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A. Pharm II > EXAM 2 > Flashcards

EXAM 2 Flashcards

1
Q

What two parts of the brain do anxiety disorders affect?

A
  1. Limbic system: set of brain structures located on both sides of the thalamus, immediately beneath the cerebrum. It controls behaviors essential to the life, such as the desire to eat and drink and in sensory input for emotions and regulating aggressive behavior.
  2. Reticular activing system: is responsible for regulating wakefulness and sleep-wake transitions, and also for promoting motor control of posture.
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2
Q

This anxiety disorder is described as having intense feelings of fear/terror/doom:

A

Panic disorder.

This person will experience a panic attack (increased HR, diaphoresis, can’t breath).

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3
Q

This anxiety disorder is characterized as temporary stressors of everyday life, no need for intervention:

A

Situational anxiety.

An adaptive response to deal with stress.

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4
Q

This anxiety disorder is described as almost a phobia of social situations:

A

Social anxiety disorder (SAD).

They may feel judged, ridiculed, embarrassed.

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5
Q

What anxiety disorder is the following: Person experiences an excessive anxiety for 6 months or more:

A

Generalized anxiety disorder (GAD).

Person experiences excessive worry and fear… trouble sleeping and unable to focus. May live with it for a longer period of time.

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6
Q

If someone experiences intrusive, repetitive thoughts or behaviors, they may be experiencing which anxiety disorder?

A

Obsessive compulsive disorder (OCD).

This can negatively impact their quality of life. Ex: fear of germs leads to obessessive cleaning and washing, damaging their skin and taking up all of their time.

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7
Q

What kind of meats are high in tyramine?

A

Liver (beef or chicken) / Pate

Hot dogs / Bologna

Pepperoni / Salami / Sausage

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8
Q

Which dairy products are a concern for tyramine?

A
  • Aged cheese
  • Sour cream
  • Yogurt
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9
Q

Which fruits are a concern for high levels of tyramine?

A
  • Avocados
  • Bananas (in large amounts)
  • Canned figs
  • Papaya products, including meat tenderizers
  • Raisins
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10
Q

Which vegetables have high amounts of tyramine?

A

Pods of fava beans

Fermented soybeans, soybean paste, soy sauce.

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11
Q

What type of fish has tyramine?

A

Dried or cured fish.

Fermented / smoked / aged fish

Pickled or kippered herring

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12
Q

Tyramine is found in which alcohol?

A

Beer

Wine (esp. red)

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13
Q

Why are protein supplements, shrimp paste, and yeast a concern for those on MAOI medication?

A

Tyramine is found in these foods and can cause HTN crisis. Some soups may also contain protein extract which could also contain tyramine.

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14
Q

How does the amino acid, tyramine, combined with the ingestion of monoamine oxidase inhibitors cause hypertensive crisis?

A

The effects of tyramine are increased in the presence of MAOIs… causing high levels of tyramine to be absorbed. Hypertensive crisis (increase of 30mmHg or more) is from the indirect release of endogenous norepinephrine from nerve terminals, induced by the tyramine. (Rapid vasoconstriction occurs).

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15
Q

What is a common MAOI that is Rx’d?
What is its onset?
What are the side effects?

A

phenelzine (Nardil)

Onset: 2-8 WEEKS

Side effects:

  • Hypertensive crisis
  • Drowsiness
  • Orthostatic hypotension
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16
Q

Why are MAOIs “last resort” drugs?

A

Because TCAs and SSRIs are tried first and because of the food restrictions (no tyramine).

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17
Q

The phobia of closed spaces:

A

Agoraphobia.

Example: airplane, elevator

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18
Q

Why is non-REM stage 4 so important?

A

Body reparation is in this stage.

R.E.M. Is dreaming but also essential for learning and memory as well.

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19
Q

The pathophysiology are similar in anxiety and sleep disorders….

A

There is a higher incidence of insomnia in patients with anxiety and depression (“feeding each other”).

Anxiety disorders and sleep disorders are treated with the same class of drugs.

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20
Q

What natural hormone is a common supplement to help with the ONSET of sleep?

A

Melatonin.

Too much may cause nightmares, HA, or mental impairment.

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21
Q

This drug’s side effect is the goal for a short term benefit to sleep disorders:

A

Antihistamines.

Drowsiness is the goal. The bad side is that the drowsiness may last too long and bleed over into the next day.

Another side effect is dry membranes.

Ex: Tylenol PM

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22
Q

If melatonin and antihistamines did not work then this would be the next step:

A

Prescription medications. These are CNS depressants.

  1. Anxiolitics
  2. Tranquilizers
  3. Sedatives
  4. Hypnotics

Low doses induce relaxation.
High doses are more of a sedative effect.

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23
Q

What is the neurotransmitter involved with anxiety and sleep disorders?

A

GABA.

In the CNS, the GABA NT is mostly an inhibitory NT.

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24
Q

What is the preferred drug for general anxiety disorders or short-term insomnia?

A

Benzodiazepines.

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25
Q

What is the main drug prescribed for general anxiety, insomnia, seizures, and alcohol withdrawal?

A

lorazepam (Ativan)

The mechanism of action is it potentiates GABA activity / receptors (this enhancement leads to CNS depression because GABA is an inhibitory NT)

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26
Q

What are some adverse effects of lorazepam?

A

All related to CNS depression:

  • Sedation
  • Respiratory Depression
  • Decrease in BP
  • Dizziness
  • Can cause a paradoxical excitation in some (mostly the elderly or children)
  • CONTRAINDICATED in pregnant women due to risk of fetal abnormalities.
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27
Q

What is alprazolam prescribed for?
What pregnant category is alprazolam?
What can inhibit its metabolism?

A

Indications: Often for sleep, other times anxiety.

(Xanax) Pregnancy category D.

Grapefruit juice can cause toxicity due to interaction with the drug and it not being metabolized.

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28
Q

Diazepam is used for what indications?

A

(Valium) Medical procedures to relax. Also is used for alcohol withdrawal, and seizures.

Works really well as anti-seizure medication… often given IV but many times PO.

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29
Q

What drug has an anterograde amnesia effect?

A

midazolam (Versed).

Used in medical procedures: colonoscopy, chest tube placement.

Given IV

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30
Q

What drug is used to reverse the effects of benzodiazepines?

A

flumazenil (Romazicon)

Given IV for rapid effect

Competes for GABA receptors to reverse sedation within minutes.

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31
Q

This nonbenzo drug is given for insomnia and is quick acting so it should be taken when the patient is already in bed (to help reduce the risk of sleep-related-behavior):

A

zolpidem (Ambien)

Adverse effects: mostly mild, amnesic effect, behavioral changes can include sleep eating, sleep driving, sleep shopping, etc.

CAN lead to dependency!

32
Q

What is the mechanism of action of zolpidem?

A

It potentiates GABA activity but only binds to ONE receptor.

This allows the sedative effect but not the muscle relaxation (so not for seizures!).

This drug has a short half life, so NO daytime drowsiness.

33
Q

This barbiturate is old (early 1900’s) and rarely used today, except for seizures:

A

phenobarbital (Luminal)

Enhances GABA activity.

Many adverse effects… extreme CNS depression, Coma and Death.

34
Q

What are some drug interactions to be aware of with phenobarbital?

A

Corticosteroids

Birth Control pills

Anti-Convulsives

This occurs because phenobarbitol increases the metabolism of these drugs thereby reducing their effect and not reaching a therapeutic level.

35
Q

When is phenobarbital contraindicated?

A
  • Pregnancy category D
  • Suicide ideation
  • CNS depression
36
Q

This mood disorder is also known as “clinical depression”:

A

Major depressive disorder

37
Q

This mood disorder is characterized by mild, chronic depression that lasts 2 + years:

A

Dysthmic disorder.

38
Q

Alternating moods of mania and depression:

A

Bipolar

39
Q

This mood disorder has manic-like symptoms and hypomanic episodes:

A

Manic and hypomanic episodes

40
Q

When someone has mild bipolar symptoms they are classified as?

A

Cyclothymic disorder.

41
Q

This inhibitory transmitter is important for sleep, pain perception, mood and emotions:

A

Serotonin.

42
Q

This neurotransmitter can be either inhibitory or excitatory in the CNS and is mostly excitatory in the PNS:

A

Norepinephrine.

43
Q

Is GABA inhibitory or excitatory?

A

Inhibitory.

44
Q

Is acetylcholine excitatory or inhibitory in the CNS?

A

Either.

45
Q

This typically excitatory NT is related to movement and attention:

A

Dopamine.

46
Q

What are the 4 classes of antidepressants?

A
  1. TCAs
  2. SSRIs
  3. Atypical antidepressants
  4. MAOIs
47
Q

This TCA is used for depression, nocturnal enuresis, chronic pain, and insomnia:

A

imipramine (Tofranil)

48
Q

What is the onset of action time for imipramine?

A

2 - 3 weeks

The patient is in a vulnerable state during this wait.

49
Q

What is imipramine’s mechanism of action?

A

Blocks reuptake of norepinephrine and serotonin. It also blocks Ach receptors (so anticholinergic effects).

50
Q

What drug is used for chronic pain and nocturnal enuresis?

A

Imipramine (Tofranil)

It’s mainly used for depression but it can be used for insomnia.

51
Q

What are the adverse effects of imipramine?

A
  • Black box: suicide risk (old and young)
  • Cardia dysrhythmias (r/t high doses)
  • Orthostatic hypotension (dizzy/falls)
  • Anticholinergic effects (from the block of the Ach sites): dry mouth, blurry vision, constipation, urinary retention.
  • Weight gain
  • Sexual dysfunction.
52
Q

What class of drug is imipramine?

A

Tricyclic antidepressants (TCAs)

They are named after their chemical structure, which contains three rings of atom

53
Q

What is another common TCA that you may see?

A

Amitriptyline (Elavil)

TCAs are good because they are cheap and because they’ve been around for a long time = proven efficacy.

54
Q

This drug class is widely prescribed and has the risks of serotonin withdrawal syndrome and serotonin syndrome:

A

SSRIs

55
Q

This drug has a 70% sexual dysfunction rate and the risk of weight gain:

A

Fluoxetine (Prozac).

Onset of action is quicker than TCAs (which is 2-3 weeks).

Mechanism of action: blocks the reuptake of serotonin.

56
Q

This occurs with abrupt discontinuation of a drug that potentiates serotonin:

A

Serotonin withdrawal syndrome.

57
Q

This occurs when multiple drugs that affect serotonin levels are taken at the same time:

A

Serotonin Syndrome (SES)

Causes high amounts of serotonin to accumulate.

58
Q

What are the signs of a serotonin withdrawal?

A

HA

Tremor

Anxiety

Sensory disturbances

59
Q

What are some common drugs that affect serotonin levels?

A
  • MAOIs (inhibit the breakdown of serotonin)
  • SSRIs (inhibit the reuptake of serotonin)
  • lithium
  • St Johns Wort
  • Illicit drugs (can cause an increase in set.)
60
Q

What are the signs of serotonin syndrome?

A
  • Mental status change (confusion, anxiety, agitation)
  • Rigidity
  • HTN
  • High fever
61
Q

What is the treatment involved with serotonin syndrome?

A

D/C medication involving serotonin

Mainly supportive: May require ventilation, muscle relaxants.

62
Q

What are some other indications for SSRIs?

A
  • Premenstrual dysphoric disorder
  • Bulimia / Anorexia nervosa
  • Obesity
  • Alcohol dependence
63
Q

3 more really common SSRIs:

A
  1. citalopram (Celexa)
  2. escitalopram (Lexapro)
  3. sertraline (Zoloft)
64
Q

What is venlafaxine (Effexor) used for?

What is its class?

A

Venlafaxine is used to treat major depressive disorder, anxiety, and panic disorder.

It is from the class Atypical Antidepressants or SNRI - Serotonin Norepinephrine Reuptake Inhibitor.

This is a newer and more diverse drug class.

65
Q

Venlafaxine’s adverse effects:

A
  • Nausea
  • Growth retardation in children
  • CNS stimulation (because this drug’s structure is similar to amphetamines)
66
Q

What is bupropion (Wellbutrin) used for?

What is its class?

Side effect?

A

It’s an antidepressant but is also used for

smoking cessation (nicotine withdrawal) and

neuropathic pain.

CLASS: Atypical Antidepressants or NDRI - Norepinephrine Dopamine Reuptake Inhibitor

Side effect is CNS stimulation (because [like venlafaxine] its structure is similar to amphetamine).

67
Q

When would phenelzine be prescribed?

A

If TCAs and SSRIs are ineffective.

This is a last resort drug because it is an MAOI.

Mechanism of action: it binds irreversibly to MAO (enzyme in liver, intestines and adrenergic neurons that destroys them, so if it’s blocked then those NTs will increase). It enhances the action of epinephrine, norepinephrine, serotonin, and dopamine in the CNS.

68
Q

What is the time frame of the onset of action for MAOIs?

What are the adverse side effects?

A

2 - 8 weeks

HTN crisis (esp if combined with tyramine)

Drowsiness

Orthostatic hypotension

69
Q

Name one mood stabilizer:

A

Lithium

70
Q

Name 3 Antiepileptics:

A

Valproic acid

Carbamazepine (Tegretol)

Iamotrigine (Lamictal)

71
Q

Name one antipsychotic:

A

risperidone

72
Q

This drugs mechanism of action is largely unknown but it is known to change the balance of NTs in the brain, is pregnancy category D, and has a narrow therapeutic index:

A

Lithium (Eskalith, Lithobid)

The variable response in individuals, coupled with its short half-life, makes it a little unpredictable.

73
Q

This drug increases the synthesis of serotonin, has an onset of action of 1-2 weeks and can create hypothyroidism through drug interaction:

A

Lithium.

Hypothyroidism can develop due to the affect of the synthesis of thyroid hormone from the lithium.

Due to the increase in serotonin, have to watch for serotonin syndrome.

74
Q

This drug has side effects of muscle weakness, lethargy, N/V, long term use - renal impairment and has a narrow therapeutic index:

A

Lithium

The renal impairment is due to buildup of lithium. It can also occur when patient takes a THIAZIDE diuretic (bc the Na is replaced with the lithium salt).

The narrow range makes it unsafe and tricky to manage.
Starting dose range is 0.8 - 1.8 mEq/L

Maintenence level is 0.4 - 1.0 mEq/L

Pregnancy category D

75
Q

Many sources prefer to use this anti-epileptic drug over lithium because of fewer side effects:

A

Valproic Acid (Depakene, Depakote)

First line drug per many sources.

Mechanism of action: increased GABA in brain.

Adverse effects (rare but serious):

  • Thrombocytopenia (low platelets = bleeding)
  • Pancreatitis
  • Liver failure
  • Teratogenic = pregnancy category D
76
Q

What drug class would you use to treat premenstrual dysphoric disorder, bulimia / anorexia nervosa, obesity, and alcohol dependency?

A

SSRIs.

A. Pharm II (7 decks)

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