Chapter 18 and 19 ANXIETY INSOMNIA & DEPRESSION Flashcards
What two drugs are used for the pharmacotherapy of anxiety disorders and what type of drugs are they
-Lorazepam (Benzo)
-Phenobarbital (Barbiturates)
what is the last name for benzodiazepines
“-azepam”
what is the prototype Benzodiazepine
Lorazepam (ativan)
What is lorazepam indicated for
generalized anxiety disorders and short term therapy of insomnia
Where are benzos metabolized and excreted
metabolized in the liver excreted by the kidneys
what are the main things to monitor when a patient is taking benzos
*remember the 5 b’s and a K of benzos
-Blood dyscrasias (blood diseases watch CBC)
-Bile (watch liver/no alcohol)
-Brain (watch CNS depression and other drugs that could suppress the CNS)
-BP (can cause hypotension)
-Bonkers (can cause delirium in elderly)
-Kidney function (since it’s excreted by the kidneys)
what is the prototype Barbiturates
Phenobarbital
What is phenobarbital indicated for
at low doses can reduce anxiety and at high doses it can induce anesthesia
What are adverse effects of phenobarbital
-over suppression of NS (coma/respiratory depression)
-Angioedema
-blood dyscrasia
-SJS
How long will a PT have to be on antidepressant therapy before their mood begins to improve
at least 3 weeks
how long do antidepressants take to reach their maximum benefits
6-8 weeks
what are the three antidepressants used with drug names
-Tricyclic antidepressants (imipramine)
-MOI’s (no drug name)
-SSRI (fluoxetine
what is the prototype tricyclic antidepressant
imipramine
What is the mechanism of action of TCA’s
block the reuptake of NE and serotonin and block ACH receptors
what NS do TCA’s stimulate
Sympathetic NS (think more NE)
What are contraindications of TCA’s
*think SNS stimulation and what will happen because of that
-Heart conditions (stims heart so will make it work harder)
-Urinary retention (More bear=less pee)
-Increase intraocular pressure (more SNS=dilated pupils eyes can’t drain)
-hyperthyroidism (SNS stim would release even more thyroid hormone)
What are considerations for TCA’s
-monitor and treat SNS stimulation symptoms (constipation urinary retention dry mouth)
-Monitor for suicidal thoughts (sometimes when a person first starts taking antidepressants their suicidal thoughts can get better before they get worse)
-Can cause sexual dysfunction
what is the mechanism of action for MAOI’s
MAOI is an enzyme that destroys NE dopamine and serotonin so when it is inhibited causes higher levels of these neurotransmitters
what are considerations for someone taking MAOI’s
-avoid foods that contain tyramine and tyrosine (people on MAOI’s already have high levels of tyramine which increase BP and if they consume food with tyramine can increase to dangerous levels=HTN crisis)
-Avoid caffeine (since caffeine contains MAOI so it can have an additive effect)
What are adverse effects of MAOI’s
-HTN crisis (usually occurs when a person taking MAOI’s eats foods containing tyramine)
-orthostatic hypotension/dysrhythmias (think since it stims SNS gets heart going and vasodilates)
-Sexual dysfunction
How does MAOI’s affect tyramine and subsequently blood pressure
MAO breaks down tyramine so when it is inhibited a person will have more tyramine and therefore increased blood pressure
What is the prototype SSRI
Fluoxetine
What is the mechanism of action for SSRI
*its in the name
blocks the reuptake of serotonin
What are the adverse effects of fluoxetine
-N/V/D/C (most of the serotonin in your body is in your gut elevated levels cause the gut to move faster also if there is too much serotonin then your body perceives this as nausea)
-sexual dysfunction (very common)
-changes in weight (serotonin also regulates your appetite)
What are the main considerations for SSRI’s
*remember the 5 S’s and 2 C’s of SSRI’s
-Seizures
-suicidal ideation
-sexual dysfunction
-stop suddenly (don’t do it)
-Seeing (narrow angle glaucoma)
-Cirrhosis (watch the liver/no alcohol)
-CNS (can cause CNS depressants if given with other meds/substances ie opioids or alcohol)
