Anxiety and Mood

Question 1

Special Considerations for Benzodiazepines:

Answer 1

–With higher doses and long term use: amnesia, memory loss, visual changes.
-Contraindicated with narrow-angle glaucoma, addiction disorders, other CNS depressants, livers disorders

Question 2

What things can be used to help with insomnia?

Answer 2

Benzodiazepines (lorazepam), nonbenzodiazepines (Ambien), and Barbiturate’s

Question 3

Special things to consider for Zolpidem (Ambien)

Answer 3

-Used to help with sleep
-Women require a much lower dose than men
-Daytime sedation, amnesia, sleep walking, depression w/suicidal ideation, hallucinations

Question 4

What symptoms over the course of 2 weeks define depression?

And how many do we need to diagnose depression?

Answer 4

– Difficulty sleeping or sleeping too much
– Extremely tired; without energy
– Abnormal eating patterns
– Vague physical symptoms
(continued on next slide)
– Obsession with death
– Avoidance of psychosocial and interpersonal
interactions
– Lack of interest in personal appearance or sex
– Delusions or hallucinations
– Inability to concentrate or make decisions
– Feelings of despair, guilt, misery; lack of self-
worth

-5 or more

Question 5

Non-pharmacologic treatment for depression:

Answer 5

• Counseling
• Behavioral cognitive therapy
• Avoid maladaptive behaviors (alcohol, drugs)
• Diet
• Exercise
• Sleep

Question 6

Pharmacological Treatment for depression:

Answer 6

• Selective Serotonin Reuptake Inhibitors (SSRI)
• Serotonin-Norepinephrine Reuptake Inhibitors
  (NSRI)
• Atypical
• Tricyclics (TCA)
• Monamine Oxidase Inhibitors (MAOI)

Question 7

Serotonin Syndrome:

Answer 7

-Too much serotonin
-Nausea, vomiting, diarrhea, dilated pupils, Tremor, myoclonus, hyperreflexia

Question 8

Neuroleptic Malignant syndrome

Answer 8

-Withdrawal of dopamine
-Led-pipe rigidity, bradyreflexia

Question 9

What are things to consider with escitalopram, and sertraline?

Answer 9

-Treats: Depression, anxiety, OCD
-Decreased libido and weight gain
-Monitor for suicidal ideation
-Do not give within 2 weeks of MAOI (Sertraline) or escitalopram

Question 10

Serotonin-Norepinephrine reuptake inhibitors:

Answer 10

-Duloxetine (Cymbalta), Venlafaxine (Effexor), Bupropion (Wellbutrin)

Question 11

Duloxetine:

Answer 11

Used for pain and depression

Question 12

Venlafaxine

Answer 12

– Inhibit reuptake of serotonin and norepinephrine
and elevate mood; may affect dopamine levels

Question 13

Bupropion

Answer 13

Norepinephrine/dopamine-reuptake inhibitor
– Used for MDD, SAD, and aid in smoking cessation
AE: dry mouth, insomnia, weight loss, seizures. Less
likely to cause sexual side effects, sedation, or wt. gain

Question 14

What medication do avoid giving within 2 weeks of other medications

Answer 14

MAOI’s

Question 15

What is the therapuetic range for lithium?

Answer 15

.6-1.5 mEq/L