Part 7-1 (Psychopharmacology: sedative-hypnotics; antianxiety drugs; antidepressants) Flashcards
Sedative-hypnotic and anti-anxiety drug Primary goals
Relax patient; promote normal sleep
Decrease anxiety without causing excessive sedation
Primary sedative-hypnotics and antianxiety drugs
Benzodiazepines
Sedative-hypnotic benzodiazepines
Estazolam
Quazepam
Temazepam
Triazolam
Antianxiety benzodiazepines
-Cause less sedation Diazepam Chlordiazepoxide Lorazepam Alprazolam
Benzodiazepines effects
Increases effects of GABA by binding to GABA-A receptor
More Cl- enters neuron through GABA channel
“Z” drugs (Sleep)
Zolpidem (Ambien)
Zaleplon (Sonata)
-Not benzos, but still bind to GABA receptors in different spot
-May produce fewer problems when discontinued
Eszopiclone (Sleep)
Lunesta
Not a benzo, but also binds to GABA receptors
Ramelteon (Sleep)
Rozerem
Melatonin receptor agonist
Azapirones (Antianxiety)
Buspirone
Stimulate serotonin receptors in CNS
May decrease anxiety with less sedation and dependence
Slow onset, moderate efficacy
Use of antidepressants as anxiolytics
Patients may have anxiety and depression
Antidepressents can have direct anxiolytic effects
May have fewer side effects than benzos; less addiction
Alternative anti-anxiety drugs
Quetiapine: antipsychotics
Gabapentin: antiseizure
Pregablin: antiseizure
Hydroxyzine: antihistamine
Sedative-hypotonic adverse effects
Residual effects; anterograde amnesia
Complex behaviors (Sleep walking/driving)
Rebound effect
Falls
Tolerance and dependence
Benzos may be linked to Alzheimer disease
Anti-anxiety drug adverse effects
Rebound effect (Increased anxiety when drug stopped)
Falls
Tolerance and dependence
Benzos may be linked to Alzheimer disease
Sleep/anti-anxiety drug rehab concerns
Do not treat the underlying cause
Benefits vs Sedation
Depression
Most common mental illness
Sadness that is incapacitating
Neurochemical basis
Depression drug strategy
Depression cause by defect in biogenic amines
Drugs increase or prolong the effects of one or more amine neurotransmitters
Biogenic amines
Norepinephrine
Dopamine
Serotonin
Types of antidepressants
- Selective serotonin reuptake inhibitors
- Serotinin norepinephrine reuptake inhibitors
- Tricyclics
- Monoamine oxydase inhibitors
- Others
SSRIs
Fluoxetine (Prozac) Paroxetine Sertraline Citalopram Escitalopram Fluvoxamine
SNRIs
Desvenlafaxine
Duloxetine
Venlafaxine
Tricyclics
Shit ton of these drugs
Named for chemical structures
MAO inhibitors
Isocarboxazid
Phenelzine
Tranylcypromine
Other antidepressents
Nefazodone & Trazodone: block serotonin receptors and reuptake
Bupropion: NE and dopamine reuptake inhibitor
Mirtazapine: may block presynaptic NE receptors
Mechanisms of antidepressents
Prolong the effects of amine neurotransmitter by either:
a. Inhibiting reuptake of amine neurotransmitters (SSRI/SNRI/Tricyclics)
b. Decreasing neurotransmitter breakdown (MAO)
How do increased monoamines treat depression?
Drugs increase activity of amine neurotransmitters
Increased NT activity increases production of brain derived neurotrophic factor
BDNF stimulates growth of neurons in hippocampus
Tricyclics adverse effects
Sedation Anticholinergic effects Orthostatic hypotension Arrythmias Seizures Fatal OD
MAO Inhibitors adverse effects
CNS excitation
Increased BP
SSRI/SNRI adverse effects
Generally well tolerated
May increase seizures
Some GI problems
Serotonin Syndrome
Possible with all antidepressants Occurs when CNS serotonin recepters overstimulated Increased HR/BP Confusion Hallucations Dystonias/Dyskinesias GI problems *Can be fatal if unchecked*
Antidepressants off label prescribed for…
Chronic pain
Antidepressant rehab concerns
Time lag before beneficial effects
Chance of increased depression during initial tx period
Recognize and acknowledge mood changes
Treatment of bipolar syndome
Classic tx: lithium
Prevents manic episodes
Mechanisms unclear
Lithium
An element that is not degraded by the liver
Have to rely on kidneys to eliminate it from body
Can accumulate rapidly
Lithium toxicity levels
Maintenance phase: .6-1.2 mEq/L
Acute manic episode: 1.0-1.5 mEq/L
Toxicity begins at 1.5 mEq/L
Requires tx at >2.0 mEq/L
Mild Lithium toxicity
metal taste
tremor
nausea
weak
Moderate lithium toxicity
vomiting diarrhea more tremor incoordinated blurred vision
Severe lithium toxicity
Confusion/hallucinations
nystagmus
dysarthria
fasciculations
Other bipolar treatments
Antiseizure drugs
Antipsychotics
