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Behavioral Dynamics Exam 3 > Mood, Anxiety, Stress & Sleep Rx > Flashcards

Mood, Anxiety, Stress & Sleep Rx Flashcards

1
Q

SSRIs

A

○ sertraline (Zoloft)
○ fluoxetine (Prozac)
○ citalopram (Celexa)
○ escitalopram (Lexapro)
○ paroxetine (Paxil)

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2
Q

SNRIs

A

○ venlafaxine (Effexor)
○ desvenlafaxine (Pristiq)
○ duloxetine (Cymbalta)

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3
Q

NDRI

A

bupropion (Wellbutrin)

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4
Q

TCAs

A

○ imipramine (Tofranil)
○ amitriptyline (Elavil)
○ nortriptyline (Pamelor)
○ doxepin (Silenor)

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5
Q

S. Mods

A

○ trazodone
○ vortioxetine (Trintellix)
○ vilazodone (Viibryd)

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6
Q

Alpha-2 Antagonist

A

mirtazapine (Remeron)

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7
Q

Benzos

A

○ alprazolam (Xanax)
○ lorazepam (Ativan)
○ clonazepam (Klonopin)
○ diazepam (Valium)
○ temazepam (Restoril)
○ chlordiazepoxide (Librium)

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8
Q

Non-Benzos

A

○ buspirone (Buspar)
○ hydroxyzine (Vistaril)

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9
Q

Nonbenzodiazepine Benzodiazepine
receptor agonists - BZRAs

A

○ zolpidem (Ambien)
○ zaleplon (Sonata)
○ eszopiclone (Lunesta)

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10
Q

Melatonin agonist

A

ramelteon (Rozerem)

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11
Q

Dual orexin receptor antagonists (DORAs)

A

○ suvorexant (Belsomra)
○ daridorexant (Quviviq)

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12
Q

Central Nervous System Stimulants

A

○ Armodafinil (Nuvigil) and Modafinil
(Provigil)

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13
Q

BBW for all SSRIs, SNRIs, NDRI, TCAs, Serotonin
Modulators, and mirtazapine

A

Increased risk of suicidal thoughts and behavior in pediatric
and young adult patients, especially during the first weeks of
therapy

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14
Q

Serotonin Syndrome

A

● The result of taking medications that increase serotonergic
neurotransmission.
● Majority of cases present between 6-24 hours of a dose increase or
initiation of an additional medication.

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15
Q

Serotonin Withdrawal Syndrome

A

Can occur during discontinuation of any medication that increases
serotonergic neurotransmission (so the same as serotonin syndrome)

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16
Q

Serotonin Withdrawal Syndrome symptoms

A

: somatic (dizzy, chills, light-headed, vertigo, shock-like
sensations, paresthesia, fatigue, HA, GI upset, tremor, visual disturbances)
and psychological (aggression/agitation, anxiety, confusion, insomnia,
irritability, mania, violent behavior)

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17
Q

Risks of serotonin withdrawal

A

○ Abrupt discontinuation (can still occur during a gradual tapering).
○ Worse with short half-life medications (eg, paroxetine, venlafaxine).
○ Higher dose and longer duration of taking the medication

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18
Q

SSRIs MOA

A
  • Inhibits the reuptake of mostly
    select serotonin (5-HT)
  • Blocks presynaptic serotonin
    reuptake proteins
  • Inhibited serotonin reuptake =
    increased serotonin in synaptic
    cleft
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19
Q

SSRIs indications

A

MDD, Anxiety disorders, Eating disorders, OCD, PTSD, Premature
ejaculation, PMDD, Somatic symptom disord

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20
Q

SSRIs adverse reactions

A

Mania or hypomania, Serotonin syndrome

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21
Q

SNRIs MOA

A
  • Inhibits the reuptake of both
    Serotonin and Norepinephrine
  • Blocks presynaptic norepinephrine
    and serotonin reuptake proteins
  • Inhibited reuptake = increased
    norepinephrine and serotonin in
    synaptic clef
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22
Q

SNRIs indications

A

MDD, Anxiety disorders, Chronic pain syndromes** , OCD, PTSD,
Body dysmorphic disorder, Menopausal hot flashes

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23
Q

SNRIs pearls

A

Great to use in patients with MDD or anxiety plus menopausal
symptoms or chronic pain. Caution about withdrawal symptoms with
venlafaxine

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24
Q

NDRI (bupropion) MOA

A

inhibits dopamine, serotonin, and norepinephrine reuptake

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25
Q

NDRI (bupropion) pearl

A

Take in the morning. There is a 12 hour and a 24 hour version

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26
Q

NDRI (bupropion) adverse reactions

A

Seizures, Mania, CNS stimulation (anxiety or agitation), Suicidality

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27
Q

TCAs MOAs

A

● Mainly inhibit reuptake of serotonin
and norepinephrine.
● Not as selective as SSRIs or
SNRIs, so a lot more side effects.
● Can affect more than just
serotonin and norepinephrine
reuptake

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28
Q

TCAs Indications

A

Major Depression
– Migraine prevention, insomnia, neuralgia, eating disorders (amitriptyline,
off-label)
– Alcoholism, anxiety, insomnia, pruritus (Doxepin)

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29
Q

TCAs contraindications

A

Heart disease, acute recovery from myocardial infarction, QT
prolongation. Caution during pregnancy

30
Q

TCAs are ____ selective than SSRIs/SNRIs

A

Less, so have many more side effects

31
Q

Serotonin Modulators MOA

A

antagonists and agonists at postsynaptic serotonin
receptors and inhibit reuptake of postsynaptic serotonin to varying degrees

32
Q

Serotonin Modulators Indications

A

Major depression, PMDD,
– Trazodone is often used as a hypnotic to treat insomnia in depression

33
Q

Serotonin Modulators pearl

A

Take trazodone at night

34
Q

Side Effects and Adverse Reactions of trazadone

A

somnolence, dry mouth, dizziness, fatigue, constipation,
vision blurred, sexual dysfunction, orthostatic hypotension, and
headache. Rare but serious side effects include priapism and cardiac
arrhythmias

35
Q

Side Effects and Adverse Reactions of Vilazodone and Vortioxetine

A

diarrhea, nausea, sexual dysfunction,
dizziness, insomnia, and vomiting

36
Q

Alpha2 Antagonist MOA

A

Enhances central noradrenergic & serotonergic activity,
histamine H1 receptor antagonism (producing sedative effect), antagonist at
muscarinic receptors

37
Q

Alpha2 Antagonist indication

A

Headache prophylaxis, MDD, Anxiety Disorders

38
Q

Alpha2 Antagonist pearl

A

Helpful to use in patients with depression and insomnia.

39
Q

Lithium MOA

A

Alters Na+ transport in nerve & muscle cells resulting in
metabolism of catecholamines, specific MOA in during mania is unknown

40
Q

Lithium Indications

A

Bipolar disorder, Schizoaffective disorder, severe MDD

41
Q

Lithium contraindications

A

Caution during pregnancy, CV disease, use of diuretics,
severe debilitation, dehydration, renal disease, or sodium depletion

42
Q

Lithium adverse reactions

A

Renal impairment (interstitial nephritis), Cardiovascular complications, lithium toxicity (see later slide)

43
Q

Drug levels for Lithium

A

Between 0.8-1.2 mEq/L for acute mania & 0.8
to 1.0 mEq/L for long-term control; Toxicity at >1.5 mEq/L
in child/adult, >0.8 in elderly

44
Q

Lithium toxicity BBW

A

Lithium toxicity is closely related to serum lithium levels, & can occur at doses
close to therapeutic levels. Facilities for prompt & accurate serum lithium
determinations should be available before initiating therapy

45
Q

Signs of Lithium toxicity

A

● Diarrhea, vomiting, tremor, mild ataxia, drowsiness, or
muscular weakness & lack of coordination may be seen at
concentrations below 2 mEq/L
● Giddiness, ataxia, blurred vision, tinnitus, or large volume of
dilute urine may be seen at concentrations above 3 mEq/L

46
Q

Benzos MOA

A

● GABA agonists
● Instantaneous effect
upon arrival in the CNS.
● Addictive

47
Q

Benzos indications

A

● Anxiety disorders
● Panic disorder
● Insomnia (no longer than 7-10 days)
● Alcohol withdrawal
(chlordiazepoxide)
● Seizures/status epilepticus
(midazolam)

48
Q

Side Effects of Benzos

A

● Drowsiness
● Impaired coordination
● Irritability
● Confusion
● Memory impairment
● Xerostomia
● Urinary retention

49
Q

Benzos Adverse effects

A

● Abuse/dependency
● Respiratory depression
● Withdrawal seizures

50
Q

T/F Benzos should not be a long term solution for most patients

A

T

51
Q

Non-Benzos indications

A

● Anxiety disorders
● Panic disorder
● Depression

52
Q

Buspirone contraindication

A

MAOI use

53
Q

Hydroxyzine contraindications

A

● Allergy to cetirizine or levocetirizine
● QT prolongation
● CNS depressant use
● Caution in elderly

54
Q

BZRAs MOA

A

enhances GABA activity, decreasing neuronal
excitability

55
Q

BZRAs BBW

A

Complex sleep behaviors (sleep-walking, sleep-driving) while
not fully awake may occur following the use

56
Q

BZRAs pearl

A

Schedule IV controlled substances. Not indicated for long term use

57
Q

Melatonin Agonist MOA

A

selective agonist of melatonin receptors in the suprachiasmic nucleus of the hypothalamus

58
Q

Melatonin Agonist indication

A

Insomnia (sleep onset)

59
Q

DORAs MOA

A

blocks binding of orexin, to suppress wake drive

60
Q

CNS Stimulants MOA

A

Increases dopamine in the brain

61
Q

CNS Stimulants Indication

A

Narcolepsy, idiopathic hypersomnia, excessive daytime sleepiness (due to shift work, sleep apnea, cancer, MS)

62
Q

Other Stimulants (Dextroamphetamine, Methylphenidate (Ritalin), and
Dextroamphetamine/Amphetamine (Adderall) MOA

A

Stimulates CNS activity; ↑ release of norepinephrine & dopamine in presynaptic terminals (sympathomimetic)

63
Q

Other Stimulants contraindication

A

High abuse potential (black box), cardiovascular
disease, arrhythmias, untreated hyperthyroidism, glaucoma

64
Q

Additional meds for Narcolepsy &
Idiopathic Hypersomnia (Pitolisant (Wakix)) MOA

A

antagonist/inverse agonist at histamine-3 receptors

65
Q

Solriamfatol (Sunozi) MOA

A

selective dopamine and norepinephrine reuptake inhibitor (DNRI)

66
Q

Sodium oxybate (Xyrem, Xywav) MOA

A

GABAB
receptor activity (noradrenergic &
dopaminergic)

67
Q

Dopamine Agonists MOA

A

Stimulates dopamine activity.

68
Q

Dopamine Agonists Indication

A

Restless leg, parkinson disease

69
Q

Gabapentin and Pregabalin (Lyrica) MOA

A

Blocks voltage-dependent calcium channels,
modulating excitatory neurotransmitter release

70
Q

Gabapentin and Pregabalin (Lyrica) indication

A

restless leg syndrome, seizures, post-herpetic neuralgia, alcohol
use disorder, GAD, neuropathic pain, fibromyalgia

71
Q

Avoid grapefruit juice w/ _____

A

buspirone

72
Q

Four category clinical presentation of serotonin syndrome

A

Altered Mental Status
Autonomic Dysfunction
Neuromuscular abnormalities
Serious Complications

Behavioral Dynamics Exam 3 (5 decks)

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