Antidepressants/ Anxiolytics

Question 1

Anxiolytics can be used for:

Answer 1

• anxiety
• sedation
• hypnosis

Question 2

Benzodiazepines

Answer 2

• anxiety, sedation, hypnosis
• alcohol withdrawal
• dose dependant
• lesser dependence risk than w/ other s-h’s
• mostly -(p)ams
• clonazepam, diazepam, lorazepam, midazolam, alprazolam

Question 3

special populations and Benzo’s

Answer 3

• do not use in pregnancy – cleft palate, cardiac defects
• start slow/ go low with elderly – paradoxical effects
• many African Americans metabolize slowly – start with low doses

Question 4

common Benzodiazepines

Answer 4

• Midazolam (Versed), 2-6 hrs
• Diazepam (Valium), 3 hrs
• Alprazolam (Xanax), 4-6 hrs
• Lorazepam (Ativan), 12-24 hrs
• Clonazepam (Klonopin), 1-5 wks

Question 5

administration considerations - Benzos

Answer 5

• LOC
• dependance can occur
• excessive sedation
• “sleep” behaviors (driving, shopping, texting your ex)
• w/ LT use, taper dose

Question 6

Barbituates

Answer 6

• older class of anxiolytic
• high risk of dependance
• high risk oversedation, respiratory depression (greatly increased w/ other sedatives such as alcohol)
• used for medically induced comas

Question 7

Phenpbarbital

Answer 7

• barbituate prototype
• most commonly prescribed
• mostly inpatient settings w/ monitoring
• sedation
• coma
• ETOH
• anti-seizure

Question 8

The other other sedatives

Answer 8

• Buspirone – newer anxiolytic, no sedation or depenence
• Dexmedetomidine – conscious sedation in vented patients
• Diphenhydramine – Benadryl
• Zolpidem – short term insomnia

Question 9

antidepressants

Answer 9

4 major classes

• 2 lesser used:
  Tricyclics
  Monoamine Oxidase Inhibitors (MAOI’s)
• 2 more commonly used:
  SSRI
  SNRI

Question 10

Tricyclics

Answer 10

• reduces norepinephrine and serotonin reuptake
• use cautiously in cardiac pts
• reduces seizure threshold
• potentiates anticoagulants
• more useful in depression w/ anxiety d/t sedative effect
• Imipramine is protoype

Question 11

Monoamine Oxidase Inhibitors (MAOI’s)

Answer 11

• inhibits reuptake of NE and dopamine
• rarely used now
• requires special diet
• may producec manic behaviors
• reduces seixure threshold

Question 12

Serotonin Reuptake Inhibitors (SSRI’s)

Answer 12

• lack most neg effects pf tricyclics and MAOI’s
• take several weeks to work
• may inc risk suicide in younger patients
• avoid herbals – St. John’s, gingko, ginseng
• Fluoxetine (Prozac)

Question 13

Serotonin Norepinephrine Inhibitors (SNRIs)

Answer 13

• similiar to SSRI’s
• reduces serotonin and NE reuptake
• may inc risk suicide in younger patients
• may inc risk serotonin syndrome when combined
• duloxetine (Cymbalta)

Question 14

serotonin syndrome

Answer 14

• may occur when combining antidepressants
• tachycardia, hypertension, hyperthermia, tremors, agitation = all worked up
• stop offending meds
• Benzo’s for symptomatic relief
• usually resolved in day or so

Question 15

lifespan issue - older adults

Answer 15

• reduced liver and renal fx
• dec GI motility
• they are drier
• polypharmacy more common
• start low, go slow

Question 16

lifespan issues - reproduction

Answer 16

• ideally, no drugs
• 2/3 take them though…
• balance risk/benefit
• ie. asthmas, always worth it
• 1st trimester, may not know
• mom may require inc dose d/t increased blood volume and renal excretion

Question 16

lifespan issues - more reproduction

Answer 16

• almost all cross placenta
• early stage effects more lethal
• later stage effects more functional
• breast milk entry more drug dependent

Question 17

lifespan issues - pediatric

Answer 17

• few drugs tested on children
• children do not metabolize drugs simply as “small adults”
• GI and pH motility
• water weight
• BSA and drug dosing – adult male BSA can be 8x that of baby
• developing metabolizing organs