EXAM 3 Flashcards
buspirone use
chronic anxiety
safe for regular scheduled use
buspirone MOA
binds to serotonin and dopamine receptors in brain
buspirone side effects
tachycardia
palpitations
paradoxical anxiety
HA
blurry vision
dizziness
nausea
poor coordination
buspirone considerations
non-habit forming
taper
assess hx substance abuse
needs to be taken daily
optimal results take 3-4 wks
drug interaction w/SSRI- serotonin syndrome
lg amounts grapefruit increased effect
do not give with MAOIs
Benzodiazepines MOA
decreases CNS activity
enhances GABA
Benzodiazepines Side Effects
risk for dependence
sedation
hypotension
impact on psychomotor abilities
dry mouth
dizziness
confusion
headache
Benzodiazepines considerations
assess LOC
med hx
risk for falls
avoid abrupt withdrawal
additive effect with other CNS depressants
Benzodiazepines meds
alprazolam, diazepam, lorazepam
alprazolam
GAd- short term use, oral contraceptives increase effectivness
diazepam
anxiety, ETOH withdrawl, status epilepticus, adjuvant for muscle spasm
oral contraceptives can increase effectivness
Lorazepam
IVP, continuous IV for severely agitated pts. ETOH withdrawal
status epilepticus IV and IM
oral contraceptives decrease theraputic effectivness
SSRI meds
fluoxetine, citalopram, sertraline, escitalopram
SSRI use
depression, bipolar, PTSD
SSRI MOA
blocks reabsorption of serotonin by nerve cells
SNRIs meds
duloxetine, venlafaxine
SNRI use
depression, GAD, adjuvant pain
SNRI MOA
blocks reabsorption of serotonin and norepinephrine in CNS
Miscellaneous meds
bupropion- NDRI, mirtazapine- tetracycline antidep.
bupropion use
depression/ SAD
bupropion action
decreased neuronal reuptake of dopamine in CNS, diminished neuronal uptake of serotonin and norepinephrine
mirtazapine- tetracycline antidep. use
depression, eating disorders, substance abuse
mirtazapine- tetracycline antidep. action
increase effectivness/ norepinephrine and serotonin, and dopamine
mirtazapine-tetracycline antidep. SE
weight gain, increased suicidal thoughts
Second- Generation Antidepressants meds
SSRIs, SNRIs, miscellaneous (bupropion, mirtazapine- tetracycline)
Second- generation antidep. SE
insomnia
weight gain
anxiety
dizziness
drowsiness
sexual dysfunction
discontinuation syndrome
second generation antidep. interactions
with other highly protein bound drugs will compete for binding sites
increased bleeding risk with anticoagulans/ NSAIDs
other serotonin enhancing drugs/ herbs will increase risk of serotonin syndrom
ETOH increased risk MAOI increased risk, over counter cold meds icnrease risk
First-Generation anitdepressant
tricyclic antidepressants (TCAS)
TCAs meds
amitriptyline
TCA use
depression, childhood enuresis, adjuvant analgesics for chronic pain conditions, neuropathic pain
TCAs MOA
potentiates effect of serotonin and norepinephrine in CNS
TCA SE
sedation
suicidal ideation
anticholinergic (dry mouth, urinary rention, constipation, blurred vision)
dyrhythmias (lethal overdose)
impotence
orthostatic hypotension
ataxia
weight gain
older patients: monitor closely for over- sedation and profound CNS depression
TCA interactions
overdose- highly lethal
so specific antidote but can decrease drug absorption with activated charcoal
TCA considerations
monotor ECG
suicidal ideation
weight and BMI before treatment
assess fasting glucose
urine- blue-green
get up slowly
taper, 2 wk washout for surgery
given if second gen fail
MAOIs meds
phenelzine, tranylcypromine
MAOIs use
atypical depression
MAOI action
accumulate dopamine, epinephrine, norepinephrine, and serotonin in body
MAOI SE
dizziness, dykinesias, nausea, syncope, hypertension
MAOI interaction
yramine:
-Foods or drinks with tyramine leads to hypertensive crises, which may lead to cerebral hemorrhage, stroke, coma, or death.
-Avoid foods that contain tyramine: Think Charcuterie board such as aged, mature cheeses (cheddar, bleu, Swiss)
Smoked, pickled, or aged meats, fish, poultry (herring, sausage, corned beef, salami, pepperoni, paté)
Yeast extracts
Red wines (Chianti, burgundy, sherry, vermouth)
Italian broad beans (fava beans)
MAOI considerations
require 3-6 wks effective
no pregnancy
2 wk washout, taper
avoid foods that contain tyramine
serotonin syndrome if taking with SSRI
selagiline patch
MOAI
Selegiline patch use
depression
selegiline patch MOA
icnreases dopamine serotonin and noreprinephrine levels in brain
selegiline patch SE
nausea, serotonin syndrome
selegiline patch interactions
no concerns with food inceractiosn at lower dose
Selegline patch considerations
peds, alochol, avoid external heating measures and sunlight
St johns wort (herbal product) use
mild/moderate depression
anxiety
sleep disorders
nervousness
st. johns wort action
antidepressant action may be due to ability to inhibit reuptake of serotonin and other neurotransmitters
st. johns wort SE
generally well tolerated
fatigue
dizziness
confusion
dry mouth
photosensitivity
st. johns wort interactions
MAOI, SSRI, TCA, benzodiazepines, tyramine-containing foods, opioids, oral contraceptives
st. johns wort considerations
pregnancy
breast feeding
peds
may cuase insomnia, anxiety, GI issues, headache, sexual dysfunction
no bipolar
no alzeimers/dementia
avoid ETOH
