AF is a 62-year-old female who presents to the clinic today with sleep complaints.  She reports that she has a history of difficulty initiating sleep.  She typically goes to bed at around 10:30 PM and most nights it takes her 90 minutes to fall asleep.  She has been taking zolpidem for her insomnia, and it helped her fall asleep, but she reports that it lasted too long, and she had carryover sedation in the morning. She walks each day at lunchtime with friends at the senior center.  She consumes 1-2 cups of caffeinated coffee during the morning and does not smoke.  AF recently had her thyroid hormone levels tested and they were normal.  She does not have any unusual leg sensations, she does not snore, and her bed partner does not report any apnea episodes during sleep.  Medications: Levothyroxine 100 mcg po daily (for hypothyroidism) Oxybutynin 10 mg daily (for overactive bladder) Zolpidem 5mg at bedtime AF would like a medication that better helps her fall asleep without carryover sedation.  The physician you are working with asks you for a recommendation.  Which of the following would be the BEST recommendation for AF to help her fall asleep and reduce the risk of carryover sedation?

A 19 yo man is presenting to clinic for evaluation of his seizures. You notice on his EMR that his gene panel notes that he is HLA -B 15:02 Positive. Which of the following drugs should be used with caution, if at all? (SELECT ALL THAT APPLY)

Which of the following is TRUE regarding antipsychotic treatment for schizophrenia?

Which of the following is NOT true about bipolar disorder?

A patient with a bipolar I diagnosis is prescribed lithium for a manic episode. They are instructed to take 600mg of lithium daily at 8PM. Which of the following educational points are CORRECT for this patient? (SELECT ALL THAT APPLY)

EM is a 24-year-old female who was diagnosed with narcolepsy.  She does not have any cataplexy or other REM manifestations.  She works a daytime shift (8 AM to 5 PM) and generally wants to be most alert and awake during those hours.  Medications: ethinyl estradiol/norgestimate – one tablet daily for contraception What would you recommend as the BEST choice(s) for EM’s therapy to improve her daytime sleepiness?

A patient who has been on lithium for 8 months has been feeling off balance the last few days and speech is slurred. The lithium level checked today is 1.6 mEq/L. Three months ago the lithium level was 1.0mEq/L. The patient reports taking 6-8 acetaminophen tablets daily for the past week. Prescription medications include: chlorthalidone 25mg daily (thiazide diuretic started 1 year ago), lisinopril 40mg daily (ACE-inhibitor, dose increased 2 weeks ago), sertraline 50mg (started 2 weeks ago). Which of the following medications is MOST likely responsible for increasing the lithium level?

A patient arrives to clinic with a migraine without aura took naproxen 4 hours ago to treat her migraine. She reports worsening headache pain (now rated moderate to severe) and very debilitating symptoms (needs the lights off and is nauseous). She is not pregnant and currently uses Flonase Nasal Spray and loratadine tablets for seasonal allergies. What option is most suitable for her current acute migraine headache?

A 32-year-old woman with a history of migraines asks about risk factors. Which of the following is NOT considered a risk factor for migraines?

A 42-year-old patient presents with persistent sadness, fatigue, and difficulty concentrating for the past 6 weeks. She reports changes in appetite and trouble sleeping. Which of the following areas are commonly disrupted in individuals with depression? (Select all that apply)