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Pharmacology II Quiz 6 > Anxiety and Mood Disorders > Flashcards

Anxiety and Mood Disorders Flashcards

1
Q

Anxiety Disorders

A 
Separation Anxiety Disorder
Specific Phobia
Panic Disorder
Agoraphobia
Substance/medication-induced anxiety disorder
Other specified anxiety disorder
Selective mutism
Social anxiety disorder
Panic attack
Generalized anxiety disorder
Anxiety disorder due to another medical condition
Unspecified anxiety disorder
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2
Q

Obsessive Compulsive and Related Disorders

A

Obsessive-Compulsive Disorder
Hoarding Disorder
Unspecified obsessive-compulsive and related disorder
Obsessive-compulsive and related disorder due to another medical condition
Excoriation disorder
Body dysmorphic disorer
Trichotillomania
Substance/medication-induced obsessive-compulsive and related disorder
Other specified trauma- and stress-related disorder

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3
Q

Trauma and Stress-Related Disorders

A

Reactive detachment disorder
Posttraumatic stress disorder
Unspecified trauma- and stress-related disorder
Adjustment disorders
Disinhibited social engagement disorder
Acute stress disorder
Other specified trauma- and stress-related disorder

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4
Q

Motor tension
Autonomic hyperactivity
Vigilance and scanning

A

Generalized Anxiety Disorder

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5
Q

Discrete period of intense fear of being in places or situations from which escape may be difficult or embarrassing or in which help might not be available

A

Panic Disorder

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6
Q

Persistent unwanted thoughts and/or repetitive behaviors

A

Obsessive-Compulsive Disorder

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7
Q

Intense fear, helplessness, and horor

A

Posttraumatic Stress Disorder

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8
Q

Panic disorder is more often seen in

A

females

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9
Q

anxiety disorders are seen in…

A

younger people.

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10
Q

Anxiety disorders are caused by

A

Genetics

Neurotransmitters?

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11
Q

What are neuropsychological factors of anxiety disorders

A

Specific Biases - attention to threatening stimuli, detect threats more rapidly, ambiguous becomes threatening.

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12
Q

What causes developmental and personality factors?

A

Higher than average traumatic experience occurrence in childhood

Persons who are timid and shy in novel situations

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13
Q

What causes anxiety disorders with cognitive origins?

A

Excessive worrying

  • To avoid the fear response
  • Intolerance of uncertainty or ambiguity
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14
Q

Anxiety Disorders Drug Treatment

A

SSRIs

Tricyclic antideperssants

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15
Q

SSRIs for anxiety disorders

A

Covers multiple anxiety disorders

Start at low dose and increase gradually to achieve therapeutic effect

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16
Q

Tricyclic depressants for anxiety disorders

A

Especially helpful with combination anxiety and depression

Issues of side effects, time to onset

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17
Q

Benzodiazepines

A 
Alprazolam (Xanax)
Clordiazepoxide (Librium)
Clonazepam (Klonopin)
Clorazepate (Traxene-T)
Diazepam (Valium)
Lorazepam (Ativan)
Oxazepam
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18
Q

MOA Benzodiazepines

A

Benzodiazepines attach to benzodiazepines receptor and cause a change to the receptor site which allows for you to pick up the GABA in the system to enhance chloride flow through the alpha gate.

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19
Q

Indications for Lorazepam

A

Management of anxiety disorders

Short-term (4 months or less) relief of anxiety symptoms

Anxiety associated with depressive symptoms

Anxiety/stress-associated insomnia

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20
Q

Indications for Alprazolam

A

Anxiety disorder

Short-term relief of symptoms of anxiety

Panic disorder, with or without agoraphobia

Anxiety associated with depression

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21
Q

Which benzodiazepine is a muscle relaxer?

A

Diazepam - Valium

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22
Q

Benzodiazepines

An amnestic effect is seen in

A

triazolam (Halcion)

midazolam (Versed)

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23
Q

Which benzodiazepine is used for status epilepticus?

A

Lorazepam

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24
Q

Which benzodiazepine is used for petit mall (Lennox-Gastaut variant) seizures?

A

Clonazepam

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25
Q

Do benzodiazepines have potential for drug dependence?

A

Physiological or behavioral symptoms after discontinuation

Withdrawal symptoms
“Bad” candidates - Older benzos hang around too long.

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26
Q

Does tolerance happen over time with benzodiazepines?

A

Yes!!

Sedation may abate but anxiolytic effect may/does remain.

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27
Q

ADRs of Benzodiazepines

A

Central Nervous System
Endocrine
Gastrointestinal
Respiratory

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28
Q

CNS ADRs of Benzodiazepines

A 
Ataxia
cognitive dysfunction
depression
dizziness
drowsiness
fatigue
irritability
memory impairment
sedation
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29
Q

Endocrine ADRs of Benzodiazepines

A

decreased libido
weight gain
weight loss

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30
Q

GI ADRs of Benzodiazepines

A

Change in appetite
Constipation
Xerostomia

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31
Q

Which benzodiazepine is carried around with EMS squads?

A

Lorazepan to treat seizures.

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32
Q

Benzodiazepines are schedule _______ drugs?

A

IV

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33
Q

Respiratory ADR of benzodiazepines

A

Nasal Congestion

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34
Q

Only use benzodiazepines for how long?

A

4-6 weeks

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35
Q

Benzodiazepines class drug

A

Alprazolam

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36
Q

Alprazolam

A

Alprazolam
0.5 mg
every 8 hours

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37
Q

Are benzodiazepines safe?

A

Yes! Very hard to kill somebody with these drugs. But do not mix opiates, alcohol, and benzos!!

Vicodin + Xanax + Jack Daniels = death

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38
Q

Brand name of Alprazolam

A

Xanax

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39
Q

Xanax dosing range - up to…

A

10 mg per day

4 mg per day is common

40
Q

With elderly people, Xanax prescription would be

A

0.12 mg - 0.125 mg every 8 hours

41
Q

Non-benzodiazepines

A

Buspirone (BuSpar)

42
Q

If ending benodiazepine therapy you must…

A

decrease the dose.

43
Q

MOA non-benzodiazepines

A

Doesn’t affect benzodiazepine-GABA receptors

Serotonin receptor partial agonist - variation of an SSRI

D2, D3, D4 dopamine antagonist (presynaptic)

44
Q

Non-benzodiazepine abuse potential?

A

Appears to not have dependence potential and no abuse potential

45
Q

Time of onset for non-benzodiazepines

A

~ 2 weeks

46
Q

ADRs of non-benzodiazepines

A

Relatively rare

Central nervous system - Dizziness, drowsiness, confusion, anger/hostility, etc.

Gastrointestinal - Nausea

47
Q

Non-benzodiazepine Class Drug

A

Buspirone

48
Q

Buspirone

A

Buspirone
15 mg
Twice a day

49
Q

A mood disorder characterized by:
Episodes of mania
Hypomania
Major depression

A

Bipolar Disorder

50
Q

Subtypes of Bipolar Disorder

A

Bipolar I

Bipolar II

51
Q

Bipolar medication effect the…

A

mania.

52
Q

Manic and mixed episodes (concurrent mania and major depression)

A

Bipolar I

53
Q

One hypomanic episode, at least one major depressive episode, and the absence of manic and mixed episodes

A

Bipolar II

54
Q

Clinically significant changes in mood, behavior, energy, sleep and cognition

A

Mania

55
Q

Symptom of Mania

A

Elevated, irritable and labile mood is the core symptom of mania

56
Q

A mood that’s unusually good, euphoric often accompanied by disinhibition

A

Class Mania

57
Q

Lithium Salts

A

Lithium Carbonate

Lithium Citrate

58
Q

Approved indications for Lithium Salts

A

Management of bipolar disorders

Treatment of mania in individuals with bipolar disorder

59
Q

Unapproved Indications of Lithium Salts

A

Augmenting agent for antidepressants

Aggression

Post-traumatic stress disorder, conduct disorder in children

60
Q

MOA Lithium Salts

A

Increases cAMP levels

Second messenger effect.

61
Q

Do lithium salts require adjustment for renal impairment?

A

Yes

62
Q

Drug interactions of lithium salts

A

Thiazide diuretics - decrease clearance by 25%

Newer NSAIDs noted to also decrease clearance of lithium - reduced lithium clearance means lithium toxicity.

63
Q

Lithium salts require monitoring of…

A

blood level

64
Q

Therapeutic level of lithium salts

A

0.4-1.2 mEq/L

65
Q

Toxic concentration of lithium salts

A

1.5 mEq/L

66
Q

Adverse Drug Reactions of lithium salts

A

CNS
Renal
Endocrine
Cardiac

67
Q

CNS ADRs of lithium salts

A

Fine postural hand tremor

Electroencephalogram changes

68
Q

Renal ADRs of lithium salts

A

Polyuria
Compensatory polydipsia

Very common!!! Check levels!

69
Q

Endocrine ADRs of lithium salts

A

thyroid enlargement

Monitor TSH

70
Q

Cardiac ADRs of lithium salts

A

Very rare but care needed with elderly patients with history of arrhythmias.

71
Q

Lithium Salts class drugs

A

Lithium carbonate ER

72
Q

Lithium carbonate ER

A

Lithium carbonate ER tablet
600 mg
One tablet twice daily

73
Q

Lithium salts have a very _______.

A

narrow therapeutic index

74
Q

Do not dose lithium salts based off of __________ do it based off of __________.

A

blood levels

patient efficacy

75
Q

Valproic Acid Derivatives

A

Divalproex
Divalproate
Valproate Sodium

76
Q

Valproic Acid Derivative MOA

A

unknown for treatment of mania

relationship to MDNA

77
Q

Indiciations for Oral and IV valproic acid derivatives

A

Monotherapy and adjunctive therapy in the treatment of patients with complex partial seizures

Monotherapy and adjunctive therapy of simple and complex absence seizures

Adjunctive therapy in patients with multiple seizure types that include absence seizures

78
Q

Indications for Depakote, Depakote ER, Stavzor

A

Mania associated with bipolar disorder.

Migraine prophylaxis

79
Q

Unapproved uses for Valproic Acid Derivatives

A

Refractory status epilepticus

Diabetic neuropathy

80
Q

Children’s tolerance of valproic acid derivatives

A

Children under 10 years of age clear the drug better than adults

Sometimes used for treatment of seizure disorders.

81
Q

Renal clearance of valproic acid derivatives

A

Clearance likely doesn’t change until less than 10 mL/minute

82
Q

What to monitor in valproic acid derivatives

A

Related to adverse reaction detection

Liver function testing monthly to start then every 3 to 4 months

83
Q

ADRs of valproic acid derivatives

A 
Weight gain 
Nausea, vomiting
Hair loss
Easy bruising
Life-threatening pancreatitis 
Polycystic Ovarian Syndrome
84
Q

Valproic acid derivatives class drug

A

Depakote ER

85
Q

Depakote ER

A

Depakote ER
500 mg
Three tablets once daily

86
Q

Valproic acid derivatives are teratogens?

A

YES!!!

Do not Rx in younger women.

87
Q

Anticonvulsants

A

Carbamazepine - Tegretol

88
Q

MOA of anticonvulsants for mania

A

unknown

89
Q

Indications for Equetrol

A

Acute manic or mixed episodes associated with bipolar 1 disorder

90
Q

The only anticonvulsant approved by the FDA for the treatment of mania

A

Equetrol

91
Q

Anticonvulsant drug interactions

A

Carbamazepine affects blood levels of multiple drugs
Some drug effects rise - Some drug effects fall

Carbamazepine is a
Major CYP3A4 substrate
Strong inducer of CYP1A2, CYP2B6, CYP2C19, CYP2C8, CYP2C9, CYP3A4 and P-glycoprotein

92
Q

ADRs of anticonvulsants

A

Ataxia, dizziness, somnolence, headache

Hematologic - Agranulocytosis, aplastic anemia, leukopenia, etc., etc.
Early detection important

Dermatologic - Stevens-Johnson syndrome
Potential for severe morbidity and death

93
Q

Anticonvulsants Class Drug

A

Equetro

94
Q

Equetro

A

Equetro
400 mg
Twice a day

95
Q

When to treat severe bipolar disorder with acute mania

A

Medication combination
Lithium + antipsychotic

Valproate + antipsychotic

Antipsychotic such as haloperidol, olanzapine, quetiapine

96
Q

Carbamazepine + an antipsychotic for use of severe bipolar disorder with acute mania.

A

Probably no more effective than carbamazepine alone

97
Q

What antipsychotic cannot be used with lithium or valproate for severe bipolar with acute mania?

A

Ziprazidone

Pharmacology II Quiz 6 (5 decks)

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