Chapter 18 and 19 ANXIETY INSOMNIA & DEPRESSION

Question 1

What two drugs are used for the pharmacotherapy of anxiety disorders and what type of drugs are they

Answer 1

-Lorazepam (Benzo)
-Phenobarbital (Barbiturates)

Question 2

what is the last name for benzodiazepines

Answer 2

“-azepam”

Question 3

what is the prototype Benzodiazepine

Answer 3

Lorazepam (ativan)

Question 4

What is lorazepam indicated for

Answer 4

generalized anxiety disorders and short term therapy of insomnia

Question 5

Where are benzos metabolized and excreted

Answer 5

metabolized in the liver excreted by the kidneys

Question 6

what are the main things to monitor when a patient is taking benzos

Answer 6

*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)

Question 7

what is the prototype Barbiturates

Answer 7

Phenobarbital

Question 8

What is phenobarbital indicated for

Answer 8

at low doses can reduce anxiety and at high doses it can induce anesthesia

Question 9

What are adverse effects of phenobarbital

Answer 9

-over suppression of NS (coma/respiratory depression)
-Angioedema
-blood dyscrasia
-SJS

Question 10

How long will a PT have to be on antidepressant therapy before their mood begins to improve

Answer 10

at least 3 weeks

Question 11

how long do antidepressants take to reach their maximum benefits

Answer 11

6-8 weeks

Question 12

what are the three antidepressants used with drug names

Answer 12

-Tricyclic antidepressants (imipramine)
-MOI’s (no drug name)
-SSRI (fluoxetine

Question 13

what is the prototype tricyclic antidepressant

Answer 13

imipramine

Question 14

What is the mechanism of action of TCA’s

Answer 14

block the reuptake of NE and serotonin and block ACH receptors

Question 15

what NS do TCA’s stimulate

Answer 15

Sympathetic NS (think more NE)

Question 16

What are contraindications of TCA’s

Answer 16

*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)

Question 17

What are considerations for TCA’s

Answer 17

-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

Question 18

what is the mechanism of action for MAOI’s

Answer 18

MAOI is an enzyme that destroys NE dopamine and serotonin so when it is inhibited causes higher levels of these neurotransmitters

Question 19

what are considerations for someone taking MAOI’s

Answer 19

-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)

Question 20

What are adverse effects of MAOI’s

Answer 20

-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

Question 21

How does MAOI’s affect tyramine and subsequently blood pressure

Answer 21

MAO breaks down tyramine so when it is inhibited a person will have more tyramine and therefore increased blood pressure

Question 22

What is the prototype SSRI

Answer 22

Fluoxetine

Question 23

What is the mechanism of action for SSRI

Answer 23

*its in the name
blocks the reuptake of serotonin

Question 24

What are the adverse effects of fluoxetine

Answer 24

-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)

Question 25

What are the main considerations for SSRI’s

Answer 25

*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)