Pharm2 6 Neuro pt2 Flashcards
Anxiety is most frequently divided into two common but distinctly different categories:
Generalized anxiety disorder
Panic disorder
(There are many others including phobias, OCD, PTSD, performance anxiety, test anxiety, and others)
Difficult to control, excessive anxiety
Last 6 or more months
Interferes with normal day to day functions or causes considerable distress
General anxiety disorder
Intermittent, intense, immediate episodes of fear, terror resulting in changing of behavior to avoid attacks
May be associated with hyperventilation, mimic heart attack
Panic Disorder
What CLASS is the Prototypical Anxiolytic/CNS Depressant? What route of admins does it exist in? (4)
Benzodiazepines
Available PO, PR, IV, IM
“Benzos” are used primarily for many anxieties
Also used to do what? (2)
break active, grand mal seizures, emergent sedation
Regarding Benzos, outpatient requires ____.
Quantities monitored carefully by State
Cannot be “phoned in”
“triplicates”
they are habituating, addictive
What is the prototypical benzodiazepine?
Alprozolam (Xanax®)
Alprozolam (Xanax®)
Indications
Mechanism of action
Indications: Short-term treatment of anxiety, panic attacks
Mechanism of action: Bind to gama-amino butyric acid (GABA) receptor-chloride channels molecules increasing the effect of GABA, a natural inhibitor neurotransmitter
Alprozolam (Xanax®)
Adverse Effects
Contraindications
Adverse Effects: CNS depression, drowsiness, dizziness, memory impairment, ataxia, hypotension, withdrawal seizures, dependence, esp. in elderly, debilitated, concomitant ETOH use
Contraindications: Allergy, glaucoma, drug/ETOH abuse, suicidal tendencies
Short term behavioral insomnia is frequently associated with ___. What else? (2)
stress
Exogenous consumption, esp. caffeine, ETOH, tobacco
Change in routine, travel, time zones
Long-term insomnia may be due to (3)
seconday to pain, psych problems, medication side fx
Insomnia Epidemiology: Which gender is it more common? Occurs in # out of # adults annually As you age, you typically need \_\_ sleep
F > M
1 in 3 adults annually
less sleep
What are largest category of drugs sold?
OTC sleep aides
Tylenol PM, Unisom, Nytol, etc.
Prototypical CNS Hypnotic for sleep:
Zolpidem (Ambien®)
Zolpidem (Ambien®)
Indications
Mechanism of action
Indications: Short-term treatment of insomnia, to treat (not induce) daytime sedation by regulating sleep cycles
Mechanism of action: hypnotic with intermediate-term benzodiazepine-like action suppressing brain impulses through limbic and reticular activating system
Zolpidem (Ambien®)
Adverse Effects
Contraindications
Adverse Effects: Dizziness, daytime drowsiness, amnesia, “drugged feeling”
Contraindications: Allergy, compromised respiratory function, concomitant ETOH use, depression, debilitated/elderly, inability to get > 7 hours of uninterrupted sleep
Prototypical CNS Hypnotic for sleep:
Zaleplon (Sonata®)
Zaleplon (Sonata®)
Indications
Mechanism of action
Indications: Short-term treatment of insomnia, to treat (not induce) daytime sedation by regulating sleep cycles
Mechanism of action: hypnotic with short-term benzodiazepine-like action suppressing brain impulses through limbic and reticular activating system
Zaleplon (Sonata®)
Adverse Effects
Contraindications
Adverse Effects: Dizziness, daytime drowsiness, amnesia, parathesias, “drugged feeling”
Contraindications: Allergy, severe hepatic impairment, compromised respiratory function, concomitant ETOH use, depression, debilitated/elderly
With Doxazocin, what must you warn them when they start taking it?
Hypotension ESPECIALLY WITH THE 1ST few doses.
Most Benzos are schedule ___
III
By far the most prescribed of Benzos:
Xanax
If dosed high enough, xanax (benzos) can have what effect?
It takes all the highs and lows away, if dosed high enough.
What occurs in Benzos (Xanax) to differing degrees?
*memory impairment for all the Benzo’s, to different degrees. You need to document that you told them not to drive for this
Benzo’s and seizures info:
Why be careful when taking someone off this who was taking it for seizures
Benzo’s raise seizure threshold – prevent them from happening.
So if they have a propensity and you LOWER the Benzo, then they’re at higher risk of the seizure.
Besides Xanax, name 3 other benzo’s and their routes of admin:
Which one is a unique route of admin? (and what is it?)
Valium (PO, IV), Adovan (IM, IV), Midazolam (IM, IV)
Valium is PO (and injectable like the others)
Name 2 much longer lasting Benzo’s than Xanax
Valium & Adovan
Which Benzo is shortest-acting?
Midazolam (Versed)
Much shorter acting
Flunitrazepam aka Roofies are technically in what class of drugs?
Benzo’s
Besides meds, if they have insomnia, what else can you do to help ‘em?
tell them they need a food diary. Identify things containing caffeine
Why can alcohol cause insomnia?
B/c it wears off, you sober, and you can’t fall back asleep
What soda contains the most caffeine?
Mountain Dew
Time zone counseling (w/o meds)
ever day adjust your clock about an hour so you adjust to the time zone. If it’s only a day, stay on your local time.
Drug tx for ppl who moved half way around the world and/or needs to stay up to work their shift (police officers, fire fighters, & PA’s!)
Modafonil, Armodafonil
with insomnia, Advise patient to do what b4 you resort to drugs?
- Sleep hygiene – go to bed ‘cleanly’ the same time every night. No caffeine, no exercise, food, and with a soft light read a book – not a magazine/catalog for 20 min, then turn the light off. If 20 min pass and you can’t fall asleep, then you give them the sleep aide. Should not have a tv/radio in the bedroom
What is the main ingredient (and therefore an alternative choice) in OTC sleep aides like Tylenol PM, Unisom, Nytol?
Diphenhydramine
___ hits the Benzo receptor even though it isn’t a Benzo.
Ambien
What’s a unique adverse effect for Ambien & Sonata? (sleep meds)
Drugged-feeling
