Module 7 Study Guide/Practice Questions Flashcards
What drugs in Module 7 prolong QT?
Chlorpromazine Citalopram Escitalopram Haloperidol Thioridazine
What are the six classifications of anxiolytics?
SSRIs SNRIs Azapirones Benzodiazepines Beta blockers Sedative Antihistamines
Should benzodiazepines be prescribed for daily use for anxiety? Why or why not?
No, high risk for Abuse potential and Addictive
What could happen if benzodiazepines are abruptly stopped after chronic use?
Risk for seizures; should be tapered over many weeks
What other drug class must be avoided in the use of benzodiazepines?
CYP450 drugs (wondering if that’s what they mean?) They are a CNS depressant. Don’t use with opioids.
Can you rate the onset of action of benzos with the likelihood of abuse or dependence?
They work quickly, with high abuse potential.
Xanax has the highest abuse potential due to its fast onset.
Take home: Prescribe cautiously and for as short as possible.
Are SSRIs a good choice for the relief of acute anxiety?
No because they may not be effective for several weeks
Can you list two drug-to-drug interactions with Buspirone (BuSpar)?
CYP450 3A4 inhibitors (fluoxetine, fluvoxamine, nefazodone) may reduce the clearance of buspirone and raise its plasma levels, so the dose of buspirone may need to be lowered when given concomitantly
What is the abuse potential when using hydroxyzine (Vistaril) in the treatment of anxiety?
From lecture: No risk.
From google: Due to its fast acting, sedative and relaxing nature, there is potential for abuse. However, there is no chance of addiction in that there are no physical side effects when discontinued.
Which patients should avoid the use of hydroxyzine (Vistaril)?
Risk of anticholinergic toxicity or delirium in the elderly or patients with neurocognitive disorders.
How do Beta-Blockers work to reduce anxiety related to public speaking?
Decreases symptoms caused by autonomic hyperactivity (tremors, sweating, tachycardia, palpitations)
Who should avoid Beta-Blockers?
Those taking it for BP management
Cardiac issues like heart failure
Can you list drug-to-drug interactions associated with St. John’s Wort?
triptans, benzos, contraceptives, digoxin, SSRIs, and antibiotics.
What are the two agents recommended in the treatment of chronic insomnia (greater than 6 months)?
Lunesta (eszopiclone) - schedule IV
Rozerem (ramelteon)
Discuss the required patient education that must be provided regarding sleep medications.
Do not take unless you have 7-8 hours to sleep
Take on an empty stomach at least 30 minutes before bedtime
Drugs with long half-lives (eszopiclone) are associated with a higher risk of next-day impairment
Sleepwalking, sleep driving, sleep eating, sleep sex have been reported with zolpidem and other “Z-drugs”
Do not use with other CNS depressants or alcohol
Which anxiolytics are considered safe in pregnancy?
(Confirming this info in the forum) short-term use of clonazepam (Klonopin) if nothing else works. Buspar (B) Clozaril (B) Zoloft (C) Prozac (C) Lexapro (C)
Which sleep medications are considered safe in pregnancy?
Visitril for short amount of time.
Ambien. Short, last resort.
How long does it take to see an initial response with antidepressants? How long for the full effect of antidepressants?
Some individuals see an initial effect after one week and up to four weeks to achieve a full effect.
What are the two main determinants for which antidepressant to use? Are there any others?
Tolerability and safety. Also to consider: D2D interactions, cost, and patient preference. (Ie low libido, do buspar. Fatigue, do a CNS stimulant, etc.)
What is serotonin syndrome? What causes it?
This can occur from overdose or drug-to-drug interaction, multiple serotonin drug uses. It is essential to review the current medication list prior to prescribing serotonergic drugs
Confusion, agitation, clonus, fever, tremor, or hyperreflexia and can result in respiratory failure and death.
How often should a patient be seen after initial treatment with antidepressants? Why?
Once a week for first month, biweekly for next four. because of high risk of suicide.
What is the BBW for antidepressants? Who is at greatest risk?
Suicide risk, especially early on, may increase.
Antidepressant-induced suicide applies mainly to children, adolescents, and adults younger than 25.
What is withdrawal syndrome? Are drugs with a short half-life or long half more likely to result in withdrawal syndrome? Why?
Starts within days and lasts up to 3 weeks. Dizziness, chills, lightheadedness. Brain “zaps.”
How do you discontinue an antidepressant?
Cross taper. Slowly decrease current while simultaneously titrating up the new drug to therapuetic drugs. Can take 1-2 weeks. Don’t cross-taper with MAOIs (need 14 day detox).
Which antidepressants are safe in pregnancy? Lactation?
Zoloft and Prozac in pregnancy (??)
Zoloft, Paxil, and Fluvox are safe and first-line in breastfeeding.
Avoid Paxil in pregnancy.
Avoid Prozac in BF.
What should people who are taking MAOIs avoid (think drug to drug and drug to food interactions)? What can happen if they do not avoid these foods/drugs?
Wine, meats, unfiltered beers, and cheeses that are high tyramine. Can spike blood pressure.
What happens if you treat a patient with bipolar by using an SSRI?
Can put them in a manic state. Want to rule out bipolar before starting.
What are some adverse effects of SSRIs and SNRIs?
Serotonin syndrome is a rare but serious complication.
Increased suicidal ideation the first 2-3 weeks.
May cause n/v, insomnia, weight gain, and sexual dysfunction.
Use caution with elderly. Start low and go slow
Venlafaxine (SNRI) may cause HTN and must be avoided with MAOI.
When is the risk for suicide greatest for children/adolescents on antidepressants?
First week.
Are there risks for the elderly taking antidepressants?
TCAs: Anticholinergic side effects. Use with caution in elderly.
MAOI’s contraindicated for elderly.
Due to decreased renal clearance, reduced hepatic function, and frequently reduced albumin levels, typically the dose is started at one-third to one-half of the usual starting adult dosage
Who is a good candidate for Wellbutrin, and why?
It is stimulating, so can be very beneficial for those individuals with depression that have symptoms of lethargy, apathy, and low motivation. Beyond its antidepressant effect, patients taking bupropion often report improved focus/concentration, reduction in appetite, increased libido, and greater motivation/energy.
When would a tricyclic antidepressant be appropriate?
- TCAs may still benefit some patients who do not respond to first-line agents
- TCAs may be beneficial to patients who have trouble sleeping.
- They have also been found to decrease pain in many patients with chronic pain including neuropathic pain.
How is bupropion (Wellbutrin) different from the other antidepressants?
bupropion boosts norepinephrine ( aka. noradrenaline ) and dopamine
What is the main concern with bupropion (Wellbutrin)?
it may increase the frequency and severity of seizures in those with a seizure disorder
What classes of drugs are used to treat ADHD?
Stimulants - first choice Non stimulants - Second Choice Noradrenergic Agents: (Atomoxetine) Alpha 2A Adrenergic Agonists: Antidepressants
What is or is not the link between ADHD and long-term drug use?
Untreated attention deficit disorder increases the significant risk for addictions due to self-medication of symptoms.
