BCPP cheat sheet

DSM-5-TR major depressive disorder requires at least 5 of 9 symptoms for 2 or more weeks, including depressed mood or anhedonia, causing clinically significant distress or impairment.

PHQ-9 bands: 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe; a score of 10 or more is the usual threshold for probable major depression.

GAD-7 bands: 5-9 mild, 10-14 moderate, 15-21 severe anxiety; a score of 10 or more prompts fuller diagnostic assessment.

MDQ bipolar screening is positive when the patient endorses 7 or more of 13 symptom items, reports co-occurrence of symptoms, and rates the problem as moderate or serious.

CIWA-Ar: 0-7 minimal, 8-15 moderate withdrawal where benzodiazepines are typically started, 16 or higher severe with seizure and delirium tremens risk.

AIMS: 7 items rated 0-4; a score of 2 or more on one item or 3 or more on two items indicates probable tardive dyskinesia and triggers reassessment.

Lithium levels are drawn as a 12-hour post-dose trough; maintenance target 0.6-1.2 mEq/L, acute mania 0.8-1.2 mEq/L, and levels above 1.5 mEq/L suggest toxicity.

Antipsychotic metabolic monitoring: BMI/waist circumference, blood pressure, fasting glucose, and lipids at baseline, at 12 weeks, then at least annually.

Major depression first-line agents are SSRIs, SNRIs, bupropion, and mirtazapine; assess response at 4-8 weeks and continue 6-12 months after remission, 2 years or longer if recurrent.

Treatment-resistant depression is failure of 2 or more adequate antidepressant trials; supported augmenting strategies include aripiprazole, lithium, liothyronine, esketamine, and ECT.

Acute bipolar mania: lithium, divalproex, or second-generation antipsychotics (aripiprazole, asenapine, cariprazine, quetiapine, risperidone); antidepressant monotherapy is avoided.

Bipolar maintenance: lithium is first-line for mania prevention and is generally continued at least 2 years after an episode, longer when episodes are frequent.

Treatment-resistant schizophrenia: clozapine after 2 or more antipsychotic failures; it is also indicated to reduce recurrent suicidal behavior in schizophrenia or schizoaffective disorder.

OCD: use higher SSRI/SNRI doses with an 8-12 week trial, then continue treatment for 1-2 years after response before considering a taper.

Alcohol use disorder: naltrexone (50 mg/day or 380 mg IM monthly) and acamprosate (666 mg three times daily) are first-line; disulfiram requires abstinence and supervision.

Opioid use disorder: buprenorphine/naloxone or methadone are first-line and reduce mortality; buprenorphine partial agonism provides a ceiling effect on respiratory depression.

Lithium toxicity above 1.5 mEq/L causes coarse tremor, ataxia, vomiting, confusion, and seizures; risk rises with NSAIDs, ACE inhibitors/ARBs, thiazides, dehydration, and renal impairment.

Clozapine risks: agranulocytosis, myocarditis (highest in the first 2 months), dose-related seizures, severe constipation, and orthostasis; smoking induces CYP1A2 and lowers levels.

Neuroleptic malignant syndrome: hyperthermia, lead-pipe rigidity, altered mental status, autonomic instability, elevated CK; stop the antipsychotic and use dantrolene or bromocriptine.

Serotonin syndrome (Hunter criteria): spontaneous or inducible clonus, hyperreflexia, agitation, hyperthermia; stop serotonergic drugs and give cyproheptadine in moderate-severe cases.

QT prolongation risk is highest with thioridazine, IV haloperidol, ziprasidone, and quetiapine; citalopram is capped at 40 mg/day, or 20 mg/day if over 60 years or CYP2C19 poor metabolizer.

Valproate: hepatotoxicity, pancreatitis, thrombocytopenia, and hyperammonemic encephalopathy; monitor LFTs, CBC, and levels; teratogenic with roughly 1-2% neural tube defect risk.

Carbamazepine: aplastic anemia/agranulocytosis, SIADH-related hyponatremia, and CYP3A4 autoinduction plus induction of other drugs; screen HLA-B*1502 in patients of Asian ancestry.

Lamotrigine requires slow titration to prevent Stevens-Johnson syndrome; valproate inhibits lamotrigine metabolism, so the starting and target doses are halved.

MAOIs: tyramine pressor crisis and interactions with sympathomimetics, meperidine, linezolid, and serotonergic drugs; fluoxetine and paroxetine inhibit CYP2D6 and raise tricyclic levels.

Antidepressant teaching: sleep, appetite, and energy often improve in 1-2 weeks while full mood response takes 4-8 weeks; abrupt discontinuation causes discontinuation syndrome.

Discontinuation symptoms are most likely with paroxetine and venlafaxine because of short half-lives; taper over weeks rather than stopping abruptly.

Long-acting injectable antipsychotics: confirm oral tolerability first; aripiprazole LAI needs 14 days of oral overlap, while paliperidone palmitate 1-month does not require oral overlap.

Food requirements: lurasidone needs at least 350 calories and ziprasidone at least 500 calories for adequate absorption.

Lithium counseling: keep fluid and sodium intake consistent, avoid dehydration and heat exposure, and check with the pharmacist before starting NSAIDs.

MAOI diet: avoid aged cheese, cured and fermented meats, tap beer, soy sauce, sauerkraut, and fava beans to prevent tyramine-induced hypertensive crisis.

Adherence measurement: proportion of days covered of 80% or higher from refill records is the common threshold; the Morisky scale is a validated self-report tool.

Benzodiazepine tapering: reduce by about 25% every 2 weeks; abrupt discontinuation risks rebound anxiety, insomnia, and seizures.

BCPP certification is awarded by the Board of Pharmacy Specialties, is valid for 7 years, and is renewed by examination or approved continuing education.

Collaborative practice agreements authorize protocol-driven initiation, adjustment, and monitoring of therapy; required elements and scope are set by state law.

42 CFR Part 2 governs substance use disorder treatment records: written patient consent is required for most disclosures and redisclosure is restricted.

SBAR (Situation, Background, Assessment, Recommendation) is a standardized tool for concise handoffs and interprofessional escalation.

Comprehensive medication management core elements: identify medication-related problems, build an individualized care plan, document the encounter, and schedule follow-up.

CMS requires documented gradual dose reduction attempts for antipsychotics in long-term care unless clinically contraindicated, with rationale recorded.

Just culture distinguishes human error, at-risk behavior, and reckless behavior so errors are reported and systems corrected rather than individuals punished.

MTM billing uses CPT 99605 (initial), 99606 (subsequent), and 99607 (additional units); documentation must support medical necessity.

Evidence hierarchy, high to low: systematic reviews/meta-analyses of RCTs, individual RCTs, cohort studies, case-control studies, case series, expert opinion.

ARR = control event rate minus treatment event rate; NNT = 1/ARR and NNH = 1/ARI.

Sensitivity = TP/(TP+FN) and specificity = TN/(TN+FP); positive and negative predictive values depend on disease prevalence.

Intention-to-treat analysis preserves randomization; per-protocol analysis can exaggerate effects by excluding nonadherent or withdrawn participants.

A 95% confidence interval for a risk ratio that excludes 1.0 corresponds to p less than 0.05; wider intervals indicate less precision.

Odds ratios approximate risk ratios only when the outcome is rare, generally under 10%; for common outcomes the odds ratio overstates the effect.

Trial phases: I safety and dosing, II preliminary efficacy, III comparison against standard care, IV post-marketing surveillance.

Publication bias is suggested by funnel plot asymmetry and tested with Egger's regression; review quality is appraised with AMSTAR or Cochrane risk-of-bias tools.