Antipsychotics, Anti-Anxiety Agents

Question 1

Alprazolam brand name

Answer 1

Xanax (XR)

Question 2

Alprazolam Indication/Dosage

Answer 2

Management of anxiety disorders or short-term relief of anxiety/anxiety-associated depressive states: 0.25-0.5mg TID, titrated to individual needs.

Question 3

Alprazolam Mechanism

Answer 3

Benzodiazepine

facilitate GABA, which mediates both pre- and post-synaptic inhibition in all regions of CNS

Question 4

Alprazolam metabolism and excretion

Answer 4

Excreted in urine

Metabolized in liver by CYP3A4

Question 5

Alprazolam Drug Interactions

Answer 5

Other CNS depressants, alcohol: increased CNS depression
3A4 Substrates alter clearance of drug
Oral contraceptives may increase effects

Question 6

Alprazolam CI/precautions

Answer 6

CI: hypersensitivity, or narrow-angle glaucoma
Caution in patients with primary depression, psychosis, and impaired renal or hepatic function
Withdrawal can be serious, esp in patients on high doses or extended therapy. Do not stop abruptly, Decrease dose by 0.5mg q3-4 days

Question 7

Alprazolam Pregnancy Category

Answer 7

D

Question 8

Alprazolam ADR’s

Answer 8

Drowsiness and hypotension

Question 9

Alprazolam Patient Education

Answer 9

Use caution operating machinery or when mental alertness is required
Avoid alcohol
May be habit forming
XR tabs - do not crush, chew, break
Do not stop abruptly, allow time for taper down.

Question 10

Aripiprazole brand name

Answer 10

Abilify

Question 11

Aripiprazole indication/dosage

Answer 11

Schizophrenia: start at 10-15mg daily, titrated in 2 week intervals to target range of 10-30mg daily
Acute manic and mixed episodes associated with bipolar: 15mg/day initially

Question 12

Aripiprazole mechanism

Answer 12

exact mechanism unknown

may be due to partial agonist activity at DA D2 and 5-HT1A receptors

Question 13

Aripiprazole metabolism and excretion

Answer 13

metabolized by CYP3A4 and 2D6 to dehydro-aripiprazole

Both are 99% plasma bound

Question 14

Aripiprazole drug interactions

Answer 14

3A4 and 2D6 inhibitors: increase Aripiprazole serum concentrations. Decrease dose to 1/2 usual dose. Ex: quinidine, fluoxetine, paroxetine)
3A4 inducers: decrease serum concentrations. Double the usual dose in these patients (carbamazepine)

Question 15

Aripiprazole CI/precautions

Answer 15

CI IN PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS
rare cases of NMS have occurred (hyperpyrexia, muscle rigidity, AMS, autonomic instability)
caution in patients with CV disease, history of seizures, risk for aspiration pneumonia, and who will be experiencing conditions which may contribute to elevated core temperature
Dispense smallest quantity manageable, due to suicide risk

Question 16

Aripiprazole pregnancy category

Answer 16

C

caution in nursing mothers

Question 17

Aripiprazole ADR’s

Answer 17

headache, anxiety, insomnia, asthenia, nausea, vomiting, constipation, weight gain, anxiety, lightheadedness, drowsiness, blurred vision.
TARDIVE DYSKINESIA is rare

Question 18

Aripiprazole patient education

Answer 18

caution when performing tasks that require mental alertness
avoid alcohol
use appropriate precautions against heat exposure and dehydration

Question 19

Buspirone brand name

Answer 19

BuSpar

Question 20

Buspirone indication/dosage

Answer 20

short-term relief of anxiety symptoms.
15mg/day initially as 2 doses
increase in 5mg increments at 2-3 day intervals
normal adult dose is 5-10mg up to QID

Question 21

Buspirone mechanism

Answer 21

not known
May be that it….
1) increases metabolism of NE in locus ceruleus
2) acts as moderate presynaptic DA agonist
3) acts as 5-HT agonist
does not effect BDZ or GABA receptors
discontinuation of therapy does not cause withdrawal!!!

Question 22

Buspirone drug interactions

Answer 22

MAO-I coadmin may elevate BP (do not use together)

grapefruit juice may increase plasma levels and should be avoided

Question 23

Buspirone CI/precautions

Answer 23

caution in patients with moderate-severe liver/renal impairment
possibility of dystonia, parkinsonism, TD due to DA binding

Question 24

Buspirone pregnancy category

Answer 24

B

use caution during lactation

Question 25

Buspirone ADRs

Answer 25

skin rash, tachycardia, headache, fatigue, sweating, muscle pain, dream disturbances, dizziness, drowsiness, nervousness, insomnia, mood alterations, depression, dry mouth, N/V/D, constipation, nasal congestion, blurred vision, tinnitus, sore throat

Question 26

Buspirone patient education

Answer 26

may cause drowsiness or dizziness, use caution
report abnormal involuntary movements of tongue or vacial muscles and changes in motor restlessness
avoid grapefruit and grapefruit juice during therapy