Exam III: Antidepressants Flashcards
What is a tranquilizer medication?
Medication that produces emotional calming, reduces anxiety, tension, agitation and other related emotional states
What is a hypnotic?
Induction of sleep
What is a myorelaxant?
Muscle relaxant
What is status epilepticus?
Seizure > 5 minutes
or Repeated seizures without returning to normal consciousness between seizures
What is euphoria?
Feeling of extreme happiness and well being
What is neurosis?
Outdated term
Long term psychiatric disorder in which patient is in touch with reality –> condition is recognized as abnormal.
What is neuralgia?
Severe burning or stabbing pain along the course of a nerve
Can be a complication of shingles
What is psychosis?
Patient loses touch with reality (Symp. delusions, hallucinations, talking incoherently)
Not aware that behavior is abnormal
“Major tranquilizers” are …?
Antipsychotics
“Minor tranquilizers” are …?
Anxiolytics
Name three barbiturates. What are they used for?
Amobarbital (Amytal®) – preoperative sedation
Pentobarbital (Nembutal®) – preoperative sedation, refractory status epilepticus
Phenobarbital (Luminal®) – antiepileptic, difficult to treat alcohol withdrawal
What are the three main problems with barbiturates?
Physical and psychological dependence
Tolerance and withdrawal
Respiratory depression in overdose
Advantages of benzodiazepines over barbiturates.
Versatile in their use
Generally safer, less respiratory depression/toxicity than barbiturates
Name Benzodiazepine indications/uses. (5)
Anxiolytic
Antiepileptic
Myorelaxant
Sedative-hypnotic insomnia
Management of Alcohol Withdrawal Syndrome (AWS)
Benzodiazepines are have a “ceiling effect” thus are safer than barbiturates. What does this mean?
At high doses barbiturates can lead to a coma.
Benzodiazepines can lead to medullary depression but plateau. Effects do not go above this level of sedation.
Benzodiazepine mechanism of action
Potentiate GABA effects (inhibitory)
Benzodiazepine withdrawal symptoms
Anxiety, depression
Seizures
Aches, Pain
Delirium
Benzodiazepines can cause “Paradoxical excitation/disinhibition” as an adverse event. What does this mean?
Paradoxical – opposite effect of what it was intended for.
Instead of intended calming effect it may cause agitation, aggression or irritability
More common in elderly patients and those with developmental disorders (ie. autism)
“Rebound anxiety” is a possible adverse event associated with Benzodiazepines. What is this?
Anxiety more intense than original levels that occurs after drug wears off
Are fatal overdoses common for benzodiazepines?
Uncommon alone
More common when taken with other CNS depressants
What benzo has a fast onset of action and a short duration of action?
This drug is also associated with a higher risk of … ?
Alprazolam (Xanax®)
More associated with a higher risk of substance abused and intense withdrawal symptoms
Name the benzo that does not end in -azepam or -azolam used as an anxiolytic.
What receptors does this drug interact with?
Buspirone (Buspar®)
No direct effect on GABA receptors
High affinity for serotonin receptors
Moderate affinity for dopamine receptors
Name these benzo muscle relaxants.
Cyclo Metho Bacl Meta Tiz Cari
Cyclobenzaprine (Flexeril®)
Methocarbamol (Robaxin®)
Baclofen (Gablofen®, Lioresal®)
Metaxalone (Skelaxin®)
Tizanidine (Zanaflex®)
Carisoprodol (Soma®)
Name three non-benzodiazepine anticonvulsants (-apine).
Carbamazepine
Oxcarbazepine
Eslicarbazepine
Three main indications for carbamazepine.
Seizure disorders
Bipolar disorder – as mood stabilizer
Neuropathic pain
Serious contraindication and precautions to look for in Carbamazepine.
Bone marrow suppression
Severe rash – Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis
Liver Disease
Hyponatremia
Interaction with many HIV medications
Birth defects
Advantages of Oxcarbazepine over Carbamazepine.
Less potential for developing liver disease and bone marrow suppression
Less drug interactions
Name the
Non-Benzodiazepine (BZD) Sedative-Hypnotics
Non-Benzodiazepine Receptor Agonists (NBRAs)
called “Z-drugs”.
Zolpidem (Ambien®)
Zaleplon (Sonata®)
Eszopiclone (Lunesta®)
Doxepin indication at normal and low dose.
Normal - TCA antidepressant
Low-dose (Silenor®) - treat insomnia (sleep maintenance)
Non-Benzodiazepine Receptor Agonists (NBRAs) mode of action?
Enhance GABA activity by binding to BZD-1 receptors
Since NBRAs do not interact with BZD-2 receptors, how do these drugs differ from benzos?
Minimal anxiolytic, myorelaxant, anticonvulsant properties
Warnings and precaution for patients taking (NBRAs).
Complex sleep behaviors (ie. sleep walking)
May worsen depression with long term use (like Benzos***)
Caution with sleep apnea, COPD
Ramelteon (Rozerem®)
Drug class?
MOA and indication?
Non-Benzodiazepine (BZD) Sedative-Hypnotics
Melatonin receptor agonist
Indicated for sleep onset insomnia
At low doses Doxepin acts as an antihistamine for insomnia. How is this action related to sleep?
Histamine is associated with a feeling of wakefulness
Orexin Antagonists
Indication?
Warnings?
Effective for both sleep onset and sleep maintenance
Narcolepsy-like symptoms
Daytime somnolence and next-day driving impairment
What is alogia?
Poverty of speech
What is avolition?
Total lack of motivation that makes it hard to get anything done
What is anhedonia?
Inability to feel pleasure
What is Extrapyramidal symptoms (EPS)?
Drug-induced movement disorders
Most first generation Antipsychotics end in what?
-azine
As in Chlorpromazine
Haloperidol is a first or second gen antipsychotic?
First gen antipsychotic
First gen antipsychotics as as…? (MOA)
D2 receptor antagonists
How do the four dopamine tracts affect untreated schizophrenic patients?
Mesolimbic, mesocortical, nigrostiatum, tuberoinfundibular
- Mesolimbic system -> increased dopamine -> positive symptoms
- Mesocortical -> decreased dopamine -> negative symptoms
- Nigrostriatum -> dopamine level not affected
- Tuberoinfundibular -> dopamine level not affected
Positive symptoms for schizophrenia.
Delusions
Hallucinations
Disorganized speech, thoughts
Paranoia
Negative symptoms for schizophrenia.
Affective flattening
Alogia
Avolition
Anhedonia
Social withdrawal
FGAs decrease/increase dopamine levels in which of the four dopamine tracts?
Decreased dopamine in all four tracts
SGAs decrease/increase dopamine levels in which of the four dopamine tracts?
Decrease dopamine levels in mesolimbic
Increase dopamine levels in the other three tracts
