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Pharmacology > CNS: Hypnotic Sedative, Depression, Anxiety > Flashcards

CNS: Hypnotic Sedative, Depression, Anxiety Flashcards

1
Q

Sleep: Barbiturates

A
  1. No longer DOC
  2. SE profile
  3. CNS depression
  4. Withdrawal or overdose issues
  5. physical and psychological dependence
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2
Q

Sleep: Benzos USE/MOA

A
  1. Older drug
  2. losing favor
  3. Short, intermediate, long acting agents

USE: short term sleep disorders
MOA: Acts on polysynaptic neuronal pathways through the CNS

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3
Q

Sleep: Benzos AE/CAUTION

A

Restricted drug

AE: sedation, short term memory loss, physical dependency, withdrawal, constipation, diarrhea, drowsiness

CAUTION: other CNS depressants, liver/renal impairment, elderly

NO CHILDREN

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4
Q

Sleep: Antihistamines

A

Diphenhydramine and hydroxyzine = used for sleep

no pharmacological dependency

Anticholinergic effects (CANT SEE, PEE, SPIT, SHIT) may produce confusion = elderly

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5
Q

Sleep: Non-Benzo Receptor Agonist

A

improved SE profile

Shorter half-lives

no known tolerance w/ long term use

Greater receptor specificity of the GABAz BZ complex

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6
Q

Sleep: Eszopiclone USE

A

Lunesta

  1. transient and chronic insomnia
  2. long term use for up to 6 months
  3. peak plasma concentrations in 1hr
  4. HIGH fat diet can affect peak concentrations
  5. No evidence of tolerance or rebound insomnia

SCHEDULE IV

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7
Q

Sleep: Eszopiclone AE/DOSAGE

A

AE: taste change, HA, somnolence, asthenia, insomnia

Dose 2mg PO at HS
Metabolized by hepatic system, half life: 6hrs, 9hrs in elderly

Start elderly at 1mg

PREG C

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8
Q

Sleep: Zolpidem USE

A

Ambien and Ambien CR

Short term relief of insomnia for both sleep onset and sleep maintenance

controlled form helps patient fall asleep and stay asleep

Onset: 30mins

PREG C
SCHEDULE IV

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9
Q

Sleep: Zolpidem AE/CAUTION/DOSAGE

A

AE: dizziness, HA, somnolence, NIGHTTIME EATING/DRIVING, suppression of REM sleep

Report unusual SE
CAUTION: hepatic/renal dysfunction

DOSE regular 10mg and CR 12.5mg, start elderly at half of each dose

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10
Q

Sleep: Zaleplon USE

A

Sonata

indicated for long-term use, occasional insomnia, and regular onset

improved sleep latency and maintenance

Short half life: 1hr
No dose adjustment for renal impairment

PREG C
SCHEDULE IV

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11
Q

Sleep: Zaleplon AE/DOSAGE

A

AE: cognitive impairment, unpleasant taste, nightmares, sensory disturbance, constipation, dry mouth, depression

Start dose at 10mg at hs, must use right before bedtime

dose range 5-20mg PO qHS. Give elderly 5mg

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12
Q

Sleep: Melatonin Receptor Agonist

Ramelteon

A
  1. one drug in category
  2. stimulates the melatonin receptors involved w/ sleep
  3. no abuse potential, dependency, tolerance, withdrawal, or rebound insomnia

Can DEC level of testosterone, INC levels of prolactin and cortisol

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13
Q

Sleep: Ramelteon USE/DOSE/AE

A

Rozerem
PREG C

Half-life: 1-2.6hrs
No dose adjustment for renal/hepatic impairment

Dose adults/elderly at 8mg PO at hs

Do NOT take w/ HIGH fat meals = delays absorption
NOT for patients w/ endocrine impairment

AE: HA, somnolence, dizziness, fatigue
Take 30min before bedtime

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14
Q

Sleep Drugs PRECAUTIONS

A
  1. Take meds right before bedtime and be prepared for full night sleep
  2. no planned activities that require full psychomotor coordination
  3. AVOID high fat foods before bed
  4. NO ETOH or other CNS depressants
  5. Ask about alternative tx
  6. Call if unusual AEs
  7. CAUTION w/ elderly, renal/hepatic impairment
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15
Q

Antidepressant GOALS of THERAPY

A
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16
Q

Antidepressant Drug CLASSES

A
  1. TCA
  2. SSRI
  3. SNRI
  4. Atypical
  5. MAOI
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17
Q

TCA: USE/MOA

A
18
Q

TCA: ADMINISTRATION

A
19
Q

TCA: WARNING/CONTRA/CAUTION

A
20
Q

TCA: AE/INTERACTIONS

A
21
Q

SSRI: USE/MOA

A
22
Q

SSRI: Administration

A
23
Q

SSRI: WARNING/CONTRA/CAUTION

A
24
Q

SSRI: AE/INTERACTIONS

A
25
Q

SSRI: MONITOR/REPORT

A
26
Q

SSRI: General tips

A
27
Q

SSRI: Citalopram

A
28
Q

SSRI: Citalopram

A
29
Q

SSRI: Fluoxetine

A
30
Q

SSRI: Fluoxetine

A
31
Q

SSRI: Fluvoxamine

A
32
Q

SSRI: Sertraline

A
33
Q

SSRI: Sertraline

A
34
Q

SSRI: Escitalopram

A
35
Q

SSRI: Escitalopram

A
36
Q

SSRI: Escitalopram

A
37
Q

SNRI: MOA/USE

A
38
Q

SNRI: Administration

A
39
Q

SNRI: WARNING/CONTRA

A
40
Q

SNRI: AE/INTERACTIONS

A
41
Q

SNRI: Venlafaxine

A
42
Q

SNRI: Venlafaxine

A

Pharmacology (12 decks)

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