Module 7 Unit A Anxiolytics and Sleep Flashcards
What are some examples of SSRIs?
paroxetine (Paxil) citalopram (Celexa) fluoxetine (Prozac) sertraline (Zoloft) Escitalipram (lexapro)
What are indications for SSRIs?
GAD, SAD, PTSD, PD, OCD
What is the MOA of SSRIs?
SSRIs block the reuptake of serotonin, resulting in an increased concentration of serotonin in the synapse and increased activation of postsynaptic serotonin receptors.
What is a safety consideration for SSRIs?
Abrupt discontinuation may result in withdrawal symptoms.
What is the BBW for SSRIs?
Suicide risk, especially early on, may increase. Antidepressant-induced suicide applies mainly to children, adolescents, and adults younger than 25.
What are three first-line SSRIs for breastfeeding? Which os not first-line?
Zoloft, Paxil, Fluvox are safe and the first-line treatment in breastfeeding. Prozac is not first-line for breastfeeding.
What are some examples of SNRIs?
venlafaxine (Effexor) duloxetine (Cymbalta) From module: (maybe don't need to memorize?) desvenlafaxine (Khedezla/Pristiq) levomilnacipran (Fetzima)
What are indications for SNRIs?
GAD, PD, PTSD
What is the MOA of SNRIs?
Boost serotonin and norepinephrine
What is a safety consideration for the SNRI venlafaxine (Effexor)?
Venlafaxine may cause HTN and must be avoided with MAOI.
What is the BBW for SNRIs?
Increased suicidality risk in children, adolescents, and young adults.
What is an example of Azapirones?
buspirone (BuSpar®)
What is the indication for Azapirones (burpirone-Buspar)?
Anxiety
What is the MOA of Azapirones (burpirone-Buspar)?
Binds to serotonin type 1A receptors
Partial agonist actions postsynaptically and may theoretically dimmish serotonergic activity and contribute to anxiolytic actions.
Partial agonist actions at presynaptic somatodendritic serotonin autoreceptors may theoretically enhance serotonergic activity and contribute to antidepressant actions.
How should Azapirones (burpirone-Buspar) be prescribed? How long does it take to work?
What is its abuse potential?
Takes several weeks to work. Not for PRN use. No abuse potential.
What type of drugs may affect Azapirones (burpirone-Buspar)?
CYP450 3A4 inhibitors (Prozac, 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.
CYP450 3A4 inducers (Tegretol) may increase the clearance of buspirone, so the dose of buspirone may need to be increased when given concomitantly.
What are some examples of Benzodiazepines?
alprazolam (Xanax)
lorazepam (Ativan)
diazepam (Valium)
What are the indications for Benzodiazepines?
Anxiety, Seizure disorder, PD
What is the MOA of Benzodiazepines?
Boost effect of neurotransmitter GABA
What schedule of drugs are Benzodiazepines?
Schedule IV drugs.
Can benzos be used in pregnancy?
No-Contraindicated in pregnancy.
When should benzos be used cautiously?
Caution in people with sleep apnea.
Caution in those with a history of alcohol or substance abuse.
Glaucoma
Why should we avoid combining benzos and other CNS depressants?
Respiratory depression can result from combining benzodiazepines with other CNS depressants such as alcohol or opioids.
What is and example of antihistamines?
hydroxyzine (Atarax, Vistaril)
What are the indications for antihistamines in this module?
Anxiety, Sleep
What is the MOA of antihistamines?
Antihistamine
What patients should we be cautious with antihistamines and why?
Anticholinergic side effects. Use with caution in the elderly.
What is the indication for Beta-blockers (-lol) in this module?
Performance anxiety
What is the MOA of Beta blockers in this module?
Decreases symptoms caused by autonomic hyperactivity (tremors, sweating, tachycardia, palpitations)
When should beta-blockers not be prescribed in this module?
Not to be used in patients already taking beta-blockers or other cardiac issues.
What are the indications for St. John’s Wart?
Sleep, anxiety, improved mood
Why is it important to know a patient is using the herb St. John’s Wart?
Many drug-to-drug interactions including, but not limited to triptans, benzos, contraceptives, digoxin, SSRIs, and antibiotics.
What side effect is higher risk with St. John’s Wart?
Risk of severe phototoxic skin reactions.
What are examples of the sedative Benzodiazepines?
estazolam (ProSom)
flurazepam (Dalmane)
temazepam (Restoril).
What is the indication for Sedatives Benzodiazepines?
Sleep
How long can sedative benzos be used for?
For short-term use only (10 days).
When are sedative benzos contraindicated?
It is contraindicated in elderly.
What is a risk of sedative benzo use?
Risk for dependence.
What can occur with rapid dose decrease of sedative benzos?
Rapid dose decrease can result in withdrawal syndrome.
What are examples of non-benzo sedatives?
Eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien
What is important to consider when prescribing non-benzo sedatives?
Zolpidem (Ambien) has sex-specific dosing.
Short-term use.
Safe in breastfeeding.
What non-benzo sedative can be used long-term. What is the max length of the others?
Lunesta is recommended for long-term use. All others are to be used for a maximum of 35 days.
What is an example of a melatonin agonist?
ramelton (Rozerem)
What is the indication for a melatonin agonist?
Sleep
Used for difficulty with sleep onset.
It may be used long-term.
What is the MOA of a melatonin agonist?
Activates receptors for melatonin.
When should melatonin agonists be used cautiously?
Caution or avoid in people with hepatic impairment.
Avoid in pregnancy and lactation.
What drug to drug interaction should be considered with melatonin agonists?
D2D- fluvoxamine (Luvox) can increase levels of ramelteon more than 50-fold.
What adverse affect may we see with melatonin agonists?
May increase levels of prolactin and decrease levels of testosterone.
Adverse effects SNRI’s
Adverse effects: Nausea Bowel changes Dizziness Dry mouth Fatigue Agitation Sexual adverse effects (e.g., delayed orgasm, anorgasmia, decreased libido, erectile dysfunction, up to 75% incidence
Effexor is discouraged in patients who _____ due to liver toxicity
Heavily drink
Side effects of BuSpar
most common side effect being dizziness (just over 10% of patients). Other common side effects include abnormal dreams, headache, blurred vision, outbursts of anger, and paresthesias.
What can be combined with SNRIs to reduce sexual adverse effects?
BuSpar
Benzodiazapine (Xanex, etc.) BBW
Risks from concomitant opioid use; Addition, abuse, and misuse; Dependence and withdrawal reactions.
What do we need to be careful with when discontinuing chronic Xanex use on a patient with seizure history?
can cause seizures; therefore, discontinuation should be gradually tapered over many weeks.
Side effects of BB?
can cause fatigue, some drowsiness, bradycardia, wheezing/bronchospasms, erectile dysfunction
