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pharmacology > EXAM 4- antidepressants and anti anxiety > Flashcards

EXAM 4- antidepressants and anti anxiety Flashcards

1
Q

psychiatric assessment

A 
Always Send Mail Through the Post Office
Appearance
Speech
Memory/Mood
Thoughts
Perception
Orientation
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2
Q

anxiety

A

Feeling of apprehension, worry, or uneasiness

  • A certain amount of anxiety is normal
  • May or may not be based on reality
  • Excess anxiety can interfere with day to day functioning
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3
Q

anti anxiety drugs

A

used to treat anxiety (anxiolytics)

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4
Q

two main classes of antianxiety

A

benzodiazepines, nonbenzodiazepines

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5
Q

benzodiazepines ex:

A

-alprazolam (xanax)
-diazepam (valium)
-lorazepam (ativan)
long term use can result in physical/psychological dependence*
(Very effective in treating anxiety disorders)

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6
Q

nonbenzodiazepines ex:

A

-Buspirone
-doxepin
-hydroxyzine
(Not as safe and effective as Benzodiazepines)

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7
Q

Antianxiety drugs produce a _______ by __________________.

A

tranquilizing effect, blocking neurotransmitter receptor sites.

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8
Q

benzodiazepines produce its effect by

A

potentiating the effects of GABA

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9
Q

nonbenzodiazepines

A

Produce its effect in a variety of ways

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10
Q

uses of anti-anxiety drugs

A
  1. Anxiety Disorders and panic attacks
  2. Preanesthetic sedation and muscle relaxation
  3. Convulsions and seizure disorders
  4. Alcohol withdrawal
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11
Q

adverse reactions anti-anxiety: early signs

A
  • Mild drowsiness and sedation
  • Lightheadedness or dizziness
  • Headache
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12
Q

adverse symptoms anti-anxiety: late signs

A
  • Lethargy and fatigue
  • Confusion
  • Anger
  • Constipation
  • Dry mouth
  • Restlessness
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13
Q

Anxiolytics should not be abruptly discontinued because of the chance of -

A

the patient undergoing withdrawal symptoms.

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14
Q

symptoms of withdrawal (usually occurs when meds are abruptly discontinued in as little as 3-4 wks)

A
  • Increased anxiety -Headache
  • Fatigue -Tremors
  • Hypersomnia -Muscle cramps
  • Psychoses/Hallucination -Nausea
  • Concentration difficulties -Convulsions
  • Sweating -Confusion
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15
Q

Antianxiety medications should not be administered if

A

the patient has a known hypersensitivity, psychoses, or acute narrow-angle glaucoma.

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16
Q

Feelings of intense sadness, helplessness, worthlessness and the patient usually has some impaired functioning

A

depression,

May also have a poor appetite, sleep disturbances, and lack of interest in their job and family

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17
Q

selective serotonin reuptake inhibitors (antidepressant)

A
  • Blocks the uptake of serotonin=stimulation of the CNS
  • Most commonly prescribed antidepressant because it is safe, has a larger therapeutic index, and less adverse reactions
  • Takes upwards of 2-3 weeks to become effective
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18
Q

ex of SSRI

A
  • citalopram (Celexa),
  • fluoxetine (Prozac),
  • paroxetine (Paxil),
  • sertraline (Zoloft)
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19
Q

Serotonin/Norepinephrine or Dopamine/Norepinephrine Reuptake Inhibitors (ANTIDEPRESSANT)

A
  • Not clearly understood

- It is thought that they affect the neurotransmission of serotonin, dopamine, and norepinephrine

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20
Q

ex of Serotonin/Norepinephrine or Dopamine/Norepinephrine Reuptake Inhibitors

A
  • venlafaxine (Effexor)

- bupropion (Wellbutrin)

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21
Q

tricyclic antidepressants (TCAs)

A
  • Inhibit reuptake of norepinephrine and serotonin in the brain
  • Very narrow therapeutic index-can be fatal in overdoses
  • Serious adverse reactions noted with TCAs
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22
Q

ex of TCAs

A
  • Amitriptyline,
  • clomipramine (Anafranil),
  • imipramine (Tofranil)
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23
Q

Monoamine Oxidase Inhibitors (MAOIs)

A
  • Inhibits the activity of monoamine oxidase an enzyme responsible forinactivating certain neurotransmitters (increase in epinephrine, norepinephrine and serotonin = CNS stimulation)
  • Not first antidepressants of choice due to side effects and dietary restrictions
  • Also problems associated with drug-drug interactions
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24
Q

ex of MAOIs

A
  • pheneizine (Nardil),
  • tranylcypromine (Parnate),
  • isocarboxazid (Marplan)
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25
Q

uses of TCAs

A
  • Depressive episodes
  • Bipolar disorder (depressive)
  • Obsessive Compulsive Disorder (OCD)
  • Chronic neuropathic pain
  • Enuresis
26
Q

uses of MAOIs

A
  • Depressive episodes

- Unlabeled use: bulimia, night terrors, migraines, seasonal affective disorder, and multiple sclerosis

27
Q

adverse reactions of SSRIs: neuromuscular

A

sedation, dizziness, headache, insomnia, tremors, and weakness

28
Q

adverse reactions of SSRIs: GI/GU

A

-Constipation, dry mouth, nausea, runny nose, and premature ejaculation

29
Q

adverse reactions of miscellaneous antidepressants: neuromuscular

A

migraines, sedation, hypotension, dizziness, blurred vision, photosensitivity, insomnia, nervousness, tremors

30
Q

adverse reactions of miscellaneous antidepressants: GI

A

nausea, dry mouth, anorexia, thrist, constipation, bitter taste

31
Q

adverse reactions of miscellaneous antidepressants: generalized body reactions

A

fatigue, tachycardia, impotence, change in libido, itching, skin rash, flushing, excessive sweating

32
Q

adverse reactions of tricyclics

A
  • Anticholinergic effects: dry mouth, sedation, visual disturbances, urinary retention
  • Constipation
  • Photosensitivity
  • Orthostatic hypotension
33
Q

adverse reactions of MAOIs: neuromuscular

A

Orthostatic hypotension, sedation, dizziness

34
Q

adverse reactions of MAOIs: GI

A

Constipation, dry mouth, nausea, and impotence

35
Q

adverse reactions of MAOIs: serious

A

hypertensive crisis when eating foods high in tyramine

36
Q

MAOI’s must be discontinued two weeks before beginning treatment with tricyclics

A

Risk of hypertensive crisis

37
Q

foods containing tyramine must not be eaten with

A

MAOI

Cheese, Wine, Beer, Coffee, Tea, Chocolate, soy sauce, yogurt, sour cream

38
Q

group of symptoms that affect mood and behavior

A

hallucinations, delusions, disorganized speech, behavior disturbance, social withdrawal, flattened affect, and anhedonia.

39
Q

antipsychotic drugs

A

Also known as Neuroleptic Medications

40
Q

typical antipsychotics

A
  • haloperidol (Haldol)

- loxapine

41
Q

atypical antipsychotics

A
  • aripiprazole (Abilify)
  • olanzapine (Zyprexa)
  • quetiapine (Seroquel)
  • risperidone (Risperdal)
  • ziprasidone (Geodon)
42
Q

Typical antipsychotics act by inhibiting or blocking the release of the neurotransmitter_____.

A

dopamine.

–Because they block dopamine they can cause a serious adverse reaction known as extrapyramidal effects

43
Q

Atypical antipsychotics act by inhibiting ___________.

A

both serotonin and dopamine receptors.

–The atypical antipsychotics are less likely to cause extrapyramidal effects

44
Q

uses of antipsychotics

A

Acute and chronic psychoses

Bipolar illness (manic-depressive)

Agitated behaviors associated with dementia

Oppositional defiant disorder

45
Q

adverse reactions of antipsychotics

A
  • Sedation, headache, hypotension
  • Dry mouth, nasal congestion
  • Photosensitivity and photophobia
  • Hyperactivity, paranoid reactions, agitation and confusion
46
Q

extrapyramidal syndrome (EPS)

A

Affects body posture and muscle groups = causes abnormal muscle movement

47
Q

extrapyramidal effects: parkison’s

A
  • Fine tremors, muscle rigidity

- Slowness of movement, slurred speech

48
Q

extrapyramidal effects: akathisia

A

Extreme restlessness and increased motor activity

49
Q

extrapyramidal effects: dystonia

A

Facial grimacing, twisting of neck

50
Q

Tardive Dyskinesia

A
  • Rhythmic involuntary movements of the tongue, face, mouth, extremities
  • Tongue may protrude
  • Chewing movements
  • Facial grimacing
  • Puckering of the mouth
51
Q

neuropletic malignant syndrome (NMS)

A

Rare reaction

  • Combination of extrapyramidal effects, hyperthermia, and autonomic disturbances.
  • Typically occurs 1 month after starting an antipsychotic
  • Potentially fatal and requires intensive supportive treatment
  • Immediate discontinuance of the medication is needed
  • Recovery is usually 7 to 10 days
52
Q

mood disorders

A

Considered a disturbance in the person’s emotional mood

Also known as an Affective Disorder

–Most common is bipolar disorder where the patient fluctuates between mania and depression.

53
Q

mood stabilizers

A

very good at treating mood cycling and manic symptoms

54
Q

If the mood disorder has an underlying depressive disorder —

A

mood stabilizers as well as antidepressant is also prescribed to treat the depressive symptoms

55
Q

ex of mood stabilizers

A
  • Lithium-classic mood stabilizer (antimanic)
  • valproic acid (Depakote)
  • lamotrigine (Lamictal)
  • carbamazepine (Tegretol)
  • oxcarbazepine (Trileptal)
56
Q

uses of mood stabilizers

A
  • Bipolar disorder
  • Manic episodes
  • Weight reduction (Topamax)
  • Appetite suppression (Topamax)
57
Q

adverse reactions of lithium

A

must be monitored in the blood, can have a toxic effect. The therapeutic index is very narrow.

58
Q

toxic reactions of lithium

A

-tremors, nausea, vomiting, diarrhea, blurred vision, confusion, hyperreflexia, seizures, coma, palpitations, death

59
Q

adverse reactions valproic acid (depakote)

A
  • Monitor lab values and watch liver function tests
  • Common side effects: weight gain, tremors, nausea, and hair loss
  • Must be monitored in the blood to ensure therapeutic effectiveness
60
Q

adverse reactions of Iamotrigine (Lamictal)

A
  • Medication must be titrated slowly
  • Watch for Steven-Johnson’s syndrome (can be fatal)
  • Other side effects include: weight gain, headaches, insomnia
61
Q

adverse reactions of carbamazepine (Tegretol)

A
  • dry mouth, constipation, urinary retention, dizziness, nausea, and vomiting
  • Serious side effects: agranulocytosis, Stevens-Johnson syndrome, and toxic epidermal necrolysis
  • Very high in the Asian population
62
Q

adverse reactions of oxcarbazepine (Trileptal)

A

headaches, dizziness, nausea, vomiting, fatigue, visual disturbances, and constipation

pharmacology (26 decks)

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