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Foundations of Pharmacy Care > Exam III: Antidepressants > Flashcards

Exam III: Antidepressants Flashcards

1
Q

What is a tranquilizer medication?

A

Medication that produces emotional calming, reduces anxiety, tension, agitation and other related emotional states

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2
Q

What is a hypnotic?

A

Induction of sleep

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3
Q

What is a myorelaxant?

A

Muscle relaxant

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4
Q

What is status epilepticus?

A

Seizure > 5 minutes

or Repeated seizures without returning to normal consciousness between seizures

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5
Q

What is euphoria?

A

Feeling of extreme happiness and well being

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6
Q

What is neurosis?

A

Outdated term

Long term psychiatric disorder in which patient is in touch with reality –> condition is recognized as abnormal.

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7
Q

What is neuralgia?

A

Severe burning or stabbing pain along the course of a nerve

Can be a complication of shingles

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8
Q

What is psychosis?

A

Patient loses touch with reality (Symp. delusions, hallucinations, talking incoherently)

Not aware that behavior is abnormal

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9
Q

“Major tranquilizers” are …?

A

Antipsychotics

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10
Q

“Minor tranquilizers” are …?

A

Anxiolytics

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11
Q

Name three barbiturates. What are they used for?

A

Amobarbital (Amytal®) – preoperative sedation

Pentobarbital (Nembutal®) – preoperative sedation, refractory status epilepticus

Phenobarbital (Luminal®) – antiepileptic, difficult to treat alcohol withdrawal

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12
Q

What are the three main problems with barbiturates?

A

Physical and psychological dependence

Tolerance and withdrawal

Respiratory depression in overdose

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13
Q

Advantages of benzodiazepines over barbiturates.

A

Versatile in their use

Generally safer, less respiratory depression/toxicity than barbiturates

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14
Q

Name Benzodiazepine indications/uses. (5)

A

Anxiolytic

Antiepileptic

Myorelaxant

Sedative-hypnotic insomnia

Management of Alcohol Withdrawal Syndrome (AWS)

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15
Q

Benzodiazepines are have a “ceiling effect” thus are safer than barbiturates. What does this mean?

A

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.

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16
Q

Benzodiazepine mechanism of action

A

Potentiate GABA effects (inhibitory)

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17
Q

Benzodiazepine withdrawal symptoms

A

Anxiety, depression

Seizures

Aches, Pain

Delirium

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18
Q

Benzodiazepines can cause “Paradoxical excitation/disinhibition” as an adverse event. What does this mean?

A

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)

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19
Q

“Rebound anxiety” is a possible adverse event associated with Benzodiazepines. What is this?

A

Anxiety more intense than original levels that occurs after drug wears off

20
Q

Are fatal overdoses common for benzodiazepines?

A

Uncommon alone

More common when taken with other CNS depressants

21
Q

What benzo has a fast onset of action and a short duration of action?

This drug is also associated with a higher risk of … ?

A

Alprazolam (Xanax®)

More associated with a higher risk of substance abused and intense withdrawal symptoms

22
Q

Name the benzo that does not end in -azepam or -azolam used as an anxiolytic.

What receptors does this drug interact with?

A

Buspirone (Buspar®)

No direct effect on GABA receptors

High affinity for serotonin receptors

Moderate affinity for dopamine receptors

23
Q

Name these benzo muscle relaxants.

Cyclo
Metho
Bacl
Meta
Tiz
Cari
A

Cyclobenzaprine (Flexeril®)

Methocarbamol (Robaxin®)

Baclofen (Gablofen®, Lioresal®)

Metaxalone (Skelaxin®)

Tizanidine (Zanaflex®)

Carisoprodol (Soma®)

24
Q

Name three non-benzodiazepine anticonvulsants (-apine).

A

Carbamazepine

Oxcarbazepine

Eslicarbazepine

25
Q

Three main indications for carbamazepine.

A

Seizure disorders

Bipolar disorder – as mood stabilizer

Neuropathic pain

26
Q

Serious contraindication and precautions to look for in Carbamazepine.

A

Bone marrow suppression

Severe rash – Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis

Liver Disease

Hyponatremia

Interaction with many HIV medications

Birth defects

27
Q

Advantages of Oxcarbazepine over Carbamazepine.

A

Less potential for developing liver disease and bone marrow suppression

Less drug interactions

28
Q

Name the

Non-Benzodiazepine (BZD) Sedative-Hypnotics

Non-Benzodiazepine Receptor Agonists (NBRAs)

called “Z-drugs”.

A

Zolpidem (Ambien®)

Zaleplon (Sonata®)

Eszopiclone (Lunesta®)

29
Q

Doxepin indication at normal and low dose.

A

Normal - TCA antidepressant

Low-dose (Silenor®) - treat insomnia (sleep maintenance)

30
Q

Non-Benzodiazepine Receptor Agonists (NBRAs) mode of action?

A

Enhance GABA activity by binding to BZD-1 receptors

31
Q

Since NBRAs do not interact with BZD-2 receptors, how do these drugs differ from benzos?

A

Minimal anxiolytic, myorelaxant, anticonvulsant properties

32
Q

Warnings and precaution for patients taking (NBRAs).

A

Complex sleep behaviors (ie. sleep walking)

May worsen depression with long term use (like Benzos***)

Caution with sleep apnea, COPD

33
Q

Ramelteon (Rozerem®)

Drug class?

MOA and indication?

A

Non-Benzodiazepine (BZD) Sedative-Hypnotics

Melatonin receptor agonist

Indicated for sleep onset insomnia

34
Q

At low doses Doxepin acts as an antihistamine for insomnia. How is this action related to sleep?

A

Histamine is associated with a feeling of wakefulness

35
Q

Orexin Antagonists

Indication?
Warnings?

A

Effective for both sleep onset and sleep maintenance

Narcolepsy-like symptoms

Daytime somnolence and next-day driving impairment

36
Q

What is alogia?

A

Poverty of speech

37
Q

What is avolition?

A

Total lack of motivation that makes it hard to get anything done

38
Q

What is anhedonia?

A

Inability to feel pleasure

39
Q

What is Extrapyramidal symptoms (EPS)?

A

Drug-induced movement disorders

40
Q

Most first generation Antipsychotics end in what?

A

-azine

As in Chlorpromazine

41
Q

Haloperidol is a first or second gen antipsychotic?

A

First gen antipsychotic

42
Q

First gen antipsychotics as as…? (MOA)

A

D2 receptor antagonists

43
Q

How do the four dopamine tracts affect untreated schizophrenic patients?

Mesolimbic, mesocortical, nigrostiatum, tuberoinfundibular

A
  1. Mesolimbic system -> increased dopamine -> positive symptoms
  2. Mesocortical -> decreased dopamine -> negative symptoms
  3. Nigrostriatum -> dopamine level not affected
  4. Tuberoinfundibular -> dopamine level not affected
44
Q

Positive symptoms for schizophrenia.

A

Delusions

Hallucinations

Disorganized speech, thoughts

Paranoia

45
Q

Negative symptoms for schizophrenia.

A

Affective flattening

Alogia

Avolition

Anhedonia

Social withdrawal

46
Q

FGAs decrease/increase dopamine levels in which of the four dopamine tracts?

A

Decreased dopamine in all four tracts

47
Q

SGAs decrease/increase dopamine levels in which of the four dopamine tracts?

A

Decrease dopamine levels in mesolimbic

Increase dopamine levels in the other three tracts

Foundations of Pharmacy Care (12 decks)

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