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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
Do benzodiazepines have potential for drug dependence?
Physiological or behavioral symptoms after discontinuation Withdrawal symptoms “Bad” candidates - Older benzos hang around too long.
26
Does tolerance happen over time with benzodiazepines?
Yes!! Sedation may abate but anxiolytic effect may/does remain.
27
ADRs of Benzodiazepines
Central Nervous System Endocrine Gastrointestinal Respiratory
28
CNS ADRs of Benzodiazepines
``` Ataxia cognitive dysfunction depression dizziness drowsiness fatigue irritability memory impairment sedation ```
29
Endocrine ADRs of Benzodiazepines
decreased libido weight gain weight loss
30
GI ADRs of Benzodiazepines
Change in appetite Constipation Xerostomia
31
Which benzodiazepine is carried around with EMS squads?
Lorazepan to treat seizures.
32
Benzodiazepines are schedule _______ drugs?
IV
33
Respiratory ADR of benzodiazepines
Nasal Congestion
34
Only use benzodiazepines for how long?
4-6 weeks
35
Benzodiazepines class drug
Alprazolam
36
Alprazolam
Alprazolam 0.5 mg every 8 hours
37
Are benzodiazepines safe?
Yes! Very hard to kill somebody with these drugs. But do not mix opiates, alcohol, and benzos!! Vicodin + Xanax + Jack Daniels = death
38
Brand name of Alprazolam
Xanax
39
Xanax dosing range - up to...
10 mg per day 4 mg per day is common
40
With elderly people, Xanax prescription would be
0.12 mg - 0.125 mg every 8 hours
41
Non-benzodiazepines
Buspirone (BuSpar)
42
If ending benodiazepine therapy you must...
decrease the dose.
43
MOA non-benzodiazepines
Doesn’t affect benzodiazepine-GABA receptors Serotonin receptor partial agonist - variation of an SSRI D2, D3, D4 dopamine antagonist (presynaptic)
44
Non-benzodiazepine abuse potential?
Appears to not have dependence potential and no abuse potential
45
Time of onset for non-benzodiazepines
~ 2 weeks
46
ADRs of non-benzodiazepines
Relatively rare Central nervous system - Dizziness, drowsiness, confusion, anger/hostility, etc. Gastrointestinal - Nausea
47
Non-benzodiazepine Class Drug
Buspirone
48
Buspirone
Buspirone 15 mg Twice a day
49
A mood disorder characterized by: Episodes of mania Hypomania Major depression
Bipolar Disorder
50
Subtypes of Bipolar Disorder
Bipolar I | Bipolar II
51
Bipolar medication effect the...
mania.
52
Manic and mixed episodes (concurrent mania and major depression)
Bipolar I
53
One hypomanic episode, at least one major depressive episode, and the absence of manic and mixed episodes
Bipolar II
54
Clinically significant changes in mood, behavior, energy, sleep and cognition
Mania
55
Symptom of Mania
Elevated, irritable and labile mood is the core symptom of mania
56
A mood that’s unusually good, euphoric often accompanied by disinhibition
Class Mania
57
Lithium Salts
Lithium Carbonate | Lithium Citrate
58
Approved indications for Lithium Salts
Management of bipolar disorders Treatment of mania in individuals with bipolar disorder
59
Unapproved Indications of Lithium Salts
Augmenting agent for antidepressants Aggression Post-traumatic stress disorder, conduct disorder in children
60
MOA Lithium Salts
Increases cAMP levels Second messenger effect.
61
Do lithium salts require adjustment for renal impairment?
Yes
62
Drug interactions of lithium salts
Thiazide diuretics - decrease clearance by 25% Newer NSAIDs noted to also decrease clearance of lithium - reduced lithium clearance means lithium toxicity.
63
Lithium salts require monitoring of...
blood level
64
Therapeutic level of lithium salts
0.4-1.2 mEq/L
65
Toxic concentration of lithium salts
1.5 mEq/L
66
Adverse Drug Reactions of lithium salts
CNS Renal Endocrine Cardiac
67
CNS ADRs of lithium salts
Fine postural hand tremor | Electroencephalogram changes
68
Renal ADRs of lithium salts
Polyuria Compensatory polydipsia Very common!!! Check levels!
69
Endocrine ADRs of lithium salts
thyroid enlargement Monitor TSH
70
Cardiac ADRs of lithium salts
Very rare but care needed with elderly patients with history of arrhythmias.
71
Lithium Salts class drugs
Lithium carbonate ER
72
Lithium carbonate ER
Lithium carbonate ER tablet 600 mg One tablet twice daily
73
Lithium salts have a very _______.
narrow therapeutic index
74
Do not dose lithium salts based off of __________ do it based off of __________.
blood levels patient efficacy
75
Valproic Acid Derivatives
Divalproex Divalproate Valproate Sodium
76
Valproic Acid Derivative MOA
unknown for treatment of mania relationship to MDNA
77
Indiciations for Oral and IV valproic acid derivatives
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
Indications for Depakote, Depakote ER, Stavzor
Mania associated with bipolar disorder. Migraine prophylaxis
79
Unapproved uses for Valproic Acid Derivatives
Refractory status epilepticus | Diabetic neuropathy
80
Children's tolerance of valproic acid derivatives
Children under 10 years of age clear the drug better than adults Sometimes used for treatment of seizure disorders.
81
Renal clearance of valproic acid derivatives
Clearance likely doesn’t change until less than 10 mL/minute
82
What to monitor in valproic acid derivatives
Related to adverse reaction detection Liver function testing monthly to start then every 3 to 4 months
83
ADRs of valproic acid derivatives
``` Weight gain Nausea, vomiting Hair loss Easy bruising Life-threatening pancreatitis Polycystic Ovarian Syndrome ```
84
Valproic acid derivatives class drug
Depakote ER
85
Depakote ER
Depakote ER 500 mg Three tablets once daily
86
Valproic acid derivatives are teratogens?
YES!!! Do not Rx in younger women.
87
Anticonvulsants
Carbamazepine - Tegretol
88
MOA of anticonvulsants for mania
unknown
89
Indications for Equetrol
Acute manic or mixed episodes associated with bipolar 1 disorder
90
The only anticonvulsant approved by the FDA for the treatment of mania
Equetrol
91
Anticonvulsant drug interactions
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
ADRs of anticonvulsants
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
Anticonvulsants Class Drug
Equetro
94
Equetro
Equetro 400 mg Twice a day
95
When to treat severe bipolar disorder with acute mania
Medication combination Lithium + antipsychotic Valproate + antipsychotic Antipsychotic such as haloperidol, olanzapine, quetiapine
96
Carbamazepine + an antipsychotic for use of severe bipolar disorder with acute mania.
Probably no more effective than carbamazepine alone
97
What antipsychotic cannot be used with lithium or valproate for severe bipolar with acute mania?
Ziprazidone

Pharmacology II Quiz 6 (5 decks)

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