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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
NDRI (bupropion) pearl
Take in the morning. There is a 12 hour and a 24 hour version
26
NDRI (bupropion) adverse reactions
Seizures, Mania, CNS stimulation (anxiety or agitation), Suicidality
27
TCAs MOAs
● 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
28
TCAs Indications
Major Depression – Migraine prevention, insomnia, neuralgia, eating disorders (amitriptyline, off-label) – Alcoholism, anxiety, insomnia, pruritus (Doxepin)
29
TCAs contraindications
Heart disease, acute recovery from myocardial infarction, QT prolongation. Caution during pregnancy
30
TCAs are ____ selective than SSRIs/SNRIs
Less, so have many more side effects
31
Serotonin Modulators MOA
antagonists and agonists at postsynaptic serotonin receptors and inhibit reuptake of postsynaptic serotonin to varying degrees
32
Serotonin Modulators Indications
Major depression, PMDD, – Trazodone is often used as a hypnotic to treat insomnia in depression
33
Serotonin Modulators pearl
Take trazodone at night
34
Side Effects and Adverse Reactions of trazadone
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
Side Effects and Adverse Reactions of Vilazodone and Vortioxetine
diarrhea, nausea, sexual dysfunction, dizziness, insomnia, and vomiting
36
Alpha2 Antagonist MOA
Enhances central noradrenergic & serotonergic activity, histamine H1 receptor antagonism (producing sedative effect), antagonist at muscarinic receptors
37
Alpha2 Antagonist indication
Headache prophylaxis, MDD, Anxiety Disorders
38
Alpha2 Antagonist pearl
Helpful to use in patients with depression and insomnia.
39
Lithium MOA
Alters Na+ transport in nerve & muscle cells resulting in metabolism of catecholamines, specific MOA in during mania is unknown
40
Lithium Indications
Bipolar disorder, Schizoaffective disorder, severe MDD
41
Lithium contraindications
Caution during pregnancy, CV disease, use of diuretics, severe debilitation, dehydration, renal disease, or sodium depletion
42
Lithium adverse reactions
Renal impairment (interstitial nephritis), Cardiovascular complications, lithium toxicity (see later slide)
43
Drug levels for Lithium
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
Lithium toxicity BBW
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
Signs of Lithium toxicity
● 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
Benzos MOA
● GABA agonists ● Instantaneous effect upon arrival in the CNS. ● Addictive
47
Benzos indications
● Anxiety disorders ● Panic disorder ● Insomnia (no longer than 7-10 days) ● Alcohol withdrawal (chlordiazepoxide) ● Seizures/status epilepticus (midazolam)
48
Side Effects of Benzos
● Drowsiness ● Impaired coordination ● Irritability ● Confusion ● Memory impairment ● Xerostomia ● Urinary retention
49
Benzos Adverse effects
● Abuse/dependency ● Respiratory depression ● Withdrawal seizures
50
T/F Benzos should not be a long term solution for most patients
T
51
Non-Benzos indications
● Anxiety disorders ● Panic disorder ● Depression
52
Buspirone contraindication
MAOI use
53
Hydroxyzine contraindications
● Allergy to cetirizine or levocetirizine ● QT prolongation ● CNS depressant use ● Caution in elderly
54
BZRAs MOA
enhances GABA activity, decreasing neuronal excitability
55
BZRAs BBW
Complex sleep behaviors (sleep-walking, sleep-driving) while not fully awake may occur following the use
56
BZRAs pearl
Schedule IV controlled substances. Not indicated for long term use
57
Melatonin Agonist MOA
selective agonist of melatonin receptors in the suprachiasmic nucleus of the hypothalamus
58
Melatonin Agonist indication
Insomnia (sleep onset)
59
DORAs MOA
blocks binding of orexin, to suppress wake drive
60
CNS Stimulants MOA
Increases dopamine in the brain
61
CNS Stimulants Indication
Narcolepsy, idiopathic hypersomnia, excessive daytime sleepiness (due to shift work, sleep apnea, cancer, MS)
62
Other Stimulants (Dextroamphetamine, Methylphenidate (Ritalin), and Dextroamphetamine/Amphetamine (Adderall) MOA
Stimulates CNS activity; ↑ release of norepinephrine & dopamine in presynaptic terminals (sympathomimetic)
63
Other Stimulants contraindication
High abuse potential (black box), cardiovascular disease, arrhythmias, untreated hyperthyroidism, glaucoma
64
Additional meds for Narcolepsy & Idiopathic Hypersomnia (Pitolisant (Wakix)) MOA
antagonist/inverse agonist at histamine-3 receptors
65
Solriamfatol (Sunozi) MOA
selective dopamine and norepinephrine reuptake inhibitor (DNRI)
66
Sodium oxybate (Xyrem, Xywav) MOA
GABAB receptor activity (noradrenergic & dopaminergic)
67
Dopamine Agonists MOA
Stimulates dopamine activity.
68
Dopamine Agonists Indication
Restless leg, parkinson disease
69
Gabapentin and Pregabalin (Lyrica) MOA
Blocks voltage-dependent calcium channels, modulating excitatory neurotransmitter release
70
Gabapentin and Pregabalin (Lyrica) indication
restless leg syndrome, seizures, post-herpetic neuralgia, alcohol use disorder, GAD, neuropathic pain, fibromyalgia
71
Avoid grapefruit juice w/ _____
buspirone
72
Four category clinical presentation of serotonin syndrome
Altered Mental Status Autonomic Dysfunction Neuromuscular abnormalities Serious Complications

Behavioral Dynamics Exam 3 (5 decks)

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