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PC707 Pharmacology > Module 8- Psych/Neuro > Flashcards

Module 8- Psych/Neuro Flashcards

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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
Drugs of choice for insomnia?
Benzos and benzo-like drugs - zolpidem, saleplon, eszopiclone
26
Max # of days benzo-like drugs can be used for insomnia?
35 days
27
What is the melatonin agonist?
Ramelton
28
Herb for insomnia?
Melatonin 3 or 6mg, kava, valerian
29
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
30
What off label drug should be avoided for insomnia in patients with depression?
Antihistamines - benadryl & vistaril
31
What drug causes sedation, but should be avoided for off label use for insomnia?
Antipsychotic - Quetiapine (seroquel)
32
What drug can be used for those with mild depression who have difficulty sleeping?
Trazadone
33
What is ramelton (Rozerem) used for?
Chronic insomnia
34
What sleep products are not controlled substances?
Lunesta and Rozerem. and benadryl
35
Most benzodiazepines are pregnancy category ___.
D
36
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
37
Why should buspirone (Buspar), a non-benzo anxiolytic, be avoided during pregnancy even though it's listed as cat B?
Limited data available
38
(What are some non-benzo short term tx options for anxiety during preg?
Hydroxyzine (vistaril) and zolpidem (ambien)(last resort for short term tx)
39
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)
40
Non benzo and breastfeeding?
Buspar - no. Hydroxyzine (vistaril in small doses) is ok If no insomnia, non-sedating antihistamines Ambien is safe with breastfeeding
41
First line drugs for panic disorder?
SSRI - decrease frequency and intensity of panic attacks
42
Characteristics of OCD?
persistent obsessions and compulsions that cause marked distress and consume at least 1 hour a day; interfere with daily living
43
First line drugs for OCD?
SSRIs
44
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
45
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
46
Antidepressants block the reuptake of _________, __________, and some __________ from the pre-synaptic neuron , increasing the amount _______________ in the synapse.
norepinephrine, serotonin, dopamine; neurotransmitter
47
For moderate to severe depression, a combination of __________ and ___________ are the most effective approach to tx.
medication and counseling
48
Maximal responses to antidepressants develop in _____ to ______ ________. In the elderly this may take _________ to _________ ___________.
4-6 weeks; 2-3 months
49
How long after remission should antidepressants be continued?
6-12 months
50
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
51
Classifications of antidepressants (5).
1. SSRIs - selective serotonin reuptake inhibitors 2. SNRIs Serotonin norepinephrine reuptake inhibitors 3. TCAs- Tricyclic antidepressants 4. MOAIs- Monoamine oxidase inhibitors 5. Other
52
How long does it take to achieve max benefit from SSRI antidepressant?
6 wks. 2-3wks for initial effect.
53
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
54
List two major advantages of SSRIs over TCAs.
1. Cause fewer side effects | 2. Safer when taken in overdose
55
Sertotonin syndrome symptoms (6).
Agitation, confusion, hallucinations, hyperreflexia, tremor, and fever
56
What drugs can cause serotonin syndrome? What makes this more likely?
SSRIs. | Combining with other serotnergic drugs or MAOIs
57
Only SSRI recommended for children 8 and older
fluoxetine
58
What SSRI can be taken during pregnancy and breastfeeding?
sertraline (zoloft)
59
T/F | Sexual dysfunction is more common with SSRIs than most other antidepressants.
True
60
Most SSRIs are more likely to have _________ effects, more TCAs are more likely to have _________ effects.
stimulant; sedation
61
The __________ in SNRIs can increase ______________ in patients with somnolence and _________ _______ secondary to depression.
norepinephrine; wakefulness; psychomotor retardation
62
Prozac, Zoloft, Paxil and Celexa are all __________
SSRIs
63
Effexor, pristiq, and cymbalta are all
SNRIs
64
Intial benefits of TCAs appear in _ to _ ______ but max benefit may take up to __ _____.
1-3wks; 2months
65
Most common adverse effects of TCAs (3)
Sedation, orthostatic hypotension, and anticholinergic effects (dry mouth, constipation, etc.)
66
Most serious adverse effect of TCAs
Cardiotoxicity
67
Why is combination of TCA with MAOI avoided?
Can cause hypertensive crisis
68
TCAs should be used very cautiously in pts with preexisting cardiac condition. Why?
Can cause widening of QRS complex
69
TCAs may be beneficial to what patients?
1. not responsive to 1st line agents 2. trouble sleeping 3. pt with chronic/neuropathic pain
70
Why are MAOIs rarely used?
Many food and drug interactions.
71
What specific foods must be avoided? What can happen?
tyramine rich foods- fermented and aged products | Hypertensive crisis can result
72
What is bupropion used for?
smoking cessation and adult ADHD in addition to depression
73
The major contraindication for buproprion
seizure disorder
74
When would trazodone be good as an antidepressant?
Mild depression with insomnia
75
Paxil (paroxetine) has been assoc with a slight increase in ____ ___________ __________ in 1st trimester.
congenital cardiac malformations.
76
Possible effects of antidepressants on pregancy?
persistent pulmonary hypertension - 3rd trimester neonatal d/c syndrome prematurity/ LBW
77
If bipolar disorder is misdaignosed as depression only and antidepressant is rx, what can happen?
hypomania or mania.
78
What three kinds of drugs are used to treat bipolar?
Mood stabilizers, antipsychotic, and antidepressant
79
Gold standard for bipolar
lithium
80
What are the preferred mood stabilizers for bipolar (2)
lithium and valproic acid
81
Common side effects of therapeutic lithium levels (3)
tremor, goiter, polyuria
82
T/F | Lithium is teratogenic and should be avoided throughout pregnancy if possible.
True - also contraindicated in breastfeeding
83
A _________ in sodium levels can lead to _______ levels of lithium.
reduction; toxic.
84
Lithium levels can be increased by ____________ and ___________.
diuretics; NSAIDs
85
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.
86
First generation antipsychotics are called ______________ antipsychotics and block _______ ______.
Conventional; block D2 (dopamine) receptors
87
Therapeutic effects of antipsychotics develop __________ and may take _________ _________ to reach max.
slowly; several months
88
Three types of early extrapyrmidal symptoms (EPS) produced by 1st gen antipsychotics.
1. acute dystonia 2. parkinsonism 3. akathisia
89
T/F | Acute dystonia and parkinsonism respond to anticholinergics.
True. Akathisia is harder to treat but may respond to anticholinergics, benzos, or beta blockers.
90
``` T/F Tardive dyskinesia (late EPS) has no reliable tx. ```
True
91
Low potency and high potency conventional antipsychotics have equal therapeutic effects. T/F
True
92
Low potency conventionals produce more ___________, _____________ ____________, _____________ __________.
sedation, orthostatic hypotension, & anticholinergic effects.
93
Risk of early EPS is much higher with ___________.
high potency.
94
Antipsychotics increase levels of circulating ______________.
prolactin
95
Three ways SGAs (atypical) differ from FGAs (conventional):
1. block receptors for serotonin in additon to dopamine 2. few or no EPS including TD 3. higher risk of serious metabolic effects
96
What serious metabolic effects are assoc with atypical antipsychotics:
weight gain, diabetes, dyslipidemia
97
Among atypical antipsychotics, metabolic effects are greatest with :
clozapine, olanzapine
98
T/F | In general, atypical antipsychotics are neither safer nor more effective than convention.
True
99
Atypical antipsychotics help with ___________ and ________ symptoms, whereas conventional work more with _____________ sx.
positive and negative; positive.
100
AEDs have 4 basic mechanisms: 1. Block _____ channels 2. Block ________ channels 3. block _______ receptors 4. potentiate ____________
1. Sodium 2. Calcium 3. glutamate 4. GABA
101
T/F | AEDs can be selective, it is important to choose the correct drug.
True
102
Mainstay tx for partial sizures and generalized tonic-clonic seizures in children and adults:
Carbamazepine (tegretol)
103
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
104
Dilantin is used for
gran mal (tonic-clonic), partial, and complex epilepsy. Carbamazepine is tolerated better than dliantin (phenytoin)
105
Preferred AEDs for absence seizures (petit mal)
ethosuximide (zarontin), valproic acid (depakote), lamotrigine (lamictal). Depakote and lamictal have fewer side effects.
106
With valproic acid (depakote) ___________ counts should be checked.
platelet
107
Which AED should not be used in pregnancy? breastfeeding?
Carbamazepine; lamotrigine (lamictal)
108
Drug types for Alhzheimers:
Cholinesterase Inhibitors & N-methyl-D-aspartic acid (NMDA)
109
Cholinesterase Inhibitors increase the availability of
acetylcholine
110
Side effects of cholinesterase inhibitors
nausea, vomiting, diarhhea, dyspepsia
111
NMDA (memantine) is approved for
moderate to severe AD

PC707 Pharmacology (5 decks)

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