Ch. 14 Drugs - Anxiety & Insomnia Flashcards
Types of Anxiety Disorders
Situational anxiety
Generalized anxiety disorder (GAD)
Panic disorder
Phobias
Social anxiety disorder
Obsessive-compulsive disorder (OCD)
Post-traumatic stress disorders (PTSD)
Regions of the brain that are associated with anxiety, expression of emotions, and a restless state.
Limbic System & Reticular Formation
Antidepressants for Anxiety & Anxiety-Related Symptoms
SSRIs
SNRIs - atypical antidepressants
TCAs
MAOIs
CNS Depressants for Anxiety and Anxiety-Related Symptoms
Benzodiazepines
Barbiturates
Other drugs
Nonpharmacologic Therapies for Anxiety and Insomnia
Cognitive Behavioral Therapy
Counseling
Biofeedback Techniques
Meditation
Short-term or behavioral insomnia is sometimes attributed to what?
Stress
What may disturb sleep?
Food or beverages with stimulants
Long-term insomnia is caused by what?
Depression
Manic disorders
Chronic pain
this is caused by the discontinuation of long-used sedative drugs
Rebound insomnia
Drugs that have the ability to relieve anxiety
Anxiolytics (Benzos)
These drugs work by slowing down the neuronal activity in the brain
CNS Agents - Antidepressants
4 classes of CNS depressants to treat anxiety and sleep disorders
Antidepressants
Benzodiazepines
Nonbenzodiazepines anxiolytics
Barbiturates
A continuum ranging from relaxation, to sedation, to the induction of sleep and anesthesia
CNS depression
These drugs treat major depression and a range of anxiety conditions
Antidepressants
What are the primary medications to reduce symptoms of panic and anxiety?
TCAs
MAOIs
SSRIs
Atypical antidepressants that do not fall conveniently into other categories
The most commonly prescribed antidepressant
SSRIs
SSRI prototype drug
escitalopram (Lexapro)
Prozac, Celexa, Paxil, & Zoloft
Examples of antidepressant drugs
Increases the availability of serotonin at specific postsynaptic receptor sites in the CNS
SSRIs MOA
Adverse Effects of SSRIs
Weight gain
Sexual dysfunction
Dizziness
Insomnia
Somnolence
Confusion
Seizures
Black Box Warning of SSRIs
Increased risk of suicidal ideation and behavior in children
Atypical Antidepressant
SNRIs - Selective Norepinephrine Reuptake Inhibitor
Cymbalta, Efecor, trazadone
Examples of SNRIs
Abnormal dreams
Sweating
Constipation
Dry mouth
Loss of appetite
Weight loss
Tremors
Abnormal vision
Headaches
Nausea/Vomiting
Dizziness
Loss of sexual desire
Hypertension
Tachycardia
Side effects of SNRIs
Black Box warning for SNRIs
Increased risk of suicidal ideation
Amitriptyline, Imipramine
Almost all drugs that end with suffix -mine or -line
TCAs - Tricyclic Antidepressants or Cyclic Antidepressants
among the first antidepressants developed
TCAs
Effective for depression resistant to other classes of medication, but have much more serious side effects
TCAs
TCAs contraindications
Heart attack
Heat block
Arrhythmia
TCAs pregnancy category
C or D
Dry mouth
Blurred vision
Urine retention
Hypertension
Angioedema
Agranulocytosis
Bone marrow suppression
TCAs side effects
Avoid concurrent use of what when taking TCAs
Alcohol or other CNS depressants
escitalopram (Lexapro)
Prozac
Celexa
Paxil
Zoloft
SSRIs drug examples
phenelzine
MAOI example
Patient education for MAOIs
Avoid foods containing tyramine - beer, wine, smoked or cured meats, aged cheese, certain type of beans
Why should a patient avoid tyramine if taking MAOIs?
Can cause hypertensive crisis if ingested while on MAOI
What drugs potentiate the effects of insulin and other diabetic drugs?
MAOIs
Common adverse effects of MAOIs
Orthostatic hypotension
Headache
Diarrhea
alprazolam (Xanax)
chlordiazepoxide (Librium)
clonazepam (Klonopin)
clorazepate (Tranxene)
diazepam (Valium)
lorazepam (Ativan)
oxazepam (Serax)
Benzodiazepines for Anxiety Therapy
estazolam
flurazepam
quazepam (Doral)
temazepam (Restoril)
triazolam (Halcion)
Benzodiazepines for Insomnia Therapy
Benzodiazepine drugs differ in what?
Onset and duration. They all have the same MOA and adverse effects
Preferred drug for anxiety disorders and insomnia
Benzodiazepines
Whats the relationship b/w benzodiazepines and insomnia?
Used for particularly short term insomnia caused by anxiety
Other indications for benzodiazepines
Seizure disorders
Alcohol withdrawal
Muscle relaxation
Induction of anesthesia for procedures
Why are benzodiazepines used?
B/c they are effective while not producing life-threatening respiratory depression
Life-threatening respiratory depression of benzodiazepines can occur when?
If used in conjunction with other substances-medications, illegal drugs, and alcohol
Withdrawal symptoms occur with benzodiazepines when?
If stopped abruptly
Drugs rarely prescribed due to side effects and dependence
Barbiturates
Barbiturates are prescribed for what?
Sedative, hypnotic, and antiseizure effects
Pentobarbital
Phenobarbital
Secobarbital
Examples of barbiturates
Barbiturates what a high risk for what?
Psychological and physical dependence
Barbiturates drug class schedule
Schedule II drug
Barbiturates withdrawal symptoms
Severe- potentially fatal
Barbiturates have a high risk for what?
Overdose & respiratory arrest
Side effects of barbiturates
Respiratory depression and increased metabolism
drugs that are chemically unrelated to either benzodiazepines or barbiturates, but also reduce anxiety
Nonbenzodiazepine, Nonbarbiturate CNS Depressants
Nonbenzodiazepine, Nonbarbiturate CNS Depressant Drug Prototype
zolpidem (Ambien)
zolpidem (Ambien) is used mainly for what?
Treatment of social anxiety symptoms and insomnia
Adverse effects of zolpidem (Ambien) and other Nonbenzodiazepine, Nonbarbiturate CNS Depressants
Mild nausea
Dizziness
Diarrhea
Daytime drowsiness
Amnesia
Sleepwalking
Eating while asleep
zolpidem (Ambien) MOA
binds to GAB receptor
Preserves sleep stage III
Offers minor effects of REM sleep
Examples of Nonbenzodiazepine, Nonbarbiturate CNS Depressants
zolpidem (Ambien)
buspirone
Precedex
Lunesta
Antiseizure med used for social anxiety
valproic acid (Depakote)
Beta Blockers used for social and performance anxiety
atenolol
propanolol
Melatonin receptor drug used for insomnia
Ramelteon
Orexin Receptor Blocker drug used for insomnia and to help maintain sleep throughout the night
suvorexant
