(P2) Practice Q's Set 1 Flashcards

1
Q

A drug with pronounced

anticholinergic properties ?

Name:

A

Amitriptyline

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2
Q

Amitriptyline

Define:

Use:

A

Amitriptyline belongs to a class of drugs called tricyclic antidepressants

treat a number of mental illnesses:

include major depressive disorder

anxiety disorders

less commonly attention deficit hyperactivity disorder (ADHD) and bipolar disorder.

Other: include prevention of migraines, treatment of neuropathic pain such as fibromyalgia and postherpetic neuralgia, and less commonly insomnia

SE: signs of an allergic reaction to amitriptyline: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

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3
Q

Amitriptyline

  • SE:*
  • mild/seriuous*
A

side effects: blurred vision

dry mouth,

low blood pressure on standing,

sleepiness,

constipation.

Serious side effects may include seizures, an increased risk of suicide in those less than 25 years of age, urinary retention, glaucoma, and a number of heart issues.

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4
Q

Amitriptyline

Contraindications:

A
  • It should not be taken with MAO inhibitors or the medication cisapride.*
  • Amitriptyline may cause problems if taken during pregnancy.*
  • Use during breastfeeding appears to be relatively safe.*
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5
Q

Bupropion

  • Define:*
  • Use:*
A

Bupropion is an atypical antidepressant.

It acts as a norepinephrine–dopamine reuptake inhibitor (NDRI) and a nicotinic receptor antagonist

USE:

to treat major depressive disorder

and

to support smoking cessation.

It is an effective antidepressant on its own,

also

used as an add-on medication* in cases of *incomplete response to first-line SSRI antidepressants

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6
Q
  • Bupropion*
  • SE:*
A

side effects of bupropion include:

a dry mouth, difficulty sleeping, agitation, and headaches.

Serious side effects increased risk for epileptic seizures and suicide.

In comparison to some other antidepressants, bupropion may have a lower rate of sexual dysfunction* or *sleepiness* and *may result* in *weight loss.

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7
Q

bupropion

Contraindications:

A

should not be prescribed to individuals with epilepsy

or

other conditions that lower the seizure threshold: anorexia nervosa,

bulimia nervosa,

benzodiazepine abuse

or withdrawal alcohol abuse or withdrawal.

Avoid in individuals who are also taking monoamine oxidase inhibitors (MAOIs).

NOTE: When switching from MAOIs to bupropion, it is important to include a washout period of about two weeks between the medications

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8
Q

Citalopram

  • Define:*
  • Use:*
A

Is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class.

USE: used to treat major depressive disorder, obsessive compulsive disorder,

panic disorder,

social phobia.

  • The antidepressant effects may take one to four weeks to occur.*
  • It is taken by mouth*
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9
Q

Fluoxetine

  • Also known as:*
  • define:*
  • Use:*
A

Prozac

an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class.

USE: for the treatment of major depressive disorder, obsessive–compulsive disorder (OCD), bulimia nervosa, panic disorder, and premenstrual dysphoric disorder.

  • It may decrease the risk of suicide in those over the age of 65.*
  • It has also been used to treat premature ejaculation.*
  • Fluoxetine is taken by mouth.*
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10
Q

Citalopram

SE:

A

Common side effects :

nausea, trouble sleeping, sexual dysfunction, shakiness, feeling tired, and sweating

Serious side effects:

include an increased risk of suicide in those under the age of 25, serotonin syndrome, glaucoma, and QT prolongation.

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11
Q
  • Citalopram*
  • Contraindications:*
A

It should not be used in someone on a MAO inhibitor.

Antidepressant discontinuation syndrome may occur when stopped.

Citalopram should not be taken with St John’s wort, tryptophan, 5-HTP, MAOI’s as the resulting drug interaction could lead to serotonin syndrome.

(SSRIs) Citalopram, can increase the risk* of *bleeding, especially when coupled with aspirin, NSAIDs, warfarin, or other anticoagulants.

NOTE:citalopramwithomeprazolemay cause higher blood levels ofcitalopram.

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12
Q
  • Fluoxetine*
  • SE:*
  • If stopped suddenly:*
A

Common side effects include indigestion, trouble sleeping, sexual dysfunction, loss of appetite, dry mouth, rash, and abnormal dreams

Serious side effects include serotonin syndrome, mania, seizures, an increased risk of suicidal behavior in people under 25 years old, and an increased risk of bleeding.

If stopped suddenly, a withdrawal syndrome* may occur with *anxiety, dizziness, and changes in sensation.

It is unclear if it is safe in pregnancy.

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13
Q
  • Fluoxetine*
  • Is it effective for Social anxiety disorder?*
A

ineffective for social anxiety disorder.

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14
Q
  • Mirtazapine*
  • Define:*
  • Use:*
A

has antihistamine, α2-blocker, and antiserotonergic activity.

It is specifically a potent antagonist or inverse agonist of the α2A-, α2B-, and α2C-adrenergic receptors, the serotonin 5-HT2A, 5-HT2C, and the histamine H1receptor.

NOTE: Unlike many other antidepressants, it does not inhibitthe reuptake of serotonin, norepinephrine, dopamine, monoamine oxidase

USE: antidepressant of the atypical antidepressants class primarily used to treat depression.

-full effect may take more than four weeks to occur, with some benefit possibly as early as one to two weeks.

Often it is used in depression complicated by anxiety or trouble sleeping.

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15
Q
  • Mirtazapine*
  • SE:*
A

Common side effects

include increased weight,

  • sleepiness*
  • dizziness*

Serious side effects may include mania, l_ow white blood cell count_, and i_ncreased suicide among children_.

Withdrawal symptoms may occur with stopping

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16
Q
  • Mirtazapine*
  • Contraindications:*
A

not recommended together with an MAO inhibitor It -is unclear if use during pregnancy is safe

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17
Q

mirtazapine

  • Indications:*
  • What main enzymes are responsible for its metabolism and altered concentrations:*
A

Concurrent use with inhibitors* or *inducers of the cytochrome (CYP) P450 isoenzymes CYP1A2, CYP2D6, and/or CYP3A4 can result in altered concentrations of mirtazapine.

As examples: fluoxetine and paroxetine, inhibitors of these enzymes, are known to modestly increase mirtazapine levels, while carbamazepine, an inducer, considerably decreases them.

Liver impairment and moderate chronic kidney disease have been reported to decrease the oral clearance of mirtazapine by about 30%; severe kidney disease decreases it by 50%.

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18
Q

mirtazapine

A

As examples, fluoxetine and paroxetine, inhibitors of these enzymes, are known to modestly increase mirtazapine levels, while carbamazepine, an inducer, considerably decreases them.[4] Liver impairment and moderate chronic kidney disease have been reported to decrease the oral clearance of mirtazapine by about 30%; severe kidney disease decreases it by 50%.

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19
Q
  • A nonselective monoamine oxidase*
  • inhibitor :*
A

Phenelzine

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20
Q

phenelzine

  • Define:*
  • Use:*
A

is a non-selective and irreversible monoamine oxidase inhibitor (MAOI) of the hydrazine class

which is used as

an antidepressant and anxiolytic.

USE: major depressive disorder, dysthymia, bipolar depression (BD), panic disorder (PD), social anxiety disorder, bulimia, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD)

NOTE: Along with tranylcypromine and isocarboxazid, phenelzine is one of the few non-selective and irreversible MAO

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21
Q

phenelzine

Pharmacodynamics:

A

is a non-selective and irreversible inhibitor of (MAO).

It inhibits both of the respective isoforms of MAO, MAO-A and MAO-B

By inhibiting MAO, phenelzine prevents the breakdown of the monoamine neurotransmitters serotonin, melatonin, norepinephrine, epinephrine, and dopamine, as well as the trace amine neuromodulators such as phenethylamine, tyramine, octopamine, and tryptamine.

This leads to an increase in the extracellular concentrations of these neurochemicals and therefore an alteration in neurochemistry and neurotransmission.

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22
Q

phenelzine

Pharmacokinetics​

A

administered orally in the form of phenelzine sulfate* and is *rapidly absorbed from the gastrointestinal tract.

Time to peak plasma concentration is 43 minutes

and

half-life is 11.6 hours.

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23
Q

phenelzine

SE:

A

Common side effects of phenelzine

include dizziness, blurry vision, dry mouth, headache, lethargy, sedation, somnolence, insomnia, anorexia, weight gain or loss, nausea and vomiting, diarrhea, constipation, urinary retention, mydriasis, muscle tremors, hyperthermia, sweating, hypertension or hypotension, orthostatic hypotension, paresthesia, hepatitis, and sexual dysfunction

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24
Q

phenelzine

Interactions:

A

The MAOIs have certain dietary restrictions* and *interactions.

Hypertensive crisis is generally a rare occurrence while taking MAOIs-may result from the overconsumption of tyramine-containing foods* *such as aged cheeses and cured meats

Anyone taking phenelzine should inform their dentist before proceeding with dental surgery, and surgeon in any other contexts.

Phenelzine has also been linked to vitamin B6 deficiency

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25
*An active metabolite of this drug has a half-life of about 10 days.* ***A.** Amitriptyline* * **B**. Bupropion * *C.** Citalopram* ***D.** Fluoxetine* ***E.** Mirtazapine*
*Fluoxetine*
26
This drug can prolong the electrocardiogram QT interval *A. Amitriptyline* *B. Bupropion C. Citalopram* * D. Fluoxetine* * E. Mirtazapine*
***Amitriptyline***
27
A ***serotonin 5-HT2A*** *presynaptic receptor blocke*r : A. Trazodone B. Bupropion C. Selegiline D. Fluoxetine E. Citalopram
***Trazodone***
28
What actions are ***anticholinergic Drugs*** known for:
Drugs that block the action of a neurotransmitter called Acetylcholine. This inhibits nerve impulses responsible for involuntary muscle movements and various bodily functions. Can treat variety of conditions-overactive bladder to obstructive pulmonary disoreder
29
# Define: ***MAOI's***
***Monoamine oxidase inhibitors*** are a class of drugs that *_inhibit the activity*_ of one or both _*monoamine oxidase enzymes_*: ***Monoamine oxidase A and B***. Known for *_Highly efficacious anti-depressants_*, as well as *effective thereapeutic agents* for ***panic disorder*** *and* ***social disorder***
30
***Amitriptyline*** * Type of drug called :* * - if given in low dose it can do what:* * -it increases which Neurotransmitter:*
***Tricyclic antidepressant*** (tx: anxiety and depression) ***Low doses:*** *_can reduce or stop pain_* ***Increases:*** *_the amount of Serotonin_*
31
Provide 4 examples of *_Non-selective Monoamine Oxidae Inhibitor_*
1. Isocarboxazid 2. Phenelzine 3. Selegiline 4. Tranylcypromine
32
***Name 5 TCA's***
* Tricyclic antidepressants:* 1. Amitriptyline 2. Doxepin 3. Imipramine 4. Nortriptyline 5. Desipramine
33
***Trazodone*** * Define:* * Use:*
-an antidepressant medication- Trazodone may *_act*_ predominantly as a _*5-HT2A receptor antagonist_* to *mediate* its t*_herapeutic benefits against_* ***anxiety*** and ***depression*** Its *_inhibitory effects_* on ***serotonin reuptake*** and ***5-HT2C receptors*** are _comparatively weak_. In relation to these properties, trazodone does not have similar properties to selective serotonin reuptake inhibitors (SSRIs) and is not particularly associated with increased appetite and weight gain—unlike other 5-HT2C antagonists like ***mirtazapine.*** ***USE:*** used to treat major depressive disorder, anxiety disorders, and, with other medications, alcohol dependence
34
Trazodone *_Pharmacokinetics_*
is *_well-absorbed_* after ***oral administration***. Its bioavailability is 65 to 80%. ***Peak blood levels*** occur ***1 to 2 hours*** after ingestion and ***peak levels of the metabolite mCPP*** occur after ***2 to 4 hour***s. Absorption is somewhat delayed and enhanced by food. Trazodone is not sequestered into any tissue. The medication is 89 to 95% protein-bound. Trazodone is ***highly lipophilic.***
35
***Trazodone*** *Interactions:*
metabolized by *_several liver enzymes_*, including *_CYP3A4 CYP2D6,_* and *_CYP1A2_*. Its *active metabolite _meta-chlorophenylpiperazine_* is known to be formed by *_CYP3A4_* and *_metabolized by CYP2D6._*
36
***Trazodone*** ***SE:***
***Common side-effects*** include dry mouth, feeling faint, vomiting, and headache. ***serious side effects*** include suicide, mania, irregular heart rate, and pathologically prolonged erections.
37
* Selegiline* * Define:* * USE:*
***also known as L-deprenyl*** acts as a *_monoamine oxidase inhibitor_*, and i*_ncreases levels of monoamine neurotransmitters_* in the brain. **_typical clinical doses_**- is a *_selective*_ and _*irreversible inhibitor*_ of _*monoamine oxidase B (MAO-B)_*, ***increasing levels*** of ***dopamine*** ***larger doses-*** it *_loses its specificit*_y and also _*inhibits MAO-A_*, *increasing levels* of *_serotonin, norepinephrine, and dopamine in the bra_*in. ***USE:*** treatment of ***Parkinson's disease*** and ***major depressive disorder.***
38
* Selegiline* * Pharmacodynamics*
Selegiline is a ***selective inhibitor of MAO-B***, *irreversibly inhibiting it by binding to it covalently*. * It exerts effects by blocking the breakdown of dopamine, thus increasing its activity also inhibits CYP2A6 and can increase the effects of nicotine as a result.* * Selegiline also appears to activate σ1 receptors, having a relatively high affinity for these recepto*r
39
***Selegiline*** ***Pharmacokinetics:***
oral bioavailability of about 10%, which increases when ingested together with a *_fatty meal,_* as the ***molecule is fat soluble***. Selegiline and its *_metabolites bind extensively to plasma proteins_* (at a rate of 94%). They ***cross the blood–brain barrier*** and ***enter the brain,*** where they *most concentrated* at the *_thalamus, basal ganglia, midbrain, and cingulate gyrus._*
40
* Selegiline* * SE:*
***Side effects*** of the *_tablet form in conjunction with levodopa_* include: in decreasing order of frequency, nausea, hallucinations, confusion, depression, loss of balance, insomnia, increased involuntary movements, agitation, slow or irregular heart rate, delusions, hypertension, new or increased angina pectoris, and syncope. *Most of the side effects are due to a high dopamine signaling, and can be alleviated by reducing the dose of levodopa.*
41
* A 43-year-old man recently diagnosed with major depressive disorder started a pharmacotherapy with an antidepressant drug.* * Name the most common mechanism underlying the therapeutic effectiveness of long-term therapy with most antidepressants drugs*
***C. Increased expression*** ***of*** ***brain-derived neurotrophic factor***
42
A leading hypothesis of depression suggests that the disease is associated with a loss of neurotrophic support in cortical areas, such as the hippocampus. The nerve growth factors, such as brain-derived neurotrophic factor (BDNF), are critical for this neurotrophic support, that is, for the regulation of neural plasticity and neurogenesis. All drugs used to treat depression share, at some level, primary effects on serotonergic and/or noradrenergic neurotransmission, as chronic treatment with these drugs increases the availability of central serotonin and/or norepinephrine. Compelling evidence suggests that sustained signaling via these neurotransmitters increases the expression of specific downstream gene products, particularly BDNF. This appears to be the ultimate mechanism of action of antidepressants.
***C. There was no answer...*** *although the first sentence of the paragraph might be the answer.*
43
A 55-year-old man suffering from severe depression was brought to the emergency department after an overdose of an unknown medication. Physical examination showed a lethargic patient with dilated pupils. Vital signs were blood pressure 95/55 mm Hg, heart rate 130 bpm, respirations 10/min. An electrocardiogram (ECG) showed tachycardia with wide QRS complex. Which of the following drugs most likely caused the patient’s signs and symptoms?
***E. Amitriptyline***
44
* Sertraline* * Define:* * USE:*
Sold under: ***Zoloft*** is an ***antidepressant*** of the ***selective serotonin reuptake inhibitor (SSRI) class***. ***USE:*** used to treat major depressive disorder, obsessive–compulsive disorder, panic disorder, post-traumatic stress disorder, premenstrual dysphoric disorder, and social anxiety disorder. Sertraline is taken by mouth.
45
* Sertraline* * SE:*
***CSE :*** include diarrhea, sexual dysfunction, and troubles with sleep. ***SSE:*** include an increased risk of suicide in those less than 25 years old and serotonin syndrome. It is unclear whether use during pregnancy or breastfeeding is safe. It *_should not be used together_* with ***MAO inhibitor medication***. *Sertraline is believed to work by increasing serotonin effects in the brain*
46
* Sertraline* * Interactions:*
Sertraline had a slight inhibitory effect on the metabolism of diazepam, tolbutamide and warfarin, which are CYP2C9 or CYP2C19 substrates; this effect was not considered to be clinically relevant. Sertraline had *_no effect*_ on the _*actions of_* ***digoxin*** and ***atenolol***, which *are not metabolized in the liver*. NOTE: *interaction* between ***sertraline*** and ***the MAOIs isocarboxazid*** and ***tranylcypromine*** may cause ***serotonin syndrome.***
47
*Sertraline* MOA:
acts as a potent serotonin reuptake inhibitor (SRI) It is highly selective in its inhibition of serotonin reuptake. By inhibiting the reuptake of serotonin, sertraline increases extracellular levels of serotonin and thereby increases serotonergic neurotransmission in the brain. *It is this action that is thought to be responsible for the antidepressant, anxiolytic, and antiobsessional effects of sertraline.*
48
*Sertraline* *_Pharmacokinetics:_*
Sertraline is *_absorbed slowl_*y when taken ***orally,*** *achieving its _maximal concentration_ in the **plasma 4 to 6 hours*** after ingestion. In the blood, it is 98.5% bound to plasma proteins and a half life of 25 to 26 hours. *Sertraline is metabolised in the liver by demethylation to an inactive metabolite*
49
***Sertraline*** ***Pharmacology:***
- a selective serotonin re-uptake inhibitor- It targets the sodium dependent serotonin transporter to inhibit the re-uptake of serotonin by neurons. This increases the concentration of serotonin in the synaptic cleft, meaning more is available to act on the post synaptic neurons resulting in antidepressant effects. Sertraline does not inhibit noradrenalin re-uptake, has little anticholinergic activity and has less sedative and cardiovascular effects than tricyclic antidepressant drugs
50
***Lithium*** * Define:* * USE :*
Lithium compounds ***(lithium salts)*** ***USE:*** primarily used as a psychiatric medication. It is primarily used to treat *_bipolar disorder*_ and _*treat major depressive disorder*_ that _*does not improve following the use of antidepressants._* In these disorders, it reduces the risk of suicideLithium is taken orally.
51
***Lithium:*** ***SE:***
1. The rate of *_hypothyroidism_* is around *_six times higher_* in people who take lithium. 2. Because lithium competes with the receptors for the antidiuretic hormone in the kidney, it increases water output into the urine, a condition called *_nephrogenic diabetes insipidus_*. 3. *_teratogen_*, causing birth defects in a small number of newborn babies 4. associated with several forms of kidney injury 5. Lithium-associated *_hyperparathyroidism_* is the leading cause of *_hypercalcemia_* in lithium-treated patients.
52
A 45-year-old woman complained of dizziness to the point of fainting upon standing. She also felt drowsy for most of the day. The patient had been admitted to a hospital psychiatric unit 2 weeks earlier because of her third episode of major de- pressive disorder. She had been receiving an antidepressant therapy for the past 10 days. Which of the following drugs most likely caused the patient’s symptoms
***C. Amitriptyline***
53
A 48-year-old man recently diagnosed with generalized anxiety disorder started an appropriate therapy with a drug that acts by increasing the availability of both norepinephrine and serotonin in the synaptic cleft of central nervous system neurons. Which of the following drugs was most likely prescribed?
***C. Venlafaxine***
54
Tricyclic antidepressants such as\_\_\_\_\_ also block\_\_\_\_\_\_\_ transporters, but they are not used as\_\_\_\_\_ agents
amitriptyline monoamine antianxiety
55
*Citalopram* blocks the \_\_\_\_\_\_transporter but not the\_\_\_\_\_\_ transporter
serotonin norepinephrine
56
\_\_\_\_\_\_\_\_\_such as *_lorazepam_* do not alter monoamine re-uptake.
Benzodiazepines
57
This drug \_\_\_\_\_\_blocks only *_norepinephrine transporter_* and \_\_\_\_\_\_\_drug blocks *_serotonin transporter_* and are ***_not used_*** as **_antianxiety agents_**.
Bupropion Trazodone
58
What ***4 drugs*** from this topic ***do not*** cause ## Footnote *_Postural hypotension_*
Bupropion Mirtazapine Paroxetine Venlafaxine
59
Which of these drugs is not an Anxiety Agent: A. Amitriptyline B. Citalopram C. Venlafaxine D. Lorazepam E. Bupropion
Amitriptyline
60
***Venlafaxine*** Define: MOA:
***-SNRI- Antidepressant Medication-*** ***Venlafaxine*** is currently a *_first-line_* agent for ***anxiety disorders***. The drug *_blocks_* both ***norepinephrin***e and ***serotonin transporters***. *_The resulting_* ***decreased reuptake*** of these *_neurotransmitters increases their availability in the synaptic cleft_* of central nervous system neurons.
61
***Venlafaxine*** *USE:*
*_antidepressant medication_* of the *_serotonin-norepinephrine reuptake inhibitor (SNRI) class_*. ***USE:****treat major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder, and social phobia.* * It may also be used for **_chronic pain_**.* * It is taken by mouth.*
62
Venlafaxine SE:
***CSE:*** include loss of appetite, constipation, dry mouth, dizziness, sweating, and sexual problems. ***SSE:*** increased risk of suicide, mania, and serotonin syndrome. Antidepressant withdrawal syndrome may occur if stopped. There are concerns that use during the later part of pregnancy can harm the baby
63
*Is* ***Venlafaxine*** *recommended for use in _Bipolar disorder ?_*
**No...** is neither recommended nor approved for the treatment of *_major depressive episodes_* in ***bipolar disorder*** *_It can induce mania*_ or _*mixed episodes_*. *Venlafaxine appears to be more likely than the SSRIs and bupropion to induce mania and m*ixed episodes in bipolar patients
64
***Lorazepam*** *USE:*
***USE:** to treat anxiety disorders, trouble sleeping, active seizures including status epilepticus, alcohol withdrawal, and chemotherapy-induced nausea and vomiting.* *- also used during surgery to interfere with memory formation and to sedate those who are being mechanically ventilated*
65
*_Lorazepam_* *SE:*
***Common side effects*** include weakness, sleepiness, low blood pressure, and a decreased effort to breathe. When given *_intravenousl_*y the person should be closely monitored. Among those who are depressed there may be an increased risk of suicide.
66
*_Lorazepam_* *_USE: Continue_*
*_Lorazepam_* is used in the short-term management of severe anxiety. Intravenous *_diazepam*_ or _*lorazepam*_ are first-line treatments for _*convulsive status epilepticus._* *_Lorazepam_* is *more effective* than *_diazepam_* and intravenous phenytoin in the treatment of status epilepticus and has a lower risk of continuing seizures that might require additional medication.
67
***lorazepam*** *SE:*
***SE:*** *include sedation and low blood pressure; the effects of lorazepam are increased in combination with other CNS depressant drugs* ***Other adverse effects*** i*nclude confusion, ataxia, inhibiting the formation of new memories, and hangover effects. With long-term benzodiazepine use it is unclear whether cognitive impairments fully return to normal after stopping lorazepam use*
68
***lorazepam*** Interactions:
- Lorazepam is not usually fatal in overdose, - may cause respiratory depression if taken in overdose with alcohol. ***Greater adverse effects*** occur when lorazepam is used with other drugs, such as opioids or other hypnotics. Lorazepam may also interact with rifabutin. ***Valproate*** *i_nhibits the metabolism_* of ***lorazepam*** ***carbamazepine, lamotrigine, phenobarbital, phenytoin, and rifampin*** *_increase its rate of metabolism._*
69
***lorazepam*** Pharmacology:
***Lorazepam*** has *_anxiolytic, sedative, hypnotic, amnesic, anticonvulsant, and muscle relaxant properties_*
70
## Footnote ***lorazepam*** *Pharmacodynamics:*
lorazepam is thought to have high affinity for GABA receptors, which may also explain its marked amnesic effects. Its main pharmacological effects are the enhancement of the effects of the neurotransmitter GABA at the GABAA receptor. Benzodiazepines, such as lorazepam, enhance the effects of GABA at the GABAA receptor via increasing the frequency of opening of the chloride ion channel on the GABAA receptors; which results in the therapeutic actions of benzodiazepines. They, however, do not on their own activate the GABAA receptors, but require the neurotransmitter GABA to be present
71
A 33-year-old woman visited a psychiatrist for what she described as a very disturbing problem. The woman, who delivered a healthy boy 1 month earlier, was distraught by recurrent intrusive thoughts about stabbing her baby. After further questioning, the psychiatrist made a preliminary diagnosis and prescribed cognitive behavioral therapy and a pharmacotherapy. A drug with which of the following molecular mechanisms of action would be appropriate for this patient?
***C. Inhibition of serotonin transporter***
72
A 75-year-old woman recently diagnosed with pancreatic cancer was sent by her family physician to a psychiatrist because she complained of significant weight loss, forgetfulness, initial insomnia, and sadness. She also reported that she was discouraged, fearful, and very anxious and that sometimes she experienced sweating with a racing heart. The woman had been suffering from paroxysmal atrial tachycardia for 5 years. Considering the clinical picture and side effect pro les, which of the following would be an appropriate therapeutic regimen for addressing these complaints?
C. Paroxetine and zaleplon
73
A 54-year-old woman complained to her physician of dizziness and vertigo when standing up rapidly. She had a long history of recurrent major depressive disorder and had taken various antidepressant drugs over the past several years. Recently, her psychiatrist decided to prescribe imipramine. Which of the following receptors most likely mediated the adverse effects of the drug in this patient?
*_Alpha-1 adrenergic_*
74
A 25-year-old woman visited a psychiatrist because she felt very anxious when she had to eat or drink in public. She acknowledged that her ideas of being watched by others were irrational, but she could not get beyond them. She also realized that alcohol helped her cope with her anxiety, and she had started drinking two or three glasses of brandy every day. After further questioning, a preliminary diagnosis was made, and cognitive behavioral therapy was prescribed, together with a pharmacological treatment. Which of the following drugs would be appropriate for this patient?
*Paroxetine*
75
A 56-year-old woman with a long history of major depressive disorder was brought unconscious to the emergency department after her husband discovered she had taken several pills of amitriptyline in a suicide attempt. Which of the following symptoms did the patient most likely show?
## Footnote **Mydriasis**
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A 52-year-old woman complained to her physician that the drug she was taking caused diarrhea. The woman, recently diagnosed with social anxiety disorder, had started a therapy with paroxetine 2 week earlier. Which of the following molecular actions in the enteric nervous system most likely mediated the adverse effect of this drug?
*Increased serotonergic activity*
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*_Paroxysmal atrial fibrillation_* Define:
*_Paroxysmal atrial fibrillation_* occurs when a rapid, erratic heart rate begins suddenly and then stops on its own within 7 days. It is also known as *_intermittent A-fib_* and *often lasts for less than 24 hours.* *Is a type of arrhythmial or irregular hertbeat.* **Proxysmal** *means that the episode of arrhythmia begins and ends abruptly.* ***Atrial** means that arrhythmia starts in the upper chambers of the heart (atria).* ***Tachycardia** means that the heart is beating abnormally fast.*
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*_Paroxysmal atrial fibrillation_* * What causes* * PAT:*
PAT is caused by abnormalities in the atrioventricular (AV) node tha leads to rapid firing of electrical impulses form the atrium that bypass the AV node under ceratin conditions, including excess alcohol consumption, stress caffeine use, overactive thyroid or excessive thyroidk hrmone intake or drugs