Module 8- Psych/Neuro Flashcards
Benzodiazepines a.re most commonly used to treat _______________. They can also be used for _____________ _____________ _________.
anxiety; acute seizure activity
Benzodiazepines are a schedue ________ drug.
IV
Benzodiazepines should be used ______ __________ to prevent _____________.
short term; abuse
How should chronic use of benzodiazapines be discontinued? Why?
Over many weeks by tapering dose. To prevent seizures
Benzodiazepines have a ________ onset of action.
rapid
Benzodiazepines are processed in the __________ and _____________ drug and food interactions must be considered.
liver; CP450
What is the most prominent difference between benzodiazepines and other anti anxiety drugs?
Onset of action.
Drugs used to treat anxiety are called _____________, _______________, or ________________.
antianxiety agents, anxiolytics, tranquilizers
Drugs that promote sleep are__________.
hypnotics.
________________ and other __________ depressants are undesirable in that they can cause fatal _______________ depression, have a high potential for ______________, cause significant _____________ and physical ___________, and often induce ________________ drug metabolizing enzymes.
Barbiturates; CNS; respiratory; abuse; tolerance; dependence; hepatic
Benzodiazepines are ___________ than other barbiturates and CNS depressants.
safer
Respiratory depression is increased in bezodiazepines when used with _______________.
alcohol, opioids, barbiturates
Selection among benzos is based on differences in _______ ___________.
time course
How long should benzodiazepines be used for transient insomnia tx?
2-3 weeks
___________ is the only approved drug for long term use of insomnia.
Lunesta (Eszopiclone)
Optimal therapy of anxiety disorders consists of ______________ combined with _________ therapy.
psychotherapy, drug
What drugs are used most often for all anxiety disorders?
SSRIs - Selective serotonin reuptake inhibitors
Benzodiazepines are used primarily for ________ disorder and acute episodes of __________.
panic; generalized anxiety disorder
What is first line drug for GAD? Long term or short term?
Benzodiazepines; short term
Buspirone, venlafaxine, paroxetine, and escitaopram are best suited for ________________ management due to_____________.
long term; delayed effects
_________________, __________________, and _________________ are especially well suited to treat pts who have both, anxiety and ____________________.
Venlafaxine, paroxetine, and escitalopram; depression
What is a good choice for performance anxiety? What does it do?
beta blockers; reduces tachycardia which reduces sx.
The distinction between antianxiety effects and hypnotic effects (for insomnia) is often a matter of _______________.
dosage.
What are the three major groups of sedative-hypnotics?
Barbiturates, benzodiazepines, & benzodiazepine-like drugs
Drugs of choice for insomnia?
Benzos and benzo-like drugs - zolpidem, saleplon, eszopiclone
Max # of days benzo-like drugs can be used for insomnia?
35 days
What is the melatonin agonist?
Ramelton
Herb for insomnia?
Melatonin 3 or 6mg, kava, valerian
What is often used in the elderly for insomnia?
What is used infrequently and why?
Antidepressants- mirtazapine (remeron) & trazodone (desyrel)
Tricyclic antidepressants, because of sig. side effects; anticholinergics
What off label drug should be avoided for insomnia in patients with depression?
Antihistamines - benadryl & vistaril
What drug causes sedation, but should be avoided for off label use for insomnia?
Antipsychotic - Quetiapine (seroquel)
What drug can be used for those with mild depression who have difficulty sleeping?
Trazadone
What is ramelton (Rozerem) used for?
Chronic insomnia
What sleep products are not controlled substances?
Lunesta and Rozerem. and benadryl
Most benzodiazepines are pregnancy category ___.
D
If other alternatives are not effective for anxiety during pregnancy, what is the best option of the benzos?
clonazepam (Klonopin) - with consultation and/or referral
Why should buspirone (Buspar), a non-benzo anxiolytic, be avoided during pregnancy even though it’s listed as cat B?
Limited data available
(What are some non-benzo short term tx options for anxiety during preg?
Hydroxyzine (vistaril) and zolpidem (ambien)(last resort for short term tx)
What benzos should be avoided during breastfeeding? Short term use of which are ok?
Those with long half life -diazepam (valium) & clonazepam (klonopin).
Those with shorter half life - midazolam (versed) & Lorazepam (ativan)
Non benzo and breastfeeding?
Buspar - no.
Hydroxyzine (vistaril in small doses) is ok
If no insomnia, non-sedating antihistamines
Ambien is safe with breastfeeding
First line drugs for panic disorder?
SSRI - decrease frequency and intensity of panic attacks
Characteristics of OCD?
persistent obsessions and compulsions that cause marked distress and consume at least 1 hour a day; interfere with daily living
First line drugs for OCD?
SSRIs
First line drugs for social anxiety disorder?
When would something else be used and why?
SSRIs.
If it is limited to fear of specific situations that arise infrequently, benzos prn
PTSD - what is the only tx with good proof of efficacy?
What two drugs are approved even though not proven effective?
Exposure therapy. SSRIs- paroxetine and sertraline
Antidepressants block the reuptake of _________, __________, and some __________ from the pre-synaptic neuron , increasing the amount _______________ in the synapse.
norepinephrine, serotonin, dopamine; neurotransmitter
For moderate to severe depression, a combination of __________ and ___________ are the most effective approach to tx.
medication and counseling
Maximal responses to antidepressants develop in _____ to ______ ________. In the elderly this may take _________ to _________ ___________.
4-6 weeks; 2-3 months
How long after remission should antidepressants be continued?
6-12 months
Follow up while taking antidepressants for children & adolescents? For adults?
Children: Weekly x2wks, every 2wks x2wks, then monthly
Adults: two weeks after initiation of therapy rather than one week, then same as children
Classifications of antidepressants (5).
- SSRIs - selective serotonin reuptake inhibitors
- SNRIs Serotonin norepinephrine reuptake inhibitors
- TCAs- Tricyclic antidepressants
- MOAIs- Monoamine oxidase inhibitors
- Other
How long does it take to achieve max benefit from SSRI antidepressant?
6 wks. 2-3wks for initial effect.
SSRI action: blocks reuptake of __________ and thereby intensify transmission at ____________ synapses. Over time this induces __________ ______________ _____________ that are ultimately responsible for relieving depression.
serotonin; serotonergic.
adaptive cellular responses
List two major advantages of SSRIs over TCAs.
- Cause fewer side effects
2. Safer when taken in overdose
Sertotonin syndrome symptoms (6).
Agitation, confusion, hallucinations, hyperreflexia, tremor, and fever
What drugs can cause serotonin syndrome? What makes this more likely?
SSRIs.
Combining with other serotnergic drugs or MAOIs
Only SSRI recommended for children 8 and older
fluoxetine
What SSRI can be taken during pregnancy and breastfeeding?
sertraline (zoloft)
T/F
Sexual dysfunction is more common with SSRIs than most other antidepressants.
True
Most SSRIs are more likely to have _________ effects, more TCAs are more likely to have _________ effects.
stimulant; sedation
The __________ in SNRIs can increase ______________ in patients with somnolence and _________ _______ secondary to depression.
norepinephrine; wakefulness; psychomotor retardation
Prozac, Zoloft, Paxil and Celexa are all __________
SSRIs
Effexor, pristiq, and cymbalta are all
SNRIs
Intial benefits of TCAs appear in _ to _ ______ but max benefit may take up to __ _____.
1-3wks; 2months
Most common adverse effects of TCAs (3)
Sedation, orthostatic hypotension, and anticholinergic effects (dry mouth, constipation, etc.)
Most serious adverse effect of TCAs
Cardiotoxicity
Why is combination of TCA with MAOI avoided?
Can cause hypertensive crisis
TCAs should be used very cautiously in pts with preexisting cardiac condition. Why?
Can cause widening of QRS complex
TCAs may be beneficial to what patients?
- not responsive to 1st line agents
- trouble sleeping
- pt with chronic/neuropathic pain
Why are MAOIs rarely used?
Many food and drug interactions.
What specific foods must be avoided? What can happen?
tyramine rich foods- fermented and aged products
Hypertensive crisis can result
What is bupropion used for?
smoking cessation and adult ADHD in addition to depression
The major contraindication for buproprion
seizure disorder
When would trazodone be good as an antidepressant?
Mild depression with insomnia
Paxil (paroxetine) has been assoc with a slight increase in ____ ___________ __________ in 1st trimester.
congenital cardiac malformations.
Possible effects of antidepressants on pregancy?
persistent pulmonary hypertension - 3rd trimester
neonatal d/c syndrome
prematurity/ LBW
If bipolar disorder is misdaignosed as depression only and antidepressant is rx, what can happen?
hypomania or mania.
What three kinds of drugs are used to treat bipolar?
Mood stabilizers, antipsychotic, and antidepressant
Gold standard for bipolar
lithium
What are the preferred mood stabilizers for bipolar (2)
lithium and valproic acid
Common side effects of therapeutic lithium levels (3)
tremor, goiter, polyuria
T/F
Lithium is teratogenic and should be avoided throughout pregnancy if possible.
True - also contraindicated in breastfeeding
A _________ in sodium levels can lead to _______ levels of lithium.
reduction; toxic.
Lithium levels can be increased by ____________ and ___________.
diuretics; NSAIDs
T/F
Antipsychotics are only used in bipolar patients with psychotic symptoms.
False. Benefits are present even without psychotic sx for long term prevention of mood episodes and acute tx of manic episodes.
First generation antipsychotics are called ______________ antipsychotics and block _______ ______.
Conventional; block D2 (dopamine) receptors
Therapeutic effects of antipsychotics develop __________ and may take _________ _________ to reach max.
slowly; several months
Three types of early extrapyrmidal symptoms (EPS) produced by 1st gen antipsychotics.
- acute dystonia
- parkinsonism
- akathisia
T/F
Acute dystonia and parkinsonism respond to anticholinergics.
True. Akathisia is harder to treat but may respond to anticholinergics, benzos, or beta blockers.
T/F Tardive dyskinesia (late EPS) has no reliable tx.
True
Low potency and high potency conventional antipsychotics have equal therapeutic effects. T/F
True
Low potency conventionals produce more ___________, _____________ ____________, _____________ __________.
sedation, orthostatic hypotension, & anticholinergic effects.
Risk of early EPS is much higher with ___________.
high potency.
Antipsychotics increase levels of circulating ______________.
prolactin
Three ways SGAs (atypical) differ from FGAs (conventional):
- block receptors for serotonin in additon to dopamine
- few or no EPS including TD
- higher risk of serious metabolic effects
What serious metabolic effects are assoc with atypical antipsychotics:
weight gain, diabetes, dyslipidemia
Among atypical antipsychotics, metabolic effects are greatest with :
clozapine, olanzapine
T/F
In general, atypical antipsychotics are neither safer nor more effective than convention.
True
Atypical antipsychotics help with ___________ and ________ symptoms, whereas conventional work more with _____________ sx.
positive and negative; positive.
AEDs have 4 basic mechanisms:
- Block _____ channels
- Block ________ channels
- block _______ receptors
- potentiate ____________
- Sodium
- Calcium
- glutamate
- GABA
T/F
AEDs can be selective, it is important to choose the correct drug.
True
Mainstay tx for partial sizures and generalized tonic-clonic seizures in children and adults:
Carbamazepine (tegretol)
Side effects of carbamazepine
Bone marrow suppression - leukopenia, anemia, thrombocytopenia. And rarely fatal aplastic anemia.
Also has many drug interactions - OCPs and folic acid.
Stevens-Johnson syndrome in Asian patients
Dilantin is used for
gran mal (tonic-clonic), partial, and complex epilepsy. Carbamazepine is tolerated better than dliantin (phenytoin)
Preferred AEDs for absence seizures (petit mal)
ethosuximide (zarontin), valproic acid (depakote), lamotrigine (lamictal). Depakote and lamictal have fewer side effects.
With valproic acid (depakote) ___________ counts should be checked.
platelet
Which AED should not be used in pregnancy? breastfeeding?
Carbamazepine; lamotrigine (lamictal)
Drug types for Alhzheimers:
Cholinesterase Inhibitors & N-methyl-D-aspartic acid (NMDA)
Cholinesterase Inhibitors increase the availability of
acetylcholine
Side effects of cholinesterase inhibitors
nausea, vomiting, diarhhea, dyspepsia
NMDA (memantine) is approved for
moderate to severe AD
