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PC707 Pharmacology > Module 8- Psych/Neuro > Flashcards

Module 8- Psych/Neuro Flashcards

1
Q

Benzodiazepines a.re most commonly used to treat _______________. They can also be used for _____________ _____________ _________.

A

anxiety; acute seizure activity

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2
Q

Benzodiazepines are a schedue ________ drug.

A

IV

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3
Q

Benzodiazepines should be used ______ __________ to prevent _____________.

A

short term; abuse

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4
Q

How should chronic use of benzodiazapines be discontinued? Why?

A

Over many weeks by tapering dose. To prevent seizures

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5
Q

Benzodiazepines have a ________ onset of action.

A

rapid

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6
Q

Benzodiazepines are processed in the __________ and _____________ drug and food interactions must be considered.

A

liver; CP450

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7
Q

What is the most prominent difference between benzodiazepines and other anti anxiety drugs?

A

Onset of action.

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8
Q

Drugs used to treat anxiety are called _____________, _______________, or ________________.

A

antianxiety agents, anxiolytics, tranquilizers

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9
Q

Drugs that promote sleep are__________.

A

hypnotics.

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10
Q

________________ 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.

A

Barbiturates; CNS; respiratory; abuse; tolerance; dependence; hepatic

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11
Q

Benzodiazepines are ___________ than other barbiturates and CNS depressants.

A

safer

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12
Q

Respiratory depression is increased in bezodiazepines when used with _______________.

A

alcohol, opioids, barbiturates

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13
Q

Selection among benzos is based on differences in _______ ___________.

A

time course

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14
Q

How long should benzodiazepines be used for transient insomnia tx?

A

2-3 weeks

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15
Q

___________ is the only approved drug for long term use of insomnia.

A

Lunesta (Eszopiclone)

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16
Q

Optimal therapy of anxiety disorders consists of ______________ combined with _________ therapy.

A

psychotherapy, drug

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17
Q

What drugs are used most often for all anxiety disorders?

A

SSRIs - Selective serotonin reuptake inhibitors

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18
Q

Benzodiazepines are used primarily for ________ disorder and acute episodes of __________.

A

panic; generalized anxiety disorder

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19
Q

What is first line drug for GAD? Long term or short term?

A

Benzodiazepines; short term

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20
Q

Buspirone, venlafaxine, paroxetine, and escitaopram are best suited for ________________ management due to_____________.

A

long term; delayed effects

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21
Q

_________________, __________________, and _________________ are especially well suited to treat pts who have both, anxiety and ____________________.

A

Venlafaxine, paroxetine, and escitalopram; depression

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22
Q

What is a good choice for performance anxiety? What does it do?

A

beta blockers; reduces tachycardia which reduces sx.

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23
Q

The distinction between antianxiety effects and hypnotic effects (for insomnia) is often a matter of _______________.

A

dosage.

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24
Q

What are the three major groups of sedative-hypnotics?

A

Barbiturates, benzodiazepines, & benzodiazepine-like drugs

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25
Q

Drugs of choice for insomnia?

A

Benzos and benzo-like drugs - zolpidem, saleplon, eszopiclone

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26
Q

Max # of days benzo-like drugs can be used for insomnia?

A

35 days

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27
Q

What is the melatonin agonist?

A

Ramelton

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28
Q

Herb for insomnia?

A

Melatonin 3 or 6mg, kava, valerian

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29
Q

What is often used in the elderly for insomnia?

What is used infrequently and why?

A

Antidepressants- mirtazapine (remeron) & trazodone (desyrel)

Tricyclic antidepressants, because of sig. side effects; anticholinergics

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30
Q

What off label drug should be avoided for insomnia in patients with depression?

A

Antihistamines - benadryl & vistaril

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31
Q

What drug causes sedation, but should be avoided for off label use for insomnia?

A

Antipsychotic - Quetiapine (seroquel)

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32
Q

What drug can be used for those with mild depression who have difficulty sleeping?

A

Trazadone

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33
Q

What is ramelton (Rozerem) used for?

A

Chronic insomnia

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34
Q

What sleep products are not controlled substances?

A

Lunesta and Rozerem. and benadryl

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35
Q

Most benzodiazepines are pregnancy category ___.

A

D

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36
Q

If other alternatives are not effective for anxiety during pregnancy, what is the best option of the benzos?

A

clonazepam (Klonopin) - with consultation and/or referral

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37
Q

Why should buspirone (Buspar), a non-benzo anxiolytic, be avoided during pregnancy even though it’s listed as cat B?

A

Limited data available

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38
Q

(What are some non-benzo short term tx options for anxiety during preg?

A

Hydroxyzine (vistaril) and zolpidem (ambien)(last resort for short term tx)

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39
Q

What benzos should be avoided during breastfeeding? Short term use of which are ok?

A

Those with long half life -diazepam (valium) & clonazepam (klonopin).
Those with shorter half life - midazolam (versed) & Lorazepam (ativan)

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40
Q

Non benzo and breastfeeding?

A

Buspar - no.
Hydroxyzine (vistaril in small doses) is ok
If no insomnia, non-sedating antihistamines
Ambien is safe with breastfeeding

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41
Q

First line drugs for panic disorder?

A

SSRI - decrease frequency and intensity of panic attacks

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42
Q

Characteristics of OCD?

A

persistent obsessions and compulsions that cause marked distress and consume at least 1 hour a day; interfere with daily living

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43
Q

First line drugs for OCD?

A

SSRIs

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44
Q

First line drugs for social anxiety disorder?

When would something else be used and why?

A

SSRIs.

If it is limited to fear of specific situations that arise infrequently, benzos prn

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45
Q

PTSD - what is the only tx with good proof of efficacy?

What two drugs are approved even though not proven effective?

A

Exposure therapy. SSRIs- paroxetine and sertraline

46
Q

Antidepressants block the reuptake of _________, __________, and some __________ from the pre-synaptic neuron , increasing the amount _______________ in the synapse.

A

norepinephrine, serotonin, dopamine; neurotransmitter

47
Q

For moderate to severe depression, a combination of __________ and ___________ are the most effective approach to tx.

A

medication and counseling

48
Q

Maximal responses to antidepressants develop in _____ to ______ ________. In the elderly this may take _________ to _________ ___________.

A

4-6 weeks; 2-3 months

49
Q

How long after remission should antidepressants be continued?

A

6-12 months

50
Q

Follow up while taking antidepressants for children & adolescents? For adults?

A

Children: Weekly x2wks, every 2wks x2wks, then monthly
Adults: two weeks after initiation of therapy rather than one week, then same as children

51
Q

Classifications of antidepressants (5).

A
  1. SSRIs - selective serotonin reuptake inhibitors
  2. SNRIs Serotonin norepinephrine reuptake inhibitors
  3. TCAs- Tricyclic antidepressants
  4. MOAIs- Monoamine oxidase inhibitors
  5. Other
52
Q

How long does it take to achieve max benefit from SSRI antidepressant?

A

6 wks. 2-3wks for initial effect.

53
Q

SSRI action: blocks reuptake of __________ and thereby intensify transmission at ____________ synapses. Over time this induces __________ ______________ _____________ that are ultimately responsible for relieving depression.

A

serotonin; serotonergic.

adaptive cellular responses

54
Q

List two major advantages of SSRIs over TCAs.

A
  1. Cause fewer side effects

2. Safer when taken in overdose

55
Q

Sertotonin syndrome symptoms (6).

A

Agitation, confusion, hallucinations, hyperreflexia, tremor, and fever

56
Q

What drugs can cause serotonin syndrome? What makes this more likely?

A

SSRIs.

Combining with other serotnergic drugs or MAOIs

57
Q

Only SSRI recommended for children 8 and older

A

fluoxetine

58
Q

What SSRI can be taken during pregnancy and breastfeeding?

A

sertraline (zoloft)

59
Q

T/F

Sexual dysfunction is more common with SSRIs than most other antidepressants.

A

True

60
Q

Most SSRIs are more likely to have _________ effects, more TCAs are more likely to have _________ effects.

A

stimulant; sedation

61
Q

The __________ in SNRIs can increase ______________ in patients with somnolence and _________ _______ secondary to depression.

A

norepinephrine; wakefulness; psychomotor retardation

62
Q

Prozac, Zoloft, Paxil and Celexa are all __________

A

SSRIs

63
Q

Effexor, pristiq, and cymbalta are all

A

SNRIs

64
Q

Intial benefits of TCAs appear in _ to _ ______ but max benefit may take up to __ _____.

A

1-3wks; 2months

65
Q

Most common adverse effects of TCAs (3)

A

Sedation, orthostatic hypotension, and anticholinergic effects (dry mouth, constipation, etc.)

66
Q

Most serious adverse effect of TCAs

A

Cardiotoxicity

67
Q

Why is combination of TCA with MAOI avoided?

A

Can cause hypertensive crisis

68
Q

TCAs should be used very cautiously in pts with preexisting cardiac condition. Why?

A

Can cause widening of QRS complex

69
Q

TCAs may be beneficial to what patients?

A
  1. not responsive to 1st line agents
  2. trouble sleeping
  3. pt with chronic/neuropathic pain
70
Q

Why are MAOIs rarely used?

A

Many food and drug interactions.

71
Q

What specific foods must be avoided? What can happen?

A

tyramine rich foods- fermented and aged products

Hypertensive crisis can result

72
Q

What is bupropion used for?

A

smoking cessation and adult ADHD in addition to depression

73
Q

The major contraindication for buproprion

A

seizure disorder

74
Q

When would trazodone be good as an antidepressant?

A

Mild depression with insomnia

75
Q

Paxil (paroxetine) has been assoc with a slight increase in ____ ___________ __________ in 1st trimester.

A

congenital cardiac malformations.

76
Q

Possible effects of antidepressants on pregancy?

A

persistent pulmonary hypertension - 3rd trimester
neonatal d/c syndrome
prematurity/ LBW

77
Q

If bipolar disorder is misdaignosed as depression only and antidepressant is rx, what can happen?

A

hypomania or mania.

78
Q

What three kinds of drugs are used to treat bipolar?

A

Mood stabilizers, antipsychotic, and antidepressant

79
Q

Gold standard for bipolar

A

lithium

80
Q

What are the preferred mood stabilizers for bipolar (2)

A

lithium and valproic acid

81
Q

Common side effects of therapeutic lithium levels (3)

A

tremor, goiter, polyuria

82
Q

T/F

Lithium is teratogenic and should be avoided throughout pregnancy if possible.

A

True - also contraindicated in breastfeeding

83
Q

A _________ in sodium levels can lead to _______ levels of lithium.

A

reduction; toxic.

84
Q

Lithium levels can be increased by ____________ and ___________.

A

diuretics; NSAIDs

85
Q

T/F

Antipsychotics are only used in bipolar patients with psychotic symptoms.

A

False. Benefits are present even without psychotic sx for long term prevention of mood episodes and acute tx of manic episodes.

86
Q

First generation antipsychotics are called ______________ antipsychotics and block _______ ______.

A

Conventional; block D2 (dopamine) receptors

87
Q

Therapeutic effects of antipsychotics develop __________ and may take _________ _________ to reach max.

A

slowly; several months

88
Q

Three types of early extrapyrmidal symptoms (EPS) produced by 1st gen antipsychotics.

A
  1. acute dystonia
  2. parkinsonism
  3. akathisia
89
Q

T/F

Acute dystonia and parkinsonism respond to anticholinergics.

A

True. Akathisia is harder to treat but may respond to anticholinergics, benzos, or beta blockers.

90
Q 
T/F
Tardive dyskinesia (late EPS) has no reliable tx.
A

True

91
Q

Low potency and high potency conventional antipsychotics have equal therapeutic effects. T/F

A

True

92
Q

Low potency conventionals produce more ___________, _____________ ____________, _____________ __________.

A

sedation, orthostatic hypotension, & anticholinergic effects.

93
Q

Risk of early EPS is much higher with ___________.

A

high potency.

94
Q

Antipsychotics increase levels of circulating ______________.

A

prolactin

95
Q

Three ways SGAs (atypical) differ from FGAs (conventional):

A
  1. block receptors for serotonin in additon to dopamine
  2. few or no EPS including TD
  3. higher risk of serious metabolic effects
96
Q

What serious metabolic effects are assoc with atypical antipsychotics:

A

weight gain, diabetes, dyslipidemia

97
Q

Among atypical antipsychotics, metabolic effects are greatest with :

A

clozapine, olanzapine

98
Q

T/F

In general, atypical antipsychotics are neither safer nor more effective than convention.

A

True

99
Q

Atypical antipsychotics help with ___________ and ________ symptoms, whereas conventional work more with _____________ sx.

A

positive and negative; positive.

100
Q

AEDs have 4 basic mechanisms:

  1. Block _____ channels
  2. Block ________ channels
  3. block _______ receptors
  4. potentiate ____________
A
  1. Sodium
  2. Calcium
  3. glutamate
  4. GABA
101
Q

T/F

AEDs can be selective, it is important to choose the correct drug.

A

True

102
Q

Mainstay tx for partial sizures and generalized tonic-clonic seizures in children and adults:

A

Carbamazepine (tegretol)

103
Q

Side effects of carbamazepine

A

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

104
Q

Dilantin is used for

A

gran mal (tonic-clonic), partial, and complex epilepsy. Carbamazepine is tolerated better than dliantin (phenytoin)

105
Q

Preferred AEDs for absence seizures (petit mal)

A

ethosuximide (zarontin), valproic acid (depakote), lamotrigine (lamictal). Depakote and lamictal have fewer side effects.

106
Q

With valproic acid (depakote) ___________ counts should be checked.

A

platelet

107
Q

Which AED should not be used in pregnancy? breastfeeding?

A

Carbamazepine; lamotrigine (lamictal)

108
Q

Drug types for Alhzheimers:

A

Cholinesterase Inhibitors & N-methyl-D-aspartic acid (NMDA)

109
Q

Cholinesterase Inhibitors increase the availability of

A

acetylcholine

110
Q

Side effects of cholinesterase inhibitors

A

nausea, vomiting, diarhhea, dyspepsia

111
Q

NMDA (memantine) is approved for

A

moderate to severe AD

PC707 Pharmacology (5 decks)

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