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1. What is the most frequently reported adverse effect associated with dextromethorphan/quinidine (Nuedexta)?

A. Constipation B. Diarrhea C. Agitation D. Bradycardia E. Unsure

2. Which of the following conditions has the highest prevalence of pseudobulbar affect?

A. Traumatic brain injury B. Amyotrophic lateral sclerosis C. Stroke D. Alzheimer's disease E. Unsure

3. A patient who experienced a stroke 2 months ago presents with complaints of uncontrolled laughter occurring several times a week. The Center for Neurologic Study-Lability Scale is administered and the patient scores 18. How is this scored interpreted?

A. The test is positive for pseudobulbar affect (PBA) and the patient should be referred for clinical diagnosis B. The patient may have PBA but needs the test repeated in 1 month for confirmation C. The test is negative and the patient does not have PBA D. The test is positive but the patient needs a magnetic resonance imaging test for confirmation of diagnosis E. Unsure

4. Which of the following medications has been shown to be effective in the treatment of pseudobulbar affect in randomized, placebo-controlled trials?

A. Trazodone B. Clomipramine C. Dextromethorphan/quinidine D. Valproic acid E. Unsure

5. Which presentation is most consistent with a diagnosis of pseudobulbar affect?

A. A patient with bipolar disorder who laughs while taking a shower B. A patient with stroke who cries when family members are leaving C. A patient with Alzheimer's disease who repeats “Where is my sister?” 20 times an hour D. A patient with amyotrophic lateral sclerosis who cries uncontrollably 10 times a day without feelings of sadness E. Unsure

6. What is the typical onset of action observed when dextromethorphan/quinidine is used for treatment of pseudobulbar affect?

A. 6 to 8 weeks B. 4 weeks C. 1 week D. 3 to 4 days E. Unsure

7. The proposed mechanism of action of dextromethorphan in the treatment of pseudobulbar affect is:

A. Antagonism of the N-methyl-D-aspartate (NMDA) glutamate receptor and agonist effect on the sigma-1 receptor B. Gamma-aminobutyric acid (GABA) receptor activation C. Blockade of sodium transport across the neuronal membrane D. Stimulation of dopamine receptors E. Unsure

8. A 49-year-old patient with traumatic brain injury is diagnosed with pseudobulbar affect and his physician wishes to try citalopram for treatment. He is not on any medications that may interact with citalopram. What dose should be used?

A. 10 mg every other day B. 10 mg daily C. 20 mg daily D. 40 mg daily E. Unsure

9. A 69-year-old patient with multiple sclerosis is diagnosed with pseudobulbar affect and her physician wishes to prescribe dextromethorphan/quinidine (D/Q). Her past medical history includes atrial fibrillation and osteoporosis. Her current medications are amiodarone, glatiramer, and alendronate. Which drug interaction is anticipated?

A. Amiodarone combined with D/Q will increase QT prolongation B. D/Q will prolong alendronate metabolism C. D/Q will increase glatiramer concentration D. Glatiramer combined with D/Q will increase delirium E. Unsure

10. A 78-year-old nursing home resident has a history of depression, Alzheimer's disease, hypertension, and osteoarthritis. He is currently taking sertraline 50 mg daily, donepezil 10 mg in the morning, metoprolol succinate 100 mg daily, and acetaminophen 650 mg 3 times daily. He has new symptoms of frequent uncontrolled crying episodes and is diagnosed with pseudobulbar affect. His physician prescribes dextromethorphan/quinidine. Which monitoring parameters are important to follow?

A. Monitor for serotonin syndrome B. Monitor for bradycardia C. Monitor for drug-induced hepatitis D. Both A and B E. Unsure

Evaluation Questions

11. How confident are you in your dose of citalopram for your patient (Q8) above?

A. Not at all confident B. Somewhat confident C. Confident D. Highly confident

12. How confident are you in your decision on drug interaction for your patient (Q9) above?

A. Not at all confident B. Somewhat confident C. Confident D. Highly confident

13. How confident are you in your monitoring parameters for your patient (Q10) above?

A. Not at all confident B. Somewhat confident C. Confident D. Highly confident

Maintenance is scheduled for 8/7/2023 7:00 AM EST - 8:00 AM EST.

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1. What is the most frequently reported adverse effect associated with dextromethorphan/quinidine (Nuedexta)?

2. Which of the following conditions has the highest prevalence of pseudobulbar affect?

3. A patient who experienced a stroke 2 months ago presents with complaints of uncontrolled laughter occurring several times a week. The Center for Neurologic Study-Lability Scale is administered and the patient scores 18. How is this scored interpreted?

4. Which of the following medications has been shown to be effective in the treatment of pseudobulbar affect in randomized, placebo-controlled trials?

5. Which presentation is most consistent with a diagnosis of pseudobulbar affect?

6. What is the typical onset of action observed when dextromethorphan/quinidine is used for treatment of pseudobulbar affect?

7. The proposed mechanism of action of dextromethorphan in the treatment of pseudobulbar affect is:

8. A 49-year-old patient with traumatic brain injury is diagnosed with pseudobulbar affect and his physician wishes to try citalopram for treatment. He is not on any medications that may interact with citalopram. What dose should be used?

Evaluation Questions

11. How confident are you in your dose of citalopram for your patient (Q8) above?

12. How confident are you in your decision on drug interaction for your patient (Q9) above?

13. How confident are you in your monitoring parameters for your patient (Q10) above?

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Maintenance is scheduled for 8/7/2023 7:00 AM EST - 8:00 AM EST.

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1. What is the most frequently reported adverse effect associated with dextromethorphan/quinidine (Nuedexta)?

2. Which of the following conditions has the highest prevalence of pseudobulbar affect?

3. A patient who experienced a stroke 2 months ago presents with complaints of uncontrolled laughter occurring several times a week. The Center for Neurologic Study-Lability Scale is administered and the patient scores 18. How is this scored interpreted?

4. Which of the following medications has been shown to be effective in the treatment of pseudobulbar affect in randomized, placebo-controlled trials?

5. Which presentation is most consistent with a diagnosis of pseudobulbar affect?

6. What is the typical onset of action observed when dextromethorphan/quinidine is used for treatment of pseudobulbar affect?

7. The proposed mechanism of action of dextromethorphan in the treatment of pseudobulbar affect is:

8. A 49-year-old patient with traumatic brain injury is diagnosed with pseudobulbar affect and his physician wishes to try citalopram for treatment. He is not on any medications that may interact with citalopram. What dose should be used?

Evaluation Questions

11. How confident are you in your dose of citalopram for your patient (Q8) above?

12. How confident are you in your decision on drug interaction for your patient (Q9) above?

13. How confident are you in your monitoring parameters for your patient (Q10) above?

« Return to Activity

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