comparing the μ-opioid receptor affinity of naloxone with that of most opioids, including heroin, naloxone has a greater affinity to bind to the receptor site. This mechanism allows naloxone to remove the opioid from the receptor site and then bind it more securely. When this occurs, respiratory depression resolves partially or fully (depending on the amount, form, and route of opioids taken), hypotension resolves, and CNS depression abates.

Depending on the type of opioid used, the individual may be at risk for experiencing rebound opioid toxicity and/or acute respiratory depression because of the short duration of activity of naloxone (i.e., 30-90 minutes).

This effect most often occurs when an individual has taken a long-acting opioid such as methadone or extended-release oxycodone. Naloxone's short duration of action is an important reason to convey to patients that receiving emergency medical care for an opioid overdose is important, even if the person has responded to the naloxone.

Naloxone is not effective in treating overdoses of non-opioid prescription medicines like benzodiazepines or barbiturates. It also is not effective in overdoses with stimulants, such as cocaine and amphetamines, or other non-opioid illicit drugs such as MDMA (Ecstasy, Molly), GHB (G), or ketamine (Special K). However, a polysubstance overdose that includes opioids warrants the use of naloxone.

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