Mood drugs

Question 1

Antihistamine anxiolytics (2)

Answer 1

Hydroxyzine

Diphenhidramine

Question 2

Antihistaime anxioltyics: MOA

Answer 2

Inhibits H1 receptors

Question 3

Antihistamine anxiolytic: indication

Answer 3

Anxiety
pruritis
sedation

Question 4

What is is about anthistamines that limit their use in the elderly?

Answer 4

Anticholinergic impact

Question 5

Antihypertensive anxiolytics (2)

Answer 5

Propanolol

Atenolol

Question 6

Antihypertensive anxiolytic: MOA

Answer 6

Beta blockade

Question 7

How do you dose BBs for anxiety?

Answer 7

At low doses

Question 8

Antiseizure drugs/mood stabilizers (3)

Answer 8

Valproate (Depakote)
Carbamazepine (Tegretol)
Lamotrigine (Lamictal)

Question 9

Antiseizure drugs/mood stabilizers: indication

Answer 9

Seizures
Mania
Aggression

Question 10

Valproate: MOA

Answer 10

Increases [GABA]

Question 11

Carbamazepine: MOA

Answer 11

Decr glutamate release

Question 12

Lamotrigine:MOA

Answer 12

Block repetitive neuron firing

Question 13

Benzo anxiolytics (5)

Answer 13

Diazepam (Valium)
Oxezepam (Serax)
Clonazepam (Klonopin)
Alprazalam (Xanax)
Lorazepam (Ativan)

Question 14

Benzo anxiolytic: MOA

Answer 14

Binds to and stabilizes BZD receptor on post synaptic GABA neuron in limbic system…enhancing GABA impact

Question 15

Diazepam: t 1/2

Answer 15

20-50 hours
up to 90 hours in elderly
active metabolite ~100 hours

Question 16

Oxazepam: t 1/2

Answer 16

5-20 hours (inactive metabolite)

Question 17

Hypnotics are a little more convoluted, so lets look more closely

Answer 17

And…….go!

Question 18

Non-benzo hypnotics (3)

Answer 18

Zolpidem (Ambien)
Eszopiclone (Lunesta)
Zaleplon (Sonata)

Question 19

Non-benzo hypnotic: MOA

Answer 19

Selective agonist for alpha1 benzo subunit on GABA receptor complex…increasing GABA impact

Question 20

Non-benzo hypnotic: indicaton

Answer 20

Insomnia

Ambien and Sonata are short term use

Question 21

Wackadoo crazy side effect of hypnotics…

Answer 21

Hazardous sleep-related activities/behaviors

Question 22

Benzo sleep aid:

Answer 22

Temazepam (Restoril)

Question 23

Temazepam: MOA

Answer 23

Binds to GABA, increasing GABA levels

Question 24

Temazepam: PG category

Answer 24

X

Question 25

Melatonin analogue hypnotic:

Answer 25

Ramelteon (Rozarem)

Question 26

Ramelteon: MOA

Answer 26

Melatonin receptor agonist

Question 27

A few points to remember about Ramelteon…

Answer 27

Do not take with a high fat meal.

No rebound insomnia, so need to taper

Question 28

Orexin-R antagonist hypnotic:

Answer 28

Suvorexant (Belsomra)

Question 29

Suvorexant: MOA

Answer 29

Blocks wake-promoting OXR1 and OXR2 receptors

Question 30

Suvorexant side effects are more common in….

Answer 30

Females

Question 31

Suvorexant freaks me out because…

Answer 31

REM sleep effects such as cataplexy involving leg weakness can occur day or night without a precipitating event.

Question 32

Buspirone (Buspar): class

Answer 32

Misc anxiolytic

Question 33

Buspirone: MOA

Answer 33

5HT partial agonist

Question 34

Buspirone: indication

Answer 34

Anxiety

Question 35

How long does it take for Buspirone to take full effect?

Answer 35

2 weeks

Question 36

Time to focus…ADHD meds

Answer 36

No, we can ride bikes later.

Question 37

Methylphenidate (Ritalin or Concerta)

Answer 37

CNS stimulant ADHD drug

Question 38

Methylphenidate: MOA

Answer 38

Blocks NE and D reuptake in presynaptic neurons

Question 39

What emergency can occur from Methylphenidate use?

Answer 39

Priapism

Question 40

Atomoxetime (Strattera): class

Answer 40

Non-stimulant ADHD drug

Question 41

Atomoxetime: MOA

Answer 41

Selectively blocks NE reuptake

Question 42

Last pharm card…

Answer 42

BOOM!