CNS Pharmacology

76-year-old male is brought in by his daughter for “abnormal movements.” Patient has been having difficulty eating and drinking, often spilling his food/drink. This started 3 months ago but hasn’t interfered with his daily activities until recently. Significant past medical history of anxiety disorder and depression. He notices it more during the day, especially after he drinks his daily morning expresso. Movements occur less at night, and he does not wake up from sleep. Vitals within normal limits, and physical exam finds a bilateral shaking of the hands “back and forth” movements. Upon further inquiry, patient reveals he drinks a bottle of wine every day, a significant increase from his occasional weekend beer since you last saw him 1 year ago. He reports he often thinks of his late wife who passed away 5 months ago but has no suicidal thoughts or ideation. He enjoys spending time with his grandchildren. What is the preferred treatment of choice for this patient’s condition?

A 81-year old female is brought in by her son to forgetfulness. Every year, she sends her son a $50 gift card for his “video games and electronics stuff,” but she forgot for the first time in 30 years yesterday. She has also misplaced her keys and has been found wandering the isles of grocery stores at times. The son grew concerned about his loss of income and got her in an MRI later yesterday. He gives the findings to you, pleading that you help her restore her functionality. MRI shows enlarged ventricles, narrowing of gyri, and prominent cerebral sulci. What will you prescribe?

13-year-old female is brought in from the swimming pool, where she had a full tonic-clonic seizure while on the high dive and fell into the water. Lifeguards quickly pulled her out and stabilized her with some fancy schmancy drugs within minutes. She soon after stopped seizing, was drowsy, and then got up. Her vitals are all normal, physical exam is unremarkable. She reports no difficulty breathing, neurological deficits, or any other symptoms. She wants to go back to the pool and try the high dive again. What drug did the lifeguards most likely use?

A worried mom brings her son into your pediatrician clinic for failing grades in school. He is a 12-year-old boy who was doing well last year. No past medical history with him or in his family. He reports getting distracted in class and that “school is boring, bro.” At home, his mother has noticed he can never have enough toys and sees him coming in and out of the house constantly. In the room, the patient is fidgeting, but the rest of the physical exam is normal. Teacher reports from the school note that he used to be an excellent student with aspiration of becoming a doctor, but recently has become less focused and doesn’t complete his homework, nor respond to the teachers when his name is called at first. The mom wants him to be treated medically. What is the mechanism of action for the drugs used to treat this condition?

A single mother of 6 kids comes into your office complaining of a headache. She reports a history of migraines that she used to manage with Naproxen in the past, but she has been having worse headaches recently, which she attributes to “the latest kid is a doozie!” The child was born 3 weeks ago. She requests a stronger medication. She has a history of a pacemaker to treat her 3rd-degree atrioventricular block as well. Which of these drugs can you not give her because it is specifically contraindicated?

A 24-year-old male medical student comes to his yearly physical. While interviewing him, he reveals that he has been feeling more stressed than usual for an upcoming test. He notices the week leading to every test, he ignores his friends, often eats tubs of ice cream for dinner, and feels sad. He has never had this before or had any previous diagnoses of anxiety or depression. What is the preferred drug for this patient?