Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3153 CNS - nat > ic15 anxiety and sleep disorders > Flashcards

ic15 anxiety and sleep disorders Flashcards

1
Q

What is anxiety disorder

A

Severe, persistent anxiety and irrational fear that impairs functioning
When anxiety is out of proportion to actual danger or threat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 5 anxiety disorders that can be treated by meds?

A

GAD
Panic disorder
Social Anxiety Disorder (SAD)
OCD
PTSD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the main neurotransmitters involved in GAD?

A

NE, Serotonin, GABA

hence drugs to treat GAD are ssri, snri, bzd

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Drugs that can induce anxiety (10 points)

A

Pseudoephedrine

Stimulants (Increase NE, DA): Amphetamine, Bupropion

Methylxanthine: Theophylline, Caffeine

Levothyroxine: activate sympathetic NS

Corticosteroids

Antidepressants
Jitteriness side effect after initiation

Dopamine agonist eg. Levodopa

Beta agonists eg. Salbutamol

Drug withdrawal

Drug intoxication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is panic attack

A

Period of intense fear
Reach peak within 10 mins, last no more than 20-30 mins
Can be expected or unexpected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Medication classes for GAD

A

Antidepressants
Pregabalin
Adjunctive Benzodiazepines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the antidepressants used for anxiety

A

1st: SSRI
2nd: SNRI
3rd: Clomipramine (TCA)
4th: Mirtazapine (if pt worry about sexual SE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why is Clomipramine 3rd line for anxiety?

A

Very effective, potent serotonin and norepinephrine reuptake inhibitor
But toxic, fatal on overdose, accumulates in heart muscles 40x more than serum level, promote seizures, cardiac conduction abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What drug cannot be used for anxiety?

A

Bupropion

Very stimulating, will worsen anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Principles of antidepressant therapy in anxiety

A

Dosing must be LOW
Reduce transient jitteriness in initial 1-2 weeks

Maintenance dose may be HIGH
Eg. Fluoxetine 60-80 mg/day, way more than MDD Fluoxetine dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Onset and duration of therapy for antidepressants

A

Onset: Takes 1-2 months for effect in “excessive worrying” symptoms
Counsel for adherence

Duration of therapy: at least 1-2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the first line Benzodiazepine and why?

A

Lorazepam

Most commonly used
Safe in hepatic impairment
Short duration of action (6-8hrs), hence safe in overdose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which BZD has active metabolites?

A

Diazepam

Diazepam has long half life, active metabolites have even longer half lives
Drowsiness and high fall risk in elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which is the last line benzodiazepine

A

Alprazolam
Highest potency, hence most toxic if overdose
Should not use frequently for GAD
Only for panic disorder, as adjunct to SSRI, SNRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Counselling points for benzodiazepines

A

SSRI will take months to start working, you will still have anxiety attack
Lorazepam, Clonazepam will help with the attacks
Give for initial 2 weeks, then review need to continue due to tolerance dependence side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what drug is contraindicated with benzodiazepines?

What to do?

A

Opioids
Opioids also cannot give with Z-hypnotics (Q3 of post lecture)
Can cause death due to CNS depression!
Cos Z-hypnotics has similar MOA as Benzodiazepines

Switch out Benzodiazepine to another sedating agent, keep the opioid for pain relief

17
Q

What are some drug drug interactions to look out for in anxiolytics (3 points)

A

1) CNS depression
Alcohol or other CNS depressants eg. Benzodiazepines
Separate 4-6 hours apart
Benzodiazepines (and Z-hypnotics) should not be given with Opioids

2) Anticholinergic agents

3) Serotonin syndrome
For opioids and drugs that increase serotonin eg. SSRI, SNRI, TCA, MAOi
Wash out period for Moclobemide

18
Q

What are the neurotransmitters involved in sleep

A

GABA
Promote sleep

NE, DA, Acetylcholine, Histamine, Orexin
Promote wakefulness

19
Q

What is insomnia

A

Inability to sleep and associated with daytime problems eg. fatigue, impaired concentration, memory

Occurs at least 3 nights a week for at least 3 months

Not caused by other disorders eg. Asthma, Pain, Itch, Obstructive Sleep Apnea

20
Q

How long is transient, short term and chronic insomnia

A

Transient: < 1 week

Short term: < 4 weeks
Sleep hygiene
Short PRN course of hypnotics

Chronic Insomnia
> 4 weeks
Likely due to secondary underlying psychiatric or medical problems

21
Q

Counselling points for sleep hygiene

A

Avoid caffeine, nicotine, alcohol in the evening
No heavy meal within 2hrs of bedtime
Dont drink water before sleep
Avoid noisy environment
Establish a routine for getting ready to go to bed
Avoid daytime naps
Regular exercise but avoid vigorous activities close to bedtime

22
Q

What are the drugs for insomnia (7 points)

A

Benzodiazepines
Z-hypnotics
Antihistamine
Melatonin
Lemborexant
Trazodone
Antipsychotics (SGA)

23
Q

Which patients should not use Benzodiazepines (6 points)

A

elderly with dementia, as BZD can cause amnesia

history of substance abuse

patients on opioids

myasthenia gravis

acute narrow angle glaucoma

history of respiratory depression

24
Q

Side effects of benzodiazepines (3 points)

A

Sedation, Drowsiness
Amnesia
Paradoxical excitement

25
Q

What are the 2 benzodiazepines indicated for insomnia?

Which is preferred and why?

A

Lorazepam
Shorter half life (12hrs) → Lesser hangover effects
Preferred over Diazepam

Diazepam
Very effective as cross BBB
Longer acting (T1/2 = 20 - 54hrs) → more hangover effects

26
Q

Advantage of BZD over antihistamines for use in elderly

A

Does not cause anticholinergic effect and delirium

but should not be used in dementia patients

BZD can cause paradoxical excitement in elderly

27
Q

Which patients cannot use Benzodiazepines and Z-hypnotics (5 points)

A

1) Acute narrow angle glaucoma
2) Respiratory depression
3) Myasthenia gravis
4) Patients with history of substance abuse
5) Patients on opioids

28
Q

4 roles of benzodiazepines

A

1) Anxiolytic
2) Sedating
3) Muscle relaxant, hence anti-convulsant
4) Cause amnesia

29
Q

What is the similarity and difference between Z-hypnotics and BZD

A

Both can be abused, have similar risk of dependence, should not use in myasthenia gravis, narrow angle glaucoma, history of respiratory depression.

Z-hypnotics is just for sleep, will not cause muscle relaxation like BZD

30
Q

What drug is contraindicated with Z-hypnotics

A

Opioids (can cause CNS depression)

31
Q

What are the 2 Z-hypnotics? Which is preferred?

A

Zolpidem and Zopiclone

Zolpidem
Useful for initiating sleep
Will not cause hangover effect
Half tablet for females, full tablet for males

Zopiclone
Useful for maintaining sleep due to longer half life
Long duration of action, hence may cause hangover effect

32
Q

Side effects of Z-hypnotics

A

Taste disturbances, metallic taste (with Zopiclone)
Sleep walking

33
Q

What H1 antihistamines are indicated for insomnia?

When are H1 antihistamines indicated

A

Promethazine, Hydoxyzine

for patients with history of substance abuse

34
Q

Who is contraindicated from antihistamines? (2 points)

A

Children 2 and below should not use Promethazine

Elderly with delirium

35
Q

What is Lemborexant

Indication

A

Orexin receptor antagonist
Orexin is a hormone that helps with alertness and appetite

For patients with history of substance abuse

36
Q

What is Lemborexant for and MOA?

Who are contraindicated with use of Lemborexant (3 points)

A

Insomnia, orexin receptor antagonist

Narcolepsy
Narcolepsy: already have low Orexin, Lemborexant will cause paralysis

CYP3A inhibitor or inducers

Severe renal impairment

37
Q

For patients with history of substance abuse, what to give for insomnia?

What cannot give?

A

H1 antihistamine, Lemborexant, Melatonin
-> wont cause dependence

Benzodiazepines, Z-hypnotics

38
Q

What are 2 off label drugs for insomnia

A

Trazodone, due to H1 antagonism
Side effects: priapism

Antipsychotics eg. Quetiapine, due to H1 antagonism

3153 CNS - nat (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions