anxiolytics & antipsychotics

Question 1

neurotransmitters in anxiety

Answer 1

• increased norepinephrine

- decreased serotonin & GABA

Question 2

benzodiazepine

Answer 2

• type of sedative hypnotic/anxiolytic
• increases attraction of GABA receptors to GABA
• neuron excitability is reduced
• also induces sleep; increased anxiety leads to insomnia

Question 3

benzodiazepines + alcohol

Answer 3

• additive sedation

- dangerous when OD

Question 4

OD of benzodiazepine

Answer 4

• wide range of safety

- not successful to OD

Question 5

s/e of benzodiazepines

Answer 5

• hangover
• REM rebound (don’t use 3-4wks+)
• dependence
• tolerance (after 4 months)
• excessive depression
• respiratory depression
• hypersensitivity

Question 6

cross tolerance of benzodiazepines

Answer 6

-tolerant to Xanax, will also be tolerant to Ativan

Question 7

contraindications of benzodiazepines

Answer 7

• respiratory disorders
• pregnancy
• small doses for renal/hepatic dysfunction

Question 8

withdrawal s/s of benzodiazepines

Answer 8

• agitation
• insomnia
• tremors
• mm cramping
• sweating
• *abrupt stop of a high dose

Question 9

geriatric considerations of benzodiazepines

Answer 9

• paradoxical reaction: more agitated, talkative, anger, and rage
• half dose recommended
• avoid Dalmane, Doral, Diazepam (long acting)

Question 10

nonadrenergic agents

Answer 10

• anxiety=increased BP, possibly reduces anxiety
• inderal (propanolol): social anxiety
• catapres (clonidine)
• inhibits the physiologic feedback

Question 11

antipsychotics

Answer 11

• any drug that modifies psychotic behavior

- block D2 receptors = reduce psychotic symptoms=EPS

Question 12

phenothiazines

Answer 12

• block dopamine receptors
• Thorazine (chlorpromazine)
• Mellaril (Thioridazine)
• Prolixin (fluphenzaine)
• lower dose with hepatic dysfunction
• caution with glaucoma

Question 13

drug/food interactions phenothiazines

Answer 13

• with kava kava=increased risk and severity of dystonic reactions
• not affected by food
• with hypotensives=additive decreased BP
• antacids decrease absorption
• anticonvulsant needs to be increased d/t lowering of seizure threshold

Question 14

nonphenothiazines

Answer 14

• more EPS effect
• Haldol (haloperidol)
• Navane (thiothixene)

Question 15

Chlorpromazine

Answer 15

-Thorazine
\+++ sedation
\+++ hypotension
\++ EPS
\+++ antiemetic

Question 16

Fluphenazine

Answer 16

-Prolixin
\++ sedation
\+ hypotension
\+++ EPS
\+++ antiemetic

Question 17

Thioridazine

Answer 17

-Mellaril
+++ sedation
+++ hypotension
+ EPS

Question 18

Haloperidol

Answer 18

-Haldol
\+ sedation
\+ hypotension
\+++ EPS
\+++ antiemetic

Question 19

Thiothixene

Answer 19

-Navane
+ sedation
+ hypotension
+++ EPS

Question 20

EPS

Answer 20

• extrapyramidal syndrome
• tardive dyskinesia
• pseudoparkinsonism
• acute dystonia
• akathesia

Question 21

tardive dyskinesia

Answer 21

• potentially irreversible
• worming, protruding tongue
• rabbit nose
• sucking/smacking lips
• chewing
• involuntary mvmt of body
• anticholinergics have little effect, should stop drug

Question 22

psedoparkinsonism

Answer 22

• tremors
• shuffling gait
• drooling
• rigidity
• pill rolling
• stooped posturing
• bradykinesia
• hands behind back could counterbalance pt for risk for falls
• tx with anticholinergic

Question 23

acute dystonia

Answer 23

• facial grimacing
• oculogyric crisis
• involuntary muscle mvmt
• involunary upward eye mvmt
• cogwheel rigidity
• benedryl, cogentin, or Ativan helps reduce these symptoms

Question 24

akathisia

Answer 24

• restless
• trouble standing still
• pacing
• feet in constant motion
• rocking back and forth
• tx with benzo, or beta blocker

Question 25

anticholinergic side effects

Answer 25

• dry mouth
• blurred vision
• constipation
• urinary retention
• confusion
• red flushed skin
• very red & hot

Question 26

neuroleptic malignant syndrome

Answer 26

• increased HR, BP, temp
• muscle rigidity
• more common d/t typical antipsychotics
• potentially fatal

Question 27

tx of NMS

Answer 27

• immediate withdrawal
• hydration
• antipyretics
• benzos
• Bromocriptine (Parlodel)
• Dantrolene (Dantrium) muscle relax

Question 28

other s/e of antipsychotics

Answer 28

• sedation
• orthostatic hypotension
• photosensitivity
• hormonal effects
• prolonged QT interval
• hypersalivation
• agranulocytosis
• taper drug to avoid sudden recurrent of psychotic symptoms

Question 29

rapid tranquilization

Answer 29

• Haldol 5mg
• Ativan 2mg
• Benadryl 50mg

Question 30

complaince vs non adherence

Answer 30

• compliance: you know everything, and you don’t want to take
• non adherence

Question 31

atypical antipsychotics

Answer 31

• effective in + and - symptoms
• not likely to cause EPS and NMS
• don’t give to dementia related psychosis
• clozapine (clozaril)
• olanzepine (zyprexa)
• quetiapine (seroquel)
• ziprasidone (geodon)
• riperidone (risperdol)